“Changing Minds: The Benefits of Community Collaboration for SWFL Families”
On Monday, Jan. 11, Stacey Cook, President and CEO of SalusCare; Dr. Paul Simeone, Vice President and Medical Director of Behavioral Health at Lee Health; and Lauren Walker, program manager, population Health at Lee Health, discussed “Changing Minds: The Benefits of Community Collaboration for SWFL Families” and the necessity of community efforts to address the pediatric mental health epidemic.
Where We Are and Where We’ve Been
Stacey: We are in a layering of crises, a compounding kind of effect. Social injustice that is reopening enduring wounds for Black and indigenous people of color, the divisive nature of politics and the pandemic have uprooted our sense of normalcy, safety and certainty combined with social distancing and isolation. This has left us collectively anxious, grief-stricken and lonely.
- We are experiencing a behavioral health surge. We’ve seen dramatic increases in the rates of depression, anxiety, trauma and substance abuse. Unemployment rates have soared, leaving many without health insurance and the inability to pay for much-needed behavioral health care and other necessary medical services. Many are accessing behavioral treatment for the first time. Others are experiencing an exacerbation of symptoms.
- Without quick access to identify, diagnose and treat these diseases, we see an increase in emergency department visits, crisis stabilization visits and hospitalizations in our community, our state and nationwide. We also know that incarceration, domestic and child abuse have increased.
- We don’t have enough behavioral health employees to meet the demand for care.
- In Florida, we have a little over 400 child and adolescent psychologists for 4 million children under the age of 18. That’s 10 child and adolescent psychologists for every 100,000 children.
- In Lee County, as of 2018, we have 129,000 youth under the age of 18. We have just 10 child and adolescent psychologists, many of whom don’t accept Medicaid, which is one of the biggest state payors. The reason they do not is because of the exceedingly low reimbursement rates which have not changed in 20+ years.
- We have approximately 30-40 licensed clinicians per 100,000 locally. We have similar dismal situation with nursing and direct-care staff.
- Behavioral health disorders are not reimbursed like other medical conditions. The work is challenging and sometimes dangerous, and the rate of burnout is quite high.
- The surge in need means an already overburdened system needs a reimagining and redesign.
- It has to be a regional approach, requiring all the area’s providers to create an innovative, targeted effective and efficient services continuum. We must break down silos and emerge into one, reallocating and redistributing vital resources.
- At SalusCare, we’ve been partnering with Lee Health and other organizations, and it has been a fruitful and inspirational experience. We’ve been able to implement incredible and innovative ideas for community benefit. But there’s much more of a need.
Paul: In the summer of 2018, we convened a convergence called “Syntegration.”
- Roughly 65 leaders throughout the Southwest Florida region gathered to develop a set of actionable recommendations to improve access to mental health care locally within the next 1-3 years.
- We created a deep and shared understanding about what we were up against, which allowed us to establish a strategic plan.
- We developed three goals:
- Unify stakeholders and to lobby for systemic change at the local and state level.
- Focus on enhancing clinical programs and pathways to begin working together to develop evidence-based and evidence-informed programs and services that deliver quality care locally.
- Improving public awareness and education about mental health problems so we can reduce the stigma that keep people from pursuing the care that they need.
- The good news is that those three objectives have been meet. It doesn’t mean the work is done. We have begun to make substantial progress in all those areas.
Annual Mental Health Fair
Lauren: This annual event is a medium for behavioral health organizations to present to one another and the behavioral health professionals in the community about programs and services offered to further enhance collaboration and understanding.
- First event was held in 2019 and included primary care providers, EMS, law enforcement, educators and more to share resources, allowing them to have the information they need.
- The networking opportunities and discussions helped build collaborative efforts to co-create and co-implement a clinical model of prevention, screening, detection and treatment.
- In 2020, the event was virtual. Just as many attendees as the year before. It was recorded so people could have access after the fact. We modeled this after a mental health fair the Kim Foundation does in Nebraska.
Paul: During Syntegration, it became clear that a lot of people were doing good work, but that not a lot of people knew about it. The Mental Health Fair is a way of addressing that, where people can talk about what they are doing, but also what changes around COVID are being implemented. It underscores the collaborative spirit.
Stacey: It’s a great opportunity for providers to connect with one another. Through relationship and familiarity helps to pave the road to better communication and continuity of care.
Multi-Agency Release Form
- The multi-agency release form allows a patient to sign one uniform document that will allow those 40 behavioral health organizations to share and transfer records to allow better coordination of behavioral care of that patient.
- The sharing of documents and medical records is critical in allowing us to collaboratively care for that patient. It allows partners to have the full picture and scope of their history, medications, services and treatment plans. Allows patients to start where they left off and have a better understanding of what they may need.
- What this form allows is people in our community often need to seek services and support from more than one organization. What we found is when you seek services from various organizations, you may not be prepared to ask questions, for example, about various medications, who you were seen by and what transpired.
- It was initially developed by Lee Health and SalusCare, but more than 40 agencies have joined us in this effort.
Stacey: When we talk about continuity of care, it’s the opportunity to holistically take care of the clients we serve. People we work with oftentimes may be working with multiple organizations. We want to be able to ensure we are not fragmenting treatment or creating barriers to care, that we are all in a place where we can work together collaboratively to provide the best care. It leads to a reduction in hospital stays, improved outcomes, days in the community, days employed, days well, all healthy positive wellness outcomes.
Paul: We know there are people out there leading really challenging lives, the so-called high-need, high-utilizing patients, and we know they get lost to follow-up all the time. This really allows for more integrative care. Creating it was more challenging than it seemed. We had to join both clinical departments and legal departments to figure out the vagaries of this because it wasn’t easy to create.
Paul: Healthy Minds began as a grassroots effort that started in April. I was reading a paper by the Wellbeing Foundation that projected deaths on unemployment during the pandemic. Shocking statistic in April was they projected 75,000 and 100,000 more deaths just because of unemployment. I was thinking we were going to see a surge in all manner of problems.
I wanted to begin a grassroots effort to begin to take care of people. We began to develop this group of 25+ provider agencies into what became Healthy Minds.
- These agencies screen for behavioral health problems, primarily anxiety, depression and substance abuse. We knew these were going to be off the charts for what people were going through. We have gone out since April screening people in a variety of events. Our wish was to go out into the community in a real way to wrap our arms around the community and tell them that we cared and wanted to help in whatever way that we could.
- We developed a resiliency tool kit, a screening kit and resources.
Lauren: Healthy Minds is one of our most collaborative efforts. It takes so much volunteer time. Resources, time after hours and on the weekends.
Stacey: We have been challenged and designated as a severe work shortage area. We have a significant demand for behavioral health services that continues to bubble up. We simply can’t meet the demand for psychiatrists, nurses, counselors, doctor, social workers, these are the people who are key to providing services right away to people in need. Part of that challenge surrounds low reimbursement rates, nationally in Florida, because reimbursement rates have remained flat over 20+ years. As a result, the reimbursement rate for Medicaid doesn’t not cover the cost for services, so we are constantly in a deficit. If as providers we are not bringing money into the organization to pay bills and take care of employees (moving, etc.), it makes it incredibly difficult to bring employees in. A number of community providers with 13 or 14 other organizations, decided it’s time that together (we’ve done it independently), that there’s power in numbers to have a collective impact. We were able to go to the legislators and presented for the group. We asked for a sponsor to move these initiatives forward.
Paul: We asked delegation to think through and advocate for us how we could begin to recruit graduate students through things like scholarships and loan forgiveness, stipends to get started here. It is very hard to recruit mid-level people. Social workers, licensed mental health counselors don’t make enough money to live in our area. That makes it hard to recruit and retain.
How Can You Help?
Paul: Changes in healthcare need to be consumer-led. We are not asking for Medicare reimbursement to feather our own nest, but to pay for services we are being asked for and need to provide. We could use help from all of you to talk about how we have an epidemic that we need to address.
- Email or call your local representatives: www.MyFloridaHouse.gov
- Donate to a local behavioral health organization
- Advocate on social media
Stacey: Take the time to talk about this. There is somebody you know who may be suffering. 1 in 4 have a diagnosable behavioral health disorder. We need to talk about it and bring behavioral health diseases to the level of other diseases like heart disease, diabetes and high blood pressure. Mental illness and substance abuse disorder are brain-based diseases. We need to start talking about them like that so that we can see parity and reimbursement rates increase. Let’s get it out there and get it out from the shadows where it has been for a long time. We know when this community comes together, we can accomplish so much.
- Healthy Minds: HealthyLee.com/HealthyMinds
- Resiliency Toolkit (available in English, Spanish and Creole): HealthyLee.com/HealthyMinds-Toolkit
- SAMHSA Disaster Distress Hotline
- SAMHSA National Helpline
- Toll-Free: 1-800-662-HELP (24/7 Treatment Referral Information Service in English & Spanish)
- National Suicide Prevention Lifeline
- Dial United Way at 2-1-1 or visit www.211.org
- Mobile Crisis Unit Hotline: 844-395-4432
QUESTIONS FROM VIEWERS
Q: How can someone get involved in volunteering with Healthy Minds?
A: Lauren: visit the Healthy Minds website: HealthyLee.com/HealthyMinds
There’s always a clinical person at our events, but we need volunteers. We offer Creole, Spanish and English information, so we can use people who speak those languages. You can see our resources and upcoming events.
Paul: There are also resources, including screeners and resilience and coping skills toolkit and resources available nationally. Share this valuable resource with your friends.