Read about: New Adolescent Depression Treatment Study * Dr. Blount Testifies in MA * Care Managers Embedded in Primary Care * Training MI Trainers

Massachusetts is currently in the process of assessing behavioral health need and how that matches existing behavioral health resources statewide.  This assessment will form the basis for future planning and allocation of resources.  I suspect this might be happening in many states.  I have not usually paid attention to processes like this.  They have seemed like very bureaucratic exercises to me.  A friend suggested I look at this process and I was shocked.  Primary care was almost non-existent in the process either as a place to assess BH need or a venue for delivering services.   So I went to a hearing of the Department of Public Health that is conducting the assessment and spoke.  Here is some of what I said. 

 

"I appreciate the opportunity of speaking today because I know that the Behavioral Health State Resource Plan currently being developed by the Department of Public Health will be the basis for planning and allotment of resources for some time in the future.  The Department of Public Health is well aware of the role that behavioral health services in primary care can play in improving health and reducing cost of healthcare.  I was honored to find myself cited more than once in the Massachusetts Behavioral Health Analysis on the DPH website in the discussion on behavioral health services in primary care.  While the report does a good job of documenting primary care as a venue for identification of people with depression, substance abuse and other behavioral health needs, and reviews the evidence that there are a number of treatments that are effective and efficient in primary care, it fails to address the importance of primary care as the setting for creating access to behavioral healthcare and for delivering behavioral health services to the vast majority of people with behavioral health needs.

 

I am concerned because the most recent version of the assessment of behavioral health needs in the Commonwealth done by DPH does not mention primary care as a venue for identification and treatment of behavioral health needs.  It only focuses on the specialty mental health system, largely because that is the system from which it can obtain utilization and other forms of data.   I believe that since primary care is the key to better BH service and the specialty system is the current source of data, we have a situation equivalent to the key and the streetlight in the old joke.  We are looking for the key under the streetlight even though we know that is not where it is located.  One way of demonstrating its commitment to assessing and analyzing the behavioral health needs of all citizens would be to include the evidence for behavioral health need in primary care in the current analysis so that it can become a part of the Commonwealth's future planning to address needs.

 

In my testimony I would like to make and support the following recommendations:

 

That primary care be used as a venue for assessing both mental health and substance abuse needs in the Commonwealth.

 

That primary care be considered the most effective setting for the delivery of care for the behavioral health needs of the general population, and for identified high need sub-populations.

 

That the DPH resume its efforts to identify and remedy the barriers to the implementation of behavioral health services in primary care created by regulation.

 

That DPH become the leader in helping Massachusetts develop a fully realized and integrated behavioral health system involving behavioral health in primary care structurally coordinated with and supported by a robust specialty mental health and substance abuse system." (Link to the complete transcript)

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In a shift from telephonic chronic care management, a new program developed by Aetna places private payer employed care managers in primary care offices. Results indicate improvement in collaboration with the primary care team and in health outcome measures above and beyond that observed in more traditional telephonic care management.

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