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Help With Depression – Is Mental Health Still the Elephant in the Room

Today, more and more people seem to be talking about psychology, therapy and mental health.

This year the media has been extra generous in its portrayal of mental health issues. We’ve had multiple soap opera plot lines and docudramas detailing the life of the rich and bipolar as well as a vast array of celebrity ‘meltdowns’. The lay man is enjoying an informed tour of mental health issues, from the comfort of his front room. Or is he?

Everyone can experience mental ill health- from the famed, to the less than famed; and if it’s on the TV it must be ok. As the adverts would have us believe, that elephant in the room has been well and truly exposed, with famous faces around the world admitting to a mental health issue or confessing to using medication for said difficulty.

With all this in hand, one might guess that a girl about town of today’s world would be more comfortable than ever before in sharing her own challenges. After all, Ms Wax does it, and makes many thousands at the West End doing so. So what does the research say on this?

As you reflect on these changes in media coverage over the last 18 months, you may find yourself not so pleasantly surprised to learn that according to research from campaigners at platform 51; A 3rd of women take anti-depressants in their life. Of those, a quarter take them for 10 years or more. And most worrying, 18% keep it a secret from their families. 1 in ten wouldn’t even tell a partner.

Alternatively, I noticed that niche holistic approaches to mental health were increasing viewed as more acceptable. Twining’s are even using the wellbeing concept as a marketing tool- to sell teabags! *After all it does seem more du jour to see an executive coach as opposed to a psychologist. And once you’re in in the healthcare system, it’s more acceptable to have a psychologist, than a psychiatrist. What is the perceived difference in this varying terminology, and why do treatments involving medications still have this stigma attached despite being so routinely prescribed?

Why is it that young women are reluctant to discuss the use of such medication for mental health difficulties? After all, sales of anti-depressants went up 45% over the last 4 years. That’s 23 million prescriptions for anti-depressants a year.

Today’s culture is increasingly driven by ambition and achievement; admitting to feeling low, stressed or anxious is just not a desirable option. One might be forgiven for concluding that it is socially acceptable for a celebrity to have a public breakdown or an overdose; But for the average woman of the world, to admit your finding life a bit stressful or god forbid admit that you just aren’t coping-is just too much social pressure to bear.

A recent survey polled by the depression alliance suggests that women often report feeling ashamed to discuss mental health concerns with friends and family for fear of being judged, misunderstood or Labelled. It has been reported that young people in today’s achievement oriented society can often feel a sense of failure, upon receiving anti-depressants; almost a last resort scenario when one cannot think of another way. And sometimes it is. But a last resort is still a choice and that in turn requires that one exercise initiative also.

People don’t like to appear weak or inadequate. Seeking help and admitting that they are not feeling good can often be a real struggle as it interferes with one of our deepest fears – of taking up residence in… The out group! Accompanying this fear, is the common misconception that once you’ve moved into the ‘out group’, and experienced a mental health difficulty, you will have it/live there forever. This is a massive misconception that many mental health organisations have been campaigning to change.

Over the last ten years, I have been involved in a community project With Leading Mental Health Organisation Mind, and their talking therapies programme. We explore and promote the idea of mental wellbeing as belonging on a continuum. Where one might find themselves high or low or anywhere in-between. We have peaks and troughs, and the key here is-this is normal!

Our places on this scale can move up and down and round and round as often as you change your socks. After bereavement you may find yourself at a low ebb, near the lower end. Will you live there, at the lower end of wellbeing forever? No. probably not!

You may experience a great achievement and find yourself glowing at the highest heights- elated even. Will you be in a state of elation forever- probably not? The same concept applies to mental health issues. Diagnosis or no diagnosis.

Despite all the support and campaigning from organisations like MIND, RETHINK and TIME TO CHANGE It is surprisingly hard to be open about these things. Mental health disclosure takes on a more serious consequence when one explores the workplace: Medical records, insurance and selection criteria. But that kettle can wait for another day.

While some research suggests that women may hide their use of antidepressants in an effort to maintain positive self-concept and appearance both to themselves and to others. It is this very seeking of help that is an adaptive and indeed resilient behaviour. A courage which can only denote a strength of character present in one who is unwilling to settle for feeling less great- then they know they can feel, and deserve to feel.

So, let’s each consider our own beliefs around mental health issues and the social stigma surrounding it! Mental health in our own personal real lives, the lives of our clients, the lives of our nearest and dearest and the lives of celebrities and those portrayed in the media – where is the heart of this stigma lying? Are collective attitudes towards ill mental health changing in line with their media presentation? – I’m not so sure, but every little helps right!

I recently watched an old black and white movie in which the leading lady flashed a little ankle and promptly pecked her dashing date on the cheek. A total shocker! She ran away bashful and shy with all those who saw tutting at her promiscuous and socially unkempt dallying.

Our attitudes and acceptance of new ways of behaving do and have changed with the passing of time. What was once a Rare, Risque1920′s ankle flash has now become a plethora of raunchy music videos.

I think there may be hope for the subject of Ill Mental health yet.

Health Insurance Options For Small Business Owners

As a businessman or would-be-entrepreneur, you face great challenges and take significant financial risks. Your health and medical care, however, is one department where you wouldn’t want to gamble. As a responsible manager, you should scope out the health insurance options available for small business owners like you.

Recently, managed care providers have been accommodating “Groups of One,” meaning you can buy a policy for yourself with premiums comparable to group insurance rates. The greatest plus of group health insurance policies is “guaranteed issue,” meaning they can’t exclude a person due to health problems.

You can also check if there are trade associations or chambers of commerce in your area that may offer membership coupled with health insurance.

If you wish to, get a plan to include your employees. Being an attractive benefit for prospective employees, a group health insurance plan can get you the best workers. In addition there are special tax deductions for businesses that offer health insurance.

To purchase the insurance plan that suits you best, you need to familiarize yourself with the basic types of managed care providers in the market:

Health Maintenance Organizations

Health Maintenance Organizations (HMOs) give you a range of health services for a set monthly fee. You pick your choice of a primary care physician from their list of affiliated doctors. With HMOs, you will not receive coverage if you go beyond their network, except for emergency cases. Most of the time, you become eligible for insurance benefits without a minimum payment (deductible), but you may be required a small copay per office visit and a steady monthly premium.

Preferred Provider Organization

The Preferred Provider Organization (PPO) is another type of care provider that extends health care through an approved group of providers, or through other providers outside the network. Usually, you have to pay a small copay and satisfy a deductible before benefits are paid. It’s less expensive to visit one of the providers in the network. You may seek out-of-network health care services, but your share of the bill will be higher.

Point of Service Plans

Similar to HMOs, your primary physician attends to you and refers to other in-network doctors in Point of Service (POS) plans. You may choose to see an out-of-network doctor and the plan will pay a predetermined amount of the bill; you will shoulder the bigger amount. These plans usually cost more, but your choice of attending physician is not restricted.

Health Savings Accounts

Health Savings Accounts (HSAs) are not part of managed care. It is a relatively new way to pay for health services. Savings accounts have tax incentives and can be accessed whenever the need for health care funding arises. Any surplus in the account earns tax-free interest.

Bottom-line, your own business is your source of income. You are its most valuable player and asset. Take care of your health and ensure your business’ smooth sail. Study your health insurance options and make the right choice.

Implementing a Population Health Management Program

Are you planning to focus on population health management at your site? If you are already focusing on population health management, are you planning to strengthen your focus? Wherever your location in population level management planning, be sure that you have first set goals to achieve for the plan. Every planning event that focuses on improving care at your site should first begin with goals.

I believe as do many healthcare professionals that the Triple Aim of the IHI (Institute for Healthcare Improvement) are very good goals. These goals are to improve the health of the population, improve the outcomes and experience of the patient and reduce the per capita cost of care for your community simultaneously. I like to add improve the bottom line of the providers. Fortunately, these can be achieved concurrently with the correct approach, although the work is very challenging.

Setting and achieving goals for population level health at provider sites is a fairly new focus in healthcare. Fortunately, health departments and epidemiologists have many tools which providers can use or adapt. Among these are collecting and analyzing data at an aggregate population level and then implementing evidenced based processes (standardized processes) that have an impact on the population. Other fields have also used population level management for their businesses or processes. Many of these are service based programs. I recently completed a population level study for the Salvation Army and an energy provider.

In the remainder of this newsletter I will describe two population level management programs and highlight some of their approaches. Before I do, let me point out that population level management can have an excellent return on investment for providers. In a recent online interview with Healthcare Informatics, Robert Fortini, R.N., M.S.N., and chief clinical officer of Bon Secours Medical Group based in Richmond, Virginia, stated that he has seen a 3:1 return on investment in Bon Secours population level health initiatives. I believe that this ROI is possible for many providers with a good risk management program.

One medical group working on population level health initiatives is Hill Physicians Medical Group in the East Bay area of California. It is a group of 3,500 physicians. This group has formed virtual care teams of pharmacists, social workers, case managers, etc. to support their physicians. Population health management requires a team approach to be successful. Hill Physician Medical Group works with the ACO model with several of its payers. This approach encourages team-work and breaks down traditional barriers in providing better care. As Darryl Cardoza, the CEO of this group, states, “And what the ACO model has enabled us to do is to begin to break down some of those walls, and to help us all work within the same system, and align incentives,” as stated in an interview with Healthcare Informatics.

Cardoza states that population health management is quite different from earlier managed care. According to Cardoza, “It’s not a matter of just preventing people from using certain kinds of resources, but rather, of managing the entirety of their care. And we were doing it by the seat of our pants, because we didn’t have the tools. It was just very, very difficult to use data, to consolidate it and evaluate it and draw meaning from IT; but those tools are available now.” Further, Cardoza states that it is very important to integrate HIT across the provider networks so that teamwork is more effective. Plus, Hill Physicians Group needs to be very good partners with other providers in the area, with local hospitals and with health plans. They work very hard at being a good partner to others.

The result of their investment in virtual teams with physicians and the connecting of its HIT internally as well as with its partners through health information networks has been a positive financial return and improved health for its patients because of improved delivery of care.

Another group that is delving into population level health initiatives is Bon Secours, mentioned above. This group had 530 employed physicians. Robert Fortina stated that “The major bulk of our work has been around supporting our medical home project, and that has involved delivery system redesign, more robust use of technology, and then good old-fashioned nursing-based case management using those tools, so the development has been multi-factorial.”

One component of Bon Secours population management is community (patient) outreach powered by software from Phytel. This software generates about 75,000 contacts a year. This outreach is based upon 20 chronic disease protocols and 15 prevention protocols. This is a good beginning for providing better care for their patients but Fortina foresees the time when their analytics will become much better and they can do a better job of stratifying patients into risk categories. Doing so will enable them to provide care that is better aligned to the needs of the individual patient.

As one can see Bon Secours Medical Group and Hill Physicians Medical Group are working hard at deploying an effective population level health model to both the benefit of the patient and to the providers. Both use team based approaches. The return on investment is positive for both groups. Contrasts do exist between the two groups too. Hill Physicians is a much larger group and can use its scale to fiscal advantage. The two use different models for their approaches. Hill Physicians uses an ACO model, contracting with several different payers, which makes its approaches to care more complex as different payers have different requirements in their contracts. Bon Secours bases its population model upon the patient-centered medical home, a long established chronic care model.

I believe that because the patient-centered medical home model is well established and well adopted in the primary care environment, it makes good sense to expand its case management model to include population level patient management. Recent data released by the Medical Group Management Association shows that although the total general operating costs of a medical home are greater than non-medical home practices–$126.54 versus $83.98 per patient-the total medical revenue after operating costs are much higher–$143.97 for the medical home versus $78.43 for the non-medical home per patient. Thus, whether using the ACO model, the PCMH model or other model, it seems that population level health management presently provides better care at a lower cost per patient and increased revenue for the provider if a carefully created risk management plan is developed.