Rx is better for mental health crisis – New York Daily News

This winter has seen a renewed focus on acute mental illness and discussion of how best New York can address the health and well-being of these residents. As an Emergency Room Psychiatrist, I began my career in the frontline of mental health crisis management in New York City and witnessed first-hand the limitations that short-term interventions place on providing long-term health and stability for residents with these health issues.

In a city where there is Estimated 1 in 25 residents Suffering from severe mental illness, involuntary adherence and the revolving door of emergency department visits has become a permanent solution for people with acute needs, yet it does little to alleviate the root of this population’s problems.

Our system for treating acute mental illness desperately needs foundational support to meet the basic needs of all people, integrate and screen for mental health, and increase capacity to care for those in need of mental health services. A solution to New York’s mental health crisis will not happen overnight – instead, we need to focus on proven, long-term, multi-level solutions.

continuum of care.

A population health-focused approach addresses the needs of individuals with more complex mental health care needs by including community organizations, health care systems, primary care providers, mental health professionals, community care management, peers, and supportive housing. It allows highly specialized mental health resources to focus on treating individuals with complex problems and liaising with primary care providers, all while meeting social needs. The primary care system and community organizations are mandated to provide basic mental health support to the wider population.

More than a decade ago, with state and federal support, we began developing a model that comprehensively addresses these complex needs through coordinated care management. Over the years, we have also integrated time-critical intervention, an intensive, time-limited form of care management that has become a cornerstone of addressing homelessness and severe mental illness. These severe cases receive intensive care management over a period of 9 months, after which we can usually connect the patient to other community support devices.

Within emergency departments and acute care units, deployment of mental health and substance abuse peers has been successful in engaging patients in clinical services, linking them to treatment options in their communities and after discharge and reducing readmissions and high utilization of acute care services. Community Care of Brooklyn has integrated peers from two community agencies—Baltic Street and Bridge Back to Life—in hospitals across Brooklyn since 2017, and surveys of emergency departments and providers show the positive impact of peers on morale and reduced utilization.

Early support and check-ups after a certain age are critical to addressing the general mental health crisis. Programs such as the Accelerated Assessment Service provide a less traumatic assessment environment for children experiencing mental health crises by sending social workers into schools to train teachers and assistant principals to better deal with mental health issues. Since 2015, such programs have been implemented in 100 middle and high schools across New York City.

The collaborative care model provides mental health treatment in primary care with a social worker and backup counseling psychiatrist. This approach treats mild to moderate mental health conditions and has been shown by numerous randomized controlled trials to be superior to the traditional practice of referring every patient with a mental health concern to a mental health professional. In addition, implementation of this model increased patient satisfaction and reduced the cost of emergency room visits and admissions.

In the community as a whole, we have built a network of community organizations that address social needs such as supportive housing, access to food, care management, and their involvement with healthcare providers. For example, we partnered with the Arab American Family Support Center in Brooklyn, working to reduce stigma around mental health in the broader Arab, Middle Eastern, Muslim, and South Asian (AMEMSA) communities in New York City. The mayor’s office and the city’s health department have been instrumental in funding community organizations’ efforts.

Together, these programs provide a roadmap for how to combat severe mental illness by creating a comprehensive network of services and organizations that work together to support the social and health care needs of individuals. I’ve seen great success from initiatives like this, and continued proper funding will allow these efforts to expand across the city. Jobs will be created by hiring and training additional peers and care managers, and a focus on reducing readmissions to preventable acute care would relieve overburdened emergency departments.

It is my hope that we can improve mental health outcomes by expanding foundational support and population-centered care initiatives.

Malavad is deputy chief of population health at Maimonides and chief medical officer at Community Care in Brooklyn.

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