This is the third in a series of live blog posts for the 2014 CFHA Conference in Washington DC. Check back for more!
Mental Health Promotion and Prevention in Primary Care: An Idea Whose Time Has Come by William Beardslee, MD
October 17th, 8-10 AM
Christine Borst and Laura Sudano: Tag team blogging in style
Christine (CB): A new college student thinks, “Six months ago I didn’t even know what an English major was, and now I are one.”
For so many of us integrated care is just inherent – we have naturally gravitated to it because it made sense. And now we are working to figure out what on Earth we’re doing.
Laura (LS): Dr. Beardslee reflects on his career as in integrating family care for depression and acknowledges that there are many societal challenges, like war, that may get in the way of research; however, there are exciting things that are happening such as government support for research. Dr. Beardslee gives kudos to the speaker Dr. Richard Frank regarding the current healthcare policies implemented to make mental health integration happen.
CB: Dr. Beardslee discussed the good things going on for the world of integrated care – the ACA (with the emphasis on prevention and collaborative care); parity legislation; lots of innovative programs at many levels. “Healthcare is a basic civil right and a basic human right – this is not negotiable. Mental health care is a basic civil right and a basic human right as well”. “Families are the cornerstone of emotional development”. How do we meet the needs of families in healthcare? We need family-centered care.
Amen. We need change. Change!
LS: Mental health care is a basic human right and basic civil right. Participants clap in agreement with his strong statement. Dr. Beardslee notes that we need to disseminate our [members of CFHA] work with proper training and measurements. Family-centered care is key to tackling promotion and prevention of mental health.
CB: Dr. Beardslee discussed the importance of the Triple Aim – improving the experience of care, improving health, reducing cost. Most of the mental adult disorders have early onset – we need a developmental perspective! Need to use this to move towards prevention FROM THE BEGINNING.
I think we are doing our children a disservice if we’re not intervening (preventatively) when it’s most helpful (Honestly, how long will it take before we a) realize early intervention is remarkably important, and b) actually implement it across the board? Family, family, family. No one lives in a vacuum, especially not children.
LS: Dr. Beardslee presents statistics of mental health and calls for a developmental perspective on mental illness. One way to decrease these statistics is to help the parent be an effective parent. Dr. Beardslee presents implementation strategies that include family-based prevention strategies, effectiveness trials, getting the community involved, and to address cultural issues related to pt care.
CB: Dr. Beardslee brought up the importance of cultural sensitivity/humility. A great reminder that it’s so important to not make assumptions based on the dominant culture. “One factor lurks in the background of every discussion of the risks for mental, emotional, and behavioral disorders and antisocial behavior: poverty…We must address poverty.” Specific and general risks for depression. 20% of significant episodes of major depression can be prevented!
“We” ask for so much physical family history (heart disease, cancer, etc) – we really should screen for mental health concerns in the same way across the board and use prevention strategies in the same way. Depression is preventable! What a great opportunity for behavioral health clinicians in primary care.
LS: Dr. Beardslee notes that we need to offer a range of treatment to people as research suggests that people who are offered a range of treatment will tend to get better. Interventions needed to help the family and treatment of parental depression is critical in prevention and treatment.
CB: “Individuals should have informed choices in treatment ‘tools’ that are available to them.” Dr. Beardslee discussed the need for family interventions if we identify a parent who is depressed. Treat the parents, provide help with parenting, and using a two-generational approach.
Parenting is a remarkably intense job. What an incredible opportunity to intervene and be helpful on this subject as clinicians/providers…to help parents be more likely to actually enjoy the job they have.
CB: “A friend, not an apple a day, will keep the doctor away.” Social connectedness.
Eat an apple with a friend maybe…while taking a brisk walk? How’s that for collaborative care?!
LS: Up to this point, Dr. Beardslee discusses the IOM report and multiple studies/papers. He states that a friend once said, “A friend, not an apple, will keep the doctor away.” His point here is that social interaction and relationship is important, and of course, low cost. We need to think about this as clinicians. Dr. Beardslee talks about the difficulty getting reimbursed by insurance, as a psychiatrist, when using preventative interventions with families; however, it appears to be the bread and butter of healthcare. Perhaps this is one way policy should be shaped in the future.
CB: Developing systems that can give two-generational responses to parental depression. Tough for reimbursement because there’s not a diagnosis for the child. Responding to the needs of vulnerable populations, especially low income, culturally and ethnically diverse families. Depression can look different. We need to be educated and aware.
LS: Dr. Beardslee reviews his study of “Family Talk Component” launched in the late 1980s and notes that it is built on principles of risk and resiliency. He acknowledges that his work has been guided by resiliency perspective.
CB: “There is a lack of a payment structure [for preventive/family care].”
Ben Miller, can you fix this too!?
Screen. Treat. Prevent. Save gobs of money. Problem solved!
CB: How can we cultivate openness in our children? This is often lost in households suffering from depression. Dr. Beardslee’s secret to prevention treatment = systemized common sense.
Can you bill for that?
Dr. Beardslee explained that the art of the process is helping the families make sense of depression, eventually seeing the emergence of the healer within. There is also a need for families to “understand depression anew across the development.”
LS: Dr. Beardslee walks through the treatment of depression and notes the first step is psychoeducation with the parent. He states, “Good preventions are systematized common sense.” Dr. Beardslee reviews the six principles for a successful family meeting and interventions with families and depression. He says that he is a “practical person” so the six principles are practical tips for working with families.
CB: Web-based training in Family Talk at ww.fampod.org for free. Parental depression is prevalent in family practice; when recognized and treated can have a multiplier positive affect on the family. Use the PHQ-2/PHQ-9 to screen parents annually. Dr. Beardslee advocated that it is essential to work with parents who are depressed as parents first.
LS: Dr. Beardslee notes that his work with Latino population suggested that the children were curious about the immigration journey of their parents, something that differed from the implementation of this program with the general U.S. population. As such, the use of immigration narrative is important in implementing Family Talk programs.