1. 1 Mental Hygiene Administration Annual Conference May 6 -7, 2008 Presentation by: Brian Hepburn, M.D. Executive Director

2. 2 Opening Remarks Maryland’s Mental Health System over the years has seen many changes. Maryland’s Mental Health System over the years has seen many changes. We are fortunate that throughout our journey it has been a collaborative process—consumers, families, advocacy and providers—wherein a shared vision continues to lead our path. We are fortunate that throughout our journey it has been a collaborative process—consumers, families, advocacy and providers—wherein a shared vision continues to lead our path. The vision of a transformed mental health system is consumer and family-driven and recovery-oriented. The vision of a transformed mental health system is consumer and family-driven and recovery-oriented.

3. 3 Ten Fundamental Components of Recovery Self-Direction Self-Direction Individualized and Person-Centered Individualized and Person-Centered Empowerment Empowerment Holistic Holistic Non-Linear Non-Linear Strengths-Based Strengths-Based Peer Support Peer Support Respect Respect Responsibility Responsibility Hope Hope

4. 4 Guided by the Recommendations of the President’s New Freedom Commission

5. 5 Mental health is essential to overall health. Mental health is essential to overall health. Mental health care is consumer and family driven. Mental health care is consumer and family driven. Disparities in mental health services are eliminated. Disparities in mental health services are eliminated. Early mental health screening, assessment, and referral to services are common practice. Early mental health screening, assessment, and referral to services are common practice. Excellent mental health care is delivered, and research is accelerated. Excellent mental health care is delivered, and research is accelerated. Technology is used to access mental health care and information. Technology is used to access mental health care and information.

6. 6 Transformation Efforts In Conjunction with Maryland’s Transformation Office, we are building upon a recovery model care system, through initiatives such as: In Conjunction with Maryland’s Transformation Office, we are building upon a recovery model care system, through initiatives such as: Initiating Wellness and Recovery Centers Initiating Wellness and Recovery Centers Moving forward with Consumer Self-Direction Moving forward with Consumer Self-Direction Increasing Peer Support Groups Increasing Peer Support Groups Expanding Evidence-Based Practices Expanding Evidence-Based Practices Strengthening community supports Strengthening community supports Through housing initiatives Through housing initiatives And expanding EBPs in Supported Employment And expanding EBPs in Supported Employment

7. 7 Evidence-Based Practices Moving toward a recovery-model system, the PMHS continues to maximize evidence-based practice (EBP) models of service. Moving toward a recovery-model system, the PMHS continues to maximize evidence-based practice (EBP) models of service. Maryland has been an historical leader in this national movement toward the implementation of EBPs and recovery-oriented practices. Maryland has been an historical leader in this national movement toward the implementation of EBPs and recovery-oriented practices. Maryland was one of four states to initially recognize the opportunities and promise offered by EBPs to positively impact the quality and delivery of mental health services. Maryland was one of four states to initially recognize the opportunities and promise offered by EBPs to positively impact the quality and delivery of mental health services.

8. 8 Ongoing Collaborations Maryland Division of Rehabilitation Services (DORS) Maryland Division of Rehabilitation Services (DORS)

9. 9 MENTAL HEALTH AWARENESS Maryland Coalition of Families for Children’s Mental Health Maryland Coalition of Families for Children’s Mental Health Celebrating May as Mental Health Month Celebrating May as Mental Health Month Celebrating Children’s Mental Health Awareness Celebrating Children’s Mental Health Awareness

10. 10 Morbidity and Mortality Statistics indicate an increase in morbidity and mortality associated with serious mental illness (SMI). Statistics indicate an increase in morbidity and mortality associated with serious mental illness (SMI). WHY: WHY: Metabolic Disorders, Cardiovascular disease, diabetes mellitus Metabolic Disorders, Cardiovascular disease, diabetes mellitus High prevalence of Modifiable Risk Factors (obesity, smoking) High prevalence of Modifiable Risk Factors (obesity, smoking) Epidemics within Epidemics ( e.g. diabetes, obesity) Epidemics within Epidemics ( e.g. diabetes, obesity) Some psychiatric Medications contribute to the risk. Some psychiatric Medications contribute to the risk.

11. 11 Why should we be concerned?

12. 12 Mental health is essential to overall health Compared to the general population, persons with major mental illness typically lose more than 25 years of normal life span. Compared to the general population, persons with major mental illness typically lose more than 25 years of normal life span. Increased risk of death from medical causes in schizophrenia and 20% shorter lifespan Increased risk of death from medical causes in schizophrenia and 20% shorter lifespan Bipolar and unipolar affective disorders associated with higher standardized mortality ratios from medical causes. Bipolar and unipolar affective disorders associated with higher standardized mortality ratios from medical causes. Cardiovascular mortality in schizophrenia increased from 1976- 1995, with greatest increase in standardized mortality ratios in men from 1991-1995. Cardiovascular mortality in schizophrenia increased from 1976- 1995, with greatest increase in standardized mortality ratios in men from 1991-1995.

13. 13 Mental Disorders and Smoking Higher prevalence (56-88% for patients with schizophrenia) of cigarette smoking (overall U.S. prevalence 25%) Higher prevalence (56-88% for patients with schizophrenia) of cigarette smoking (overall U.S. prevalence 25%) More toxic exposure for patients who smoke (more cigarettes, larger portion consumed) More toxic exposure for patients who smoke (more cigarettes, larger portion consumed) Smoking is associated with increased insulin resistance Smoking is associated with increased insulin resistance Similar prevalence in bipolar disorder Similar prevalence in bipolar disorder George TP et al. Nicotine and tobacco use in schizophrenia. In: Meyer JM, Nasrallah HA, eds. Medical Illness and Schizophrenia. American Psychiatric Publishing, Inc. 2003; Ziedonis D, Williams JM, Smelson D. Am J Med Sci. 2003(Oct);326(4):223-330

14. 14 Schizophrenia: Natural Causes of Death Higher standardized mortality rates than the general population from: Higher standardized mortality rates than the general population from: Diabetes 2.7x Diabetes 2.7x Cardiovascular disease2.3x Cardiovascular disease2.3x Respiratory disease3.2x Respiratory disease3.2x Infectious diseases 3.4x Infectious diseases 3.4x Cardiovascular disease associated with the largest number of deaths Cardiovascular disease associated with the largest number of deaths 2.3 X the largest cause of death in the general population 2.3 X the largest cause of death in the general population

15. 15 Serious Mental Illness may be a health risk factor because Patient factors, e.g.: a motivation, fearfulness, homelessness, victimization/trauma, resources, advocacy, unemployment, incarceration, social instability, IV drug use, etc Patient factors, e.g.: a motivation, fearfulness, homelessness, victimization/trauma, resources, advocacy, unemployment, incarceration, social instability, IV drug use, etc Provider factors: Comfort level and attitude of healthcare providers, coordination between mental health and general health care, stigma, Provider factors: Comfort level and attitude of healthcare providers, coordination between mental health and general health care, stigma, System factors: Funding, fragmentation System factors: Funding, fragmentation

16. 16 What can we do?

17. 17 PRIORITIZE FOCUS ON PREVENTION AND WELLNESS FOCUS ON PREVENTION AND WELLNESS IMPLEMENT ESTABLISHED STANDARDS OF CARE… IMPLEMENT ESTABLISHED STANDARDS OF CARE… PREVENTION, SCREENING, TREATMENT PREVENTION, SCREENING, TREATMENT IMPROVE ACCESS TO AND INTEGRATION OF PHYSICAL HEALTH AND MENTAL HEALTH CARE IMPROVE ACCESS TO AND INTEGRATION OF PHYSICAL HEALTH AND MENTAL HEALTH CARE

18. 18 Promote and Educate Promote coordinated and integrated mental health and physical health care for persons with serious mental illness. Share information widely about physical health risks in persons with SMI to encourage awareness and advocacy. Educate the health care community. Encourage consumers and family members to advocate for wellness approaches as part of recovery.

19. 19 Consumer Wellness and Empowerment Support consumer wellness and empowerment to improve personal mental and physical well-being educate / share information to make healthy choices regarding nutrition, tobacco use, exercise, implications of psychotropic drugs teach /support wellness self-management skills teach /support decision making skills motivational interviewing techniques Implement a physical health Wellness approach that is consistent with Recovery principles, including supports for smoking cessation, good nutrition, physical activity and healthy weight. attend to cultural and language needs

20. 20 Mental Health First Aid Maryland is adopting the program. Maryland is adopting the program. Mental health first aid is the help provided to a person developing a mental health problem or in a mental health crisis. Mental health first aid is the help provided to a person developing a mental health problem or in a mental health crisis. It is not therapy…it teaches people how to recognize mental health problems so they can provide some initial assistance, and guiding persons towards appropriate/professional treatment. It is not therapy…it teaches people how to recognize mental health problems so they can provide some initial assistance, and guiding persons towards appropriate/professional treatment.

21. 21 SB 210 – New Initiative Lt. Governor Anthony Brown was a key force in passing legislation to establish a new $2.8 million program that will provide mental and behavioral health services to Iraq and Afghan veterans, especially in rural areas. Lt. Governor Anthony Brown was a key force in passing legislation to establish a new $2.8 million program that will provide mental and behavioral health services to Iraq and Afghan veterans, especially in rural areas. Lt. Governor will chair a Veterans Behavioral Health Advisory Board and will work with a coalition of stakeholders to identify the gaps in behavioral health services for veterans and their families. Lt. Governor will chair a Veterans Behavioral Health Advisory Board and will work with a coalition of stakeholders to identify the gaps in behavioral health services for veterans and their families. The program will be administered by the Maryland Department of Health and Mental Hygiene. The program will be administered by the Maryland Department of Health and Mental Hygiene. The program will eliminate gaps in services by providing crisis The program will eliminate gaps in services by providing crisis intervention, case management, improved outreach and short-term health-related services to veterans of the Iraq and Afghanistan wars. -- MHA will provide resource coordination.

22. 22 Network of Care Network of Care is a highly interactive, single information Web site where consumers, organizations and staff can go to access a wide variety of information. Network of Care is a highly interactive, single information Web site where consumers, organizations and staff can go to access a wide variety of information. Within this site, resources include a Service Directory; links to pertinent Web sites from across the nation; a comprehensive, easy-to-use Library; an advocacy tool; and message boards. Within this site, resources include a Service Directory; links to pertinent Web sites from across the nation; a comprehensive, easy-to-use Library; an advocacy tool; and message boards. We plan to expand Networks of Care throughout the counties. We plan to expand Networks of Care throughout the counties.

23. 23 Moving Forward As we continue to transform Maryland’s Public Mental Health System, we will prioritize our systems of care to eliminate disparities in healthcare for those with mental illness. As we continue to transform Maryland’s Public Mental Health System, we will prioritize our systems of care to eliminate disparities in healthcare for those with mental illness. We will closely monitor the morbidity and mortality rates in the PMHS’ populations. We will closely monitor the morbidity and mortality rates in the PMHS’ populations.

24. 24 Concluding Comments We will continue to redefine the PMHS—toward a system of care that provides the holistic approach to well-being, which supports a consumer-driven system that encourages evidenced-based and promising practices. We will continue to redefine the PMHS—toward a system of care that provides the holistic approach to well-being, which supports a consumer-driven system that encourages evidenced-based and promising practices. Resulting renewed hope and optimism for an individuals success in community living. Resulting renewed hope and optimism for an individuals success in community living. With that I once again welcome each of you to this year’s conference; and applaud your continued commitment to improving Maryland’s Public Mental Health. With that I once again welcome each of you to this year’s conference; and applaud your continued commitment to improving Maryland’s Public Mental Health.