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Local Caregivers Ready for Reform of the Mental Health Care System 

Their vision reflects a goal of providing treatment at the 'right place, right time and right cost.'

By Richard Carriuolo and Dennis P. King

Appearing in the Portland Press Herald July 15, 2010

SOUTH PORTLAND - Several years ago, in anticipation of sweeping changes in the health care system, Spring Harbor Hospital in Westbrook, with support from its board of trustees and its parent, MaineHealth, developed Maine Mental Health Partners, a network of treatment providers in the southern part of the state.

The idea was to improve access to high-quality mental health services while reducing costs. Passage of national health care reform confirms that we were on the right track.

As the law presently reads, health care in Maine -- and the nation -- will need to be accessible to more and delivered less expensively, yet more effectively, than it is today.

One of the key assumptions of health care reform is that the creation of Accountable Care Organizations will improve the health care system.

An ACO is a group of health care providers working together to share accountability for not only the cost of the care they provide to a specific population, but also for its effectiveness.

The MMHP vision of coordinating quality mental health services so they can be delivered at the "right place, right time and right cost" aligns well with this accountable care philosophy.

It reflects a commitment to provide effective treatment at the earliest possible time and in the least expensive yet appropriate care setting, such as in the home or school, or in the local therapist's office or counseling center.

The goal is to keep individuals mentally well and, in so doing, help them avoid the need for more restrictive and intensive care, such as that delivered in hospital emergency rooms and psychiatric units. In an accountable care environment, the providers who can deliver on this promise will also benefit from better reimbursement.

As access to insurance coverage expands, delivering mental health services in primary care settings will be a natural progression.

At MMHP, some of our member agencies and strategic partners, including Community Counseling Center, Maine Medical Center, Mid-Coast Mental Health Center, Southern Maine Medical Center, and Spring Harbor Community Services, are already involved in this work.

In fact, through the MaineHealth Primary Care Integration Program, mental health services are now available at or through 20 primary care offices from Rockland to Biddeford and Norway to Brunswick.

This innovative delivery model allows for more comprehensive patient care, while also helping reduce the stigma of mental illness.

Health care reform will also bring about universal movement toward evidence-based treatments.

In the mental health field, as in other parts of medicine, there are evidence-based practices that have been proven to enhance both treatment outcomes and quality of life.

Examples include cognitive behavioral therapy, co-occurring disorders treatment, dialectical behavioral therapy, and assertive community treatment, to name only a few.

Similarly, some medications have proven more effective than others in the treatment of specific mental disorders.

In the brave new world of mental health care reform, treatment will be dictated much less by the latest pharmaceutical miracle or provider's personal preference than by actual evidence of effectiveness.

Prevention is another key to assuring health, which is why the new law calls for a national strategy to promote wellness and disease prevention.

For the mental health field, opportunities exist to identify and treat illness at the earliest signs of onset, as well as prevent illness altogether.

One of the most promising prevention efforts in the field today is a locally developed research protocol called the Portland Identification and Early Referral Program.

Based at the Center for Psychiatric Research at Maine Medical Center, the project is gathering evidence about the possibility of preventing serious, lifelong psychiatric disorders, such as schizophrenia.

In addition to research, providers of mental health services will need to invest in community health through public education, screening and early intervention services.

Soon begins a new era of mental health care delivery.

The old way of doing business -- a fragmented mental health system that rewards providers for the number of patients they see and services they deliver -- will be replaced by one that holds providers accountable for delivering the best treatment outcomes in an increasingly efficient manner.

This is good news for the one in four Americans who seek mental health care at some time, as well as for all of us who pay for its delivery.

Richard Carriuolo is board chairman for Maine Mental Health Partners. Dennis P. King is CEO of the organization.

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