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Report: East Metro Roundtable Discussion on Behavioral Health
Monday, April 17, 2006
Regions Hospital, St. Paul, Minn.
Summary
On April 17, 2006, a select group of more than 25 community leaders and decision makers from the East Metro region met at St. Pauls Regions hospital for a 2.5 hour Roundtable Discussion on Behavioral Health.
The goal: To identify two or three tangible steps that could be taken -- either by individual agencies or in partnership -- to address crisis-level needs in mental health care delivery in the East Metro.
The result: Formation of separate working groups to investigate short-term solutions in three critical areas: behavioral health crisis capacity, patient flow and medication availability. Group members agreed to reconvene in approximately three months and that working groups would meet in the interim to clarify objectives, begin to construct a work plan and identify resource needs.
Overview
Every year, more than $1.2 billion is spent on mental health services in Minnesota, involving hundreds of public and private mental health programs, activities and agencies. Yet advocates, patients, families and providers often are dissatisfied with how the mental health system falls short. Lack of available services and resources as well as bottlenecks in the mental health care delivery system have created crises of care that too often have heartbreaking results.
With serious and growing shortages in mental health services and capacity, the behavioral health crisis in Minnesota demands immediate attention. Twin Cities hospitals and communities need short- and long-term strategies to improve the system.
The East Metro Roundtable Discussion on Behavioral Health was intended to engage leaders from both public and private sectors to:
- build awareness of the scope of the issue,
- refine understanding of current barriers and challenges in the East Metro system,
- and generate practical short- and long-term solutions and new ways of providing behavioral health care
The meeting was modeled on similar and productive roundtable discussions held in 2002 and 2003, which led to creation of successful community partnerships and policy work addressing shortages in crisis support such as the East Metro Adult Crisis Stabilization (EMACS) program and Hovander House, as well as new crisis response services for children and adolescents.
The discussion was hosted by HealthPartners and Regions Hospital in partnership with St. Paul Mayor Chris Coleman. Former McKnight Foundation President Rip Rapson served as facilitator. All participants had an opportunity to contribute to the robust discussion, which reflected the urgency and impassioned dedication surrounding behavioral health issues from a number of different perspectives.
General aims
In remarks prefacing the Roundtable, Mayor Coleman emphasized the interconnectivity of regional and statewide behavioral health care and the need for a maintaining a regional outlook even while focusing on East Metro solutions. HealthPartners Mary Brainerd described the meeting as an opportunity to bring about pragmatic, local change on issues that pervade at the national level. She encouraged the group to consider the Institute of Medicines focus on six aims necessary to achieve high quality health care, based on care that is:
- Safe
- Effective
- Patient Centered
- Timely
- Efficient
- Equitable
Citing a common understanding of previous work outlining the significant barriers in the behavioral health delivery in the East Metro, the co-hosts encouraged the group to devote most of the meeting to discussion of potential solutions that could result in short-term improvements for the East Metro system.
In introducing himself or herself, each participant cited one significant problem or barrier, which ranged from lack of coordination between agencies, need for more early intervention, uncertainty about the status of available resources, housing issues, incarceration issues related to mental health, and many others.
Results/Commitments
Participants discussed and debated many different issues and agreed to prioritize three of the most critical for immediate action by subgroups. Prioritization was based on general consensus about which needs were most critical and actionable in the short-term.
Each subgroup will be headed by a chair or co-chairs who will recruit subgroup participants from within the larger group. Contact information will be shared among group members so that individuals may contact chairs to indicate interest and vice versa.
Each subgroup will refine its respective charge and report back to the larger group at the next meeting. The following descriptions are general starting points from which the subgroups may begin their work.
1. Crisis Capacity Analysis
Chair: Kirk Fowler, Community Mental Health Services
Participants discussed the fact that many crisis-response behavioral health resources are in place but they are not leveraged optimally. There is a sense, for example, that available crisis teams could help alleviate pressure on East Metro hospital emergency departments but the system currently lacks coordination to enable that consistently. Participants shared many other examples and compelling anecdotes, illustrating the depth and breadth of this issue throughout the region.
This subgroup will investigate and inventory the resources currently in place and give thought to how current crisis resources could potentially work more effectively. It may also examine, for example, possibilities for standardizing and/or centralizing intake and discharge procedures across the region.
2. Patient Flow Analysis
Co-Chairs: Paul Goering, M.D.. United Hospital and Michael Trangle, M.D., HealthPartners
Participants cited the need for current and useful East Metro data about how patient cases flow through the behavioral health system, from emergency departments to step-down facilities, supportive housing and beyond. Participants agreed that collection of such data should be a fundamental enabling step for further improvements, citing examples of what this knowledge might help accomplish.
This group will review the current patient flow, examine potential gaps in the service mix and suggest longer-term solutions for mapping patients to services more efficiently. One long-term possibility described was the concept of a GPS system for East Metro behavioral health that would depict real-time information about available services, at the fingertips of hospital and community based organizations as a shared resource.
3. 24/7 Medication Availability
Co-Chairs: Mary Brainerd and Donna Zimmerman, HealthPartners
Participants discussed the importance of medication availability in treatment, citing barriers to certain patients' abilities to obtain medication at certain times of the day, especially in the middle of the night. Barriers also included lack of supportive services to help people stay on medications. Participants cited several examples of the difficulties caused by the unavailability of medications and agreed that this issue represented an area in which action could bring about tangible benefit.
Operating under the assumption that all persons should have their medications available 100 percent of the time, this group will review the current situation and investigate possible solutions for guaranteeing 24/7 access to behavioral health medications in the East Metro.
Other categories discussed
Participants discussed other issues deemed worthy of additional follow up but, given the many important ideas expressed, the group decided that they should be noted and perhaps addressed in other groups or at a later time.
These issues included investigation of promising models of evidenced-based care for prevention and early intervention (with dissemination and measurement of these practices), prevention efforts focusing on children and adolescents, gaps in culturally sensitive services, communications between different agencies and institutions, development of indicators of community wellness, and others.
Next steps
The group agreed to meet again in approximately three months, with the three working groups expected to report back to the larger group with work plans and resource needs. The hosts agreed to serve as conveners once again.
CO-HOSTS
Mary Brainerd
President and CEO
HealthPartners
Mayor Chris Coleman
City of St. Paul
FACILITATOR
Richard "Rip" Rapson
Former President
McKnight Foundation |
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PARTICIPANTS
Sue Abderholden
Executive Director
National Alliance for Mentally Ill
Jerry Boardman
Vice President, Community Partnerships
Central Community Housing Trust
Matt Bostrom
Senior Commander
St. Paul Police Department
Ron Brand
Executive Director
Community Mental Health Association
Tim Burkett
Executive Director
People, Inc.
Toni Carter
Commissioner
Ramsey County
Sue DeNuccio
Board Member
HealthPartners
Father John Estrem
CEO
Catholic Charities
Kirk Fowler
Manager
Community Mental Health Services
Rob Fulton
Director
Ramsey County Public Health
Paul Goering, M.D.
Medical Director
United Hospital |
Jesse Bethke Gomez
President
Comunidades Latinas Unidas En Servicio (CLUES)
Kevin Goodno
Commissioner
Minnesota Department of Human Services
Representative Mindy Greiling
Minnesota House of Representatives
Chief Judge Gregg Johnson
Ramsey County District Court
Tom Kingston
President
Wilder Foundation
Wes Kooistrra
Assistant Commissioner, Chemical and Mental Health Services
Minnesota Department of Human Services
Dianne Mandernach
Commissioner
Minnesota Department of Health
Ann Mulholland
Chief of Staff
City of St. Paul
Brock Nelson
President and CEO
Regions Hospital
Michael Trangle, M.D.
Vice President of Medical Affairs and Associate Medical
Director, Behavioral Health
HealthPartners
Raymond Yu
Director of Student Services
St. Paul Public Schools |
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