Dr Benjamin Van Voorhees from the Department of Paediatrics in the University of Illinois at Chicago, outlines innovative strategies to tackle the mental health crisis in the US
Healthcare systems and processes in the United States are undergoing radical changes as a result of the Affordable Care Act and related efforts to move from a fee-for service model of health services provision to one that focuses on a managed care, value added payment model. As a part of this shift, services such as mental health that were once excluded are now being mandated for inclusion in coverage. For providers serving a young, publicly insured (Medicaid) population, this creates a problem. The mental health workforce is seriously understaffed, particularly for those with pediatric specialisation. Furthermore, Medicaid reimbursement is substantially below what mental health providers typically charge, creating a disincentive to serve Medicaid recipients.
The University of Illinois at Chicago, Department of Paediatrics (UIC, Paediatrics) has developed a model of mental health service provision for a young (25 years of age or less), low-income urban population with one or more chronic diseases. Chronic disease is highly correlated with depression and that disorder can have a profound effect on a patient’s physical health, as well as on the family’s ability to provide support. UIC, Paediatrics is testing a model that seeks to meet the mental health needs of patients with chronic illnesses for both preventive and symptomatic mental health concerns. Mental health disorders are a particular focus due to their impact on the health and wellbeing of patients.
The model is designed to integrate mental health services with primary care, making it possible to identify mental health concerns at an early stage of development so that preventive and ameliorative interventions can be deployed to prevent the escalation of mental health issues to a more serious level. The model also includes providing supportive services for families of the enrolled patients so that they are better able to manage both their child’s behavior and his or her chronic illness, reducing the level of stress in the household and facilitating improved health outcomes.
