Paul Gionfriddo, President and CEOMHA Annual Meeting Opening, September 2014

Welcome to Mental Health America

Prevention

Early Identification

and Intervention

Integrated Care and

Treatment

Recovery

Through the Lens of MHA’s Vision

What’s Coming Up?

U.S. Surgeon General

In the United States, mental disorders collectively account for more than 15 percent of the overall burden of disease from all causes and slightly more than the burden associated with all forms of cancer. These data underscore the importance and urgency of treating and preventing mental disorders and promoting mental health in our society.

U.S. Surgeon General’s Report, 1999, page 1

Prevention

Preventable risk factors for mental illnesses – LA Times, 1990

48% of schizophrenia, bipolar patients suffered trauma. (Alvarez, 2011)

Children experiencing 4 types of trauma are 30% more likely to have behavioral and learning problems. (Carrion, 2011)

Early Identification

Any Disorder

Severe Disorder

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

NIMH: Lifetime prevalence, 13-18 Year olds

Early InterventionOnly 1 in 25 with ED is Identified with ED

1990-91 1995-96 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10 2010-11

389437

481 483 485 489 489 477 464 442 420 407 389

Children with ED in Special Ed (thousands)

Severe

Moderate

Mild

Positive

Negative

Severe

ModeratelySevere

Moderate

Mild

Positive

Minimal

Minimal

Negative

Early Identification: MHA SCREENING

Does Income Inequality Matter?

Less than $20,000 $80,000+

8675

42745109 5120

MHA Screening Results, 2014: Low v High IncomeSerious Illness Minimal to Moderate Illness

Integrating Care: People with Mental Illness Receive Less Treatment

10

Adults with SMI Children with MI

41%

49%Receiving No Treatment

Source: NIMH

11

Primary Care and Mental Health

See PCP % antidepressants by PCPs

% stimulants by PCPs

% antipsychotics by PCPs

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

The Obamacare Effect

Integrating Care

13

What Was Supposed to Happen in Every State: ACA 2016

Uninsured

Exchange Cov-erage

Medicaid Ex-pansion

Source Note: Pie slices derived from RAND analysis published in Health Affairs, June 2013

14

What Will Happen in Non-Expansion States: ACA 2016

Uninsured

Exchange Cov-erage

Source Note: Pie slices derived from RAND analysis published in Health Affairs, June 2013

15

Who’s in the ACA Coverage Gap?

16

Post-ACA Inpatient MH Admissions Will Increase More

Inpatient Visits Increase MH Visits Increase

3.5%

9.0%

19-26 year olds v 27-29 year olds, post 2010 ACA Dependents Provision

Source: NBER, Antwi, et al, June 2014

17

…But Payments for Mood Disorders are Low

Mood Diso

rders

Diabetes Mellit

us

All Diagn

oses

Intracra

nial Injury

Respira

tory

Arrest

$4,800

$9,000 $9,700

$18,000

$22,300

Mean Cost Per Hospital Stay, 2010

Source: “Costs for Hospital Stays in the U.S., 2010,”AHRQ, 2013

18

…And People are Frequently Re-admitted

> 15% >20% >25% >30%0

5

10

15

20

25

30

35

180 Day Readmission Rates

Number of StatesAlaskaNew Hampshire

WisconsinNevada

DelawareKansas

KentuckyMichigan

19

To Integrate Care, Providers form Accountable Care Organizations (ACOs)

Total Medicare

18.3

5.2

13.6

ACO Covered Lives, 2013 ACO Covered Lives, 2012

Source: Health Affairs, 1/2014

But integrating care won’t work without parity, too.

RecoveryMood disorders ranking by age group as principle inpatient diagnosis:

Age 1-17 #1

Age 18-44 #3 Note: 4 of top 5 related to delivery

Age 45-64 #5 Note: top four related to aging

Source: “Most Frequent Conditions in US Hospitals, 2010,” AHRQ, January 2013

Why Recovery Is A Goal

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. (SAMHSA, 2011)

Peers, family, providers, treatment, drug therapies, nutrition, exercise, counseling, etc., all play a role in supporting recovery.

23

NIMH RA1SE

• Recovery After Initial Schizophrenia Episode (RA1SE).

• Field Research.• Coordinated and aggressive treatment.• Reduce the likelihood of long term disability

related to schizophrenia.

Why MHA Matters

WE CAN MAKE A DIFFERENCE

Our Affiliates are the Most Innovative in the Nation

• Be Merge – MHA of Palm Beach County• BOSS (Back Office Support Services) – MHA of Middle Tennessee• Check Your Head – MHA of Colorado• FERC (Family Education and Resource Center) – MHA of Alameda County (CA)• I.C. Hope – MHA of Middle Tennessee• Mental Health 101 – MHA of East Tennessee• Peer Place – MHA of Palm Beach County• Peer Recovery Call Center – MHA of East Tennessee• Project Healthy Moms – MHA of Georgia• Respect Institute – MHA of Georgia• Stop the Crazy Talk – MHA of Franklin County (OH)• Texas Youth Suicide Prevention Initiative – MHA of Texas• Youth Screen – MHA of Illinois

26

Social Media Reach

Families USA10125

9420

Twitter Facebook

27

Social Media Reach

Children's Defense Fund

Families USA

41890

10125

23600

9420

Twitter Facebook

28

Social Media Reach

NAMI

Children's Defense Fund

Families USA

18000

41890

10125

40600

23600

9420

Twitter Facebook

29

Social Media Reach

MHA

NAMI

Children's Defense Fund

Families USA

68000

18000

41890

10125

37000

40600

23600

9420

Twitter Facebook

What Do People Need from Us?

Mental health conditions are the only chronic conditions that as a matter of public policy we wait until Stage 4 to treat, and then

often only through incarceration.

32

#B4Stage4

What’s the Alternative?

% of Overall Population % of Men in Prison % of Women in Prison

6%

15%

31%

People with Serious Mental Illnesses

Source: Steadman et al, 2009

What’s the Alternative?

Serious MI Alcohol Dependency Drug Dependency

33%38%

26%

Percent of Homeless People

36

What’s the Alternative?

THANK YOU And Enjoy the Meeting.