Mental Health Pharmacy Workforce Proposal: Addressing Underserved and Rural Minnesotans Needs for Improving Mental Health

Transcription

1 Mental Health Pharmacy Workforce Proposal: Addressing Underserved and Rural Minnesotans Needs for Improving Mental Health MPhA House of Delegates Randy Seifert, PharmD

2 Learning Objectives Following the presentation each participant will be able to: 1. Describe the current state of mental health care in rural and underserved areas of Minnesota 2. List 5 recommendations from the Gearing Up for Action: Mental Health Workforce Plan for Minnesota January 15, 2015 report to the Minnesota Legislature 3. Describe the key features of Senate Bill 1246 and the potential impact on pharmacy practice in Minnesota 4. Develop additional key solutions that place pharmacists in a good position to provide advanced mental health care services

3 National Workforce Study Background u An Action Plan for Behavioral Workforce Development (2007) u Prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by The Annapolis Coalition on the Behavioral Health Workforce (Cincinnati, Ohio) u Report stated a high degree of concern about the workforce and was in crisis with its ability to provide quality care. u There is overwhelming evidence that the behavioral health workforce is not equipped in skills or in numbers to respond adequately to the changing needs of the American population.

4 Some National Figures: Background u In 2002 estimated about 500,000 clinically trained mental health workers in the US u Lack of cultural and racial diversity u In most disciplines over 50% were over the age of 50 u Geographic distribution over 85% of the 1669 federally designated mental health shortage areas where in rural areas and half the counties in the US had no mental health professional

5 Background

6 Pennington County 11.9/1000 St. Louis County 13.9/1000 Minnesota Average +14 Years and above = 8/1000 About 34,000 annually accessed April 1, 2015

7 Minnesota Department of Health Services Psychotropic Medication Use FFS and MCO 2014

8 Minnesota Department of Health Services Psychotropic Medication Use FFS and MCO 2014 *Total for < 18 year olds is inflated by overlap in both FFS and MCO. That number is 11.5%. Unduplicated 18,049

9 Minnesota Department of Health Services Psychotropic Medication Use FFS and MCO 2014 Total MCHP lives (2013) was 1,101,643 FFS lives 220,328 MCO lives 881,314 <18 lives 418, and above 683,018 If you assume fairly consistent numbers from 2013 to 2014: u About 13% of children less than 18 years were receiving a psychotropic (37% on a antidepressant) u 38% of adults 18 years and above were receiving a psychotropic (Data provided by DHS 4/2/2015)

10 Wall Street Journal November 16, 2011

11 Minnesota Gearing Up for Action: Mental Health Workforce Plan for Minnesota January 15, 2015 report to the Minnesota Legislature Prepared by HealthForce Minnesota u Grew out of concern for the ability of Minnesota s mental health workforce to meet current and future demands u Demands on the workforce ACA expansion Aging population Aging mental health workforce Discrimination associated with mental illnesses, low wages, increasing regulations and the costs of education and training

12 Recommendations Recommendations fall under the general categories of: u Recruitment u Education and training u Placement after program completion u Retention u Assessment

13 Education and Training Recommendation 6: The Minnesota Private College Council, HealthForce Minnesota, and the Office of Rural Health and Primary Care will co-convene a discussion with representatives from Minnesota s higher education institutions to assess the availability of higher-level mental health degree programs in rural areas of the state. Specific areas to be addressed include: a. Expansion of psychiatric nurse practitioner programs b. Expansion of social work and mental health programs to tribal colleges c. Determination of the need for new programs and curriculum development d. Expansion and/or better promotion of existing weekend cohort or online master s programs e. Evaluate how grant funds for Minnesota higher education institutions could ensure access to mental health master s programs around the state, including rural areas

14 Education and Training Recommendation 7: Increase by four the number of psychiatric residency and fellowship slots in Minnesota over the next two years. Recommendation 10: Support efforts to expand and broaden mental health telemedicine, including using the technology in training programs, grants and funding to expand telemedicine capacity throughout the state. Require commercial health plans to cover services delivered via tele-health technology. Recommendation 11: Improve and expand cultural competency (awareness) training. Establish cultural competence (awareness) as a core behavioral health education and training requirement for all licensure/certification disciplines.

15 Education and Training Recommendation 12: Develop a faculty fellowship model to engage faculty in newest understanding and treatment of mental illness in both children, youth, adults and older adults. Recommendation 13: Charge the Department of Human Services with establishing criteria and a payment mechanism to incentivize mental health settings committed to providing students with a practicum experience that features evidencebased treatment interventions. Recommendation 14: Increase exposure to psychiatric/mental health experiences for nursing and medical school students and increase continuing education offerings for licensed nurses and physicians.

16 Education and Training Recommendation 17: Minnesota Department of Health will evaluate Medical Education and Research Costs (MERC) funding to identify changes needed to support mental health workforce development and will add Licensed Marriage and Family Therapist and Licensed Professional Clinical Counselors professions to the program. Recommendation 18: Promote a team-based healthcare delivery model for mental health treatment.

17 Legislation Senate Bill 1246 Sponsor: Senator Clausen u SF 1246 establishes a comprehensive Health Care Workforce Council. u SF 1246 also establishes a grant program to expand clinical training for advanced practice registered nurses, physician assistants, and mental health professionals u a grant program to expand primary care residency training u a grant program to for health professions student preceptors and medical resident preceptors u Amended to include pharmacists

18 Proposal for Advanced Training Program Goals 1. Improve service access, delivery and outcomes by utilizing the workforce and skill set of pharmacists in the care of patients with mental illness 2. Train 70 rural and underserved-area practicing pharmacists in advanced medication management in mental health. This is about one pharmacist per county excluding seven metro counties and Olmstead County. 3. Place residency trained psychiatric pharmacist specialist in strategic underserved and rural communities to support population mental health needs and interprofessional team care for Minnesotans with mental health illnesses 4. Assess ways in which pharmacists can support gaps in the health care system to improve care and outcomes

19 Concept u Develop a system of community-based pharmacist providers who would have an additional focus on mental health; direct patient care and public health u Maintain support through a group of consultants psychiatric pharmacist specialists, psychiatrists and others u The system would be collaborative and interprofessional u Why consultants and interprofessional?

20 Pharmacist Training Program Eligibility Must be credentialed in the CoP MedEdgeRx Network Why CoP? Composition: u Online and live didactic content utilizing College of Psychiatric and Neurological Pharmacists online learning CE programs Supplemented with webinars (or other media) or chat sessions around case presentations or other advanced topics u Live training Either on site with a psychiatric pharmacist specialist or via video conferencing at the pharmacists practice site u Mentoring and peer review u Community interprofessional training

21 Interprofessional Collaboration Support u Securing collaborative practice agreements u Community based protocols and guidelines u Joint CE programs and forums u Community education u Public health

22 Consultant Support u Peer support group assigned to the community and pharmacists u Back-up support for complex or difficult cases u Composed of psychiatric pharmacist specialist, psychiatrist and other mental health professionals e.g. psychologist, social worker etc.

23 Didactic Training Phases u CPNP offers a 20-credit online psychiatric pharmacotherapy course for pharmacists and physicians that would be used as the base didactic training course. u These online modules would be supplemented with College of Pharmacy live media content that would bring in more patient experience training from College of Pharmacy or other faculty.

24 Training Phases Direct Patient Care Experience u Concomitant with the didactic training course modules the participant may spend time in the clinic with a psychiatric specialist pharmacist or; u the pharmacist may not be able leave their practice and to accommodate them we have developed an option for the pharmacist and preceptor to conduct 20 to 25 patient cases using via tele-precepting u This would constitute the direct patient care experience portion of the certificate program and the pharmacists would have the opportunity to hone skills such as motivational interviewing.

25 Funding Seed: u CoP would provide initial funding of $10,000 for support of 6-10 awards for practicing pharmacists u Intermediate funding estimated at approximately $558,000 for 70 pharmacists

26 Funding Personnel u What do we need to create a system of ongoing direct patient care? u What is the strategy?

27 Funding Sustained u Training program numbers would likely be reduced after Year 3. u Determined in middle Year 2 depending on evaluation of outcomes of Year 1 and first half Year 2 u Professional fees for delivered care

28 Proposed sites (not limited) Bemidji Roseau Baudette Detroit Lakes Fergus Falls New Ulm Worthington Mankato St. Cloud Park Rapids Grand Rapids Mora Grand Marais International Falls Morris Hibbing Ely Aitken Crookston Wadena Brainerd Little Falls Alexandria Marshall Redwood Falls Willmar Morris Albert Lee Winona Sandstone

29 Questions and Discussion

30 Post test questions Which on of the following best describes the number of mental health professions in the US as surveyed in 2002? A. 250,000 B. 500,000 C. 1,000,000 D. 2,000,000 E. None of the above

31 Post test questions Which one of the following Counties in Minnesota has the highest per capita admissions for mental health illnesses? A. Wadena B. Hubbard C. Hennepin D. St. Louis E. None of the above

32 Post test questions In the original Senate Bill 1246 and House Bill 1447 which professional was not listed? A. Pharmacists B. Nurse practitioners C. Psychiatrists D. Family medicine E. None of the above