National Health Service Corps Host Three Mental Health Summits Across the Nation
January 14, 2001
During the fall of 2000, the National Health Service Corps (NHSC) held three Mental Health Summits designed as a forum to create strategies and commitments to ensure the supply of mental and behavioral health care services and providers. The Summits’ goals are consistent with the Health Resources and Services Administration’s (HRSA) campaign to achieve 100% access (for underserved populations), 0% health disparities (for racial and ethnic minorities) nationwide. Don Weaver, Director of the NHSC named four qualities necessary for the successful implementation of a health care program in underserved areas. These qualities are: community based; cultural competent professionals; interdisciplinary, integrated team of health care professionals; and services that address the entire life span of an individuals, beginning with pre-natal care and ending with older adult care. Communities achieving these qualities will be able to achieve improved and expanded mental and behavioral health care services.
A total of 26 states volunteered to participate in this initiative and develop state (or regional)-wide plans for placing psychologists and other mental and behavioral health care providers in underserved communities. Participants included representatives from the public and private sector, state and local governments, local university officials and health, mental and behavioral health and substance abuse professionals.
The three Summits were funded by a $1 million appropriation awarded to the NHSC through the advocacy efforts of APA Education Advocacy staff and APA members Herb Goldstein, PhD, and Nate Perry, PhD. To develop the three Summits, the NHSC, housed within HRSA worked closely with the Substance Abuse and Mental Health Services Administration (SAMHSA).
The first of three summits took place in late September, in Des Moines, Iowa with a total of nine Midwestern states participating and had a specific focus on the mental health issues related to the farm crisis. The participating states were: Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin. The Iowa state plan involves organizing a statewide system with a uniform definition of services, eligibility and credentialing. The system would be designed to treat the whole person by integrating physical and mental health, including substance abuse services. Regional service centers would be established and telehealth services would be used to reach all those in need. Cost cutting would occur by pooling all funding streams into a single source payor system and if possible, use tax revenues for core services. In addition, a consortium for cross-training needed health professionals would be created as well as greater use of the NHSC and J1 Visa Programs for recruitment and retention. Technical Assistance for developing a management information system as well as learning about model interdisciplinary programs in other states is requested.
The second summit occurred in late October/early November, in Nashville, Tennessee, as a coordinated effort with the Appalachian Regional Commission. This summit focused on the mental health needs of the thirteen Appalachian states (Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia). The Tennessee state plan focuses on the implementation of an integrated system of care through TENNCARE via a carve-in, which would require a Medicaid waiver for Medicaid, uninsured, and uninsurable (pre-existing conditions) patients. The system would be consumer-oriented and based on a successfully integrated program, Cherokee Health Center, which is administered by a psychologist, Dennis Freeman, PhD, as a model. The Family Practice Apprenticeship Program would be expanded to include psychologists and other mental and behavioral health professionals. Cross-training would be used as well. The Primary Care Association will reconvene Summit participants to work towards implementing the state plan. Technical Assistance for identifying interdisciplinary training models as well as models for integration and anticipated outcomes data from other states is requested.
In December, the third and final summit took place in St. Petersburg, Florida, home district for Congressman Young, Chairman of the House Appropriations Committee. This summit was the only summit to focus solely on one state, Florida. The state was divided into seven different local regions to allow regional concerns on linkages with the Bureau of Health Professions AHEC Program, expanding interdisciplinary training and service delivery throughout the state to be the focus. The regional plan for the Central West region of Florida (consisting of the following counties: Hardee, Highlands, Hillsborough, Manatee, Pasco, Pinellas & Polk) includes developing a regional planning authority that is consumer focused and provides an easily accessible client database for a seamless system of care. Human resource development would include expanded use of AHEC (Area Health Education Centers funded by the US Bureau of Health Professions) which includes psychologists; applying for HPSA (Health Professional Shortage Areas) from the US Bureau of Primary Health Care and for health professionals from the National Health Service Corps; and using Telehealth to reduce cost and deal with transportation problems. Technical assistance was requested on models and best practices, data/information system, and for reviewing the various funding streams.
Each of the three Summits included facilitated discussions on several different topics. Such discussions included: creating a clear vision, local needs, local, state and federal barriers, key strategies, cost-effective care, and human resource development. From these discussions, we found that in all three Summit regions the most serious obstacles to expanded and effective services were funding and regulatory issues directly related to Medicaid, Medicare and managed care. As a result of these obstacles, in all three regions of the country represented, current providers find themselves overwhelmed by struggling to run current programs and find that they have limited time, personnel and funding to examine new ones. In addition, in all three Summit regions there is an undercount of the Mental Health Professional Shortage Areas (MHPSA). It was found that often individuals did not know about the Mental Health designation, or were focusing on either the medical or dental designations.
The make-up of the state delegation may determine the chances for success for the state or regional plans. If policy makers were involved, we believe the group is more likely to succeed. However, the NHSC will be working with the smaller delegations (those with either none or limited policy makers participating) to assist them in gaining the participation of their local government. The key will be in reaching out to those individuals not in attendance but needed in the implementation of state and regional plans.
Currently, the APA is in the process of developing a listserv consisting of the participants of all three Summits. The goal of the listserv will be to engage Summit participants in advocacy efforts for the reauthorization and appropriations efforts for the NHSC. The listserv will be working to further our goals, including expanding the reauthorization of the NHSC in Loan Repayment Program and gaining access for participation for mental and behavioral health professionals in the Scholarship Program.
In addition, the NHSC will provide technical assistance for all requesting Summit participants, and minimal seed money to assist in the start of the implementation of the state or county action plans developed. Participants were also encouraged to make use of the NHSC, and request NHSC health care providers for their local health care centers.
Upon arrival at each summit, participants found themselves posed with the following focus question, "How is it possible to create thriving, community-based settings for primary care, mental and behavioral health and substance abuse services that can effectively engage consumers who are currently underserved and including co-occurring illnesses?" The Summits provided an opportunity for the sharing of ideas, success stories and potential resources among participants within states, across states and with the sponsoring agencies and organizations to enable communities to address the focus question. The Summits also provided the impetus for many to come together and work toward achieving a seamless system of care within their communities. As it was said by Maggie McGlynn, to achieve such a goal will require "Daring passionate leadership and extraordinary results!"