In October, Dr. Karen Stephen, the Director of Behavioral Health at Partnership Health Plan,\u00a0\u00a0attended the CIBHS 2015 California Behavioral Health Policy Forum. She returned with some reflections from a presentation by Marvin Southard, the much-beloved retiring Director of Los Angeles County Mental Health Department. He presented one slide that highlighted what is important to acknowledge in treating both behavioral health and substance abuse problems.\u00a0 He entitled the slide, \u201cWhat Counts.\u201d<\/p>\n
He said that if we look at what contributes to overall health outcomes in terms of both length of life and quality of life, there are two factors that account for 50% of that outcome. The first is the physical environment<\/em> in which people live which contributes 10% to overall health outcomes. This includes housing, transit, and air and water quality. The second are social and economic<\/em> factors which contribute 40% to health outcomes. These include education, employment, income, family and social support, and community safety.<\/p>\n The other 50% of overal health outcomes are determined by clinical care <\/em>and health behaviors. \u00a0Clinical care <\/em>accounts for 20% of the overall outcome and includes access to care and quality of care. \u00a0Health behaviors<\/em> include tobacco use, diet and exercise, alcohol and drug use, and sexual activity and account for 30% of the overall outcome.<\/p>\n As clinical providers and as health plans, therefore,\u00a0 we can maximally impact 50% of what contributes to good health outcomes. The other 50% of physical environment and sociodemographic factors are unchartered territory for health providers. Interestingly, what we know now as public health grew from attempts to improve these other 50%. One theory for instance suggested that diseases were due to \u201cbad air\u201d. Interventions were designed to improve \u201cbad air\u201d with improvements in living conditions and sanitation.<\/p>\n With the advent of \u00a0germ<\/em> theory of disease, focus was shifted back to biological causes of illness. Therapies were developed to attack the underlying pathology of disease, whether its microbiologic or genetic in origin.<\/p>\n Now the pendulum is swinging back. Socio-cultural context is re-emerging as key contributors to health outcomes. Educational inequality, income inequality, blighted and poor neighborhoods, and social exclusion and isolation are now recognized as major players for poor health outcomes. Economically-associated factors such as housing instability, under or un-employment, food insecurity, and limited access to health care are now considered key contributors.<\/p>\n Finally, adverse life experiences including both early life and later life experiences called \u2018trauma-informed care\u2019. History of sexual abuse, substance-impaired parents, physical or emotional abuse, especially early in\u00a0 life, can scar the patient for life, and adversely affect their life-long health.<\/p>\n Project 25<\/em> is a shining example of how addressing social determinants of health can impact health outcomes. Undertaken in San Diego from 2010 to 2013 , Project 25<\/em> provided an integrated program addressing physical and mental health, substance abuse, and criminality. \u00a0Twenty eight of the highest cost individuals in the public system (including both health and judicial costs) were enrolled in an intensive program of services which emphasized \u201chousing first\u201d (with ongoing support to landlords to support stable housing), a comprehensive medical home (with all physical, mental health, substance abuse, and social services received in one location), and both harm reduction and abstinence philosophies for substance abuse (how many other programs allow beer in the fridge!). This program was funded by United Way and involved the\u00a0\u00a0 cooperation of a large consortium of public and community based health and judicial organizations.<\/p>\n Preprogram costs for all public services (ED visits, hospitalizations, arrests, days in jail, ambulance transportation) were $111,000 per person in 2010, while the individuals were still living on the streets. The median expense in 2013 was only one-tenth of that amount, less than $12,000, \u00a0after being placed in permanent housing with comprehensive services. \u00a0At the end of the project, one third were able to maintain their lives on their own, one third were on their way to doing so, and one third were determined to need the intensive services for the rest of their lives (still a savings compared to what was being spent on them without those services).<\/p>\n Successful programs throughout the state have used similar approaches.<\/p>\n A very touching moment at the CIBHS program was when a rehabilitated career-criminal drug abuser told the audience of health professionals that what was most important in his success, where there had been zero success before, was seeing a person who \u201clooked like him\u201d when he stepped out of prison, having counselors listen with unconditional acceptance. being immediately offered a housing voucher, and having a client-centered goal setting approach in all services provided. We need to pay heed to those we serve.<\/p>\n","protected":false},"excerpt":{"rendered":" In October, Dr. Karen Stephen, the Director of Behavioral Health at Partnership Health Plan,\u00a0\u00a0attended the CIBHS 2015 California Behavioral Health Policy Forum. She returned with some reflections<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1726","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n\n