Doing Better at Doing Good

Durham mental health initiative strives to address treatment gaps

January 19, 2013 

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Pictures of victims of the Sandy Hook Elementary School shooting are seen on artificial roses at a roadside memorial December 20, 2012 in Newtown, Connecticut. People continue to mourn the killing of 20 students and 6 adults by gunman Adam Lanza on December 14, 2012 at Sandy Hook Elementary School. AFP PHOTO/Brendan SMIALOWSKI (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)

BRENDAN SMIALOWSKI — AFP/GETTY

In the weeks since the Newtown school massacre by mentally disturbed shooter Adam Lanza, the state of mental health care in America has come under renewed scrutiny.

For decades, public investment in mental health care has dwindled. In the past few years alone, federal and state support has plummeted by billions of dollars, leaving many people with limited treatment options or none at all. Even the mental health coverage provided by private insurers is often insufficient.

In its most recent report, the National Alliance on Mental Illness gave North Carolina – and the United States as a whole – a “D” grade for its delivery of mental health services. Not one state earned an “A” and just a handful got a “B.”

Meanwhile, 10 to 15 percent of all American children – at every point on the socioeconomic spectrum – suffer from a significant mental disorder. In many cases, helpful treatments do exist.

But less than 25 percent of children will ever access those services. Of those, even fewer will be treated effectively.

The costs in terms of health care, underperformance in the classroom and sheer human suffering are extraordinary. In the worst instances, mass killers like Lanza emerge.

Though lack of funding is getting a lot of attention, there is another crucial and less-discussed obstacle to effective mental health care for children and young adults: a badly fragmented delivery system in which schools, social workers, health care providers, government agencies and community partners often work in silos.

That’s where an ambitious new project led by Duke Medicine strives to make a lasting difference.

Just three weeks before Lanza’s horrific attack in Connecticut, the Charlotte-based Duke Endowment awarded a four-year, $1.6 million grant to fund the Integrated Pediatric Mental Health Care Collaboration in Durham.

Durham’s children

Designed to aid children in Durham’s public schools, the initiative aims to identify gaps in mental health care delivery, strengthen coordination and collaboration among existing providers, train health care providers and educators to identify mental health problems early and study the impact of innovative new models for improving mental health care.

“We have a lot of systems of care in Durham that have been developed by smart, caring people,” says Dr. Helen Egger, who is leading the overall project as chief of the Division of Child and Family Mental Health and Developmental Neuroscience at Duke University Medical Center. “Some of those systems are working and some of them aren’t. We will honestly look at what is actually happening on the ground to actual children.”

Already, Egger and her colleagues know massive gaps exist.

Right now, for example, a student might be sent to an emergency department for evaluation if a fight at school indicates psychiatric problems. Sometimes that student will be admitted to the hospital and treated. But after their discharge, underpaid, swamped case workers can’t monitor their status carefully. Educators don’t talk with health care providers about that student’s subsequent behavior. And no one is consistently connecting the dots among these groups. There’s a good chance the student will ultimately have another episode and go back to the emergency department, starting the process all over again.

Technology, collaboration

Egger imagines a scenario in which the school reaches out immediately, via videoconferencing technology, to an on-call psychiatrist who can address the situation and eliminate the ER visit. Meanwhile, a case coordinator with a more balanced and focused workload ensures that families, doctors, teachers and social workers can rally quickly to support the student.

“The challenges are old, but there are new ways to think about them,” Egger says, particularly with opportunities afforded by technology and improved data systems. The first step involves greater collaboration among the many groups with a stake in mental health care – and Egger is bringing more than 20 partners to the table for this project, ranging from the Durham Board of Education to several state agencies to a half-dozen departments within Duke Medicine.

The complexity of the project is high – the list of collaborators in Egger’s funding proposal alone covers one-and-a-half pages – but so are the stakes. In the end, Egger hopes it results in a sustainable, replicable, affordable model that communities can put to work nationally – and swiftly. “If we don’t invest in this now,” she says, “it costs us greatly as a society.”

Christopher Gergen is founder of Bull City Forward & Queen City Forward, a fellow with Fuqua’s Center for the Advancement of Social Entrepreneurship at Duke University, and the author of “Life Entrepreneurs.” Stephen Martin, a director at the nonprofit Center for Creative Leadership, is author of the forthcoming book “The Messy Quest for Meaning” and blogs at www.messyquest.com. They can be reached at authors@bullcityforward.org and followed on Twitter through @cgergen.

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