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Mental health institute will draw on population health’s community playbook

May 15, 2017

By JUDITH VANDEWATER

Providence St. Joseph Health has set out to ignite transformative change in mental health and wellness in the United States. The system recently funded the Institute for Mental Health and Wellness as an independent foundation dedicated to advancing mental, social and spiritual well-being in the nation.

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The choice of Tyler Norris as the institute's first chief executive is an indication that principles of population health, social justice and community wellness will be integral to Providence St. Joseph Health's and the institute's strategy to improve access to quality mental health services, and to support upstream initiatives that can reduce the incidence of mental illness, homelessness and addiction.

Norris, who holds a master's in divinity, has extensive experience in population health improvement and in structuring programs, building data tools and making investments to support healthy, equitable communities. He's a devotee of ideas espoused by the late James Rouse, a prominent developer who set out to demonstrate that communities can be designed and scaled to allow people to thrive and reach their full potential. Rouse's approach finds a corollary in programs that address social determinants of health — including safe streets, adequate housing, good education, and strong social networks — as a way to promote physical and mental well-being.

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Tyler Norris

Norris will join Dr. Amy Compton-Phillips, executive vice president and chief clinical officer of Providence St. Joseph Health, in leading an Innovation Forum at the Catholic Health Assembly in New Orleans. They'll explore what it will take to build a broad social movement in the United States — one intended to have a large-scale impact on mental health and wellness services and on aspects of communities and culture that best enable individuals to flourish. He spoke to Catholic Health World about the institute and its broad charge.

What can population health programs teach us about how to reduce the incidence of mental illness in a population?
The more we can help build well-being and resilience in children, teens and families to face and withstand life's challenges, the more we can get upstream from some of the drivers of mental illness and addiction. How do you build resilience? To me, you start at conception with approaches that support a healthy mom, a healthy family, and a conducive home and community environment. We would look at conditions that support healthy brain development and seek to create pathways of support from gestation to a young child's entering kindergarten ready to talk, read, play, count and sing.

It is essential that we address personal and community-based trauma, given that so many of the mental health and substance abuse issues we see are driven by trauma early in individuals' lives. There is much good work we can build on, including what communities and funders have learned about addressing toxic stress in communities. One of the things we'll look at is: How do we create healthy communities that give rise to mental, emotional well-being in the first place?

Will the institute make grants to community-level programs, or is its intent to innovate and explore big ideas for reshaping mental health policy and care delivery nationally?
While national in scope, the institute will also support local communities. Our first grants will be to a portfolio of national organizations, and to clinical and community initiatives within Providence St. Joseph Health. Over time we will broaden our funding. Eventually, the institute will invite other health care systems and philanthropies committed to mental health and wellness to join as co-investors and partners. We will have research, policy and communication agendas. However, we are very much in the formative stage right now.

What are the institute's priorities?
The institute has several priorities: Ease access to mental health care services; build resilience in children, teens and families; reduce suffering from depression, anxiety and social isolation; decrease addiction and substance abuse while increasing access to treatment; and create hope for people and families with persistent mental illness. What we see as a sixth priority actually spans across and supports all the other focus areas: to eliminate the stigma of mental illness and addiction. Finally, all our foci center on creating healthy, equitable communities.

How will you accomplish those goals?
We'll use partnerships to do together what we can't do alone. We'll engage leadership across multiple sectors and fields including health care, philanthropy, faith-based initiatives and government to explore how to drive and sustain change. We'll look for opportunities to collaborate across sectors. We'll support discovery, research and innovation. We'll identify metrics that will allow us to be predictive about health and wellness. We'll make grants that support community partnerships and transformation of mental health care delivery at the community level. And we'll develop an advocacy strategy that will have local, state and national reach.

What's the dynamic between the institute and Providence St. Joseph Health?
Providence St. Joseph Health conceived the institute to improve mental health and wellness in the U.S. As part of that commitment, it made an initial seed investment of $100 million to fund the institute. The system will also invest an additional $30 million over three years to strengthen mental health and wellness in California. (As a condition of approving the merger of Providence Health & Services and St. Joseph Health in 2016, the California Attorney General required that the new entity spend $30 million over three years to strengthen mental health services in that state.) In California, our initial focus will be in Los Angeles, Orange County, the High Desert area, and Sonoma, Napa and Humboldt counties.

Providence St. Joseph Health system continues to integrate mental and behavioral health into primary care and along the care continuum, and has been doing that for some years. In the end, integrating mental health care into primary care and across the continuum can improve diagnosis, reduce suffering and get people the care they need. And, it could begin to lower the total cost of that care.

Why is it taking so long nationally to integrate behavioral health care with other aspects of health care delivery?
There are plenty of models around integrating behavioral health into primary care — the challenge is financing them. We are looking at alternative payment models — specifically global payments. We are talking about creating partnerships that can make investments and go at-risk on payment strategies together. In California, that might involve partnerships between payers, providers, counties, social service agencies, Catholic Charities and the like.

Another strategy we are interested in is funding initiatives that integrate behavioral health services and related social needs into low-income housing developments. A housing initiative in Portland, Oregon, comes to mind, where several organizations including Providence Health & Services in Oregon, invested in a partnership to help those affected by homelessness, poverty and addictions. The initiative includes wrap-around services for substance abuse, mental health care and housing. We think there is so much we could do by funding demonstrations and furthering proofs of concept.

We must advocate to save the access and coverage made possible by the Affordable Care Act. While we hope for a different solution, should Congress decide to block grant Medicaid to the states, and states face losing a great deal of money, we may help develop strategies to help them prepare for the change in financial circumstance that provides protections for mental health and other essential health services.

 

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