All Catawba County community members have access to equitable and affordable primary care that incorporates behavioral health.

Behavioral health is an important part of overall health and includes emotional, psychological, and social well-being (CDC, 2020). An individual’s behavioral health can affect many aspects of their life including their ability to cope with stress, resiliency levels, build sustaining relationships, and make healthy choices. Integrated behavioral health care incorporates primary medical care with behavioral healthcare. Integrated behavioral health care includes whole person wellness with the individual as part of the team and care includes both the individual and their support system. The movement towards integrated behavioral health emphasizes the importance of whole person health.

During the community listening sessions for health priority selection in 2019, 34.2% of participating community members identified a need for increased access to behavioral health services, resources, social supports, and behavioral health professionals (Catawba County Public Health, 2020). From 2016 to 2019, 13.2% of all emergency department visits by Catawba County residents were for anxiety, mood, and psychotic disorders (The University of North Carolina at Chapel Hill, 2020). Access to equitable and affordable primary care that incorporates behavioral is both an applicable and realistic need as Catawba County continues to move forward and cope with the unintended consequences of COVID-19.

References:

Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment. Retrieved on November 30, 2020 from https://catawbacountync.gov/site/assets/files/2488/2019_catawba_county_cha.pdf.

Centers for Disease Control and Prevention. (2020). Learn about Mental Health. Retrieved on November 30, 2020 from https://www.cdc.gov/mentalhealth/learn/index.htm.

The University of North Carolina at Chapel Hill. (2020). NCDETECT- Emergency Department Data for Catawba County for Anxiety, Mood, and Psychotic Disorders from 1/1/2019 to 11/30/2020. Retrieved on December 1, 2020 from https://ncdetect.org/.

As Catawba County continues to move forward and cope with the unintended consequences of COVID-19, access to equitable and affordable primary care that incorporates behavioral is both an applicable and realistic need. In 2019, 15.5% of all emergency department visits were for anxiety, mood, and psychotic disorders. From January 1 to November 30, 2020, 15.8% of all emergency department visits have been for anxiety, mood, and psychotic disorders (The University of North Carolina at Chapel Hill, 2020).

Behavioral health conditions, such as anxiety, mood, and psychotic disorders, affect a person’s thinking, feeling, mood, or behavior in a way that influences their ability to relate to others and function each day. These conditions may be situational, short-term, or long-lasting, chronic (Centers for Disease Control and Prevention, 2020). Emergency department visits are categorized by ICD-10-CM codes and anxiety, mood, and psychotic disorders are defined as follows:

• Anxiety disorders are a category of behavioral health disorders characterized by feelings of anxiety and fear, where anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a racing heart and shakiness. There are a number of anxiety disorders including generalized anxiety disorder, a specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, and panic disorder among others. While each has its own characteristics and symptoms, they all include symptoms of anxiety (UNC, 2020).
• Mood Disorders include bipolar disorder, also known as bipolar affective disorder or manic depression, and major depressive disorder. Bipolar disorder is a mental disorder characterized by periods of elevated mood and periods of depression. The elevated mood is significant and is known as mania or hypomania depending on the severity or whether there is psychosis. During mania an individual feels or acts abnormally happy, energetic, or irritable. They often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced. Major depressive disorder, also known as clinical depression, major depression, unipolar depression, or unipolar disorder; or as recurrent depression in the case of repeated episodes, is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The term "depression" is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood (UNC, 2020).
• For psychotic disorders, psychosis refers to an abnormal condition of the mind described as involving a "loss of contact with reality". People with psychosis are described as psychotic. People experiencing psychosis may exhibit some personality changes and thought disorder. Depending on its severity, this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out daily life activities (UNC, 2020).

The Behavioral Health Work Group continues to consider if they have a full understanding of root causes and continue to discuss equity, stigma, non-medical drivers/ social determinants of health, case management and lack of wrap around services. 

References:

Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019: Coping with Stress. Retrieved on December 3, 2020 from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. 

The University of North Carolina at Chapel Hill. (2020). NCDETECT- Emergency Department Data for Catawba County for Anxiety, Mood, and Psychotic Disorders from 1/1/2019 to 11/30/2020. Retrieved on December 1, 2020 from https://ncdetect.org/. 

In June 2020, Catawba County Public Health and LiveWell Catawba convened work groups for each of the 2020 to 2023 health priorities: chronic disease, behavioral health, and healthy foods & healthy weight. The Behavioral Health Work Group narrowed their focus from behavioral health prevention to the prevention of anxiety, mood, and psychotic disorder relapses. As the work group moved through the results-based accountability process to develop the community health improvement plan (CHIP), they discussed on an ongoing basis who are partners and community members that are not involved that should be involved.

The Behavioral Health Work Group is continuously expanding to include a diverse group of community members, subject matter experts, agencies, and sectors. A current list of Behavioral Health Work Group members is available here.

The Behavioral Health Work Group through the strategy selection process discussed best practices that work to support access to equitable and affordable primary care that incorporates behavioral health, potential low cost and no cost ideas, and data needed to better inform the work.  

Strategy Selection Process

In 2020, the Behavioral Health Work Group Group selected the overarching strategies of whole person care, technology supported care, and community education to support access to equitable and affordable primary care that incorporates behavioral health. The strategy selection process included the work group members rating each strategy idea as high, medium, or low on the criteria of leverage (short-term: 3 years, intermediate: 3 to 5 years, and long-term: 10 years), feasibility, values, and specificity. The work group then reviewed the rating survey results, discussed each strategy, identified the overarching strategies based on related themes of the strategies selected, and determined, based on the criteria and rankings, which strategies should not be included in the community health improvement plan. The work group continued to update their strategies and action steps throughout 2021 and 2022. In 2021, the Whole Person Care Subgroup and Technology Supported Care Subgroup merged into one subgroup for Whole Person Care & Telehealth. 

What are the programs and/or interventions recognized as best practices? 

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.] 
• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model) 
• Reducing behavioral health stigma
  • Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
  • Mental health first aid training
  • Working with the businesses/ worksites/ workforce development

What are potential low cost and/or no cost ideas for immediate improvements? 

• Building collaboration with agencies and partners already doing the work
• Educating the community on behavioral health
• Facilitating open community discussions about behavioral health
• Finding out about what is currently working well
• Learning about available resources
• Offering community mental health first aid trainings
• Partnering with municipalities to promote behavioral health resources
• Partnering with the Society for Human Resource Management to promote employee assistance programs (EAPs)
• Sharing available educational tools and resources

What data is needed to better inform the work? 

The Behavioral Health Work Group has discussed the following data needs and/or additional data to consider if available.

• Number of emergency department visits for anxiety, mood, and psychotic disorders by census tract
• Number of emergency department visits for psychotic disorder relapses 
• Number of integrated primary and behavioral health care providers 
• Number of integrated primary and behavioral health care providers and/or behavioral health care providers offering technology supported care

At the Behavioral Health Work Group meeting on January 19, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings. 

Strategies: Whole Person Care & Technology Supported Care

• Behavioral health primary care integration, including bringing mental health screenings into primary care settings and Integrative care team approach (holistic)
• Telehealth and virtual health expansion and outreach, including education on community benefits of using these options. [Technology supported care includes telehealth (phone conversations) and virtual health (provider can see the client) for behavioral health care.]

Strategies: Community Engagement 

• Resources on techniques to deal with anxiety and depressive disorders
  • An example: CRM (Community Resiliency Model)
• Reducing behavioral health stigma
• Education for the community on anxiety, mood, and psychotic disorders and resources available for behavioral health care
• Mental health first aid training
• Working with the businesses/ worksites/ workforce development