Spring 2016 Issue
By Varun Choudhary, MD, MA, DFAPA
Varun Choudhary, MD, MA, DFAPA
“Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” ― Margaret Mead
We all have our callings. What is it that motivates people to take leadership positions? For some, such as our current national presidential contenders, it seems to be for ego or ideology. A number of people enjoy the spotlight and attention. Others look to fulfill an unresolved ego conflict. For a select few, such as Margaret Mead, it is to give voice and power to those who do not have them. Leadership can be a noble cause, especially when we, as professionals, represent our patients. There is underlying nobility in our profession that instills in us the desire to advocate for those to whom we provide care. This can range from interpersonal interactions to lobbying for changes on national level. This is most important during times of flux and change. It is at these moments when our patients, and our profession itself, can be most vulnerable. These are the times when proper guidance is the most valued commodity.
We are at such a crossroad in this point of time. Mental health reform has never seen such impetus and energy since the time of Margaret Mead. We, as a society, are at a new precipice of awareness that mental wellness is just as important, if not more so, than our physical health. The stigma that people with mental illnesses faced is beginning to fade, giving way to great awareness of the need to adopt a recovery perspective. The is reflected not only in potential changes in national policy, such as Representative Tim Murphy’s Helping Families in Mental Health Crisis Act, but also in a number of proposals moving Virginia forward. There has been a push to improve community- based mental healthcare for years, but recently a number of pilot projects have been funded to explore new directions in this arena.
There are three such initiatives occurring at this moment in the Commonwealth: DBHDS led Certified Community Behavioral Health Clinics funded by a SAMSHA grant, DMAS led Substance Use Disorder treatment delivery system overhaul via a CMS waiver, and the Virginia Center for Health Innovations Regional Accountable Care Communities project through a Virginia State Innovation Model SIM Grant.
DBHDS has picked eight CSBs to become CCHBCs. These new entities are “designed to serve individuals with SMI & SUD and provide intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment, prevention and wellness services; This includes 24/7 crisis response and peer support services.” These community service boards are: Harrisonburg Rockingham CSB, Rappahannock Area CSB, Cumberland Mountain CSB, Mount Rogers CSB, New River Valley CSB, RBHA, Chesapeake Integrated Behavioral Health, and Colonial Behavioral Health. There will be an emphasis on greater care coordination and collaboration in serving the clientele to increase the quality and satisfaction of care at a lower overall cost to the system.
DMAS recently got approval from CMS to provide a number of new services for individuals suffering from substance use disorder and to overhaul the current system and reimbursement structure to incentivize more providers to join. There will be more medication assisted treatment options, new intensive outpatient services, and increased residential and inpatient treatment. For Virginians on Medicaid, this has been a missing part of the system of care for years. This initiative will go live across the Commonwealth on April 1, 2017.
The Virginia Center for Health Innovation (VCHI) was created in 2012 and to date has partnered in raising more than $21 million to advance health reform initiatives. It is a non-profit, non-state agency. VCHI was awarded a State Innovation Models design grant from Health & Human Services/CMS in 2015. The creation of Accountable Care Communities (ACCs) in Virginia is the core strategy of the SIM award. The creation of five regional ACCs is proposed to begin the process. The purpose of these organizations are to identify regional population health priorities and the care models needed to address them with the goal of creating an all encompassing integrated care approach.
It is an exciting time to be a psychiatrist in the Commonwealth of Virginia at this time. The demand for psychiatric services is at an all time high across the nation. There is a significant national shortage of psychiatrists to the point that the latest statistics show the ratio of psychiatrists to the population is 1:30,000. Salaries and reimbursement should soon be commensurate to reflect this discrepancy. But more important is the recognition of our field and profession as delivering a vital service to those in need. I commend and salute you, the psychiatrists of Virginia and our nation!