What is the difference between mental health and mental illness? The former refers to our emotional and psychological state, our social well–being and how we feel about ourselves and interact with others. Mental health is not the same as mental illness, although poor mental health can lead to mental and physical illnesses.

When we have good mental health, we are resilient, can handle life’s challenges and stresses, have meaningful relationships and make sound decisions. Being mentally healthy, like being physically healthy, is important at every stage of life, from childhood and adolescence through adulthood and old age.

Being mentally healthy is influenced by life experiences, relationships with others, physical health and one’s environment. Just as people may experience physical problems over the course of their lives, they may also experience emotional or mental health problems that affect their thinking, mood and behaviors. This does not necessarily mean that a person who is going through a difficult time and is experiencing poor mental health has a mental illness. Feeling miserable and socially isolated are red flags that one’s mental health needs attention.

The benefits of improving one’s mental health are well worth the effort. Being mentally healthy helps you feel confident in your worth and abilities, accept your strengths and weaknesses, set realistic goals and create a sense of meaning and purpose in your life. Emotional health and mental health are closely intertwined, and both can positively or negatively impact physical health as well.

What is Mental Illness?
Mental illness refers to a wide range of disorders that affect mood, thinking and behavior. Mental illness can affect anyone regardless of age, gender, social standing, religion or race/ethnicity. People with mental illness often experience distress and problems functioning at work, home and in social situations. Mental illness is not something the person can “overcome with willpower,” and can be caused by biological factors such as genes or brain chemistry, trauma and abuse, and family history of mental illness.

The major types of mental illness include:
• Depression
• Anxiety
• Mood disorders, including bipolar
• Personality disorders
• Schizophrenia
• Trauma disorders
• Eating disorders
• Addictive behaviors

Mental illnesses are common in America, and approximately one in five adults lives with a mental illness (43.8 million in 2015.)1 While depression and anxiety are two of the most common disorders, mental illness includes many different conditions that range from mild to moderate to severe. People who don’t have a mental illness might still be impacted by the mental illness of a friend or family member.

Signs and symptoms of mental illness vary, but may include changes in sleep, appetite, and energy level, severe mood swings, persistent thoughts or compulsions, hearing voices, social withdrawal, feeling sad, hopeless, or agitated, having trouble performing everyday tasks, or wanting to hurt oneself or others.

With the right treatment, people can and do recover from mental illness. Friends and family members can be important influences to help someone get the treatment and services they need. Primary care physicians can refer individuals to psychiatrists and other professionals who specialize in mental health treatment. Treating a physical illness might require medications and physical therapy, and treating a mental illness might also require medications and different therapies. For many people, the first step is to recognize there is a problem and be willing to accept help.

For more information on treatment resources, contact:
National Institute of Mental Health
https://www.nimh.nih.gov/health/find-help/index.shtml

NAMI (National Alliance on Mental Illness)
http://www.nami.org/

Substance Abuse and Mental Health Services Administration (SAMHSA) https://findtreatment.samhsa.gov/https://www.mentalhealth.gov/

Mental Health.gov
https://www.mentalhealth.gov/
Help is available. For additional information, visit MagellanHealth.com/MYMH

1. https://www.nami.org/learn-more/mental-health-by-the-numbersd to replace a visit with a provider. Magellan Health does not endorse other resources that may be mentioned

Read more more about this topic from Magellan Health Insights

 National Eating Disorder Awareness Week is observed annually on the last week of February , to mark the occasion, we are sharing some important Dos and Don’ts for families and friends of people suffering from an eating disorder.

Eating disorders can be among the most difficult afflictions for family members and friends to understand. Feelings of frustration and helplessness are common. Early diagnosis and treatment can save the life of a person with an eating disorder, but it is important to remember that only an experienced doctor or therapist can treat them effectively.

If the person has lost a significant amount of his or her normal body weight, or you feel that his or her life is in danger, seek immediate medical attention. The following are some additional tips if someone you know is suffering from an eating disorder.

Eating Disorder Dos . . .

• Educate yourself. Read as much as possible about eating disorders. This will help you understand the problem and put you in a better position to help those around you.
• Listen. People with eating disorders often feel ashamed and alone. Your support may provide the strength the person needs to seek professional help.
• Encourage the person to get help. Try to get the person to seek professional help, but don’t be too forceful. This will make the person more anxious, and could discourage the person from seeking help. Unless in immediate danger, avoid forcing the person to get help.

Eating Disorder Don’ts . . .

• Nag about eating or not eating. People with eating disorders are extremely self-conscious about their eating habits. By nagging, you will just make them more uncomfortable and reinforce the behavior.
• Hide food to keep the person from binge eating. Although people with bulimia or binge eating disorder may ask for your help, hiding food from them will only create resentment.
• Force the person to eat. Forcing the person to eat will make him or her feel childish, out-of-control, disapproved of, and scolded. Once again, this just reinforces the behavior.

Help is available

An eating disorder is an illness that is difficult to understand. Identifying and treating these disorders can also be hard. But the sooner a person is diagnosed, the better the chances are for recovery. While you can’t force someone to seek help, you can educate yourself and develop a support system for those around you who may be at risk. The good news is that most people do well in treatment and can recover from eating disorders.

Magellan’s own Chairman and CEO, Barry M. Smith, was recently featured in Behavioral Healthcare Executive, talking about the importance of prioritizing behavioral health as a part of disaster recovery.

In the article, Barry discusses how delivering innovative access to behavioral health services is critical to enabling not only physical, but emotional renewal.

Read Barry’s complete article here.

Download a copy of this infographic here.

Source: https://www.womenshealth.gov/nwhw/tools/infographics/mental-health/

Being a parent is one of the most challenging and rewarding jobs an individual can hold. When behavioral health challenges are added, it becomes even more difficult. Try, for a moment, to imagine being a foster parent to a child with behavioral health challenges. Where does one even begin to find the help and services they need to best care for their child?

Through our collaboration with the Wyoming Department of Health, Division of Healthcare Financing (Medicaid), Magellan in Wyoming coordinates care, including behavioral health interventions with other youth serving agencies in our system, using the High Fidelity Wraparound (HFWA) model to build a team of support for the successful management of complex conditions and behaviors in home- and community- based settings. The team creates steps to help youth stay in their homes, schools and communities. Through the 10 guiding principles of the program, families and youth have a voice in their care and choice in the kind of care they receive. We help to strengthen community support, understanding, and education of at risk youth ages 4-20 with complex behavioral health needs.

Magellan in Wyoming recently had the opportunity to hear from a former foster parent and HFWA graduate to discuss how the program benefited them through their challenges and supported their growth. “Opening my heart up to love and attachment with these children, parenting them with unconditional love, all the while knowing, they might not stay was difficult,” said the foster parent.

The siblings involved and their foster family cycled through numerous foster care workers in three years, creating more trauma for everyone. There was no stability and no consistency. Dealing with several different mental health diagnoses and many weekly appointments, in addition to the strain of everyday life, took a toll.

When this family discovered HFWA, they were naturally a little skeptical. They had experienced enough “new” things; however, this was the beginning of a completely new outlook on life. From the very start, HFWA taught the foster parent that it was okay to take a breath, to sleep and to ask for support. More importantly, it became evident that people wanted to help and be on the family’s team to help support them.

The family had spent so much time triaging the risk aspects of their children’s lives, that it had drained them of most of their hope. Through the strengths-based principles of the HFWA program, the family was able to gain new insight into ways they could focus on the local supports available to help them.

The program taught them to see the progress. By forming a HFWA team around the foster children and the whole family, they were able to gain some positive, strengths-based perspective along with stability and consistency.

HFWA empowered the family to have a voice and to use it effectively. “I knew all the people on my team before HFWA, but the program taught me how to use my voice. It taught me how to say what was going on and who to say it to,” said the foster parent. It was because of the family’s team, as well as community investment in the program, that today, the family is enjoying a life full of hope and possibility.

It’s 11:30 on a Tuesday night in the emergency department of a local county hospital. The doctor pulls back the curtain on his next patient and frowns. He has seen this man before. He looks down at the chart and recognizes the name. He’d been in about eight weeks before with trouble breathing and chest pains. Gears click in doctor’s memory, as he recalls this patient. His medical work-up had shown nothing acutely wrong. He’d been encouraged to take his usual medications, and sent home with instructions to see his regular doctor as soon as possible to make sure his chronic diabetes and congestive heart failure were under good control.

The doctor pulls a stool across the floor and sits down bedside.

“Hi Brian, what seems to be the trouble?”

“My chest. I couldn’t breathe. And I can’t seem to concentrate. I just don’t want to do anything.” Brian’s voice is listless and low, and he looks fatigued.

“I see you were in a couple of months ago. Did you go and see your regular physician?”

Brian shrugs but doesn’t say anything. His eyes are fixed firmly on the floor.

The doctor pauses. He looks at Brian for a while. The man looks like he hasn’t taken care of himself. His clothes are wrinkled, and he’s lost some weight since his last visit to the emergency department. The doctor looks over Brian’s vitals and labs. He finds nothing concerning on physical exam. He asks, “Brian, has anyone ever talked to you about depression?”

In the case above, Brian is a fictional character, but the situation is not. The co-occurrence of mental health disorders with physical ailments is common. A Substance Abuse and Mental Health Services Administration (SAMHSA) report found that 68 percent of adults with mental disorders have medical conditions, and 29 percent of adults with medical conditions have mental disorders. The most common of these is depression. Many research studies have found high rates of comorbid depression with chronic and terminal medical conditions. In many cases, the medical conditions or treatments for the conditions can cause depression. In others, the depression itself can lead to health behaviors that cause or worsen medical illness, and even higher risk of death. For instance, persons with depression have higher rates of smoking cigarettes than the general public. This can lead to heart disease. But, depression itself can also cause changes in brain chemistry and platelets, which can worsen existing heart disease.

Common Conditions with Comorbid Depression

Comorbid depression in some medical conditions is common. According to the National Institute of Health, there is a close relationship between depression and other physical ailments:

• Alzheimer’s disease and other dementias
• Cancer
• Coronary artery disease
• Congestive heart failure
• Diabetes
• Epilepsy
• HIV/AIDS
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Stroke
• Systemic lupus erythematosus

Depression also has a negative effect on treatment and outcomes for these diseases. A 2015 published research study showed those with comorbid depression had more negative outcomes for their primary ailment than those who only had the primary ailment. Research also shows a lower quality of life, lower compliance with medical treatments, and lower rates of exercise and healthy eating habits for patients with comorbid depression compared to those with the same physical ailment(s) who did not suffer from depression.

This comorbidity has consequences beyond the health of the patient. People with multiple medical conditions are a rapidly growing and extremely costly segment of the US population. Patients with behavioral health disorders spend more on treatment for general medical conditions. When compared to those without depression, overall health care spending for medical conditions is higher than those without, in addition to treatment for the depression itself.

Improving Care for Comorbid Behavioral Health Conditions

The first step is identifying patients with comorbid behavioral health conditions before they reach the dangerous and costly levels discussed above. The primary care setting may be the best place to first find depression. But how?

Magellan’s Screen and Engage program is an innovative, user-friendly application that primary care physicians (PCPs) can use to identify patients at risk for a mental illness. Using a Magellan-provided iPad, the patient answers questions about his or her health and well-being while waiting for an appointment. The screening tools are also available in Magellan’s Virtual Care Solutions. Magellan’s proprietary algorithms assess the results, identify potential behavioral health issues and suggest recommendations for treatment, and flag clinicians to engage the patients.

The benefits of the tool are clear. Given the limited amount of time that a PCP has for each appointment, he or she must focus the conversation on the primary reason for the visit. As such, there is little opportunity to probe for behavioral health concerns. By conducting the screening before the short appointment, the PCP has a chance to be notified of the screening results, and discuss them during the visit.

Screening for behavioral health conditions is just the first step. Step two is treating them. In general, depression is treated with either medications and/or cognitive behavioral (CBT) psychotherapy. CBT is a specific type of therapy that relies on identifying and changing ones thoughts that can lead to depression. Research shows that the combination of the two is better than either done separately. While it may be easy to receive anti-depressants from medical doctors, it is often difficult to find CBT.

Cobalt, Magellan’s computerized Cognitive Behavioral Therapy (CCBT) program, is a cost-effective solution to address common behavioral health conditions. Cobalt provides CCBT online or through a smartphone/tablet app. This makes face-to-face CBT—proven to work but often difficult to find providers, especially in rural areas and for working people—available anywhere, any time. It is also a more private approach to CBT. Patients can access treatment from their homes versus an office.

Computerized CBT has proven to be just as effective as in-person CBT. Magellan offers Cobalt modules for insomnia, depression, anxiety, substance use disorder and obsessive-compulsive disorder, treating more than 90 percent of behavioral health conditions seen in primary care and behavioral settings.

Tackling Comorbid Conditions for a Healthy Future

At Magellan, we have made it our mission to help individuals like Brian, whose case is all too common. Tackling comorbid behavioral health issues alongside common medical conditions is one way we do it. Investing in and using new technology, we can identify more people who need help and expand their access to effective, proven treatments.

Magellan’s collection of HEDIS (Healthcare Effectiveness Data and Information Set) quality measures for 2017 has entered the final phase of data collection. You’ve probably heard of the acronym HEDIS – but what does it stand for and what does it mean to you? The Healthcare Effectiveness Data and Information Set – HEDIS — was created by the National Committee for Quality Assurance (NCQA) to measure the clinical quality performance of health plans.  This is accomplished through the collection and analysis of data documenting the clinical care received by individual plan members from providers, influenced through activities and programs delivered by the health plans.  The data is aggregated and reported collectively to reflect the ‘collective’ or population-based care received by the plan’s membership.  These reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by Centers for Medicare & Medicaid Services, states offering Medicaid and other entities. Right now, Magellan has entered the final phase of data collection for HEDIS quality measures for 2017.

There are 91 HEDIS 2017 measures, but it’s important to note that the number may vary from year to year as new measures are added to the set and some are retired. The measures cover many aspects of healthcare including preventive care such as screening tests (e.g., mammograms) and immunizations, management of physical and mental health conditions, access and availability of care, patient experience, utilization and relative resource use.  Data is reported individually for each product and line of business

Measure data is collected is a variety of ways.  Claims are the major source of data, but specific measures may also allow plans to survey members or to access member medical records for additional data not captured in claims.  This type of data collection (combined claims and chart data) is called hybrid.  The final phase of data collection for health plans choosing to do hybrid runs from January through May and is often called MRR for medical record retrieval, or simply ‘chart chase.’  Final HEDIS data covering services rendered in 2016 and prior will be submitted to NCQA by June 15, 2017.  Final health plan ratings for all lines of business are published on the NCQA website by October 2017.

For health plans, HEDIS ratings can be very important. The scores on measures can help them understand quality of care being delivered to their members in some of the most common chronic and acute illnesses.  Higher scores can help compete more effectively in various markets. HEDIS score reporting are often required in public markets as well, where the results are often reported to the states, or occasionally counties, in which the plans reside.

Behavioral health and pharmacy are well represented in the HEDIS measure set. Behavioral health has multiple measures that include ensuring continuity of care, appropriate psychotropic medication management/adherence, and initiation and engagement of drug and alcohol abuse treatment.  Pharmacy measures focus on medication management of acute and chronic physical and mental illness, appropriate medications in the elderly, and management of polypharmacy.  Specialty measures are directed toward inappropriate imaging.

So, what is the value of HEDIS to Magellan?  Aside from being a collection and reporting contract requirement for many of our customers and our own health plan, HEDIS gives Magellan valuable information about the populations we serve.

By following the behavioral health data, we collect, for example, we can identify gaps in network performance in patient follow-up patterns, management of drug and alcohol abuse, and prescribing and adherence to medications.  This allows us to design and implement interventions that can improve outcomes and reduce cost of care.

The same type of analysis/intervention applies to physical health conditions.  Analysis of HEDIS data helps identify gaps in care, particularly preventive care, in such important and chronic populations as patients with diabetes mellitus, patients with cardiovascular disease, and patients with lung disease.  We can also identify and address at-risk pediatric populations who fail to complete preventive care such as immunizations, dental and well-child care.

As the healthcare industry moves more and more toward value-based purchasing, all providers, insurers and their vendors are necessarily increasingly focused on the quality of care that is delivered.  The impact of this should be better outcomes for our members.

Find more articles about NCQA here