Translator: Napakcha P. Reviewer: Peter van de Ven
Shortly after my 40th birthday,
I got in the car and merged onto the highway on the way to work.
And suddenly my heart was pounding
and my chest was tight
and I couldn't breathe.
So I pulled off to the side of the road,
I made a quick phone call to my wife Sherrie
and left her a brief message that I loved her,
and then I called 911.
A short time later the paramedics arrived,
and they loaded me onto the ambulance,
and they put nitroglycerin under my tongue.
Nitroglycerin. I thought, “Wow! They must think I'm dying too.”
So they loaded me into the ambulance,
and they took me to the local emergency room.
The emergency room doctor there ran a number of tests,
and she came back and said to me,
“Not really sure what's going on with you,
but you don't seem to be in any immediate danger.”
And so I was discharged from the hospital
with a number of referrals for follow-up.
And so then, over the next several weeks,
I saw a variety of specialists,
received a variety of diagnoses,
was started on a variety of medications
to treat everything from heart disease to acid reflux.
And then, a couple months later, it happened again,
but this time I was able to immediately get in to see my longtime doctor.
So he sat me down, and he said, "Tom, there is nothing wrong with your heart.
What's going on with you?”
And after a conversation about everything that was going on in my life in that time,
he gave me the correct diagnosis of having depression and anxiety,
and it was manifesting itself in these terrible anxiety attacks
that were making me feel like I was dying.
I was really lucky.
I'm a mental health professional.
I went to my medical provider thinking I had a medical condition,
but he saw the larger picture.
He saw me as a whole person,
and he was able to identify [that] what I was facing
were challenges related to my mental and emotional wellbeing.
Unfortunately, this is not the norm in our country.
The medical, mental health and addiction treatment systems
are existing in these separate silos
and they're creating this fragmented, difficult-to-navigate maze,
a game of hide-and-seek
in order to find the care that one really needs.
This leads to overly narrow diagnoses
and at times really bad outcomes for folks,
where they end up in emergency room hospital beds
and other institutional settings at the highest cost
and likely the least effective treatment in the long run.
So, to see how this plays out in real life,
let's follow the story of Emma, who's in fourth grade.
Emma's teacher expresses concerns
that she's often absentminded in the classroom,
at times she's falling asleep,
and she's making frequent visits to the school nurse
with a variety of complaints of aches and pains.
Emma takes her to the doctor.
Her doctor, after a brief visit, gives her a diagnosis and sends her home,
likely without having evaluated or treated all her needs.
So how does that play out for Emma?
Continued difficulty in the classroom,
maybe getting in trouble at school leading to tension at home,
adding to the stress of whatever she's already trying to cope with.
That's an example
of how the fragmented healthcare system is failing us.
But, thankfully, this is changing.
We're changing the way we're caring
for people's mental and emotional wellbeing
as well as our physical health.
We're recognizing that mental health conditions and addictions
are genuine health conditions, just like heart disease or diabetes.
And this shift is laying the platform to move away from this fragmented system
to one that is more integrated and treats the whole person.
It's leading to integrated care experiences.
So how would this change for Emma?
Emma's mom takes her to the doctor,
the doctor now realizes “Wait a second,
there's more going on here than just a physical illness.”
Emma and her mom are able to go down the hallway
and make an appointment with a social worker,
one that specializes in working with kids.
And that social worker is able to take the time
to make a full assessment of all of Emma’s needs.
Now, the social worker, the doctor, Emma and her mom
are able to work together to create a care plan
that addresses all those needs.
This is an example
of how an integrated care approach can be transformational
in the lives of those that we serve.
There's another innovation I want to share with you.
It's the growing recognition in the healthcare system
that unless one's basic needs are met,
good overall health is very difficult to achieve.
We refer to this as the social determinants of health.
You may be familiar with Maslow's Hierarchy of Needs.
Developed by Abraham Maslow,
this well-accepted theory maintains that unless one's basic needs are met,
it's hard to achieve those higher-level goals and aspirations in your life.
The social determinants of health is a similar theory,
that maintains that unless one's basic needs are met,
good overall health, again, is very difficult to achieve.
Simply put,
it means that if people don't have a decent affordable place to live,
access to adequate amounts of nutritional food
and other basic needs met,
all the best care in the world may not make a difference.
What if Emma and her mom are living in a homeless shelter
or in their car?
What are the medical and behavioral health providers supposed to do about that?
I'll tell you what.
Increasingly,
medical providers and behavioral health providers
are partnering together with social service providers
in order to develop comprehensive care plans.
I mean, now we're really getting at somewhere,
not only having Emma's medical and behavioral health needs met,
but also her basic needs,
and everybody working together as a team
on her behalf.
There's a movement going on around the country and here at home
where medical providers are increasing their ability to identify and assess
the behavioral health needs of those that come to them for care.
Also, they're increasing their ability
to provide treatment for those behavioral health needs.
Coinciding with those changes
are changes that are happening in the behavioral health system,
where behavioral health providers
are increasing their ability to recognize the medical conditions
of those that come to them for behavioral healthcare.
And they're increasing their ability to treat those needs,
either within their own practices
or in partnerships with other medical providers.
And so you can begin to see
we're trying to aspire to create this no-wrong-door system
in order to get the care that's required for your whole person.
It's estimated by the American Psychiatric Association
that one-third of all adults that are receiving medical care
also have a behavioral health condition such as depression or anxiety.
If there are 300 of us here today,
that means a hundred of us are facing these challenges;
a third of the neighbors in your neighborhood;
a third of the students in our schools.
Additionally, 70% of people who are receiving behavioral healthcare
also have a coinciding medical condition.
This can range from persistent headaches to insomnia
to more chronic conditions, such as diabetes.
And guess what: an integrated care approach will not cost more money.
In fact, we think it will not only dramatically improve care,
but it will do so at a lower cost.
It's estimated that an integrated care approach
will save commercial insurers Medicaid and Medicare
26 to 48 billion dollars a year, just in our country alone.
How is this possible?
Well, it's possible because when people get all the care they need,
when they need it,
in the communities in which they live,
they're able to avoid those higher cost stays in emergency rooms
and hospital beds and other institutional settings,
again, likely at the least effective care for them in the long run.
We can do so much better
for those of us that have heart disease and also suffer from depression.
And we can do so much better
for those of us that face mental health challenges
and need specialized assistance
in order to care for conditions such as diabetes.
And we sure don't need nitroglycerin to be put under our tongue
to know that now is the time to begin to make these changes.
We can begin to work together as a community,
asking individuals to join in together with us
in order to face these issues,
not just alone but together,
core issues that we face in our communities,
such as chronic homelessness, addiction and mental illness.
For example, in the city of Everett,
the city is partnering with law enforcement,
medical providers, mental health providers,
addiction treatment providers,
low-income housing providers and social service providers
in order to create comprehensive care plans
to help with the chronic homeless in our community,
all of us bringing our expertise to the table
and developing holistic care plans,
one by one,
to help these communities rise up off of the streets,
get a place to live, get a job and rejoin us as community members.
If you know someone that could benefit from an integrated care approach,
would you suggest the resource?
Because they do exist.
The Everett clinic, for example, provides behavioral health treatment
to those to whom they also provide medical care.
And at Compass Health,
we are beginning to more and more provide medical care
to those that come to us for behavioral healthcare.
We don't have to stay stuck in a system
that isolates us from the care that we need.
And we can imagine and we can envision
what it would begin to look like if integrated whole person care
were widely practiced in our communities.
People who are frozen in their situation
having their suffering eased
and regaining their lives of emotional richness.
Again, the homeless having all the systems come together
and approaching them with a whole person care approach
that really allows them the best opportunity possible
to get off the streets,
get into treatment,
get a place to live
and begin that road of recovery to a life that's full of purpose.
Parents who are ill and addicted getting there suffering eased
so that they can be the parents that their children need them to be,
to move beyond the hopelessness, despair and anger
and regain the confidence and enthusiasm to raise their kids.
I think this is our best shot
at attacking the opioid crisis both across the country and here at home.
So many people with opioid addictions have everything going on.
They have medical challenges, addiction challenges,
mental health challenges, basic need challenges.
And unless we come together
and bring forward an approach that addresses all those needs,
I don't think we're going to make any progress
in terms of helping them as individual
or in attacking the problem as a whole.
A friend of mine told me about an experience that some have
when they're receiving treatment for AIDS.
It's called the Lazarus Effect.
And in the treatment process,
they move from being frail skeletons,
and then they rise up out of that process, the perfect pictures of health.
I've seen this happen at Compass Health.
People come to us and they're at the end of their rope.
They don't have a home,
they're ill,
they have mental health challenges,
they have addictions, and they don't have any hope.
But when we're able to embrace them as a whole person,
we give them that best opportunity
to raise them up and have that experience
to regain lives that are full of recovery and purpose.
And so, I ask that you’d join me
in shaping and sharing a new future
of health that treats the whole person
and gives all of us the best opportunity
to live lives that are full of good health and happiness.
Thank you.
(Applause)