Meeting Minutes - Executive overview
Minutes of December 22, 2015 were accepted.
The work group discussed the document “Prevention Agenda Recommendations” which was created to inform the group of population level interventions proposed by the NYS Prevention Agenda and the Prevention Agenda Refresh. One particular intervention, Mental Health First Aid, was discussed.
Work group members expressed a few concerns about Mental Health First Aid and the proposed NY State legislation that would require teachers to become certified. Of note was how the program would be paid for in the school districts and the exact roles and responsibilities of Mental Health First Aid responders. Also noted was the lack of mental health providers in the region and across the state.
Another topic discussed was the role stigma plays in prevention. The group discussed collaborating on an anti-stigma campaign with consistent messages across the Mohawk Valley region.
The group was also made aware of a system of care funding opportunity with a deadline that was looming large. The particulars of the grant were discussed, and there were concerns about the time frame and the number of agencies involved in order to qualify. The group was advised that the grant is something that is anticipated to be offered again next year, so while this opportunity may pass, it will come up again.
The group tasked the MV PHIP staff to:
1. Get a copy of the proposed legislation to get the exact wording and which legislators support the bill
2. Get more information about Mental Health First Aid, preferably a copy of the training manual
3. Find existing awareness and anti-stigma campaigns for the group
4. Disseminate the SAMHSA’s System of Care Grant
5. Review the State Mental Health Association
6. Utilize a listserv and/or Facebook
The next meeting will be held on April 14th from 1-3pm in Herkimer County.
Mohawk Valley PHIP
February 25, 2016
Access to Mental Health Work Group
Work Group Members: Lori Kinch-Ashley (Catskill Area Hospice,) Debi Crisalli (Montgomery Public Health,) John Nasso (Catholic Charities,) Barbara Finkelstein (Family Resource Network,) Christina Cain (Herkimer Public Health,) Darlene Haman (Herkimer Integrative Planning,) Sara Boerenko (Mental Hygiene Services of Montgomery County,) Michael McMahon (DSS of Montgomery County,) Denis Wilson (Fulmont Community Action Agency,) Ann Black (Fulmont Community Action Agency,) Heidi Bond (Otsego County Public Health,) David Jordan (Montgomery County Office for the Aging,) Julie Dostal (LEAF, Inc,) Scott Friedlander (St. Mary’s Healthcare,) Melissa Carmel (St. Mary’s Healthcare,) Lisa Kinowski (Liberty ARC,) Danica Sessions (Opportunities for Otsego,) Nancy Dingee (Schoharie County OFA,) Linda Hill (Schoharie County Dept. of Health,) Amy Gildemeister (Schoharie County Dept. of Health,) Janine Dykeman (Mental Health Association of Fulton & Montgomery Counties,) Zvia McCormick (RCIL,) Doris Hill (RHENSOM,) Lynae Wyckoff (RHENSOM,) Joseph Yelich (Oneonta City School District,) Breelynd Eggleston (Herkimer ARC,) and Betsy Jay (Bassett Healthcare).
Staff: John May, Aletha Sprague, Melissa Scribani, Anna Gleboff, Bonita Gibb, and Felicia Johnson
Welcome & Approval Minutes:
Dr. Dostal calls the meeting to order and seeks approval of the minutes.
Prevention Agenda Recommendations:
Dr. Dostal turns the meeting over to Ms. Sprague to review the document, “Prevention Agenda Recommendations.” Ms. Sprague describes the document as a tool to frame the level of intervention based using the CDC’s Health Impact Pyramid. Ms. Sprague reviews the CDC’S Health Impact Pyramid and describes the lower you go on the pyramid the larger the population level impact.
Dr. Dostal asks whether this work group is tasked with addressing specific goals, or is the work group’s goal of accessing mental health care an overarching goal. Ms. Sprague responds that the topic of access was selected by the stakeholders and board, but the work group can make its own goals as it sees fit. She states at the last meeting the group discussed whether or not access to mental health care was even population-based and if they want to be more expansive than simply access. Dr. Dostal questions whether the several different goals in the document “Prevention Agenda Recommendations” are all tasked to the work group, or if they are all just recommendations by the NYS Prevention Agenda. Ms. Sprague responds that the document reflects the different recommendations by the work group and the NYS Prevention Agenda and the group should focus on two or three. She also notes that some interventions fall on multiple parts of the pyramid. Ms. Sprague mentions that the minutes, specifically the executive overview, list interventions proposed by the work group. She also refers to an article on Mental Health First Aid which is one of the proposed interventions by both the NYS Prevention Agenda and some work group members. The article describes a bill to make Mental Health First Aid a requirement for teachers as part of their mandatory education. Ms. Sprague asks Supt. Yelich about his opinion on the bill. He responds that he is in favor of the idea of first aid for people with mental health crises. He states that he came from a county where mental health care was accessible. However, he states that there is still a lack of places for the people identified by the Mental Health First Aid to go for treatment.
Ms. Boerenko states that she is a Mental Health First Aid trainer and she has attempted to provide free training to the school districts in her county. She has met with some resistance from the teachers because of the length of the training and it is not in their union contract. Ms. Boerenko states that some teachers have volunteered to take the course on their own time, but overall they have not had much success. She wonders if the superintendents could discuss this with the unions and make it part of continuing education. Supt. Yelich responds that this is possible to an extent, but cost is a concern. Dr. Dostal states that this bill is a population level intervention by changing the mandatory education requirements of teachers. She goes on to say that the group trying to get into every school individually is not population-level prevention. She states that one way the group can make a population-based change is to support the policy makers who are proposing the bill.
Comm. McMahon asks about the support the policy makers have for this bill. Ms. Sprague responds that the MV PHIP research staff can find this information out. Dr. Dostal reminds the group that many are prohibited from lobbying. She states that we can show our support without crossing the threshold of lobbying. The work group can advocate and educate, but not lobby. Supt. Yelich replies that anecdotal evidence from “the field” is a great way to educate policy makers by showing them need and what the crises look like from your perspective. It demonstrates the need for bills such as the one proposed. Dr. May interjects that some of the other 10 PHIPs have identified mental health as a need in their regions as well. He states that the group can instruct the MV PHIP staff to find educational materials for the work group regarding this matter as well as to contact the other PHIPs and see if they would be interested in also advocating for Mental Health First Aid at the policy level. Dr. Dostal said that all the PHIPs working together would be a force to be reckoned with. Ms. Boerenko asks if the work group could draft a template letter to send to the policy makers. She states that her office has good relationships with Assemblyman Santabarbara and Senator Amedore. She offers to collect the letters and deliver them to the legislators’ offices. Dr. Dostal states that it would be worthwhile to find out who has a good working relationship with which policymakers. Mr. Friedlander agrees and comments it would be good to get a list together.
Mr. Wilson asks why the teacher’s union is opposed to Mental Health First Aid. Supt. Yelich responds that the answer depends on the district and their relationship with the unions but the teachers have been asked to take on too many additional responsibilities without always funds to pay for the additional activities which leads to difficult budget choices. The purpose of the unions is to make sure things don’t get cut, whereas the responsibility of the superintendent is to manage the budget. This creates some tensions. Dr. Dostal states that there are similar problems with primary care providers. It’s not that the providers don’t or won’t do more, but that there is such limited time and too many demands on them that they simply cannot do more. Mr. Nasso would like to know how this legislation would impact school taxes. Mr. Wilson also would like to see a copy of the legislation before supporting it. Comm. McMahon mentions that some of the costs may not have been factored into the bill such as; 8 hours of paid work time to attend the training for each staff member. Dr. Dostal tasks the MV PHIP staff with getting a copy of the bill for the work group to review.
Ms. McCormick asks for more information about Mental Health First Aid. Ms. Boerenko replies the course is designed to teach laypeople how to deal with an immediate crisis and to stabilize them for treatment. It is similar to traditional First Aid which teaches non-medical professionals and laypeople how to treat someone who has a broken leg so that no further harm comes to them between the moment of discovery and the medical professional who will actually fix their broken leg. She states there is a 5-step process including a follow-up. She uses an anxiety attack as an example. The layperson would be able to assist the person in crisis in getting to the treatment they need, and to help them remain in control of their actions until help can be obtained. It also teaches the helper how to talk to a family member to help the person in crisis get treatment. It also includes how to follow up to make sure the person got the help they needed. The course teaches about signs and symptoms of anxiety, depression, schizophrenia, eating disorders, and so forth. Ms. McCormick asks if data exists which supports that the follow-up interventions are helpful. Ms. Boerenko replies yes. When you take the course you are give a 135 page manual about interventions and data to support the program. She states the course is very intense. Ms. McCormick expresses concern that this bill trivializes the need for mental health care and the need for mental health professionals. Ms. Carmel responds that her understanding of the training is for the teacher to be more comfortable dealing with children with mental health concerns and to be able to capably respond to crisis situations, similar to traditional First Aid. She also sees the program as a way for teachers to become sensitive to behavior issues that they might otherwise be overlooked or written off in the multitude of tasks a teacher is asked perform. Ms. Bond likens the program to allergy training. She states that if a child had a peanut allergy, the teachers would be prepared to act in case of anaphylaxis. She states that the training would give teachers the tools to deal with a mental health crisis. Dr. Dostal states as a culture we are taught to be sensitive to people who have all kinds of medical conditions, but we now have to teach ourselves to think of mental illness in the same way. Ms. McCormick requests a copy of the manual for Mental Health First Aid. Dr. Dostal requests the MV PHIP staff provide the Mental Health First Aid curriculum to the work group.
Dr. Gildemeister states that teachers who are engaged with their students are already doing this. This program, however, gives the teachers the tools they need to do something about the knowledge they have about their students. Supt. Yelich states that there is a need for mental health providers in the area. This training is not going to impact that need. Dr. Dostal agrees that it is important that the legislation also include the resources the teachers need to make this successful and not just simply mandate the program. She suggests that the group back legislation that would provide those resources. She also suggests that the group form a listserv. Dr. Dostal states that a letter coming from this group that supports the legislation, either the way it is written or with suggestions for changing it, would be very powerful, and a way to impact changes on the population level.
Mr. Friedlander asks Ms. Boerenko who created the Mental Health First Aid training. She responds that it started out in Australia and has been adapted to meet the needs of the United States. There are five different courses that are tailored to address the type of person who is in crisis. For example, there is a course specifically designed to help a layperson deal with a clergyperson who is in crisis. These groups include clergy, youth, law enforcement, military personnel, adults, and geriatric populations. Ms. Carmel states that, as a mental health professional, this legislation is great but there is a lack of providers and psychiatrists in the area. Mr. Jordan responds that the lack of providers doesn’t change that there are kids in crisis and we need to help them. Ms. Carmel states that one of the proposed interventions, starting schools later in the day, is something that would make it easier for the kids so they aren’t sleep deprived when they get to school. She states that it is important to not only treat kids who are in crisis, but prevent them from getting there in the first place. Ms. Finkelstein states that Mental Health First Aid could help teachers recognize the warning signs before a child has a crisis. Dr. Gildemeister expresses concerns over the liability of being trained in Mental Health First Aid and having a negative outcome from the crisis. Comm. McMahon replies that with CPR or fire extinguisher training there is no liability. No one is mandated to intervene even if they have the training. Dr. Dostal states that in Otsego County there is a strong discussion about trauma-informed care and it is also a goal of the NYS Prevention Agenda. Supt. Yelich discusses Chautauqua County’s system of care grant that is similar to the trauma-informed system of care and it is something that he would like to see be put in place in the MV PHIP region.