APA, MH Groups Agree on Principles to Improve Care of SMI
Abstract
The meeting convened by APA that led to the agreement was the first that brought together various mental health disciplines to address the crisis in care for people with serious mental illness (SMI).
“Team-based care” is the heart of a joint statement by 11 mental health organizations, convened and organized by APA, expressing key principles for interprofessional mental health care of people with serious mental illness (SMI).
The principles are not official policy of APA or any of the other 10 organizations; they represent a vision for optimal team-based care of people with SMI.
“In these times of divisiveness and conflict, recognizing our common values and obstacles felt really important.” —Sandra DeJong, M.D., M.Sc.
The collaboration that resulted in the statement of principles was started when then APA President Bruce Schwartz, M.D., M.Sc., appointed the Multiorganizational Task Force on Interprofessional Collaboration with APA Secretary Sandra DeJong, M.D., as its chair. The statement is posted on SMI Adviser, APA’s Clinical Support System for Serious Mental Illness, which incorporates educational courses, fact sheets, toolkits, and consultation to expand the base of clinicians able to provide evidence-based care to individuals with SMI.
“My hope was to begin the dialogue with our colleagues in other mental health disciplines and for APA to demonstrate leadership in addressing what I and advocates and families believe is a crisis,” Schwartz told Psychiatric News. “Agreeing on principles of collaboration is a first step.
“There is a terrible problem of access to care for people with SMI,” he continued. “These patients have comprehensive needs—for housing, social services, occupational and peer services, family treatment—which are beyond the ability of any individual psychiatrist to provide. In academic centers and health systems, collaboration with social workers, nurse practitioners, psychologists, and occupational therapists is readily available, and team-based care is the norm. We have to be proactive in partnering with other mental health clinicians if we are ever going to meet the needs of this population. We possess the knowledge and training, but the system of care is failing these individuals.”
Schwartz said the meeting convened by APA that led to the agreement—which took place in January 2020 with follow-up videoconference calls—“was the first ever in which leaders of all mental health disciplines came together to address what is a crisis in our country.”
He said, “APA’s convening this meeting was an important and ground-breaking precedent and evidence of the leadership that we can bring to this human crisis. There was a remarkable unanimity of what the issues are, as well as the importance of different disciplines bringing their expertise to a team-based model of collaboration.
“This is about bringing needed comprehensive and high-quality team-based treatment to an underserved, seriously mentally ill population,” Schwartz said. “It is about trying to make progress in caring for a population who at present do not receive adequate psychiatric care and end up in our prisons and jails or the streets or they cycle endlessly through psychiatric units.”
Promoting Team-Based Care of SMI
The following are the nine key principles for interprofessional care of people with serious mental illness (SMI):
The mental health care of adults diagnosed with SMI is optimally delivered in an environment of mutual respect and support and can be greatly enhanced by a collaborative team, which includes the adults diagnosed with SMI and their natural support systems.
Training and education are optimized by mental health professionals learning together and learning with people in recovery from mental health conditions.
Explicitly learning specific skills in interprofessional collaboration is a core competency of education and training in all mental health professions.
Knowledge about racism (systemic, interpersonal, and intrapersonal), cultural differences, and social determinants of health and addressing their impact as individual professionals and collectively are essential to providing optimal care.
Organizational structures and aligned leadership should be configured to promote interprofessional practice, eliminate barriers to interprofessional collaboration, and support mental health professionals working to the top of their training and individual licenses.
Interprofessional collaboration is needed to recruit and retain a diverse and inclusive workforce of adequate size to meet population needs.
Payment models should support interprofessional collaboration of all team members with appropriate reimbursement.
Communication and information sharing among team members, adults diagnosed with SMI, and their natural support network should be facilitated by organizational systems, including technology platforms.
Quality care requires supporting the use of existing evidence-based treatments and investing in research to expand our understanding of how best to provide care in an interprofessional model.
The joint statement includes nine “key principles” for interprofessional collaboration in caring for people with SMI (see box). It asserts that “[e]nsuring access to affordable, high-quality, and timely treatment, rehabilitation, and recovery opportunities for adults diagnosed with serious mental illness is a public health responsibility.”
Further, “Social determinants of health are critical to the care of adults diagnosed with SMI. Services should be delivered in the least-restrictive setting and should be commensurate in all domains with the Mental Health Parity and Addiction Equity Act. Care should be informed by the evidence, grounded in recovery principles, and delivered in a person-centered, shared decision-making model with cultural humility, responsiveness, and sensibility. The clinical and learning environment should be diverse, equitable, and inclusive.”
The 10 groups working with APA were American Mental Health Counselors Association, Association for Behavioral and Cognitive Therapies, American Psychiatric Nurses Association, College of Psychiatric and Neurologic Pharmacists, National Association of Peer Supporters, National Alliance on Mental Illness, American Psychological Association, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Association of Social Workers.
SMI Adviser is funded by the Substance Abuse and Mental Health Services Administration and led by APA to support interprofessional education and consultation for those caring for individuals with SMI.
Tristan Gorrindo, M.D., the project’s principal investigator and APA’s chief of education, said, “The SMI grant is an embodiment of what the task force is trying to achieve. For three years we’ve been promoting, supporting, and training all the members of the SMI care team via SMIAdviser.org. We have thousands of evidence-based resources to help clinicians treating those with serious mental illness.”
DeJong characterized the day-long meeting of the groups at APA headquarters and follow-up video-conferencing calls as collegial and collaborative.
“We focused our statement on individuals with serious mental illness, rather than specific diagnoses, because of the implied functional challenges those individuals face,” she said. “It is a group that can have a hard time finding outpatient treatment and support, and when they do, those clinicians and support systems face impediments to working together on behalf of the patient.
“I was proud to be part of this leadership effort by APA. It was a constructive effort to think on a systemwide level how we can work together to improve access to quality care. In these times of divisiveness and conflict, recognizing our common values and obstacles felt really important. It was clear that at the end of the day, we are all committed to taking care of patients in the best possible way.” ■
“Key Principles for Interprofessional Collaboration Among Mental Healthcare Providers in Treating Adults Diagnosed With Serious Mental Illnesses” is posted on SMI Adviser here.
