MINNEAPOLIS, February 6, 2008— A report released Wednesday from The Minnesota Council of Health Plans (MCHP) asserts that about one out of every ten insured Minnesotans will be diagnosed with mental illness at some time in their lives. The MMA added clarification to two of the survey's harsher findings.

Depression accounted for much of the MCHP diagnosis. Other major problems cited include anxiety and attention deficit disorder.
Eleven percent of individuals enrolled in Minnesota health plans have been diagnosed with a mental illness, the report said – a total of 274,000 persons.

“This data is intended to create greater understanding of mental health in our state and to further our work with community and medical organizations working to improve mental health care,” Julie Brunner, executive director of MCHP, said in a news release.

The report from MCHP included these statistics:

• About 6 percent of Minnesotans diagnosed with a mental health problem received emergency or hospital services
• More than 80 percent of medications for mental illness in Minnesota are prescribed by primary care physicians in family practice, internal medicine, OB/Gyn, pediatrics, etc.; only 20 percent are prescribed by psychiatrists or specialists in mental health.
• 21 percent of people with Minnesota Health Care Program coverage have a mental health diagnosis; only 12 percent of people in employer-based or individual plans are so diagnosed, and only 10 percent of Medicare patients statewide.

The report's most controversial assertions were that:

• The vast majority of children prescribed antidepressant medications – 97 percent – did not receive the follow-up care recommended by the U.S. Food and Drug Administration.
• Seniors with mental illness are taking three or more drugs that are potentially dangerous for elderly patients, according to the Beers guidelines published in the Archives of Internal Medicine.

The MCHP study is based on claims data, which, while providing important confidentiality, does not always capture the range of services that show up in medical records.

St. Cloud family physician George Schoephoerster, M.D., spoke to the problem of following up on mental health diagnoses in children. "The follow-up problem is worse with children because follow-up recommendations are more frequent than for adults. We must also remember that follow-up visits cost money, which families may feel they cannot afford. "

Oftentimes, Schoephoerster said, children and adolescents see a doctor rather a psychologist because they didn’t realize they were depressed, or they didn’t have the time or money for weekly counseling. "As a result, follow-up occurs informally, through phone calls and through conversations with parents. These events are neither charged nor paid for, so they don’t show up in claims data."

Solutions for this problem are available, Schoephoerster said. "Create a medical home where disease episodes are paid for, and the actual paying for a visit becomes one less barrier. Another way is to pay for phone consultations, so that claims data are generated."

"Finally," he said, "it needs to be recognized that sometimes it's the patient’s choice not to follow FDA guidelines and get that follow-up. A challenging aspect of patient-centered care is that it is driven and defined by the patient’s needs and values, not by the guidelines we set down."

The MMA has also been involved in assessing the state of the state's mental health practices. Its Psychiatric Bed/Patient Diversion Task Force, composed of physician members from psychiatry, emergency medicine, family practice and internal medicine, has been working to address access issues to mental health services in order to identify statewide solutions to the problem of access to psychiatric services.

The MMA task force has called for:

• Early intervention/Prevention for child/adolescent mental illness. Begin screening earlier.
• Coordination of mental health care to include primary care physicians and psychiatrists working together on a treatment plan. The primary care system is the main portal for children being screened for mental illness.
• Opening the lines of communication between primary care and psychiatry.
• Increased intermediate and outpatient options. Data has shown that too many individuals (children, adults, and the elderly) are seen in the ER and are kept in the hospital because of lack of intermediate options for treatment and medication maintenance.
• Increasing the number of child/adolescent psychiatrists so that children and adolescents have timely access to treatment and services.

The MMA recognizes that there is a shortage nationally of child and adolescent psychiatrists, the task force document says. Minnesota is far below the national average for child and adolescent psychiatrists. Physicians and others need to concentrate their efforts on increasing that number. One way to increase access is to co-locate child psychiatrists within the family practice setting.