In the 1990’s, pharmaceutical companies pushed doctors to prescribe Opioid pain relievers and patients started using them at unprecedented rates. The addictive qualities of Opioids was not fully understood or advertised. Today, this has resulted in a massive Opioid epidemic with severe consequences. Drug addiction, overdoses, and drug withdrawal syndrome in newborns have increased dramatically in the last two decades, peaking in 2017. The healthcare system has struggled to grapple with the magnitude of this problem. As of January 2019, more than 130 people die every day from Opioid overdoses. The United States is facing a massive mortality epidemic. Prevention is critical, but so is providing high quality and timely treatment for those who already struggle with addiction.
Mercy Health is a part of Bon Secours Mercy Health, the fifth largest Catholic health system in the United States with locations in seven states and Ireland. Mercy Health is redesigning how health care providers deliver behavioral healthcare. It is integrating behavioral health care into inpatient care, psychiatric services, emergency medicine, and primary care. By addressing the psychological needs of patients in the context of hospital care, patients have the opportunity to receive more holistic and effective treatment.
This is especially important for those struggling with drug addiction. The current structure of the healthcare system takes an incredibly indirect and ineffective approach to treating addiction. If a person comes to the emergency room from an overdose, doctors save his or her life, but there is no protocol for follow up visits or treatment plans. If a patient comes to their primary care doctor for their drug addiction, they are often given a long list of names and numbers for drug treatment facilities which usually have extensive waiting periods. Most people who struggle with addiction have multiple encounters with the healthcare system before actually being enrolled in a treatment plan.
Mercy Health is working on a local, regional level to desegregate the many different types of services and specialties that exist, bringing them together into one cooperative system. They have combined forces with drug treatment centers and psychologists so if a patient comes to the hospital with a drug addiction, a long term treatment plan can be developed quickly and efficiently upon the patients’ first exposure to the health system. Mercy Health is treating addiction as a chronic disease rather than a personal failing that the patient is responsible for.
Providing Access to Care: Many people with Opioid addiction go to their primary care doctor first so that’s where care needs to be provided. Mercy Health is making behavioral health more accessible, more transparent, and more effective to put forth the necessary response to the epidemic. Addiction needs to be managed on outpatient terms with robust ongoing services.
Mainstreaming Behavioral Health: Mercy Health is creating a system in which a person who comes to the emergency room with a drug overdose or comes to their primary care doctor about their addiction can immediately receive treatment and be referred to a specialist. Doctors and nurses are trained to become familiar with behavioral health treatment so that behavioral health methods can be implemented into every level of treatment. This will help normalize behavioral health, reduce stigma, and treat addicts as patients with a health problem rather than an individual who makes bad choices.
Inertia: People always have a tendency for doing things the way they have always been done. Mercy Health strives to start changing the way people view addiction and health care, both on the individual and institutional level.
Social Stigma: Mercy Health combats the perception that addiction is a moral failing and that people would be better off if they made better choices. Addiction is a medical condition that needs a healthcare response and long term treatment.
Sustaining the effort: Mortality rates have slightly decreased since 2017, but Mercy Health is preparing for what the next wave might consist of. The crisis started with prescription medication, then led to heroin usage, and we are currently battling synthetic opioids. It is important to continue the broader conversation of behavioral health, mental health, and trauma.
Solutions: The most important way to foster change is by truly listening and by building a coalition to make rapid large scale change. Listen to what the resistance is to change, and have answers for the questions people will have. Those leading the charge to change need perseverance and grit.
Integrating Health Care: Mercy Health has been successfully working on integrating behavioral health into all stages of health care to treat mind as well as body in all their patients. This is especially important and effective for those struggling with Opioid addiction.
Building a Collaboration: By working with the framework that already exists in their region and opening up a dialogue within that framework, Mercy Health has been able to quickly build an efficient system for comprehensive addiction treatment. There are currently eighteen members in the addiction treatment collaborative which are rapidly connecting people to services. Mercy Health initiates treatment and then a collaborative continues treatment in an ongoing capacity.
Support from Leadership: Mercy Health is affecting lasting change by convincing the leadership and boards of their own and other organizations that behavioral health and opioid treatment is a priority. Without working from the top down, real change is incredibly difficult to achieve. Inform and train leadership so they can inform and train every person working below them, truly shifting the way things are done.
In terms of policy, Dr. Navdeep Kang hopes to find a way to require the DATA2000 waiver for all clinicians in practice, in medical schools, etc. The DATA2000 waiver is a requirement of the Narcotic Addict Treatment Act for doctors to treat opioid addiction. With more, or all, doctors having this certification, opioid addiction treatment would be much more accessible.
Mercy Health envisions a future in which when a patient comes into the hospital with opioid addiction, the hospital and staff know what to do and say, where to send the patient, and how to set up a treatment plan. Behavioral health and addiction treatment should be integrated into the routine delivery of care at every level of care in every setting.
Dr. Navdeep Kang is the Head of Behavioral Health Operations for Mercy Health – Cincinnati and has spearheaded the Mercy Health Addiction Treatment Collaborative.
To learn more about Mercy Health, please visit: https://www.mercy.com/