T H E US D E P T . O F S T AT E M E N T AL - H E AL T H P R O G R AM - - - AM O D E L O F I N T E G R AT E D B E H AV I O R AL H E AL T H C AR E

K E N N E T H B . D E K L E V A , M D , A S S O C . P R O F . , U T S W M E D I C A L C T R .

D E P T . O F P S Y C H I A T R YG R A N D R O U N D S , D E C E M B E R 1 4 , 2 0 1 6K E N N E T H . D E K L E V A @ U T S O U T H W E S T E R N . E D U

O V E R V I E W

• Mission

• Places

• Transport

• People

• Leadership

• Disaster; trauma

• Outcomes

• Integration

• Future

U S D E P T . O F S T AT E H E AL T H U N I T S

C O M M O N P R O B L E M S S E E N I N E L I T EE M P L O Y E E S

• Stress reactions• Sleep disturbances• Circadian rhythm disturbances; jet-lag• Loss of resilience in a ‘high op-tempo’ setting• Vicarious traumatization• Vigilance fatigue

1 2 - M O N T H P S Y C H I A T R I C S E R V I C E U S E :U S V S . D I P L O M A T I C C O M M U N I T YO V E R S E A S *

8.8%

0%

2%

4%

6%

8%

10%

US Outpt State Outpt

Anxiety

Child

Depression

Adj

V Codes

Use of psychiatrists in the same ballpark

*Wang, AGP, 2005; **Flynn, DOS, 2006; Valk FSMB, 1990

5.6%**

50%

0%

1%

2%

3%

4%

5%

6%

State Outpt Med evac

Mental health evacuations needed by perhaps 3-4%

R A T E O F O U T P A T I E N T V I S I T S A N D M E N T A LH E A L T HE V A C U A T I O N S A T S T A T E

56 per1,000*

2 per1,000

*RMOP data, 2006; Med evac data, 08-10

C O N D I T I O N S L E A D I N G T O A M E N T A L H E A L T HE V A C U A T I O N , 2 0 0 8 - 2 0 1 0

22%

17%

16%

8%

8%6%4%

0%

20%

40%

60%

80%

100%

Suicide A

Parent-Child

PTSD

Adj

Partner

Alcohol

Mood

Mood disorders, alcohol and partner problems5-6x as common as PTSD

55%

A N N U A L H O S P I T A L I Z A T I O N R A T E F O RD E P R E S S I O N( P E R 1 , 0 0 0 )

52

40

27

21

0.20

10

20

30

40

50

60

Medicaid Military Commercial VA State

Less than 1% of the MDD hospitalization ratefor a commercial plan or the VA

Gibson TB ,Military Medicine , 2009.

• Integration: Psychiatrist;Psychologists; SocialWorkers; NPs, PAs;nurses.

• Decreased costs andstigma

• Improved medical andbehavioral-healthoutcomes; evidence-baseand treatment to remission

UTSW PMI team

Source: Oliver Wyman Consulting, 2011

Hassel Map

F U T U R E• Self-care vs. organic medical

capabilities: DARPA; NASA;JSOC

• Resilience; mindfulness;wellness; cognitive style;stress management

• Wearables; SMARTtechnologies; AI

• Telemedicine: patient-centricand networked; SHR; TexasVHN

• NASA: WINSCAT;COGNITION

NASA: A Multi-Media, Computer-Based, Self-Directed,Autonomous, Stress and Anxiety-ManagementCountermeasure Project