Triage, Referral and Caring for the Community

Richard Kadison M.D.

Chief, Mental Health Service

Harvard University Health Service

Coordinating Care

• Resources

• Restrictions

• Realities

Resources

• What are the available staff?

• How many prescribers?

• What are the programs:Therapies, Wellness

• Community Resources

• Insurance Coverage

• Medication Coverage

Data

• 2000 National College Health Assessment 16000 students 20 public and 8 private colleges around US

• 9.4% Seriously considered suicide

• 93% of students felt overwhelmed

• 44.5% felt so depressed, hard to function

• 65% of students report feeling hopeless

Data

• Antidepressant sales increased 800% since 1990 10.7 billion dollars 2001

• Medication is very expensive

• 9.3% students seen in counseling

• 17% students who are seen are on antidepressants nationally

Data

• Directors report a significant increase in acuity and severity- 2002 AUCCD

• 65% of schools have psychiatric services on campus

Suicide

• Rate 7.5/100,000 in college which is half the rate of age matched population

• More younger men are successful but equalizes as group gets into early 20’s

• About 1% of students make attempts

• Risks increase with age- graduate school

Parallel Problems

• 40-45% of College Students Binge drink- no change from 1993-2001 (Wechsler)

• 3-5% of students have serious eating disorders (Bulimia and Anorexia) with mortality rates of 5-15%

Restrictions

• Stigma

• Health Care information- Parents

• Managed Care changes

• University Budgetary Concerns

Restrictions

• Student Mentality

• Health Care Costs

• DNKA (did not keep appointment

• Disability and Learning problems

Realities

• Reduce stigma for Care

• Normalize the problems

• Outreach Needed

• Managed Care changes

• Diminished community resources

• Confidentiality

Access Structure

• Triage system- Brief contact with clinicians

• Philosophy of Care: How much care for whom- development vs. serious mental illness

• Referrals: to whom

• Central Schedule

• Reporting ( visits, new students)

Caring for the community

• Outsourcing

• Outreach to students, faculty, and staff

• Consultation role to University

Coordination

• After Hours coverage: Who and Where

• Medical Leave- reentry and policy

• Identifying Students at Risk

• Contact with Deans/ residential staff

• Confidentiality- Handbook notification of medical leave and hospital admission

New Directions and Issues

• Web- Self screening, alcohol education, health information

• Web- staff listing, groups, policies,• Parents information and orientation• Future of in loco parentis• Email• Documentation and diagnosis• Student involvement in programs and feedback

Summary

• Triage and rapid intake crucial

• Outreach and Education

• Clear philosophy about Resource Utilization

• Student involvement in programs and development