Treating the Whole Person

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Key takeaways:

  • Lee Health is committed to treating the whole person, especially considering whether and how mental health affects physical health
  • Sadly, there is hard evidence that compared to the rest of Florida and the nation, Lee County has drug overdose, excessive drinking, suicide and depression challenges
  • Material strides have recently been made
  • Further attention is warranted, including growing the workforce that provides behavioral health care
  • Part of the workforce challenge may be resolved by having primary care providers aid in the care of uncomplicated cases

As part of fulfilling its mission of “empowering healthier lives through care and compassion,” Lee Health provides behavioral health and substance abuse care. Programs include pediatric and adult behavioral health as well as addictive medicine.

In addition, understanding the growing need for help in treating mental health and addiction, Lee Health has added new, nationally recognized leadership to the program and recently expanded the size and scope of its services. This is excellent.

Lee Health treats the whole person.

These services are core to Lee Health’s mission not only because of their direct impact on a patient’s mental health and/or addiction but also because physical illness is much harder to treat if the patient has an untreated behavioral health disorder.

Prompting the Lee Health expansion has been the unmet need:

  • The most recent Community Health Improvement Plan for Lee County (2018-2022) references mental health and substance abuse as priority area one, with top goals being decreasing drug overdose and suicide death rates.
  • The (most recent) 2017 Community Health Needs Assessment for adults’ notes:
    • Among key informants in Lee County, 7% report substance abuse is major problem in the community
    • The all drug overdose death rate per 100,000 is 30.6 in Lee County versus a Florida average of 22.8, and a national, of 20.7
    • The all drug overdose death rate per 100,000 in Lee County has increased to the current 30.6 from 14.0 in 2003
    • The percent of adults who are excessive drinkers in Lee County is 26.8% compared to a national average of 22.2%
    • The percent of adults who are excessive drinkers in Lee County has increased to the current 26.8% from 23.1% in 2011
    • Age-adjusted suicide death rates per 100,000 is 16.9 in Lee County versus a Florida average of 14.0 and a national, of 13.0
    • Age-adjusted suicide death rates per 100,000 in Lee County has increased to the current 16.9 from 15.7 in 2006-2008
    • Percent diagnosed with depression is 22.1% in Lee County versus a Florida average of 16.5% and a national, of 17.9%
  • The 2020 Lee County Human Services Gap Analysis for youth notes that Lee County resembles the rest of Florida (which in turn resembles the nation):
    • Major depressive episodes in the past year among 12-to-17-year-olds increased to 14.4% from 9% in 2004
    • Major depressive episodes with severe impairment in the past year among 12-to-17-year-olds are increasing to 10% from 5.5% in 2006
    • About 66% of adolescents ages 12-17 with a major depressive episode did not receive treatment

This unmet need is expected to grow due to COVID-19.

Based on the experience with other pandemics, there will be a very material increase in behavioral health disorders. One national survey on whether people are reporting serious psychological stress due to the pandemic showed an increase among the general U.S. adult population from 3.9% in April 2018 to 13.6% in April 2020.

Particularly vulnerable to pandemic-caused adverse psychosocial outcomes are:

  • Patients who were infected by COVID-19
  • High-risk but not infected patients (for example, elderly, residents of congregate housing and/or those with compromised immune systems)
  • Other individuals who isolated to avoid the disease because of pre-existing medical, psychiatric or substance use problems
  • Individuals who lost their job or had their income reduced

Also at elevated risk are health care workers, especially those directly caring for patients, suffering PPE shortages and working extended shifts.

Lee Health is to be complimented for its excellent work in pediatric behavioral health. Among noteworthy achievements is the community leadership focused on advocacy, regional strategic planning and inter-agency clinical cooperation. Other material contributions include school collaborations/navigator program and community outreach de-stigmatization efforts including Kids’ Minds Matter.

Also, extremely important is the growth of the behavioral health staff at Golisano Children’s Hospital including three pediatric psychiatrists, five psychologists and four developmental pediatricians. The staff has grown from 6 to 29 from fiscal year 2017 to FY20. This has enabled visit growth from 6,980 in Fiscal Year 2017 to 14,570 in Fiscal Year 2019.

Plans are being developed to create a testing center, inpatient psychiatric consults, expanding sites of care and hours of operation and joining with FGCU and FSW train more behavioral health workers.

These are stellar accomplishments which warrant continuing broad support.

Looking forward, as resources and bandwidth become available, further attention must be provided to adult behavioral health care and substance abuse. Hopeful ideas include having Lee Health behavioral health services collaborate with family medicine providers to allow uncomplicated behavioral health cases to be treated at the primary care level.

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