Sensitivity and Awareness Training

1. Sensitivity and Awareness Training

2. Introduction • Critical need for this program • Meets information reporting requirements • Builds on SAMHSA partnership • Mutual goal to increase use of preventive benefits • How to access the materials

3. Objectives • Understand CMS goals related to this technical assistance • Define the impact of mental illness on people with Medicare • Recognize strategies for improving benefit counseling with people with a mental illness • Learn how to access mental health information and local resources

4. Partnering with SHIPs The Ombudsman is charged with working with the SHIPs to facilitate the provision of information to beneficiaries.

5. Goals for SHIP Assistance • Goal of CMS/OMO • To help SHIPs and other community partners build bridges and expand the network of help to beneficiaries with • Mental illnesses • Disabilities • HIV/AIDS • And other vulnerable populations • Pathway to goal fulfillment • Worked with national mental health partners to develop and implement a technical assistance program (TAP) focused on • Sensitivity and awareness of underserved populations • Expanding SHIP network of mental health partners

6. Sensitivity and Awareness Package • Medicare Benefit Counseling for People with Mental Illness: A Guide and Toolkit for SHIP Directors • Directors Guide • PowerPoint Slides and Facilitator Notes • Tip & and Fact Sheets • Training Activities

7. Definitions • Mental Illness • “Health conditions that are characterized by alterations in thinking, mood, or behavior…associated with distress and/or impaired functioning.”—Mental Health: A Report of the Surgeon General, 1999 • “…No bright line separating health from illness, distress from disease.” – National Alliance on Mental Illness

8. Definitions • Mental Health • “Mental Health refers to the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity.”—Mental Health: A Report of the Surgeon General, 1999 • “Manifestations of mental disorders vary with age, gender, race, and culture.” – Healthy People, 2010

9. How Prevalent Is Mental Illness in the U.S.? • Mental illness causes more disability than heart disease and cancer • There are more than 200 mental disorders, with anxiety being the most common • More than a quarter of the population will experience an anxiety disorder during their lifetime • About 20% of American’s suffer from a mental illness

10. Conversation: Stigma of Mental Illness • In your experience, how does the stigma, embarrassment, and denial associated with mental illness get in the way of helping beneficiaries?

11. Why Underserved? • Stigma, embarrassment, denial • Emotions that may be experienced by beneficiaries, caregivers, or SHIP counselors • Lack of a clear line between health and illness • Less than a third of people with diagnosable mental illness receive help

12. Your Role • Build on existing Medicare benefit counseling skills by helping counselors become more sensitive toward and aware of persons with mental illness SHIP Counselors are not expected to diagnose or treat mental illness

13. Your Role • The training relies on role plays • Information in Directors Guide • Chapter on Sensitivity & Awareness and Training Activities document • Facilitator notes indicate where to use role plays • Need to approach with sensitivity • Facilitator should help participants use role plays to discover effective strategies

14. Mental Illnesses You May Encounter

15. Fact Sheets • Depression • Anxiety • Dementia

16. Conversation: Depression, Anxiety, Dementia • What do you do when people: • Cannot remember what they have selected, today or previously? • Start becoming violent? • Do not seem connected to reality? • Want to address all tasks associated with benefit selection at once? • Do not believe they can make benefit decisions?

17. Medicare Benefits Counseling for People With Mental Illness

18. Conversation: Developing Strategies for Success • What do you do when a person: • Becomes agitated? • Refuses or cannot provide information? • Requests an increasing amount of your time? • Will not stop talking about other problems in their lives? • Speaks angrily to you? • Cannot focus on the task at hand?

19. Strategies for Successful Conversations • Redirect the conversation if a person becomes agitated or resistant • Ask for information in multiple ways • Maintain boundaries • Be empathetic and patient • Be respectful of the person • Put your feelings (but not your safety) aside

20. Prescription Drug Coverage Counseling • Counselors’ key conversations on Part D • Be sure the plan covers the person’s drugs • Prescribed dose vs. covered dose • Contingency plans • Step therapy • Annual costs and alternative funding sources

21. Connecting With Mental Health Resources

22. Conversation: Current Practice for Connecting to Mental Health Resources • What do you do when a person: • Self-identifies with a mental illness and asks for assistance? • Displays what you perceive to be symptoms of a mental illness? • Exhibits crisis behaviors such as talk of suicide or harm to others? • Requests or seems to need a resource not provided by your SHIP?

23. Strategies for Connecting • Recognize that the best way to help is to make a connection with the appropriate expert • Always act within the boundaries of your role as a SHIP Counselor as defined by SHIP Director and training • You can connect by … • Having an awareness of your local mental health landscape • Being familiar with national mental health resources

24. Local Mental Health Landscape • Who operates the mental health centers in my region? • What are their respective roles?

25. National Resources • Crisis hotlines • Suicide • 1-800-273-TALK (8255) or 1-800-799-4889 (TTY) • 1-800-SUICIDE • Substance Abuse • 1-800-662-HELP (4357) • Substance Abuse and Mental Health Services Administration (SAMSHA) • mentalhealth.samhsa.gov/databases • 1-800-789-2647

26. National Resources, Continued • Counseling resources • The American Psychiatric Association • www.psych.org • National Council on Community and Behavioral Health Care (NCCBH) • www.nccbh.org • National Association of State Mental Health Program Directors (NASMHPD) • www.nasmhpd.org • National Association of County Behavioral Health Directors (NACBHD) • www.nacbhd.org

27. National Resources, Continued • Advocacy resources • Mental Health America • www.nmha.org • National Alliance on Mental Illness • www.nami.org

28. Pilot State—Texas • "SHIP TAP was successful in Texas  because of the strong support for theproject at the federal state and local level partners."

29. Pilot State—North Carolina • “The tip and fact sheets provide good information that will be useful to our SHIP Counselors, just as most SHIP counselors could benefit from a better understanding of the facts and impact of mental illness.”

30. Other Conference Sessions • A Conversation with the Medicare Ombudsman’s Office – Defining Future SHIP Technical Assistance Needs – Roundtable Discussion • Dan Schreiner and Tangita Daramola, CMS • SHIPs and CMS – Working Together to Build Bridges and Expand the Network of Help for People with Mental Illness • Tangita Daramola and Janet Miller, CMS Carla Obiol, NC SHIP Roger Adams, TX SHIP

31. Summary • CMS goals related to SHIP TAP • Facilitate the provision of information to people with Medicare • Reach out to vulnerable populations • Work with partners to improve service to people with Medicare • Mental illness • Impacts people of all ages and social structures • Responsible for more disability than any other illness • Strategies for success • Appropriate tools for diverse situations

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