A drum circle performance and the gift of a blanket touched off state addictions and mental health director Pamela Martin‘s presentation to a crowd of just under 300 people last week at OHSU’s auditorium.
Martin’s brief talk -– about half an hour long – was punctuated with humor and emphasized the ways healthcare has changed since she started her career 30 years ago. She identified four major shifts: first, a shift in developed countries from acute disease care to chronic disease management, a shift from institution-based to community-based and outpatient care, from organization-driven care to person-centered care and from “siloed” care handled by disconnected specialists to integrated care managed by a team.
Martin started her talk with slides from the London Bill of Mortality from the 1600s, which chronicled deaths from the bubonic plague as well as other acute, communicable diseases like cholera and whooping cough, as well as stillbirths. Developing countries list similar ailments – such as AIDS, tuberculosis and lung infections – among their chief causes of death, where patients in developed countries are more likely to carry and eventually die of chronic conditions like diabetes and dementia, as well as cancers that go into and out of remission.
“In Western countries, we’re spending about 35 percent of our healthcare dollars on chronic illness,” Martin said. A few decades ago, chemotherapy drugs were typically administered in hospitals, but it’s more common now for patients to self-administer those drugs at home. As a result, compliance with cancer treatment can be very low – 50 percent – because patients distrust their doctors’ advice, or find the instructions confusing.
“This is why we in behavioral health have such a strong role in management of chronic illnesses because lots of chronic illnesses involve depression,” Martin said.
Showing a slide of the first hospital she worked at – a large residential psychiatric facility in upstate New York that housed thousands of patients, where she worked while obtaining her PhD at the State University of New York at Binghamton – Martin talked about how the transition from institution-based to outpatient care has been less than smooth.
She then asked Oregon State Hospital superintendent Greg Roberts, seated in the audience, how many patients currently reside at the facility. “About 600,” he responded.
Calling that number “probably about right” and noting its reduction from nearly 5,000 in 1955, Martin said there will always be a need for hospitals, including psychiatric hospitals, but they should be small. The move to close and reduce censuses at mental institutions happened for several reasons – the advent of psychotropic medications, the Civil Rights movement and changes to funding – but the end result was not what stakeholders were promised, she continued..
“There was a promise. Was there not a promise that there would be community mental health funded care? Not just a crummy safety net that you would fall into, but a real community based hospital,” Martin said. Not only did that not happen, it simply shifted the burden, with corrections facilities acting as some of the largest mental health providers in the nation.
“We have to do something different. Mentally ill people should not be incarcerated,” said Martin, who also discussed the rise of patient-centered medical homes and her hopes for coordinated care, stressing the importance of community health workers in delivering culturally competent care.
“Peer delivered services are incredibly important. The one to one experience is very powerful,” Martin said. “The peer support person walks side by side with a person on their journey, giving encouragement and hope and inspiration.”
Martin introduced the final segment of her talk – about the shift from siloed care to integrated care — by displaying a slide with a picture of a cow and a dolphin side by side, leaping out of an ocean.
“Occasionally I feel like the dolphin, but most days I feel like the cow,” she said, with the audience laughing.
“Partnerships are always the consumer plus,” Martin said. “The consumer plus law enforcement, the consumer plus detention centers — these are all the silos we have to break down.”
Martin stepped into her position in April, after serving in a variety of public and private leadership roles in mental health in New Mexico.