Peer Intervention Journal: The community feedback period for this idea began on 7/17/2019 and ended on 9/15/2019

What is the problem that needs to be addressed? Please describe how it is related to mental health.
Professions and professional organizations typically have a peer-reviewed academic journal to share information, ideas, and outcomes. This submitter has yet to encounter a journal devoted to sharing interventions and outcomes associated with peer specialist programs, support groups, and interventions. This project likely depends upon the outcome of Informed Consent.

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
Orange County can possibly learn what other jurisdictions are doing with peer programs for mental health. Peers in Orange County – if they were allowed – could share their programs with others. At least one peer in Orange County has an original group design that this submitter has not seen elsewhere. This could provide great insight into the structures of other jurisdictions and ideas for how to structure Orange County Services to better serve its population. Open questions that such a journal can address include: 1) The social contract for people with mental illness 2) What interventions are effective and how was effectiveness measured? 3) Which jurisdictions are best for someone with a mental illness and which are not? 4) What was the outcome of Medicaid Expansion on the mental health population? 5) Models of funding peer mental health services from other jurisdictions 6) The challenges and expense of mental healthcare in Maine and Alaska (is it a supply chain issue or a seasonal affective disorder issue) 7) Economic success in different jurisdictions 8) Method for moving between jurisdictions to maintain mental healthcare support systems.

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
Unknown.

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
This idea takes a standard of the profession from others – a peer-reviewed academic journal – and applies it to the mental health peer model of mental health services.

What is the project idea? Please describe how this project will operate.
Originate a journal for peer specialists/peer programs to publish their interventions/ideas and outcomes on a regular basis (i.e. annually, semi-annually, quarterly or more frequently). Addressing the contractual ban on publication of interventions and outcomes imposed on Orange County Contractors would need to be addressed. Protecting the privacy of peers while allowing them to communicate with their greater community would be an interesting challenge to solve. This project would look like the editorial board and publication of a peer-reviewed academic journal like JAMA, NEJM, Science, etc. The publication could be online to reduce the costs associated with printing and mailing. After the Innovation peroid of 5 years, it is possible that subscription costs would finance some or all of a journal’s expenses.

Additional Information:
https://jamanetwork.com/ https://www.nejm.or

 

July 2, 2019

2 comments

Thank you for your submission. The Mental Health Services Oversight and Accountability Commission posts information and outcomes from programs throughout the state, many of which utilize peers. How would this journal add to new learning within this area of mental health?

Typically, academic journals are published based upon a discipline, interest or subject matter. Journals are not typically published by geographic region. The Journal of the American Medical Association describes itself as “an international peer-reviewed medical journal” with one (of many) goals “To improve health and health care internationally by elevating the quality of medical care, disease prevention, and research.” The New England Journal of Medicine describes itself as a “high-quality, peer-reviewed research and interactive clinical content to physicians, educators, and the global medical community.” NEJM cites 600,000 subscribers from nearly every country with more than half of its published manuscripts originating from outside the United States. Furthermore, low income countries are granted free access to NEJM content 6 months after publication and back to 1990.

The Mental Health Services Oversight and Accountability Commission (MHSOAC) publishes outcomes and programs funded via Prop 63. Thus it is a highly restricted list of projects and outcomes from a single geographic area. I temporarily restricted my world view to looking at the Mental Health Services and Oversight Accountability Commission website where I found the following comparisons between the County of Orange and Statewide FSPs for FY 2016-2017 (the most recent data posted):
* The county of Orange experiences an FSP success rate (Met Goals) of 28%; Statewide is 38%
* The county of Orange experiences an FSP incarceration rate of 12.6%; Statewide is 9.1%
* The county of Orange experiences an FSP lost to follow-up/goals not met rate of 48.6%; Statewide is 40.1%
* The county of Orange experiences an FSP “other” rate of 10.5%; Statewide is 12.2%

Other notables:
* Los Angeles FSPs experience a 42% success rate (Met Goals), but its “Tracked and Assessed” rate is super low.
* San Luis Obispo FSPs experience a 3.3% incarceration rate

That is quite a bit of variance presented without any easily found narrative/analysis. Since it is a government document, I wouldn’t bother looking since governments in the United States doesn’t answer the question “Which is better and why?” Understanding “which is better and why” is interesting on so many levels. For the future peer-specialist, it is good to understand what risk factors exist for bad outcomes. For existing peer-specialists it is good to understand the mix of risk factors in their equivalent of a caseload to answer the question: “Are all the high risk cases being dumped on me?” Orange County has about a three-fold greater risk of incarceration compared to San Luis Obispo County. If I was in a healthcare setting with bad outcomes 2.82 times more likely then I would most definitely attempt relocation to the healthcare system with better outcomes. If I was a provider in a health system with bad outcomes 2.82 times more likely then I would move even quicker, consider retirement, ponder patient selection, etc. Such data is also useful to understand which jurisdiction is favorable to life for a person experiencing mental illness.

I stopped restricting my world view to MHSOAC data after writing the previous paragraph.

There are people with mental illness that live outside of California. Perhaps it would be worthwhile to see what happens in Australia where Mental Health First Aid originated? What are they doing there? How about England that has the National Health Service – what are their successes with people experiencing mental illness? A journal can solicit manuscripts from these locations.

This project submission was motivated by an invitation to a national conference on peer led mental health interventions. There is likely more value in running a journal than in sending every peer mentor to a national conference for an annual event. A journal captures information for everyone, condensed into the meaningful, significant nuggets of value.

This is a platform project with all the benefits of a platform tool to do better. The major learning objective for this project would be to set editorial/publication standards that would protect the privacy of peers, allow the sharing of information without downside risk to (hopefully) anyone. A combination of healthcare, legal, bio-statistics and journalism talent would likely be required to develop such publication/editor standards.

Orange County doesn’t have to do this or any other INN project. There isn’t an equivalent “wish list” forum anywhere else that has the purchasing power to try meaningful activities surrounding mental health. Prop 63 INN funding is preferred over NIH SAMHSA funding because SAMHSA only funds projects identified by SAMHSA.

If an INN project cannot be spun off into an independent, self-sustaining entity then it would be preferred that this project not be advanced to funding via the MHSA INN option. If an INN project cannot have some freedom of speech then it is preferred that this project not be advanced to funding. If a county other than Orange is a better fit for this idea then it is preferred that this project be moved to that county.

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