Needs Assessment Committee Meeting June 9, 2020

Meeting of the
NEEDS ASSESSMENT COMMITTEE
Amanda Lugg and Marcy Thompson, Chairs
June 9^th, 2020, 10:00AM -12:00PM
By Zoom Conference Call

Members Present: Marcy Thompson (co-chair), Amanda Lugg (co-chair), Maria Diaz, John Schoepp, Leo Ruiz, David Klotz, Randall Bruce, Lisa Best, Rob Walker, Tim Frasca, Jennifer Irwin, Micah Domingo, Claire Simon, Billy Fields, Fay Barrett, Finn Schubert, Jamie Walkup, Jonathan Reveil, Karen Mckinnon, Maiko Yomogido, Mytri Singh, Randall Bruce, Francine Cournos, 

DOHMH, PHS, NYS and Other Staff: Cristina Rodriguez-Hart, Guadalupe Dominguez Plummer, Ashley Azor, Claire Simon, Graham Harriman, Johanna Acosta, Kimbirly Mack, Roland Torres, Bettina Carroll, Brian Meisel, Jose Colon-Berdecia, Perminder Khosa, 

Welcome/Introductions/Moment of Silence/Public Comment/

Review of the Meeting Packet/Review of the Minutes:

Ms. Lawrence opened the meeting in partnership with co-chairs Marcy Thompson and Amanda Lugg with an icebreaker summer activities.  Introductions with pronouns were conducted and a moment of silence was held. The May minutes were presented and accepted. 

Persons with Serious Mental Illness (SMI) Referred to Select Bureau of Mental Health (MH) Services and Matched to Persons with HIV

Slides will be available for viewing online. Key highlights and questions presented follow:

• This match is specific to NYC and does not include persons residing in the tri-county area
• The Bureau of MH (BMH) estimates approximately 200,000 people with SMI are living in NYC
  • The 45,000 people with SMI found in the match are people whose SMI has caused them to “touch” the system – either by being referred or mandated to treatment
  • Significantly more people with SMI compared to PWH overall are diagnosed in a hospital 
• Cause of death is what is listed on the death certificate
• BHIV data is relatively clean due to the extensive history of refining data collection techniques.
• How to galvanize stakeholders to bring data and other resources to the table.
• Significant gaps in data for this population
  • Original question asked where are PWH with SMI getting their HIV care – this still isn’t clear.
  • Is it possible to bring down silos between populations
• BMH has access to the Medicaid data warehouse
• Now have concrete evidence that there is significant unmet need.
• Three D’s: Diagnosis, Disability and Duration – the exclusion of depression has to do with how it plays out clinically and its impact on function.
• BMH aligned its definition of SMI with the Division of Mental Hygiene’s definition
• Do not know if individual who were referred to AOT and SPOA (the two databases the match is based on) actually received services.
• Represented population cannot be characterized regarding treatment – just know individuals were referred to services and may include people who were not SMI.
• Significant limitations to the data exist.
• Major depression and anxiety disorders are the most common disorders. Depression has a wide berth – can be disabling, but is not necessarily so – goal was to look at people with the most severe mental health disorders. 
• Currently BMH does not have follow up information on whether or not the people referred to the database actially received the services for which they were referred.
• 37% of PWH with SMI who were virally suppressed had a HIV related death.
• Important to be cautious of the age adjusted death rate result – the n is very small, and people with SMI generally have a reduced life expectancy.
• Psych system is not doing a great job with HIV testing – speaks to silos between primary MH and substance use care
• Can an HIV diagnosis trigger SMI?
  • When HIV epidemic started – could see the order of events – onset of SMI or infection with HIV – but now cannot discern. Highly unlikely that an HIV diagnosis would trigger SMI
• Not a common practice to develop care continuums in MH
• Latest estimate of PWH with SMI out of California, estimates that approximately 7% of PWH also have SMI

Draft Road Map to Improve Outcomes for PWH with SMI

1. Does NY Knows partner with any MH agencies to conduct HIV testing?
2. Need to reach out to MH agencies to better understand if and how testing is done – many HIV agencies are AIDS Service Organizations have MH services, and offer testing, but may not serve a significant population of SMI
3. Importance of writing a letter to OMH and bringing them to the table – they manage over 400 MH programs – many challenges have been detailed about coordinating care during this process. 
4. Working on a collaboration between BMH and BHIV to re/engage people with SMI and HIV into care.
5. When thinking about the pandemic – how are people accessing testing now?
6. When thinking about linkage to care – a lot of the data comes from places where patients were expecting an HIV test – what about when patients who aren’t thinking about an HIV test as a part of routine testing? How will their expectations/emotional response be managed?
7. Is discharge an opportunity for intervention – a surprising number of people are discharged without a primary care physician or follow up? Could a special patient navigator provide support for an intensive intervention? 

Public Comment

None