Joan Mikula named DMH commissioner in Massachusetts

Joan Mikula was named Commissioner of the Massachusetts Department of Mental Health (DMH), after serving as interim commissioner since March.

Mikula has served the department for 30 years, most recently as Deputy Commissioner for Child and Adolescent Services.

One of Mikula’s first-year priorities will be behavioral health integration, working with primary care practitioners to develop tools they can use to identify behavioral health issues and refer patients to appropriate resources. DMH’s role as the State Mental Health Authority provides expertise and direction for behavioral health integration and mental health parity.

“The majority of the people who have mental health distress are likely going to see their primary care doctor before they are going to see a mental health clinician,” Mikula said. “(Primary care doctors) are really in the position to help screen – when it comes to children, particularly – and understand what the issues are and make sure individuals are connected with the services they need, whether in their practices or beyond.”

Massachusetts has already committed to this integration through a number of programs, including The Wellness and Recovery Medicine (WaRM) clinic, a public/private partnership between DMH and Brigham and Women’s Hospital that integrates primary care with mental health services provided to individuals served at the Massachusetts Mental Health Center.

Also, the DMH-funded Massachusetts Child Psychiatry Access Project (MCPAP) now provides real-time consultation to 97 percent of pediatric medical practices across the state to help pediatricians provide and/or connect children and families with behavioral health services.

A MCPAP initiative for parents has been rolled out in several locations as well, to help identify mothers who may be suffering from post-partum depression.

Mikula said she would also like to investigate offering a similar real-time consultation model for the public school system. “The schools are concerned that they have challenging kids, there’s not one place they can call for advice and there’s been a reduction in support and school psychologists at a time we need them more than ever,” she said.

Also, “We’re looking to have MCPAP really play a role with the pediatrician around consultations that relate to substance abuse, as well as mental health,” Mikula said.

Addressing co-occurring mental health and substance abuse issues is another priority for Mikula. “We need to look at how do we cross-train, how do we do the kind of work force development that really assures that when people go to mental health treatment that the provider who is working with them is savvy enough around substance abuse issues that they can deal with the full burden of the problem?” she said.

Mikula is passionate about children’s mental health. “That’s my heart,” she said. One newer initiative will focus on pre-school-aged children, she said, with consultation programs funded across the state to help preschool teachers and directors of those environments identify red flags, talk to parents about what they are seeing and connect them with appropriate providers.

Mikula is also focused on mental health parity. “Parity is a great concept, and we’ve made really good strides in Massachusetts, but we’re not there,” she said. “When an individual needs help, the likelihood of a mental health provider being available within the network of a particular insurance plan can be challenging. We are going to be working with the division of insurance and with commercial plans and private plans advocating pretty strongly for parity.”

Mikula is also seeking feedback from mental health providers, to discuss what factors – such as reimbursement rates, administrative workload, etc. – prevent them from accepting certain insurance, and what would bring them back into these health plans and insurance networks.