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Case Studies

Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services

Brief description: Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) offers integrated behavioral health and intellectual disability services in one comprehensive system. The mission of DBHIDS is to improve the health status of Philadelphians in need of behavioral health and/or intellectual disability services. This is accomplished through an emphasis on recovery and resilience-focused behavioral health services, as well as an emphasis on self-determination for individuals with intellectual disabilities. Services are provided through a network of agencies and collaborations with the Philadelphia School District, the child welfare system, and the judicial system, among other stakeholders. DBHIDS manages the behavioral health treatment services for all Medicaid-eligible Philadelphians. Since mid-2012, DBHIDS and has trained 26,300 individuals who live, work, or study in Philadelphia in Mental Health First Aid (MHFA), as of December 2017. A core value of DBHIDS is to place the focus of care on integrating individuals and families into the larger life of their communities, connecting with the support and hospitality of the community, developing community resources (such as MHFA) that support recovery and resilience, and encouraging service contributions to and from the larger community. Resilience, recovery and wellness can be tapped, initiated, catalyzed and promoted in care settings, but can only be maintained in the context of people’s natural environments.1
Bridging recovery and resilience
According to DBHIDS Assistant Director of Health Promotion, Maria Boswell, the department selected MHFA for several reasons, including: strong alignment between MHFA’s outcomes and the DBHIDS Practice Guidelines core values, the opportunity to utilize trainings as a keystone of their approach to both transformation and recovery work for those who are unwell or in crisis, and their broader integration of a population health frame, focused on helping those who may be at-risk, or well, to stay healthy. DBHIDS’ approach to behavioral health stems from a belief that recovery for the unwell, and building resilience for those who have recovered, or are at-risk, is critical to improving population health in Philadelphia. Believing in a recovery orientation, DBHIDS focuses on the central role of individuals and families in responding to, managing, and overcoming behavioral health challenges. First aiders who are able to identify, understand, and respond to signs of behavioral health challenges or crises are a key element to both sides of this equation. According to Boswell, “MHFA was a natural fit with DBHIDS’ focus on utilizing community and individual strengths to drive our systems transformation efforts. Giving our community members tools to increase mental health literacy and early intervention, all while reducing stigma around behavioral health issues, made it clear that MHFA was in line with our transformation philosophy.” When asked why it is important to implement MHFA, Arthur C. Evans, former commissioner of DBHIDS and current CEO of the American Psychological Association, explained, “If you’re in a restaurant and someone has a heart attack, they’ll probably be five or six people who can jump up and do CPR. If you’re in a restaurant and someone starts to exhibit psychiatric symptoms, most people run the other way.”2

Moreover, MHFA was a long-term solution for DBHIDS, as they developed a vision of moving from treating the unwell to a population health focus that would allow those who were at-risk or well to build resilience to avert a crisis. Boswell notes, “What we most appreciated and recognized about MHFA was the comprehensiveness of the training and the opportunity it provided for us to educate all people we serve no matter their health status.” Additionally, when reflecting on the 12th anniversary of DBHIDS, Evans reasoned, “If we don’t have these public health strategies to reach out to communities, we’re going to continue the same pattern of people in those settings not getting the help that they need.” In another instance, Evans expressed the importance of moving to a population health strategy by claiming, “Our method of only treating people who are ill is going to bankrupt us.” DBHIDS proposed to both the Philadelphia City Council and the Office of The Mayor that MHFA be added to the portfolio of services offered to Philadelphians, and received strong support and budget allocations from both parties.
What set MHFA apart from other mental health trainings was the fact that the intervention was being endorsed and offered by the National Council on Behavioral Health (NCBH) and had national recognition. NCBH is a nationally recognized leader in the behavioral health space and, as Boswell notes, “NCBH has an extensive reach serving millions of families through their network of organizations, and seen as an advocate, and champion of recovery.” Pairing this “seal of approval” with the national and international recognition that MHFA had received made MHFA a logical choice. Boswell adds, “Not only did we recognize the national momentum behind this training, but noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) had included MHFA in their registry of evidence-based programs and practices. The reputation of NCBH, the MHFA “movement,” and SAMHSA’s approval, all carried a lot of weight.”
Results of MHFA
In regard to the impact that MHFA has had in Philadelphia, Evans noted, “We got a really good response to this and it’s been one of the most important things I’ve seen in terms of reducing stigma and changing perception.”14 As of December 2017, DBHIDS has trained ~26,300 first aiders and sponsored over 250 members of the community to become certified MHFA instructors. Moreover, the number of first aiders trained in any given neighborhood has become one of the quality indicators that the City of Philadelphia uses to measure progress on behavioral health. Boswell also considers the opportunity MHFA has provided DBHIDS to work with other community organizations to be of major benefit, saying, “We could not have achieved any of our milestones without community partnerships such as the American Red Cross, and public safety partnerships with the Philadelphia Prison System, Philadelphia Fire and Police Department. Other city departments, area hospitals, universities, faith-based organizations and our school district have also made significant contributions. Roughly 40% of our first aiders are trained through community hubs, and our partnerships with these organizations have really blossomed through MHFA.”
Future direction of MHFA 
MHFA is strongly entrenched in the City of Philadelphia, and the DBHIDS team plans to continue to grow the number of Philadelphians trained. This will require the team to drive more demand through social media and print advertising, large city-wide campaigns, and continued commitment from city government and the people of Philadelphia. To date, most group training requests are driven by word of mouth and the positive first aider experience. The team will also work to establish the impact of MHFA trainings on DBHIDS’ community behavioral health offerings, as a way to understand whether access to direct services has been positively influenced by the trainings. Finally, DBHIDS will continue to use MHFA as an opportunity to learn about community needs. Boswell mentions, “One of the most valuable components of MHFA is that it acts, in a sense, as an eight-hour focus group where community members get to listen, learn, and connect with one and other. It helps us to understand what the needs of the community are, what our neighbors may struggle with, and the best ways for organizations to meet the needs of the community. It also gives us a great opportunity to connect people with services and answer the questions they have about where a person can seek help.”