Have You Met?

From the minute I saw Joan DiMaria's photo, I knew this was a kind-hearted soul.  After meeting the CEO and Executive Director of the Arapahoe/Douglas Mental Health Network (ADMHN) in person, I knew I had just met one of the most compasionate, as well as competent, professionals in the mental health field.

In light of all the tragedies we recently have faced in our country with mass shootings and violence, we must help those affected afterwards; and it's critical to try and identify the signs of mental illness early before these horrifying acts occur.  With mental health issues such as anxiety, depression, addictions, schizophrenia, PTSD, or bipolar disorder affecting 1 in 5 American families each year, there is an urgent need for more investments in mental health support before it destroys lives and families.   

With over 33 years in the mental health field, Joan's work as a psychiatric nurse brought her to ADMHN in 1990.  She quickly rose to become program manager, clinical director, deputy director, and then she was appointed chief operations officer in 2006.  DiMaria led the implementation of the current stratetic plan and led the charge of opening the ADMHN Pharmacy (which is actually owned by the organization), planning and implementing the Mental Health Court, creating the Bridge House Acute Treatment Unit and planning the "Be Well" Primary Care Clinic.     

Joan has been referred to within her organization as a "talented executive, extremely knowledgeable in the fields of behavioral health, integrated care, business systems, and community mental health and makes a positive impact wherever she goes to represent ADMHN." 

 I learned much from Joan in just the couple of hours we spent together.  She's patient and gentle and believes the key to change and better understanding is to keep elevating the conversations between different groups of people... encouraging all of us to stay open-minded and respectful of one another.  She also feels it's important to speak up for those who are voiceless and can't speak for themselves, and behavioral services should be integrated with physical health care.

When asked about her thoughts on retirement at some point, Joan said: "I love what I do, and there is still so much to accomplish in this field."  In deed there is, and with Joan's dedication and passion for her work, champion and leader Joan DiMaria, continues to move in the right direction to make needed change happen in the world of mental health services. 

(Arapahoe/Douglas Mental Health Network is celebrating their 60th year with a special event "Shine On 6O Years" on Wednesday, October 14, 2015, at the Grand Hyatt Downtown, with Oscar-nominated actress and author, Mariel Hemingway, as the keynote speaker.  Mariel speaks openly about her family's history of mental illness, addiction, and suicide.  Proceeds from the event support mental health crisis care and suicide prevention.  Tickets can be purchased through Blacktie-Colorado at: www.blacktie-colorado.com  go to our calendar for October 14th; and the event i.d. # is: 264493.  You can contact Blacktie at:  303-832-2903) 

How soon did you know you were interested in the mental health field, and why do you think you had that interest?  I wanted to be a nurse--like my Mom--for as long as I could remember.  During college where I received a BSN (Bachelor or Science in Nursing), I met a wonderful psychiatric nurse who encouraged me to go into this field and became my mentor.  I went on to Yale University where I received an MSN in adult psychiatric nursing.  My Master's Thesis was on Nurses' Identification and Response to Emotional Illness in Terminally-ill Patients.  I became very interested in hospice work and really was focused on doing inpatient hospital consultation  when I left New Haven.  After moving to Denver in 1974, I began working in a community mental health center and found a new passion--and this is truly where my heart is.


What was your first exposure to a challenging mental health situation?  I think that it was in my early work with hospice and working with individuals who suffered from depression or other mental illnesses.  In those days, it was not unusual to find nurses closing the dying patient's door in the hospital and just waiting for them to die.  That was heartbreaking and absolutely unacceptable.  And, thankfully, this has changed over the years.  This is when I realized that there were other professionals who could provide good physical health care, but there was a huge unmet need in behavioral healthcare in both inpatient and outpatient settings.


What is your greatest fear for the future of mental health?

I fear that we, as a nation, cannot solve the rising (and unsustainable) cost of healthcare ( about $3 Trillion dollars per year) until we address the healthcare needs of individuals with serious mental illnesses and substance use disorders --and the behavioral healthcare of everyone in the United States.  And, I fear that many decision-makers do not recognize this. 


On a more local level, I worry about the slow destruction of the current funding levels that support the infrastructure of the behavioral health safety net in Colorado.  People continue to go untreated for their behavioral health needs--nation-wide, more than one in three adults with serious impairment received no mental health treatment during the past year and receive care considered to be minimally adequate.  We have to address significant issues around access to health care for this population--who die 25 years sooner than the remainder of the population.  People with psychotic disorders and bipolar disorders are 45 percent and 26 percent less likely to have a primary care doctor than those without mental health disorders.  Medical costs for treating those patients with both chronic medical and behavioral health conditions (MH/SUD) can be 2-3 times as high as for those who don't have comorbid conditions.


So these are big problems that need to be addressed!  There are conflicting issues around "self-interest", stigma, and fragmented healthcare systems that confound our ability to make quick changes.   Even in the face of daily news stories about the tragic results of untreated behavioral health problems, we all struggle in making decisions that would move us forward.


An estimated $26-48 billion can potentially be saved annually through effective integration of medical and behavioral services.  We need to move big systems to go in that direction--and some big hospital systems are a risk to lose revenue (lucrative emergency department (ED) and in-patient revenue), so conflict of interest becomes challenging to this process. 


What do we need to do?

-Close the gap between those needing mental illness/substance use treatment services and those receiving it

-Better integrated medical and behavioral healthcare--as well as better substance use disorders and mental health care

-Expand the use of evidence-based practices to coordinate care, treat behavioral health disorders, and treat chronic medical conditions.


What do you consider your greatest accomplishment? As the CEO of Arapahoe Douglas Mental Health Network for the past 2 1/2 years, I began with an assessment of our internal infrastructure in a few key areas.  We found that we need to make  transformative changes in those areas (Information Technology (IT), Human Resources, and our Development efforts) --and I have been building the team that is needed to execute the process of implementing these changes.  Through our strategic plan, we are addressing key initiatives that support the needs of individuals with serious mental illness/substance use disorders and the behavioral health needs of all Americans:  access to care (Open Access), integration of medical and behavioral healthcare and new care coordination models , and expanding the use of evidence based practices. 


In addition, we are beginning to address a major concern which is a dwindling workforce in the arena of behavioral healthcare.  These are all priorities and very necessary for us to be a successful organization in the future.  And the bottom line, is always that we must make all of our decisions by asking what is in the best interest of the people that we serve. 


Over the course of my career, my greatest accomplishment was the creation of our 18th Judicial District Mental Health Court.  Independent evaluators estimated an approximate 2 Million per year to the criminal justice system due to this program.


In addition, I initiated our risk management program and our training program at ADMHN. 


What do you still hope to accomplish? These issues and the solutions that we have begun to put in place are long term 'fixes' to huge system problems.  I hope to move the needle a lot further before I leave ADMHN.  I believe that my understanding of healthcare and my vision for ADMHN becoming a Center of Excellence is at the heart of our work in the future. 


How do we attract good people to consider a career in the mental health field? I think that our field is too far removed from our universities and colleges!  I believe that we need to connect more with those institutions to make sure that we (providers in community mental health centers) are aware of what the 'disconnects' are.  Research in the field of brain science and behavioral health treatment is too far removed from the communities where most of the treatment occurs.  I want to add a research arm to Arapahoe Douglas Mental Health Network (ADMHN) that could add to excellence in clinical practice.  I also believe that our future work in integrated care settings is going to impact the career choices of future and current healthcare workers.  For example, if we are beginning to provide care in integrated care settings, we need universities to understand the changing field and provide training to young professionals that give them the skill sets to provide care in this setting (integrated physical and behavioral health--which is very different from traditional outpatient care). 


And of course, we need to keep the pay ranges in an acceptable place.  We cannot compete with corporate America, but we can --and should--compete with other healthcare providers.  We need to nurture and support young professionals by hosting 'open houses' for college/university students so that they have a better understanding of what we do.  We need to then become an Employer of Choice--which involves retaining the excellent staff that we have. 


Tell us about an upcoming project you are excited about? I am very excited about our newest project to provide Open Access to psychiatric services.  Our community members are reporting 4-6 months to get an appointment with a psychiatrist.  Through the leadership of our Chief Medical Officer (CMO), Dr. Kaan Ozbayrak, we implemented a new system whereby individuals will be able to access care within three days of their request.  This will have a huge impact in getting services to people in need!!


I also have to say that I am very excited about our 60th Anniversary Celebration that is coming up October 14th!


In light of all the gun violence tragedies taking place in our country, and most of it leading back to perpetrators with mental health problems, what do you as a mental health service provider feel you can do differently or better to deal with this issue? This is a community problem--not solely a mental health problem.  Most of these tragic situations occur because the individuals did not get or have access to mental health treatment.  So, as providers, we do want to open access to services to as many people as we can.  In reviewing the data around these tragedies, we often find that there were 'red flags' or indicators of mental health problems that were ignored.  Or, family members, neighbors, class mates did not know what to do about the problems or how to get help for family members.  There is often situations where there is inadequate funding to expand services to school settings or develop school based health clinics where youth can get help. 


There is also a lack of funding for prevention and early intervention services.  It really makes sense to try to avert or mitigate problems early in life rather than wait until they are severe, debilitating, and much more expensive to treat.  Mental Health First Aid (MHFA) is an evidence based practice ( research studies confirm that it is effective) that can educate the public about how to how to recognize mental illness and how to refer someone for services.  There are several similar programs that teach people what to do if someone  is feeling suicidal.  Suicide prevention techniques really are effective and we need to get this information out to people in our communities. 


What can all of us do to create better mental health around us?

Take a MHFA class and learn as much as you can about mental illness and Substance Use Disorders --and how to refer someone to needed treatment.


If someone looks to be in distress, stop and ask if you can help. 

Volunteer in an organization that mentors or helps youth--a school or non-profit organization.

Keep an eye on your elderly neighbors and make sure that they are not too isolated in their homes.


Support efforts that decrease homelessness.


Learn about suicide prevention and some of the evidence based treatments that are available. 


What do you do to decompress after a busy day?

I work out at the gym, read, I enjoy sudoku, spending time with family and friends, and playing with my Golden Retriever, Ace!


How do you stay so upbeat and enthusiastic after dealing with issues that we imagine are sad and heartbreaking? Long ago, I realized that the people that we serve are some of the most courageous and motivating people in my life!  I believe--and have witnessed many times--that behavioral health treatment works--that is, the vast majority of individuals with mental illness who receive appropriate treatment improve.  For example, the rate of improvement following treatment for individuals with bipolar disorder is about 80 percent.  These rates are quite comparable to rates for improvement for individuals with physical impairment--70-80% for asthma and diabetes--or only 41-52% for heart disease. 


Of course, we lose some amazing people to suicide and this makes me very sad--with every loss.  I become even more motivated to read the latest research, provide the best evidence based treatment and educate as many people in our community as possible about mental illness and depression through  Mental Health First Aid (MHFA)! 


What do you appreciate and value the most in life? Easy answer--my family (husband, Vince and children, Mike, {daughter-in-law, Kim and grandson, Matteo} and Cristy {and son-in-law, Shane}); my health, and my dear friends. 


I have been in the same Book Group for over 30 years and those wonderful women are like my family, too. I lost one of my sisters to cancer six years ago and that will always be a pivotal point in my life.  She is always still 'with me' and reminding me the importance of 'a life well lived' and of how short life is.  


My husband, Vince, and I have been married for 41 years and we love to travel!  I feel blessed to have the opportunity to take one 'big' trip every year or two.  I think that there is great value in learning from other cultures and challenging ourselves to think about the world from another perspective.   


Please share with us one of your favorite childhood memories.

I was very close to my paternal grandmother/grandfather.  I always felt unconditional love and acceptance from them.  I remember running into their house, getting a huge hug and then running up their attic to find the 'toy box' with lots of fun things to play 'dress up.'  My grandma also made many hand-made clothes for my favorite dolls!


If you were invisible, and could do anything without being seen, what would you try to do? That sounds like magic!  I don't think that there is anything that I want to do while invisible--I like to be a visible leader.  Mental illness is often said to be an invisible disability--we need to work to decrease stigma and bring mental illness out in the open.  We need to recognize that brain disorders are like any other medical condition that need treatment.  If I could have a magic wand, I would eliminate the stigma of mental illness--and provide a cure for severe and persistent mental illness and severe substance use disorders.  That would be a great use of magic!


What will we usually find you doing on the weekends?

 Spending time with my family--at the pool, out to dinner, playing with our grandson, taking our dog out for a long walk-- or reading a good book!  We also occasionally entertain friends.  I usually do try to sneak in a little work on Sunday afternoon/evening just to get ready for the work-week. 


What does the future hold for Joan DiMaria? I hope for good health and the opportunity to continue 'making a difference'--both in my work life and in my personal/family life. I have a very long list of interests and hobbies that I hope I can throw myself into when I have 'more time!'  I hope to use my experience and expertise to provide consultation services or mentoring for young leaders in our field--particularly young women.  


What would you most like to leave behind for future generations?

I would like to leave a vibrant, successful company that offers excellent behavioral health services to all who need them. 

I would like to do whatever possible to stop the stigma of having a mental illness and leave a company that provides quick access to care whenever needed.


I would like to address the workforce barriers that exist in our environment and leave a company that is an Employer of Choice, has very low turnover rates and every open position is sought after by experienced clinicians.


I would like to leave a company that it is a Provider of Choice.  ADMHN will provide evidence-based and excellent behavioral health care that has repeatedly excellent outcomes.


I would like to leave a company where services are primarily provided in integrated care sites where health care is coordinated and person-centered; and ADMHN will be a Center of Excellence.