What are the issues?

The PERU IHSI team focuses on solving many complex and important healthcare problems and crises, including but not limited to substance misuse, suicide and self-harm, untreated mental health disorders, COVID-19, and rising healthcare costs.

Drug-related overdose deaths are the leading cause of unintentional death, and suicides are the 10th leading cause of death in the U.S.1,2

20.4 million
The number of individuals aged 12 and older diagnosed with a substance use disorder (SUD) with only 1.5% receiving any substance use treatment.3

4th highest
Pennsylvania had the fourth highest drug overdose death rate in 2019.4

The number of drug overdose deaths in the United States (U.S.) in 2019; a 4.6% increase from 2018.3

The number of Americans who died by suicide with 1.4 million who attempted suicide in 2018.1

51.5 million
The number of adults (21%) with a mental health disorder in 2019 and less than half (43%) received mental health services in the past year.3

9.5 million
The number of people with a SUD and co-occurring mental health disorder in 2019.3

$740 billion
The cost of substance misuse each year is related to crime, lost work productivity and health care.5

$93.5 billion
The cost of suicides and suicide attempts annually are related to medical costs and lost income and productivity.6

How does IHSI address the issues?

The IHSI team’s efforts address the many complex factors contributing to substance misuse and suicides among other challenges. These factors and the strategies our team uses to mitigate them include:

Limited Prevention and Early Identification Efforts

In 2019, 60% (165.4 million) of those aged 12 and older used a substance in the past month, and 20.4 million had a SUD.3

Integration of early intervention programs can reduce substance misuse and suicide risk in the general population and ensure those at risk are connected to treatment and services.3

The IHSI team works with stakeholders to:

  • Increase the early identification of those at risk for SUD and suicide through Screening, Brief Intervention, and Referral to Treatment (SBIRT) implementation at healthcare facilities, including primary care, behavioral health, emergency departments, OBGYN, and pharmacies.
  • Increase the early identification of those with co-occurring mental health conditions by supporting the integration of physical and behavioral health care and screening for mental health disorders.
  • Support evidence-based prevention efforts within communities and organizations we serve.

Limited Education Among Healthcare Professionals

Research indicates 40 – 80% of healthcare providers felt their education and training were unsatisfactory in equipping them to address chronic pain and the rise in substance misuse.7-9

The IHSI team works with stakeholders to:

  • Develop and integrate comprehensive SUD education into health professional curricula, including medical, advanced practice provider, and social work programs.
  • Increase healthcare professionals’ knowledge, confidence, and competence in treating patients with SUD through both didactic and practice-based training.
  • Increase education and awareness of SUD and suicide by training healthcare professionals, patients, and communities on best practices for prevention, treatment, and recovery.
  • Reduce stigma associated with SUD and suicide by increasing education and awareness among healthcare professionals, local stakeholders, and community members.

Lack of Access and Initiation in Treatment

In 2019, 7.8% of people aged 12 or older (21.6 million) needed SUD treatment, yet only 1.5% (4.2 million) received any form of treatment.3

Increasing access to treatment for SUD and co-occurring mental health disorders can help to decrease substance misuse and prevent suicide deaths.3

The IHSI team works with health professionals to:

  • Increase access to and utilization of SUD treatment by recruiting providers to implement medications for opioid use disorder (MOUD) treatment into their practices.
  • Improve the quality of treatment and services by integrating data informed continuous quality improvement processes based in the Principles of Lean.
  • Increase clinical efficiency and effectiveness by utilizing analytical findings and improving treatment data accessibility and usability for healthcare professionals to support decision making.
  • Demonstrate clinical quality and outcomes by utilizing analytical findings to support and guide the transition to value-based payment models and optimize reimbursement to promote both financial and programmatic sustainability.

Lack of Coordination of Care

Fewer than 40% of U.S. physicians reported they frequently coordinate their patients’ needs with social service agencies, and only one-third reported usually receiving timely reports from specialists.10

Care coordination can improve the effectiveness, safety, and efficiency of healthcare as well as enhance outcomes for patients, providers, and payers.11

The IHSI team works with healthcare professionals and communities to:

  • Integrate care coordinators within healthcare settings to provide patient-centered, coordinated care and to assist in addressing social determinants of health through customized training and data-informed technical consultation efforts.
  • Develop interdisciplinary warm handoff referral pathways within communities by implementing referral protocols based in Lean Rules in Use for organizations, including physical/behavioral health, pharmacies, case management, criminal justice, first responders, child welfare, recovery services, and other community partners.
  • Improve communication and collaboration among treatment and service providers (e.g., primary care, behavioral health, emergency departments, pharmacies, OBGYN, case management agencies, state/local agencies) by implementing communication protocols based in Lean Rules in Use.

Limited Integration of Physical and Behavioral Health Care

Collaborative care models for integrated physical and behavioral health care have shown significantly greater improvements in short-, medium-, and long-term outcomes for adults with depression and anxiety than non-integrated models of care.12

Caps on benefits and lower reimbursement rates have led to under‐investment in mental health services and resulted in inadequate capacity for both inpatient care and outpatient care.13

To address this, the IHSI team works to:

  • Provide concierge technical assistance to assist health systems integrate physical and behavioral health within their facilities, including primary care, emergency medicine, and specialty settings.
  • Integrate clinical tools and instruments within electronic health record (EHR) systems to allow for performance measurement, data reporting, and quality improvement to improve the sustainability and success of service integration.
  • Develop EHR reports derived from clinical data to enhance data sharing and coordination among the treatment and service providers involved in the patient’s care to improve engagement in services.


  1. American Foundation for Suicide Prevention. (2019). Suicide Statistics. Retrieved from https://afsp.org/suicide-statistics/.
  2. Centers for Disease Control and Prevention. (2020). National Center for Health Statistics: Accidents or Unintentional Injuries. Retrieved from https://www.cdc.gov/nchs/fastats/accidental-injury.htm.
  3. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
  4. Hedegaard H, Miniño AM, Warner M. Drug Overdose Deaths in the United States, 1999–2018. NCHS Data Brief, no 356. Hyattsville, MD: National Center for Health Statistics. 2020.
  5. National Institute on Drug Abuse. Trends and Statistics: Costs of Substance Abuse. National Institute on Drug Abuse, 14 Oct. 2020. Retrieved from www.drugabuse.gov/drug-topics/trends-statistics/costs-substance-abuse#supplemental-references-for-economic-costs.
  6. Shepard, D. S., Gurewich, D., Lwin, A. K., Reed, G. A., Jr., & Silverman, M. M. (2015). Suicide and suicidal attempts in the United States: Costs and policy implications. Suicide and Life-Threatening Behavior.
  7. Keller CE, Ashrafioun L, Neumann AM, Van Klein J, Fox CH, Blondell RD. Practices, Perceptions, and Concerns of Primary Care Physicians About Opioid Dependence Associated with the Treatment of Chronic Pain. Substance Abuse. 2012;33(2):103-113.
  8. Upshur CC, Luckmann RS, Savageau JA. Primary care provider concerns about management of chronic pain in community clinic populations. Journal of general internal medicine. 2006;21(6):652.
  9. Yanni LM, McKinney-Ketchum JL, Harrington SB, et al. Preparation, confidence, and attitudes about chronic noncancer pain in graduate medical education. J Grad Med Educ. 2010;2(2):260-268.
  10. Doty MM, Tikkanen R, Shah A, Schneider EC. Primary Care Physicians’ Role in Coordinating Medical and Health-Related Social Needs in Eleven Countries. Health Affairs. 2019;39(1).
  11. Care Coordination. Content last reviewed August 2018. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/ncepcr/care/coordination.html
  12. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012 Oct 17;10:CD006525. doi: 10.1002/14651858.CD006525.pub2. PMID: 23076925.
  13. Chang TE and Ferris TG. A Blueprint for Integrated Mental Health. Health Services Research. 2020 Nov 30; 55(6):911-912.