HCA 210 Introduction to Health Care
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What is the definition of mental illness? Can mental illness be as clearly defined as a physical illness such as diabetes? Can mental illness be cured?
o Has the concept of deinstitutionalization been effective in providing needed services to the mentally ill? Why or why not?
o What populations or groups were most adversely affected by deinstitutionalization? What are the benefits of deinstitutionalization?
o Are health care professionals who provide mental health care integrated with other systems of care? What are the consequences of separating mental health from physical health care? What other services (social and health) might be needed by the mentally ill?
o What are three governmental sources that pay for mental health care? What populations are covered by these sources?
o What are some of the challenges to using a managed care approach in mental health care? How does a managed care model of mental health care reduce health care spending?
o How would you ensure the mentally ill are placed into the appropriate care facility?
o Be sure to cite any sources you searched used while answering the questions in this case study in APA format.
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According to MedicineNet(2008), “Mental illness is any disease or condition affecting the brain that influences the way a person thinks, feels, behaves and/or relates to others and to his or her surroundings. Although the symptoms of mental illness can range from mild to severe and are different depending on the type of mental illness, a person with an untreated mental illness often is unable to cope with life's daily routines and demands.” (para. 1)
Illnesses such as Diabetes and Heart Disease are generally easily discernable with simple blood or diagnostic testing. Mental Illness is not so easily diagnosed. There are a number of different combinations of factors that cause mental illness, and they cannot be prevented. (MedicineNet, 2008) These factors include, genetic, biological, environmental and psychological. Mental illness is not personal weakness, a character defect or the result of poor upbringing. “Experts believe that many mental conditions are linked to problems in multiple genes -- not just one, as with many diseases -- which is why a person inherits a susceptibility to a mental disorder, but does not always develop the condition” (The Kim Foundation, 2006)
Unlike physical ailments, mental illness cannot be cured. It can however be treated. Most people diagnosed with a serious mental illness can be treated for their symptoms; this is usually done by actively participating in an individual treatment plan. Other than treatment with medication, psychosocial treatment such as cognitive behavioral therapy can assist with recovery. (National Alliance on Mental Illness, 1996-2009).
The move to deinstitutionalization the mentally ill began with a woman named Dorothea Dix, who took an interest in the conditions of almshouses and jails where the mentally ill were kept if they had no family or friends to care for them. Unfortunately, even with support for community based care and treatment the sheer number of people needing outpatient treatment inevitably overwhelmed the federal government’s financial allotment. States were expected to provide funds and many outpatient facilities were closed or the services provided were cut. So although the concept of deinstitutionalization is wonderful and well meaning, it has not to date been effective in providing the needed services to the mentally ill. Often deinstitutionalization has hindered in the continued care of mentally ill patients, especially those with no family or friends to assist them. “This came to be known as the ‘revolving door’ concept.” Patients would get treatment on a short-term in-patient basis and be discharged after being stabilized with the use of psychotropic drugs and intense therapy. However, without continued support patients would invariably stop taking their medication, have severe psychotic breaks, and end up back in an in-patient facility.
“Few communities have a truly integrated system of treatment and social support for people with mental illness. Managed care’s entry into the mental health services market has helped with coordination of medical services but has done little to enhance the type of social services needed by many people who suffer from mental illness.” (Barsukiewicz, C., Raffel, M., Raffel, N. 2002) “Numerous studies over the last 30 years have found high rates of physical health-related problems and death among individuals with serious mental illnesses. In one study, nearly half had at least one chronic illness severe enough to limit daily functioning. People with mental illnesses are also more likely to have multiple physical disorders. A study in Massachusetts found that adults with a mental illness were roughly twice as likely to have multiple medical disorders as adults without a mental illness and that those with both a mental illnesses and a substance abuse disorder were the likeliest of all to have medical problems”. (Bazelon, n.d. para. 6 & 7) Other services that are needed by the mentally ill more so than not are on-going social support, advice, understanding and medical services such as substance abuse treatment, parenting classes and coping skills.
Medicare, Medicaid and The Veteran’s Association are three governmental sources that pay for mental healthcare. Respectively the population that is covered by these are people over 65 or considered disabled, low-income person’s that have met certain criteria and Military Service veterans. Depending on medical necessity, managed care will cover a limited amount of mental health services. However, the “hoops” one has to jump through are in most cases the reasons that people do not get the help that they need. Bazelon (n.d.), “Separate health, mental health and substance abuse service delivery systems and funding sources, differences among providers in practice orientation and training, and various consumer concerns are just some of the barriers that must be overcome to deliver effective integrated care. Despite widespread understanding that fragmentation negatively affects quality of care and outcomes, a number of stumbling blocks remain.” (para. 15)
In Managed Care, physical health, mental health and substance abuse are funded under separate contracts; this perpetuates the isolation of services. “The payment system constrains efforts to improve integration since providers generally are not reimbursed for time spent communicating with colleagues and are discouraged by inadequate reimbursement for the longer office visits that would uncover issues beyond the primary presenting disorder.” (Bazelon, n.d. para. 17)
Unified primary care and mental health programs seems to be the sound approach to integrating care, administration and financing. By combining community health care with community mental healthcare, we are overcoming barriers of time and resource collaboration. Providers are paid by agencies for the time spent in collaboration including case-planning team meetings. Participating agencies can include mental health, health, substance abuse, Medicaid, child welfare, juvenile justice and maternal/child health. Bazelon (n.d.), “Unified arrangements are economically efficient, offering opportunities for administrative savings and physical plant efficiencies. Data from the Mental Health Services Program for Youth in Massachusetts, for example showed that in the first year it reduced per member/per month costs by 18% over the estimated capitation rate.” (para. 48)
What populations or groups were most adversely affected by deinstitutionalization? What are the benefits of deinstitutionalization?
In what ways do health care expenses affect an economy? What are the economic advantages to government involvement in health care? What are the economic disadvantages? Do you feel that government involvement has served to increase healthcare costs or contain costs? Why? What are some ways of curbing the negative effect of rising health care costs on an economy? What impact does healthcare inflation have on the healthcare reform debate?