Unequal Coverage for Psychiatric & Behavioral Disorders Responses
Post 1
When I lived in Venezuela, I was doing my clinical practicum in el Hospital de los Chorros (IVSS) which is Social Security in my country. The conditions were heartbreaking, no power, water, food or even medications to treat patients. They were mainly patients who had affective disorders, ranging from SquizoAffective, Squizophrenic to Bipolar. This is the experience I attribute most of my clinical knowledge to, since the Head of the Psychology Department thoroughly trained us in diagnosing with CIE-10 and would prompt us to work directly with patients constantly. If anything, this experience has made me want to become a better professional in order to be able to make a difference when I go back.
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I had a close friend arrive to the center when I was there, about to have a psychotic episode due to substance abuse. I was in shock, my supervisor told me about the case and then I started realizing who it was because she mentioned my university and described him physically. He was denied care because he was not psychotic and in that hospital, they only provide inpatient care when they are Baker Acted or hospitalized against their will by a family member. These conditions make mental health in Venezuela a challenge, regardless of your economic position, social class or possibilities to access professionals. They are underpaid or not paid at all and have to work under nonhumane conditions. This definitely marked me and makes me appreciate other systems that function, period, whether they have flaws or not.
Post 2
The organization and financing of mental health services.
Mental health services are the means by which effective interventions for mental health are delivered. The way these services are organized has an important bearing on their effectiveness.
According to the textbook, poor coordination of facilities and services has led to the mental health service delivery system being called de-facto mental health service system, which is organized and structured in four sectors; they are characterized by poor communication and isolated funding flows.
1. The psychiatric and behavioral health sector consists of behavioral health professionals, such as psychiatrists, psychologists, psychiatric nurses, psychiatric social workers, and behavioral health physicians working in outpatient settings.
Acute care is provided in psychiatric units of general hospitals or beds located in hospitals, and Intensive treatment for adults and children is provided in private psychiatric hospitals, with residential treatment centers available for children and adolescents.
2. The primary care sector is the initial point of contact, it made up of health professionals, such as internists, family doctors, pediatricians, and nurse practitioners in private practices, clinics, hospitals, and nursing homes.
3. The human services sector consists of social service agencies, school-based counseling services, residential rehabilitation services, vocational rehabilitation services, criminal justice/ prison-based services, and religious professional counselors.
4. The volunteer support network sector consists of self-help groups and family advocacy groups. This sector has been invaluable in shifting public attention to people with persistent and severe mental illness.
According to the textbook, Mental health services are funded in many ways, including private health insurance, Medicaid, Medicare, state and county funding, as well as contracts and grants. The history of insurance coverage for behavioral health services has been one of unequal coverage for psychiatric and behavioral health disorders when compared to coverage for non-psychiatric medical illnesses. Insurance inequalities have taken many forms and imposed limitations on the amount and kind of care people with chronic and severe mental illness, such as schizophrenia, have been able to access.
Financing is an important factor for the realization of a viable mental health system, it is a mechanism by which plans and policies are translated into actions through the allocation of resources. With funding, a resource base is created for operations and delivery of services, for the development and deployment of a skilled workforce, and for the infrastructure and technology.
According to the text book, the Mental Health Parity Act of 1996 allowed for many cost change loopholes, such as setting limits on days of psychiatric confinement, prescription drugs, outpatient visits, increasing coinsurance and deductibles, and modifying the definition of medical necessity.
The law did not require employers to offer mental health coverage, nor did it impose limits on insurance copays, deductibles, days, or visits. So the importance of the ACA to US behavioral health services is enormous, millions of low-income people who previously lacked their rights and their children now have access to Medicaid, removing major financial barriers to access to psychiatric and behavioral health care services.
Financing is a fundamental pillar on which the other critical aspects rest. As such, funding is not only an important driver of the system, it is also a powerful tool, with which policymakers can develop and shape mental health services and the impact of their service.
Post 3
The historical trends and the forces effecting the distribution and types of mental health services
Mental health facilities in the US date back to as early as 1817 when the first asylum was established, which was the closest thing to a mental health care facility. The facility offered room for specialized psychological care for the mentally ill while they engaged in other activities such as work, education and recreation. The situation in the asylums remained unchanged until post world war one when biological treatment of mental illness such as psychosurgery and insulin coma were embraced. Special attention was paid to mental illness owing to the large number of veterans who were mentally ill after the war. In light of the need to attend to mental health issues, the federal government passed the National Mental Health Act that led to the establishment of National Institute of Mental Health in 1946. Through state and federal government funding, a series of psychiatric hospitals and clinics were established.
Until the mid-1950s, psychiatric services were provided by the state psychiatric hospitals which at these points were overwhelmed by huge number of patients (Young & Kroth, 2017). Substandard quality of healthcare services offered in the psychiatric facilities prompted congress to push for further funding that intensified community based mental health care services alongside the reliability of Medicare and Medicaid in attending to mental health patients. The expansion of the facilities saw more professionals venture into the field as fewer patients experienced severe mental illness. Overtime, the cost of treatment was faced and some reforms in insurance policies took form. Insurance policies shifted towards ambulatory care within community health centers and nursing homes. Treatment has ever since been focused more towards outpatient services while a series of reform make Medicaid and insurance covers more efficient in catering for the cost of treating mental illness.