Unprotected and Unparticipation Mental Health in Regulation Worker

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Opportunities in mental health services research.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Mitigating the Impact of Coronavirus Disease-2019 on Child and Family Behavioral Health: Suggested Policy Approaches

Health Care Reform and Care at the Behavioral Health--Primary Care Interface

Back to table of contents Previous article Next article Professional NewsFull AccessUntreated Chronic Illness Blamed for High MortalityRich DalyRich DalySearch for more papers by this authorPublished Online:15 Aug 2008https://doi.org/10.1176/pn.43.16.0007Contrary to what may be a popular belief, a person with serious mental illness is more likely to die of a heart attack or complications from diabetes than by suicide.Misperceptions about the health care needs of people with mental illness extend even to health care professionals, which may be one of the reasons such patients are dying prematurely—25 to 30 years earlier than other Americans, according to federal health statistics. This gap in life expectancy is an increase from the 10- to 15-year mortality difference in the early 1990s between individuals with mental illness and others.To reverse this trend, advocates for people with mental illness recently called for federal intervention, including improving the tracking of these individuals' physical and mental health; removing obstacles to their receiving quality, integrated physical and mental health care; and encouraging primary care providers to work in close proximity in the same facility with mental health clinicians to improve provision of that care.“We have to get past the point of psychiatrists saying 'I don't do that internal medicine stuff,' and internists saying 'I don't want to take all of the time that people with mental illness need,'” said Joe Parks, M.D., medical director of psychiatric services for the Missouri Department of Mental Health.Parks and other mental health experts briefed congressional staff in June on the need for federal efforts to reverse the declining life expectancy for people with serious mental illness. The briefing was organized by the Senate Mental Health Caucus.It was Park's 2007 report that identified the lower life expectancy of people with serious mental illness compared with the general population and that dispelled the “suicide” stereotype behind the early deaths. Early deaths, Parks said, were largely due to untreated or undertreated nonmental chronic health conditions. Among the leading preventable medical conditions driving the increased morbidity and mortality in this population were metabolic disorders, cardiovascular disease, and diabetes mellitus.Park's research also found a high prevalence of modifiable risk factors, including obesity and smoking. Cigarette use, he noted, is so widespread among people with serious mental illness that they now smoke about 44 percent of all cigarettes sold in the United States. “We really need to focus on smoking because it is a big opportunity” to prevent disease and death, Parks said.The prevalence of risk factors among people with serious mental illness is exacerbated by poor health care access among this population and by the stigma they face—even from medical professionals, according to a consensus of the literature.Similar health disparities exist even in populations with broad access to health care, such as veterans, said Barbara Mauer, a health care consultant in Seattle. Mauer, who has studied the issue, blamed both the negative attitudes of health care providers toward mental illness and a failure to educate patients to seek both needed mental and primary health care.Research studies designed to address disparities between mental health care and general health care have found health improvements when nurse case managers coordinate both mental and physical care for each patient, while educating and giving patients new skills to better manage their own illnesses.Analysis of one nurse case manager pilot program found that medical problems were newly detected by staff in one-third of participating patients taken to a mental health facility for evaluation and treatment. At the same time, there was an increase in disease-prevention health care provided to these patients.Another pilot program approached the challenge of split—and therefore fragmented—mental and general health care from the behavioral health care side by placing nurse practitioners in mental health clinics. In one such program in Massachusetts, the nurse practitioners ensured that the mental health patients also received general health care services.A Colorado pilot program that is addressing health care providers' negative attitudes toward mental illness and improving access to care has found some success. The integrated care program in Summit County combined the staffs of a community health center and a mental health clinic to create “care teams” of general and mental health care providers within a facility that had previously emphasized general health care. The program provided training for the mental health staff in the common physical health care needs of people with mental illness and educated the general health care providers on signs that patients may also need mental health and substance abuse treatment.Among the biggest impacts of the program was the improved communication it encouraged between two traditionally separate organizations, to the extent that both were comfortable referring patients and seeking additional information from the other side of the program.“It's important to share our knowledge and share our ignorance,” said Helen Royal, a nurse in the program.Advocates at the congressional briefing said the federal government can encourage such pilot programs by including funds for them in their established grant programs.Also, the Community Mental Health Services Improvement Act (S 2182 and HR 5176) would create a new grant program through the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund the co-location of primary care services within mental health organizations. The legislation, which would provide $50 million in grants for the first year of a five-year program, was included in draft legislation to reauthorize SAMHSA, but that legislation has stalled for the year.Supporters are optimistic that the grant program will be revived in Congress next year, along with efforts to require insurers to cover smoking cessation and obesity treatment programs.The text of S 2182 and HR 5176 can be accessed at<http://thomas.loc.gov> by searching on the bill numbers. ▪ ISSUES NewArchived

A conceptual framework for the revision of the ICD‐10 classification of mental and behavioural disorders

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Previous analyses demonstrated an elevated occurrence of perceived unmet need for mental health care among persons with co-occurring mental and substance use disorders in comparison with those with either disorder. This study built on previous work to examine these associations and underlying reasons in more detail. Secondary data analyses were performed on a subset of respondents to the 2002 Canadian Community Health Survey (unweighted N=4,052). Diagnostic algorithms classified respondents by past-year substance dependence and selected mood and anxiety disorders. Logistic regressions examined the associations between diagnoses and unmet need in the previous year, accounting for recent service use and potential predisposing, enabling, and need factors often associated with help seeking. Self-reported reasons underlying unmet need were also tabulated across diagnostic groups. Of persons with a disorder, 22% reported a 12-month unmet need for care. With controls for service use and other potential confounders, the odds of unmet need were significantly elevated among persons with co-occurring disorders (adjusted odds ratio=3.25; 95% confidence interval=1.96-5.37). Most commonly, the underlying reason involved a preference to self-manage symptoms or not getting around to seeking care, with some variation by diagnosis. The findings highlight potential problems for individuals with mental and substance use disorders in accessing services. The elevated occurrence of perceived unmet need appeared to be relatively less affected by contact with the health care system than by generalized distress and problem severity. Issues such as stigma, motivation, and satisfaction with past services may influence help-seeking patterns and perceptions of unmet need and should be examined in future work.

How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV