Emotional and cognitive well-being are phrases used to describe mental health. Positive coping mechanisms and an assessment of suicide lethality are assessments providers consider when identifying a psychiatric patient. Those that suffer from mental health disorders are every- where, they are our neighbors, friends, family members, and our patients. When someone can no longer cope with stress is usually when some type of intervention is sought or furnished. This fractured mental state is very fragile and has great potential to deteriorate quickly and possibly violently.
It is in this exposed state this population finds themselves, vulnerable. Population Demographics Mental health disorders can affect anyone at any given time in any age group or demographic. Disabilities can range from mild to the most severe and characteristically, run the gamut. Centuries ago, there was a stigma with mental health where imprisonment was thought to be the logical solution. Nineteenth century insane asylums held the promise of compassionate rehabilitation; unfortunately, lapses in funding prohibited this dream from becoming a reality (“Kirkbride Buildings”, 2001-2012).
Dr. Kirkbride, advocate of the tenets of Moral Treatment, foresaw a treatment facility that was idealistic in grandeur and architecture where he hoped to create a place of healing for the mentally ill. With plenty of fresh air and open spaces, “these asylums replaced cruder methods of coping with the mentally ill, such as confining them to prisons or poorhouses where they were often abused and their special needs were rarely met” (“Kirkbride Buildings”, 2001-2012).
Sadly, his humanitarian movement was thwarted by over-crowding and under-funding; leaving these beautiful buildings and altruistic ideals subject to the elements and deteriorating morals of how to treat this special population. Many movies have been made regarding the occupants of these haunting facilities; in which we see children, men and women of all ages. Mental illness doesn’t see a poverty line, age group or education level. It can lay dormant waiting for an opportunity to expose itself or can manifest at an early age where commitment to a then facility, or now, program holds the promise of a better life.
Why is the Psychiatric Population Vulnerable The psychiatric population is vulnerable for several reasons. Historically, they have been vulnerable as they were made into science experiments where physicians attempted barbaric methods like frontal lobe lobotomy and the controversial electroconvulsive therapy, better known as ECT. Though patients now still suffer from chronic assertions of providers to know what’s best for them, this population doesn’t seem to have many advocates in the national arena.
In an article by Schomerus, Matschinger, and Angermeyer (2006), they conducted a survey where they examined where the public preferred to see spending cut. “Participants were presented with a list of nine medical and mental diseases including alcoholism, depression, schizophrenia, Alzheimer’s disease, cancer, diabetes, rheumatism and AIDS and were asked to name three conditions where they would prefer to see health-care resources cut” (p. 369). Sadly, their conclusion was that most participants were willing to cut funding for psychiatric illness.
The authors state (2006), “Mental diseases evoked a far greater desire for social distance than most medical diseases which had considerable influence on resource allocation” (Schomerus, Matschinger, & Angermeyer, p. 369). So it would seem even though insane asylums are a thing of the past where mental health patients were truly out of sight out of mind, society has kept them imprisoned by their willingness to cut spending thus perpetuating the stigma and “social distance”. Ironically, advertisements put mental illness like depression in our faces at every commercial break.
Medications and wellness for depression, alcoholism and PMDD grace our living rooms every day, all day. In the late 90s more and more advertisements for medications to treat depression were allowed to run to try and “de-stigmatize” seeking help for mental illness. “Ask your doctor”, “break free from depression”, follow Karin’s story on Abilify. com; these tactics were to help the viewer at home identify with the illness so they may begin to educate themselves (Stresing, 2010).
Though this breaking down of barriers and giving patients courage to take the first step in seeking treatment is, and has been, widely accepted and motivating, it has excluded and sustained the social distance of more serious illnesses like schizophrenia, bipolar and multiple personality disorders to name a few. According to the Mental Health America website (2012), ECT is making a comeback. They assert with “the increase in the elderly population and Medicare, and the push by insurance companies to provide fast, “medical” treatment rather than talk therapy” (para. has created yet another potentially dangerous field to navigate.
Is it appropriate to treat these elderly patients with ECT when they have pre-existing medical conditions, specifically cardiac conditions where an electric shock could be fatal? Who is the advocate for the elderly widow without family to speak for her should she become so incapacitated by mental illness this becomes a viable option? This patient is vulnerable to the wills of society, and physicians who will do what with her; commit her to a state run facility where her future and livelihood is in their hands.
Challenges Facing the Psychiatric Population Creating Vulnerability The challenges facing this population are plentiful; multiple providers, lack of continuing care, individual inability to stick to a treatment plan, lack of resources, being cut loose from treatment centers due to insufficient coverage, and medications cut from Medicaid are complications that resemble a virtual minefield the mentally ill patient is unlikely to navigate. Further challenge is for providers to take the mental health patient eriously.
With constant digression back into an acute phase of their illness and non-compliance, it is difficult for providers to trust the mental health patient will succeed in managing their medications and triggers. It is even more difficult to ascertain what is mental illness and what is true illness; many potentially life endangering diseases could be missed because a schizophrenic patient makes so many trips to the local ER he gets treated more like a ’psych patient’ than a true medical patient.
The cost of return visits is up there with the non-compliant diabetic, more if the patient needs further outpatient care. In an article by Walker & Eagles (2009), they contend “in the period following discharge from hospital, psychiatric patients are at high risk of readmission. Within the first 6 months, readmission occurs for between 20 and 40% of patients” (p. 241). Poor communication between providers can account for this lack in continuing care that may be partly responsible for the frequent re-admissions.
Without the ability to give a medical report on themselves, the very people there to help the psychiatric patient are failing them in the most basic of ways. In a study by Hospitals & Health Networks (2008), they discovered of the significant barriers to care a largely unconsidered one is “a lack of understanding about how the mental health system works” (p. 77). More than half of those polled had lack of knowledge of the process, concerns about the cost and lack of insurance coverage (H&HN, 2008, p. ).
Typically, the psychiatric patient is insured through Medicaid, if at all, which is receiving backlash for cutting funding to their insured. In a report by the national Alliance on Mental Illness, authors Honberg, Kimball, Diehl, Usher and Fitzpatrick (2011) illustrate the cutbacks, “on June 30, 2011, federal stimulus funds that temporarily increased the federal match for Medicaid expired, resulting in the projected loss of $14 billion dollars for state Medicaid programs.
The National Association of State Budget Officers estimated that state Medicaid spending would rise by 19 percent, largely because of the loss of these federal stimulus dollars” (p. 4). Though comparison of the overall big picture of federal and state cuts to mental health funding to the proportion of those actually mentally ill is necessary, the fact remains, financial support for this demographic has been dwindling over the last 3 years. “Advocates in Arizona say the loss of virtually all services for 12,000 unqualified individuals diagnosed with serious mental illness has caused harm to the people.
Hundreds have been incarcerated, hospitalized due to psychotic breakdowns or fallen through the tattered safety net and disappeared. For example, St. Joseph’s Hospital and Medical Center in Phoenix saw a 40 percent spike in emergency room psychiatric episodes after services were eliminated for those who do not have Medicaid” (Honberg, et. al, 2011, p. 5). Reports such as these are staggering and leave this vulnerable population in a seriously disadvantaged position.
Impact of the Psychiatric Population on the Health Care System With such a great influx of mental health related emergency room visits across the nation, the cost of healthcare will continue to rise. Frequent digression into illness and lack of access to continued care further creates a financial burden on the health care system. According to Cawthorpe, Wilkes, Guyn, Bing & Mingshan, (2011) “Having a mental health problem is related to greater health-related expenditures. This has important policy implications on how mental health resources are constructed and rationed within the health care system” (p. 1).
In a review of 3,256 co-eds at Hofstra University, John Gutham, director of student counseling, learned 96% were diagnosed with a mental disorder in 2009; 24% of these students were taking psychiatric meds and a significant portion were suicidal (“More college students today are mentally ill,” 2010). With counseling, however, Gutham observed a significant decline and “attributed the drop to better suicide prevention and more awareness of available resources” (“More college students today are mentally ill,” 2010, p. . More and more of the population are identifiable as having a mental health illness or disease yet health care systems can’t keep the funding flowing to facilities set-up to relieve the burden from city ER’s (Honberg, et. al, 2011).
Provider burnout and fatigue, especially in the rural setting, can complicate the frontline delivery of care. Kee, Johnson & Hunt (2002) point out there isn’t sufficient research to support mental health provider burnout, but do categorize the risk factors.
Rural mental health counselors are inclined to be subject not only to the stress of working in a public setting, but they also face an unusual array of potentially stressful conditions endemic to the rural community. These include ethical issues related to limits of competence and dual relationships, impact of deteriorating economic base on funding for mental health services, geographic barriers to the delivery of social services and professional isolation” (para. 5). These categorical risk factors are such that their urban counterparts may fall victim to one or several of those mentioned as well.
The perpetual lack of funding and inevitable provider burnout will put these patients out in the streets, so to speak, putting pressure on public law enforcement to pick up the pieces; thereby creating a different expense unto the state they live in. Budget cuts are across the board, law enforcement agencies are on a hiring freeze, lack of public law enforcement personnel can greatly endanger the public when such an influx of mentally ill patients are without sufficient care and a place to go.
Analysis of how Stakeholders in Various Sectors of the American Health Care System are Affected by the Psychiatric Population Maintaining the status quo in health care represents a significant threat to government finances, the economy, Americans’ standard of living, and our nation’s future. Each one of us is a stakeholder in the American health care system. It is our duty as stakeholders to understand the ever-changing world we live in. One group that would be beneficial to become stakeholders in the mental health crisis is pharmacists.
In article regarding the evolution and explanation of Medicare Part D, Dr. Beirdt (2005) submits pharmacists becoming stakeholders and being reimbursed for their time. Though details would have to be worked out and a regulatory system in place, Dr. Beirdt goes on to say, “I think it is a good way for providers to get to know pharmacists better and pharmacists to get to know providers better, and create a team for the benefit of the patient, especially when it comes to psychiatric patients” (p. 25).
This type of pharmaceutical involvement is reminiscent of times when there was only one pharmacist in a town; in our society of abundance, a patient has a choice in pharmacies on every corner. Anonymity in the pharmacy is prevalent, and loyalty to one pharmacist is unlikely. Perhaps the re-creation of the patient/pharmacist relationship will help this population find solace; help them to believe someone out there does care about their well being. How Can the Health Care System Best Serve the Psychiatric Population The US health care system needs to re-kindle the Humanitarian effort Dr. Kirkbridge started centuries ago.
The mental health care system cannot survive in the hobbled, swiss cheese state it’s in. Honberg, et. al (2011) suggest some policy recommendations that make sense. “Beginning with restoring the spending cuts, protecting and strengthening mental health services. Improving data collection and outcome measurement for mental health services and preserving access to acute care and long-term care services” (p. 6). As a society we need to protect our future in healthcare; we are stakeholders that have to insure there will be a system in place for our descendants.
Acute episodes needing hospitalization can potentially further cripple our rural and urban hospitals. More and more children are being treated with mental health disorders such as attention deficit disorder and bi-polar disorder; future generations need systems in place where they can seek positive treatment and become functioning members of society as opposed to frequent flyers in the ER. Conclusion Much work is to be done if the US health care system is to find a solution to the many problems it faces.
In a time of shrinking resources, states face difficult choices about the extent to which resources are targeted for inpatient treatment or community based services” (Honberg, et. al, 2011, p. 7). The population of mentally ill is growing and seems to be everywhere we look. As a society, we can no longer turn a blind eye to the problems this population faces. For the mentally ill, accountability can’t truly be a viable option; it has to lie within compassionate policy makers and budget cutters to see the harm they create for our Nation’s men, women and children.
Courtney from Study Moose
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