Question

The numerous sources of financing for behavioral health services in the United States create a patchwork of programs that—sometimes in concert and sometimes in conflict—collectively form the behavioral health system for the nation. This “system” supports a broad range of patients— from those who rely on outpatient services for short-term problems to those with highly-disabling conditions who require intensive medical and social support services—as well as a range of both specialized and general providers. Experts conclude that, in general, the financing system for behavioral health services has led to great improvements in the well-being of individuals with mental health or substance abuse problems. Yet there is still unmet need for care both among those with insurance coverage and those without any source of payment for services. As policymakers debate how to best structure the overall health system to control costs and provide coverage to the uninsured, it is important to bear in mind how proposed changes will impact the complex system that finances services for some of the nation’s most vulnerable individuals.

DISCUSSION: How has mental health changed in the last 20 years? Answer this question through choosing ONE mental disorder listed in Table 9.2, found on pg 145-148 of your book, briefly describing it, how the care of this disorder has evolved in the U.S. over the past 2 decades and discuss treatment options:

• drugs
• diagnosis classification
• societal stigma & ethical considerations
• Mental health community services available (some may not have any)
• future outlook for this disorder

I would challenge you to look at current events and medical advances to enhance your post development.

Answer 1

Starting in 1954 and gaining popularity in the 1960s, antipsychotic medications were introduced. These proved a tremendous help in controlling the symptoms of certain psychological disorders, such as psychosis. Psychosis was a common diagnosis of individuals in mental hospitals, and it was often evidenced by symptoms like hallucinations and delusions, indicating a loss of contact with reality. Then in 1963, Congress passed and John F. Kennedy signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, which provided federal support and funding for community mental health centers (National Institutes of Health, 2013). This legislation changed how mental health services were delivered in the United States. It started the process of deinstitutionalization, the closing of large asylums, by providing for people to stay in their communities and be treated locally. In 1955, there were 558,239 severely mentally ill patients institutionalized at public hospitals. By 1994, by percentage of the population, there were 92% fewer hospitalized individuals.

Today, there are community mental health centers across the nation. They are located in neighborhoods near the homes of clients, and they provide large numbers of people with mental health services of various kinds and for many kinds of problems. Unfortunately, part of what occurred with deinstitutionalization was that those released from institutions were supposed to go to newly created centers, but the system was not set up effectively. Centers were underfunded, staff was not trained to handle severe illnesses such as schizophrenia, there was high staff burnout, and no provision was made for the other services people needed, such as housing, food, and job training. Without these supports, those people released under deinstitutionalization often ended up homeless. Even today, a large portion of the homeless population is considered to be mentally ill. Statistics show that 26% of homeless adults living in shelters experience mental illness.

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals focused on short-term care. In all types of hospitals, the emphasis is on short-term stays, with the average length of stay being less than two weeks and often only several days. This is partly due to the very high cost of psychiatric hospitalization, which can be about $800 to $1000 per night. Therefore, insurance coverage often limits the length of time a person can be hospitalized for treatment. Usually individuals are hospitalized only if they are an imminent threat to themselves or others.