Abstract This paper will discuss the different effects managed care has on the quality of mental health care for its clients. On the positive, managed care has increased availability to a cliental that would otherwise not be able to afford mental health care. On the negative, there has been a reduction in quality in order for managed care corporations to keep costs low and still make money. Proper implementation of managed mental health care would likely result in high quality, low cost mental health care. Introduction Two decades ago hospitals were for the physically ill and asylums were for the mentally ill. With the stigma fading from mental illness and a movement toward deinstitutionalization, this paradigm of segregation of mental and physical health care does not hold true today. A direct effect of the paradigm shift is a greater willingness on the part of the public to seek help for mental health problems. (Madonna, 2000, ¶ 6) Managed care has stepped up to fill the increasing need for inexpensive mental health care coverage. Each year, 52 million Americans have some form of mental health problem and out of those patients 60% are members of a managed care group. (Madonna, 2000, ¶ 8) Managed mental health care’s successes and failures now bear directly on the mental wellbeing of 32 million particularly vulnerable Americans. Initially managed care was intended to be a “comprehensive approach to healthcare that included balancing cost, quality, utilization, and access.” (Madonna, 2000, ¶ 23) In theory, this is an optimal approach to the delivery of health care and it has proven somewhat successful in the area of physical health, but it has not provided the same success in the area of mental health. Mental health is still being treated as a separate and less important aspect of health care despite the fact that some mental health disorders, such as schizophrenia, have shown higher success rates than those of common medical procedure, such as angioplasty. (Etheredge, 2002, ¶ 6) The Cons First and foremost managed mental health care is a business and good business often prevents good medicine. Theoretically, a well implemented managed care could work well, but in order to make their stockholders happy, managed care companies do not always implement policies to help the patient. An example of this would be the common policy of company personnel making tre... ... middle of paper ... ...business. Also, the government needs to step up and pass legislation that puts more pressure on employers to include mental health coverage. Legislation pertaining to parity was a step forward, but an employer currently can simply drop mental health coverage to circumvent the laws. Finally, it is the duty of practitioners to serve the patients best interest, not that of the managed care company. Practitioners must put pressure on managed mental health care companies to place power back into the hands of the mental health professional who provide care for the patients daily. Patients are people not numbers. References Coleman, M. (2003). Behind managed care’s courtship of clinical social workers. Behavioral Heath Management, 23, 36-37. Madonna, T. (2000). Providing mental health services under managed care arrangements. Hospital Topics, 78, 23-27. Bernard, D. & Shulkin, D. (1998). The media vs. managed health care. Archives of Internal Medicine, 158, 2109-2111. Alexander, E. (1997). Gags rules and trade secrets in managed care contracts. Archives of Internal Medicine, 157, 2037-2043. Etheredge, J. (2002). Misperceptions behind mental health policy. JAMA, 287, 1858-1859.
The fight for improved health care for those with mental illness has been an ongoing and important struggle for advocates in the United States who are aware of the difficulties faced by the mentally ill and those who take care of them. People unfortunate enough to be inflicted with the burden of having a severe mental illness experience dramatic changes in their behavior and go through psychotic episodes severe enough to the point where they are a burden to not only themselves but also to people in their society. Mental institutions are equipped to provide specialized treatment and rehabilitative services to severely mentally ill patients, with the help of these institutions the mentally ill are able to get the care needed for them to control their illness and be rehabilitated to the point where they can become a functional part of our society. Deinstitutionalization has led to the closing down and reduction of mental institutions, which means the thousands of patients who relied on these mental institutions have now been thrown out into society on their own without any support system to help them treat their mental illness. Years after the beginning of deinstitutionalization and after observing the numerous effects of deinstitutionalization it has become very obvious as to why our nation needs to be re-institutionalized.
The culture of managed care for behavioral mental health is rapidly changing. In 2014, the American health care community saw new federal legislation requiring the inclusion of behavioral health in insurance plans (retrieved: http://www.nytimes.com/2014/01/10/your-money/understanding-new-rules-that-widen-mental-health-coverage.html?_r=0) . These legislations came at the heal of several debates about the gro...
Health Care Service Corporation. Serious Vs. Non-Serious Mental Illness. 10 August 2013. blueaccess. Web-site. 9 November 2013. .
Continuing budget cuts on mental health care create negative and detrimental impacts on society due to increased improper care for mentally ill, public violence, and overcrowding in jails and emergency rooms. Origins, of mental health as people know it today, began in 1908. The movement initiated was known as “mental hygiene”, which was defined as referring to all things preserving mental health, including maintaining harmonious relation with others, and to participate in constructive changes in one’s social and physical environment (Bertolote 1). As a result of the current spending cuts approaching mental health care, proper treatment has declined drastically. The expanse of improper care to mentally ill peoples has elevated harmful threats of heightened public violence to society.
Mental healthcare has a long and murky past in the United States. In the early 1900s, patients could live in institutions for many years. The treatments and conditions were, at times, inhumane. Legislation in the 1980s and 1990s created programs to protect this vulnerable population from abuse and discrimination. In the last 20 years, mental health advocacy groups and legislators have made gains in bringing attention to the disparity between physical and mental health programs. However, diagnosis and treatment of mental illnesses continues to be less than optimal. Mental health disparities continue to exist in all areas of the world.
“Insurance companies often cover mental illness in a more limited fashion than physical illness” (Christensen). The lack of mental health care provided for the mentally ill has been a growing issue in the US during the previous years, and there has been some progress. For example, there has been the Mental Health Care and Parity Law of 2008 that was enacted so that the insurers would cover mental illness just as they would cover other illnesses. In addition, the Affordable Care Act was enacted to enforce that the insurers abide by the rules. Unfortunately, that hasn’t helped much, hence: the sneaky behavior of insurance companies. This sneaky behavior seems to be unnoticed by the government the majority of the time unless the patient or his family decides to file a lawsuit. Until then, insurance companies have been constantly bending rules and finding loopholes to not pay insurance for mental illness.
In the case of changing the mental health policy in North Carolina, the impetus for the change seems to be adopted by the State Auditor’s report beside other reports of many entities confirming the deviation of mental health service away from its original goal. According to these reports, mental health services are still delivered via traditional health delivery models rather than coordinated well-managed ones. Interestingly, these reports analyze the spectrum of mental health services nationwide with the exception of the State Auditor’s 2000 report Study of the Psychiatric Hospitals and the Area Mental Health Programs which was specifically designed for the North Carolina.
If the United States had unlimited funds, the appropriate response to such a high number of mentally ill Americans should naturally be to provide universal coverage that doesn’t discriminate between healthcare and mental healthcare. The United States doesn’t have unlimited funds to provide universal healthcare at this point, but the country does have the ability to stop coverage discrimination. A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at those services from 2005 to 2009. 3 Separate research from the same agency found 45 percent of those not receiving mental health care listing cost as a barrier.3 President Obama and the advisors who helped construct The Affordable Care Act recognized the problem that confronts the mentally ill. Mental healthcare had to be more affordable and different measures had to be taken to help patients recover. Although The Affordable Care Act doesn’t provide mentally ill patients will universal coverage, the act has made substantial changes to the options available to them.
In conclusion, managed care integrates the functions of financing, insurance, delivery, and payment within an organization. It also exercises formal control over utilization. Managed care is viewed as accepting the lowest competitive bid for services rendered. Today, HMOs and PPOs are the most common and widely used models for managed care. Although managed care is here to stay, it requires revision in some areas. Challenges that are to be faced include double agentry, fidelity, confidentiality, honesty, and vulnerability. With the help and guidance of health information professionals, managed care will continue to escalade and become better for all.
First off, clinical social workers work one-on-one with individuals by utilizing psychosocial casework to improve their client’s lives. Social workers at the micro level typically provide case management by coordinating and monitoring services, developing a treatment plan, advocating for new services, providing psychoeducation, and by helping clients learn more about their specific disorder (Marx). They also provide psychotherapy through three major therapeutic approaches- psychodynamic, cognitive-behavioral, and humanistic (Marx). When it comes to the mezzo level social worker work with groups and families. They may initiate therapy groups, support groups, psychoeducational groups, and socialization groups all in order to uplift their clients about their mental disorder (Marx). On top of that, social workers also offer family therapy with the goal of helping families learn and function effectively by meeting the needs of a family member with a mental illness (Marx). Finally, social workers also work on a macro level through advocacy and policy changes, and in an administrative setting. Through advocacy, social workers may lobby for policy changes on a local, state, or national level in order to promote positive
The NSDUH reports that individuals with a mental illness is more like to also have a chronic health condition and are more likely to use hospitalization and emergency room treatment (NSDUH, 2014). According to SAMSHA (n.d.), 50% of Medicaid enrollees have a diagnosable mental health condition. Individuals with a diagnosed mental health condition have health care cost that is 75% higher than those without a mental health diagnosis (SAMSHA, n.d.). For an individual with a co-occurring disorder the cast is nearly three times higher than what the average Medicaid
Those with mental illness would live in the community with an array of services and be able to be free from the constraints of confinement. In the early 1960’s the United States began an initiative to reduce and close publicly-operated mental hospitals. This became known as deinstitutionalization. The goal of deinstitutionalization was to allow people suffering from mental illness to live more independently in the community with treatments provided through community health programs. Unfortunately, the federal government did not provide sufficient ongoing funding for the programs to meet the growing demand. States reduced their budgets for mental hospitals but failed to increase funding for on-going community-based mental health programs. As a result of deinstitutionalization hundreds of thousands of mentally ill people were released into the community without the proper resources they needed for their treatment. (Harcourt,