Integrating Primary Care And Specialist Mental Health Care

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5.2.2 Integrating primary care and specialist mental health care in an enhanced environment of a community based setting, involving Community –based health teams (CMHT) for patients with severe mental illness (SMI) OECD study (2012) found that approximately 5% of the working-age population have a dangerous mental disorder, such as schizophrenia, bipolar disorder, or life-threatening depression. (OECD 2014, Ch 3). The appraisals of the burden of disease reported by WHO (2013) identified schizophrenia as making up the 17th greatest burden of disability adjusted life years (DALYs), with bipolar disorder at 18th; schizophrenia accounted for an approximated 13.1 million DALYs lost in 2011, with bipolar disorder accounting for 13 meg. Moreover, people with SMI experience increased co-morbidities with physical ill-health, and reduced life expectancy (OECD 2014, Ch. 3). What is more disconcerting to note is that there exists a high treatment gap for severe mental disorders. In a study comparing treatment gap countries around the globe, the median treatment gap was found to be 32.2% for schizophrenia and 50.2% for bipolar disorder (Kohn et al., 2004). A cross-national study by WHO of 439 patients with major depression followed for 10 years found that 36% were readmitted to hospital; 11% committed suicide; and more than 18% received a poor clinical outcome (Kohn et al 2004). For people with mental disorders having serious, enduring and disabling conditions (like intellectual disabilities, schizophrenia and dementia), there is an urgent need for deinstitutionalisation and provision of acute and continuing care services closer to the communities where those affected live (Patel et al 2010). While ‘General’ hospital services (short stay w... ... middle of paper ... ...sociated with the ACA must be at full parity. This provision means that insurers are prohibited from capping annual and lifetime spending for mental health and addictions treatment at levels below the caps imposed for physical health treatment (Croft et al 2013). In addition, according to these authors, several elements of the ACA have the potential to move systems towards integration through financing and reimbursement changes and incentives Further, under the provision of ACA, nearly all individuals under age 65 who have incomes below 133% of the federal poverty level will be eligible for Medicaid. In the USA, under the Medicaid program, the ACA creates a health home program to promote integrated care. Beneficiaries with a serious and persistent mental illness, or and with comorbid chronic medical condition, are eligible to participate in the health home program.
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