The mental health crisis

Public funding for behavioral health care continues to dwindle, and the number of psych facilities and providers can't meet the demand. What are some hospitals doing to avert a growing crisis?     

A 'quiet' crisis in health care: developing our capacity to hear

Abstract In this paper we suggest that it is a mistake to understand the current situation in nursing as primarily a problem of 'shortage', a problem which may be solved through supplying 'more nurses, faster'. This way of thinking is understood as reflecting an invalidation of nurses and nursing and, by fostering false beliefs about nursing, as functioning to exacerbate rather than resolve the current situation. Unlike many mainstream conceptualizations of the current situation in nursing, we begin by understanding the experiences and concerns of nurses as meaningful. Feminist and hermeneutic philosophies, as well as Foucauldian perspectives on discourse, encourage us to take seriously the gender relations of power through which nursing comes to be articulated and to cultivate ways of thinking which can generate more productive analyses of the current situation in nursing. Rather than accepting instrumental understandings of nursing as adequate, we question the everyday beliefs and assumptions, the dominant discourses at work both in the world and in ourselves, which allow the suffering of nurses to be thought irrelevant and their concerns to remain unheard. We theorize both why the suffering of nurses can be considered irrelevant in this way and the difference it would make were we to take the experiences of nurses seriously. This undertaking requires that we reflect on that which constrains – and enables – the ways we are able to write, speak and think about nursing.     

The mental health services program for youth

This paper traces the development of The Robert Wood Johnson Foundation’s Mental Health Services Program for Youth, a private initiative designed to improve the organization, financing, and delivery of service to seriously mentally ill youth. The rationale and structure of this five-year initiative are discussed. In July 1989, 12 one-year development grants were awarded under the program’s first phase. All of the grantees propose to utilize a number of strategies to restructure their mental health financing systems. Other common features include: the development of central intake units, early identification mechanisms, stronger utilization review protocols, and unified client tracking mechanisms.     

Debt crisis, health and health services in Africa

In the early 1960s when most of Africa became independent, the hope for the resolution of the related problems of poverty, illiteracy and disease became the primary agenda of its sovereign states. There were indeed initial gains in various aspects of social infrastructure, especially education and medical services. Beginning from the mid 1970s, but particularly since 1980, this initial progress is, however, being reversed as Africa totters under an excruciating debt burden and accompanying austerity programmes. This essay provides a kaleidoscope of this ominous decay with particular reference to health and health services. Several proposals for the way forward are discussed.     

Priority setting in mental health services

This paper sets out an approach to priority setting in mental health services, built around programme budgeting and marginal analysis (PBMA). The paper also discusses the question of building in equity, especially the concept of vertical equity which, given the relative neglect of mental health services when resources have been allocated in the past, might serve as a mechanism for redressing the imbalance in resource allocation to the mentally ill. Beyond that the importance of eliciting community values to aid priority setting in mental health services is highlighted, particularly with respect to the principles underlying the mental health services or what one might call 'the nature of the good' that society wants from its mental health services. While it can be argued that trying to ascertain these principles or the nature of the good applies in all health services--and that is not disputed here--in mental health there is yet more need for clarification than in many other, indeed most other, health services. The need to exercise value judgments is emphasised. There is also a word of caution on the dangers of over-reliance on waiting for perfect evidence. Finally the paper considers how best to operationalise priority setting in mental health services, and perhaps make it less of a nightmare for mental health service planners than it currently seems to be.     

Making mental health services affordable

The prevalence of mental health problems is far more than what is perceived by the general public. The billions of dollars of lost productivity due to mental health problems and the affect of mental health on total health costs cannot be ignored.