Planning for mental health services

This article outlines the model used to develop and analyze the data needed for the mental health component of a health system plan, required under Public Law 93-641. The model includes a review of existing utilization patterns, an assessment of community levels of risk, and the forecasting of the need for mental health services.Thomas M. Wernert is Executive Director of the Lucas County Mental Health and Mental Retardation Board, One Stranahan Square, Suite 517, Toledo, Ohio 43604.     

Planning mental health services for chronic patients.

At the present time, deinstitutionalized services for the chronically mentally ill are less than satisfactory. If planning for the future is to reverse the trend of incomplete service delivery for this population, it must start with the recognition and application of certain fundamental concepts. Effective planning requires idealism, vision, and a sense of reality. Six separate but interrelated dimensions of reality must be taken into account: the need for mental hospital; the importance of precise planning goals; the unique service needs of the chronically mentally ill; the need for interagency planning; the importance of a functioning and sensitive patient tracking system; and appreciation of the attitudinal structure within which services are delivered. Wherever the chronically mentally ill live, whether in the hospital or in the community, their requirements must be made the primary focus in mental health planning.     

Planning mental health services: II. Current Canadian initiatives.

A brief overview of recent policy developments across Canada and a discussion of the common themes and challenges they address demonstrates the scope of activity in this field. The federal level of mental health planning and a summary of recent of policy developments in each province are described. Significant progress has been made in Canada in the development of mental health services since deinstitutionalization. Major challenges remain, however, which are being addressed to varying degrees across the country. The challenges related to the key issues of major mental illness, integration and consumerism are illustrated.     

Tertiary mental health services: I. Key concepts.

There are some individuals with severe and persistent mental illnesses who cannot be managed by primary and secondary services and who require tertiary care. Such clients are characterized by aggressiveness, noncompliance with medication, and dangerousness. Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services. Increasingly, organized systems have been developed to ensure that individuals meet criteria for tertiary care and receive the most appropriate level of care. Most importantly, the delivery of tertiary care must not be tied to particular settings or time frames, and level of care must be delinked from model or location of care in order to create flexible, efficient, effective mental health services.     

Changing mental health services in Madrid: international issues

With the backing of a socialist government that came to power in 1982, mental health services in Spain are shifting away from institutional and custodial care toward community-based services. Provincial governments now control most mental health programs as a result of a law passed in 1983. In Madrid, mental health service priorities include preventing psychiatric hospitalization, developing a range of residential facilities, reducing the population of chronic patients in hospitals, and improving the quality of hospital care. A network of 20 health promotion centers is being developed to serve newly identified patients, while long-stay hospital patients who can be discharged will become the responsibility of social services. From an international perspective, the most interesting aspect of the Spanish transformation is how the country will deal with the problems other nations have encountered in implementing systems reforms.     

Major issues in mental health services for children

One of the most neglected groups in the mental health field has been children and adolescents. In recent years, however, there has been increased interest on state and national levels in improving services, particularly for seriously emotionally disturbed children. This paper identifies and discusses major issues that policy-makers need to address in order to enhance mental health services for children and adolescents. These issues include creating a balance between different types of services, reducing reliance on residential treatment, improving coordination of children's services, creating a public sector—private advocate partnership, establishing community-based systems of service, and strengthening fiscal policies.Dr. Friedman is with the Florida Mental Health Institute of the University of South Florida, 13301 N. 30th St., Tampa, Florida 33612.     

Community mental health services in rural areas: Some practical issues

Several critical issues involved in successfully initiating and maintaining a community mental health center program in a rural setting are discussed. These include the necessity of accurately assessing the existing social, cultural, and political system, and of fitting the mental health center program into these systems as smoothly as possible; the special problems faced in maintaining confidentiality; and the importance of recognizing and dealing with the front-line pressures on professional staff that are peculiar to the rural setting. Advantages as well as disadvantages of working in a rural program are considered.Mr. Jeffrey was affiliated with the Blue Ridge Community Mental Health Center, 1602 Gordon Avenue, Charlottesville, Virginia at the time the article was written.     

Developing needs led child and adolescent mental health services: issues and prospects

For many years mental health services for children have been developed incrementally with little attention to the needs of the local population. However, over the past decade there have been attempts to develop more rational ways of planning child mental health services. This paper describes the information required to develop a needs-led child mental health service and, within that context, discusses how priorities should be set. It will be suggested that although the assessment of needs for child and adolescent mental health services is still very haphazard, there is now a clear trend for the evaluation of clinical practice to become more systematic. At an individual level we know quite a lot about the efficacy of treatment and the measurement of outcomes. At the service level, several models of good practice are being specified and evaluated. Accepted: 16 September 1998     

A front line police perspective of mental health issues and services

Background Changes in mental health service provision in most western countries have been associated with an increasing role of the police in the community management of people with mental health problems, but little is known about how the police perceive this in the UK. Objectives To investigate police officers' views on their roles in dealings with people with mental health problems and with mental health services. Methods Nine in‐depth semi‐structured interviews were conducted with front line police officers. These interviews were analysed for recurrent themes using interpretative phenomenological analysis. Results The recurrent themes identified were: emotional aspects of dealing with people with mental health problems and with services, impact of incidents on police resources and on people with mental health problems, success through collaborative working with health services and failure in its absence. Conclusions Police officers' experiences of work with people with mental disorder in the community in Scotland had much in common with those previously reported in the USA and in Australia. Development of more collaborative approaches and mutual respect between the police and mental health service providers would resolve many of the currently perceived difficulties. Copyright © 2010 John Wiley & Sons, Ltd.     

Critical issues in the JCAH accreditation program for community mental health services.

Since its introduction in 1976, the accreditation program for community mental health centers and services has been the focus of considerable comment, both positive and negative. Much of the criticism of the program derives from its theoretical framework, the Balanced Service System, with its unfamiliar service structure and terminology. The author, who played a leading role in developing the accreditation program, discusses the major concerns of the critics and the program revisions that have been made to deal with them while retaining the benefits of the BSS model. He emphasizes the importance of the model in providing a way to uniformly review the widely varying program and administrative configurations that operate as community mental health service programs.     

Planning for managed mental health services in Los Angeles county

The challenges related to developing a local managed mental health care system could not be greater than those confronting a large, diverse county like Los Angeles which serves a population larger than those of many states. This article highlights the planning related to negotiating with an array of stakeholders and addressing the need for significant administrative restructuring. The role of state funding, the need to expand the management information system, and the coordinating of providers are some of the challenges facing the evolving managed mental health system in Los Angeles.     

The fate of mental health services in health care reform: I. A system in crisis.

The U.S. health care system is in the midst of a severe crisis. More than 50 million Americans are uninsured or underinsured. Medicare and Medicaid are not adequately serving populations in need. Analyses and reform proposals are often based on biased interpretations of data, resulting in confusion and heated debate. To avoid jeopardizing psychiatric care in a national health care reform movement, we must understand the causes of the national crisis. In the first part of a two-part paper, the author describes factors such as demographic trends and limitations in public health coverage that have contributed to the crisis. Outcomes of the current system include higher morbidity and mortality among the uninsured and a high prevalence of untreated illness. The author reviews direct and indirect costs of health care and concludes that in attempts to solve the difficult equation of access, cost, and quality, mental health services are in serious jeopardy.     

High users of outpatient mental health services, I: Definition and characteristics

Mental health coverage generally limits benefits for high use, which is assumed to be discretionary. The authors present data from the National Medical Care Utilization and Expenditure Survey. Of the individuals who made mental health outpatient visits in 1980, 9.4% made 25 or more visits and accounted for 50% of mental health visits and expenditures. These high users were compared with low users and with high users of other health care. One-third of the mental health high users were highly disabled and had multiple medical disorders. The authors point out the heterogeneity of this population and suggest that psychiatric benefits be differentiated according to patients' needs and services offered.     

Politics and mental health I.

The origins and evolution of psychiatry as a medical discipline since the end of the 18th century have been influenced by society's beliefs about the 'nature of man', the dominant forms of social organisation, and the level of technology which could be mobilised to modify human behaviour. These are also the themes from which politics develop. Throughout the past two centuries and up to the present day, two distinct streams can be traced in the political history of psychiatry: first, psychiatry as social control of deviance; and secondly, psychiatry as advocacy of the 'right to be different'. The 'third psychiatric revolution' which is now in progress in many parts of the world has been inspired by the second set of beliefs. It has already produced positive effects on the quality of life of many patients but is also experiencing certain setbacks. The extent to which the new approach to mental health care delivery will benefit patients and society depends not so much on psychiatry as a discipline as on the perceptions and actions of politicians.     

Clients and patients of mental health services.

To determine how a cohort of patients admitted to a mental health center in a single month used the center's clinical services over a year's time, an index of service utilization for each patient was developed. The weighted score took account of days of inpatient and day hospital care and minutes of outpatient time consumed. It was found that 15% of the cohort (48 patients of 330 admitted) used 70% of the total clinical services delivered to the cohort. Analyses of the data on patient characteristics as related to the index or score included the chi 2 test and multiple regression analysis. Not a single sociodemographic variable predicted high utilization of services. Only such clinical characteristics as severity of psychopathology as reflected in patients' diagnoses, suicidal behavior, and a history of prior inpatient treatment contributed to the prediction. The largest group of entrants had relatively brief encounters with the center, and the bulk of the services were actually delivered to a small, severely disturbed minority.