Mental Health Policy Mental Health Cases in The Community Presentation

Mental Health Policy Mental Health Cases in The Community Presentation ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Mental Health Policy Mental Health Cases in The Community Presentation Structure a Health Policy Analysis about particular HealthCare Issue. Healthcare issues in local community. The topic selected is Mental Health. As a Nurse Practitioner in a primary care practice one has noticed a mental healthcare in a local community. Mental Health Policy Mental Health Cases in The Community Presentation Presentation /PowerPoint with speaker notes at the bottom . Addressing the following topics particular to your health problem. The Topic selected is Mental Health (Health Care Issue in a Local Community) It must address the following topics ( I have included screen shot of the requirements) you can use peer review articles, I have included some articles, but need to have peer review articles. Problem Statement(questions must be narrow in focus) Background (Facts/Statistics) Landscape Options Recommendations structure_a_health_policy_analysis_about_particular_healthcare_issue.docx coming_problems_in_behavioral_health_care.pdf community_interventions_to_promote_mental_health_and_social_equity.pdf federal_parity_in_the_evolving_mental_health_and_addiction_care_landscape.pdf promoting_mental_hea Structure a Health Policy Analysis about particular HealthCare Issue. Healthcare issues in local community. The topic selected is Mental Health. As a Nurse Practitioner in a primary care practice one has noticed a mental healthcare in a local community. Presentation /PowerPoint with speaker notes at the bottom . Addressing the following topics particular to your health problem. The Topic selected is Mental Health (Health Care Issue in a Local Community) It must address the following topics ( I have included screen shot of the requirements) you can use peer review articles, I have included some articles, but need to have peer review articles. Problem Statement (questions must be narrow in focus) Background (Facts/Statistics) Landscape Options Recommendations Structure a Health Policy Analysis about particular HealthCare Issue. Healthcare issues in local community. The topic selected is Mental Health. As a Nurse Practitioner in a primary care practice one has noticed a mental healthcare in a local community. Presentation /PowerPoint with speaker notes at the bottom. Addressing the following topics particular to your health problem. The Topic selected is Mental Health (Health Care Issue in a Local Community) It must address the following topics ( I have included screen shot of the requirements) you can use peer review articles, I have included some articles, but need to have peer review articles. Problem Statement (questions must be narrow in focus) Background (Facts/Statistics) Landscape Options Recommendations Op-Ed Coming Problems in Behavioral Health Care D AV I D M E C H A N I C T he hue and cry of “repeal and replace” the Affordable Care Act (ACA) has the potential to put many Americans at risk but none so much as the mentally ill, whose care has long been the stepchild of our health care system. People with serious mental health and substance abuse disorders remain among the most neglected and stigmatized in our health and social services systems. Many with profound disabilities are impoverished, are unable to work, are commonly inadequately housed and at risk of homelessness, are victimized, and have difficulty accessing appropriate and even minimally responsive care consistent with their needs. Arrest and imprisonment are common, exacerbating the stigma and neglect of these maladies. Fortunately, the ACA and expansions and implementation of the Mental Health Parity and Addiction Equity Act of 2008 provided a significant turning point in addressing these challenges vital to the nation’s health.1 With the legal requirement of mental health and substance abuse services as essential to acceptable coverage, these laws have made possible large extensions of insurance coverage to many millions of persons lacking insurance. With the ACA, people with preexisting conditions, often those with behavioral disorders, can now acquire insurance on the same basis as others. Extensions of Medicaid in those states that participated, along with provisions of the ACA, have provided much-needed opportunities to develop closer relationships between behavioral health and medical services, encouraging collaborative care through mechanisms such as medical and health homes and reducing the extraordinary gaps and fragmentation characterizing the care for many vulnerable people with behavioral disorders. The ACA also addresses workforce challenges and has initiated some, but not enough, new efforts to deal with the difficulty of connecting patients to appropriately prepared personnel. The ACA has been a start in addressing these challenging issues in a thoughtful The Milbank Quarterly, Vol. 95, No. 2, 2017 (pp. 233-236) c 2017 Milbank Memorial Fund. Published by Wiley Periodicals Inc. 233 234 D. Mechanic and systematic way. Moreover, it provides a strong framework on which to build.2 For much of our history, there was little formal treatment beyond institutional care in asylums and large public hospitals. Mental Health Policy Mental Health Cases in The Community Presentation People not requiring hospital care were untreated or cared for by families and, when available and affordable, by psychiatric clinics, individual psychiatrists, or interested general practitioners, usually on a fee-for-service basis. Most public resources were for inpatient care aimed at those considered too deviant to adjust to family and community life. Hospitalization was often involuntary. Other than moral care (a form of psychosocial intervention), there were few effective interventions, and care was predominantly custodial.3 Sadly, the United States has never had a coherent behavioral health policy. The fate of persons with behavioral disorders has been shaped largely by medical and social policies formulated with other issues in mind. Financial incentives for federal reimbursement have encouraged deinstitutionalization and the transfer of inpatient care to short-term general hospitals and nursing facilities. Following the social welfare legislation of the 1960s and 1970s, fiscal and administrative responsibilities were increasingly shifted to the federal government, which supported the care of many more people, largely through the Medicaid program. Soon afterward, newly developed pharmaceutical agents, paid for by Medicaid and by the growth of private insurance, became the most prevalent treatments, and inpatient care was now primarily used for short-term crisis admissions. Tax and employment policies encouraged employers to provide health insurance to workers and their families. Large gaps in coverage remained, however, and behavioral health coverage was typically more limited than medical services and surgical procedures. Recent legislation has done much to correct this disparity, although protecting and enforcing parity remains a problem. Medicaid became the mental health safety net for the poor and those with the most serious and persistent disorders. Over time, the program developed and supported interventions that extended beyond typical medical and pharmaceutical treatment. Nevertheless, treatment and care, especially for the most severely ill, has remained fragmentary because of limited financing, suboptimal interventions, and the unavailability of adequately trained personnel. Major efforts have been made in recent decades, especially through the ACA, to extend insurance coverage to this population, which has Coming Problems in Behavioral Health Care 235 a high rate of uninsurance, to achieve parity with medical and surgical services, and to divert persons with severe disorders from the criminal justice system to a range of integrated services needed. Over time, the Medicaid program has become the most important sources of access and such services, particularly for the poorest and most disabled clients.4 No doubt, the challenge of remaking the behavioral health care system is formidable and one that will require years, if not decades. But the ACA’s provisions have brought many millions of disenfranchised citizens into the health care system and have already begun the essential process of developing the building blocks for more effective treatments and rehabilitation. Behavioral health has not been a particularly partisan issue. Over the years, politicians from both parties have led reform efforts, often energized by their family experiences with persons struggling with disabling disorders and with intractable service systems. The ACA is a broad and extensive federal law affecting almost every aspect of our health care system and a large proportion of our population. Although the public debate focuses on what may appear as a discrete set of concerns, the ACA’s provisions are highly complex and interconnected, so that changes in one important provision can do considerable collateral damage to others. The risks are particularly large for behavioral health. Provisions of the ACA such as prohibiting exclusion from coverage or cost differentials on the basis of preexisting conditions are of primary importance for behavioral health because many people with these disorders who are not eligible for insurance through employers or Medicaid could not pay the premium costs.Mental Health Policy Mental Health Cases in The Community Presentation It is difficult to see how subsidies for insurance, even if continued and increased, could meet the needs of these high-risk clients without the prohibition of cost differentials based on preexisting conditions. While there is great public and political support for prohibiting exclusion or pricing on the basis of preexisting conditions, which depend on having a large and heterogeneous insurance pool, there has been no convincing proposal to compensate for the proposed elimination of the individual mandate. Some seemingly reasonable suggestions, such as maintaining the exclusion as long as insurance is maintained continuously or adopting the Medicare provision that penalizes persons for each year that they fail to enroll by the required enrollment period, puts a large burden on those with severe disorders, the poor, and people living disrupted lives who are more likely 236 D. Mechanic than others to experience discontinuities in coverage and fall through the cracks. Most central to most Americans with severe mental health disorders is the fate of the Medicaid program.5 Withdrawal of financing for expansion would place states under great financial stress, and those states that have been especially aggressive in expanding their programs would be particularly penalized. Converting Medicaid to block grants with the intention of reducing federal expenditures as some proposals advocate would exacerbate the trade-offs that states now must make among services and populations. Past experience suggests that when state fiscal problems increase, expenditures for behavioral services are disproportionately reduced, and critical services are more likely to be withheld. The importance of behavioral care has been increasingly recognized, but behavioral health advocacy and support remain relatively weak in the competition among “disease lobbies” in the face of a shrinking pie. The coming months will require vigilance and persistent advocacy. References 1. Mechanic D. Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system. Health Aff. 2012;31(2):376-382. 2. Mechanic D. More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Aff. 2014;33(8):1416-1424. 3. Grob GN. The Mad Among Us: A History of the Care of America’s Mentally Ill. New York, NY: Free Press; 1994. 4. Frank RG, Glied SA. Better but Not Well: Mental Health Policy in the United States Since 1950. Baltimore, MD: Johns Hopkins University Press; 2006. 5. Mechanic D, Olfson M. The relevance of the Affordable Care Act for improving mental health care. Annu Rev Clin Psychol. 2016;12(6):515-542. Address correspondence to: David Mechanic, Rutgers University, Institute for Health, Health Care Policy and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901 (email: [email protected]). Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Current Psychiatry Reports (2019) 21:35 https://doi.org/10.1007/s11920-019-1017-0 PUBLIC POLICY AND PUBLIC HEALTH (G NORQUIST, SECTION EDITOR) Community Interventions to Promote Mental Health and Social Equity Enrico G. Castillo 1,2,3 & Roya Ijadi-Maghsoodi 1,4,5 & Sonya Shadravan 1 & Elizabeth Moore 1 & Michael O. Mensah III 1 & Mary Docherty 6 & Maria Gabriela Aguilera Nunez 1 & Nicolás Barcelo 1 & Nichole Goodsmith 1 & Laura E. Halpin 1 & Isabella Morton 1 & Joseph Mango 1,7 & Alanna E. Montero 1,7 & Sara Rahmanian Koushkaki 1,7 & Elizabeth Bromley 1,7,8,9,10 & Bowen Chung 1,7,9,11,12 & Felica Jones 12 & Sonya Gabrielian 1,5 & Lillian Gelberg 10,13,14 & Jared M. Greenberg 1,5 & Ippolytos Kalofonos 1,2,15 & Sheryl H. Kataoka 1,7,16 & Jeanne Miranda 1,7,14 & Harold A. Pincus 9,17 & Bonnie T. Zima 1,7,16 & Kenneth B. Wells 1,7,9,14 # The Author(s) 2019 Abstract Purpose of Review We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/ or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, schoolbased interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. Mental Health Policy Mental Health Cases in The Community Presentation Recent Findings There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. Summary There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations. Keywords Mental health (MeSH) . Mental health intervention (MeSH) . Community networks (MeSH) . Social problems (MeSH) . Community interventions (MeSH) . Community-based interventions (MeSH) . Social determinants of health . Mental health equity . Health disparities . Multi-sector interventions Introduction Families, workplaces, schools, social services, institutions, and communities are potential resources to support health. In This article is part of the Topical Collection on Public Policy and Public Health Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11920-019-1017-0) contains supplementary material, which is available to authorized users. * Enrico G. Castillo [email protected] Extended author information available on the last page of the article 1948, the World Health Organization defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. Multi-sector and community-based mental healthcare approaches can help address health and social inequities by promoting social wellbeing and addressing structural determinants of mental health (public policies and other upstream forces that influence the social determinants of mental health). A 2015 Cochrane review described three assumptions that underlie community interventions [2•]. The first is an awareness of the multiple forces that exist at all social-ecological levels (i.e., individual, interpersonal, organizational/institutional, community, and policy) that facilitate or obstruct mental health [3]. The second is investment in community 35 Page 2 of 14 participation to provide resources and inform interventions, recognizing expertise outside of the healthcare system. The third is prioritization of community mental health and social outcomes. This review focuses on recent developments in community interventions to promote mental health. We highlight major developments and trends, rather than providing a comprehensive systematic review. Our review defines community interventions as those that involve multi-sector partnerships, include community members (e.g., lay health workers) as part of the intervention, and/or involve the delivery of services in community settings (e.g., schools, homes). We include interventions focused on traditional mental health outcomes (e.g., depression remission) and studies that include a wider range of outcomes including mental health-related knowledge, quality of life, and social well-being. We do not include substance use interventions, which warrant a separate review. To complete our review, we enlisted a large team of experts and trainees with experience in pertinent intervention areas. Our review focuses on interventions published in peerreviewed medical journals from 2015 to 2018, with additional studies identified through reference mining and expert recommendations. We concentrate on seven topic areas, chosen for their salience and quality of evidence in recent literature: multi-sector collaborative care, early psychosis interventions, school-based interventions, homeless services, criminal justice, global mental health, and mental health promotion and secondary prevention. We selected studies for their design, outcomes, and/or impact (Appendix A). These were chosen from a larger number of relevant community interventions (Appendix B). Multi-sector Collaborative Care Collaborative care models in mental health have historical roots in the Chronic Care Model (CCM) of chronic disease management [4, 5••]. The CCM envisioned a combination of health system reforms and community-based resources to support the ability of healthcare settings to improve outcomes for those with chronic illnesses [4]. Many collaborative care studies, often for depression, have focused on incorporating mental health services to varying degrees within primary care settings [6–10]. Adaptations exist for other target populations (e.g., children) and settings (e.g., obstetrics/gynecology practices, mental health clinics) [5••, 11–13].Mental Health Policy Mental Health Cases in The Community Presentation Studies have noted the importance of community organizations and social services, particularly when inequities play a large role in determining outcomes and require services beyond the healthcare sector, for example for underresourced populations and natural disasters [5••, 14, 15, 16, 17••]. Community Partners in Care (CPIC) was a depression collaborative care study that involved 95 programs in five Curr Psychiatry Rep (2019) 21:35 sectors: outpatient primary care, outpatient mental health, substance use treatment services, homeless services, and other community services (e.g., senior centers, churches) [18•]. A 2015 Cochrane review identified CPIC as the only “high-quality study” that “specifically evaluated the added value of a community engagement and planning intervention (i.e. a coalition-led intervention) over and above resource enhancement and community outreach” [2•] (page 32). CPIC was a group-level randomized study that compared two programlevel quality improvement interventions: Community Engagement and Planning (CEP) and Resources for Services (RS). RS programs received a depression care toolkit with technical assistance and consultation to implement a community-wide approach to depression care. CEP programs received the same resources within a multi-sector coalition approach to co-leading, implementing, and monitoring multi-sector depression services (e.g., encouraging community programs to be active in psychoeducation and screening, with streamlined referrals to clinics and social services) [19]. CPIC’s community-partnered participatory research approach and development of community partnerships are described in detail in several articles [19–24]. Unlike many collaborative care studies, CPIC focused on a predominantly under-resourced racial/ethnic minority sample (n = 1018, 46% African American, 41% Latino, 74% with family incomes below federal poverty level) and had few exclusion criteria, enrolling many participants with co-morbid substance use disorders and serious mental illnesses in the study [25, 26]. At 6-month follow-up, participants in CEP (n = 514) compared to RS (n = 504) had significantly improved health-related quality of life, increased physical activity, reduced homelessness risk factors, and reduced behavioral health hospitalizations [18•]. Sub-group analyses and followup studies at 12 and 36 months support some significant beneficial effects of CEP over RS, with main effects seen predominantly during the first 6 months post-intervention and diminishing over time [25, 27–34, 35•]. Since CPIC, only a handful of collaborative care studies have included non-healthcare partners [36–38, 39•]. Hankerson et al. conducted depression screenings in three predominantly African American Christian “mega churches” (? 2000 worshippers per weekend) in New York City, using a community coalition approach, including faith-based organ … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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