hsci 678 intro to us healthcare system the care of special populations and special disorders chapter...
TRANSCRIPT
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HSCI 678 Intro to US Healthcare System
The Care of Special Populations and Special Disorders
Chapter 18
Dr. Tracey Lynn Koehlmoos
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Introduction
• Defining special populations
• Systems that exist
• Types of providers
• Policy issues
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American Psychiatric Assoc.
• A mental disorder is a clinically significant behavior or psychologic syndrome or pattern that occurs in an individual and that is typically associated with either a painful symptom (distress) or impairment in one or more important areas of functioning (disability). (APA 1980)
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Conceptualization
• Mind/Body Schism—historical
• Emotional/Mental distress = Morbidity– Immune functions– Cancer– Heart Disease
Biologically perceived health is a strong predictor of mortality
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Defining Mental Illness
• Multiple disorders
- More than 15% (30% annually)
- 1% unable to care for themselves
• Common diagnoses– Schizophrenia, Schizoaffective, Bipolar
• Notable Exclusions– Developmental disabilities– Substance abuse: lack of data/excessive care
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Providers
• Psychiatrists, psychologists, counselors, therapists, social workers, ARNP, etc.
• Numerous facilities– State, VA– Private (health plan participants)
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Public/Governmental Role
• Chronic Mental illness: some can be treated/some limited recovery options
• Government institutions (48 states)
• Mental health care unresponsive to financial incentives; outside continuum of care
• State mental hospitals—long tradition– 80% had chronic mental illness in the 1930’s– Population peaked at ~1/2 million in 1955
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Movement toward Community Care
• Shift of psychiatrists out of mental hospitals/replaced by FMGs—problematic
• Psychoanalytical transition—little proof
• Social welfare increases
RESULTS:
Smaller in-patient population
Allowed for treatment/ not warehousing
Only care for severely mentally ill
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Deinstitutionalization
• 33-40% homeless, chronic illness
• Elderly residents—to nursing homes (Medicaid/ Medicare)
• Payment shift from State to Federal govt.
• Federal programs:– SSDI– SSI
MEDICAID big payer for mental health services
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Un-met Need
• About 150,000 chronic residential patients
• Where is everyone else?– No access to care– 15% uninsured—hard to get to Medicaid– Private insurance—inadequate provisions– Managed care—discourage enrollment– Social stigma
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Policy Issues
• Physical/Mental health schism
• Institution/Community schism
• Unmet treatment needs– Substance abuse– Young, disturbed and alcoholic
• Stigma, stigma, stigma
• Managed Care-advent of mental healthcare
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Conclusion
• Diverse population--disparities
• Difficult to reach
• Difficult to treat
• Difficult to project prognosis
• Lack of advocacy
• Lack of parity