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The Care of Special Populations and Special Disorders. Chapter 18 Dr. Tracey Lynn Koehlmoos. Introduction. Defining special populations Systems that exist Types of providers Policy issues. American Psychiatric Assoc.

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the care of special populations and special disorders

The Care of Special Populations and Special Disorders

Chapter 18

Dr. Tracey Lynn Koehlmoos

HSCI 678 Intro to US Healthcare System

introduction
Introduction
  • Defining special populations
  • Systems that exist
  • Types of providers
  • Policy issues
american psychiatric assoc
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)
conceptualization
Conceptualization
  • Mind/Body Schism—historical
  • Emotional/Mental distress = Morbidity
    • Immune functions
    • Cancer
    • Heart Disease

Biologically perceived health is a strong predictor of mortality

defining mental illness
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
providers
Providers
  • Psychiatrists, psychologists, counselors, therapists, social workers, ARNP, etc.
  • Numerous facilities
    • State, VA
    • Private (health plan participants)
public governmental role
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
movement toward community care
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

deinstitutionalization
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

un met need
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
policy issues
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
conclusion
Conclusion
  • Diverse population--disparities
  • Difficult to reach
  • Difficult to treat
  • Difficult to project prognosis
  • Lack of advocacy
  • Lack of parity