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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
Chapter 18
Dr. Tracey Lynn Koehlmoos
HSCI 678 Intro to US Healthcare System
Introduction
- Defining special populations
- Systems that exist
- Types of providers
- Policy issues
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
- 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
- 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
- Psychiatrists, psychologists, counselors, therapists, social workers, ARNP, etc.
- Numerous facilities
- State, VA
- Private (health plan participants)
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
- 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
- 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
- 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
- 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
- Diverse population--disparities
- Difficult to reach
- Difficult to treat
- Difficult to project prognosis
- Lack of advocacy
- Lack of parity
