Mental illness, or “mental disorder,” consists of any number of varying psychiatric conditions that impair an individual’s normal mental development or function. This can be caused by physiological or psychosocial factors (Dictionary of Modern Medicine, 2002). Because our hospital does not provide any behavioral health services, this report will provide information and resources to help develop a contingency plan to place the mentally ill in appropriate care for their condition.
Views of mental illness have changed dramatically over time, and the present American Medical Association views mental illness as a clearly defined illness, with symptomology and basis in medical fact (Lomas, 1963, 374:5). Indeed, the newer thinking in the medical and psychological community shows that there is a great deal of synergy between the physical and psychological basis of illness, even to the point that a patient’s mental state is crucial to their physical symptoms and recovery. In regard to mental illness, advances in technology have proven that there are clear and verifiable chemical and physical changes that occur in mental conditions (Science of Mental Illness, 2005). In the same vein, mental illness can be, as in traditional physical illness, helped through a variety of treatment options, and, in some cases cured. Treatment options vary, just as, with physical disease, there are numerous symptoms and treatment options, the same holds true with mental illness. Those options can include pharmaceuticals, therapy, non-traditional medicine, meditation, etc. (BBC).
The concept of deinstitutionalization, beginning in the cash-strapped 1960s, but coming to the forefront in the 1980s, focused on releasing mentally ill patients into the community, ostensibly into half-way houses or other partial care facilities, or even back into their family situation. The benefit, it was thought, was both societal (dramatically reducing the cost of treatment), and personal – a chance to function outside a structured setting. The concept was sound, in that the idea was to help integrate patients with mental problems back into society, rather than keeping them “caged” and apart. Adherents to the concept believed that, with certain types of mental illness, the patient would actual improve more dramatically if asked to be a part of a work or social environment. Of course, deinstitutionalization was also to have a continued treatment component, and the mental health “system” was still to have regular contact and appropriate follow-ups (Lamb, 2001).
In reality, however, deinstitutionalization often stratifies patients based on economic and social conditions. Many of the mentally ill who are mid-high functioning, but without funds or family support, simply dissolve into the homeless population – and, because they have no structured care, often get worse instead of better. Indeed, these individuals on the “edge” of society often end up in the legal system, and then society’s prisons become the caretakers of the mentally ill – a position in which they are not prepared nor trained (Human Rights Watch, 2004). Indeed, patients with such illnesses as schizophrenia and bi-polar disorder are often sent back into the community, hoping that they will continue on their medication and treatment options, but having no real way of structuring that treatment plan. Many of these patients are high-performers within a structured environment, where their medication is managed, and thus looked at for candidates to be in the outside world, where that structure fails them completely. Critics then believe that the process of deinstitutionalization is more an economic decision than a health-based option, moving the fiscal burden from the State based systems to the local (cities and counties) (Martin, 1995).
It is important to note that it is dependent upon the particular doctor, clinic, organization or institution for the advocacy of combining mental and physical health care. It is vital that the two be joined in a more holistic approach, and certainly more education and attention has been given to standard health care professionals asking about mental issues, and, typically, referring issues to mental health or social services professionals. For someone who struggles with mental illness, it is not just the structured environment of care than is necessary, but a way for the micro-system to help with day-to-day issues such as transportation, ensuring compliance with medication, help with job placement and follow up, counseling to help reintegrate into society, and assistance with housing and other personal issues. It is also noteworthy that, in the last decade, many businesses include mental health hotlines and mental health care within the purview of their own insurance and employee benefit programs. (Gomez, 1990).
Mental health care has, thanks to the media (movies, television, advertising, and star “role models” who have admitted to mental illness), become more visible within both societal and governmental structures. The Federal Department of Health and Human Services provides numerous grants and funding, Medicaid covers numerous mental health issues, and there are Statewide and Multistate programs that track, manage, and fund mental health care. Typically, these programs are focused on the disadvantaged, since the population with insurance coverage and managed care systems have integrated mental health into their programs. However, in terms of managed care, unlike many physical aliments, mental health cannot necessarily be boxed into a timed and easy treatment plan. Individuals vary, and unlike prescribing an antibiotic treatment for an infection, requires numerous trials and mediation prior to finding the right treatment, which may in turn take far longer and be far more costly, than other standard physical treatments (NMHIC). While managed care can reduce the overall societal cost for mental issues (by synergizing treatment facilities, staff, and bringing down costs of medication), it is still important to remember that mental illness is not as easy to quantify economically, again, as physical illness.
For our particular situation, it would seem that we might adopt the American Psychiatric Association standards in reviewing, organizing, and appropriately sending patients who need mental health care, to the right source (mental health triage, if you will) (ASA, inclusive). We must liaison with the appropriate federal, state, and local agencies (HHS, DSHS, etc.) for listings of appropriate care centers and/or resources for those in need. Despite the fact that we do not provide long-term mental health care, because we do have Psychiatric Staff, a protocol must be developed that allows our medical professionals to treat what they can, but also provide services for what is outside their purview.
References:
American Psychiatric Association, cited in:
BBC, (2005), “The Science of Mental Illness,” cited in:
Editors, (2002), Dictionary of Modern Medicine, Mc-Graw Hill, cited in:
Gomez, Joan, (1998), Liason Psychiatry: Mental Health Problems and The General Hospital,
Routlege.
Human Rights Watch, (2/12/04), “Prisons No Place For The Mentally Ill,” cited in:
Lamb, H.R., et.al (8/2001), “Some Perspectives on Deinstitutionalization,” Psychiatric Services, 52:1039-1045.
Lomas, Jack, (1963), “The A.M.A. Congress on Mental Illness and Health,”California Medical Journal, 98(6).
Martin, J. (4/1995), “Deinstitutionalization: What Will It Really Cost?” Schizophrenia Digest, cited in:
National Mental Health Information Center (NMHIC), cited in: