Continuum of Care Paper
June 21, 2010
Dr. Denise W. Hines
Continuum of Care
The component of the U. S. health care delivery system continuum discussed in this paper will be mental health care. Mental health is how we think, feel, and act as we cope with life. It helps determine how we handle stress, relate to others and make choices. Like physical health, mental health is important to every stage of life, from childhood through adulthood. Mental illnesses are common and they affect about one in five families in the United States. These disorders, depression, phobias, bipolar disorder, schizophrenia and many others, are real diseases that you cannot will or wish away. They are treatable through medicines and therapy and the lives of people with mental disorders can improve.
Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans over the age 18 and older, about one in four adults, suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U. S. Census, this figure translates to 57.7 million people. Even though mental disorders are widespread, about 6 percent or 1 in 17 suffer from a serious mental illness. Mental disorders are the leading cause of disability in the Unites States and Canada for ages 15 – 44. Many people suffer from more than one mental disorder at a given time.
Prior to 1963, when President John F. Kennedy signed the community Mental Health Centers Act, persons with any mental health problems were institutionalized in public mental institutions. But the signing of the act brought about change by allocating funds for the construction of community mental health treatment centers and began the release of thousands of psychiatric patients from state hospitals. The number of patients in public mental hospitals reached a peak of 558,922 in 1955. Between 1970 and 1986, the number of in-patient beds in state and county hospitals declined to 119,000 from 413,000. Today, there are fewer than 75,000 in public mental hospitals.
The goal of deinstitutionalization was to release the mentally ill into the charge of community mental health centers (CMHCs) where the patients would be closes to their families and more independent. However, the CMHCs were not given adequate funding and vital links between state hospitals and local community mental health centers were never established allowing for discharged patients to stop receiving treatments or to be monitored. Although some CMHCs were able to treat the more severely mentally ill, those such as schizophrenia and manic depression, there was no system to ensure that discharged psychiatric patients received care. The CMHCs were more inclined to offer drug and alcohol treatment, family counseling or psychotherapy, leaving thousands of psychiatric patients without proper care. Patients did benefit from payments from federal entitlement programs primarily Medicaid, Supplemental Security Income for the Aged, Blind and Disabled (SSI) and Social Security Disability Insurance (SSDI). Payments from these programs enabled many people with mental illness to survive in the community.
Many observers of mental health policy in the United States agree that deinstitutionalization has failed simply due to the fact that community mental health services have not been able to meet the needs of the mentally ill. Policy makers had hoped that people with mental illnesses would be better served in community settings, where they would be less geographically isolated form friends and family and encouraged to become integrated into society. Some who suffer from mental illnesses ranging from schizophrenia to manic depression have been able to find effective treatment in their communities. But, thousands have fallen through the cracks of the fragmented public mental health system and have ended up on streets, homeless. To date, few American municipalities have developed...
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