Continuum of Care in Mental Health Care - Essay Example

Continuum of Care in Mental Health Care Introduction: With the mounting healthcare costs, the healthcare providers are frantically attempting to create an environment of strict principle-based restrictions where reimbursement cutback is the goal. In this environment, efficient utilization of all the available resources is mandatory to ensure effectiveness and viability of all healthcare settings. The Concept of Continuum of Care: To find out other possible resources in implementing standard healthcare in stages of disease that does not necessarily need all the elements of conventional care settings, such as, hospital care, it was identified that home- or community-based care programs might serve as an alternative for continuum of care in conjunction with physician-provided hospital care. Particularly in the area of psychiatric care, this might prove really meaningfully implemented since psychiatric patients after being controlled in the hospital-based psychiatry units may need support at home. At the home or community environment, a coordinated mental health care which can be an extension of care of the hospital can create a seamless system of health care delivery, at least to alleviate the high level of anxiety and stress of the patients and the caregivers at home. In this work, the author desires to analyze the various aspects of continuum of care as applicable to mental health care in United States. This also will attempt to examine whether such systems of care can cause successful transition of the patient from one stage to another, what are the positive aspects of this system, its drawbacks, whether it really is an effective way of managing resources, and how it can lead to future trends of healthcare delivery system (Falter, E.J., 1999). Services Provided: Effective mental health care has a wide range of health and social benefits. Mental health care encompasses the whole population, individuals with risk of developing mental health problems, and vulnerable people with mental health problems. It has been demonstrated that targeting populations has positive outcomes. Priority of the mental health sector is to focus on those at risk of developing mental health problems as well as the people vulnerable with mental health problems through prevention and early intervention strategies. The outpatient and the outreach programs serve as the pivot of the comprehensive community mental health service. These programs encompass assessment and treatment for those who have or suspected to have established mental illness, such as, depression, anxiety, or schizophrenia; or a mental, behavioral, or emotional disorder; people with severe functional impairment or individuals at risk of severe functional impairment. The services may include early diagnosis and intervention, assessment and management. Each area will have adult services as well as child and adolescent services (Lock, J. and Walsh, M., 1999). Early Identification: Continuum healthcare services was originally resident-centred independent services that support the highest practicable quality of care to the clients in the community. These services are targeted to various groups of adults, children, and youth at risk. Early identification of a mental condition and necessary preventative measures restricts the emergence of the disorder. For example, neurodevelopmental services can intervene children with early signs of behavioral problems. Assessment and Treatment Services: These services are offered in the hospital setting upon referral from a primary healthcare professional or by self-referral. As a result, the management can be time-limited due to scarcity of the resources. These services may include crisis and emergency response services, individual/group/family assessment and management services, and consultation services. Intensive Acute Treatment Services: These treatments include day care, day hospital, and in-hospital services. Day, evening, night, and weekend mental health services can employ an integrated, comprehensive, and complementary service in collaboration with the community-based services to take the load off of the hospital-based care setting. The goal is to provide intensive, coordinated, and structured clinical services to significantly impaired individuals who are suffering from psychiatric, emotional, and behavior disorders (Evans, R.L., 1966). Crisis Response Service: Children, youth, and adults that experience critical and acute mental health problems need immediate supportive interventions. Within the mental health clinical setting, crises manifest in many ways. It may range from acute mental illness to loss of housing and support networks and the overwhelming emotional consequences resulting out of them. A crisis is a situation where an individual’s coping strategies are off-balance, putting the individual in a situation of dire necessity of support as soon as possible. It should be mentioned that all such crises are not mental emergencies calling for an urgent stabilization. However, there is no difference of opinion among the authorities that an individual’s coping mechanisms may be so disturbed leading to a flare-up to such a degree that the patient may be potentially harmful to self and others and as such to the community (Aita, S.J., 2004). The Place of Continuum of Care: The pattern of psyche may be so disturbed that the individual may fail to recognize the necessity of intervention at that particular point in time. It is in this scenario that community care system can behave as a fruitful transitional system to communicate with the hospital to initiate care. Once the acute condition is abated, and the patient no longer needs inpatient psychiatric care, yet vulnerable for tipping the balance off, he is in need of support in the community so that there is a gradual transition to the normalcy. This support may be counseling or even insurance of drug therapy, that is, actual treatment followup. Continuum of care may serve a very significant role in this transition. Continuum of Care and Fitment to Mental Health Service: When the vulnerable individual’s wellbeing is threatened, an immediate emergency response from these ‘transitional units’ may provide one of the best modes of continuity of care. Skilled professional staff appointed there may identify a true emergency situation, and treatment process and further care planning may be initiated at that point of contact. The professional in this situation will be able to diagnose and handle managements of other cases that may simulate an acute clinical state yet may be handled in the community, thus will help to reduce the burden in the mental health units. The effective management and control of the crisis will, on the other hand, depend on the availability of the experienced and skilled professional staff in these community units outside the hospital. These staffs may be the points of first contacts, may it be telephonic or walk-in contacts. This initial triage will allow the critical baseline information to be revealed, and they may serve as two-way agents to inform the referring professionals about the condition and to the care facility about the necessity of treatment if admission to the in-hospital setting to control such clinical presentations (Arah, O. A., Klazinga, N. S., Delnoij, D. M. J., Ten Asbroek, A. H. A., and Custers, T., 2003). Contribution to the Overall Management of Healthcare Resources: The range of functions that these transition care services may provide can of a diverse expanse. The foremost is stabilization of an individual in crisis. The goal is to restore pre- crisis level of functioning which has social and financial implications for the individuals, the state, and also the providers. Thus, this system can try to solve the problem from the point of view of natural support system. It is well known that while talking about mental health in most of the cases, a disturbance of the natural support system precipitates or contributes to the crisis. These patients, even when out of the hospital, have ongoing support needs from the community point of view. The continuum of care services can link these people with other services and supports available, thus contributing to resource preservation. These units may further liaison appropriate followup mental health care, which is an absolute necessity and without which the whole system of mental health care is a failure. This system works fine since these units have access to regional psychiatric inpatient units and crisis beds. Timely consultation and intervention, which are essential in reducing costs and thereby preserving valuable resources and cutting costs, yet not compromising the standards of care. This is and can be made available in these transition units through various service providers, such as, physicians, guidance counselors, and other professionals who assist in identifying and intervening the actual emergencies. At the same time effective liaison protocols for primary health care services, hospital emergency services, police, and inpatient psychiatry units in indicated cases will provide the appropriate service to the appropriate individual. This service can be transformed into a proactive outreach service, where a process can be developed for facilitation of referrals to mental health system (Smith, K.L. and Lurie, L.B., 2005). Future Trends: Mental health care as pertinent to assessment and treatment services is increasingly being seen as a part of a care system with articulated activities directed to care in various levels where the patient is just transitioning from one level of serious illness to other level of less serious condition. Different levels of the patients’ mental health and the appropriate support thus calls for a wide range of skills and expertise. It is to be understood that mentally ill population in the community should cope up with the community at the first place. In practice, levels vary widely, some needing acute management in the hospital setting, some may be managed successfully locally without a referral, some need counseling, some need followup, and some need support from different support groups. When resources are concerned, the inpatient psychiatry unit bed occupancy absorbs the lion’s share of the resources, and admission to such units may be a liability in terms of funding. Continuum of care can successfully act as the catalyst in this process of transition of these patients from one level to the other when most patients’ first contact point is a community care center. This, in turn, hints to a multidisciplinary approach to service delivery. These services can be provided upon referral from primary care, school, other community service agency, correctional services, other human service provider, or on self referral. Services will be provided to those individuals who have acute or mainly chronic major mental illnesses, mood or anxiety disorders, disruptive behavior, or other impairments in functional status to such severity that most of these cases can be satisfactorily attended by community-based outpatient treatment. The increasing understanding that mental health services need close partnership with primary care and other community human service agencies in the form of close collaborative care has led to the concept of continuum of care in mental health care services. This model, in future, would share mentally ill individuals in terms of care delivery (Veronesi, J.F., 2001). The main obstacle to this plan is, to be a successful model, it needs greater opportunity to educate, collaborate, plan the care together for better use of the resources available in the best interests of the individual. The top of the tier, the inpatient facilities should stop considering these agencies as secondary providers to ensure better maintenance and followup through this proposed collaboration to turn this impossibility into a resource- saving successful reality. Despite these obstacles, things are changing now with promise that this system will turn out to be a giant leap toward a mentally healthy balanced society. Reference List Aita, S.J., (2004). A Rational Approach to Consumer-Directed Health Care: Engaging Consumers and Providers in Controlling Health Care Costs. Compensation Benefits Review; 36: pp. 40 - 47. Arah, O. A., Klazinga, N. S., Delnoij, D. M. J., Ten Asbroek, A. H. A., and Custers, T., (2003). Conceptual Frameworks For Health Systems Performance: A Quest For Effectiveness, Quality, And Improvement. International Journal of Quality Health Care; 15: pp. 377 - 398. Evans, R.L., (1966). Federal Legislation And The Smaller Health Care Facility. Quality Of Care Audits: Foundation For A Health Care Continuum. Hospitals; 40(11): pp. 75-78. Falter, E.J., (1999). The Health Care Continuum. How To Make The Business Of Nursing Work For You. American Journal of Nursing; 99(1 Pt 1): pp. 63-64. Lock, J. and Walsh, M., (1999). Development And Implementation Of Depression Care Along The Health Care Continuum. Journal of Nursing Care and Quality; 13(3): pp. 13-22. Smith, K.L. and Lurie, L.B., (2005). Economic Grand Rounds: Evaluating Health Care Systems. Psychiatric Services; 56: pp. 534 - 536. Veronesi, J.F., (2001). Home Health Integration for the Future. Home Health Care Management Practice; 13: pp. 286 - 289. Read More