Quality of Health Care for the Mentally Ill - Essay Example

Quality of Heath Care for the Mentally Ill According to Andrews , more than 25% of adults and children in the US suffer from diagnosable mental health problem yet less than 50% of this population seeks for treatment. Of those who receive care, it would be through their primary care physician as opposed to a mental health professional such as a psychiatrist or a psychologist. This traditional ‘as-needed’ approach to mental health treatment has proven to be inadequate in addressing the needs of mentally ill persons. The need for quality health care among the mentally ill forms the basis of this paper. Giving statistics on the prevalence of mental illness, the paper analyzes the challenges facing the provision of mental health care and gives appropriate recommendations based on its findings. The evaluation encompasses the perspective of the system, practitioners and patients combined. Introduction Roberts, Cruz and Puamau define mental health as that “state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity” (2007, p.107). In spite of mental health affecting the general body functioning, its significance in human health has been minimally appreciated. To understand the importance of mental health, Reeves et al. (2011) cite World Health Organization findings which indicate that more than any other illness, mental illness causes more disability in developed countries with the most common mental illnesses being mood disorders and anxiety. Poor quality or lack of proper mental health care exposes the patients to severe mental illnesses and even chronic illnesses including the highly infectious hepatitis and tuberculosis. Hahm and Segal (2005) note that the mentally ill persons who do not access treatment would be 11 times more likely to contact hepatitis as compared to the general population in the US. These associated diseases exacerbate morbidity in mental illness. Therefore, just as other health systems seek to promote the health of humans (Sparer, 2011), mental health systems should also seek to promote quality health care among the mentally ill. In nursing homes setting, the prevalence of people with mental illnesses has been estimated at 50% by Grabowski, Aschbrenner, Rome and Bartels (2010). Challenges affecting the quality of health care to the mentally ill Inadequacy of resources One of the reasons that most mentally ill patients turn to their primary care doctors as noted by Andrews (2011) would be the short supply of psychiatrists with the situation being worse in rural than urban areas. Citing the findings of a research study by the Tennessee Psychological Association, the journalist noted that non-emergency cases would have patients wait for between 54 and 90 days before seeing a psychiatrist. A similar challenge has been observed in nursing homes hosting the mentally ill with Grabowski et al. (2010) observing that 80% of residents of such facilities with mental illness fail to be attended to by psychiatrists, psychologists or even licensed social workers due to their shortage and that over two thirds of those suffering from significant depression end up not receiving treatment. In this setting, psychiatric services would be provided by psychiatric consultants if available, and these do not form part of the full-time staff of such facilities. About 50% of the nursing homes do not provide adequate psychiatric consultation with about 75% being unable to obtain educational and consultation services for problems related to human behavior. Even with the provision of adequate staff in mental health, lack of resources among the patients could deter their access to quality health care. For example, Hahm and Segal (2005) observe that lack of insurance could by three times impede a mentally ill patient from seeking medical attention as compared to those with insurance covers. In fact, even those under criminal justice system would be 3.8 times more likely to access mental health care services than those without insurance. Failure to acquire insurance covers could be attributed to the financial burden that comes with copayment and under-coverage. Stigmatization and myths Acknowledging the substantial prevalence of morbidity and mortality associated with mental illness Hahm and Segal (2005) seek to determine the reason behind this phenomenon. These researchers observe that majority of the psychiatric patients, estimated at 68% undergo physical examination only during admission hence exposing them to major risks associated with mental illness. In as much as majority of the patients would seek mental health services, the evidence of their use of medical services remains elusive due to the utilization patterns of mental health care. The predisposition among the mentally ill based on ethnicity, education and gender impede the attainment of quality mental health care. The many misunderstandings and myths associated with mental illness lead to stigmatization of such persons with the mentally ill being suspicious of health care providers largely due to the fear of being forcefully confined to a psychiatric ward. Lawrence and Kisely (2010), while reviewing health care provision among the mentally ill, note that even practitioners in this setting propagate stigma through exhibition of negative attitude towards the character traits of the mentally ill which include disruption and being difficult to handle, which should instead be viewed as symptoms of illness as opposed to being their individual behavior. De Hert et al. (2011) document stigma in mental health as a major barrier to quality health care as it lessens responsiveness to health care and could also cause delays in seeking for treatment. Unequal health care provision There has been a growing contribution to the body of knowledge that perceives the unequal provision of health as a contributor to the overall quality of health care provision in mental health. In some cases, this inequality has contributed to the increased mortality among the mentally ill persons. According to Lawrence and Kisely (2010), majority of the deaths among schizophrenic patients would be associated with cardiovascular diseases, but such people pose less probability for surgical interventions like bypass grafting and stenting. These patients with schizophrenia, when suffering from appendicitis, would be more likely to exhibit symptoms of mental illness late and tend to have more complications like appendix perforation and have worse outcomes from surgeries. Following a stroke attack, it would be difficult to provide warfarin or cerebrovascular arteriography intervention among people with psychosis. Similarly, people with diabetes combined with mental illness would have challenges in receiving standard diabetes care. Severely mentally ill patients would most likely have physical co-morbidities and would most likely have untreated physical health problems with more physical co-morbidities being associated with worse cases of mental health. Other major challenges towards the provision of quality health care in a mental set-up include the patient’s lifestyle. It has been noted that schizophrenic patients have limited access to medical care accompanied by limited consumption of medical care and exhibit less compliance with medical care (Lawrence & Kisely, 2010). This suggests the reason for discouragement of invasive cardiac procedures among these patients. More so, their aggressiveness poses greater complexity during surgeries or chemotherapy. Dietary habits also contribute towards the quality of mental health care. Solutions to the challenges The challenges outlined in this paper point out to the need to address factors that affect the system, the patient and the health providers so as to improve the quality of health care among the mentally ill. To reduce the long periods of time that patients wait to have their appointments with psychiatrists honored, psychologists could be given the prescription powers for psychotropic medications as already adopted in Louisiana and New Mexico (Andrews, 2011). Whereas psychiatrists encompass medical doctors who specialize in psychiatry, psychologists have doctoral degrees having been trained in the diagnosis and management of mental illness. In as much as any doctor could prescribe psychotropic drugs, psychologists would have to undergo a clinical psychopharmacology master’s degree equivalent training. Other than psychiatrist, these psychologists would be the best suited doctors to prescribe medication for mental disorders. Furthermore, they offer additional treatment approaches including cognitive behavioral therapy and talk therapy as contrasted to psychiatrists who would only prescribe drugs, with survey indicating that only 10.8% of the latter offer talk therapy. Hahm and Segal (2005) appreciate that enhancing the opportunities for provision of healthcare would prevent aggravation of illness and minimize the cost of healthcare provision, from which the savings would be used to improve the quality of the provided health care. Other propositions for reducing the time taken by mentally ill patients before seeing psychiatrists include the integration of mental with primary health care. With Andrews (2011) estimating the rise in people subscribing to health insurance governed by the health care overhaul law at 32 million people, this could be a viable solution. This approach would be effective since more than a third of the mentally ill patients see their primary care providers. This observation has been supported by Grabowski et al. (2010) who appreciate the Medicare Improvements for Patients and Providers Act, MIPPAA 2008 for providing parity in mental health services coverage. By 2014, MIPPA will see the copayment rate attached to mental health outpatient treatment come down to 20% from 50%. While supporting this approach, Hahm and Segal (2005) note that it would enhance prevention, screening and patients’ adherence to the provided treatment. Similarly, people suffering from chronic illnesses like asthma, heart disease and diabetes pose a greater risk of suffering from mental illnesses. Health insurance would generally cover prescription drugs when it comes to mental health locking out therapy sessions. With the seriousness of mental health drugs posing serious side effects among those using them, it would be important to promote other alternatives such as talk therapies with their coverage under health insurance policies most likely to propagate such achievements. Advocating for public sensitization and awareness, Hahm and Segal (2005) note that the move would provide solutions to the poor who do not have the ability to access quality mental health care but qualify for government health insurance programs because of sensitization. With the increase in insurance coverage, most of the patients would be able to access private office services which encourage mentally ill patients to seek treatment. Other than improving the quality of health of such patients, the use of private offices would also avoid employment of coercive interventions hence enhancing patient engagement and thus therapeutic relationship. The public awareness programs would also educate on misunderstandings and myths surrounding mental illness thus promote health care access. De Hert et al. (2011) and Lawrence and Kisely (2010) recommend the extension of education to the mental health care community particularly on physical health risks. To reinforce this, the scholars support the enactment of anti-discrimination legislation that would guarantee equal health care access. Much related to legislation would be the recommendation by Fleishhacker et al. (2008) on the parity in mental health care. According to the researchers, since so little could be done to change situations contributing to these inequalities, it would be appropriate to regard them as basic human rights. But this suggestion has raised much debate with scholars arguing on whether equality in health should translate to equality in health care provision. According to this human rights argument, people carrying greater burden of physical illness should be provided with greater access to health care due to their higher health level need (Sparer, 2011). It would be important to note that no solution would solely provide the much needed improvement in the quality of mental health provision. The ultimate solution lies in adopting a multifaceted approach through a combination of several of these approaches. Conclusion Provision of quality mental health care remains a challenge in various settings in the US and indeed globally. The major challenges include lack of adequate resources among the providers, particularly the shortage in supply of psychiatrists. Similarly, patients with inadequate resources face greater challenges in accessing the required mental illness treatment. Secondly, the misunderstanding and negative myths surrounding mental illness deter patients from seeking treatment. Unequal health care provision due to inherent conditions among the mentally ill also limits the provision of quality health care. These challenges point out to three factors affecting the quality of mental health care: provider issues, system level factors and patient-related issues. From this paper, systemic issues would include resource separation of mental from other health facilities and under-resourcing mental health care. Provider level issues would encompass stigmatization and resource constraints. Patient related factors encompass issues like fear, socio-economic factors and non-adherence to medication. In order to improve on the quality of mental health care, there would be need to provide for psychologists to prescribe psychotropic drugs so as to reduce the burden on psychiatrists. A much supported approach would be the integration of mental and primary health care so as to enhance coverage by insurance covers. Education and public awareness combined with legislation against discrimination would also provide the much needed solution. The effectiveness of these solutions lies in combining several of them together. References Andrews, M. (2011, March 21). For people with mental health problems, care can be elusive. Los Angeles Times. 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