Barriers and Facilitators in a Multi-Disciplinary Mental Healthcare System - Essay Example

? Barriers and Facilitators in a Multi-Disciplinary Mental Health Care System Introduction Less than half of the 23.7 million adults experiencing serious psychological problems received mental health care owing to financial, systemic and social hindrances. Even then, the care that was administered was not comprehensive. This is following a report published by the federal Substance Abuse and Health Services Administration in 2007, where the psychological problems cited included mood disorders along with anxiety that led to functional impairment and in turn impeded on at least one major life activity. The reason for failure of comprehensive health care being administered was that there is a lacking of well-trained mental health care staff and certain infrastructure not being in place making it difficult to provide quality care (Sundararamann, 2009). The Journal of the American Medical Association, which features a study carried out by the Centre for Disease Control lists tobacco, poor nutrition, excess alcohol consumption and infections as the main predisposing factors that result in death. This implies that focus should be on administering health care primarily in the form of educating the public as opposed to focusing on heart diseases, cancer and stroke, as has been the case. America has the largest budget on health care making it perceivable as the best in health care administration; however, this is not the case as the budget goes to medical care instead where the best medical facilities in form of research centres and medical schools have been set up. It thus becomes imperative to create a distinction between medical care and health care where the former is characterized by use of new technologies and the latter is centred on administration of quality care. In America this is evidenced by the fact that it has a higher infant mortality rate compared to England and France and similarly a shorter life span compared to Japan (Schimpff, 2012). In dealing with this problem of non-comprehensive mental health care administration, a mulch disciplinary team has become the solution where medical specialists from various fields are assembled to design a system that will facilitate quality health care administration. This is because a mulch disciplinary approach has been proven to achieve the best results when solving complex social problems such as childhood obesity. It follows a system of design thinking, which is defined as a novel, empirical, human centred, investigative approach to innovation aimed at providing innovative solutions not just to social organizations but businesses as well. It involves bringing together psychologists, anthropologists and other specialists to work collaboratively to design a system that solves a social problem in terms of administration of quality care. In most cases, consumers are also included in the designing in order to ensure the solution arrived at is agreeable. Its popularity arises from the fact that various skills, mind-sets and processes that have been gathered due to experience and cannot be taught in schools, are combined (Innovation design thinking, n.d). Mental health care refers to a broad range of services that vary from marital or family counselling to more specialized treatments for illnesses such as bipolar. It also encompasses mental disorders alluded to certain age groups for instance Alzheimer’s in old people and Attention Deficit Disorder in children, along with postpartum depression in middle-aged people. When administering mental health care, the services would include counselling, prescribing medications, inpatient care and outpatient care. There has been a shift in attention to medical health care following incidences such as the Virginia Tech shooting, leading the Congress to set out to transform the mental health care system; more so, because there was an outcry by the public regarding its adequacy. In 2008, following the Mental Health Parity and Addiction Equity Act, health insurers that choose to cover mental illnesses have to match the cover to physical illnesses with regards to benefits (Sundararamann, 2009). In England, the National Health Services provides comprehensive health care to citizens ranging from inpatient and outpatient hospital care, inpatient along with outpatient care, dental care, physician services and mental care. All professionals and hospital services are administered deprived of charge although user responsibilities are applicable to outpatient drugs, ophthalmology and dentistry (Wolper, 2010). Multi-disciplinary team and Inter-disciplinary approach The milieu required by a mental patient is dependent upon the skilful handling of the situation, experience and qualification of the multi-disciplinary team using a similar approach. This means that members of the team have to coordinate their activities so as to create a therapeutic environment. In general, four mental health professionals make up a multi-disciplinary team, all from the key mental health disciplines, psychiatric social work, clinical psychology, psychiatry and psychiatry nursing. Contribution of all the members is largely significant towards the assessment, diagnosis and treatment of the mentally ill patient during in-patient rehabilitation and community-based rehabilitation. Such team work also involves the patient’s family in delivering exemplary care, as this goes a long way into achievement of holistic patient care (Patidar, n.d). In mental health care, there is a concept of allied health that arises and it is described as direct service provision of personal and social care- psychosocial care administered by personal care attendants, complementary therapists, art/music therapists among others. These are professionals needed in order to achieve an acute, community environment necessary for the overall wellbeing of a mental patient. The challenge then arises when synchronizing their efforts and skills to match those of the primary care providers that is, the psychiatric nurses and doctors. The issue of interdisciplinary approach comes into play as allied health and primary health care providers come together to form the multi-disciplinary team. Interdisciplinary approach refers to adapting of responsibilities, skills, knowledge and roles to adjust to those of other professionals within the team. Hence, this is the main challenge as conflicts are bound to arise due to factors such as failure to appreciate efforts made by other professionals within the group. Secondary to this is communication where members of the multidisciplinary team have cited maintaining confidentiality/ privacy, home based records and correctly following care plans as the other challenges (Quayle, n.d). The barriers to effective mental health care are centred on patient, provider and system factors. Patient factors include where the patient fails to recognize or understand their symptoms making them reluctant to seek medical care. In the same way, the patient may be reluctant to seek medical care owing to stigma attached to mental illnesses. In addition, the patient may be reluctant to adhere to treatment recommendations. Provider factors are based on primary care providers who may be lacking in proper training as well as confidence needed to administer mental health care and treatments. Even where the primary care providers are well trained and eager, they are limited by time where an office visit is meagre 10-15 minutes and the provider still has to address other issues both medical and social. System factors are related to health insurers that offer restricted and heavily managed mental health benefits compared to other health benefits. Hardly any insurance plans cover provider’s charges for implementing screenings and care management services together with other proactive services that have been seen to improve treatments and recovery (Goldman, Buck andThompson, 2009). Inter-disciplinary work is further described as readiness to share and give up special claims to expert knowledge and skills if the needs of a client can be arrived at more effectively with the assistance of other professional groups. The term inter-disciplinary is synonymous with multi-disciplinary as the latter is viewed as the mechanism needed to achieve holistic patient care and the former as the guiding principal. Members of a multi-disciplinary team have to hold themselves mutually accountable for the wellness of the mental patients and commit to this goal and approaches to be adopted using their complementary skills. In a brief but concise sense, the primary purpose of a multidisciplinary team is to maximize clinical effectiveness (Mental Health Commission, 2006). Consumers and carers are being employed to participate in the recovery of mental patients as evidence shows that this has resulted in cost savings since hospital stays are shorter and recovery experiences are improved, and overall improved service quality. The consumer is needed for knowledge and the carer for skills, fundamentally, together their positions can be well designed and integrated into a supportive workplace environment by identified workers. This is in order to facilitate delivery of targeted peer support and mentoring of the clients and protectors, capacity to connect traditional mental health care to the public. Moreover, breaking down of stigma through role models for the consumers and carers along with their colleagues outside mental health services and creating channels for voicing individual and system shortcomings (National Mental Health Consumer and Carer Forum, 2010). In quantifying the effectiveness of approaches used by a multi-disciplinary team, recovery is looked into. There are two views of recovery- medical and personal; the two are easily distinguishable using the outcomes perceived where the former is measured using reduced medication use, hospitalization and symptomatology and the latter using control of symptoms, wellbeing, healing and self-defined goals along with empowerment. These views are conflicting as either is identified differently since the medical view is objective and comprehended as the return to former health of the patient while the personal view is subjective with regard to recovery and mental illness experiences. Nonetheless, key concepts to recovery include understanding one’s illness, symptoms along with medication, building a healthy lifestyle, having supportive relationships, cultivating one’s spirituality and social inclusion in the community. The community within which one exists should provide education, training, accommodation and employment (NSW- Consumer Advisory Group, 2009). Moreover, of importance as well when facilitating multi-disciplinary health care in mental patients is understanding that they encounter high rates of physical illnesses and these usually go undetected. Psychiatric outpatients have been cited as being nearly twice as likely to die as the general population thereby calling for medical professionals to become aware and undertake thorough medical screenings and treatments. For instance schizophrenia patients are forced to endure long-term effects of anti-psychotic medication that turns out to be substance misuse as the urgent causes of their mortality are related to natural causes. Notably also, members of a multi-disciplinary team should consider the social backgrounds of their mental patients that is, source of income if any, housing facilities and genera livelihood. These are often known to cause or aggravate the mental illnesses but at times they have been seen to be the direct effects of the illnesses (Phelan Stradins and Morrison, 2001). Regardless of their specialty, members of the multidisciplinary team should be tasked with promoting psychological wellbeing mainly in terms of fulfilment and contentment, as this is seen as preventative and positive approach towards mental health (NHS Confederation, n.d). Integrated care is also central in mental health care where primary care situations are incorporated into mental health care and substance abuse situations plus mental health care into primary care situations. This allows for a more comprehensive, higher quality and coordinated effort into dealing mental health issues, particularly in youth. Innovation is required when piloting integrated care as it is a practical approach that considers the specific nature of the mental illnesses and the patients themselves, and their surroundings (National Alliance on Mental Illness, n.d). Integrated care involves setting up a community-based rehabilitation centre where primary care physicians are in charge of diagnosing patients, administering treatments and rehabilitation allowing patients to receive outpatient treatments in their communities. Mental health experts are on hand as well to give recommendation in complex cases. The primary care physicians practice and general medicine residents use the community centres as training sites. This enhances access to mental health services are patients are more inclined to seek help and they are socially integrated. Costs are also cut back as psychiatric services are used sparingly and institutional services are shunned. In some cases, integrated care encompasses home visits by psychiatry nurses that check up on primary care workers and provide support while ensuring care plans are being followed to detail (World Health Organization, 2008). Another perspective calls for focusing on two things- the mind and the brain, where patients can be taught how to modify their brains using their minds and their minds using their brains. This allows for less use of medicines and achievement of overall wellness. This is because mental illnesses have been linked to psychological factors subsequently; psychological interventions can be used to reverse changes in the brain that are seen to cause mental disorders. This can be illustrated following an example of clinical depression, which thins the bones and is seen to increase by four times the likelihood of developing diseased coronary arteries in the patient. Following this perspective allows mental health care providers to offer their patients more choices and holistic care (Morris, 2008). Still on choices, mental health care providers and consumers should strive to remain abreast of recent advances by including them in education and training programs. This allows patients to benefit from any changes in health and health care in recent times. In addition, it is important that the consumers and carers have a chance to conduct research on ways to improve mental health care and prevent its occurrence to people who may be at risk (Agency for Healthcare Research and Quality, 2004). Including consumers and carers in interdisciplinary team meetings allows for case managers, usually the psychiatrist, to have an opportunity to educate the patients while monitoring their progress or lack thereof. Holding meetings allows for better communication as it brings primary care providers, specialists, consumers and general carers together face-to-face. Similarly, care processes should be standardized as a strategy towards general quality improvement. In addition, primary care providers and specialists can communicate about their findings and opinions regarding cases. Heavy workloads may get in the way of these efforts thus it is important to foster collaboration within the multi-disciplinary team. It is crucial that caseloads be minimal and additional staff resources be brought on. This helps facilitate a more coordinated multi-disciplinary team and in turn comprehensive care (Committee on Crossing the Quality Chasm, 2006). A multi-disciplinary team should have standardized assessment tools that record client/patient information so as to support care planning and delivery as well as health care system management for mental patients receiving community-based services along with hospital care services, that is, inpatient and outpatient care. These tools will be used to evaluate the strengths, needs and preferences of mental patients from various age groups, which ensure that the care plans developed are effective particularly with inpatient care as the psychiatric settings need to be considered (Ontario Hospital Association, n.d). Both consumers and carers should also come up with outcome measurements so as to measure changes in the health status of mental patients, this has been reported as a key performance indicator. Including consumer measurement helps in combating attitudinal challenges and encourages workforce to develop a human centred approach to dealing with mental patients, in essence, getting a different perspective (Victoria’s Mental Health Services, 2011). References Sundararaman, R. (2009). U.S. Mental Health Delivery Infrastructure: A Primer. Darby: DIANE Publishing. Schimpff, S. (2012). “America has a medical care system not a health care system” Retrieved from http://www.kevinmd.com/blog/2012/02/america-medical-care-system-health-care-system.html Innovation design thinking. n.d. What is Design Thinking. Retrieved from http://innovationdesignthinking.wordpress.com/what-is-design-thinking/ Wolper, L. (2010). Healthcare Administration: Managing Organized Delivery Services. 5th Edition. Massachusetts: Jones and Bartlett Publishers. Patidar, J. (n.d). Multidisciplinary Health Team. Retrieved from http://www.slideshare.net/drjayeshpatidar/multidisciplinary-mental-health-team Quayle, C. (n.d). Challenges of the Multidisciplinary Team: a reflection of the Mercy experience in West Melbourne. Retrieved from http://www.palliativecare.org.au/Portals/46/Together%20conference/E5%20Carol%20Quayle.pdf Goldman, H., Buck, J., Thompson, K. (2009). Transforming Mental Health Services: Implementing the Federal Agenda for Change. Washington, D.C: American Psychiatric Pub. Mental Health Commission. (2006). Multidisciplinary Team Working- From Theory to Practice. Retrieved from http://www.mhcirl.ie/documents/publications/Discussion%20Paper%20Multidisciplinary%20Team%20Working%20%20From%20Theory%20to%20Practice%202006.pdf National Mental Health Consumer and Carer Forum. (2010). Supporting and developing the mental health consumer and carer identified workforce – a strategic approach to recovery. Retrieved from http://www.nmhccf.org.au/documents/MHCA%20CareWF%20Layout%2016-9.pdf NSW- Consumer Advisory Group. (2009). Literature Review on Recover. Retrieved from http://www.mhcc.org.au/documents/Projects/NSW-CAG-MHCC-Project-Recovery-Literature-Review.pdf Phelan, M., Stradins, L., Morrison, S. 2001. “Physical health of people with mental illnesses” British Medical Journal 24; 322(7284): 443–444. NHS Confederation. (n.d). A Primary Care approach to mental health and wellbeing. Retrieved from http://www.nhsconfed.org/Publications/Documents/Case-study-report-on-Sandwell.pdf National Alliance on Mental Illness. (n.d). Integrating Mental Health and Pediatric Primary Care Resource Center Retrieved from http://www.nami.org/Template.cfm?Section=child_and_teen_support&Template=/ContentManagement/ContentDisplay.cfm&ContentID=120673 World Health Organization. (2008). Integrating Mental Health into Primary Health Care: A Global Perspective. Switzerland: World Health Organization. Morris, M. (2008). Mental Health for Primary Care: A practical guide to non-specialists. London: Radcliffe Publishing. Agency for Healthcare Research and Quality, Rockville. (2004). Programs and Tools to Improve the Quality of Mental Health Services: Research in Action Issue Retrieved from http://www.ahrq.gov/research/findings/factsheets/mental/issue16/index.html Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders . (2006). Improving the quality of healthcare and substance use conditions. National Academies Press: Washington, D.C. Ontario Hospital Association. (n.d). Mental Health Assessment Tools: Facilitating Mental Care across the continuum. Retrieved from http://www.oha.com/Education/Pages/CalendarofEventDetails.aspx?eventid=EP12113 Victoria’s Mental Health Services. (2011). Opportunities in practice: Outcome measurement in mental health 2008. Retrieved from http://www.health.vic.gov.au/mentalhealth/outcomes/ Read More