The Care of Special Populations and Special DisordersIntroductionAmerican Psychiatric Assoc.ConceptualizationDefining Mental IllnessProvidersPublic/Governmental RoleMovement toward Community CareDeinstitutionalizationUn-met NeedPolicy IssuesConclusionHSCI 678 Intro to US Healthcare SystemThe Care of Special Populations and Special DisordersChapter 18Dr. Tracey Lynn KoehlmoosIntroduction•Defining special populations•Systems that exist•Types of providers•Policy issuesAmerican Psychiatric Assoc.•A mental disorder is a clinically significant behavior or psychologic syndrome or pattern that occurs in an individual and that is typically associated with either a painful symptom (distress) or impairment in one or more important areas of functioning (disability). (APA 1980)Conceptualization•Mind/Body Schism—historical•Emotional/Mental distress = Morbidity–Immune functions–Cancer–Heart DiseaseBiologically perceived health is a strong predictor of mortalityDefining Mental Illness•Multiple disorders- More than 15% (30% annually) - 1% unable to care for themselves•Common diagnoses–Schizophrenia, Schizoaffective, Bipolar•Notable Exclusions–Developmental disabilities–Substance abuse: lack of data/excessive careProviders•Psychiatrists, psychologists, counselors, therapists, social workers, ARNP, etc.•Numerous facilities–State, VA–Private (health plan participants)Public/Governmental Role•Chronic Mental illness: some can be treated/some limited recovery options•Government institutions (48 states)•Mental health care unresponsive to financial incentives; outside continuum of care•State mental hospitals—long tradition–80% had chronic mental illness in the 1930’s–Population peaked at ~1/2 million in 1955Movement toward Community Care•Shift of psychiatrists out of mental hospitals/replaced by FMGs—problematic•Psychoanalytical transition—little proof•Social welfare increasesRESULTS:Smaller in-patient populationAllowed for treatment/ not warehousingOnly care for severely mentally illDeinstitutionalization•33-40% homeless, chronic illness•Elderly residents—to nursing homes (Medicaid/ Medicare)•Payment shift from State to Federal govt.•Federal programs:–SSDI–SSI MEDICAID big payer for mental health servicesUn-met Need•About 150,000 chronic residential patients•Where is everyone else?–No access to care–15% uninsured—hard to get to Medicaid–Private insurance—inadequate provisions–Managed care—discourage enrollment–Social stigmaPolicy Issues•Physical/Mental health schism•Institution/Community schism•Unmet treatment needs–Substance abuse–Young, disturbed and alcoholic•Stigma, stigma, stigma•Managed Care-advent of mental healthcareConclusion•Diverse population--disparities•Difficult to reach•Difficult to treat•Difficult to project prognosis•Lack of advocacy•Lack of