Essay on Changes to North Carolina Mental Health Systems

Many years ago, mental illness was viewed as a demonic possession or a religious punishment. In the 18th century, the attitudes towards mental illness were negative and persistent. This negativity leads to the stigmatization and confinement of those who were mentally ill. The mentally ill were sent to mental hospitals that were unhealthy and dangerous. A push in the mid 1950s for deinstitutionalization began because of activists lobbying for change. Dorothea Dix was one of these activists that helped push for change. The change called for more community oriented care rather than asylum based care. The Community Mental Health Centers Act of 1963 closed state psychiatric hospitals throughout the United States. "Only individuals who posed an imminent danger to themselves or someone else could be committed to state psychiatric hospitals" (A Brief History of Mental Illness and the U.S. Mental Health Care System). Deinstitutionalization meant to improve quality of life and treatment for those who are mentally ill. This would hopefully result in the mentally ill receiving treatment so they could live more independently. The hope was that community mental health programs would provide this treatment but sadly there was not sufficient or ongoing funding to meet the growing demand for these programs. Budgets for mental hospitals were reduced but there was no increase for the community based programs. Many mentally ill individuals have been moved to nursing homes or other residential

In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the

Bachrach, the author of dozens of articles on mental health, reports on the development deinstitutionalization in “Deinstitutionalisation: promises, problems and prospects” (1995). Bachrach argues that deinstitutionalization is not a perfect solution to the problem of the treatment of PMI and supports her argument with discussions about both the drawbacks and “positive legacy” of deinstitutionalization. She explains that deinstitutionalization has three parts: the release of patients into the community, the diversion of possible new patients and the development of newer community programs; Bachrach logically explains that the last process is “particularly important” because it impacts the entirety of the patients new independent life in the community. Multiple sources remarked that the third step of deinstitutionalization had not been properly handled (SOURCES?), one author going so far as to call the last step, and deinstitutionalization as a whole, an “abject failure” (Kara, 2014). While the author supports this claim with the consequences that things such as the lack of community resources has had on the population of PMI, she does not concede any of the positive outcomes of deinstitutionalization making her argument somewhat one sided. The article explains that while institutions began closing, “hundreds of vulnerable people were displaced” to communities that were not properly equipped to support them. An article from the Canadian Mental Health Association website by Diana Ballon supports this claim with a more concrete figure stating that since 1950s and 60s and the beginnings of deinstitutionalization there has been “the closure of almost 80 percent of beds in psychiatric hospitals” (n.d.). This increase of PMI living in communities with a lack of proper housing lead to a disproportionally large number of PMI being homeless or living in poverty which “greatly increase[s] the odds of PMI

Statement of the Problem/Issue: Providing geriatric patients with better options for mental healthcare is an ongoing issue in long-term care statewide. Under the Omnibus Budget Reconciliation Act (OBRA) of 1987, congress made a Preadmission screening and resident review program (PASRR), to help alleviate worries that numerous individuals with genuine emotional instability and mental impediment were living in nursing homes that lacked sufficient assets to suitably meet their needs. PASRR enactment obliges state Medicaid organizations to implement programs that screen and distinguish nursing facility applicants and residents with chronic mental illnesses (Shea & Russo, 2001).

The findings of the research case study undeniably supported the researchers’ hypothesis when they were compared to the secondary data. Findings from three empirical studies also supported the researchers’ hypothesis. In the article, the Large Residential Care Facilities findings specify that people who were removed from institutions and placed in the community were provided better services (Alvarez, 2016). The article Mental/ Behavioral Health Services found that large adjustment occurred across states in projected spending for services, spending per participant, annual hours of service per participant, and hourly reimbursement rates (Friedman, Lulinski, Rizzolo, 2015). The article Understanding Deinstitutionalization results presented that

What was the main event that occurred that led to the need for change for this intervention?

Since the nineteen eighties when President Reagan was in office, I recall him basically shutting down some mental facilities and discharged them to the streets. Having lived through this and seen some of the effects it has had on some communities is troublesome. So where did some of these people go (besides dying by suicide or failed living arrangements)? Nursing homes and some to assisted living facilities. This is reflected in our reading of Touhy, T. A., Jett, K. F., Ebersole, P., & Hess, P. A. (2016) that although not licensed psychiatric treatment facilities, they are providing the majority of care to older adult with psychiatric conditions. And what is more troublesome is the numbers related to mental health conditions that range from sixty-five percent to ninety-one percent with only twenty percent receiving treatment for their condition. We try to provide the care they need but are met with a shortage of trained personnel, limited availability and access to psychiatric services, inadequate insurance to meet their healthcare needs (p. 358). So

Mental health services have gone through a radical transformation over the past 30 years. This process began with a wholescale transformation process known as deinstitutionalisation - that is, shifting care and support of people with mental health problems from psychiatric institutions into community based settings. At the start of the process, these, these institutions housed approxiamately 100,000 people; by the end, all hjad closed.

Psychiatric communities can be seen in the psychiatric hospitals used to treat those with mental illness before the deinstitutionalization movement. This approach was unsuccessful and yet after taking away these facilities those with mental illnesses face even more problems. Through the examination of total institutions and the effects deinstitutionalization, it is apparent that those with mental illness would best benefit from community programs such as the Supported Housing project. I argue this because after the deinstitutionalization of treating those with mental illness there was not any programs in place in the community to help those leaving the facilities to re-enter society.

The need for special programs continues to increase yet numerous states have a suspension on building new residential programs. People have reduced attendant care programs that are often vital in providing persons with disabilities essential services for day to day living. Mental health programs have been underfunded leading

Failure to implement deinstitutionalization and inadequate community support puts more strain on the mental illness population. The mental health system has failed to divert services, resources, and budget funds from hospital-based care to community care at the same rate as it has discharged patients to the community. In addition there are too few vocational rehabilitation, case management services and community residence (page 8) (Robertson & Greenblatt, 1992). Mental illness complicates how an individual can control their emotions and decision making contributing to the hardships they will endure trying to function in society whether it is at a job setting or in an educational

Beginning in 1955, (with the greatest conversion occurring in the 1980s and 1990s), deinstitutionalization in the United States slowly transitioned individuals with mental illness and various disabilities from large state institutions to community group homes and smaller residential organizations (Koyanagi, 2007). This transition placed a need for community organizations and nonprofits to train and hire direct care workers (Koyanagi, 2007). Direct Care workers provide services to individuals whom may be suffering from mental illness, developmental disabilities, physical disabilities,

When there is a strength there comes a weakness. Weakness occurs as a result from certain areas.

There are great health care benefit programs for employees in most organizations. However, the age limitations are causing serious concerns when it comes to mental care for dependent adults over the age of 26. This needs to change, as mentally ill patients over the age of 26 are left without healthcare insurance; which is never a good thing. Mentally challenged individuals deserve to be protected and covered as dependents under their caregiver’s insurance plans as long as they live. The term dependent should not be restricted to an age, but rather be a term that defines the individual who is unable to provide for themselves due to some mental disorder. Therefore, if organizations change their policies and include the mentally ill as a dependent regardless of age, then, it is likely for economies to see declining crime rates, less cost to taxpayers for essential services, and better overall rehab facilities.

Additionally, legislative actions were taken in the 1960s and 1970s that made it even more difficult to help those who needed it the most. The system for community mental care was vastly underfunded and many people did not have access to care. As of 1977, according to statistics from Officer.com, “there are 650 community health facilities serving 1.9 million mentally ill patients a year” (Deinstitutionalization). A major problem was that funding was given and then taken away, or diverted to other causes (Thomas). This increasingly paints a picture of the community mental health initiative as a rapidly sinking ship. At this point, not only were mentally ill people being discharged from inpatient treatment facilities with nowhere else to go, they could not even get the help that they needed if they were willing to seek treatment. For those unwilling, or unable, to seek treatment, the Lanterman-Petris-Short Act, and others like it, made forcing the issue even more difficult. To make matters worse, underfunding was also having a negative impact on the few remaining state hospitals. Because the jobs paid so