Essay on Changes to North Carolina Mental Health Systems

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

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).

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

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

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

Access to mental health care is not as good as than other forms of medical services. Some Americans have reduced access to mental health care amenities because they are living in a countryside setting. Others cannot get to treatment for the reason of shortage of transportation or vast work and household tasks. In some areas, when a

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

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.

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

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.

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

The amount of mentally ill people who are homeless has risen since the start of deinstitutionalization: Many residents of mental institutions have no families or homes to go to; board-and-care facilities are often substandard; and the community mental health centers have often been ill prepared and insufficiently funded to provide needed services for

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,

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

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