Intensive Case Management

Institutional care was condemned, as in many cases patients’ mental conditions deteriorated, and institutions were not able to treat the individual in a holistic manner. In many state institutions, patients numerously outnumbered the poorly trained staff. Many patients were boarded in these facilities for extensive periods of time without receiving any services. By 1963, the average stay for an individual with a diagnosis of schizophrenia was eleven years. As the media and newspapers publicized the inhumane conditions that existed in many psychiatric hospitals, awareness grew and there was much public pressure to create improved treatment options (Young Minds Advocacy, 2016). .

Other housing needs for the mentally ill include specialized in- house primary care, health promotion programmes, open access mental services (accessible to all at any time, missed appointments are also tolerated), assertive management, street based service provision, holistic and generalist support apart from just clinical diagnosis, talking therapies and full access to mainstream services. Most importantly, the housed mentally ill persons have to be shielded from becoming homeless again. Such assurance that they will forever have a comfortable place to stay will relax their minds. This will go a long way in promoting their mental well being (Randall et al. 2006).

Apart from medical technology and medications, the housing treatment has played a great role in improving the treatment of mental illness since the early 1990s. First and foremost, in the past the patients of mental illness were treated as prisoners by being isolated in hospitals or asylums but now they are treated as normal human beings with great care and respect. Secondly, in the past the patients stayed in the hospitals for long periods of time, whereas nowadays patients stay in their home community for most treatments. Only in severe cases, such as violent patients or those who cause harm to themselves may be required to stay in hospitals or more intense observation. Another form of housing treatment is community treatment in which the patients are treated in a friendly way while in

Saratoga County no longer has safe, stigma-free, places for individuals with severe and persistent mental illness (SPMI) to spend their days. SPMI individuals need somewhere to go where they can feel safe and can interaction with others. In the past SPMI Individuals in Saratoga County had the options of attending day treatment, going to a drop-in center called The Social Club, or spending the day being productive in a sheltered workshop environment. Over the past few years all of these options have been removed. First, The Social Club was closed. Next, the day treatment center was changed to a “PROS” model where services are limited, time specific, and the focus is on community integration. Lastly, state and county funding was cut for shelter workshop environments and funneled into work readiness programs focused on integrating SPMI individuals into the community workforce. Integration is a noble aspiration. However, many SPMI individuals do not have the capacity to successfully integrate into community settings. These individuals are better served in situations where their special needs are appreciated and met such as sheltered workshops, drop-in centers and day treatment. Thus, due to the closing or changes in these types of programs, Saratoga County no longer offers safe supportive places for many SPMI Individuals to spend their days.

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.

Today, the U.S. mental health services are multifaceted and complex, containing people in general and private segments, general wellbeing and claim to fame mental well-being suppliers, and social administrations, lodging, criminal equity, and instructive offices. These offices don't generally work in an organized way. The design of the framework reflects fundamental reactions to an expansive cluster of elements including change developments, budgetary motivating forces in light of who pays for what sort of administrations, and advances in consideration and treatment innovation. In spite of the fact that the cross breed framework that exists today serves assorted capacities well for some individuals, people with the most complex needs and the least money related assets regularly discover the framework divided and hard to utilize. A test for the Nation in the close term future is to speed the exchange of new confirmation based medicines and aversion intercessions into differing administration conveyance settings and frameworks, while guaranteeing more noteworthy coordination among these settings and

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

Ryon, S. B., Early, K. W., Hand, G. & Chapman, S. (2013). Escalation and Effective Alternatives to Residential Placement, 52, 358-375

Forcing patients into treatment has many positive outcomes such as decreased hospital rates, length of stay, attendance to follow up increases, the patient becomes more willing to take their medication regularly and decreased violent behavior. In fact, many mental health professionals believe it is very effective in stability with the most difficult patients. The most effective result of involuntary out-patient is high levels of service. Those that receive treatment longer and are given more support are more complying and have more positive outcomes.

This article focused on a study that showed coordinated specialty care(CSC) for young people that have had a first episode of psychosis. Although this treatment is less cost effective, according to the results it produces a higher clinical and quality of life outcomes. With these results, some believe that this treat program is of better value. Coordinated specialty care is a team of specialists who work with a client to create a person treatment. It consists of a structured system of steps as soon as the psychotic symptoms begin.

The CTT program through FSWP follows the Assertive Community Treatment model. In a world dominated by managed care regulations, the community stabilization offered by the ACT model shows to be more cost effective than continual hospitalization for individuals with severe and persistent mental illnesses (Essock, Frisman & Kontos, 1998). This has made CTT gain popularity in the last 15 years. The ACT model is widely researched method and endorsed by both governmental and public advocacy groups as an evidence-based best practice, it is generally accepted as a state-of-the-art approach to long-term care method for serving individuals suffering from severe and persistent psychiatric issues (Ellenhorn, 2015). A six month outcome study done by Young, et al.(2014) showed that CTT involvement lead to statistically significant improvements in mental health symptomatology and residential stability over time. (pg. 474).

In a study by Jackson et al, 1998 in which the therapist engages with the patient shortly after the first psychotic symptoms have subsided. The focus of the therapy is the patient’s adaptation to the psychotic illness and secondary symptoms. Patients who received CBT and those who refused CBT were compared with those who did not qualify for CBT on either of the conditions and who lived outside the region. When compared with the control group those who received CBT adapted better to the illness, understood the illness more (the Explanatory model), scored better on the Quality of Life Scale and the Scale for the Assessment of Negative Symptoms (SANS). However the CBT group only outperformed the CBT refusal group on the adaptation to the illness. There was no significant difference in the relapse rates of either group. This particular study is limited by pre-treatment differences. The control group had a mean duration of psychosis of 91 days and the CBT patients 19 days; also the reliability of the study was not reported. Thus this study which focussed on early intervention showed only slight benefit of CBT.

Navigation of life is not void of challenges; however, in the presence of a mental disorder, these normal life challenges are exacerbated. Because of this continued mental health services are of fundamental importance for the suffer given they can ease the burden of the disorder. Unfortunately, numerous barriers interrupt the path to care and treatment, which many suffers cannot navigate, thereby severing their link to these vital services. Barriers are either attitudinal (stigma and adverse perception about mental health efficiency) or structural (e.g. location, distance, accessibility, inadequate health coverage) both of which appear to have an impact in this particular case (Eaton, 2012). Ms. Jones unwillingness to accept her diagnosis with paranoid schizophrenia is indicative of the power of stigmas, as well as their ability to obstruct treatment.

Central to S+C is a focus on the case management component of eligibility requirements. With the goal of increasing participant’s ability to retain their S+C voucher, it is required that they meet with a mental health professional on a regular basis. This component of the program is invaluable in terms of both providing proof that recipients are remaining eligible (via continued disability, income, familial status, etc.), and assisting them with the skillset necessary to maintain housing and improve ability to complete their activities of daily living (timely payment of rent and utilities, cooking and cleaning, hygienic concerns, mediating communal disputes, etc.). Society largely supports this aspect of S+C because it offers oversight of the program to discourage fraud, as well as offers assistance to those that have historically proven unable to maintain housing when left to their own

Burns et al. (1999) clearly state the purpose as, “to assess the effect of intensive case management (defined as a smaller caseload size) in patients with serious mental illness in four inner-city mental health services (Burns et al., 1999, p. 2185). The purpose is to argue why ICM is not effective in UK and Europe. The