Addressing the Care Disparities of Living Well with Severe Mental Illness - PowerPoint PPT Presentation

Loading...

PPT – Addressing the Care Disparities of Living Well with Severe Mental Illness PowerPoint presentation | free to download - id: 6913ab-YjI3N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Addressing the Care Disparities of Living Well with Severe Mental Illness

Description:

Addressing the Care Disparities of Living Well with Severe Mental Illness Suzanne Vogel-Scibilia MD Asst Clinical Professor: University of Pittsburgh – PowerPoint PPT presentation

Number of Views:101
Avg rating:3.0/5.0
Slides: 33
Provided by: owner
Learn more at: http://www.umassmed.edu
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Addressing the Care Disparities of Living Well with Severe Mental Illness


1
Addressing the Care Disparitiesof Living Well
with Severe Mental Illness
  • Suzanne Vogel-Scibilia MD
  • Asst Clinical Professor University of Pittsburgh
  • Boardmember American Association of Community
  • Psychiatrists

2
THE PERFECT STORM Crisis in US Mental Health
3
WHAT IS THE PERFECT STORM?
  • Service Infra-structure Deficits
  • Access to care
  • Lack of Parity
  • Lack of Safe Havens for the SMI
  • Trans-institutionalization
  • Fragmented care
  • Consumers without a voice.
  • Criminalization
  • Entitlement Cutbacks
  • Lack of Medical Care
  • IOC/Mental health Courts
  • Housing cutbacks
  • For Profit Managed Care
  • Lack of Central Accountability in Government

4
We are all ignorant just about different
things.
-- Mark Twain
5
What is the Mental Health Reform History?
  • 1960-1980 Liberal Era de-institutionalization/re
    strictive commitment/ NGBRI or diversion to
    treatment.
  • 1980 onwards Neo-conservative Era increased
    criminalization/commitments protect the
    community not individual rights.
  • Back to the Asylum Fond Durham Oxford Press
    1992

6
Deinstitutionalization
  • Mixed conscience and convenience
  • Promised infrastructure never completed.
  • Acute care model for community mental health
    not treatment of persons with chronic mental
    illness. Hospitals/ intense crisis services
    monetary black holes resource allocation
    shortages privacy concerns block data
    collection inability for severely ill consumers
    to advocate for themselves civil liberties
    without safety/protection coercive control not
    engagement . Criminalization.

7
NAMI Grading the States
  • Providers/outpatient services expansion
  • Funding care appropriately
  • More Crisis Services
  • Safety Net Resources
  • Alternatives to Traditional Public Providers
  • Address Medical/Psychiatry Interface/
    Medical Care
  • Mental Health Parity
  • In North Carolina W-S Journal 2005 the
    missing factor is money.

8
A Great Social Experiment De-institutionalizatio
n to Trans-institutionalization
  • Three major concepts in mental health care of
    persons in crisis moral treatment, mental
    hygiene and then the community health movement.
  • Trans-institutionalization as a repetitive force
    first almshouses to state mental hospitals and
    now state mental hospitals to jails and prisons.
    Full circle.

9
Deinstitutionalization
10
Topeka State Hospital - 1949
  • Menningers of Topeka began administrating Topeka
    State Hospital after reports of deplorable
    conditions.
  • Pre chloropromazine, pre- Medicaid
    entitlements, and pre-community psychiatry
    movement - the Menningers were able to
    transition many people to the community this
    was accomplished by concentrating expenditures on
    clinical personnel.
  • Burnham JC Persp Biol Med 2006 Spring 49(2)
    page 220-237.

11
Brewster v. Dukakis knowledge gained
  • 1978 consent decree affecting one section of
    Massachusetts produced a huge reduction in
    patients able to receive care at a state hospital
    where significant bed contraction had previously
    been undertaken.
  • Less census reduction occurred than hoped
    mostly clients with MR or of geriatric age less
    effective with persons with long-term CMI and new
    chronic patients.
  • Many required repeated hospitalizations despite a
    huge number and variety of community-based
    services.
  • Geller JL Am J Psych 1990 Aug147(8) p982.

12
Criminalization of Persons with Mental Illness in
the US
  • Markowitz, F Criminology, 2006 Volume 44 (1)
    page 45.
  • As state hospital beds contract, homelessness and
    criminalization increases proportionally.
  • Extended acute care beds do not reverse this
    trend.

13
De-Institutionalization Difficulties
  • Undertaken despite marked community service
    needs.
  • Undertaken with acute shortage of providers of
    care in many areas.
  • Undertaken into the general population that has a
    lack of tolerance and a lack of any other types
    of asylum to harbor people in crisis. This
    leads to trans-institutionalization into jails,
    prisons and the streets.

14
Who/What Are The Culprits?
  • Increasing Homelessness
  • Health Coverage either inadequate or nonexistent
  • Medicaid Reform (restricted formularies,
    preferred drug lists)
  • Managed care corporations (HMOs)
  • Negative Side Effects of Medications
  • Selectivity of private psychiatric hospitals and
    care providers in treatment
  • Anosognosia
  • Mistakes Made by Clinicians
  • Stigma/Lack of Safe Havens

15
No Mercy
  • Mercy Bookings often put persons with mental
    illnesses at greater risk.
  • As Jails are often Characterized by
  • - Inadequate Mental Health Treatment
  • - Increased Potential for Victimization
  • - Lack of Discharge Planning

16
Sequential Intercept Model
  • Munetz M and Griffin P Psych Serv
  • Elaborates a strategy for policy makers and
    clinicians to appreciate the points in a
    consumers interaction with the criminal justice
    system where interventions could occur to receive
    psychiatric treatment diversion and/or re-entry.
    Positively embraced in the US.

17
Crisis in Mandarin Chinese
18
Crisis Intervention Teams Memphis Model
  • Educational Trainings
  • Signs and Symptoms
  • Officer Safety
  • De-escalation techniques
  • Screening for medical problems
  • Site Visits
  • Intervention techniques
  • Service education
  • Presentation by consumers/FM

19
Memphis Model - CIT
  • Demonstrated to have less injury/death to
    consumers and officers when officers trained in
    CIT.
  • Multiple other CIT models exist in US.
  • Another model has social workers who ride with
    police
  • Another model has mobile crisis teams who show up
    when called by police.
  • CIT models exist more commonly in urban than
    rural areas of the US.

20
Airport Crisis Intervention
  • 1980s Help is on the way
  • 1990s Help but you are charged
  • 2000s You get shot Miami Tarmac incident.

21
Outpatient Commitment PLC or TLC?
  • PLC persuade, leverage, coerce
  • TLC tender loving care
  • improved patient centered tx
  • entitlements and service delivery
  • assertive outreach - rather than
    penalties or conditions on access to services -
    to induce compliance.

22
Does Outpatient Commitment Work?
  • Catch too many Dolphins with the Tuna.
  • Coercive/Lack of Dialogue with consumer
  • Not utilized because it is time
    consuming/costly/providers become police
  • Public Relations Nightmare for consumers and
    the community
  • Effects Voluntary Supply and Demand for services

23
IT IS NOT JUST ABOUT MENTAL HEALTH IT IS
PHYSICAL TOO
  • THE PERFECT STORM

24
CATIE Study produced a dire warning..
  • Using the Framingham coronary heart disease risk
    data for the general population and comparing it
    to the same risk factors for 689 persons
    participating in CATIE, the ten year coronary
    heart disease risk was elevated in males (9.4 vs
    7.0) and females (6.3 versus 4.2) in persons
    with schizophrenia.

25
THE DEPTH OF THE PROBLEM
  • SMOKING - 68 versus 35
  • DIABETES - 13 versus 3
  • HYPERTENSION 27 versus 17
  • LOWER HDL (good) CHOLESTROL
  • 43.7 versus 49.3.

26
WHAT IS METABOLIC SYNDROME??????
  • LIPID ABNORMALITIES TRIGLYCERIDES AND
    CHOLESTEROL
  • ELEVATED BLOOD PRESSURE
  • ELEVATED BLOOD SUGAR
  • PRO-COAGULATION
  • PRO-INFLAMATION
  • Waist circumference is an indicator of
    free fat mass..

27
STRATEGIES TO ADDRESS METABOLIC SYNDROME
  • ADDRESS THE PROBLEMS THAT DEVELOP
  • See the doctor take the treatment.
  • ATTACK THE COMMON SOIL THAT CREATES THE PROBLEM
  • Big problems like smoking, or weight
  • Little problems that count like dental
    hygiene.

28
WHAT CAN WE DO ABOUT THIS?
  • THE RESEARCHER, THE CARDIOLOGIST, THE VERY LARGE
    CANADIEN EXPERT AND MYSELF AT THE APA.
  • IF YOU DONT TAKE A TEMPERATURE - YOU CANT FIND
    A FEVER. (the importance of monitoring)

29
  • Obtain a metabolic panel, complete blood cell
    count, and lipid panel every six months until
    your medication regimen is stable, and you are
    adhering to the testing.
  • Check your waist circumference 35 inches or
    less for women and 40 inches or less for men.
  • Calculate your BMI
  • 25 to 30 is overweight.
  • 30 and above puts one at metabolic risk.

30
  • Follow the recommendations in Hearts and Minds..
  • Exercise
  • Cut down on the smoking
  • Follow a diet that is reasonable
  • Set small, incremental goals
  • Remember little things and little
    changes make the difference.
  • Seek treatment for BOTH types of
    illness!

31
Why is Self-determination Linked to Recovery?
  • Trauma theory of mental illness (NAMI Programs)
  • Instillation of hope and optimism
  • (Resnick SG et al Psych Serv 2004 May
  • 555 page 540-547).
  • Transformation of the self concept into a more
    functional sense of self.
  • (Davidson Straus BJ of Med Psychology
  • 1992 June 65-part 2 131-145 )
  • Empowerment and consumer driven care helps to
    heal the psychological wounds of mental illness
    and assuage the feelings of guilt and
    powerlessness that is the first-person experience
    of these brain disorders.

32
Promising Interventions
  • Crisis Intervention Team training (CIT)
  • Mental Health Courts
  • Probation Officer Mental Health Specialists
  • Discharge Planning/Re-Entry
  • Assertive Community Treatment
  • Clubhouses
About PowerShow.com