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Promotion of Outreach Services to Vulnerable Psychiatric Patients
Rachel Friemoth
Chamberlain University
ENGL148: Advanced English Composition
Professor Kayla Kassakatis
August 1, 2023
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Promotion of Outreach Services to Vulnerable Psychiatric Patients
There is no denying the fact that mental health and the treatment of such disorders carries
an unprecedented amount of stigma and even shame for the individual who is plagued with the internal battles of real versus intrusive thoughts. In a Journal article published by The Permanente Journal, it states that one-third of the world’s disabilities are due to mental health problems. It also states that because of these staggering numbers, there is a direct relationship between mental health and increased socioeconomic costs and suffering for those inflicted (Lake & Turner (2017). With all the implementations of inclusion for different populations of people, those who suffer with mental health disorders are guaranteed to have stories and experiences where they felt the sting of judgement because of the ways these illnesses affect them. Whether a
person deals with debilitating anxiety or depression or suffer with more severe symptoms such as
paranoia and self-harming behavior, it is the duty of mental health providers to advocate and create a system to which these patients will remain in control of their disorder, maintain compliance and thus be able to maintain stability and not be a burden to the system. Lake & Turner (2017) also reported that the average patient requires almost 10 years of treatment, but because of lack of adequate care, more than two-thirds of patients will never receive the care needed for a full recovery. Because of these alarming and very concerning statistics, it is imperative that improvements be made, if anything to allow these individuals to thrive and maintain the highest level of independence as possible. Mental health providers should be required by governing bodies, such as CMS, or the Mental Health Board in the patient’s local area to enforce a system to require all patients be screened for the potential of non-compliance, and then implement policies that will then reachout to the patient after a period of 4 months to
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address needs in medication refills, face to face appointment with therapist or mental health provider, or arrange for inpatient admissions if warranted.
Non-compliance in regard to mental health treatment is a complex problem. Many factors
are credited to the failure of long-term recovery for psychiatric patients. Many communities across the country lack community involvement to intervene during acute and chronic mental health crisis. There is also a huge lack of funding for mental health services. Many racial and ethnic groups suffer greatly from these disparities. According to an article in FOCUS, a journal published by the American Psychiatric Association, individuals living in minority ethnic groups, an average of 20-50% of these patients are less likely to initiate mental health services, and those
that do seek treatment, 40-80% of them are more likely to drop out prematurely (Mongelli et al., 2020). According to Mongelli et al., 2020, these individuals instead utilize emergency services, or enter treatment involuntarily after run-ins with law enforcement. After these admissions, they are less likely to follow-up with regular outpatient services after discharge. Because of the lack of ongoing treatment, these patients do not generally achieve or experience remission, and therefore are unlikely to improve or return to normal functions that allow them to return to a normal work life. Some communities across the country have begun implementing mobile outreach teams. These teams are staffed by mental health professionals who bring needed services and resources to people. The idea behind these practices is that “services need to move toward people rather than wait for people to move toward them” (Mongelli et al., 2020). Other implementations include Peer navigator programs, which are services that are rendered by professionals and paraprofessional staff who have similar life experiences and are recognized as being more empathetic, more emotionally present and believed to be better listeners than the nonpeer providers. (Mongelli et al., 2020).
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Being a practicing mental health provider can be very discouraging. Especially when many patients fail to achieve or sustain recovery. Burnout is a major concern. Many healthcare providers find it difficult to treat patient, who they see as not interested in recovery. Some of the resistance to treatment comes from the implied belief by patients that their providers believe they
“know better than the persons with mental illnesses what the best treatments are” (Roe & Davidson, 2017). Roe & Davidson argue that patients discontinue their treatment for a broad array of reasons, but that healthcare providers have been known to quickly label noncompliance as a bad choice. Because of the constant pendulum between active treatment and relapse, it is believed that these patient lack competence to make good decisions. According to Jauch et al. (2023) the frequency of mental health providers who knowingly and frequently stigmatize their patients is associated with negative outcomes. The articles research indicates that the stigma causes a perception that patients with borderline features as “dangerous” and people with schizophrenia to be “undesirable” and because these stigmas are occurring that the patients are not receiving the best possible outcomes in regards to recovery.
A major factor to noncompliance with mental health treatment solely falls on the ability to pay for psychiatric services. Insurance reimbursement for services rendered isn’t enough to cover growing costs. Psychiatric Times reports that “cost or poor insurance coverage was the top barrier to seeking effective mental health services for American”, and that “1 in 4 Americans had
to choose between mental health care treatment and paying for daily necessities, and 1 in 5 had to choose between treatment for physical condition or a mental health condition because of the costs”. If Americans are being forced to make a choice between physical and psychological needs, with mental health services being substantially higher in cost, it is no surprise that one is being chose over the other. Shana, 2020, states “we can keep doing what we are doing and
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continue to see those systems lose support, lose funding, lose personnel, lose expertise, lose their
attractiveness as training center for new mental health providers…or, we could raise revenue in the state, we can invest in these social safety net services.” This means that inorder to acquire changes that private citizens and mental health advocates need to make their intentions and desires clear to their state representatives and governments. The reports also brings to light the misuse and inequality in processes such as prior authorization requirements and limitations in repayment protocols, as well the fact that insurance companies are engaged with staggering evidence that insurance providers are participating in noncompliant insurance practices (Shana, 2020). If a psychiatric patient’s basic treatment isn’t being billed correctly and being reimbursed improperly, then the patient and the community at large are the ones who suffer greatly. The most effective way to achieve recovery and stability is to take all these factors and restructure the system in otrder to keep the patient as the main focus. Government regulations need to be developed to prevent misuse and mismanagement. Providers of psychiatric services should be required to have a system in place, to screen for the potential for noncompliance. These assessments should be strictly enforced by governing bodies, and penalties put in place for
the failure to do so. Stigma and bias displayed by the professionals towards patients should be identified and additional training should be assigned to promote empathy and an increased awareness. It is important that mental health professionals create an environment that patients can develop trust, feel respected and then feel supported, especially when other physical needs occur that may hinder the continuance of mental health treatment. Social services need to be involved to balance these things. The end goal should be that the patient is fully functioning and healthy physically and mentally.
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References
Jauch, M., Occhipinti, S., & O’Donovan, A. (2023). The stigmatization of mental illness by mental health professionals: Scoping review and bibliometric analysis.
PLOS ONE
,
18
(1), e0280739.
https://doi.org/10.1371/journal.pone.0280739
Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care.
The Permanente journal
,
21
, p. 17-24. https://doi.org/10.7812/TPP/17-024
Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to
meet the mental health needs of underserved and disenfranchised populations in the United States.
Focus
,
18
(1), p. 16-24.
https://doi.org/10.1176/appi.focus.2019002
Roe, D., & Davidson, L. (2017).
Noncompliance, nonadherence,
and
dropout
:
Outmoded terms for modern recovery-oriented mental health.
Psychiatric Services, 68
(10), 1076–1078.
https://doi.org/10.1176/appi.ps.201600522
Shana, A. (2020b, June 17). Mental health parity in the US: Have we made any real progress?
Psychiatric Times
.
https://www.psychiatrictimes.com/view/mental-health-parity-in-the-us-have-we-
made-any-real-progress
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