American Psychiatric Association's Diagnostic - Essay Example

American Psychiatric Association's Diagnostic Mental illness is characterized by an abnormal mental condition. Mental illness can also be referred as ‘mental disorder’, and is a key issue for the mental health care providers. The mental illness is not considered as physical illness; therefore the definition of mental illness varies according to the social, legal and political context. The factors that account for the variation influence admission and access to health care facility. These factors also play an important role in defining the use of mental health care services. The definition of mental illness can be divided into two groups according to the clinical literature. An American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) defines mental illness as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual,...is associated with present distress...or disability...or with a significant increased risk of suffering." The duration and severity of symptoms decides the treatment strategy. The biopsychiatrists discusses mental illness with limiting biological criteria which includes heritability, biochemical markers, and anatomical lesions. The federal mental health policy includes all disorders in DSM. In order to receive appropriate treatment, care, and respect to seriously mentally ill populations; policy makers and clinicians have surveyed service programs and epidemiological studies. Previously seriously mentally ill populations are categorized according to their residence in state institutions. After the process of discharging clients from institutions, definitions used in the clinical literature and federal policy are diverse, but focuses on all issues related to mental illness like diagnosis, functional disability, and the duration of illness. The state uses three terms consisting of "broad-based mental illness," "serious mental illness," and "biologically based mental illness" to define mental illness (Peck & Scheffler, 2002). The primary treatment responsibility for the mentally ill individuals is shifted from State mental health and mental retardation facilities to service providers in community-based settings by the report created by federal law to Congress and launched in 1965. The benefits of deinstitutionalization were aimed to improve behavioral outcomes, enhance life satisfaction, and greater level of competence in activities of daily living. This concept of deinstitutionalization has not been effective in providing needed services to the mentally ill individuals from all aspects involved right from ethical to legal. The positive implementation of deinstitutionalization is a difficult task, since it involves numerous components such as involves a number of different agencies, treatment and support services, and procedures. The resources for community care are not properly evaluated and implemented. A marginalized group of people living in scattered sites in the community, the serious mental disorder patients, chronic patients, and aged population are the most adversely affected by deinstitutionalization because of the difficulty of finding resources to meet their needs (Koyanagi, 2007). Though various issues related to housing, disability, education and employment programs for patients are addressed by policy makers; the accessibility to these facilities is still a question. Training and support programs should be properly focused and employed when the mental illness sufferers leave the institutions to live in the outside world. The health care professionals who provide mental health care should be integrated with other systems of care like primary care, rehabilitation, specialty, long-term care, and community-based care settings. The coordinated approach is essential since it augments access to mental health services, improves quality of care, and lowers overall health care expenditures. The metal health and physical health are interlinked and can not be separated. Mental illnesses are often associated with a variety of physical health problems. For example, schizophrenic patients can suffer from obesity, high blood pressure, diabetes etc. To tackle with such medical problems quality physical healthcare should be accessible for such patients. The excess illness and mortality continue unabated if better medical screening and treatment is not delivered to psychiatric patients. Therefore, to control unacceptably high death rate and reduced life expectancy, physical health services are important. To improve the physical health of the patients with severe and persistent mental illness, multimodal treatment strategy is important that combines education and lifestyle intervention which includes diet, exercise and healthy lifestyle modifications (Garrison, 2004). Medicare, Medicaid and state Department of Mental Health or general funds, are the three governmental sources that pay for mental health care. Medicare covers seniors and persons who are disabled. Medicaid covers low income persons with severe mental illness (Jacobes et al., 2004). Department of Mental Health or general funds cover persons who are disadvantaged, who are not eligible for Medicare or Medicaid, or who are deemed “work ready” within 6 months. Some benefit packages, such as Medicare, exclude crucial levels of care for individuals with serious mental illness. Only Medicaid and state-funded services systematically fund outreach and case management to prevent relapse. Rehabilitation services are not financed by Medicare and are not covered expansively by all states under Medicaid. Housing and support services, which are often essential to the recovery of the seriously ill patient, are funded mainly outside of the medical insurance system, and individuals with serious mental illness are not always a priority. It is critical to build a broad assessment and care plan system for care facility. At the same time, develop minimum training levels for the staff. Staff must be trained based on specific needs of the inhabitants served including residents in secured environments and individuals with severe and persistent mental illness. Facilities must provide adequate training to staff in several areas including identifying and dealing with difficult situations and behaviors. A strong system for initial screening and follow-up mental health assessments needs to be in place for compliance. Policies and procedures on behavior management are required. These must address evaluation of behavior management and development of interventions for each behavioral symptom. Managed care frequently involves unreasonable limits on visits with mental health providers. Most people with mental health problems, that need therapy and medication, require weekly therapy visits and monthly psychiatrist visits and this may be required for years or for life. A person struggling with such illnesses is often not up to dealing with the insurance company repeatedly, fighting to get the care they need. Inadequate care ends up being more expensive in the end because untreated mental illness costs society a tremendous amount of money. They also limit what medications to be prescribed. They determine what medicines are ideal, though medication efficacy is a very individual thing. It can take a long time to find the ones that work. A doctor should be determining, this, not a health insurance company. Managed care is a driving force in the evolution of the U.S. health care system, but it no longer is viewed by most employers and federal and state governments as the primary means by which health care costs can be brought under control (Boyle & Callahan, 1995). Some experts contend that managed care can control costs without jeopardizing the quality of care. They point out that when working properly, managed-care plans and providers are rewarded financially for keeping people healthy, which limits cost increases and improves quality. A managed care's superior use of preventive services and patient education helps to cut costs, as has the development of clinical guidelines that allow physicians to forgo costly procedures that have slight possibility of improving a patient's health. As medical science is able to define more precisely what works and what does not, they assert that unnecessary care can be identified and reduced and quality enhanced. References Peck, M. C., & Scheffler R. M. (2002). An Analysis of the Definitions of Mental Illness Used in State Parity Laws. Psychiatr Serv, 53, 1089-1095. Garrison, P. (2004). The Impact of Physical Health Problems for Persons with Severe Mental Disorders. The World Federation for Mental Health (WFMH) URL: www.sahealthinfo.org/mentalhealth/2004wfmh.pdf Jacobs, S., Steiner, J., & Schaefer, M. (2004). Financing the Care of Individuals With Serious Mental Illness. Psychiatric Services, 55 (10), 1096-1098. Boyle, P. J. & Callahan, D. (1995). Managed care in mental health: the ethical issues. Health Affairs, 14 (3), 7-22. Koyanagi, C. (2007). Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long-Term Care Reform. Kaiser Commission on Medicaid and the uninsured, p. 1-28. Read More