U.S. mental health policy: Doomed to fail.

Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, US health policy in the 20th century has been inherently flawed. The short-term general hospital, the "doctors' workshop," emphasizing acute care and surgery, has been the cornerstone of US health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Doomed and double doomed?: Health care reform and the mental health policy challenge.

Comments on C. A. Kiesler's (see record 1993-10935-001) article on health care reform and mental health policy. Much of the current debate is driven by economists, sociologists, political scientists, and physicians, who specialize in health policy analysis and research. To the degree that psychologists are not involved in health policy analysis and research, their interests and perspectives are not likely to be sufficiently represented. Kiesler's work and that of others can serve as models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reimbursement policy and cost-effective mental health care.

Examines past efforts to curb the cost of insuring mental health care that have involved such devices as cost-sharing, benefit ceilings, and limitations on eligible providers. More recently, attention has been turned to regulatory schemes that would employ the results of efficacy research. Specifically, public debate has focused on using demonstrated effectiveness as a criterion for approving certain treatments for reimbursement. Such a strategy may increase costs, inhibit innovation, and interfere with clinical practice. A regulatory model is proposed that would use the criterion of cost as well as the criterion of effectiveness. This method would permit effective, lower cost treatments to be substituted for high-cost therapies. Provider participation and systems innovation would be fostered through decentralized implementation. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The new politics of U.S. health policy

Following the demise of comprehensive health care reform in 1994, some reformers are seeking comfort in the successful "incremental" strategy for enacting Medicare that emerged out of President Harry Truman's failed campaign for national health insurance in 1948-50. But despite similarities between the Truman and Clinton health security efforts, overall contexts of government and politics are much less hospitable to governmentally funded reforms today than they were after Truman's defeat. Back then, market transformations and political dynamics were both pushing toward expanded access to health services and insurance coverage. Today, by contrast, both push in the opposite direction. The private insurance market is fragmenting, federal budgetary constraints stymie new programs, and the deficit dominates debate over existing programs. Equally important, a stable pro-reform coalition like that of Truman's day has yet to emerge, while a new and fiercely conservative corps of Republicans is championing coherent programmatic alternatives based on antigovernment premises. Although passage of the Kassebaum-Kennedy health insurance reform bill in 1996 unleashed a wave of enthusiasm about incremental health care reform, formidable political, fiscal, and technical obstacles continue to stand in the way of even relatively modest incremental solutions.     

The current state of health care in the former Soviet Union: implications for health care policy and reform

OBJECTIVE: To study planning of movement in Parkinson's disease. METHODS: The spatiotemporal pattern of movement related desynchronisation (MRD) preceding a self paced voluntary wrist flexion was compared between two groups of 10 untreated right and left hemiparkinsonian patients receiving no treatment and 10 control subjects. The MRD was computed in the 9 to 11 Hz frequency band from 11 source derivations covering the frontocentral, central, and parietocentral areas, during two successive left and right experimental conditions. RESULTS: In the two patient groups the desynchronisation appeared over the primary sensorimotor area contralateral to the affected side with a shorter latency (750 ms before movement onset for the right hemiparkinsonian group and 875 ms for the left hemiparkinsonian group) than in the control group (1750 ms), only when the movements were performed with the akinetic hand. For the non-affected hand, the same latency as in the control group was noted (1750 ms). CONCLUSION: The delay of appearance of MRD in Parkinson's disease confirmed that the programming of movement is affected, thus partially explaining akinesia.     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

American Indian mental health policy.

Examines the utilization and delivery of mental health services for Native Americans (NAs). Delivery systems discussed include the Indian Health Service, the Bureau of Indian Affairs, university- and urban-based care, and tribal mental health care. It is noted that many NAs view mental illness as a justifiable outcome of human weakness and as a result of excessively individualistic behavior. Treatment of disturbed individuals is considered a community matter. Psychologists often try to impose their values on NAs. It is suggested that psychologists need to become familiar with mental health prevention processes. Recommendations for improving service provision and policies toward NAs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of specialty mental health organizations by older adults: U.S. national profile

Data from the four most recent biennial inventories of mental health organizations and general hospital mental health services conducted by the U.S. Department of Health and Human Services (1988 through 1994) were used to examine utilization of specialty mental health organizations by older adults. The data show steady inverse trends in utilization rates for inpatient and ambulatory care. The oldest clients (age 75 and older) had both the highest percentage decrease in use of inpatient services and the highest percentage increase in use of ambulatory services. The expected growth of the older adult population will challenge the ability of systems of care to maintain or increase the rate of ambulatory mental health care.     

Costs and effects in mental health policy.

Argues that C. A. Kiesler (see record 1982-31029-001) inadvertently overstates the expense of institutionalization in present mental health policy and hence overestimates the relative fiscal viability of alternative care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of mental health legislative reform in Ontario.

Many jurisdictions in North America have revised their civil commitment laws to specify more concretely the conditions under which an individual may be involuntarily hospitalized. The present study analyzed the effects of such reforms on admission rates to Ontario public mental and psychiatric hospitals. Results indicate that despite a significant trend toward a decreasing rate of involuntary hospitalization prior to legislative revision, there was a subsequent trend toward an increasing rate of civil commitments in the years following the change in the law. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost-effectiveness analysis in mental health policy research.

Comments on C. A. Kiesler's (see record 1981-30977-001) argument for cost benefit (CB) and cost-effectiveness (CE) studies in mental health program evaluations. The present author maintains that Kiesler failed to mention the work of several psychologists who investigated the application of CB and CE analyses to mental health. Several misconceptions of CB and CE analyses that were not mentioned by Kiesler are reviewed. These include: (1) the confusion that CB and CE are somewhat interchangeable, (2) the misconception that direct or budgetary costs are the only relevant costs in these analyses, (3) the oversimplification that CB and CE involve only quantitative ratios, and (4) the tendency for these techniques to be seen as objective and nonjudgmental. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing chronically ill older people in the midst of the health care revolution

The health care revolution is challenging nursing to change, as are the rapidly changing population demographics. The aging of America underlines a need for the health care revolution to address continuum-based care requirements, particularly of the chronically ill older population. They and their families are stressed with the current fragmentation of the health care system. Continuum-based care for the chronically ill is critical in altering the trajectory of health care consumption, and case management is central to it. A model of nurse case management is presented as an emerging solution.     

New directions in children's mental health policy: Psychology's role.

The policies that influence the practice of children's mental health affect psychologists across the nation. Major recent events have brought this topic to the attention of national policymakers at the highest level and have created opportunities for psychologists to present information regarding recent scientific advances in the treatment of childhood disorders and to be involved in the development of solutions to address the needs of our nation's children. This article reviews these recent events, summarizes current knowledge in the field, and addresses specific issues and critical gaps in current national policies on children's mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Migrant mental health: A model for indicators of mental health and health care consumption.

Objective: This study explores the relationship between mental health and health care consumption among migrants in the Netherlands. Design: Samples of the Turkish (n = 648), Moroccan (n = 102), and Surinamese (n = 311) populations in Amsterdam were examined. The study tested a hypothesized model of risk factors for psychiatric morbidity, indicators of well-being, and indicators of health care consumption. The model was specified on the basis of information from earlier research on the sample and literature on the topic. The model was tested and refined using structural equation modeling. Main outcome measures: Psychiatric morbidity and well-being measures were assessed with the CIDI 1.1 and MOS-sf-36 subscales, respectively. Health care consumption was assessed by the question "Have you ever consulted one or more of these professionals or health care facilities with respect to mental health problems or problems related to alcohol or drugs usage?" Results: The primary result of this study was the confirmation that health care consumption among migrants is predicted by need and predisposition factors, such as health condition and sociodemographic characteristics. In addition, mental health care consumption of migrants is predicted by acculturation characteristics. This result suggests an effect of cultural and migrant-specific factors in help-seeking behavior and barriers to mental health care facilities. Conclusions: Findings confirm the existence of migrant-specific mechanisms in health care consumption. Mental health care professionals should be aware of these. However, ignoring common ground for interventions unnecessarily creates distance between migrant groups and between migrant and indigenous Dutch groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Serious mental health problems: policy changes

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.     

Health care reform: The 1993–1994 evolution.

Health care costs in the US continue to increase, as does the number of individuals who lack health care coverage. The magnitude of these critical problems assures that reform of the health care system will continue to be debated over the next decade. Increasing health care costs are associated with increased complexity of services and a greater number of health care providers. As health costs increase and the number of individuals covered by private insurance decreases, states will face increasing pressure to develop effective methods of providing coverage for those without health insurance. Employer mandates will be viewed as one method of extending health coverage. Psychologists must be involved in policy issues so as to ensure the utilization of psychological knowledge and attention to psychological and behavioral health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Israel's health policy breakthrough: the politics of reform and the reform of politics

After decades of attempts, Israel has enacted a national health insurance law and begun to substantially change its health care system. I explore the conditions that enabled final passage of the law in light of theories of nonincremental change in pluralist policy systems. I also discuss the implications of this policy breakthrough for links between policy subsystems, leadership, and the establishment of a new policy equilibrium.