Behavioral Health And Mental Health

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Behavioral Health And Mental Health Essay

Behavioral health and mental health are sometimes used interchangeably, but behavioral health extends beyond mental health and encompasses a broad array of psychiatric and/or psychological services provided in many different settings. Behavioral healthcare is used to describe the connection between behaviors and the health and well-being of the mind, body, and spirit. It can include behaviors, such as habits like eating or drinking, that impact humans over time or immediately either physically or mentally.Behavioral Health And Mental Health Essay It can also refer to much broader factors such as dealing with stress over long periods of time or living in overpopulated areas. When it comes to these behaviors, some are controllable and some are not. Many are limited by things that are outside of our control. In the 70s and 80s, behavioral health referred mostly to behaviors that promote health or help to prevent illness. As time progressed, an updated meaning has become necessary. Behavioral health now includes mental health and a great deal of mental and behavioral health conditions can be attributed to the environments we live in, biological factors such as our genetic makeup, and experiences we have throughout our lives. The overall goals of both behavioral health and primary care are similar: helping people to function fully and live long, healthy, full lives. The combination of behavioral and primary health care can help people to function and lead those healthy, full lives.Behavioral Health And Mental Health Essay

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In view of the strict confidentiality requirements for patient records, particularly in cases involving mental health and illness, both mental health patients and the general public were assured in accordance with the nursing and midwifery council code of conduct (NMC 2008), to respect and observe mental patients rights to confidentiality. Furthermore any information obtained about them as part of this research was not shared or disclosed with/ to any third party without their ultimate permission been given (Mental health and learning disabilities 1998).Behavioral Health And Mental Health Essay

WHAT IS MENTAL HEALTH
There have been so many attempts by writers and authors to define what mental health is? So many different definitions have been given and for the purposes of this research only two of them were mentioned. According to The World Health Organisation (2001) health is the state of being complete mentally, emotionally, socially, physically, psychologically fit and not just a mere absence of sickness. But Keyes (2002) pointed out that mental health does not refer to a single instance of an individual’s state of mind, but rather, it covers a broad spectrum and describes a collective sequence of behaviour over time. It may be generally explained and the argument is that diverse bodies, environments and settings use dissimilar means of conceptualizing the term. In other words what constitutes mental health in one profession or community might not necessarily mean the same in another. It could be classified as the disturbing toughness which allows individuals to take pleasure in their existence and endure pain, distress and depression which can also be said to be a good signal for individual`s interests and a fundamental idea in our personal, and other’s (Weare 2000). In some cases stating what mental health is? can include a broad scope of capacities which emphasises our potential in growth, change and also social nature (Department of Health 1995a) There are a many of mental health situations that could result to a disability, such as nervousness, sadness, as well as schizophrenia (web 1).Behavioral Health And Mental Health Essay In a report issued by the World Health Organisation (2003) it indicated how secretive and covered the shame and favouritism associated with mental health have been and emphasised the need to uncover and bring to the public domain. The extent of agony and challenge with regards to disability and spending for people, relatives and communities are overwhelming. The world has now recognised in the last few years the huge trouble and the probable danger associated with the illness.

The discovery here indicated astonishing figures all over the world on the epidemic with it seriousness been sometimes overlooked. Surprisingly more than 450 million individuals go through mental or disorders in behaviour. Almost one million individuals do kill themselves each year and due to neuropsychiatric disorders (depression, alcohol-consumption disorders, schizophrenia and bipolar disorder), four of the six leading causes of years lived with disability. Mental disorder can at least be found in every four families and relatives are normally the main care providers for persons with mental health problems. The degree of the challenge on relatives as a result of the complications to measure and as a result often uncared for. Nevertheless, the considerable effect on their relatives` quality of life has always been negative. People affected by mental illness incur both social costs and mental health costs and is victims of discrimination, human rights abuse, stigmatisation and both internal and external dejection (WHO 2003).Behavioral Health And Mental Health Essay

WHAT IS MENTAL ILLNESS
This is where the functioning of the mind becomes affected due to the series of signs and experiences of conditions, such as phobias, schizophrenia, depression, anxiety, mania and substance misuse disorders (Carol and ASH 2004, health welfare 1998, Trent 1999, Tudor 1996). Due to how rampant and common mental illnesses have become in recent years, in the course of an average person’s life, it is possible that they will either develop a mental health problem themselves, or have close contact with someone who does (Kitchener and Jorm 2002). In a research conducted in Scotland, it concluded that one in every four adults will experience mental health problems at some stage in their lives (Scottish Association for Mental Health (2003a). Weiss et al (2001) advocated that mental illnesses have been stigmatized in several nations and cultures. Current findings have proved the attempt in some countries to minimise the degree of stigmatisation through scientific approach and educational efforts (Rahman et al 1998). But notwithstanding these efforts, the disgrace and panic attached to mental illness remains a considerable barrier to finding assistance to identify and to treat.Behavioral Health And Mental Health Essay The association of stigmatization on mental illness has caused disparities, as oppose to other forms of illnesses, and its` further violation human rights abuse regarding people having these disorders. Even though mental health and mental illness are not the same but they are inter- related and so sometimes used interchangeably (World Health Organization 2003). Mental health is how individuals think, feel, and behave as they cope with daily life. It assists in deciding how people cope with stress, relate to others, and make choices. On the other hand, Mental illness is a collective term for a broad range of mental disorders and the mental disorders are medical conditions that disrupt how a person thinks, feels, and/ or behave, resulting in distress and/or impaired functioning (Austin 2010).Behavioral Health And Mental Health Essay

CHALLENGES OF MENTAL HEALTH PATIENTS WELLBEING
Patients with mental disabilities have problems and the range of the challenges encountered in their everyday life are numerous and involves for example reactions to adjustments (external situations normal responses); either short or longer-term disability connected to signs of hopelessness and nervousness (and psychiatrically linked with diagnoses such as gloominess, but may be generally constructed); bipolar disorder, schizophrenia (with a obvious genetics root, more simply clear by its signs but also with important the general public meaning and penalty). There may be coexist between each other, and also with problems linked to the drinking of alcohol or drugs, and with problems ensuing from complications traits and personality types (The Royal College of General Practitioners 2007). The case study below attempted to explain Ms. Catherine who suffers from postpartum depression.

CASE SENARIO – Ms Catherine suffers from postpartum depression
Brief Description
“Postpartum” depression is a type of depression that happens to women after they give birth and they are of two different categories which are postpartum or maternity “blues,” a calm frame of mind problem of minimum period and “postpartum chief depression”, a painful and likely life damaging illness of a longer duration. The Postpartum blues affect between 50%-80% of new mothers after labour and symptoms are normally begin from 3 to 4 days after delivery, getting worse by days 5 upwards, and may be likely to leave the mother away by the 12 day. The new mother could have atmosphere swings with period of feeling weeping, irritable, interspersed and nervous or with situations of feeling well; and she may have difficulty sleeping. If the signs continue more than 2 weeks, it is essential to look for medical assistance (Moline et al 2001). On the other hand, the starting of “Postpartum major depression” could be at any period in the initial periods after given birth and is extreme intense than postpartum blues. It is the changes in the brain chemistry that causes it and lead to mood disorder; a genetic illness which does not happen by the fault of the mothers or the consequence of a “weak” or unsound personality. Medically there are professional treatments since it is treatable and curable.Behavioral Health And Mental Health Essay The postpartum depression has major symptoms such as dejected atmosphere throughout the day, almost every time, for not less than 2 weeks and leading to loss of activities that were interesting or enjoying before. Other signs involve tiredness, feeling fidgety or slowed losing, a common sense guilt or insignificance, complicatedness in concentration, sleeplessness, and persistent belief of death or suicide (Moline et al 2001).

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Detailed Analysis- Ms Catherines story Ms Catherine story started one day when she came home from the hospital with her beautiful baby daughter after delivery, but her world began to fall apart. She was hit by intense nausea, vomiting, diarrhoea, dehydration, and fainting. Breast feeding her baby became out of question. Every time she held her baby to her breast, she needed to quickly lay her back down so she could run to the bathroom. In the course of the first 3 months of her daughter’s life, she was hospitalized twice, removed from her children including the newly born. She was completely changed from a very strong, vibrant, healthy and physically active person to something else, unable to carry out even the simplest daily responsibilities. She became devastated and a failure as a mom and couldn’t even get out of bed where she even wanted to die. During her second hospital stay, a nurse gently suggested that she might have postpartum depression but was stunned. How could the horrible gastrointestinal symptoms she was experiencing be caused by depression? She however understood how she could be depressed because of the sickness she was suffering from, but not the other way around. And she had never heard ofpostpartum depression`. But she took the suggestion to heart and quickly sought a diagnosis information, and help. In the process started taking an antidepressant and also immediately began seeing a psychologist for therapy. Ms Catherine showed sign of recovery but has always wanted someone around her to assist her in her daily routine duties.Behavioral Health And Mental Health Essay

My Encounter with Ms Catherine
I found it difficult in interacting with and responding to Ms Catherine initially because little did I know about mothers suffering from postpartum depression after given birth. But later on I realised that it is a common mental illness problem that affect most women after child birth. Immediately afterwards my attitude and behaviour towards her changed and begin to interact with her freely. The instance recognition of Ms Catherine ill health changed my thoughts, attitude, belief and perception of people with mental disability and the need to assist them to cope with their everyday life. Ms Catherine behavioural practices are sometimes strange than normal with her consistence ineffectiveness couple with her cold attitude and responsiveness regarding what ought to be routinely practices. It is therefore imperative that patients with mental disability are treated and dealt with according to their specific circumstances since this helps in addressing their individual concerns effectively. One of the weaknesses I have was to getting closer to people who suffer from mental related illnesses but I now come to realise that my fear of not wanting to approach people with mental disability because of how they can be aggressive sometimes has changed drastically. As a consequence I have now been able to build on my strengths in terms of always given a helping hand to patients and more on to people whose mental wellbeing has been challenged.Behavioral Health And Mental Health Essay

ENGAGING WITH AND ASSISTING MENTAL HEALTH PATIENTS
The responsibility of assisting, caring and engaging people with mental health disabilities and challenges does not rest with or depend on only one person but rather on every single individual, the society as well as organisations. As depicted in the figure 1 below, the interest and the desire to demonstrate the willingness to help manage the challenges of the mental health patients` wellbeing cat across every angle and borders.

Figure 1: A diagrammatical representation of different identifiable individuals and groups who are to assist in mental health patients’ wellbeing challenges.

Source: Adapted from World Health Organization 2003

But for the purposes of this study the concentration was narrowed down to the role of different health and social care professionals in mental health promotion. Their roles are numerous involving supporting them to keep on with their medication as this will guard against the harmful effects that can cause further breakdowns, try to minimise additional pressure by supporting them to amend to the effects of the illness. Also work with their relatives and the community to support the patient, support them to sort out any difficulties they may face that are causing them stress. Assisting them again to stay away from becoming annoyed or violent of them and avoid being too protective and not to treat them like children (Mental Health Training n. d). The National Mental Health Act of 1946 acknowledged psychiatric nursing as one of four core areas for the provision of psychiatric care and treatment, along with psychiatry, psychology and social work. Since Nurses played an important role in the treatment of increasing demand for psychiatric services resulting from mental health issues in order to meet the rising demands (Bigbee and Amidi-Nouri 2000).Behavioral Health And Mental Health Essay As a mental health nurse I may see patients who are living in the society, normally in the patient`s own home or in a clinical based. As a nurse providing support to mental health patients through difficult periods of their illness is significant. I will see patients who are currently well to ensure everything is going on well with them and be the first point of contact if the patients begin to experience any unusual signs of additional ill conditions. I will also be helping patients with their medication and make sure that the patient understands what they should be taking and when, since that is very important at this stage of their lives. I will provide information to the patient’s immediate family on the need to understand and cope with their relative’s ill condition (s) and not to neglect or reject them. I may also be involved in cases where the patient’s transition from hospital back into the community is carried out (Web 2). Within the continuum of mental health interventions, prevention and promotion have become practical and proofing based, backed by a fast increasing body of knowledge from areas as divergent as developmental psychopathology, psychobiology prevention, and health promotion sciences (WHO, 2002). Rutz et al (1992) indicated how the preventive measures and promoting programmes have also been shown to result in substantial cost-effective savings to the public since that stops any occurrences of any mental illness. The mental health professionals have different identifiable roles in the promotion of quality mental health. The World health organisation declared and has set aside a day in the whole world as the world mental health day after recognising the need to promote good mental practices. WHO indicated that the process of assisting mental health patients and the general public to gain increase awareness and control over their own health and better it is essentially worth noting (WHO 1986). As shown in figure 1 above these health and social care professionals are all involve in the daily promotion and sensitization of the challenge. The practices of improving the quality standard of life and the possible good living are interlinked, rather than only an amelioration of symptoms (Secker 1998). Psychosocial issues persuade a number of health behaviours (e.g. proper diet, adequate exercise, and avoiding cigarettes, drugs, excessive alcohol and risky sexual practices) that have a wide-ranging negative effect on the domain of health (WHO 2002).Behavioral Health And Mental Health Essay

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CONCLUSION
It however became evidenced that mental health illnesses pose a serious threat and damage to our daily lives. It is no doubt mental illnesses are of different kinds and levels of severity. Some of the major types discovered included depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders, and eating disorders. But the main frequent mental illnesses are anxiety and depressive disorders and so it was not surprising when the case study above was on postpartum depression. Even though most people go through feelings of strong tension, panic, or depression sometimes, but a mental illness is observe only when these symptoms turn out to be so worrying and devastating that individuals experience immense complicatedness enjoying their normal routine activities, for example work, enjoying relaxation time, and maintaining associations. More attention needs to be devoted to the sickness since failure to over look its existence could result to a potential disaster and further deaths. The decision by the world health organisation to declare a day as “world mental health day” is important and must be observe by all but having regard to the enormous benefits it will yield to us. The cost of treating and caring for mental ill patients increases as the days goes by as oppose to the amount involve in prevent the condition from occurring. The contributions of health and social care professionals over the years have been incredible and therefore ought to continue in order to prevent, reduce and even a further eradication of the epidemic. It must however be noted that the sickness is preventable and even treatable so do not die in silence since “the problem shared, is the problem solved”.

Mental health is an integral and essential component of health. The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities.Behavioral Health And Mental Health Essay

Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

Mental health is fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world.

Determinants of mental health
Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, violence and persistent socio-economic pressures are recognized risks to mental health. The clearest evidence is associated with sexual violence.Behavioral Health And Mental Health Essay

Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, physical ill-health and human rights violations.

There are specific psychological and personality factors that make people vulnerable to mental health problems. Biological risks include genetic factors.

Mental health promotion and protection
Mental health promotion involves actions that improve psychological well-being. This may involve creating an environment that supports mental health.

An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health. Without the security and freedom provided by these rights, it is difficult to maintain a high level of mental health.Behavioral Health And Mental Health Essay

National mental health policies should be concerned both with mental disorders and, with broader issues that promote mental health. Mental health promotion should be mainstreamed into governmental and nongovernmental policies and programmes. In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors.

Specific ways to promote mental health include:

early childhood interventions (e.g. providing a stable environment that is sensitive to children’s health and nutritional needs, with protection from threats, opportunities for early learning, and interactions that are responsive, emotionally supportive and developmentally stimulating);
support to children (e.g. life skills programmes, child and youth development programmes);
socio-economic empowerment of women (e.g. improving access to education and microcredit schemes);Behavioral Health And Mental Health Essay
social support for elderly populations (e.g. befriending initiatives, community and day centres for the aged);
programmes targeted at vulnerable people, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters);
mental health promotional activities in schools (e.g. programmes involving supportive ecological changes in schools);
mental health interventions at work (e.g. stress prevention programmes);
housing policies (e.g. housing improvement);
·violence prevention programmes (e.g. reducing availability of alcohol and access to arms);
community development programmes (e.g. integrated rural development);
poverty reduction and social protection for the poor;
anti-discrimination laws and campaigns;
promotion of the rights, opportunities and care of individuals with mental disorders.
Mental health care and treatment
In the context of national efforts to develop and implement mental health policy, it is vital to not only protect and promote the mental well-being of its citizens, but also address the needs of persons with defined mental disorders.Behavioral Health And Mental Health Essay

Knowledge of what to do about the escalating burden of mental disorders has improved substantially over the past decade. There is a growing body of evidence demonstrating both the efficacy and cost-effectiveness of key interventions for priority mental disorders in countries at different levels of economic development. Examples of interventions that are cost-effective, feasible, and affordable include:

treatment of depression with psychological treatment and, for moderate to severe cases, antidepressant medicines;
treatment of psychosis with antipsychotic medicines and psychosocial support;
taxation of alcoholic beverages and restriction of their availability and marketing.
A range of effective measures also exists for the prevention of suicide, prevention and treatment of mental disorders in children, prevention and treatment of dementia, and treatment of substance-use disorders. The mental health Gap Action Programme (mhGAP) has produced evidence based guidance for non-specialists to enable them to better identify and manage a range of priority mental health conditions.Behavioral Health And Mental Health Essay

WHO response
WHO supports governments in the goal of strengthening and promoting mental health. WHO has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate effective strategies into policies and plans.

In 2013, the World Health Assembly approved a “Comprehensive Mental Health Action Plan for 2013-2020”. The Plan is a commitment by all WHO’s Member States to take specific actions to improve mental health and to contribute to the attainment of a set of global targets.

The Action Plan’s overall goal is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. It focuses on 4 key objectives to:

strengthen effective leadership and governance for mental health;
provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
implement strategies for promotion and prevention in mental health; and
strengthen information systems, evidence and research for mental health.Behavioral Health And Mental Health Essay
Particular emphasis is given in the Action Plan to the protection and promotion of human rights, the strengthening and empowering of civil society and to the central place of community-based care.

In order to achieve its objectives, the Action Plan proposes and requires clear actions for governments, international partners and for WHO. Ministries of Health will need to take a leadership role, and WHO will work with them and with international and national partners, including civil society, to implement the plan. As there is no action that fits all countries, each government will need to adapt the Action Plan to its specific national circumstances.Behavioral Health And Mental Health Essay

Mental health is a term that refers to a person’s psychological, emotional, behavioral and social well-being – how a person thinks, feels, acts, relates to others, makes choices and handles stress. The term is also sometimes used to denote the absence of mental illness. Some psychologists and health experts have proposed a spectrum of symptoms, with good mental health at one end and mental disorders at the other.

Being mentally healthy is one of the most important things in life – it contributes to physical health and happiness, makes a person resilient and capable of handling adversity in all its forms.

What is Mental Illness
Mental illness is a wide-ranging term encompassing several conditions that affect how a person thinks, feels or acts. Mental illness also affects a person’s ability to negotiate day-to-day life. According to experts, anyone can become a victim of mental illness, regardless of age, gender, ethnicity or socio-economic status.Behavioral Health And Mental Health Essay

Statistically, about 1 in 5 Americans suffer from some form of mental illness, with a large proportion experiencing more than one. In fact, mental illness in the United States and much of the developed world, is a leading cause of disability.

Some of the factors that contribute to mental illness include:

Biological factors – brain chemistry, genes, certain kinds of brain infection or defects, injury to the brain, prenatal trauma
Psychological factors – Physical/sexual/emotional abuse, neglect, early loss of an important loved one
Environmental factors – Dysfunctional family life, divorce or death of spouse or parents, changing schools, jobs or homes, substance abuse, socio-cultural expectations
Mental illness is common, but many disorders can be treated and a lot of people with mental health problems do get better or even recover completely.Behavioral Health And Mental Health Essay

If health services research is a relatively new discipline, mental health services research is of even more recent vintage. In a brief ten or fifteen years the initial group of mental health services researchers have built on the early foundation of studies in health care and expanded the knowledge base, particularly regarding systems of care and the relationship of public and private services.

Health care reform comes at an opportune time, as the debate demonstrates daily the need for systematic knowledge to answer immediate questions and to develop, support, or oppose the myriad proposals and permutations under consideration. Whatever the outcome of the reform process, it is abundantly clear that services research is an essential element of the health care infrastructure.Behavioral Health And Mental Health Essay

Mental health now constitutes one of the most promising areas of opportunity in health services research. The availability of credible mental health information—unexpected by many policymakers—in the health care reform debate has enhanced the stature of the research and its practitioners. The reform debate itself has highlighted both the common and the specialized mental health issues within the health care framework.

The public sector remains the predominant source of funds for mental health services research, primarily via the National Institute of Mental Health (NIMH) and other federal agencies. On the private side, a review of annual reports of various private foundations with significant health services research interests reveals none with a specific focus on mental health. However, most of these foundations have funded several projects involving mental health in conjunction with their major areas of focus, such as substance abuse, homelessness, elderly, children, education, and primary health care. These include The Robert Wood Johnson Foundation, The Pew Charitable Trusts, The Commonwealth Fund, The Henry J. Kaiser Family Foundation, W.K. Kellogg Foundation, Milbank Memorial Fund, and The William T. Grant Foundation, The John D. and Catherine T. MacArthur Foundation health program, which does not accept unsolicited proposals, supports two endeavors to conduct and/or publish significant mental health services research: the Mental Health Policy Resource Center and Health Affairs. In addition, MacArthur’s Law and Mental Health Research Network focuses on many issues germane to mental health services research. This essay examines the development of mental health services research and the opportunities for future research that merit the attention of both public- and private-sector funders and researchers.Behavioral Health And Mental Health Essay

WHAT IS MENTAL HEALTH SERVICES RESEARCH?
Unlike other areas of health, mental health has long looked to a single federal agency—NIMH—as the major source of national funding for all types of research, services, training, and statistics. Perhaps for that reason, NIMH has defined the services research arena somewhat more broadly than does the Association for Health Services Research (AHSR), which defines services research as “a field of inquiry that examines the impact of the organization, financing and management of health care services on the delivery, quality, cost, access to and outcomes of such services.” For NIMH, the boundaries among clinical, epidemiological, treatment, and services research are not always clear. For instance, considerable attention has been devoted to distinguishing between clinical services research and service systems research, both of which have been treated as part of mental health services research.Behavioral Health And Mental Health Essay

Mental health services research began in the late 1970s and early 1980s; it grew out of NIMH’s epidemiology and data collection programs and emphasized statistical information and economics. The priority of the institute during this time was the public mental health system and the primary public patient population—persons with serious and persistent mental illness—and this priority was reflected in the services research program. In its 1991 report, Caring for People with Severe Mental Disorders: A National Plan of Research to Improve Services , a chapter entitled “Clinical Services Research: Enhancing the Real-World Applications of Clinical Science” articulates the boundary with other types of research:Behavioral Health And Mental Health Essay

Clinical services research begins where clinical research itself leaves off. It is concerned with the application of clinical knowledge gained in a controlled research environment, to the larger, relatively uncontrolled environment in which the mentally ill actually function. Its goal is to improve the quality of care of everyday clinical practices so that they consistently meet existing state-of-the-art criteria. 1

Major areas of concern for this research include salient characteristics of mental illness, such as demographics, risk factors, cultural influences, and family issues; assessment in terms of specific diagnoses as well as physical, social, and vocational functioning; specific treatment and rehabilitation interventions; and outcomes and effectiveness of services.Behavioral Health And Mental Health Essay

The next chapter of NIMH’s 1991 report, “Service Systems Research: Improving the Organization and Financing of Care,” describes service systems research as focusing on how to provide services most efficiently, economically, and equitably. It encompasses a broad and eclectic set of questions and issues: identifying the nature and scope of local needs; matching local services to needs; structuring integrated care that reaches the consumer; allocating financial resources so that consumers and providers have proper protection and incentives to use services appropriately; legal issues such as the role of the criminal justice system, civil commitment, patient rights, and confidentiality; human resource issues; and stigma and strategies for changing attitudes.Behavioral Health And Mental Health Essay

The Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) Reorganization Act of 1992 (P.L. 102-321) split the services and research programs of NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and transferred the three as research-only institutes to the National Institutes of Health (NIH). Services research went with the research portfolios, protected by a mandatory set-aside—12 percent of research funds in fiscal year 1993 and 15 percent in fiscal years 1994 and 1995 must be spent on services research. The new Substance Abuse and Mental Health Services Administration (SAMHSA)—including its new mental health component, the Center for Mental Health Services (CMHS)—was given evaluation authority but no specific funding in the form of a line item to support evaluation studies.

The ADAMHA Reorganization Act defined health services research as “study of the impact of the organization, financing, and management of health services on the quality, cost, access to, and outcomes of care.” This definition is essentially the same as that used by AHSR. Mental health services research may be defined most simply as a subset of this domain.Behavioral Health And Mental Health Essay

Given the mandated set-aside, it has become particularly important to distinguish between mental health services research and other forms of research. A recent work group convened by the Foundation for Health Services Research (FHSR) suggested two key distinguishing factors: (1) the intent of the study and nature of the hypotheses, and (2) the distinction between studies of factors influencing the effectiveness of health services in “real-world settings” (health services research) and studies concerning the efficacy of specific preventive, diagnostic, or treatment services done under highly controlled conditions (not health services research). 2 One NIMH services research official recently offered the following general definition:

Services research differs from treatment research, which examines clinical treatments under highly controlled experimental conditions, by including factors such as costs, reimbursement mechanisms, treatment ideologies, and personal and organizational interests that affect how providers actually deliver services.Behavioral Health And Mental Health Essay

For this essay we reviewed recent and active projects in mental health services research and consulted with selected knowledgeable persons; this provides a descriptive snapshot of the kind of work currently funded and under way. This base, together with the newer areas of priority resulting from the health care reform process, suggests many promising opportunities for the future.

CURRENT WORK
For an overview of recent grants identified as mental health projects, we turned to the Health Services Research Grants Information System, a database of ongoing and recently completed health services research projects that is being developed by FHSR and the Cecil G. Sheps Center for Health Services Research of the University of North Carolina at Chapel Hill. This database, whose creation was funded by The Pew Charitable Trusts, will allow researchers as well as policymakers to keep abreast of current research, rather than waiting until the results are published.Behavioral Health And Mental Health Essay

The Health Services Research Grants Information System will become a part of the National Library of Medicine’s MEDLARS system. The information system is scheduled for completion in late 1993. Information in the database will include the name and address of the performing organization and principal investigator, amount of the award, an abstract of the project, and a description of the population studied. Initial funding agencies include the Agency for Health Care Policy and Research (AHCPR), the Health Care Financing Administration (HCFA), NIH, the Health Resources and Services Administration (HRSA), the Department of Veterans Affairs (VA), and seven private foundations (The Pew Charitable Trusts, The Robert Wood Johnson Foundation, The John A. Hartford Foundation, W.K. Kellogg Foundation, The Henry J. Kaiser Family Foundation, The Commonwealth Fund, and The William T. Grant Foundation). Additional federal agencies and private foundations will join the effort in the future.Behavioral Health And Mental Health Essay

Our database search turned up nearly 200 grants (of a total of 1,500 listed) that focused on mental health issues. All but a handful were funded by NIMH and other federal agencies. Of these, roughly one-third could be generally categorized as targeting services for persons with the most serious mental illnesses. The remaining two-thirds covered a wide spectrum of topics, including mental health issues related to aging, women, family violence, adoption, various minority groups, alcohol and/or drug abuse (which generally coincide with mental health problems), general health care, homelessness, and many more.

NIMH is by far the largest funder of projects identified specifically as mental health services research. The NIMH Services Research Branch oversees a broad program of investigator-initiated grants addressing virtually any area related to mental health services. Funding in fiscal year 1987 was $18 million. The current set-aside (12 percent of the total NIMH research budget) translates into roughly $50 million for fiscal year 1993.Behavioral Health And Mental Health Essay

More than 250 active grants (listed with NIMH as of January 1993) are concentrated in the following areas in descending order: severely mentally ill adults; mental health economics; children and adolescents; rural mental health; adult primary health care; and multiple diagnoses of alcohol, drug abuse, and mental (ADM) disorders. Significant numbers focus on mental health service systems, minority mental health, homeless mentally ill, and research scientist awards, and some are devoted to disability and rehabilitation, human immunodeficiency virus (HIV) infection, self-help services, research methods, and state research capacity building.

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NIMH has established a program to develop and maintain Centers for Research in particular areas of priority: severely mentally ill adults, children and adolescents, minority mental health, rural mental health, and self-help. Exhibit 1 lists specific grant announcements that detail areas of focus and priority.Behavioral Health And Mental Health Essay

In addition to NIMH, a variety of federal agencies have services research programs that include mental health issues as a component, although not as a priority. Agencies that are funding projects included in the FHSR database are the Department of Veterans Affairs, the National Institute on Aging (NIA), NIDA, NIAAA, HCFA, the Office of Rural Health Policy, the National Center for Nursing Research, and AHCPR.

FUTURE OPPORTUNITIES
The heightened health care reform debate has accelerated the development of agendas in mental health services research and is likely to provide a framework for setting priorities for the next several years, both in foundations and in the various federal agencies. Even at this early date it is possible to discern several significant themes. These can provide some guidance for the development of mental health services research ideas and extended programs during the next several years.Behavioral Health And Mental Health Essay

REFORM-RELATED ISSUES WITH A SIGNIFICANT MENTAL HEALTH DIMENSION.
The issue of risk adjustment in health insurance has particular relevance to mental health. Risk adjustment has to do with the probability that any given health plan may become responsible for a larger number of persons with more serious health problems than other competing health plans-Health plans that fear this situation could develop procedures that discriminate against persons with known high-cost illnesses; the more severe mental illnesses, as well as acquired immunodeficiency syndrome (AIDS), cancer, and others, lead the list of illnesses that insurers wish to avoid. A concern will be how to protect health plans with disproportionate numbers of high-risk enrollees and how to protect high-risk persons from creative forms of exclusion.

Exhibit 1 Mental Health Services Research Announcements Issued By The National Institute Of Mental Health (NIMH), Selected Projects, 1990-1993

Implementation of Caring for People with Severe Mental Disorders: A National Plan of Research to Improve Services (April 1992)Behavioral Health And Mental Health Essay
Centers for Research on Services for People with Severe Mental Disorders (June 1992)
Implementation of The National Plan for Research on Child and Adolescent Mental Disorders (April 1991)
Centers for Research on Mental Health Services for Children and Adolescents (November 1991 )
Research on Hospitalization of Adolescents for Mental Disorders (April 1991)
Research on Emergency Mental Health Services for Children and Adolescents (April 1993)
Research on Reimbursement Issues in Mental Health Services Delivery (Revised announcement issued June 1989; to be reissued soon as the new mental health economics research announcement) Research on Managed Mental Health Care (June 1991)
Research on Integrating Mental Health and Related Services for Persons with Severe Mental Disorders (May 1993)
Research on Mental Health Services in the General Health Care Sector (September 1992) Research on Disabilities and Rehabilitation Services for Persons with Severe Mental Disorders (July 1991)
Mental Health Research on Homeless Persons (Revised May 1991)
Research on Services for Persons with Mental Disorders that Co-occur with Alcohol and/or Drug Abuse Disorders (Revised March 1990)
Research on Mental Disorders in Rural Populations (Revised April 1991)Behavioral Health And Mental Health Essay
American Indian, Alaska Native, and Native Hawaiian Mental Health Research (February 1993)
Minority Mental Health Research Centers (September 1992)
Research on Severely Mentally Ill Persons at Risk of or with HIV Infections (September 1988)
Research on Effectiveness and Outcomes of Mental Health Services (March 1990)
Research Infrastructure Support Program (RISP) (September 1992)
Note: To obtain a copy of any of the announcements listed, or to obtain information about upcoming research conferences, contact the Services Research Branch, National Institute of Mental Health, 5600 Fishers Lane, Room 10C-06, Rockville, Maryland 20857, (301)443-3364.

A second issue relates to functional disability. Current measures of illness, such as diagnosis, often are not good predictors of service needs and outcomes. The problem of measuring illness is now a policy issue for long-term care in determining eligibility and assessing needs. This same issue will become a problem for acute care, as the need arises to sort out persons with significant service needs from those with less serious conditions, be they physical or mental Behavioral Health And Mental Health Essay

Third, in a health care system that relies heavily on managed care, the development of appropriate standards for such management becomes essential Practice variations are widespread, and good managed care systems are difficult to define and measure. No recognized standards now exist either for “carved-out” programs to manage mental health care or for addressing mental health issues within an overall managed care program. Furthermore, once managed care is in place, how will its performance be monitored? What are reasonable measures of undertreatment? These issues are likely to be important for various vulnerable populations, including the mentally ill

Fourth, the definition of outcomes, as well as the design of outcome measures, is a major preoccupation of the health care reform process. The new emphasis on quality-of-life measures necessarily involves mental health considerations. And the emphasis in medical outcomes on effectiveness (what works in real-world conditions) as opposed to efficacy (what has a statistically significant impact in ideal research conditions) also involves psychological and psychosocial factors.Behavioral Health And Mental Health Essay

Fifth, the interaction between physical and mental health is likely to attract increasing attention in a managed care environment. The mutual impact of physical and mental factors on health and care-seeking behavior is better recognized than it is understood. As mental health care is more explicitly integrated into general health care settings, this interrelationship will continue to stimulate research interest.

Sixth, a reformed health care system is likely to include a major role for states. Historically, states have played a more comprehensive role in mental health than in any other area of health, and much can be learned from that experience. The new configuration will provide a natural laboratory for explaining and exploring different states’ approaches to their new role in both physical and mental health.

Finally, the incorporation of Medicaid (in whole, in part, or not at all) into a reformed health care system will create numerous opportunities for assessing different configurations of services that are included or excluded and their impact on various elements of the Medicaid population (particularly indigent persons with severe mental illness and welfare mothers and children).

INTERSECTION OF MENTAL HEALTH CONCERNS WITH POPULATION GROUPS OR ISSUES.
Different segments of the population have unique needs that demand research attention. The necessity of integrating health and mental health services for children with a host of other types of services (education, income support, social welfare, juvenile justice, and so forth) has been a continuing theme of the health care reform debate. Similarly, in the coming debate over welfare reform, what should be the interface between mental health and child welfare? The mental health services research sector has been a leader in developing model approaches for integrated systems of care for children. The elderly also pose unique challenges to services research.Behavioral Health And Mental Health Essay The recognition and treatment of mental disorders in elderly persons is a major issue for both the primary care and long-term care elements of the health care system. The impact of mental health conditions on the ability of aging persons to live independently and to manage their own health care has gained much attention. Finally, different patterns for various population groups in the use of general health versus mental health services raise many concerns. The interplay between minority cultural norms and majority community attitudes is of particular interest.

In addition to population-linked concerns, specific issues have a major mental health facet. Both alcohol and drug abuse disorders frequently overlap with mental disorders. The service systems are sometimes integrated but more often operate separately from each other. Agencies concerned with ADM problems recognize the need for collaboration and exchange on issues of etiology and comorbidity. Mental health and behavioral issues are also important in AIDS prevention and treatment. In fact, persons with severe mental illnesses have been found to be at especially high risk for contracting AIDS. Finally, the emergence of violence as a public health issue has led to heightened interest in researching possible relationships between violence and mental health. Is there a link between mental disorder and violent behavior, and, if so, what are its parameters? Also, what are the health care and mental health care consequences of experiencing or witnessing violence?Behavioral Health And Mental Health Essay

INTEGRATION OF HEALTH AND MENTAL HEALTH DATA SYSTEMS.
A reformed health care system will require extensive collection of uniform data. Historically, health and mental health information systems have been separate. In efforts to redesign existing national data sets, as well as to plan for new data collection systems, the issue of the separation or integration of mental health information must be addressed. Episodes of care are likely to be a significant form of measurement in a reformed health system. Appropriate and consistent definitions for both health and mental health care will need to be developed.Behavioral Health And Mental Health Essay

POTENTIAL SOURCES OF FUNDING
Foundations are identifying issues ranging from how various elements of the new system will operate, to financing strategies for services that are not fully covered in the new system, to the impact of reform on individuals and families. In general, as foundations announce their primary health care interests or priorities, they can consider developing the mental health dimension as an example or element of the foundation’s particular areas of focus.Behavioral Health And Mental Health Essay

By far, the most significant funder of mental health services research remains the federal government. Numerous agencies of the Department of Health and Human Services (HHS) are discussing health care reform implementation issues (many of which include mental health); however, until legislation is passed, clear lines of responsibility cannot be established. The broad agenda described above likely will fit within the research programs of NIMH, NIAAA, and NIDA via the 12 percent set-aside for services research in fiscal year 1993 and 15 percent in fiscal years 1994 and 1995. The office of the HHS Assistant Secretary for Planning and Evaluation (ASPE)/Health may fund some research into risk adjustment, managed care, and functional disability. Under SAMHSA, the Center for Mental Health Services is likely to concentrate on system evaluation, integrated services for children and adults with severe mental illness, homelessness, prevention services (if funds are appropriated), and Medicaid. The SAMHSA Center for Substance Abuse Prevention and Center for Substance Abuse Treatment likely will fund research into comorbidities. The AHCPR, in accordance with its mandate, likely will produce mental health practice guidelines, and HRSA likely will focus on primary care, indigent populations, and rural health care.Behavioral Health And Mental Health Essay

Probably the most significant change in NIMH’s services research agenda is the broadening of its focus to include more issues beyond those involving persons with severe mental illness. The implementation of national and state health care reforms will have a dramatic effect on both public and private service providers and on access to and use of mental health services by the general population (including low-income persons). The severely mentally ill population remains a high priority, and NIMH remains committed to its National Plan of Research to Improve Services. However, the infusion of new money from the set-aside and the demand for information on additional reform-related matters have combined to stimulate a broader agenda.

NIMH is now developing a new grant announcement on issues relating to health care reform; this announcement is expected in fall 1993. It is likely to encourage research on risk adjustment and to emphasize the impact of health care reform on the states. Comparisons of different states’ approaches to financing and covering mental health services—from publicly managed, capitated forms of financing catastrophic and long-term mental health care to buying into private managed care systems—may be highlighted. Development and assessment of monitoring capabilities and methods of assuring quality of care also are likely to be emphasized.Behavioral Health And Mental Health Essay

NIMH also will reissue its mental health and economics announcement.This research area targets the role of economic factors in mental health services delivery, providing a near-term opportunity to develop essential baseline information before enactment and implementation of health care reform. Later, this research funding should provide an opportunity to assess the reform system in relation to mental health and to develop recommendations for change. Specific areas of interest include assessment of factors affecting supply and demand; financing of publicly supported mental health services; financing of alternative delivery systems, managed care, long-term care, and catastrophic care; the impact of reimbursement methodologies and insurance benefit design; social and economic costs of mental disorders; cost-effectiveness of services; the impact of reimbursement policies on quality of care; the impact of legislation and regulations on reimbursement; financing and reimbursement policies affecting the market for services of providers in various settings; financing of services for particular population groups (for example, minorities, children, and the elderly); and the impact of state rate-setting methods and systems on services.Behavioral Health And Mental Health Essay

NIMH also will continue to give priority to its National Plan for Research on Child and Adolescent Mental Disorders (1990), including services research issues. 4 During 1994 research is expected to focus on obtaining baseline data on who is providing what services to children and adolescents. Research probably will encompass delivery of mental health services to children and adolescents in general health care, specialty mental health, and other settings; coordination and integration of mental health services with other services such as criminal justice, education, and welfare; service needs and delivery of services to subpopulations of youths with comorbidities of various types; and evaluation of innovative service models.Behavioral Health And Mental Health Essay

CONCLUDING COMMENTS
In conducting this brief review, we were struck by the perception on the part of funding agencies and others that the limited number of mental health services researchers hampers the progress of a field that is ripe for expansion. There is a clear and explicit interest in developing new talent and attracting experienced researchers from a variety of other disciplines and areas.Behavioral Health And Mental Health Essay

Mental health will be a particularly interesting area of change and challenge in health care reform. Among the salient issues will be tensions among national, state, and private-sector roles in providing and financing mental health services; the likelihood of early coverage limitations designed to be expanded later; and how to assure nonmedical wraparound services for vulnerable groups such as children and adults with severe mental illness.Behavioral Health And Mental Health Essay

Underlying these questions is the larger issue of integrating mental and physical health services. Which services are health, which are mental health, and which are “something else?” Will (or should) there continue to be a separate mental health system? If so, for whom? Is mental health services research separate from health services research?

Mental health services research began in an era in which mental health services and policy were defined largely in terms of mental illness—indeed, in terms of the most severe mental illnesses. As the health care reform debate continues, attention increasingly is drawn to the broader issues of mental health care for the general population. The challenge for mental health services research will be to address both the traditional and the expanded agendas within a changing health care system. This may suggest expanding the field of mental health services research to encompass both the discrete specialty researcher and a wider group of health services researchers who address mental health factors as a matter of course in examining health issues.Behavioral Health And Mental Health Essay