Behavioral Health

Behavioral Health

Overview

Epidemiologic data on the prevalence of psychiatric and substance disorders compared with the nation’s behavioral health care needs highlights gaps in service adequacy. Continuing changes in organization and fiscal structures resulting from the implementation of the Patient Protection and Affordable Care Act (ACA), specifically how Medicaid expansion impacts behavioral health services, is an important area of concern. In addition, there are special challenges of the homeless and incarcerated mentally ill populations. Behavioral health also has a workforce shortage. This is another area for improvement in health care organizations throughout the nation.

Review and analyze the graphs in Figure 10-1, Prevalence of any Mental Illness Among U. S. Adults; Figure 10-2, Prevalence of Serious Mental Illness Among U.S. Adults; Figure 10-3, Top Leading Disease or Disorder Categories Contributing to U.S. Disability-Adjusted Life Years (DALYs) (2010), and Figure 10-4, U.S. DALYs for Mental and Behavioral Disorders as a Percent of Total U.S. DALYs.

Some of the barriers to care are provider geographic distribution, financial limitations, lack of or inadequate health insurance, stigma, misunderstandings about the treatability of conditions, personal and provider attitudes, cultural issues, and a poorly organized care delivery system (see page 285 of the textbook). Consider also the mental health services of children and adolescents. Consider the current events with mass shootings at schools, movie theaters, concerts, et cetera and have tough conversations about mental health.

Instructions

Write a three to four-page paper in which you:

1. Analyze the graphs and figures noted and describe your findings in behavioral health. 

2. Explain the Mental Health Parity and Addition Equity Act of 2008.

3. Explain the role of the National Institute of Mental Health and its influence on access to and utilization of health care services within the current health care system.

4. Use at least three recent (that is, last five years) quality academic resources in this assignment. Note: Wikipedia and similar websites do not qualify as academic resources.

The specific course learning outcome associated with this assignment is:

· Assess the impact of legislation and a research organization on utilization of health care services.

Fig 10-1

Fig 10-2

Fig 10-3

Fig 10-4

Text pg 285

Children and Adolescents

Data on the use of mental health services by children and adolescents diagnosed with mental disorders first became available in 1999 following a NIMH survey of children and adolescents between ages 9 and 17. Only 9 percent of children and adolescents had been able to access and receive some mental health services in the general medical and specialty mental health delivery sectors. This accounted for fewer than half of those with a diagnosed mental illness. The study found that the largest provider of services to children and youth was the school system. 30  In 2009, results from a larger study indicated that the prevalence of mental health disorders in children aged 4–17 had increased more than 40 percent between the mid-1990s and 2006, with 7 percent of this population being diagnosed with at least one psychiatric illness. Increased sensitivity and use of screening tools by primary care physicians appeared to have had a major effect on findings. The rate of mental illness diagnosis among children aged 4–17 seen in primary care offices doubled between 1996 and 2006. 31  However, access to care remains problematic, particularly for children with severe disorders. The American Association for Child and Adolescent Psychiatry reported in 2016 that there is an ongoing critical shortage of U.S. child and adolescent psychiatrists compounded by severe geographic maldistribution particularly in low-socioeconomic and rural areas. 32

Clinical research involving children and adolescents suffering from mental illness has lagged considerably behind that for adults. Inadequate research has been particularly notable regarding pharmaceuticals to treat all types of children’s illnesses. In response, Congress passed two laws to increase the study of drugs in children. In 2002, the Best Pharmaceuticals for Children Act (BPCA) was enacted and reauthorized in 2007 to establish and conduct a program for pediatric drug development through the National Institutes of Health (NIH). The BPCA’s intent is threefold: 33

· Identify and prioritize drugs needing study

· Develop study requests in collaboration with NIH, Food and Drug Administration, and other organization experts

· Conduct studies on priority drugs after manufacturers decline to do so.

The Pediatric Research Equity Act (PREA) of 2003 recognized that some drugs that work for adults may not work for children. The Act also recognizes that a drug’s use in children may entail safety concerns or dosage parameters that differ from those in adults. For these reasons, PREA requires drug companies to study products in children for the same use for which they were approved in adults. 34  These laws have resulted in some gains. Prior to their enactment, more than 80 percent of the drugs approved for adult use were being used in children, even though their safety and effectiveness had not been established in children. Today, the number has been reduced to about 50 percent. Clearly, there remains much need for improvement. 34

Although diagnostic techniques have been highly refined through standardized diagnostic interviews and symptom rating scales that facilitate accurate identification of those in need of service, research funding for treatment of mental illness in childhood and adolescence has not kept pace. The effects of a mental disorder on the developmental process of children are only beginning to be appreciated, but they clearly impact development in emotional, social, and cognitive domains. Moreover, few practitioners access research findings regarding treatment efficacy, and there are inadequate numbers of well-trained child and adolescent psychiatrists available for the population at risk. The need for expanding the workforce, developing early interventions, providing treatment and rehabilitation services, and seeking enhanced funding for research is critical.