Alternative Systems of Care and Consumer-Driven Health Care

2013 ◽  
pp. 161-167
Author(s):  
Daniel Guss

Expert public psychiatrists use case studies to share best practice strategies in this clinically oriented introduction to community mental health. Today, the majority of psychiatrists work with people who suffer not only from mental illness but also from poverty, trauma, social isolation, and discrimination. Psychiatrists cannot do this work alone but, instead, are part of teams of behavioral health workers navigating larger health care and social service systems. In an increasingly complex health care environment, mental health clinicians need to master systems-based practice in order to provide optimal care to their patients. The rapid development of public psychiatry training programs is a response to the learning needs of psychiatrists in an evolving system. This book begins with seven foundational principles of public psychiatry—recovery, trauma-informed care, integrated care, cultural humility, harm reduction, systems of care, and financing care—using cases to bring these concepts to life. Then, using a population health framework, cases are used to explore the typical needs of different age groups or vulnerable populations and to illustrate evidence-based/best practices that have been employed to meet these needs. Common to all of the chapters is a focus on the potential of each person, regardless of illness, to achieve personal goals, supported by a clinician who is also an advocate, activist, and leader.


2009 ◽  
Vol 28 (2) ◽  
pp. 35-46 ◽  
Author(s):  
Larry Davidson ◽  
Priscilla Ridgway ◽  
Melissa Wieland ◽  
Maria O'Connell

Recent commissions in Canada and the United States have stipulated recovery to be the overarching aim of mental health care and have called for systems of care to be transformed to be made consistent with this aim. If these efforts are not simply to repeat the mistakes of the past, a new conceptual framework will be needed to provide an alternative foundation for rethinking the nature of care for people with serious mental illnesses. In this paper, the authors identify the limitations of the conceptual framework of the deinstitutionalization movement and then offer the capabilities approach developed by Sen (1992, 1999) and others as a more adequate framework for the post-institutional era.


2004 ◽  
Vol 32 (3) ◽  
pp. 426-432 ◽  
Author(s):  
Bruce Siegel ◽  
Marsha Regenstein ◽  
Peter Shin

Millions of Americans are dependent on what is often called the “safety net.” These loosely-organized networks of health and social service providers serve the many Americans who are uninsured, dependent on public coverage, or for a variety of reasons unable to access other private systems of care. The Institute of Medicine (IOM) report, America’s Health Care Safety Net: Intact but Endangered, called attention to both the fragility and the resilience of this health care safety net. The IOM report underscored the critical importance of the safety net to the health and well-being of millions of individuals and called for efforts to strengthen it and improve the nation’s ability to monitor its viability. Given this central role, any health care reform efforts need to be fully informed by an understanding of what the safety net includes, how it is financed, and how it is responding to a series of challenges it now faces.


Author(s):  
Raymond F. Patterson

Correctional settings hold a range of opportunities for Psychiatrists to assume leadership roles. The increase in the number of detainees and inmates who require mental health services has created numerous administrative and clinical opportunities for psychiatrists. The ‘front end’ of arrest and pretrial determinations has been a longstanding component of forensic practice, related to competence, criminal responsibility, and probation. Following incarceration, assessment of mental health needs, access to care, and provision of treatment as well as quality improvement partially constitute the jail and prison components of mental health services. The ‘aftercare’ aspect of mental health services in correctional psychiatry involves individuals released on parole with need and/or requirement for mental health treatment. The leadership role for psychiatrists working in correctional environments is distinctly different from typical psychiatric venues where the psychiatrist and other mental health professionals are ‘in control;’ in correctional environments, the dynamics are different and require collaboration and advocacy. Within correctional systems it is essential that ‘correctional culture’ be understood by the psychiatric/mental health leadership. With effective psychiatric leadership, mental health care delivery and its coordination with correctional management of prisoners both stand to be improved. The need for dedicated and qualified leadership for mental health services and appropriate education and training in correctional mental health practices provide remarkable opportunities for psychiatrists. Psychiatrists and other health care professionals must be educated and trained to provide the necessary leadership for these extraordinarily complex systems of care and confinement.


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