scholarly journals Population-Based Approaches to Mental Health: History, Strategies, and Evidence

2020 ◽  
Vol 41 (1) ◽  
pp. 201-221 ◽  
Author(s):  
Jonathan Purtle ◽  
Katherine L. Nelson ◽  
Nathaniel Z. Counts ◽  
Michael Yudell
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Health Care System ◽  
Public Health Practice ◽  
The United States ◽  
Population Based ◽  
Public Health Department ◽  
Services Research ◽  
Care System

There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: ( a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, ( b) public health practice interventions that can be implemented by public health department officials, and ( c) health care system interventions that can be implemented by hospital and health care system leaders.

scholarly journals The United States: A system built on fragmentation

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H. Jarman
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Universal Health Care ◽  
Local Public Health ◽  
The Us ◽  
Universal Health ◽  
Care System

Abstract Background The United States is effectively a laboratory for ways to produce public goods, such as public health, on the cheap. Its c. 90,000 governments compete for residents, businesses, taxes, development, and jobs while also trying to compensate for the lack of universal health care coverage. They all have structural incentives to provide services as cheaply as possible. The effects are diverse and poorly mapped. They can mean innovation in organizational forms, a different and typically less expensive skill mix among the workers, poor quality, or simple under provision. The exact mix can often be hard to identify. It can also mean extreme responsiveness to funding from higher levels of government such as the states or federal government. Methods A comparative historical analysis (CHA) based on government documents, law, and secondary sources. Results The distinctively expansive scope of US public health actions is largely due to the country’s failure to establish a universal health care system, and the diversity of US public health tasks reflects local adaptation of tens of thousands of governments. This means that public health in the United States retains much of the activity it had in, for example, the UK before the establishment of the US. In particular, and even in states that accepted the Medicaid expansion in the Affordable Care Act (ACA), local public health departments provide a substantial amount of direct care and fill in for gaps in health care provision. Conclusions The US public health system is highly fragmented like the governments that run it, and therefore diverse. Reflecting the failures of the US health care system, it carries out many more tasks that in other countries are seen as health, especially primary, care.

scholarly journals Overcoming the Challenges of the Mental Health Care System in United States in the Aftermath of COVID-19

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 176-176
Author(s):  
Amir Radfar ◽  
Maria Mercedes Ferreira Caceres ◽  
Juan Pablo Sosa ◽  
Irina Filip
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care System ◽  
Mental Health Problems ◽  
Health Problems ◽  
Mental Health Care System ◽  
The Us ◽  
Care System

AbstractStudy Objective(s)The impact of pandemic events such as the coronavirus (COVID-19) pandemic led to an economic crisis worldwide as well as an increase of mental health problems. In the United States, the gaps in the mental health care system struggle to meet the needs of vulnerable populations and have caused a major public health problem. We aim to increase the awareness of health care professionals, psychiatrists, and policy makers regarding failures and gaps in the mental health care system and suggest new ideas to overcome the growing burden of mental disorders.MethodWe utilized data from PubMed, Science Direct, Cochrane, Embase and Clinicaltrials.gov databases to analyze available information on the US mental health system. We included any relevant articles addressing the prevalence of mental diseases, disparities and the gaps for an accessible and affordable mental health system, as well as the psychological impact of COVID-19 pandemic.Keywords‘COVID-19’, ‘Coronavirus’, ‘SARS-CoV-2’, ‘mental health’, ‘Health, Mental’ were used.ResultsFollowing scoping review of several studies we noticed that while prevalence of mental health problems in the US varies between states and socio-demographic groups, it is among the top 10 causes of premature death and disability in adults. We noticed that mental health problems are currently one of the costliest public health issues in the healthcare system. Tracking Poll from one of the studies in our scoping review suggested that financial inequities are magnified by the COVID-19 pandemic and that psychological distress was substantially larger among respondents with lower income (33%), Hispanics (28%) and Blacks (26%). Furthermore, in another poll 62% of US population are shown to be anxious due to COVID-19. We observed that the prevalence of reported symptoms of psychological distress among US adults increased when compared to 2018. Common barriers such as failure of accessibility, insufficient funding, insufficient psychiatric beds, limited insurance access and economic burden, clinician shortages, fragmented care, insufficient mental health care policies and insufficient education and awareness about mental illness become more prominent during the COVID-19 pandemic era.ConclusionsThe impact of COVID-19 on mental health is alarming, which affects public health and has made the health care system more vulnerable. Pandemic events not only cause acute negative impact, they also result in long-lasting health problems, isolation and stigma. The COVID-19 pandemic threatens the mental health of the population and its long-term consequences can lead to a secondary pandemic. The outcomes of the COVID-19 pandemic on mental health emphasize the need for policies and strategies to support and strengthen a concerted effort to address its burden on the US mental health care system. In addition, it magnifies the need for high quality and well-funded research for future pandemics.

Community Planning for Pandemic Influenza: Lessons From the VA Health Care System

2008 ◽  
Vol 2 (4) ◽  
pp. 251-257 ◽  
Author(s):  
Nicole Lurie ◽  
David J. Dausey ◽  
Troy Knighton ◽  
Melinda Moore ◽  
Sarah Zakowski ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
Pandemic Influenza ◽  
Community Planning ◽  
The United States ◽  
Health Care Facilities ◽  
Standards Of Care ◽  
Va Health Care System ◽  
Care System

ABSTRACTBackground: Coordination and communication among community partners—including health departments, emergency management agencies, and hospitals—are essential for effective pandemic influenza planning and response. As the nation’s largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning.Purpose: To identify issues relevant to VA–community pandemic influenza preparedness.Methods: As part of a VA–community planning process, we developed and pilot-tested a series of tabletop exercises for use throughout the VA system. These included exercises for facilities, regions (Veterans Integrated Service Networks), and the VA Central Office. In each, VA and community participants, including representatives from local health care facilities and public health agencies, were presented with a 3-step scenario about an unfolding pandemic and were required to discuss issues and make decisions about how the situation would be handled. We report the lessons learned from these pilot tests.Results: Existing communication and coordination for pandemic influenza between VA health care system representatives and local and regional emergency planners are limited. Areas identified that would benefit from better collaborative planning include response coordination, resource sharing, uneven resource distribution, surge capacity, standards of care, workforce policies, and communication with the public.Conclusions: The VA health system and communities throughout the United States have limited understanding of one another’s plans and needs in the event of a pandemic. Proactive joint VA–community planning and coordination—including exercises, followed by deliberate actions to address the issues that arise—will likely improve pandemic influenza preparedness and will be mutually beneficial. Most of the issues identified are not unique to VA, but are applicable to all integrated care systems. (Disaster Med Public Health Preparedness. 2008;2:251–257)

scholarly journals Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion

Laws ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 22
Author(s):  
Sebastian von Peter ◽  
Martin Zinkler
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care System ◽  
Police Custody ◽  
Judicial Control ◽  
Mental Health Care System ◽  
The Will ◽  
Alternative Scenarios ◽  
Care System

In August 2019, a manuscript was published in this journal that aimed at imagining a mental health care system that renounces the judicial control to better focus on the will and preferences of those who require support. Alternative scenarios for dealing with risk, inpatient care, and police custody were presented that elicited strong and emotionally laden reactions. This article adds further reflections to this debate, aiming at contributing explanations for this unsettlement. A productive notion of criticism is discussed, and ways to achieve change toward a more human rights-oriented psychiatric practice are outlined.

scholarly journals An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues

2021 ◽  
pp. 194173812110215
Author(s):  
Gillian R. Currie ◽  
Raymond Lee ◽  
Amanda M. Black ◽  
Luz Palacios-Derflingher ◽  
Brent E. Hagel ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care System ◽  
Policy Change ◽  
National Policy ◽  
Ice Hockey ◽  
Public Health Care ◽  
Public Health Care System ◽  
Body Checking ◽  
Care System

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously. Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs. Study Design: Cost-effectiveness analysis alongside cohort study. Level of Evidence: Level 3. Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking significantly reduced the rate of game injuries (−2.21; 95% CI [−3.12, −1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (−$83; 95% CI [−$386, $220]) or private health care costs (−$70; 95% CI [−$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively. Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.

scholarly journals Modelling the dynamics of a public health care system: evidence from time-series data

2011 ◽  
Vol 44 (23) ◽  
pp. 2955-2968 ◽  
Author(s):  
Fabrizio Iacone ◽  
Steve Martin ◽  
Luigi Siciliani ◽  
Peter C. Smith
Keyword(s):  
Public Health ◽  
Health Care ◽  
Time Series ◽  
Health Care System ◽  
Time Series Data ◽  
Public Health Care ◽  
Series Data ◽  
Public Health Care System ◽  
Care System
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