scholarly journals Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Robert Myers
Keyword(s):  
Mental Illness ◽  
Special Needs ◽  
Medical Home ◽  
Social Needs ◽  
Community Treatment ◽  
Outcome Analysis ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Persistent Mental Illness ◽  
Management Approaches

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

scholarly journals Fully-integrated medical home for people with severe and persistent mental illness: A description and outcome analysis of a Medicare Advantage Chronic Special Needs Program

2018 ◽  
Vol 10 (2) ◽  
pp. 48-52
Author(s):  
Robert Myers
Keyword(s):  
Mental Illness ◽  
Special Needs ◽  
Medical Home ◽  
Social Needs ◽  
Community Treatment ◽  
Outcome Analysis ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Persistent Mental Illness ◽  
Management Approaches

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

Crisis Occurrence and Resolution in Patients with Severe and Persistent Mental Illness

Crisis ◽  
2005 ◽  
Vol 26 (4) ◽  
pp. 160-169 ◽  
Author(s):  
Paul S. Links ◽  
Rahel Eynan ◽  
Jeffrey S. Ball ◽  
Aiala Barr ◽  
Sean Rourke
Keyword(s):  
Mental Illness ◽  
Suicide Ideation ◽  
Rating Scale ◽  
Psychiatric Symptoms ◽  
Self Report ◽  
Community Treatment ◽  
Persistent Mental Illness ◽  
Crisis Events ◽  
Symptom Distress Scale ◽  
Distress Scale

Abstract. Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.

The Relationship Between Employment Status and Quality of Life For Individuals with Severe and Persistent Mental Illness

1997 ◽  
Vol 28 (4) ◽  
pp. 4-8 ◽  
Author(s):  
Donna C. Vanden Boom ◽  
Daniel C. Lustig
Keyword(s):  
Quality Of Life ◽  
Mental Illness ◽  
Effect Size ◽  
Employment Status ◽  
Community Treatment ◽  
Living Situation ◽  
Persistent Mental Illness ◽  
Global Quality Of Life ◽  
The Relationship

The relationship between quality of life and employment status for individuals with severe and persistent mental illness was investigated. Forty individuals in the Program for Assertive Community Treatment (PACT) participated in the study. PACT is a community-based program for persons with severe and persistent mental illness which emphasizes the importance of employment in rehabilitation. Participants were interviewed using Lehman's Quality of Life Interview. A large effect size for difference between individuals who were employed and those who were unemployed was found for assessment of global quality of life. Medium and small effect sizes were found for satisfaction with family, financial situation, health and social relations, safety, and daily activities. Minimal effect size was found for satisfaction with living situation.

Estimating the cost impact of three case management programmes for treating people with severe mental illness

1998 ◽  
Vol 173 (S36) ◽  
pp. 26-32 ◽  
Author(s):  
Teh-Wei Hu ◽  
Jeanette M. Jerrell
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Case Management ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Public Funding ◽  
Persistent Mental Illness ◽  
Treatment Services ◽  
Frequent Use ◽  
Management Approaches

The treatment of people with severe and persistent mental illness entails long-term intervention and may be very costly, primarily due to their frequent use of acute and subacute treatment services or because of prolonged stays in health care institutions. Given the rising costs of health care and the decreasing public funding for treating people with severe mental illness, mental health professionals are adopting case management approaches to provide more efficient care to these individuals.

Palliative Care for Patients with Mental Illness

2019 ◽  
pp. 503-512
Author(s):  
John D. Chovan ◽  
Betty D. Morgan
Keyword(s):  
Mental Illness ◽  
Palliative Care ◽  
Special Needs ◽  
Ethical Decision Making ◽  
Healthcare Providers ◽  
Interdisciplinary Teams ◽  
Underserved Population ◽  
Persistent Mental Illness ◽  
Life Threatening ◽  
Persons With Schizophrenia

This chapter describes the challenges and special needs for persons living with severe and persistent mental illness as they face chronic and life-threatening illnesses. Healthcare providers, especially those working on palliative care interdisciplinary teams, will learn the magnitude of this underserved population; their circumstances; the special needs of the persons with schizophrenia, bipolar disorder, and personality disorders; and those aspects of their mental illness that limit access to and delivery of appropriate healthcare throughout the trajectory of their illnesses. Techniques for caring for and communicating with patients and their families are offered, as are ethical decision-making advice regarding refusal of treatment, capacity and competence, advance directives, and interpersonal issues.

Stigma and discrimination in individuals with severe and persistent mental illness in an assertive community treatment team: Perceptions of families and healthcare professionals

2019 ◽  
Vol 65 (7-8) ◽  
pp. 570-579 ◽  
Author(s):  
Claire L O’Reilly ◽  
Diane Paul ◽  
Rebecca McCahon ◽  
Sumitra Shankar ◽  
Alan Rosen ◽  
...  
Keyword(s):  
Mental Illness ◽  
Assertive Community Treatment ◽  
Healthcare Professionals ◽  
Family Members ◽  
Clinical Staff ◽  
Community Treatment ◽  
Treatment Team ◽  
Assertive Community Treatment Team ◽  
Stigma And Discrimination ◽  
Persistent Mental Illness

Aim: To explore family member and staff perceptions of clients’ experiences of stigma and discrimination, in those living with severe and persistent mental illness in an Assertive Community Treatment Team. Method: This qualitative study used the Discrimination and Stigma Scale to conduct structured face-to-face and telephone interviews of family members and healthcare professionals, working with the Assertive Outreach Team (AOT) (an Assertive Community Treatment Team) of a northern inner suburban catchment of Sydney, New South Wales, Australia. Results: Forty-one people participated in the study (23 AOT clinical staff members and 18 family members). Family and clinical staff commonly reported stigma and discrimination amongst their relatives and clients, respectively. Four overarching themes emerged from the data: (1) appearance and behaviour, (2) avoidance and being shunned, (3) key areas of life affected by discrimination and (4) impacts of discrimination and skills to cope with discrimination. Conclusion: Reports of stigma and discrimination were common, yet varied between groups with clinical staff commonly witnessing experiences and impacts of discrimination in everyday life, with families’ reports being substantially less. Due to the strong advocacy and support provided by the AOT model, clinical staff often buffered experiences of stigma and discrimination. Further research is needed to explore effective interventions to reduce experiences of discrimination in this population group.

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