Psychology Treatment Thesis

Pages: 27 (8451 words)  ·  Bibliography Sources: 15  ·  Level: College Senior  ·  Topic: Psychology

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[. . .] 29).

A crisis in mental health care funding is approaching rapidly given that the Baby Boomer generation will retire over the next twenty years and expenditures for older Americans with major psychiatric disorders will double. There will also be a serious lack of mental health services, providers and funding. About 20% of all adults over age 55 have major mental illnesses such as depression and dementia, although these are often under-reported and under-diagnosed (Bartels et al., 2010, p. 261). Medicare and Medicaid expenditures for nursing homes, outpatient and inpatient services, pharmacy and emergency room visits always "increase with advancing age" especially for those age 85 and over requiring "acute and long-term care." These expenses increase further for patients with schizophrenia and bipolar disorder, although elderly patients with these conditions are far less likely to receive mental health care than younger patients. Nearly half of all Medicare expenditures in the mental health field are for acute inpatient hospitalization, while 65-91% of nursing home patients "have a significant mental disorder," mostly dementia and cognitive disorder (Bartels et al., p. 263). Over 57 million people have a diagnosable mental illness -- about 26% of the population -- and one-fifth of these are severely ill, yet only one in four actually get the mental health care they need (Videbeck, 2010, p. 5).

Medicare is open to all people over age 65% and is federally funded, while Medicaid requires 50% matching funding from the states, which are required to provide aid to the blind, disabled and mentally ill. These programs are means-tested and have other restrictions on eligibility that vary by state. Older adults and the disabled are one-third of all Medicaid enrollees and account for three-quarters of all spending. In 2006, two-thirds of its expenditures were for nursing homes and home and community-based care. It also funded one-quarter of all mental health care expenditures, more than any other insurance provider. People over 65, especially the poor disabled and mentally ill, are "dually eligible" for Medicare and Medicaid, and account for 42% of all Medicaid expenditures (Bartels et al., p. 269). The lack of parity for mental health and medical care in Medicare and Medicaid had long beeen a "standing priority for reform among consumer advocacy and provider organizations." The 1996 Mental Health Parity Act prohibited private insurers from "setting lower annual or lifetime dollar caps on mental health benefits," and of course when Obama Care phases in over the next few years these caps will be eliminated completely. In 2003, Paul Wellstone proposed eliminating the 50% co-payment required for psychiatric services under Medicare compared to 20% for medical care. In the 2008 Medicare Improvement for Patients and Providers Act this was scheduled to be eliminated over the following six years with co-payments reduced to 20% for mental health care services. It also increased reimbursements to providers by 1.1% per year (Bartels et al., p. 269). That same year, Congress passed the Mental Parity and Addiction Equity Act that applied to Medicaid and private insurance plans. Under this new law, they were also required to provide parity in treatment for both mental and physical disorders, and could not limit hospital days or outpatient treatment sessions or have higher co-payments and deductibles for psychiatric care. No exclusions are allowed, such as treatment for substance abuse, although plans were still allowed to drop coverage for psychiatric and substance abuse treatment completely (American Psychological Association 2008).

Although the issue of parity for Medicare and Medicaid patients was resolved in 2008, there are still a wide variety of issues for which mental health advocates would recommend urgent reforms, particularly in the context of the current economic recession and rapidly aging population. Among these are:

The Healthy People 2010 Mental Health Objectives included recommendations to increase treatment for adults with severe mental illness from 25% to at least 50%, and to 75% for those with schizophrenia. Other goals are to reduce the percentage of mentally ill homeless to 19% of the total homeless population and to increase the number of states with treatment plans for crisis intervention, screening and mental health care for the elderly (Videbeck, p. 7). This would require more funding for community-based mental health centers and inpatient psychiatric facilities.

Psychiatry is particularly expensive because of the long-term nature of the illnesses and funds for these always "lag far behind the need that exists." Many people who are eligible for Medicaid never apply for it or are not approved, which means that millions of patients "with severe and persistent mental illness have no benefits at all" (Videbeck, p. 8). More efforts are necessary to ensure that the mentally ill who are eligible for Social Security disability, supplemental income and Medicaid actually receive these benefits.

Informal and family caregivers cost the economy at least $9 billion per year and provide essential services to the elderly mentally ill. Over 70% of Alzheimer's patients live at home with three-quarters of their care provided by family and friends. This "shadow workforce" will require more support and training, particularly as the Baby Boomers age (Bartels et al., p. 265). Federal and state programs should provide more funding for these informal caregivers, along with in-home and visiting nursing assistance, so that these patients will not have to be placed in nursing homes or other institutions.

Although the Community Mental Health Act of 1963 reduced the trend of institutionalization and 'warehousing' in state psychiatric hospitals, many of the elderly mentally ill were simply transferred to nursing homes. Given that community mental health centers have never been adequately funded, especially for the elderly, nursing homes became "default mental institutions." The Omnibus Budget Reconciliation Acts of 1987 and the Supreme Court's Olmstead decision of 1999 all attempted to reduce the number of patents sent to psychiatric facilities and nursing homes and required these to "whether they could be receiving care in a less restrictive community-based environment" (Bartels et all, p. 266). This will also become a greater priority for Medicare and Medicaid funding as the Baby Boomers retire and costs escalate. Deinstitutionalization did not reduce the numbers of people requiring mental health care, but did increase the numbers of homeless mentally ill, as well as the number of emergency room visits by people in severe distress and short-term stays in general hospital psychiatric units by 400-500% (Videbeck, p. 5). Once again, this problem will have to be resolved by more funding for community mental health programs and psychiatric inpatient services. Perhaps the pendulum of deinstitutionalization has also swung too far in the opposite direction and should be reconsidered to some degree, since there are obviously a large percentage of mentally ill homeless adults who will have to be permanently institutionalized.

Because of inadequate Medicare reimbursements, many younger physicians have been avoiding a career in geriatric medicine, especially because they leave medical school with high student loan debts. Geriatric psychiatry is an even less popular field than internal and general medicine for the elderly. In 2007 Congress proposed student loan forgiveness for doctors and other providers who specialized in geriatrics and this should be implemented (Bartels et al., 273). Congress to take steps to provide free medical education for physicians, nurses, psychologists, and social workers who specialize in geriatric mental health care or agree to work in underserved and low-income areas.

Given the fact that the United States will have a rapidly aging population over the next twenty years, Congress should urgently consider the need for increased Medicare and Medicaid funding for the large number of elderly patients who will end up permanently institutionalized because of dementia. It should also expand money for research and treatment of Alzheimer's Disease in order for these patients to be able to live longer, more healthy lives outside of nursing homes. Medicare, Medicaid and private insurance have already been reformed so that benefits available for physical and mental illnesses will be at parity, but greater efforts are necessary in order to ensure greater access to treatment for the poor and elderly mentally ill. These psychiatric disorders are still underfunded, under-reported and under-treated and millions of people who are eligible for benefits do not receive them. Community mental health care centers, and formal and informal caregivers who maintain patients at home also require more funding and support, so that they elderly and severely disabled mentally ill do not all end up in nursing homes -- which is the most expensive method of care and already a severe burden of Medicare and Medicaid. At the same time, more permanent institutionalization may well be necessary for the homeless mentally ill in order relieve the burden on hospital emergency rooms and general psychiatric wards.

Recent studies indicate that 11% of the U.S. population suffers from anxiety disorders every year, and that 29% will experience… [END OF PREVIEW]

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Psychology Treatment.  (2011, March 22).  Retrieved December 9, 2018, from https://www.essaytown.com/subjects/paper/psychology-treatment-most/6045976

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https://www.essaytown.com/subjects/paper/psychology-treatment-most/6045976.