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Part 2 Organizational Aspects of Health Care Delivery

Chapter 10 Mental Health Services Delivery


Ardis Hanson, Bruce Lubotsky Levin, Carol A. Ott, Helen Meldrum

Learning Objectives
Provide a brief overview of current mental health services in the United States; Understand the role of epidemiology and service delivery systems, such as clinical psychiatric pharmacist, for individuals with mental disorders; Understand evidence-based practice/treatment guidelines for the clinical and community psychiatric pharmacist; and Better assess the potential role for pharmacists as members of mental health teams, and Identify emerging issues, including medical homes, ERISA, and rural health

Global Burden of Disease


Mental illness is a significant global public health issue 14% of the global disease burden is due to mental disorders Increased risk for physical illnesses & injury Health care costs 16% of the nations gross domestic product; mental disorders 6.2% of national expenditures Expected 6.6% annual increase in MH/SA disorders

Co-Occurring Disorders
Treatment exacerbated by lifestyle issues, atrisk behaviors, service utilization, and barriers to care Higher rates of premature death disability Gender differences
Women are more prone to depression than men

$1 invested in treatment saves $7 in social and health costs

Criminal Justice Settings


Over 12 million adults in jails annually (760,000 on any given day) More than half of all inmates have a mental health or substance abuse problem Exacerbated by mercy arrests Only 1 in 6 jail inmates and 1 in 3 state prisoners receive MH/SA services After MH/SA release services not guaranteed

Epidemiology of Mental Disorders


DALY (Disability-Adjusted Life Years) is the loss of one year of full health Estimated 237 DALYs per 1000 population
60% premature death ; 40% non-fatal health outcomes

National Studies
Epidemiologic Catchment Area (ECA) National Comorbidity Survey National Comorbidity Survey Replication Study (NCS-R)

Epidemiology of Mental Disorders


Homeless populations
estimated 3.5 million people annually (700,000 a night) 38 percent report an alcohol dependency problem 42 percent of persons who are homeless are African American/Black; 38 percent are White, non Hispanic, and 11.6% are Hispanic

Epidemiology of Mental Disorders


Dually eligible populations
receive both Medicaid and Medicare the oldest, poorest, sickest, & most disabled individuals 15% account for 41% of Medicaid services
Over one-third are under the age of 65 38% have cognitive or mental impairments 22% have multiple physical impairments 23% are institutionalized 75% live in nursing homes

Reports & Legislation


Community Mental Health Centers Act of 1963 Titles XVIII & XIX of the Social Security Act Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Joint Commission on Mental Health and Illness Report (1961) Mental Health: A Report of the Surgeon General (1999) Achieving the Promise (2003)

Mental Health Services Delivery and the Community Pharmacist


Medication Adherence Evidence-Based Practice/Treatment Guidelines Preferred Drugs Lists (PDLs)
State of Indiana MHQAC program (1325) Reduction of polypharmacy

Mental Health Teams


Clinical Psychiatric Pharmacist
Graduate from accredited School or College of Pharmacy Post-Graduate Year Two residency BCPP designation

Expanded roles and services


Depression screening Physician extender

Prevention & Promotion


Primary, secondary, & tertiary prevention Mental Health Promotion Healthy People 2010
14 objectives

Healthy People 2020


New focal area depression screening

Institute of Medicine Informing the Future: Critical Issues in Health

Emerging Issues
Medical Home
New Patient Care Models

ERISA
Pharmacist as Fiduciaries Business models

Rural Populations
Health Promotion

Legal & Ethical Issues


Privacy issues: Googling patients Resource limitations Denial of service

Summary
Growing Team Collaboration Re-tooling Curriculum Community-centered Pharmacy Practice Role of the Clinical Psychiatric Pharmacist Training the Public About Pharmacy Practice

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