Fluent Essays

SOCW 6351: Social Policy, Welfare, and Change Week 6 Discussion 1: Mental Health Care/Managed Care Mental health care is a primary concern to social workers, who are the main providers of care to populations with mental health diagnoses. The system that provides services to individuals with mental health issues is often criticized for being reactive and only responding when individuals are in crisis. Crisis response is not designed to provide on-going care and is frequently very expensive, especially if hospitalization is involved.  Critics suggest a comprehensive plan, which involves preventive services, as well as a continuum of care. However, there are few, if any, effective and efficient program models. Social work expertise and input are vital to implementing effective services. Targeting services to individuals with a diagnosis of mental illness is one strategy. Another approach includes providing an array of services that are also preventative in nature. How might these suggestions address potential policy gaps in caring for individuals such as the family members in the Parker Family case? For this Discussion, review this week’s resources, including the Parker Family video. Then consider the specific challenges or gaps in caring for individuals with a chronic mental illness might present for the mental health system based on the Parker case. Finally, think about how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging. Post by 10/05/21 an explanation of the specific challenges or gaps in the mental health care system for the care of individuals with chronic mental illnesses. Base your response on the Parker case. Then, describe how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging. Support your post with specific references to the resources. Be sure to provide full APA citations for your references.           Top of Form Discussion 2: Emerging Issues in Mental Health Care Like so many areas of practice in social work, mental health is dynamic and ever-evolving. Research continues to provide new information about how the brain functions, the role of genetics in mental health, and evidence to support new possibilities for treatment. Keeping up with these developments might seem impossible. However, being aware of and responsive to these developments and incorporating them into both your practice and social policy is essential to changing the lives of individuals and families who live with a mental health diagnosis and the impact it brings to their daily lives. For this Discussion, review this week’s resources. Search the Walden Library and other reputable online sources for emerging issues in the mental health care arena. Think about the issues that are being addressed by social policy and those that are in need of policy advocacy and why that might be the case. Then, consider what social workers can do to ensure that clients/populations receive necessary mental health services. Also, think about the ethical responsibility related to mental health care social workers must uphold in host settings when they encounter conflicts in administration and home values. Finally, search your state government sites for the mental health commitment standards in your state and reflect on the mental health services covered under your state’s Medicaid program. By 10/05/2021 , post an explanation of those emerging issues in the mental health care arena that the policymakers address and those that are in need of policy advocacy and why. Then, explain what strategies social workers might use to ensure that clients/populations receive necessary mental health services. Finally, explain the mental health commitment standards and mental health services in your state (Florida). In your explanation, refer to the services covered under your state’s Medicaid program. Bottom of Form Learning Resources Required Readings Popple, P. R., & Leighninger, L. (2019). The policy-based profession: An introduction to social welfare policy analysis for social workers (7th ed.). Upper Saddle River, NJ: Pearson Education. · Chapter 8, “Mental Health and Substance Abuse (pp. 161-191) Conclusion for Chapter 8, “Mental Health and Substance Abuse (pp. 161-191) Mental illness and substance abuse have been individual and social problems since the founding of the country. And debates over the degree of individual and social responsibility for them have continued for at least that long. The policy pendulum has swung back and forth as we weigh individual freedom versus collective obligation. The issues are complex, and morality as well as practicality are involved. Of the many substances that are abused, some are legal and some or not. Should we decriminalize some and/or make others harder to obtain? Should everyone be subjected to drug tests? Should people with a mental illness who might harm others be denied privacy and confidentiality? Should parents be allowed to refuse to vaccinate their children if this results in the deaths of others? Are our communities safer with more guns or fewer guns? Should cyberspace be more carefully regulated? How do we reintegrate our veterans into peacetime society? What roles can social workers play in all this? The use and abuse of illegal substances are not just problems for specific groups in American society, as we used to think. We find these problems in all socioeconomic, racial, and religious groups. Different drugs are adopted and discarded by various groups at various times, in various places. The extent to which use is considered a problem and the extent to which abuse is prosecuted seems to depend a lot on who the users are. And in the pharmacological revolution, this issue can only get more complicated. World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader]. · Part 1, "The Parker Family" (pp. 6–8) Mental Health America. (n.d.). Retrieved from https://mhanational.org/ Required Media Laureate Education (Producer). (2013). Sessions: Parker family (Episode 5 of 42) [Video file]. Retrieved from https://class.waldenu.edu Responsiveness to Directions 27 (27%) - 30 (30%) Discussion posting fully addresses all instruction prompts, including responding to the required number of peer posts. Discussion Posting Content 27 (27%) - 30 (30%) Discussion posting demonstrates an excellent understanding of all of the concepts and key points presented in the text(s) and Learning Resources. Posting provides significant detail including multiple relevant examples, evidence from the readings and other scholarly sources, and discerning ideas. Peer Feedback and Interaction 22.5 (22.5%) - 25 (25%) The feedback postings and responses to questions are excellent and fully contribute to the quality of interaction by offering constructive critique, suggestions, in-depth questions, additional resources, and stimulating thoughts and/or probes. Writing. 13.5 (13.5%) - 15 (15%) Postings are well organized, use scholarly tone, contain original writing and proper paraphrasing, follow APA style, contain very few or no writing and/or spelling errors, and are fully consistent with graduate level writing style. The Parker Family Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years, since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance abuse; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and Klonopin®. Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie currently has active Medicare and receives Social Security Disability (SSD). Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance abuse. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge. A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing all my stuff.” During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home. Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing, but denied physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get my things back.” The APS worker observed that Sara’s appearance was unkempt and disheveled, but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family was in need of a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women. As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home, based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept what needed to be done so they would not be forced to move. The Parker Family Sara Parker: mother, 72 Stephanie Parker: daughter, 48 Jane Rodgers: daughter, 45 Stephanie reported her mother is estranged from her younger sister, Jane, because of the hoarding. Stephanie also mentioned she was dissatisfied with her mother’s psychiatric treatment and felt she was not getting the help she needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently increased her Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel this had been helpful and actually wondered if it was contributing to her mother’s confusion. I asked for permission to contact Jane and both of their outpatient treatment teams, and both requests were granted. I immediately contacted Jane, who initially was uncooperative and stated she was unwilling to assist. Jane is married, with three children, and lives 3 hours away. At the beginning of our phone call, Jane said, “I’ve been through this before and I’m not helping this time.” When I asked if I could at least keep in touch with her to keep her informed of the situation and any decisions that might need to be made, Jane agreed. After a few more minutes of discussion around my role and responsibilities, I was able to establish a bit of rapport with Jane. She then started to ask me questions and share some insight into what was going on in her mother and sister’s home. Jane informed me that she was very angry with her mother and had not brought her children to the apartment in years because of its condition. She said that her mother started compulsively shopping and hoarding when she and Stephanie were in high school, and while her father had tried to contain it as best he could, the apartment was always cluttered. She said this had been a source of conflict and embarrassment for her and Stephanie all of their lives. She said that after her father died of a heart attack, the hoarding got worse, and neither she nor Stephanie could control it. Jane also told me she felt her mother was responsible for Stephanie’s relapses. Jane reported that Stephanie had been compliant with her medication and treatment in the past, and that up until a few years ago, had not been hospitalized for several years. Jane had told Stephanie in the past to move out. Jane also told me that she “is angry with the mental health system.” Sara had been recently hospitalized for depression, and Jane took pictures of the apartment to show the inpatient treatment team what her mother was going home to. Jane felt they did not treat the situation seriously because they discharged her mother back to the apartment. Stephanie had been hospitalized at the same time as her mother, but in a different hospital, and Jane had shown the pictures to her sister’s treatment team as well. Initially the social worker recommended that Stephanie not return to the apartment because of the state of the home, but when that social worker was replaced with someone new, Stephanie was also sent back home. When I inquired if there were any friends or family members who might be available and willing to assist in clearing out the apartment, Jane said her mother had few friends and was not affiliated with a church group or congregation. However, she acknowledged that there were two cousins who might help, and she offered to contact them and possibly help herself. She said that she would ask her husband to help as well, but she wanted assurance that her mother would cooperate. I explained that while I could not promise that her mother would cooperate completely, her mother had stated that she was willing to do whatever it took to keep living in her home. Jane seemed satisfied with this response and pleased with the plan. I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the psychologist who administered the tests she had stopped taking her medications for depression. It was determined Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more specialized treatment. Sara’s psychologist was in agreement. Because they had both stated that they did not want to be removed from their home, I worked with Sara and Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the house for 1 hour a day until arrangements were made for additional help from family members. In an attempt to alleviate Sara’s anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional support and observation as it progressed. Jane notified me that her two cousins were willing to assist with the cleanup, make minor repairs, and paint the apartment. Jane offered to schedule a date that would be convenient for her and her cousins to come and help out. Key to Acronyms APS: Adult Protective Services ICM: Intensive Case Management services SSD: Social Security Disability We then discussed placement for at least some of the cats, because six seemed too many for a small apartment. Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats were adopted within a week. During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to continue to live with her mother. She requested that I complete a housing application for supportive housing stating, “I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the supermarket was pleased with her performance and was prepared to hire her as a part-time cashier soon. She expressed concern about how her mother would react to this decision and asked me for assistance telling her. We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was initially upset and had some difficulty accepting this decision. Sara said she had fears about living alone, but when we discussed senior living alternatives, Sara was adamant she wanted to remain in her apartment. Sara said she had lived alone for a number of years after her husband died and felt she could adjust again. I offered to help her stay in her apartment and explore home care services and programs available that will meet her current needs to remain at home. Learning Resources Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader]. · Part 1, "The Parker Family" (pp. 6–8) MENTAL HEALTH POLICY, PLANS AND PROGRAMMES Mental Health Policy and Service Guidance Package World Health Organization, 2004 “A mental health policy and plan is essential to coordinate all services and activities related to mental health. Without adequate policies and plans, mental disorders are likely to be treated in an inefficient and fragmented manner.” (updated version) MENTAL HEALTH POLICY, PLANS AND PROGRAMMES Mental Health Policy and Service Guidance Package World Health Organization, 2004 (updated version) © World Health Organization 2004 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed in Singapore WHO Library Cataloguing-in-Publication Data Mental health policy, plans and programmes - Rev. ed. (Mental health policy and service guidance package) 1. Mental health 2. Mental health services organization and administration 3. Public policy 4. National health programmes organization and administration 5. Health plan implementation 6. Health planning guidelines I. World Health Organization II. Series. ISBN 92 4 154646 8 (NLM classification: WM 30) Technical information concerning this publication can be obtained from: Dr Michelle Funk Mental Health Policy and Service Development Team Department of Mental Health and Substance Abuse Noncommunicable Diseases and Mental Health Cluster World Health Organization CH-1211, Geneva 27 Switzerland Tel: +41 22 791 3855 Fax: +41 22 791 4160 E-mail: [email protected] ii Acknowledgements The Mental Health Policy and Service Guidance Package was produced under the direction of Dr Michelle Funk, Coordinator, Mental Health Policy and Service Development, and supervised by Dr Benedetto Saraceno, Director, Department of Mental Health and Substance Abuse, World Health Organization. The World Health Organization gratefully thanks Dr Alberto Minoletti, Ministry of Health, Chile, who prepared this module. Editorial and technical coordination group: Dr Michelle Funk, World Health Organization, Headquarters (WHO/HQ), Ms Natalie Drew, (WHO/HQ), Dr JoAnne Epping-Jordan, (WHO/HQ), Professor Alan J. Flisher, University of Cape Town, Observatory, Republic of South Africa, Professor Melvyn Freeman, Human Sciences Research Council, Pretoria, South Africa, Dr Howard Goldman, National Association of State Mental Health Program Directors Research Institute and University of Maryland School of Medicine, USA, Dr Itzhak Levav, Mental Health Services, Ministry of Health, Jerusalem, Israel and Dr Benedetto Saraceno, (WHO/HQ). Dr Crick Lund, University of Cape Town, Observatory, Republic of South Africa finalized the technical editing of this module. Technical assistance: Dr Jose Bertolote, World Health Organization, Headquarters (WHO/HQ), Dr José Miguel Caldas de Almeida, WHO Regional Office for the Americas (AMRO), Dr Vijay Chandra, WHO Regional Office for South-East Asia (SEARO), Dr Custodia Mandlhate, WR/ Namibia, Dr Claudio Miranda (AMRO), Dr Ahmed Mohit, WHO Regional Office for the Eastern Mediterranean, Dr Wolfgang Rutz, WHO Regional Office for Europe (EURO), Dr WANG Xiandong, WHO Office for the Western Pacific, (WRPO), Dr Derek Yach (WHO/HQ), Mrs Margaret Grigg (WHO/HQ) and staff of the WHO Evidence and Information for Policy Cluster (WHO/HQ). Administrative and secretarial support: Ms Adeline Loo (WHO/HQ), Mrs Anne Yamada (WHO/HQ) and Mrs Razia Yaseen (WHO/HQ). Layout and graphic design: 2S ) graphicdesign Editor: Walter Ryder iii WHO also gratefully thanks the following people for their expert opinion and technical input to this module: Dr Adel Hamid Afana Director, Training and Education Department Gaza Community Mental Health Programme Dr Bassam Al Ashhab Ministry of Health, Palestinian Authority, West Bank Mrs Ella Amir Ami Québec, Canada Dr Julio Arboleda-Florez Department of Psychiatry, Queen's University, Kingston, Ontario, Canada Ms Jeannine Auger Ministry of Health and Social Services, Québec, Canada Dr Florence Baingana World Bank, Washington DC, USA Mrs Louise Blanchette University of Montreal Certificate Programme in Mental Health, Montreal, Canada Dr Susan Blyth University of Cape Town, Cape Town, South Africa Dr Thomas Bornemann Director, Mental Health, The Carter Centre Mental Health Program, Altanta, USA Ms Nancy Breitenbach Inclusion International, Ferney-Voltaire, France Dr Anh Thu Bui Ministry of Health, Koror, Republic of Palau Dr Sylvia Caras People Who Organization, Santa Cruz, California, USA Dr Claudina Cayetano Ministry of Health, Belmopan, Belize Dr CHANG Chueh Taipei, Taiwan, China Professor YAN Fang Chen Shandong Mental Health Centre, Jinan People’s Republic of China Dr Chantharavdy Choulamany Mahosot General Hospital, Vientiane, Lao People’s Democratic Republic Dr Ellen Corin Douglas Hospital Research Centre, Quebec, Canada Dr Jim Crowe President, World Fellowship for Schizophrenia and Allied Disorders, Dunedin, New Zealand Dr Araba Sefa Dedeh University of Ghana Medical School, Accra, Ghana Dr Nimesh Desai Professor of Psychiatry and Medical Superintendent, Institute of Human Behaviour and Allied Sciences, India Dr M. Parameshvara Deva Department of Psychiatry, Perak College of Medicine, Ipoh, Perak, Malaysia Professor Saida Douki President, Société Tunisienne de Psychiatrie, Tunis, Tunisia Professor Ahmed Abou El-Azayem Past President, World Federation for Mental Health, Cairo, Egypt Dr Abra Fransch WONCA, Harare, Zimbabwe Dr Gregory Fricchione Carter Center, Atlanta, USA Dr Michael Friedman Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Mrs Diane Froggatt Executive Director, World Fellowship for Schizophrenia and Allied Disorders, Toronto, Ontario, Canada Mr Gary Furlong Metro Local Community Health Centre, Montreal, Canada Dr Vijay Ganju National Association of State Mental Health Program Directors Research Institute, Alexandria, VA, USA Mrs Reine Gobeil Douglas Hospital, Quebec, Canada Dr Nacanieli Goneyali Ministry of Health, Suva, Fiji Dr Gaston Harnois Douglas Hospital Research Centre, WHO Collaborating Centre, Quebec, Canada Mr Gary Haugland Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Dr HE Yanling Consultant, Ministry of Health, Beijing, People’s Republic of China iv Professor Helen Herrman Department of Psychiatry, University of Melbourne, Australia Mrs Karen Hetherington WHO/PAHO Collaborating Centre, Canada Professor Frederick Hickling Section of Psychiatry, University of West Indies, Kingston, Jamaica Dr Kim Hopper Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Dr HWANG Tae-Yeon Director, Department of Psychiatric Rehabilitation and Community Psychiatry, Yongin City, Republic of Korea Dr Aleksandar Janca University of Western Australia, Perth, Australia Dr Dale L. Johnson World Fellowship for Schizophrenia and Allied Disorders, Taos, NM, USA Dr Kristine Jones Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Dr David Musau Kiima Director, Department of Mental Health, Ministry of Health, Nairobi, Kenya Mr Todd Krieble Ministry of Health, Wellington, New Zealand Mr John P. Kummer Equilibrium, Unteraegeri, Switzerland Professor Lourdes Ladrido-Ignacio Department of Psychiatry and Behavioural Medicine, College of Medicine and Philippine General Hospital, Manila, Philippines Dr Pirkko Lahti Secretary-General/Chief Executive Officer, World Federation for Mental Health, and Executive Director, Finnish Association for Mental Health, Helsinki, Finland Mr Eero Lahtinen Ministry of Social Affairs and Health, Helsinki, Finland Dr Eugene M. Laska Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Dr Eric Latimer Douglas Hospital Research Centre, Quebec, Canada Dr Ian Lockhart University of Cape Town, Observatory, Republic of South Africa Dr Marcelino López Research and Evaluation, Andalusian Foundation for Social Integration of the Mentally Ill, Seville, Spain Ms Annabel Lyman Behavioural Health Division, Ministry of Health, Koror, Republic of Palau Dr MA Hong Consultant, Ministry of Health, Beijing, People’s Republic of China Dr George Mahy University of the West Indies, St Michael, Barbados Dr Joseph Mbatia Ministry of Health, Dar es Salaam, Tanzania Dr Céline Mercier Douglas Hospital Research Centre, Quebec, Canada Dr Leen Meulenbergs Belgian Inter-University Centre for Research and Action, Health and Psychobiological and Psychosocial Factors, Brussels, Belgium Dr Harry I. Minas Centre for International Mental Health and Transcultural Psychiatry, St. Vincent’s Hospital, Fitzroy, Victoria, Australia Dr Alberto Minoletti Ministry of Health, Santiago de Chile, Chile Dr Paula Mogne Ministry of Health, Mozambique Dr Paul Morgan SANE, South Melbourne, Victoria, Australia Dr Driss Moussaoui Université psychiatrique, Casablanca, Morocco Dr Matt Muijen The Sainsbury Centre for Mental Health, London, United Kingdom Dr Carmine Munizza Centro Studi e Ricerca in Psichiatria, Turin, Italy Dr Shisram Narayan St Giles Hospital, Suva, Fiji Dr Sheila Ndyanabangi Ministry of Health, Kampala, Uganda Dr Grayson Norquist National Institute of Mental Health, Bethesda, MD, USA v Dr Frank Njenga Chairman of Kenya Psychiatrists’ Association, Nairobi, Kenya Dr Angela Ofori-Atta Clinical Psychology Unit, University of Ghana Medical School, Korle-Bu, Ghana Professor Mehdi Paes Arrazi University Psychiatric Hospital, Sale, Morocco Dr Rampersad Parasram Ministry of Health, Port of Spain, Trinidad and Tobago Dr Vikram Patel Sangath Centre, Goa, India Dr Dixianne Penney Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Dr Yogan Pillay Equity Project, Pretoria, Republic of South Africa Dr Michal Pohanka Ministry of Health, Czech Republic Dr Laura L. Post Mariana Psychiatric Services, Saipan, USA Dr Prema Ramachandran Planning Commission, New Delhi, India Dr Helmut Remschmidt Department of Child and Adolescent Psychiatry, Marburg, Germany Professor Brian Robertson Department of Psychiatry, University of Cape Town, Republic of South Africa Dr Julieta Rodriguez Rojas Integrar a la Adolescencia, Costa Rica Dr Agnes E. Rupp Chief, Mental Health Economics Research Program, NIMH/NIH, USA Dr Ayesh M. Sammour Ministry of Health, Palestinian Authority, Gaza Dr Aive Sarjas Department of Social Welfare, Tallinn, Estonia Dr Radha Shankar AASHA (Hope), Chennai, India Dr Carole Siegel Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA Professor Michele Tansella Department of Medicine and Public Health, University of Verona, Italy Ms Mrinali Thalgodapitiya Executive Director, NEST, Hendala, Watala, Gampaha District, Sri Lanka Dr Graham Thornicroft Director, PRISM, The Maudsley Institute of Psychiatry, London, United Kingdom Dr Giuseppe Tibaldi Centro Studi e Ricerca in Psichiatria, Turin, Italy Ms Clare Townsend Department of Psychiatry, University of Queensland, Toowing Qld, Australia Dr Gombodorjiin Tsetsegdary Ministry of Health and Social Welfare, Mongolia Dr Bogdana Tudorache President, Romanian League for Mental Health, Bucharest, Romania Ms Judy Turner-Crowson Former Chair, World Association for Psychosocial Rehabilitation, WAPR Advocacy Committee, Hamburg, Germany Mrs Pascale Van den Heede Mental Health Europe, Brussels, Belgium Ms Marianna Várfalvi-Bognarne Ministry of Health, Hungary Dr Uldis Veits Riga Municipal Health Commission, Riga, Latvia Mr Luc Vigneault Association des Groupes de Défense des Droits en Santé Mentale du Québec, Canada Dr WANG Liwei Consultant, Ministry of Health, Beijing, People’s Republic of China Dr Erica Wheeler Ornex, France Professor Harvey Whiteford Department of Psychiatry, University of Queensland, Toowing Qld, Australia Dr Ray G. Xerri Department of Health, Floriana, Malta Dr XIE Bin Consultant, Ministry of Health, Beijing, People’s Republic of China Dr YU Xin Consultant, Ministry of Health, Beijing, People’s Republic of China vi Professor SHEN Yucun Institute of Mental Health, Beijing Medical University, People’s Republic of China Dr Taintor Zebulon President, WAPR, Department of Psychiatry, New York University Medical Center, New York, USA WHO also wishes to acknowledge the generous financial support of the Governments of Australia, Finland, Italy, the Netherlands, New Zealand, and Norway. vii viii “A mental health policy and plan is essential to coordinate all services and activities related to mental health. Without adequate policies and plans, mental disorders are likely to be treated in an inefficient and fragmented manner.” Table of Contents Preface x Executive summary 2 Aims and target audience 11 1. Introduction 12 2. Developing a mental health policy: essential steps 17 Step 1. Assess the population’s needs 19 Step 2. Gather evidence for effective strategies 22 Step 3. Consultation and negotiation 23 Step 4. Exchange with other countries 25 Step 5. Set out the vision, values, principles and objectives of the policy 26 Step 6. Determine areas for action 30 Step 7. Identify the major roles and responsibilities of different sectors 38 Examples of policies 40 3. Developing a mental health plan 44 Step 1. Determine the strategies and time frames 44 Step 2. Set indicators and targets 48 Step 3. Determine the major activities 49 Step 4. Determine the costs, the available resources and the budget 50 Examples of plans 55 4. Developing a mental health programme 59 5. Implementation issues for policy, plans and programmes 61 Step 1. Disseminate the policy 61 Step 2. Generate political support and funding 61 Step 3. Develop supportive organization 62 Step 4. Set up pilot projects in demonstration areas 63 Step 5. Empower mental health providers 63 Step 6. Reinforce intersectoral coordination 68 Step 7. Promote interactions among stakeholders 72 Examples of the implementation of policy 76 Table of Contents 6. Case examples of mental health policy, plans and programmes 78 7. Barriers and solutions 82 8. Recommendations and conclusions 88 Annex 1. Examples of effective mental health interventions 89 Annex 2. Principles for the development of mental health guidelines 93 Annex 3. Supporting the development of mental health policy, plans and programmes: functions of some key stakeholders 94 Definitions 97 Further reading 97 References 98 ix Preface This module is part of the WHO Mental Health Policy and Service guidance package, which provides practical information to assist countries to improve the mental health of their populations. What is the purpose of the guidance package? The purpose of the guidance package is to assist policy-makers and planners to: - develop policies and comprehensive strategies for improving the mental health of populations; - use existing resources to achieve the greatest possible benefits; - provide effective services to those in need; - assist the reintegration of persons with mental disorders into all aspects of community life, thus improving their overall quality of life. What is in the package? The package consists of a series of interrelated user-friendly modules that are designed to address the wide variety of needs and priorities in policy development and service planning. The topic of each module represents a core aspect of mental health. The starting point is the module entitled The Mental Health Context, which outlines the global context of mental health and summarizes the content of all the modules. This module should give readers an understanding of the global context of mental health, and should enable them to select specific modules that will be useful to them in their own situations. Mental Health Policy, Plans and Programmes is a central module, providing detailed information about the process of developing policy and implementing it through plans and programmes. Following a reading of this module, countries may wish to focus on specific aspects of mental health covered in other modules. The guidance package includes the following modules: > The Mental Health Context > Mental Health Policy, Plans and Programmes > Mental Health Financing > Mental Health Legislation and Human Rights > Advocacy for Mental Health > Organization of Services for Mental Health > Quality Improvement for Mental Health > Planning and Budgeting to Deliver Services for Mental Health x Mental Health Context xi Legislation and human rights Financing Organization of Services Advocacy Quality improvement Workplace policies and programmes Improving access and use of psychotropic medicines Information systems Human resources and training Child and adolescent mental health Research and evaluation Planning and budgeting for service delivery Policy, plans and programmes still to be developed Preface The following modules are not yet available but will be included in the final guidance package: > Improving Access and Use of Psychotropic Medicines > Mental Health Information Systems > Human Resources and Training for Mental Health > Child and Adolescent Mental Health > Research and Evaluation of Mental Health Policy and Services > Workplace Mental Health Policies and Programmes Who is the guidance package for? The modules will be of interest to: - policy-makers and health planners; - government departments at federal, state/regional and local levels; - mental health professionals; - groups representing people with mental disorders; - representatives or associations of families and carers of people with mental disorders; - advocacy organizations representing the interests of people with mental disorders and their relatives and families; - nongovernmental organizations involved or interested in the provision of mental health services. How to use the modules - They can be used individually or as a package. They are cross-referenced with each other for ease of use. Countries may wish to go through each of the modules systematically or may use a specific module when the emphasis is on a particular area of mental health. For example, countries wishing to address mental health legislation may find the module entitled Mental Health Legislation and Human Rights useful for this purpose. - They can be used as a training package for mental health policy-makers, planners and others involved in organizing, delivering and funding mental health services. They can be used as educational materials in university or college courses. Professional organizations may choose to use the package as an aid to training for persons working in mental health. - They can be used as a framework for technical consultancy by a wide range of international and national organizations that provide support to countries wishing to reform their mental health policy and/or services. - They can be used as advocacy tools by consumer, family and advocacy organizations. The modules contain useful information for public education and for increasing awareness among politicians, opinion-makers, other health professionals and the general public about mental disorders and mental health services. xii Format of the modules Each module clearly outlines its aims and the target audience for which it is intended. The modules are presented in a step-by-step format so as to assist countries in using and implementing the guidance provided. The guidance is not intended to be prescriptive or to be interpreted in a rigid way: countries are encouraged to adapt the material in accordance with their own needs and circumstances. Practical examples are given throughout. There is extensive cross-referencing between the modules. Readers of one module may need to consult another (as indicated in the text) should they wish further guidance. All the modules should be read in the light of WHO’s policy of providing most mental health care through general health services and community settings. Mental health is necessarily an intersectoral issue involving the education, employment, housing, social services and criminal justice sectors. It is important to engage in serious consultation with consumer and family organizations in the development of policy and the delivery of services. Dr Michelle Funk Dr Benedetto Saraceno xiii MENTAL HEALTH POLICY, PLANS AND PROGRAMMES Executive summary 1. Introduction An explicit mental health policy is an essential and powerful tool for the mental health section in any ministry of health. When properly formulated and implemented through plans and programmes, a policy can have a significant impact on the mental health of the population concerned. The outcomes described in the literature include improvements in the organization and quality of service delivery, accessibility, community care, the engagement of people with mental disorders and their carers, and in several indicators of mental health. Despite wide recognition of the importance of national mental health policies, data collected by WHO reveal that 40.5% of countries have no mental health policy and that 30.3% have no programme (WHO, 2001b). This module presents evidence-based guidance for the development and implementation of mental health policies, plans and programmes. The experiences of several countries are used as practical sources for drawing up mental health policies and implementing them through plans and programmes. Mental health policy is commonly established within a complex body of health, welfare and general social policies. The mental health field is affected by many policies, standards and ideologies that are not necessarily directly related to mental health. In order to maximize the positive effects when mental health policy is being formulated it is necessary to consider the social and physical environment in which people live. It is also necessary to ensure intersectoral collaboration so that benefit is obtained from education programmes, health, welfare and employment policies, the maintenance of law and order, policies specifically addressing the young and the old, and housing, city planning and municipal services (WHO, 1987; WHO, 2001a). The information provided in this module is considered relevant for various health systems, including those that are decentralized. It is generally accepted that national policy, plans and programmes are necessary in order to give mental health the appropriate priority in a country and to organize resources efficiently. Plans and programmes can be developed at the state, province, district, municipal and other local levels within countries in order to respond to specific local circumstances, while following national plans. If no overall national plan exists there is a risk of fragmentation or duplication of plans developed more locally. The concepts and recommendations presented in this module are intended for countries and regions with a wide range of circumstances and resource levels. The module provides examples of how policy, plans and programmes can be developed for countries with low and medium resource levels. 2 2. Developing a policy: essential steps It is important to have a time schedule in mind when approaching a mental health policy. It is probably realistic to allow one to two years for development and five to ten years for implementing and achieving changes (WHO, 1998a). Different elements of policy, plans and programmes may require different time scales. Step 1. Gather information and data for policy development Good policy is dependent on information about the mental health needs of the population and the mental health system and services offered. The needs of the population can be determined from, for example, prevalence and incidence studies, determining what communities identify as problems and an understanding of help seeking behaviour. Establishing priorities for mental health must also be done. In addition, the current system for delivering mental health care must be well understood and documented. Knowing who delivers mental health, to whom and with what resources is an important starting point for developing a reasonable and feasible mental health policy. Needs can be determined by the following methods: a) Formal research: Epidemiological studies in the general population and in special populations (e.g. schools and workplaces), simple epidemiological studies of people visiting health facilities, burden of disease studies involving the use of disability-adjusted life-years (DALYs), in-depth interviews and focus groups. b) Rapid appraisal: Secondary analysis of data from existing information systems, brief interviews with key informants and discussion groups involving people with mental disorders, families, carers and health staff. Step 2. Gather evidence for effective strategies Evidence can be obtained by visiting local services and reviewing the national and international literature. a) Evidence from a country or region: The principal evidence comes from the evaluation of previous policy, plans and programmes. Pilot projects and local experiences are also excellent sources of information. b) Evidence from other countries or regions: Evidence can be gathered most usefully from countries or regions with similar cultural and socio-economic features. c) Evidence from the literature: Evaluations of national or regional mental health policies. Step 3. Consultation and negotiation The process of formulating and implementing a mental health policy is mainly political. To a lesser degree it is a matter of technical actions and resource-building. The role of the health ministry is to listen to the various stakeholders and to make proposals that blend their different views with the evidence derived from national and international experience. An active compromise of the majority of the key stakeholders may be required in order to develop and implement a mental health policy. It is very important to obtain political support. Step 4. Exchange with other countries Sharing experiences with other countries may help a country to learn about both the latest advances in more developed countries and about creative experiences and lower-cost 3 interventions in less developed countries. International experts may also be helpful in this connection. Step 5. Set out the vision, values, principles and objectives When information has been gathered from a variety of sources through steps 1 to 4 the substance of the policy can now be set out by describing the vision, values, principles and objectives for mental health. a) Vision: The vision usually sets high expectations for mental health, describing what is desirable for a country or region. However, it should be realistic, covering what is possible in accordance with the available resources and technology. b) Values and principles: Different countries and regions have their own values associated with mental health and mental disorders. During the process of formulating mental health policy it is necessary to discuss which values and guiding principles should be adopted. c) Mental health objectives: The three overall objectives of any health policy (WHO, 2000a) are applicable to mental health policy. 1. Improving the health of the population. The policy should clearly indicate the objectives for improving the mental health of the population. Ideally, mental health outcome indicators should be used, such as quality of life, mental functioning, disability, morbidity and mortality. If this is not possible, process indicators can also be used, such as access and service utilization. 2. Responding to people’s expectations. In mental health this objective includes respect for persons and a client-focused orientation. 3. Providing financial protection against the cost of ill-health. Among the issues of relevance to mental health are: equity in resource distribution between geographical regions; availability of basic psychotropic drugs; parity of mental health services with those of general health; allocation of an appropriate percentage of the total health budget to mental health. Step 6. Determine areas for action The next step is to … SOCW 6351: Social Policy, Welfare, and Change Week 6 Top of Form Discussion 1: Mental Health Care/Managed Care Mental health care is a primary concern to social workers, who are the main providers of care to populations with mental health diagnoses. The system that provides services to individuals with mental health issues is often criticized for being reactive and only responding when individuals are in crisis. Crisis response is not designed to provide on-going care and is frequently very expensive, especially if hospitalization is involved.  Critics suggest a comprehensive plan, which involves preventive services, as well as a continuum of care. However, there are few, if any, effective and efficient program models. Social work expertise and input are vital to implementing effective services. Targeting services to individuals with a diagnosis of mental illness is one strategy. Another approach includes providing an array of services that are also preventative in nature. How might these suggestions address potential policy gaps in caring for individuals such as the family members in the Parker Family case? For this Discussion, review this week’s resources, including the Parker Family video. Then consider the specific challenges or gaps in caring for individuals with a chronic mental illness might present for the mental health system based on the Parker case. Finally, think about how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging. Post by 10/05/21 an explanation of the specific challenges or gaps in the mental health care system for the care of individuals with chronic mental illnesses. Base your response on the Parker case. Then, describe how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging. Support your post with specific references to the resources. Be sure to provide full APA citations for your references. Top of Form Discussion 2: Emerging Issues in Mental Health Care Like so many areas of practice in social work, mental health is dynamic and ever-evolving. Research continues to provide new information about how the brain functions, the role of genetics in mental health, and evidence to support new possibilities for treatment. Keeping up with these developments might seem impossible. However, being aware of and responsive to these developments and incorporating them into both your practice and social policy is essential to changing the lives of individuals and families who live with a mental health diagnosis and the impact it brings to their daily lives. For this Discussion, review this week’s resources. Search the Walden Library and other reputable online sources for emerging issues in the mental health care arena. Think about the issues that are being addressed by social policy and those that are in need of policy advocacy and why that might be the case. Then, consider what social workers can do to ensure that clients/populations receive necessary mental health services. Also, think about the ethical responsibility related to mental health care social workers must uphold in host settings when they encounter conflicts in administration and home values. Finally, search your state government sites for the mental health commitment standards in your state and reflect on the mental health services covered under your state’s Medicaid program. By 10/05/2021 , post an explanation of those emerging issues in the mental health care arena that the policymakers address and those that are in need of policy advocacy and why. Then, explain what strategies social workers might use to ensure that clients/populations receive necessary mental health services. Finally, explain the mental health commitment standards and mental health services in your state (Florida). In your explanation, refer to the services covered under your state’s Medicaid program. Bottom of Form Learning Resources Required Readings Popple, P. R., & Leighninger, L. (2019). The policy-based profession: An introduction to social welfare policy analysis for social workers (7th ed.). Upper Saddle River, NJ: Pearson Education. · Chapter 8, “Mental Health and Substance Abuse (pp. 161-191) Conclusion for Chapter 8, “Mental Health and Substance Abuse (pp. 161-191) Mental illness and substance abuse have been individual and social problems since the founding of the country. And debates over the degree of individual and social responsibility for them have continued for at least that long. The policy pendulum has swung back and forth as we weigh individual freedom versus collective obligation. The issues are complex, and morality as well as practicality are involved. Of the many substances that are abused, some are legal and some or not. Should we decriminalize some and/or make others harder to obtain? Should everyone be subjected to drug tests? Should people with a mental illness who might harm others be denied privacy and confidentiality? Should parents be allowed to refuse to vaccinate their children if this results in the deaths of others? Are our communities safer with more guns or fewer guns? Should cyberspace be more carefully regulated? How do we reintegrate our veterans into peacetime society? What roles can social workers play in all this? The use and abuse of illegal substances are not just problems for specific groups in American society, as we used to think. We find these problems in all socioeconomic, racial, and religious groups. Different drugs are adopted and discarded by various groups at various times, in various places. The extent to which use is considered a problem and the extent to which abuse is prosecuted seems to depend a lot on who the users are. And in the pharmacological revolution, this issue can only get more complicated. World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader]. · Part 1, "The Parker Family" (pp. 6–8) Mental Health America. (n.d.). Retrieved from https://mhanational.org/ Required Media Laureate Education (Producer). (2013). Sessions: Parker family (Episode 5 of 42) [Video file]. Retrieved from https://class.waldenu.edu Responsiveness to Directions 27 (27%) - 30 (30%) Discussion posting fully addresses all instruction prompts, including responding to the required number of peer posts. Discussion Posting Content 27 (27%) - 30 (30%) Discussion posting demonstrates an excellent understanding of all of the concepts and key points presented in the text(s) and Learning Resources. Posting provides significant detail including multiple relevant examples, evidence from the readings and other scholarly sources, and discerning ideas. Peer Feedback and Interaction 22.5 (22.5%) - 25 (25%) The feedback postings and responses to questions are excellent and fully contribute to the quality of interaction by offering constructive critique, suggestions, in-depth questions, additional resources, and stimulating thoughts and/or probes. Writing. 13.5 (13.5%) - 15 (15%) Postings are well organized, use scholarly tone, contain original writing and proper paraphrasing, follow APA style, contain very few or no writing and/or spelling errors, and are fully consistent with graduate level writing style. WAL_SOCW6351_06_A_EN-CC.mp4