Historical Development of Mental Health Services in the US: A Timeline, Slides of Management Fundamentals

Download Historical Development of Mental Health Services in the US: A Timeline and more Slides Management Fundamentals in PDF only on Docsity! MACMHB Governance and Leadership Development Program Public Policy Docsity.com Learning Objectives • Understand “policy” levels • Understand the history of mental health policy and/or answer the question, “How did we get to where we are today?” • Understand the role of the CMH Board in local policy setting • Understand the interplay between how we view consumers, funding and policy setting Docsity.com Consumer Perspective Federal State Local 1950’s Mental Illness viewed as moral problem - Stigma Community Orientation Begins Research subjects No civil rights Isolated from the community 1960’s Consumer as patient and we do for the consumer Deinstitutionalization with very few services in the community Lack of needed services Poor planning upon release Child Guidance Clinics Develop Psychoanalytic treatment 1970’s Civil Liberty Movement Long-term stays in the state hospital Recipient Rights System Inter-dependence between system and patient Recipient Rights Services Civil Rights in commitment proceedings Earlier intervention/less secondary disability 1980’s Emphasis on SPMI Loss of federal SSI benefits NAMI begins/advocacy role Case Management Emerges Community Support Program State NAMI chapters evolve ACT develops in Wisconsin and Michigan Reduced service criteria to SPMI in some places Increased homelessness due to lack of benefits Local NAMI develops 1990’s Emphasis on prevention Acceptance as a “disease” Person Centered Planning Self Determination Involved in Governance Expanded rights and grievance and appeals Stigma busting activities Full integration into communities 2000’s Recovery Focus Integration of mind of body Choose in provider and services Consumer/family centered Participation on MH Commission Recovery Council Consumer involvement at all levels Self-directed lives Peer Supports Docsity.com Services Available Federal State Local 1950’s Community based care model Psychotropic medication State Facilities Psychotropic medication Independent, private psychiatrists 1960’s Required five then twelve services to be provided in states and local communities Inpatient Care Preadmission and post discharge services Outpatient Services ,Emergency Care, Partial Hospitalization Education and Consultation Child/Adolescent Services Elderly services, Alcohol and Drug 1970’s Active policy direction setting, staffing help, assistance to local settings Large State Hospital Settings State-run Residential Settings Hospital Staff in the Community Better medications Behavior Management Techniques 1980’s Primarily research and demonstrations State Facility Size Reductions State staff moving to local CMH’s Reduction in state funding Movement to restrict services to SPMI/most severely disabled AIS Home Development Psychosocial rehab options 1990’s Emphasis on brain research rather than service research SAMHSA emerges Reduction in State Hospital Usage Community Hospital Expansion Clubhouse/Drop In Center Supported Community Living Programs to services 2000’s Individualized plan of care Screening, Assessment, Referral School based services Co-occurring services Screening in primary care Reduced number of state hospital beds Compliance monitoring Consumer Run Services Micro-enterprises for consumers Docsity.com Funding Mechanisms Federal State Local 1950’s Recommended five fold increase in funding for community care State funds state hospitals Virtually no local or private funding for mental health and substance abuse 1960’s Large amounts of federal funding State funding for hospitals Federal funding to develop CMHC Federal dollars in a grant format that bypasses states and goes directly to local 1970’s Federal anxiety about costs as health care costs increasing Grant Based Funding with Global budgets Full Management Boards Private insurance stats paying 1980’s Increased emphasis on Medicaid, SSI, SSDI Reagan - block grants to states Federal funding for case management in Medicaid Medicare - Mental Health Block grants Emergence of Fee for Service to expand Medicaid Medicaid Expansion State Facility Trade Offs Full Management Boards Fee for service billing Continued expansion of services to Medicaid population State tradeoffs deinstitutionalization 1990’s Federal push back on the cost of federal participation in state Medicaid programs Creation of Waiver options Medicaid Waivers •Hab Support Waiver •Child Waiver •Combined B&C Waiver Medicaid Cost Containment and Managed Care -1998 Capitated Payments Fundamental shift from fee for service to capitation Entitlements/risk shift to local Continue loss of state general fund 2000’s Balanced Budget Act New Freedom Commission Institute of Medicine Report on Mental Health/Substance Use Regional Health Information Systems Mental Health Commission Report Recovery Emphasis Evidence Based Practice Electronic Medical Records Full consumer integration in planning and providing care Primary Care Integration Strategies EBP Implementation locally Docsity.com The 1960’s Federal Level State Level Local Level Consumer Perspective Consumer as patient and we do for the consumer Deinstitutionalization with very few services in the community Lack of needed services Poor planning upon release Child Guidance Clinics Develop Psychoanalytic treatment Services Available Required five then twelve services to be provided in states and local communities Inpatient Care Preadmission and post discharge services Outpatient Services Emergency Care Partial Hospitalization Education and Consultation Child/Adolescent Services Elderly services Alcohol and Drug Funding Mechanisms Large amounts of federal funding State funding for hospitals Federal funding to develop CMHC Federal dollars in a grant format that bypasses states and goes directly to local Governance/ Policy Setting Mental Health Action Report -61 CMHC Act of 1963 State Plans for Mental Health Services Implementation of community services Docsity.com The 1970’s Federal Level State Level Local Level Consumer Perspective Civil Liberty Movement Long-term stays in the state hospital Recipient Rights System Inter-dependence between system and patient Recipient Rights Services Civil Rights in commitment proceedings Earlier intervention/less secondary disability Services Available Active policy direction setting, staffing help, assistance to local settings Large State Hospital Settings State-run Residential Settings State Hospital Staff in the Community Better medications Behavior Management Techniques Funding Mechanisms Federal anxiety about costs as health care costs increasing rapidly Grant Based Funding with Global budgets Full Management Boards Private insurance stats paying for mental health/sub abuse treatment Governance/ Policy Setting Expanded AOD attention, taking dollars from Mental Health Federal ADAMHA President’s Commission on Mental Health – Carter 1977 – endorsed everything – no clear plan of action Mental Health Code - 1974 Expanding CMHC’s in the state in numbers, services and customers Docsity.com The 1980’s Federal Level State Level Local Level Consumer Perspective Emphasis on seriously and persistently mentally ill Loss of federal SSI benefits NAMI begins and takes up advocacy role Case Management Emerges Community Support Program State NAMI chapters evolve ACT develops in Wisconsin and Michigan Reduced service criteria to SPMI in some places Increased homelessness due to lack of benefits Local NAMI develops Services Available Primarily research and demonstrations State Facility Size Reductions State Community staff moving to local CMH’s Reduction in available state funding Movement to restrict services to SPMI and most severely disabled AIS Home Development Psychosocial rehab options Funding Mechanisms Increased emphasis on Medicaid, SSI, SSDI Reagan eliminates federal role in funding and block grants to states emerge Federal funding for case management in Medicaid Medicare expands to cover Mental Health Block grants Emergence of Fee for Service to expand Medicaid Medicaid Expansion •Pros •Cons State Facility Trade Offs Full Management Boards Increased finance staff for fee for service billing Continued expansion of services to Medicaid population State tradeoffs fund deinstitutionalization Governance/ Policy Setting Mental Health Systems Act (from Carter Commission) 1980 Federal Leadership role diminishes State leadership role expands in policy setting, funding and direction of local CMHC’s Larger Budgets for Boards to manage More local risks emerge Different rates of movement to new funding mechanisms Docsity.com Summary of Trends • Cyclical Nature of policy • The overall CMH system lags behind in implementing federal policy • The Michigan system leads in creating policy • Devolution of policy, planning and funding • Increasing recognition of the role of consumer in their own treatment • Use (or lack of use) of research within the system below federal level • Lack of focus in commissions leads to lack of leadership, strategies and effective implementation • Implication of loss of federal direction and planning as compared to FQHC’s Docsity.com The Future • What does it mean that Board’s set policy? • How do you go about doing that locally? • Where do you see for the future of – The system – Your CMH • How can we influence that direction as individual boards, an association and as consumers? Docsity.com