02 Sep SOCW 6351 Wk6 Discussion 1
The mental health care system can be complex and convoluted, which presents challenges to both patients and social workers trying to help clients. One of the issues facing the system is the separation of care for those with mental health problems and substance abuse issues (Budhwani & De, 2019). These two issues are highly concurrent in the population, which means that often people seeking help for anxiety, depression, and schizophrenia (among others) will need treatment for substance abuse issues (Mechanic, 2014). Providers, on the other hand, do not always provide care for both in a complete protocol, but may send someone for substance abuse help without treating the underlying cause. Another issue is that many people cannot afford mental health care. There is reduced coverage for mental health care in the Untied States and those who do not have full insurance (or any insurance) are often the hardest hit by this lack of coverage (Mechanic, 2014).
In addition to this, environmental stressors often make the issue worse. Not having health insurance that covers mental health care is a major challenge, but often the poverty or stress that is associated with this lack of coverage can exacerbate mental health issues. For example, someone who lives in poverty is more likely to experience stress, which can worsen symptoms. Those living in poverty may also have to change appointments because of shift work, or a lack of available childcare to attend therapy sessions. Those living in poverty may also have a sense of shame about their living conditions, and the stigma of both poverty and mental illness combined can be a barrier to many seeking help. In addition, many of those who are living in poverty are in shift or unstable work, which means that there is an additional stress coming from the lack of security in their lives, which again needs to be addressed by provision of full mental health coverage.
References
Budhwani, H., & De, P. (2019). Perceived Stigma in Health Care Settings and the Physical and Mental Health of People of Color in the United States. Health Equity, 3(1), 73-80. doi: 10.1089/heq.2018.0079
Mechanic, D. (2014). More People Than Ever Before Are Receiving Behavioral Health Care In The United States, But Gaps And Challenges Remain. Health Affairs, 33(8), 1416-1424. doi: 10.1377/hlthaff.2014.0504
Colleague 2 – David
Mental illness is an ongoing struggle and maintaining good mental health treatment is vital to an individual’s success. One significant gap that I see all the time in my program, and that is experienced in the Parker case, is the lack of continuation of care during and following a hospital discharge. Individuals with severe and persistent mental illnesses, such as bipolar, will be hospitalized where they take their medication regularly, have constant structure and routine, meet with the treatment team frequently, and receive consistent care. Once they are more stabilized, they are often just sent back to the same situation where they came from, and expected to maintain their own stability. They are supposed to take their own medication regularly, pay attention to their nutrition and hygiene, as well as get themselves to and from appointments that they are expected to remember on their own. Now, for some individuals they are able to manage all of these things, however, they are typically not the ones who get hospitalized regularly or semi-regularly.
In the Parker case, both Sara and Stephanie have been through periods of time when they needed hospital level of care, when they stepped down, they went directly back into their previous living conditions, without additional supports. As is often the case, we need to look at funding when discussing the lapses in continued care, as well as the level of need for the services being provided. Regarding hospitalization, we can’t just ignore the fact that Stephanie has been hospitalized four times, “the rehospitalization rate among persons with severe mental illness is quite high, and treatments for mental difficulties may take longer than those for other health problems” (Popple & Leighninger, 2019, pg. 163). Unfortunately, each day and night spent at the hospital is extremely expensive, and the funding for mental health services is limited, so the goal is stabilization and discharge. However, this tactic does not set clients up for success, in fact it almost guarantees a relapse, and possible rehospitalization.
Environmental stressors have a significant impact on mental health and factors such as poverty, clutter, poor hygiene, unclean living environments, etc. can actually exacerbate the issues. Continued care, sometimes including in-home/community-based services, are not only beneficial, but in certain cases necessary for an individuals continued success following hospital discharge.
References
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