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Bhalla IP, Siegel K, Chaudhry M, Li N, Torbati S, Nuckols T, Danovitch I. Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making. Psychiatr Q 2022; 93:297-310. [PMID: 34536188 DOI: 10.1007/s11126-021-09939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
Emergency department (ED) psychiatrists face the consequential decision to pursue involuntary inpatient psychiatric admission. Research on the relationship between patient characteristics and the decision to pursue involuntary psychiatric admission is limited. Using data from 2017 to 2018 at an urban Los Angeles hospital, we used generalized linear mixed effects models to compare patients who were involuntarily admitted to inpatient psychiatry to patients who were discharged from the ED. Of 2,448 patients included in the study, 1,217 (49.7%) were involuntarily admitted to inpatient psychiatry and 1,231 (50.3%) were discharged. After controlling for sociodemographic characteristics, admitted patients were more likely to have been brought in by police, have had an organized suicide plan or recent attempt, physical signs of harm, psychosis, depression or hopelessness, lack social support, have diagnoses of schizophrenia or bipolar disorder, and be administered injectable psychotropic medications. Stimulant use, a diagnosis of anxiety or developmental disorders, and recent medical ED utilization were associated with discharge. Psychiatrists pursued involuntarily psychiatric hospitalization based on factors potentially indicative of dangerousness, leaving patients, particularly those with recent substance use, without immediate access to treatment. Policies should focus on increasing follow up to high quality, voluntary outpatient mental health care.
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Affiliation(s)
- Ish P Bhalla
- National Clinician Scholars Program At UCLA Funded By Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA.
| | - Keith Siegel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ning Li
- David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA
| | - Sam Torbati
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Segal SP. Hospital Utilization Outcomes Following Assignment to Outpatient Commitment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:942-961. [PMID: 33534072 PMCID: PMC8329100 DOI: 10.1007/s10488-021-01112-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
Outpatient civil commitment (OCC) requires people with severe mental illness (SMI) to receive needed-treatment addressing imminent-threats to health and safety. When available, such treatment is required to be provided in the community as a less restrictive alternative (LRA) to psychiatric-hospitalization. Variance in hospital-utilization outcomes following OCC-assignment has been interpreted as OCC-failure. This review seeks to specify factors accounting for this outcome-variation and to determine whether OCC is used effectively. Twenty-five studies, sited in seven meta-analyses and subsequently published investigations, assessing post-OCC-assignment hospital utilization outcomes were reviewed. Studies were grouped by structural pre-determinants of hospital-utilization and OCC-implementation-i.e. deinstitutionalization (bed-availability), availability of a less restrictive alternative to hospitalization, and illness severity. Design quality at study completion was ranked on causal-certainty. In OCC-follow-up-studies, deinstitutionalization associated hospital-bed-cuts, when not taken into account, ensured lower hospital-bed-day utilization. OCC-assignment coupled with aggressive case-management was associated with reduced-hospitalization. With limited community-service, hospitalizations increased as the default option for providing needed-treatment. Follow-up studies showed less hospitalization while on OCC-assignment and more outside of it. Studies using fixed-follow-up periods usually found increased-utilization as patients spent less time under OCC-supervision than outside it. Comparison-group-studies reporting no between-group differences bring more severely ill OCC-patients to equivalent use as less disturbed patients, a success. Mean evidence-rank for causal-certainty 2.96, range 2-4, of 5 with no study ranked 1, the highest rank. Diverse mental health systems yield diverse OCC hospital-utilization outcomes, each fulfilling the law's legal mandate to provide needed-treatment protecting health and safety.
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Affiliation(s)
- Steven P Segal
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- School of Social Welfare, University of California, Berkeley, 120 Haviland Hall (MC #7400), Berkeley, CA, 94720-7400, USA.
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. Geographic variations in involuntary care and associations with the supply of health and social care: results from a nationwide study. BMC Health Serv Res 2018; 18:253. [PMID: 29625567 PMCID: PMC5889610 DOI: 10.1186/s12913-018-3064-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 03/27/2018] [Indexed: 11/17/2022] Open
Abstract
Background Involuntary psychiatric care remains controversial. Geographic disparities in its use can challenge the appropriateness of the care provided when they do not result from different health needs of the population. These disparities should be reduced through dedicated health policies. However, their association with the supply of health and social care, which could be targeted by such policies, has been insufficiently studied. Our objectives were therefore to describe geographic variations in involuntary admission rates across France and to identify the characteristics of the supply of care which were associated with these variations. Methods Involuntary admission rate per 100,000 adult inhabitants was calculated in French psychiatric sectors’ catchment areas using 2012 data from the national psychiatric discharge database. Its variations were first described numerically and graphically. Several factors potentially associated with these variations were then considered in a negative binomial regression with an offset term accounting for the size of catchment areas. They included characteristics of the supply of care (public and private care, health and social care, hospital and community-based care, specialised and non-specialised care) as well as adjustment factors related to epidemiological characteristics of the population of each sector’s catchment area and its level of urbanization. Such variables were extracted from complementary administrative databases. Supply characteristics associated with geographic variations were identified using a significance level of 0.05. Results Significant variations in involuntary admission rates were observed between psychiatric sectors’ catchment areas with a coefficient of variation close to 80%. These variations were associated with some characteristics of the supply of health and social care in the sectors’ catchment areas. Notably, an increase in the availability of community-based private psychiatrists and the capacity of housing institutions for disabled individuals was associated with a decrease in involuntary admission rates while an increase in the availability of general practitioners was associated with an increase in those rates. Conclusions There is evidence of considerable variations in involuntary admission rates between psychiatric sectors’ catchment areas. Our results provide lines of thoughts to reduce such variations, in particular by supporting an increase in the availability of upstream and downstream care in the community. Electronic supplementary material The online version of this article (10.1186/s12913-018-3064-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France. .,AP-HP, URC Eco, Paris, France.
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, 4603, Paris, EA, France
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,World Health Organization Collaborating Centre for Research and Training in Mental Health, Lille, France
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France.,AP-HP, URC Eco, Paris, France
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Lebenbaum M, Chiu M, Vigod S, Kurdyak P. Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study. BJPsych Open 2018; 4:31-38. [PMID: 29467057 PMCID: PMC6020272 DOI: 10.1192/bjo.2017.4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admissions to psychiatric hospitals are common; however, research examining the trends in prevalence over time and predictors is limited. Aims To examine trends in prevalence and risk factors for involuntary admissions in Ontario, Canada. METHOD We conducted an analysis of all mental health bed admissions from 2009 to 2013 and assessed the association between patient sociodemographics, service utilisation, pathway to care and severity characteristics for involuntary admissions using a modified Poisson regression. RESULTS We found a high and increasing prevalence of involuntary admissions (70.7% in 2009, 77.1% in 2013, 74.1% overall). Individuals with police contact in the prior week (risk ratio (RR) = 1.20) and immigrants both experienced greater likelihood of being involuntarily admitted, regardless of control for other characteristics (RR = 1.07) (both P < 0.0001). CONCLUSIONS We identified numerous modifiable and non-modifiable risk factors for involuntary admissions. The prevalence of involuntary admissions was high, linearly increasing over time. Declaration of interest The authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This study was conducted using funding entirely from public sources. P.K. has received operational support via an Ontario Ministry of Health and Long-Term Care (MOHLTC) Health Services Research Fund Capacity Award to support this project. The Institute for Clinical Evaluative Sciences (ICES) is funded by the Ontario MOHLTC. The study results and conclusions are those of the authors, and should not be attributed to any of the funding agencies or sponsoring agencies. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. All decisions regarding study design, publication, and data analysis were made independent of the funding agencies.
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Affiliation(s)
- Michael Lebenbaum
- Epidemiologist, Mental Health and Addictions Program,ICES, and PhD student,IHPME,University of Toronto,G-106, 2075 Bayview Avenue,Toronto, ON M4N 3M5
| | - Maria Chiu
- Staff Scientist,Mental Health and Addictions Program,ICES,G-106, 2075 Bayview Avenue,Toronto, ON M4N 3M5
| | - Simone Vigod
- Scientist,Women's College Research Institute,Assistant Professor,IHPME,University of Toronto
| | - Paul Kurdyak
- Director of Health Outcomes and Performance Evaluation (HOPE),CAMH,250 College Street,Toronto, ON M5T 1R8,Program Lead,Mental Health & Addictions Research Program,ICES,Associate Professor,IHPME,University of Toronto
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Hashmi A, Shad M, Rhoades HM, Parsaik AK. Involuntary detention: do psychiatrists clinically justify continuing involuntary hospitalization? Psychiatr Q 2014; 85:285-93. [PMID: 24570222 DOI: 10.1007/s11126-014-9289-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To elucidate disparities in clinical and legal documentation for patients admitted involuntarily to a county psychiatric hospital in Texas. The study sample comprised of 89 randomly selected patients, involuntarily hospitalized to our facility in September 2011. All patients met criteria for involuntary detention based on the legal documents filed by admitting psychiatrists. Electronic medical records were reviewed to assess if the clinical documentation from the same date when legal documents were filed; demonstrated criteria for involuntary detention (harm to self, harm to others, inability to care for self). A logistic regression model was used to assess the predictors of concordance between legal and clinical documentation of involuntary detention criteria. Of 89, 6 patients were made voluntary, while two were discharged within 24 h, thus removed from the analysis pool. Of 81, 31(38.2 %) patients lacked sufficient clinical documentation on medical records required for involuntary hospitalization. Patients, for whom detention was justified in clinical notes, were more likely to have single marital status, longer duration of hospitalization and they were more likely to undergo commitment for further inpatient mental health treatment. Our study found that involuntary detention of many patients based on the legal documents filed by admitting psychiatrists was not justified by the clinical documentation. This indicates that appropriate standards are not maintained when completing the medical certificates for involuntary detention. Maintaining appropriate standards may reduce the need for involuntary hospitalization, increase patient autonomy, and reduce resource utilization.
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Affiliation(s)
- Aqeel Hashmi
- Department of Psychiatry and Behavioral Sciences, Harris County Psychiatric Center, University of Texas Health Science Center, 2800 South Macgregor Way, Houston, TX, 77021, USA,
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Civil commitment law, mental health services, and US homicide rates. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1449-58. [PMID: 22072224 PMCID: PMC7336875 DOI: 10.1007/s00127-011-0450-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 10/27/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE The study considers whether involuntary civil comment (ICC) statute provisions are associated with homicide rates. Do statutes based solely upon dangerousness criteria versus broader ICC-criteria-i.e. "need for treatment," "protection of health and safety," and family protection-have differential associations related to their goal of reducing the frequency of homicide? METHOD State-level data were obtained from online data bases and key-informant surveys. Ordinary-least-squares and Poisson regression were used to evaluate the association between statute characteristics, mental health system characteristics, and 2004 Homicide Rates after controlling for firearm-control-law restrictiveness and social-economic-demographic-geographic-and-political indicators historically related to homicide rate variation. RESULTS Poisson and OLS models, respectively, were significant: likelihood ratio χ(2) = 108.47, df = 10; p < 0.000 and Adj. R (2) = 0.72; df = 10, 25; F = 10.21; p < 0.000. Poisson results indicate that social-economic-demographic-geographic-and-political-indicators had the strongest association with state homicide rates (p < 0.000). Lower rates were associated with: broader ICC-criteria (p ≤ 0.01), fewer inpatient-bed access problems (p ≤ 0.03), and better mental health system ratings (p ≤ 0.04). OLS results indicate that social-economic-demographic-geographic-and-political indicators accounted for 25% of homicide rate variation. Broader ICC-criteria were associated with 1.42 less homicides per 100,000. Less access to psychiatric inpatient-beds and more poorly rated mental health systems were associated with increases in the homicide rates of 1.08 and 0.26 per 100,000, respectively. CONCLUSIONS While social-economic-demographic-geographic-and-political indicators show the strongest association with homicide rate variation, the results show the importance and potentially preventive utility of broader ICC criteria, increased psychiatric inpatient-bed access, and better performing mental health systems as factors contributing to homicide rate variation.
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Lindsey MA, Joe S, Muroff J, Ford BE. Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth. Gen Hosp Psychiatry 2010; 32:300-9. [PMID: 20430234 PMCID: PMC2862230 DOI: 10.1016/j.genhosppsych.2010.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 12/30/2009] [Accepted: 01/05/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined the social and clinical factors associated with arrival status (e.g., involuntary versus voluntary) and civil commitment decisions in psychiatric emergency services (PES) to assess African-American youths' help-seeking patterns and entrée into care. METHODS Patient records were reviewed for 1621 African-American youth from an inner-city PES between October 2001 and September 2002. Multivariate logistic regression was used to examine the social and clinical factors associated with arrival status (e.g., involuntary vs. voluntary admission) and case disposition among youth who were involuntarily and voluntarily admitted (e.g., disposition upheld vs. dismissed). RESULTS Low-income youth with behavior disorders were less likely to arrive voluntarily to PES. Medical insurance, suicidality, DSM diagnosis, substance involvement, Global Assessment of Function (GAF) scores and time of day the youth arrived to PES were predictors of voluntary arrival. Older age and GAF scores significantly predicted the decision to uphold an involuntary commitment. Age (younger age less likely), higher GAF scores, insurance status, substance abuse involvement and arrival time (evening shift) significantly predicted the decision to uphold a voluntary decision. IMPLICATIONS Our findings suggest that psychiatric and nonpsychiatric factors influence both how African-American youth arrive to PES and the decisions made regarding their voluntary/involuntary commitment.
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Affiliation(s)
- Michael A. Lindsey
- School of Social Work, University of Maryland, Baltimore, Maryland,Correspondence concerning this article should be addressed to Michael Lindsey, School of Social Work, University of Maryland, address, Baltimore, Maryland, email, Tele: 410-706-8781, Fax: 410-706-6046
| | - Sean Joe
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | - Jordana Muroff
- School of Social Work,Boston University, Boston, Massachussetts
| | - Briggett E. Ford
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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9
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Høyer G. Involuntary hospitalization in contemporary mental health care. Some (still) unanswered questions. J Ment Health 2009. [DOI: 10.1080/09638230802156723] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lorant V, Depuydt C, Gillain B, Guillet A, Dubois V. Involuntary commitment in psychiatric care: what drives the decision? Soc Psychiatry Psychiatr Epidemiol 2007; 42:360-5. [PMID: 17396204 DOI: 10.1007/s00127-007-0175-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychiatric commitment laws have been reformed in many European countries. We assessed the relative importance of the different legal criteria in explaining involuntary commitment under the Belgian Mental Health Act of 1990. METHOD Psychiatric assessments were requested for 346 patients living in Brussels who were randomly selected from a larger group and were being considered for involuntary commitment. A retrospective study of these patients' files was carried out. RESULTS More than half of the requests for involuntary commitment were turned down. The lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment. Alternative forms of care were more likely to be unavailable for psychotic individuals, foreigners, and patients not living in a private household. CONCLUSION Involuntary commitment is mainly due to the inability of the mental health care system to provide more demanding patients with alternative forms of care.
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Affiliation(s)
- Vincent Lorant
- Public Health School, Faculty of Medicine, Université Catholique de Louvain, Louvain, Belgium
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Dressing H, Salize HJ. Compulsory admission of mentally ill patients in European Union Member States. Soc Psychiatry Psychiatr Epidemiol 2004; 39:797-803. [PMID: 15669660 DOI: 10.1007/s00127-004-0814-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS A standardised and systematic analysis of commitment laws in the European Union Member States is still missing. This study aimed at gathering, describing and analysing information on the differences or similarities of legal frameworks for involuntary placement and treatment of mentally ill patients across the European Union Member States. METHOD Information was gathered by means of a detailed questionnaire filled in by experts from all EU Member States. Legal criteria for compulsory admission and details of the assessment and decision process of compulsory admission are outlined. RESULTS Although common patterns among Member States can be identified upon comparison of crucial legislative or procedural details, these patterns are far from being consistent across all analysed items or approaches. With regard to compulsory admission quotas no significant influence of legal commitment criteria and the involvement of judicial authorities could be found, but Member States with an obligatory inclusion of a legal representative during the commitment procedure showed significantly lower compulsory admission quotas. CONCLUSION Results of this study show the strong necessity for further research in this field. Common international health reporting standards as annually updated involuntary placement rates detailed for regular and emergency cases seem to be essential.
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Affiliation(s)
- Harald Dressing
- Central Institute of Mental Health, 68159 Mannheim, Germany.
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Segal SP, Laurie TA, Franskoviak P. Ambivalence of PES patients toward hospitalization and factors in their disposition. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2004; 27:87-99. [PMID: 15019770 PMCID: PMC7337012 DOI: 10.1016/j.ijlp.2003.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Steven P Segal
- School of Social Welfare, University of California, 120 Haviland Hall (MC# 7400), Berkeley, CA 94720-7400, USA
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Segal SP, Riley S. Caring for Persons with Serious Mental Illness: Policy and Practice Suggestions. SOCIAL WORK IN MENTAL HEALTH 2003; 1:1-17. [PMID: 33564276 PMCID: PMC7869837 DOI: 10.1300/j200v01n03_01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.
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Affiliation(s)
- Steven P Segal
- Mental Health and Social Welfare Research Group, University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, Berkeley, CA 94720
| | - Sharon Riley
- Mental Health and Social Welfare Research Group, University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, Berkeley, CA 94720
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