Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets

Abstract

The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders’ experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders’ perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.

Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: A critical review

“…Several state systems across the U.S. have initiated formal “trauma initiatives” to address this service gap and improve care for patients with SMI and trauma-related difficulties (Cusack, Wells, Grubaugh, Hiers, & Frueh, 2007; Frueh et al, 2001). Unfortunately, severe cuts to state mental healthcare budgets have seen a dramatic rollback of therapeutic services for patients with SMI and it is likely that clinical services and resources for treating PTSD in most state systems has been dramatically reduced (Frueh, Grubaugh et al, manuscript under review). …”

“…Unfortunately, one current reality of public mental health care in the U.S. is that state mental health budgets have received dramatic cuts over the past few years due to a variety of factors, including the economic recession (Frueh et al, manuscript under review). Mental health services and infrastructure have been reduced across the continuum of care (e.g., inpatient, outpatient, residential, day-hospital, case management).…”

Governance and mental health: contributions for public policy approach

“…We referred to the social, communal, juridical and legal context. The studies with a perspective on the organization and the quality of the services 2 , 8 , 10 , 12 - 14 , 26 , 29 , 32 , 34 , 35 , 39 , 40 , 43 had an exclusively clinical approach ( Table 3 ).…”

“…Also, not all the providers agree on incorporating the users in the process of taking decisions. Providers argue that they have the legal responsibility and mention the lack of resources, infrastructure and the medical condition of the own patients as barriers for adopting the system 10 , 12 , 14 .…”

“…The strategies were not followed by a wholesome policy, such as providing services of mental attention in the communities. This fact created another problem: the raise in demanding of attention in the service of hospital emergencies and abandon of the treatment 14 . In the case of the American and Australian health systems, the strategies were followed by the participation of other social sectors in order to make sure the continuance of the treatments.…”