1 / 45

A History of Behavioral Health Policy in America

A History of Behavioral Health Policy in America. “Policy” Webster's Dictionary 1966. “Prudence or wisdom in the management of public affairs”

ryann
Download Presentation

A History of Behavioral Health Policy in America

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. A History ofBehavioral Health Policy in America

  2. “Policy” Webster's Dictionary 1966 • “Prudence or wisdom in the management of public affairs” • “A definite course or method of action and selected from among alternatives and in the light of given conditions to guide and determine present and future decisions”

  3. “Policy” Thomas Fuller 1608-1661 “Policy consists in serving God in such a manner as not to offend the devil”

  4. Policy According to Broadway • “Money makes the world go round.”Song Line from musical Cabaret • “I'm just a girl who cain't say no,I'm in a terrible fix” Song Line from musical Oklahoma

  5. 1700’s Family’s, Poor Houses, Jails

  6. 1840’s First wave of Public Hospital Development

  7. 1880’s Second Wave of State Hospital Development Shifts Cost and Responsibility to State Level

  8. 1920 & 1930’s Departure of Syphilitics Departure of Epileptics

  9. Post World War II MI Begin to Depart to Community

  10. 1950’s Arrival of Effective Antipsychotics and Antidepressants State Hospitals Develop Outpatient Medication Clinics Arrival of Child Guidance Movement

  11. 1960’s Medicaid/Medicare Shift Many Costs to Fed Persons with Dementia (and many MI) Depart to Nursing Homes Growth of General and Private Acute Inpatient Growth of Outpatient CMHC Movement and Federal Grants

  12. 1970’s IMD Exclusion Exemptions - ICF MR created and MR/DD population Departs - Persons under 21 y.o. Commitment Limited to Dangerousness Harsher Drug Laws Increase number of MI in Jail and Prisons First Presidential Report on Mental Health

  13. 1980’s IMD Exclusion Exemption for facilities of less than 16 beds Fed Block Grants CMHC Funds to States States Retarget CMHC’s to SMI TEFRA Stimulates Private Sector Inpatient Growth States Take Advantage of DSH to Shift Costs to Fed

  14. 1990’s Medicaid Waivers Allow States to Increase Federal Share of Funding Behavioral Managed Care Causes Loss of Private Sector Inpatient

  15. 2000 Second Presidential Commission on Mental Health

  16. 2000 Up to 2008 • Bed capacity fairly stable • Stigma much reduced • Increased Medication Usage • Increased MH prescribing by PCPs • Emergence of EBP • Integration of BH and Medical Care

  17. Overall Treatments get continually better Financing and Administration has become ridiculously complex Community Focus and Locus Increases

  18. “Better But Not Well”Richard Frank, PhD • Improvements in Care to MI due to: • Disabled income and housing supports • Newer medications easier to prescribe correctly • Many more persons with SMI treated by PCPs with medication

  19. 2008 through 2010Suddenly A New Environment • 2008 - MH and SA Parity Act • 2009 – Economic Crisis • 2009 – HIT Act • 2010 – Health Care Reform

  20. Public Sector Mission To Care for Persons whose behavior is so dangerous or socially unacceptable that their communities cannot tolerate their presence and no other entity can or will work with

  21. Public Sector Goals • Treatment and Recovery • Public Safety

  22. Public Sector Admission Criteria The facility or program is the least inappropriate currently available.

  23. Missouri DMH • Serves - 36% of persons in Missouri with SMI 5% of persons with a non-SMI psychiatric need • Try to serve as many as possible with limited resources • Breadth vs. Depth

  24. Everyone’s Choices • Give the best to a few • Give minimally adequate to many • Give something to everyone

  25. Politically Viable Choices Winners: Medication Access, Kid Services Losers: Provider Rate Increases, Rehab Programs, Psychotherapy, Dental Services

  26. Our Choices MaximizeMinimize Case Management Therapy/Counseling Medication Services Inpatient Medicaid Uninsured Ambivalent Housing Employment Crisis

  27. Mo National Per Capita Rank 2007 – Psych Bed Resources • All Inpatient 20th • State Hospital 14th • Forensic Beds 8th • Residential Services 31st

  28. DMH Beds by Category Type 2007 2010 Percent Acute adult 279 86 7.1 % Acute child 48 28 2.3% Intermediate 25 62 5.1% MIDD 20 20 1.6% LTC (88% forensic) 918 893 73.4% SVP 133128 10.5% Totals 1423 1217 -14.5%

  29. States with No DMH Adult Acute Beds Arizona Pennsylvania Florida Oregon Hawaii Maryland Indiana Michigan District of Columbia

More Related