Mental Health Services Within the Criminal Justice System

1 January 2017

These days it seems that more and more people are being diagnosed with some form of mental disorder or disability. It’s important that those who provide mental health services be properly trained and certified so as to provide the best possible care and treatment for those who suffer from mental health disorders and disabilities. The history of mental health services is quite extensive. In 1773 the first hospital for the mentally ill in the US opened in Williamsburg, Virginia. In 1840 there were only eight “asylums for the insane” in the United States.

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Dorothea Dix crusaded for the establishment or enlargement of 32 mental hospitals, and transfer of those with mental illness from almshouses and jails. The first attempt to measure the extent of mental illness and mental retardation in the United States occurred with the U. S. Census of 1840, which included the category “insane and idiotic. ” The “mental hygiene” movement began in 1900. Clifford Beers, a mental health consumer shocked readers with a graphic account of hospital conditions in his famous book, The Mind That Found Itself.

Inspection of immigrants at Ellis Island included screening to detect the “mentally disturbed and retarded”. The high incidence of mental disorders among immigrants prompted public recognition of mental illness as a national health problem. In 1930, The US Public Health Service (PHS) established the Narcotics Division, later named the Division of Mental Hygiene, bringing together research and treatment programs to combat drug addiction and study of the causes, prevalence, and means of preventing and treating nervous and mental disease. During World War II, severe shortages of professional mental health personnel and the nderstanding of the causes, treatment, and prevention of mental illness lagged behind other fields of medical science and public health. Dr. William Menninger, chief of Army neuropsychiatry, called for federal action. A national mental health program was proposed, forming the foundation of the National Mental Health Act of 1946. On July 3, 1946, President Truman signed the National Mental Health Act, creating for the first time in US history a significant amount of funding for psychiatric education and research and leading to the creation in 1949 of the National Institute of Mental Health (NIMH).

Congress authorized the Mental Health Study Act of 1955 and called for “an objective, thorough, nationwide analysis and reevaluation of the humane and economic problems of mental health”. The act provided the basis for the historic study conducted by the Joint Commission on Mental Illness and Health, Action for Mental Health. In 1961 the Action for Mental Health was transmitted to Congress. It assessed mental health conditions and resources throughout the United States “to arrive at a national program that would approach adequacy in meeting the individual needs of the mentally ill people of America. Congress appropriated $12 million for research in 1956 the clinical and basic aspects of psychopharmacology and the Psychopharmacology Service Center was established. The number of consumers in mental hospitals began to decline reflecting the introduction of psychopharmacology in the treatment of mental illness. The Health Amendments Act authorized the support of community services for the mentally ill, such as halfway houses, daycare, and aftercare under Title V. The CMHC (Community Mental Health Center) Act Amendments of 1965, (P. L. 1-211), were enacted and included the following major provisions: Construction and staffing grants to centers were extended and facilities that served those with alcohol and substance abuse disorders were made eligible to receive these grants. Grants were provided to support the initiation and development of mental health services in poverty-stricken areas. A new program of grants was established to support further development of children’s services. By 1988, the concept of behavioral health managed care evolved from theory to practice.

Massachusetts was the first state that utilized a managed care platform regarding service of its behavioral healthcare needs. The state “carved out” mental health from physical healthcare and awarded the contract for management of the mental health benefits to a private company whose responsibilities included service authorization, utilization, quality management, a provider network, claims processing and interagency coordination. The managed care platform was based on efficiency and effectiveness, and sought to take advantage of emerging technologies.

However, capturing the cost savings proved to be a difficult task as managed care programs spread throughout different states. Population disparities in the rural and urban areas, unfulfilled technological promises, decreasing social service budgets in the states, and erosion in the areas of access and quality had a lasting effect on managed care systems. “Mental health services are designed to promote and maintain mental health, prevent mental illness, and treat and rehabilitate mentally ill persons. ” (Dolgoff & Feldstein, 2009, p. 69). Community mental health centers provide a variety of services. Such services include, but are not limited to, emergency services, diagnosis, treatment, referral, and community education and coordination. Mental health issues involve a wide array of behaviors ranging from severe mental impairments that would require hospitalization to mildly impairing behaviors. Another specific goal of mental health services involves promoting maximum mental health by support help in life transitions and difficult periods of stress.

In recent years there has been more focus on the interrelationship of biological and psychosocial factors as they relate to mental health. “Mental health facilities include both public (state and county) and private psychiatric hospitals in which patients are either voluntarily committed or involuntarily committed by court order or following certification by two physicians. Aftercare is often provided for discharged patients in a local community facility. ” (Dolgoff & Feldstein, 2009, p. 269). According to Patty Fleener, “The purpose of Mental Health Today is to help stop the pain caused by mental health disorders.

The hope is to provide the latest information about mental health disorders to mental health clinicians as well as consumers and families who are now beginning to demand better treatment. Communities have been created for emotional support, articles are written to assist in recovery, crisis intervention is provided by recovering mental health consumers, and resources are given. ” Financing for mental health services can get tricky and complicated. “Using monies from federal block grants, state mental health departments operate statewide networks of mental health services. ”(Dolgoff & Feldstein, 2009, p. 70). In addition, state departments of education also provide financing through special education programs. Complications arise however, when we get into private insurances and what they will and will not cover. “Despite research findings that behavior and mood illnesses such as severe depression and schizophrenia are disorders of brain circuitry, debate continues whether mental health conditions are physical or mental. ”(Dolgoff & Feldstein, 2009, p. 270). The reason this piece of information is so important is because insurance companies do not equally cover mental illness and physical illness.

Today, more and more insurance companies are restricting coverage for mental health services. This includes services that are normally provided by social workers. This was motivated by several concerns. Insurers feared that coverage of mental health services would result in high costs associated with long-term and intensive psychotherapy and extended hospital stays. They also were reluctant to pay for long-term, often custodial, hospital stays that were guaranteed by the public mental health system, the provider of “catastrophic care. These factors encouraged private insurers to limit coverage for mental health services. (U. S. Public Health Service). Federal public financing mechanisms, such as Medicare and Medicaid, also imposed limitations on coverage, particularly for long-term care, of “nervous and mental disease” to avoid a complete shift in financial responsibility from state and local governments to the Federal government. The purpose of mental health insurance is to protect the individual from catastrophic financial loss. A 1996 review of the evidence for the efficacy of well-documented treatments (Frank et al. 1996) suggested that covered services should include the following: * Hospital and other 24-hour services (e. g. , crisis residential services); * Intensive community services (e. g. , partial hospitalization); * Ambulatory or outpatient services (e. g. , focused forms of psychotherapy); * Medical management (e. g. , monitoring psychotropic medications); * Case management; * Intensive psychosocial rehabilitation services; and * Other intensive outreach approaches to the care of individuals with severe disorders.

Since resources to provide such services are finite, insurance plans are responsible for allocating resources to support treatment. Each type of insurance plan has a different model for matching treatment need with insurance support for receiving services. (U. S. Public Health Service). Health insurance, whether funded through private or public sources, is one of the most important factors influencing access to health and mental health services. Of the roughly 32 million uninsured Americans required by law to enroll in health insurance plans by 2014, about half-or 16 million-will sign up for Medicaid.

And of those new enrollees, one-third will have preexisting mental health or substance abuse conditions. Not surprisingly, state governments (which will implement the law) are desperate to cut costs. People with chronic psychiatric conditions, after all, are among the most expensive to insure because their crises usually lead to emergency room visits and lengthy stays in institutions, at a cost of thousands of dollars a day. Many mentally ill patients cope by smoking, abusing drugs, or overeating, leading to an increased risk of cancer, diabetes, and other expensive “co-morbidities. One study published in 2000 estimated that people with psychiatric or substance abuse problems consume 44 percent of all the cigarettes sold in the United States. This is one reason why the average life expectancy of an American with a chronic mental illness is about 25 years shorter than the national average. (The American Scholar). Nearly 12 percent of U. S. adults (27 million low-income individuals on public support) receive Medicaid coverage (with more than 2 percent having dual Medicare/Medicaid coverage).

With per capita expenditures of $481 a year for mental health services, the average cost of this coverage is 2. 5 times higher than that in the private sector. An explanation for this higher average cost is the severity of illness of this population and greater intensity of services needed to meet their needs. State mental health policymakers have begun to blend funding streams from Medicaid and the state public mental health expenditures under Medicaid “waivers,” which offer the potential of purchasing private insurance for certain public beneficiaries who have not been eligible for Medicaid.

This new option has recently been raised as a means of concentrating public mental health services on forensic and other long-term intensive care programs not covered by private insurance (Hogan, 1998). Given the extremely low level of funding for the uninsured with less severe mental illness, the recently implemented Federal legislation to fund a State Child Health Insurance Program (CHIP) could result in considerably increased coverage for previously uninsured children.

It is noteworthy that CHIP benefits vary from state-to-state particularly for mental health coverage. America is about to undergo a massive shift in how health care is paid for, and at the state level the responses have been varied. South Carolina, for example, slashed mental health spending 39 percent between 2009 and 2012, and nine other states cut their mental health budgets more than 10 percent over that same period, according to the National Alliance on Mental Illness, leaving significantly more people on the street, in jail, or dead.

In other states, the objective is to replace custodial care, which is often inefficient and inhumane. The new model of care encourages a far greater degree of independence, and at a fraction of the cost of hospital wards. Consider that the state of New York spends about $220,000 a year to keep a person in the Buffalo Psychiatric Center. Now compare that with the annual direct cost of supported housing in Buffalo- about $8,000 per person, according to Joe Woodward, director of a peer-run housing agency in western New York.

About 25 million adults in this country suffer from serious psychological distress; some surveys estimate that half of all Americans will have a diagnosable psychiatric condition at some point in their lives. And yet, the mentally ill are a largely forgotten part of the population. Governments especially seem to deal with the problem by ignoring it. The major obstacle, still to this day-is social stigma, which the sociologist Erving Goffman elegantly defined as “the process by which the reaction of others spoils normal identity. ” This stigma is what peers can best combat. People may not know how to make recovery happen, but that doesn’t mean that it can’t happen,” said John Allen, a peer activist for decades and now the director of the Office of Consumer Affairs at New York State’s Office of Mental Health. “I believe that recovery is possible for every human being. ” The mental health care in America is extremely poor at this time. Many people continue to suffer and lives are literally lost due to lack of interest in our society in assisting people with mental health disorders and people continue to be heavily stigmatized.

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