Causes for Lack of Adequate Care: A Look at Mentally Ill Patients
The goal of this paper will be to examine the causes of inadequate care with regard to patients with mental illnesses, irrespective of the type of mental illness the patient has. Historically the care of patients with a mental illness has been minimal at best. Many patients with mental illnesses face inadequate care in today's society, particularly in the United States.
The primary causes for insufficient care of mentally ill patients include: (1) a lack of adequate healthcare coverage, (2) lack of access to sufficient and qualified healthcare professionals/providers and (3) social stigma that might prevent patients from seeking out care when needed (Mechanic, 2004; Hollingsworth, Hollingsworth & De Gruyter, 1994; Boulard, 2000). There are other reasons that patients might not receive adequate care, often associated with the primary reasons listed above. These will be described in greater detail below.
The consequences of a lack of adequate care for mentally ill patients are extreme. Patients that do not receive adequate care are more likely to relapse, or suffer from more severe forms of their illness; others turn to violence, suicide or are incarcerated as a result of their mental illness, and the care provided in prisons and jails is even worse than the care provided in many community service centers (Boulard, 2000). This paper will examine the causes for the lack of adequate care for mentally ill patients in greater detail.
Barriers to Effective Care for Mentally Ill Patients
Mentally ill patients have historically faced many obstacles when seeking out health care. For those that do have health insurance, many policies limit coverage. In some instances for example, patients are limited to 90 day in patient stays, even in the event that they are diagnosed with symptoms that indicate they may pose a danger to themselves or others (SAMHSA, 1999). The Surgeon General recently discussed the issue of parity with regard to mental health care. Specifically parity deals with the notion that mental health treatment should be financed in the same manner that general heath care services are (SAMHSA, 1999).
In recent years there has been a movement among government legislatures to address the differentiation in treatment provisions allocated for patients with mental illnesses vs. patients with traditional physical disorders from an insurance standpoint (SAMHSA, 1999). Parity legislation would require all insurers to not only cover mental illness, but would require all providers to offer the same type of coverage across the board, and coverage that was equivalent to the coverage offered for all other physical disorders (SAMHSA, 1999).
Many plans in the past have restricted the number of inpatient days a mentally ill patient could stay; other plans described lifetime limits for inpatient and outpatient services that were typically low (SAMHSA, 1999). Many employer sponsored health care programs limit mental health benefits, which can create a financial burden for patients and their families and result in inadequate care or lack of care (SAMHSA, 1999).
According to many studies, more than half of patients who are seriously mentally ill do not receive adequate care (Hollingsworth, Hollingsworth & De Gruyter, 1994: 145; Torrey, 1988). Many programs fail because they do not provide mentally ill patients with the right resources to recover or with adequate safety and care, particularly mental hospitals (Hollingsworth, et. al, 1994). Other programs fail because they provide patients with pharmaceutical care for a limited time, but do not provide patients with adequate secondary care, which includes social and emotional support for addressing their illness and the impact their illness has on their life (Boulard, 2000).
In particular a lack of adequate care has been noted among professionals and laypersons alike in the United States (Boulard, 2000). Part of the problem in the United States according to professionals and one of the causes for a lack of adequate care for mentally ill patients, is that people with a mental illness have been "deinstitutionalized" or discharged from hospitals, and "fledgling facilities located in the community" are expected to "take up the burden of providing adequate medical and social care" (Hollingsworth, et. al, 1994). These community-based resources are often unable however to provide either the right types of care or the desired care, and the qualifications of many deinstitutionalized providers is often consider less stringent than others (Hollingsworth, et. al, 1994).
According to Buehler, Smy & Yurkovich (1997), the core variable necessary to maintain health and proper care for mentally ill patients, at least according to patients themselves is preventing a loss of control. Further, mentally ill patients state that control can be maintained "through informal relationships and a supportive environment," rather than an environment that exudes excessive forced control (Buehler, et. Al, 1997:33). The problem with many community care centers is that they do not provide patients with a supportive enough environment for patients to feel that they are in control. Because of this many patients fail to recover sufficiently in these centers.
Mentally ill patients also have difficulty receiving quality care because mental health care is not considered a high priority on many political agendas (Hollingsworth, et. al, 1994). In the United States in particularly, patients with mental illnesses have generally been regarded "without esteem" and often lack the influence that other groups with disabilities have; they are also traditionally the most "stigmatized disability group" and as a result have had little influence in the political arena (Hollingsworth, et. al, 1994: 147).
Because many mentally ill patients often lack the ability to care for themselves and cannot care for themselves, many private citizens assume that it is the obligation of state authorities or the government to protect and provide for them, however there is generally very little role the government plays in the role of care for the mentally ill (Hollingsworth, et. al, 1994). The primary role the government has taken with regard to caring for the mentally ill has been that of a research authority, as well as providing care for veterans and providing a small amount of funding to some community mental health centers (Hollingsworth, et. al, 1994).
Another obstacle facing patients with mental illness and a cause for inadequate care are the costs associated with adequate and continuous treatment. The costs associated with caring for mentally ill patients are generally quite high, and many mentally ill patients lack adequate insurance to cover the cost of health care services (Boulard, 2000). Most mentally ill patients without health insurance must rely on local health departments for services or choose to forgo care altogether (Boulard, 2000). The increased burden community programs face have resulted in "skyrocketing costs" which include the cost of providing coverage for pharmaceuticals, often necessary for treating mentally ill patients (Boulard, 2000).
For treatment to be effective, mentally ill patients must be afforded access to proper community support services, medication therapy and social support in order to help them maintain relationships, manage their lives and become productive members of society (Boulard, 2000). Many patients are not afforded these luxuries, thus lack of availability to proper care might be cited as a cause for inadequate care.
Personal supervision, continuity of care and coordination of treatment are all important elements of an adequate mental health support system; unfortunately these aspects of care are often lacking in many community support centers (Boulard, 2000:32).
Lack of availability of care and accessibility of care are also causes that mentally ill patients are not being treated appropriately (Hurd, 2001). According to reports in some states more than 90% of state hospital beds allocated to psychiatric care have been eliminated (Hurd, 2001). Other factors that have contributed to inadequate care for mentally ill patients include the reduction in psychiatric care centers (referred to earlier as deinstitutionalization) and the reduced overall availability of care (Hurd, 2001).
Mentally ill patients are also often stigmatized, whether by society, family members or health care providers, and such stigmatization can result or lead to inadequate treatment or lack of care (Boulard, 2000; Hurd, 2001). For mentally ill patients to receive care, they must first feel comfortable seeking out care. This is often not the case when patients feel uncomfortable with their illness. Many health care providers are eager to provide pharmaceutical treatment for patients with mental illnesses, but are not eager to provide adequate support systems, whether social or emotional, necessary for patients to overcome the stigma associated with their illness (Hurd, 2001; Boulard, 2000).
Mentally ill patients face many barriers to treatment, which results in inadequate care. These barriers to adequate care have also been identified as the primary causes for inadequate care among the mentally ill patient population. What are the primary causes for a lack of adequate care for mentally ill patients? Studies have indicated that inadequate insurance coverage, lack of availability, rising costs and social stigmatization are among the leading causes of inadequate health care for patients with mental illnesses.
Even patients that have access to insurance coverage often face limitations to their coverage that prevent continuous and adequate care over…