Mental Health: Continuum of Care

Mental Health: Continuum of Care

The health care delivery component's role in service provision in the area of mental health is a critical contributor to the overall management of health care resources. This is because a 'continuum of care' mental health care environment is characterized by an ongoing and highly informed practice in service provision. Because of the differential treatment regimens, the ever-expanding knowledge in the research of mental health science accompanied by ongoing rapidly developing technologies and pharmaceuticals treatment options, continuum of care in mental health cannot possibly allocate health care resources in an efficient manner. The problem is that there are barriers to continuum of care provision that mental health care service providers often have little to no control over in the life of their patient.

'CONTIUUM OF CARE'

Continuum of care can be described as ongoing, continuous, seamless, non-interrupted, fully-informed and integrated health care service provision. The work of Wong, Park and Nemon (1993) states that the point of entry into 'Continuum of Care' (CoC) is the often that of emergency services. Continuum of care is described in the work of Behar, Macbeth and Holland (Wong, Park and Nemon, 1993) to be the result of increased attention nationally of serious mental health problems and states that the goals of the U.S. states been to address the needs by developing a comprehensive array of public and private services, called a continuum of care or system of services, implying an organized, systematic method of planning and delivering services. As the needed services are frequently delivered by multiple agencies, a coordinated approach across agencies is an essential part of this approach." (Behar, Macbeth and Holland, 1993)

The work of Johnsen and Morrissey (1998) published in the Journal of Community Psychology reports empirical evidence existing that mental health care service systems are "interorganizational networks" and reports findings that indicate continuum of care service systems are more organized and that once implemented the systems "converged over time toward moderately high levels of system organization..." A study reported in the 1996 work of Hamner, Warren and Bickman states findings that children receiving mental health treatment in a continuum of care had superior outcomes at 18 months as compared to those patients who did not receive a continuum of care in mental health service provision. The work of Kiser, Lefkovitz and Kennedy (2001) entitled: "The Integrated Behavioral Health Continuum" states that the integrated system of today is a "service delivery integration process" in which "an organized system of care [is] rooted in a common vision and defined by processes intended to promote continuity and quality of care, coordination of efforts efficiencies of operation, and seamless patient movement through an otherwise bewildering array of health care services."

II. BARRIERS & CHALLENGES

Wong, Park and Nemon (1993) state: "Emergency shelters, transitional housing, and permanent supportive housing are distinct programmatic responses to address the housing and service needs of the homeless population under the Continuum of Care (CoC) model..." In homeless service delivery. However, do not be deceived in believing that Continuum of Care at the level of housing has nothing to do with mental health care service provision through a continuum of care.

Continuum of care one must remember is a highly integrated network and this network is comprised by a vast range of Continuum of Care service providers linked at many levels. In fact, many homeless individuals are also individuals in critical need of mental health care services and vice-versa.

In fact, Wong, Park and Nemon (1993) state: "An emergency shelter can be considered a "catchall" program serving individuals with diverse needs, from transitionally homeless people with no or little behavioral or physical health problems to chronically homeless people with major functional disabilities."

III. CONTINUUM OF CARE IN ACTION

The work of Mohatt (1997) entitled: "Access to Mental Health Services in Frontier America" cites the following specific barriers in rural areas to accessing a continuum of care in mental health services:

Wide Dispersion of Population

Geographically Vast Areas

Few Inpatient Psychiatric Resources

Chronic Shortages of Health and Mental Health Professionals

Lower Per Capita Participation in Health Insurance

Lower Per Capita Participation in Medicaid

Limited Array of Health and Mental Health Services

Dependence Upon Public Subsidy for Mental Health Systems

Limited Supportive Services (Housing, Transportation, Vocational)

Low Penetration of Commercial Managed Care

Limited Consumer Advocacy

Limited Self-Help Resources

Stigma

Lack of Anonymity (Mohatt, 1997)

Comprehensive healthcare reform faces barriers presented by a rapidly changing healthcare marketplace. However, integrated continuum of care networks presents a viable solution to mental health care delivery that properly allocates resources a collaborative and cooperative service delivery system.

Needed, according to Mohatt (1997) is "vertical integration' in the "approaches to managed care" in networking a group of healthcare providers, at various levels of primary care and behavioral health, to form an integrated service network. They seek to develop, via cooperation, a coordinated, consumer focused, seamless continuum of care designed to improve access and availability through efficiencies gained by the elimination of redundant services or systems."

Mohatt reports just such as system being in existence and specifically the Laurel Health System in northeastern Pennsylvania "founded in 1989 with the merger of five not-for-profit organizations..." This network spans the human service gamut inclusive of primary care, nursing homes, senior housing, ambulance service, and hospital." (1997) Mohatt reports another example stating: