Chapter 2 Mental Health

• Canada: Single-payer system (since late 1960s), run by the Department of National Health and Welfare. Based on 5 principles: universality, portability, accessibility, comprehensiveness, public administration.

• Norway: National insurance system under the National Insurance Act of 1967. Citizens pay out-of-pocket until a “payment ceiling” (~$175), then services are covered (except adult dental).

• United Kingdom: Government-managed national health system; funded by taxes; mental health care part of standard benefits; eye care excluded, dental limited.

• Australia: Mixed system — public health plan + national private supplement + private insurance. Mental Health Bill of 2013 addressed fairness/accountability/inclusion of family.

• United States: Private insurance model. >75% covered by private insurance/Medicare/Medicaid; >15% uninsured. Medicare funds 30–50% of state mental health systems.

2. Major difference: inpatient vs. outpatient

• Inpatient = 24-hour supervised, safe/secure environment for stabilization.

• Outpatient = client remains in home/community; supervision is limited, responsibility for controlling behavior rests with the individual.

3. Community Support Systems (CSS) model

Views clients holistically — as people with basic needs, ambitions, rights. Goal: foster growth/independence through coordinated social, medical, psychiatric services. Must be consumer-oriented, culturally appropriate, flexible, accountable, coordinated.

4. Four settings for community mental health delivery (Table 2.1)

• Emergency care (EDs, psychiatric clinics)

• Residential programs (group homes)

• Partial hospitalization (day treatment centers)

• Psychiatric home care

• (plus Community mental health centers)

5. Five components of case management

1. Psychosocial rehabilitation

2. Consultation

3. Resource linkage

4. Advocacy

5. Crisis intervention

(Therapy is sometimes listed as a 6th component)

6. Multidisciplinary team roles/purpose

Purpose: avoid fragmented/disjointed care, cost-effective, holistic treatment plan with client/family involvement.

• Psychiatrist — MD; team leader; diagnosis/medical management

• Clinical psychologist — PhD; diagnostic testing, treatment

• Psychiatric social worker — MSW; family/environment evaluation, admits clients

• Psychiatric nurse — coordinates care team, ADLs, individual/group/family therapy

7. Four high-risk populations

Homeless individuals, children/adolescents, elderly, people with HIV/AIDS, veterans, rural residents (pick any 4)

8. Five community services for HIV/AIDS clients

Mental status/suicide risk assessment, crisis intervention services, individual/group therapy, family support groups, respite care, prevention/education programs

|Fact |Detail |

|----------------------------------------------------------|-----------------------------------------------------------------------------------------|

|Norway National Insurance Act |**1967** |

|US Health Care Financing Administration established |**1983** (created DRGs) |

|Number of DRGs |400+ |

|Australia Mental Health Bill |**2013** |

|Admission rates to inpatient psych facilities lowest by |**1983**, then rose again by 1988 |

|% US adults with mental illness |~18% |

|% world population with lifetime mental illness |25% |

|% US uninsured |>15% |

|Medicare funds what % of state mental health systems |30–50% |

|% prisoners with mental illness |>20% |

|% state prisoners w/ recent mental health history |~20% |

|% local jail prisoners w/ recent mental health history |~21% |

|Incarcerated persons w/ serious mental illness (2018 data)|383,000 |

|Rate of mental illness in prison vs. general population |up to 3x higher |

|% Vietnam veterans w/ PTSD |>30% |

|US veterans total (2017) |~23 million |

|Afghanistan/Iraq war veterans |2.8 million+ |

|Veterans receiving specialized MH treatment from VA |1.3 million+ |

|% homeless with addiction/mental illness |85% |

|% homeless over age 60 |~10% |

|US citizens below poverty line (2017) |~12% (45 million people) |

|Mental illness costs in lost earnings/year |$193.2 billion |

|State mental health budget cuts (2009–2011) |$1.8 billion |

|People served by US mental health facilities today |57+ million |

|Core multidisciplinary team members |Psychiatrist, psychologist, nurse, social worker |

|ACT team composition |Social worker, psychiatrist, addictions counselor, 2 RNs, 2 social workers (4 clinicians)|

• Recidivism = relapse/return of symptoms → repeated readmission (NOT just “returning to community”)

• Resource linkage = matching client needs to services + ongoing monitoring (not just referral)

• CSS model = holistic, not purely medical/symptom-based

• ACT (Assertive Community Treatment) = 24-hr, community-based team for severe, treatment-resistant illness

  1. What type of health system does Canada have?

    • A) Private insurance

    • B) Mixed system

    • C) Single-payer system

    • D) National insurance system

  2. In Norway, what is the payment model until reaching the payment ceiling?

    • A) All services covered

    • B) Out-of-pocket payment

    • C) Tax-funded

    • D) Only for dental services

  3. Which country has a government-managed national health system funded by taxes?

    • A) Australia

    • B) United Kingdom

    • C) Norway

    • D) United States

  4. What features does Australia's health system comprise?

    • A) Private insurance only

    • B) Public health plan and national private supplement

    • C) Only government-funded services

    • D) Out-of-pocket payment only

  5. What is the dominant model of healthcare in the United States?

    • A) National insurance

    • B) Single-payer system

    • C) Private insurance model

    • D) Universal health care

  6. What does 'inpatient' refer to in mental health services?

    • A) Care in a community setting

    • B) Day treatment programs

    • C) 24-hour supervised environment

    • D) Minimal supervision

  7. Which model views clients holistically and fosters growth through coordinated services?

    • A) Community Support Systems (CSS) model

    • B) Outpatient model

    • C) Inpatient model

    • D) Mixed model

  8. Which component is part of case management?

    • A) Transportation services

    • B) Crisis intervention

    • C) Real estate advice

    • D) Fitness programs

  9. Who typically leads a multidisciplinary team in mental health care?

    • A) Clinical psychologist

    • B) Psychiatric social worker

    • C) Psychiatrist

    • D) Psychiatric nurse

  10. Which population is considered high-risk in mental health care?

    • A) Teenagers

    • B) Elderly

    • C) Veterans

    • D) All of the above

  11. What type of service is NOT typically covered for adult dental in Norway?

    • A) Emergency care

    • B) Preventive care

    • C) Dental services

    • D) Routine check-ups

  12. What is a key feature of the Assertive Community Treatment (ACT) model?

    • A) It is only offered in hospitals

    • B) It is community-based and provides 24-hour support

    • C) It relies on outpatient visits

    • D) It does not focus on severe illness cases