usa psychiatric services

graemesouness · Nov 1, 2002

To those of you working in psychiatric services in the USA, I'm curious as to what they consist of?

Here in England, a person gets admitted to a hospital either through GP referral or on a section (MHA) and most of the services are available on the NHS.

Then we have forensic services, CPN's, day services,etc.

How does it compare with USA??

Cheers,

Graeme

sanakruz, ADN · Nov 15, 2002

Just found this post!

Here in the US we have FEE FOR SERVICE medical care. If one has insurance coverage, one gets care. Insurance plans vary, some cover more things than others. Most plans are available through employment, and a monthly fee is deducted from one's paycheck. One can also purchase health insurance if needed or desired from an insurance broker that will also try to sell you life, auto, burial, etc., insurance. Many people that are self- employed will purchase these policies. They are comparible to employee offered plans, and more expensive because allegedly we get a break on our premiums because of a "group discount"

An issue that was on the ballot this month here in California was "parity", which means insurance companies need to be compelled to look at mental illness in the same way as physical illness and to provide coverage for their health plan members.The initiative did not pass.

That said- Treatment for mental illness is often on an involuntary basis. Each state will deal with this in a different way.(Jeffersonian Democracy in action!) Here in California, an individual can be detained for 72 hours for psych assessment if this person meets 1 of 3 spacific criteria: "Danger to Self " "Danger to Others" or "Grave Disability" The first two are self explanatory. "GD" is the hardest one to assess because a person must be unable to provide for themselves food clothing or shelter RIGHT NOW, not tomorrow or next week, and this must be becuase of a MENTAL ILLNESS, not Etoh or drug addiction, anger, beat up by a spouse, etc. This is getting long so let me submit and se what happens

sanakruz, ADN · Nov 15, 2002

Ok it's not too bad.

Often a person with mental illness is not insured. If the person is a documented poor person, they will be covered by some form of state aid based insurance which in most states is called MEDI-AID.Here in CA it's called MEDI-CAL Cute, huh? back in the day of Edmond and even Jerry Brown this meant something; it was superior to what other states offered, well no more. I wont say why now; dont get me started!

Ok so say law enforcement has placed this person on a 72 hour hold. Their stay in a hospital is likely to be just that because of "Managed Care" Ther is little community based treatment. Some larger counties are able to offer day treatment centers and and supervised living environments (As in LA county), but here in bum**** county we have a smaller tax base and therefore no services except this here out patient clinic where I am the only nurse.

Now please let us know what a section is, along with CPN and MHA?

maureeno · Nov 15, 2002

In Washington state we are in crisis mode. There are fewer psych beds [inpatient and supported living] than 25 years ago. The community system has gone through so many changes it is an abuse of workers and clients. We've tried county based managed care and that is now changing too. If you can get in the system you get a case manager, hopefully one who knows something but there are no guarantees. Most insurance plans are inadequate for mental health, but drugs, drugs, drugs are paid for. Another big problem is housing, so jails, shelters and streets provide. Involuntary treatment for mental disorder is being ever more widely applied. Any symptom of a mental disorder will rule you in; got dementia, develomental delay, addiction, delerium and are refusing or resisting treatment? Bang! You are locked up with me taking care of you. [okay, also have to be dangerous or GD as in California]. Involuntary mental health has become the dumping ground for difficult patients, in part because we have the ability to use physical and chemical restraints. Then our social workers get stuck trying to place people and the expense grows enormously...for nothing.

I remember so fondly the hope and promise of community mental health.

graemesouness · Nov 15, 2002

many thanks, v.interesting and v.different to things over here!!

CPN..community Psychiatric Nurse

Section...usually either section 2 (28 days detention) or section 3 (6 month detention)

All is available on the National health service, there are private hospital facilities but thats mainly for neurotic rich people!!

Thanks for the interseting insight into US psychiatric services

J. Tigana · Nov 15, 2002

When Sean Davis scored that goal, the fans sang "Souness whats the Score? and Tigana rang up the sideline to ask Souness if he still believed that Blackburn were the better team. I know it's not an answer to your question but I've been listening to a talkshow who's topic was " sportsmen eating humble pie".

sanakruz, ADN · Nov 15, 2002

Graemesouness- Those are awfully long detentions- Holy Cow! What happens here in CA is : If after 72 hours an individual's crisis is not resolved and that person is unwilling to stay as an inpt. as a voluntary pt. ( which is basicly meaningless, because only the very sickest are hospitalized and are generally unable to accept that they are indeed mentally ill or if they are willing to stay their health plan wont pay for a voluntary stay,"pairty" problem again) a physician,(psychiatrist) can petition the court to have a person held involuntarily for UP TO 14 days. This is called a 14-day hold or a 5250 ( the 72 hr hold is called a 5150) The individual as the right to a hearing before an administrative law judge/represntative of the court to determine if the criteria for keeping them against their will can be upheld. These are very somber, seroius legal proceedings where everything must be done by the book or the pt. wil be released on a technicality( the nurse did not call the court and record it in the specified time table, for example- It's always the nurse, Eh?) A PATIENTS RIGHTS ADVOCATE will come to the hospital and act as the pts "attorney" and one of the nursing staff will act as the "prosecutor". The judge(hearings officer) will read all the documentation in the chart and listen to the patients "plan" to keep themself well and make a decision on weather or not the person is cut loose. If the criteria is not upheld the pt will be released that day. If the citeria is upheld the person may stay up to 14 days. If they are still acute by the 13th day, 2 mds must patition the court for temporary conservatorship, 90 days of involuntary treatment. If the T-Con goes through, they person will be transfered out of the acute facility and into a locked IMD ( institute for the mentally disorderd) a big huge wherehouse like place where unfortunately little healing takes place. A full conservatorship last for 1 year and must subsequently be renewed each year in superior court. This is only in CA; each state does it differently. Sounds like they play it fast ans loose in WA! We have seperate services for DD pts- Up until this year they were well funded, too. We did not see DD clients in psych facilities.

maureeno · Nov 15, 2002

While in Washington we lump too many into our involuntary mental health system, the commitment process is more legalistic. Special 'county designated mental health professionals investigate grounds for the initial 72 hour detention, taking statements of danger or GD from police, health care people, families any referal source. Before their interview clients are given Miranda warnings by the MHPs. If detained, clients are assigned a public defender [attorney] and evaluated again this time by a Ph.D psychologist who also Miranda warns ['you have the right to remain silent..anything you say can be held against you']. If a petition for 14 days if filed, a normal type [attornies both sides] trial is held in civil court.

If detained for 14 days and still the hospital team decides more treatment is needed the social worker files a 90 day petition. The public defender can ask for two continuances and delay the hearing. Patients are supposed to go to the state hospital if held for the 90 days, but that can't always happen either because the hospital is full, or not appropriate for that patient. Remember in Washington the mental health law has been expanded by practice [not words] to be used for everyone not other wise able to be cared for.

Some people remain on the involuntary care unit I work on for months. The costs are astronomical. Our system is a broken disgrace.

sjoe · Nov 15, 2002

"The costs are astronomical. Our system is a broken disgrace."

I hear that.

And since no one has yet pointed it out on this thread, the mentally ill DON'T VOTE in large numbers, and have little financial clout, so no improvements are to be expected.

patadney · Nov 17, 2002

Here in the heartlland the process is a little different. A person may be admitted on a hold if he is a danger to himself or others for only 48 hr and then a hearing must be scheduled or the pt is DC'd. They can be placed on inpt or outpt commital and the pt is represented by a lawyer at a court hearing. the doc must say why he is a danger and submit a plan of care. The magistrate may order the person released or committed inpt or outpt and to a state or county institution or to the hospital. We have many different community-based systems for supporting these people on the outside.Due to poor economy,we have lost state beds,so pt end up staying in the hospital longer.I am ofraid this is more expensive and the pt can't pay so the hospital "eats"it. So somebody is paying-I guess we all will.

sanakruz, ADN · Nov 18, 2002

This is a very interesting thread to me! Miranda in WA! Wow!

sjoe- at our outpatient clinic we give voter registartion forms to each new client. Not all choose to exercise their right, but were trying.

Pat-e we are about to embark on out patient commitals here in CA. The problem is the bill was passed WITH NO FUNDING ATTACHED !Eavh county will have to pick up the tabs. Some of us may be out of a job because of budget constraints. I'm also afraid we will not be able to hospitalize those that really need it. Oh its a frigging mess! Good to know I'm not alone....