Providing Behavioral Health Care in PACE - A Review of Federal and State Manual Regulations.

OBJECTIVES: Present analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). DESIGN: Review and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH-Serious Illness Care (SIC) model domains. SETTING AND PARTICIPANTS: The 155 PACE organizations operating in 32 states and the District of Columbia. METHODS: A multipronged search was conducted to identify official state and federal manuals guiding the implementation and functions of PACE organizations. The CMS PACE website was used to identify the federal PACE manual. State-level manuals for 32 states with PACE programs were identified through several sources, including official PACE websites, contacts through official websites, the National PACE Association (NPA), and public and academic search engines. The manuals were searched according to the BH-SIC model domains that pertain to integrating BH care with complex care individuals. RESULTS: According to the CMS Manual, the interdisciplinary team is responsible for holistic care of PACE enrollees, but a BH specialist is not a required member. The CMS Manual includes information on BH clinical functions, BH workforce, and structures for outcome measurement, quality, and accountability. Eight of 32 PACE-participating states offer publicly available state PACE manuals; of which 3 offer information on BH clinical functions. CONCLUSIONS AND IMPLICATIONS: Regarding BH, federal and state manual regulations establish limited guidance for comprehensive care service delivery at PACE organizations. The absence of clear directives weakens BH care delivery due to a limiting the ability to develop quality measures and accountability structures. This hinders incentivization and accountability to truly all-inclusive care. Clearer guidelines and regulatory parameters regarding BH care at federal and state levels may enable more PACE organizations to meet rising BH demands of aging communities.

Ley 21331: nuevos desafíos de la Ley del reconocimiento y protección de los derechos de las personas en la atención de salud mental / Law 21331: new challenges of the law of recognition and protection of people's rights in mental health care

Since the dawn of the Republic, the question regarding the diagnosis, management and treatment of mental illnesses has been an unresolved issue to this day. Since before the time of the colony, at the time of the conquest, mental illnesses abounded, both in the Mapuche population - autochthonous indigenous - and in the Spanish. The presence in the river basins of heavy metals and minerals toxic for human consumption, as was originally the Mapocho River, whose waters were not drinkable and were only used for crops adopted from the Inca culture, were consumed by the population of the Spanish conquerors, who manifested various types of mental disorders, either due to the consumption of polluted water and the neurological damage that it caused them, the high levels of stress due to the same occupation and the isolation in which they found themselves and the diseases venereal that they carried, which they progressively transmitted to the aboriginal population. (1) On the other hand, the Mapuche population had magical-ritual treatments and methods to treat these and other diseases based on herbalism, phytotherapy and rituals (2) for the evil of melancholy (depression), anxiety disorders, panic attacks and schizophrenia. (3) Centuries later, when medicine and hard science are presented in society giving way to the scientific method, key people make their appearance within mental health studies, who made their way into the national and world panorama, and who, despite the dark past and the tortuous evolution of this branch of medicine, stand out figures who were pioneers and who gave rise to a reality that today continues in constant development and debate. Today mental health is an issue on the table, and Law 21331, promulgated on April 23, 2021 (4) is a response to changes in the perception that society currently has of the concept of disease, which is contrasted to the thinking and management that existed for years, decades and centuries ago around mental health

Desde los albores de la República, la cuestión referente al diagnóstico, manejo y tratamiento de las enfermedades mentales ha sido un tema sin resolver hasta nuestros días. Desde antes del tiempo de la colonia, en la época de la conquista, las enfermedades mentales abundaban, tanto en la población mapuche -indígena autóctona- como en la española. La presencia en las cuencas fluviales de metales pesados y minerales tóxicos para el consumo humano, como fue en su origen el río Mapocho, cuyas aguas no eran bebestibles y solo se utilizaban para los cultivos adoptados de la cultura inca, fueron consumidas por la población de los conquistadores españoles, los cuales manifestaron diversos tipos de trastornos mentales, ya fuese por el consumo de aguas contaminadas y el daño neurológico que les provocaba, los altos niveles de estrés debido a la misma ocupación y al aislamiento en el que se encontraban y las enfermedades venéreas que portaban, las cuales transmitieron progresivamente a la población aborigen. (1) Por otra parte, la población mapuche tenía tratamientos y métodos mágico-rituales para tratar estas y otras enfermedades basados en la herbolaria, la fitoterapia y los rituales (2) para el mal de la melancolía (depresión), trastornos ansiosos, crisis de pánico y la esquizofrenia.(3) Siglos más tarde, cuando la medicina y la ciencia dura se presentan en sociedad dando paso al método científico, hacen su aparición personas clave dentro de los estudios en salud mental, quienes se abrieron camino dentro del panorama nacional y mundial, y que, pese al pasado oscuro y a la evolución tortuosa de esta rama de la medicina, se destacan figuras que fueron pioneras y que dieron pie a una realidad que hoy en día continúa en constante desarrollo y debate. Hoy la salud mental es un tema sobre la mesa, y la Ley 21331, promulgada el 23 de abril del año 2021 (4) es una respuesta a los cambios en la percepción que la sociedad actualmente tiene frente al concepto de enfermedad, que se contrasta al pensamiento y manejo que durante años, décadas y siglos atrás existió en torno a la salud mental

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province.

BACKGROUND:  Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. AIM:  This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). SETTING:  The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. METHODS:  A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. RESULTS:  This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. CONCLUSION:  The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.

Integrating Health and Mental Health Services: A Past and Future History.

The authors trace the modern history, current landscape, and future prospects for integration between mental health and general medical care in the United States. Research and new treatment models developed in the 1980s and early 1990s helped inform federal legislation, including the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act, which in turn are creating new opportunities to further integrate services. Future efforts should build on this foundation to develop clinical, service-level, and public health approaches that more fully integrate mental, medical, substance use, and social services. [AJP AT 175: Remembering Our Past As We Envision Our Future July 1928: A President Takes Stock Adolf Meyer: "I sometimes feel that Einstein, concerned with the relativity in astronomy, has to deal with very simple facts as compared to the complex and erratic and multicontingent performances of the human microcosmos, the health, happiness and efficiency of which we psychiatrists are concerned with." (Am J Psychiatry 1928; 85(1):1-31 )].

Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported?

This policy brief summarizes findings from the first study to evaluate how California's public mental health delivery system has served older adults (60 years of age and over) since the passage of the Mental Health Services Act (MHSA) in 2004. Study findings indicate that there are unmet needs among older adults with mental illness in the public mental health delivery system. There are deficits in the involvement of older adults in the required MHSA planning processes and in outreach and service delivery, workforce development, and outcomes measurement and reporting. There is also evidence of promising programs and strategies that counties have advanced to address these deficits. Recommendations for improving mental health services for older adults include designating a distinct administrative and leadership structure for older adult services in each county; enhancing older adult outreach and documentation of unmet need; promoting standardized geriatric training of providers; instituting standardized data-reporting requirements; and increasing service integration efforts, especially between medical, behavioral health, aging, and substance use disorder services.

40th birthday of the Italian Mental Health Law 180 - perception and reputation abroad, and a personal suggestion.

How things are perceived from a distance may help better understand their nature. Perceptions at home are likely to shape perceptions abroad. The mutual cross-references between local and distant perspectives on the Italian Mental Health Law 180 may help understand the process which preceded and resulted in the reform. This editorial argues that Law 180 came about at a unique - enabling - time in history. It argues that the run-up to and passing of Law 180 constituted a great accomplishment by professionals, the wider public and politicians/administrators. This editorial goes on to argue that the profession managed to cope with (many) adverse effects of the reform. The attention that Law 180 has received internationally should be devoted to other national (or regional) mental health reform processes as this may help us to understand how mental health care systems evolve and what defines 'windows of (operative) opportunity' or 'moments for (public) action'.

[The first Mental Health Act in China 2013 : An historical step towards human rights]. / Chinas erstes Gesetz zur psychischen Gesundheit 2013 : Ein historischer Schritt auf dem Weg zu einem Menschenrecht.

In the past, the mentally ill used to be relentlessly stigmatized and their basic needs grossly neglected in China. Only the coastal cities with their Western oriented universities provided Western type mental healthcare. In general, traditional Chinese medicine (TCM) embracing medicinal herbs and acupuncture was practiced. Mental hospitals were non-existent before 1889 and care of the chronically mentally ill rested with their families and the community; however, the prevalence and spectrum of mental disorders were similar to those in Western countries. After the establishment of the People's Republic of China old-fashioned mental hospitals were founded. The "Great Leap Forward" starting in 1958 envisaged the creation of a mental healthcare system based on Soviet Union standards. Psychiatry had a strong biological orientation, and psychotherapy did not exist. Psychology was rejected as not being science and was not taught at universities before 1978. With the Reform and Opening Policy in 1978 the education of psychology was stepped up. Psychology was introduced as an academic discipline in 1978 and psychotherapy and psychosomatic medicine were established in mental healthcare. The current mental healthcare in China resembles the standard in Germany before the "Psychiatrie-Enquete" (expert commission official report). With the Mental Health Act adopted in 2013 after 27 years of planning, China has laid the legal foundation for planning and establishing a humane system of mental healthcare. The Act safeguards patients' human and individual rights and increases trust in psychiatric institutions. It guarantees the right to optimal treatment and provides legal protection in cases of malpractice.

The new Irish maternity strategy 2016-2026.

Report review runs alongside Guideline commentary and the other evidence series articles, examining local, national and international reports that have implications directly or indirectly for midwives. It helps readers to understand what reports mean for midwifery practice and to place report recommendations into context. As with all our evidence series articles, report reviews support you to critique recommendations and implications for your own practice. In 2016, Ireland launched its first ever maternity strategy (Department of Health (IDH) 2016). This followed many high-profile controversies, including maternal and neonatal deaths due to medical misadventure. This article reviews Ireland's history of maternity services, the new strategy and current perinatal mental health services.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health.

INTRODUCTION: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. OBJECTIVE: To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). METHOD: Review of mental health legislation from 1990 to 2014. RESULTS: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. CONCLUSION: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health / Hospital-dia e Centro de Atenção Psicossocial: ampliando o debate da internação parcial em saúde mental

Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Resumo Introdução: desde a segunda metade do século XX, as discussões em torno da assistência ao doente mental revelam o debate, ainda inacabado, entre dois paradigmas de atenção à saúde: o paradigma biomédico/biopsicossocial e o paradigma psicossocial. A luta pela hegemonia sobre as formas do cuidado, sobre a melhor maneira de lidar com a experiência do adoecimento, subjaz a uma intencionalidade de reorganização dos saberes sobre o binômio saúde/doença, que se reflete nos modelos propostos para a execução das ações e serviços de promoção, prevenção, assistência e reabilitação da saúde humana. Objetivo: problematizar as diretrizes do cuidado do Hospital-dia em Saúde Mental (HDSM) em contraste com o Centro de Atenção Psicossocial tipo III (CAPS III). Método: revisão da legislação em saúde mental entre 1990-2014. Resultados: não foi encontradas a definição de projeto terapêutico e as atividades e técnicas que devem ser empregadas por esses serviços de saúde. Conclusão: o HDSM e o CAPS III são serviços substitutivos à internação hospitalar psiquiátrica que se caracterizam pela complementaridade na atenção ao doente mental. Pelos seus variados e distintos métodos de intervenção, em ação sinérgica, potencializam-se com as contribuições tanto de um modelo quanto do outro modelo de atenção. As discussões em torno do melhor modelo de atenção em saúde mental mostram-se polarizadas entre os paradigmas biomédico/biopsicossocial e psicossocial, condição que reflete a supremacia do segundo sobre o primeiro no discurso político-ideológico que circunscreve a reforma da assistência psiquiátrica, fato que pode prejudicar o desfecho clínico para o paciente e sua família.

An analysis of the functioning of mental healthcare in northwestern Poland.

Introduction: Modern psychiatry faces numerous challenges related with the change of the epidemiology of mental disorders and the development of knowledge in this area of science. An answer to this situation is to be the introduction of community psychiatry. The implementation of this model in Poland was the aim of the National Mental Health Protection Programme. The aim of the study was to analyse the functioning of mental healthcare using the example of the West Pomeranian Province in Poland. Materials and methods: The analysis relied on a qualitative method. Three group interviews in an interdisciplinary advisory panel were conducted. People representing various areas acting for people with mental disorders participated in each meeting. Based on the conclusions that were drawn, PEST and SWOT analyses of functioning of mental healthcare were performed. Results: Within the analysis of the macro-environment of mental healthcare, the influence of the following factors was evaluated through PEST analysis: political and legal, economic, socio-cultural, and technological. All of these factors were assessed as negative for the functioning of mental healthcare. Then, a SWOT analysis was performed to indicate the strengths, weaknesses, opportunities, and threats in the functioning of mental healthcare. Conclusions: 1. Mental healthcare is more influenced by external factors than by internal factors. 2. Macro-environmental factors influence the functioning of mental healthcare in a significantly negative manner. 3. The basic problem in the functioning of mental healthcare is insufficient funding. 4. In order to improve the functioning of mental healthcare, it is necessary to change the funding methods, regulations, the way society perceives mental disorders, and the system of monitoring mental healthcare services.

Assessing the legacy of a legislative Workgroup for bidirectional integration of services.

Across the USA, health care systems are recognizing the value of integrating behavioral health services and primary care. The Texas Legislature took a unique approach to integration, passing legislation creating a Workgroup to explore key issues, identify best practices, and recommend policy and practice changes. This article situates the Workgroup in a rapidly evolving policy environment, describing the passage of integrated health care legislation in Texas, the Integration of Health and Behavioral Health Services Workgroup that was created by the legislation, and the policy recommendations that emerged from the Workgroup. The article analyzes how the Workgroup process intersected with a changing policy environment in Texas and nationally, opening the door for essential collaboration and partnership. The Workgroup ultimately laid the groundwork for integration's key role in a comprehensive Medicaid transformation waiver designed to expand access, improve population health and satisfaction with treatment, while better managing costs.

The Affordable Care Act and integrated care.

The Patient Protection and Affordable Care Act (ACA) of 2010 offers a comprehensive, integrated health insurance reform program for those who are eligible to enroll. A core feature of the ACA is the integration of primary health, behavioral health, and related services in a new national program for the first time. This article traces the history of past federal services integration efforts and identify varying approaches for implementing them to improve care, especially for underserved populations. The business case for integrated care, reducing escalating health care costs and overcoming barriers to implementation, is also discussed.