RESUMO
President Clinton's health care reform proposal articulates a complete vision for the mental health and substance abuse care system that includes a place for those traditionally served by both the public and the private sectors. Mental health and substance abuse services are to be fully integrated into health alliances under the president's proposal. If this is to occur, we must come to grips with both the history and the insurance-related problems of financing mental health/substance abuse care: (1) the ability of health plans to manage the benefit so as to alter patterns of use; (2) a payment system for health plans that addresses biased selection; and (3) preservation of the existing public investment while accommodating in a fair manner differences in funding across the fifty states.
Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Seguro Psiquiátrico/legislação & jurisprudência , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Transtornos Relacionados ao Uso de Substâncias/economia , Controle de Custos/legislação & jurisprudência , Financiamento Governamental/legislação & jurisprudência , Reforma dos Serviços de Saúde/economia , Humanos , Benefícios do Seguro/economia , Benefícios do Seguro/legislação & jurisprudência , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/legislação & jurisprudência , Transtornos Mentais/reabilitação , National Health Insurance, United States/economia , National Health Insurance, United States/legislação & jurisprudência , Centros de Tratamento de Abuso de Substâncias/economia , Centros de Tratamento de Abuso de Substâncias/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estados UnidosRESUMO
Analysis of dreams is often used in group psychotherapy to explore common group tensions and individual internal conflicts. The author pays special attention to the first dream which a patient reports in the course of group psychotherapy. These first reported dreams clearly and accurately reveal the patient's basic conflicts and also reflect the progressive stages of group-as-a-whole tension from issues of dependency, advice-giving, and universality to explorative resolution of conflicts.
Assuntos
Sonhos , Interpretação Psicanalítica , Terapia Psicanalítica , Psicoterapia de Grupo , Adulto , Conflito Psicológico , Dependência Psicológica , Emoções , Feminino , Humanos , Relações Interpessoais , Masculino , Relações Profissional-Paciente , Transferência PsicológicaRESUMO
Health care reform, which is anticipated at the federal level and is ongoing at the state level, presents both challenges and opportunities for psychiatrists and other mental health practitioners. It is important that all the mental health professions examine their training programs in preparation for the changes that are likely to occur in the future. The author relates training and practice trends to trends in mental health services delivery that are likely to accelerate in the context of health care reform.
Assuntos
Reforma dos Serviços de Saúde , Psiquiatria , Síndrome da Imunodeficiência Adquirida/psicologia , Educação , Etnicidade , Soropositividade para HIV/psicologia , Sistemas Pré-Pagos de Saúde , Humanos , Serviços de Saúde Mental/tendências , Psiquiatria/educação , Psiquiatria/tendências , Psicologia/tendências , Serviço Social/tendências , Estados Unidos , Recursos HumanosAssuntos
Deficiência Intelectual/enfermagem , Transtornos Mentais/enfermagem , Serviços de Saúde Mental/organização & administração , Casas de Saúde/legislação & jurisprudência , Desinstitucionalização , Humanos , Assistência de Longa Duração/economia , Medicaid/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Modelos Teóricos , Casas de Saúde/economia , Estados UnidosRESUMO
The community meeting is often established as a part of the program on a psychiatric treatment unit to enhance the therapeutic atmosphere and advance the unit's goals. Such meetings usually consist of at least 30 or more individuals, including patients, staff, and trainees, and therefore incorporate small-group dynamics as well as phenomena more typical of large groups. Leaders should try to ensure the effectiveness of their meetings by assessing tasks and boundaries, as well as the extent to which small-group dynamics and techniques used in large groups apply.
Assuntos
Transtornos Mentais/terapia , Unidade Hospitalar de Psiquiatria , Comunidade Terapêutica , Processos Grupais , Humanos , Resolução de Problemas , Relações Profissional-PacienteRESUMO
Shortly after his election in 1992, President Clinton appointed a health care reform task force to develop a proposal for providing health care benefits for all American citizens and legal residents. Between February and May 1993 the Interdepartmental Working Group, composed of more than 30 working groups addressing specific health care issues, prepared options for the task force. The Health Security Act was introduced in November 1993. Besides universal coverage and a basic benefit package, provisions included health insurance reform, regional alliances for structuring competition among health insurance plans, consumer choice of health plans, and provisions for Medicaid beneficiaries. Proposed mental health and substance abuse provisions included coverage of intensive nonresidential services, medical management, evaluation and assessment services, and case management. Initial limitations on coverage of inpatient mental health services and psychotherapy would be removed by 2001. The Clinton plan also called for integration of public mental health and substance abuse services into the full range of health services offered by local health plans. Major issues that will have to be resolved if health care legislation is to be enacted include whether regional alliances should be mandatory and whether employers should be required to contribute to insurance premiums.
Assuntos
Reforma dos Serviços de Saúde , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Programas de Assistência Gerenciada , Medicaid/economia , Medicaid/organização & administração , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Estados UnidosRESUMO
The Hispanic American population, the second largest and fastest growing minority population in the United States, faces barriers to access to both medical health and mental health care. This paper examines both financial and cultural barriers to utilization of mental health care services; it is a broad review of the literature and is not intended to be comprehensively detailed. The research review suggests that the financial barrier is a major determinant of mental health service access for Hispanic American populations. Also, nonfinancial barriers such as acculturation are examined. A two-part plan is suggested to reduce both financial and nonfinancial barriers. Very little literature on utilization of substance abuse services was found; suggestions for further research are thus proposed.
Assuntos
Acessibilidade aos Serviços de Saúde/economia , Hispânico ou Latino/psicologia , Serviços de Saúde Mental/estatística & dados numéricos , Aculturação , Barreiras de Comunicação , Características Culturais , Humanos , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Pobreza/economia , Relações Profissional-Paciente , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Estados UnidosRESUMO
OBJECTIVE: A consensus conference on the reasons for the undertreatment of depression was organized by the National Depressive and Manic Depressive Association (NDMDA) on January 17-18, 1996. The target audience included health policymakers, clinicians, patients and their families, and the public at large. Six key questions were addressed: (1) Is depression undertreated in the community and in the clinic? (2) What is the economic cost to society of depression? (3) What have been the efforts in the past to redress undertreatment and how successful have they been? (4) What are the reasons for the gap between our knowledge of the diagnosis and treatment of depression and actual treatment received in this country? (5) What can we do to narrow this gap? (6) What can we do immediately to narrow this gap? PARTICIPANTS: Consensus panel members were drawn from psychiatry, psychology, family practice, internal medicine, managed care and public health, consumers, and the general public. The panelists listened to a set of presentations with background papers from experts on diagnosis, epidemiology, treatment, and cost of treatment. EVIDENCE: Experts summarized relevant data from the world scientific literature on the 6 questions posed for the conference. CONSENSUS PROCESS: Panel members discussed openly all material presented to them in executive session. Selected panelists prepared first drafts of the consensus statements for each question. All of these drafts were read by all panelists and were edited and reedited until consensus was achieved. CONCLUSIONS: There is overwhelming evidence that individuals with depression are being seriously undertreated. Safe, effective, and economical treatments are available. The cost to individuals and society of this undertreatment is substantial. Long suffering, suicide, occupational impairment, and impairment in interpersonal and family relationships exist. Efforts to redress this gap have included provider educational programs and public educational programs. Reasons for the continuing gap include patient, provider, and health care system factors. Patient-based reasons include failure to recognize the symptoms, underestimating the severity, limited access, reluctance to see a mental health care specialist due to stigma, noncompliance with treatment, and lack of health insurance. Provider factors include poor professional school education about depression, limited training in interpersonal skills, stigma, inadequate time to evaluate and treat depression, failure to consider psychotherapeutic approaches, and prescription of inadequate doses of antidepressant medication for inadequate durations. Mental health care systems create barriers to receiving optimal treatment. Strategies to narrow the gap include enhancing the role of patients and families as participants in care and advocates; developing performance standards for behavioral health care systems, including incentives for positive identification, assessment, and treatment of depression; enhancing educational programs for providers and the public; enhancing collaboration among provider subtypes (eg, primary care providers and mental health professionals); and conducting research on development and testing of new treatments for depression.