Letter to the Editor: Mental Ill Population Health Policy Advocacy

Competency 1: Evidence-Based Advanced Nursing Care for Achieving High-quality Population Outcomes of Mentally Ill Patients.

Evaluating the current state of care and outcomes for the population suffering from mental health is essential. Mental health conditions are one of the leading causes of death related to suicide in the USA. Mental disorders are primarily associated with racial discrimination, palliative care patients, and substance abuse. According to the National Alliance of Mental Illness survey (Richards, 2012), half of the 60 million children and adults living with mental conditions do not get access to care and go without any treatment, despite the passage of the federal mental health and addictions parity law in 2008. The act called for parity in coverage for health insurance for mental and physical health in both quantifiable and non-quantifiable treatment plans. Despite the requirements, mental health patients encounter a mental health provider network that is short of supply compared to primary and specialty care. Significant barriers present to a patient trying to access mental health care plans, such as denial of care by insurers, hardships in finding psychiatrists and other mental health workers in insurance networks, and problems accessing mental medications. Most healthcare providers do not accept new patients or do not accept their healthcare plans because of the large number of patients compared to providers. Access to providers is even worse for people living in rural areas, though the prevalence of mental disorders is almost equal. An estimated 65% of rural counties in the USA do not have mental health service providers. More than 60 % of mental health patients live in areas that experience psychiatric service shortages. People in rural areas receive treatment less frequently and from providers with less specialized training and experience than those in urban areas (Morales et al., 2020). According to the survey by NAMI, these barriers present themselves regardless of whether public or private insurance networks cover the patient. It is argued that the patients pay an additional out-of-pocket cost, such as fuel costs, for mental health services compared to other healthcare services.

A policy will improve the mentally ill population's quality of care and outcomes. The limited access to mental health care caused by a short supply of providers, financial problems, lack of insurance with mental health coverage, the stigma associated with seeking mental health services, and geographical isolation hinder many individuals with severe mental conditions from seeking and obtaining appropriate care. The rate of suicide among patients has significantly increased over the years in the USA. It is the 10th leading cause of death, according to the Centers for Disease Control and Prevention 2017. The current dominant care models do not address the primary challenges of mental conditions such as ethnicity, beliefs, and preferences achieved through collaborative care (Lake & Turner, 2017). The gap between the mental healthcare needs of the country and the available resources necessitates policy development and advocacy in mental healthcare. Mental health providers are among the oldest medical workforce members, with many psychiatrists arriving at their retirement age or way past the retirement age. In addition to the increased vacancies in training programs, the psychiatry staffing requirements are continuously decreasing, leaving specialty mental health practitioners to solve the challenge of improving access to care. Leadership for mental health that will advocate for providing comprehensive, integrated mental health and social care in a rural-based setting, implementing strategies that promote prevention, and upgrading research-based evidence for quality care needs to be established. Compelling health insurers and Medicaid managed care to incorporate rates of out–of–network examinations for mental health services and take steps to do away with disparities in access to mental care. It is achieved by increasing the incentives for physiatrists and other mental clinicians, promoting models that integrate mental healthcare, such as the collaborative care model, and educating and encouraging advanced practice nurses and other clinicians with proper training to prescribe mental health medication. This way, mental health care will be accessible to most US citizens.

Competency 2: Evaluating the Efficiency and Effectiveness of Inter-professional Interventions in Achieving Desired Population Health Outcomes.

??????????? Developing a patient-centered policy in delivering care and promoting the country's expansion of mental health providers is vital. Policies that favor the increase in specialist psychiatrists will enable most patients to access. Patients with severe mental depressive disorders, including schizophrenia, bipolar, and substance use disorders, will receive health care at minimal costs. Individuals aged 15-44 years lose annual productivity over $ 31 billion in occupational, social, and psychological costs associated with depressed moods (Lake & Turner, 2017). Policies that necessitate health insurers to include off-network costs that patients incur while trying to access providers and medication would nationally shape the future of mental health. A mental health model that integrates inter-professional care delivery is vital in improving patients' quality of life through the collaborative efforts of different stakeholders. A policy to develop a collaborative care model in primary and specialist care settings can incorporate alternative medical approaches and biomedical therapies, providing earlier detection and intervention of mental conditions. Alternative medical plans should be introduced by insurance providers, such as patient-centered interventions where the needs of the patients are placed first, making it easier to understand the core challenges that most patients undergo. Healthcare providers should understand the patient's beliefs and wish to enable them to adjust and anticipate the quality of life, preventing the patient from harming themselves. Expansion of the expertise base to deal with mental health will enhance therapeutic, non-invasive interventions to improve the quality of life.

Competency 3: Analysis of the Population Health Outcomes in Terms of Their Implications for Health Policy Advocacy.

Autism Spectrum Disorder has the traits of impaired social communication and interactions. The expected healthcare interventions relate to developing conceptualized models for handling the extremes of symptoms. For many years, access to mental healthcare has focused on children, with the USA having estimates of 16.8% per 1,000 8-year children (Shattuck et al., 2020). Access to quality healthcare influences the development of healthcare for children with this disorder. The story of the healthcare approaches for children with autism relates to the generation of specific interventions based on the level of the condition (Kilbourne et al., 2018). The severity of autism has reduced in the USA because of consistent access to healthcare services, even into adulthood. The institutional approach enables the children to access financial, social, and emotional support, which has improved the lives of autistic children.

From a workforce perspective, accessing and providing quality healthcare for autism ensures that the condition is detected and necessary. Professionals in autistic children enhance professionalism in the service. The main challenge is developing diverse approaches that influence access to psychological and mental health requirements (Malik-Soni et al., 2021). Lack of structures for planning and preparedness affects the quality of healthcare. The need for additional focus on specialty providers within the healthcare spectrum remains essential in addressing the gaps in providing quality healthcare. An adequate system depends on a change of policy in training and allocating mental healthcare professionals based on the demands of each condition.

Advocating for policy development in other care settings concerning the mental illness problem is essential. Policy development influences the achievements across the system to create the best environment to encourage the achievement of quality healthcare. The healthcare systems develop internal tasks and activities dedicated to quality through policies. The appreciation of developing recurring mental conditions amongst patients is essential in policy reformulation. The transition from autism in children to other mental disorders in adults affects the performance of the primary healthcare systems (Kilbourne et al., 2018). During childhood, accessing an adequate support system is high compared to adult life. From a social perspective, creating policies to promote sufficient support for people with mental disorders remains an essential strategy for compelling healthcare needs. Adults with a history of autism are exposed to depression, anxiety, and poor social integration. The lack of a systematic approach to handling the transitions affects the ability to implement quality healthcare. In autism, losing social connections and interactive capabilities remains a consistent challenge. Factors such as costs, accessibility, social responsibilities, and individual esteem are among the factors that affect everyday lives. Community health development should be one approach that promotes effectiveness in promoting healthcare amongst people with mental disorders (Maddox & Gaus, 2019). Additional measures, such as cognitive behavioral therapy, require dedicated professionals. Lastly, the policy should be instrumental in actualizing consistent and comprehensive healthcare requirements for mentally ill persons.

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References

Kilbourne, A. M., Beck, K., Spaeth‐Rublee, B., Ramanuj, P., O'Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: a global perspective.?World Psychiatry,?17(1), 30-38. https://doi.org/10.1002/wps.20482

Lake, J., & Turner, M. S. (2017). Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care.?The Permanente Journal,?21, 17–024. https://doi.org/10.7812/TPP/17-024

Maddox, B. B., & Gaus, V. L. (2019). Community mental health services for autistic adults: Good news and bad news.?Autism in Adulthood,?1(1), 15-19. doi:10.1089/aut.2018.0006.

Malik-Soni, N., Shaker, A., Luck, H., Mullin, A. E., Wiley, R. E., Lewis, M. S., ... & Frazier, T. W. (2021) Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood.?Pediatric Research, 1. 1-8. https://doi.org/10.1038/s41390-021-01465-y

Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463–467. https://doi.org/10.1017/cts.2020.42

Maddox, B. B., & Gaus, V. L. (2019). Community mental health services for autistic adults: Good news and bad news.?Autism in Adulthood,?1(1), 15-19. doi:10.1089/aut.2018.0006.

Malik-Soni, N., Shaker, A., Luck, H., Mullin, A. E., Wiley, R. E., Lewis, M. S., ... & Frazier, T. W. (2021) Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood.?Pediatric Research, 1. 1-8. https://doi.org/10.1038/s41390-021-01465-y

Richards D., A.? (2012). Stepped care: a method to deliver increased access to psychological therapies. Can J Psychiatry;57(4):210-5. doi: 10.1177/070674371205700403.

Shattuck, P. T., Garfield, T., Roux, A. M., Rast, J. E., Anderson, K., Hassrick, E. M., & Kuo, A. (2020). Services for adults with autism spectrum disorder: a systems perspective.?Current psychiatry reports,?22(3), 1-12. https://doi.org/10.1007/s11920-020-1136-7

Shattuck, P. T., Garfield, T., Roux, A. M., Rast, J. E., Anderson, K., Hassrick, E. M., & Kuo, A. (2020). Services for adults with autism spectrum disorder: a systems perspective.?Current psychiatry reports,?22(3), 1-12. https://doi.org/10.1007/s11920-020-1136-7