CAUSES OF DI
description
Transcript of CAUSES OF DI
![Page 1: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/1.jpg)
![Page 2: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/2.jpg)
US PUBLIC INPATIENT 1830-1955
0
100
200
300
400
500
600
1830 1875 1920 1955
residents
![Page 3: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/3.jpg)
PUBLIC INPATIENT 1955-2006
0
100
200
300
400
500
600
1955 1970 1990 2006
residents
![Page 4: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/4.jpg)
CAUSES OF DI
• 1. DRUGS• 2. PHILOSOPHICAL CHANGES• 3. LEGAL CHANGES• 4. ECONOMIC CHANGES
![Page 5: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/5.jpg)
![Page 6: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/6.jpg)
![Page 7: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/7.jpg)
![Page 8: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/8.jpg)
![Page 9: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/9.jpg)
I. DRUG TREATMENT
• ANTI-PSYCHOTICS THORAZINE AND LITHIUM IN MID-1950’S
• DON’T CURE BUT CONTROL• IMMEDIATE SUCCESS• EASY TO ADMINISTER• NEW HOPE AND OPTIMISM• BUT MAJOR CHANGES 1970 -
![Page 10: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/10.jpg)
II. PHILOSOPHY
• 1. ANTI-MENTAL HOSPITALS - E.G. CUCKOO’S NEST
• 2. PRO-COMMUNITY TREATMENT - 1960’S
• LIBERAL PHILOSOPHY OF GOVERNMENT
• STRONG FEDERAL ROLE – BYPASS STATE MENTAL HOSPITALS
![Page 11: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/11.jpg)
CMHC
• BUILD LARGE NETWORK OF COMMUNITY MENTAL HEALTH CENTERS (CMHC)
• FEDERAL – LOCAL PARTNERSHIP• SERVED DIFFERENT POPULATION
THAN STATE MENTAL HOSPITALS - LESS SERIOUS, EASIER TO TREAT
![Page 12: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/12.jpg)
CMHC
• NOT INTEGRATED WITH STATE HOSPITALS - FEW PROGRAMS FOR S.M.I.
• CREATED GREAT GAP IN CARE – HOW FILL OLD ROLE OF STATE HOSPITAL?
![Page 13: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/13.jpg)
III. LEGAL
• JUDICIAL AND LEGISLATIVE CHANGES
• 3 ASPECTS - COMMITMENT TO HOSPITAL, CONDITIONS IN HOSPITAL, RELEASE TO COMMUNITY
• MOVE FROM MEDICAL TO LEGAL MODEL
![Page 14: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/14.jpg)
MEDICAL AND LEGAL
• PRIMACY OF HEALTH
• PATERNALISM• BETTER SAFE
THAN SORRY
• PRIMACY OF LIBERTY
• ADVERSARIAL• NO TREATMENT
UNLESS NECESSARY
![Page 15: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/15.jpg)
1. COMMITMENT
• UP TO 1970 PRIMACY OF MEDICAL • ANYONE CAN BRING PETITION
ASSERTING MENTAL ILLNESS• M.D. MUST SIGN• ROUTINE EXAM BY COURT PSYCH.• BRIEF HEARING• ALMOST ALL COMMITTED
![Page 16: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/16.jpg)
1970-2006
• EXPANSION OF LEGAL MODEL FOR COMMITMENT
• HAD BEEN “MENTAL ILLNESS”• NOW - DANGER TO SELF OR OTHERS• SOMETIMES GRAVELY DISABLED• SPECIFIC AND OVERT ACTIONS• PROCEDURAL PROTECTIONS
![Page 17: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/17.jpg)
• EMERGENCY COMMITMENTS FOR BRIEF PERIODS - 2 WKS OR MONTH
• OLMSTEAD DECISION – 1999: LEAST RESTRICTIVE ALTERNATIVE
• UP TO STATE TO PROVE NEED FOR COMMITMENT
COMMITMENT
![Page 18: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/18.jpg)
2. WITHIN HOSPITAL
• MANDATED STANDARDS OF CARE WITHIN HOSPITAL – TREATMENT, STAFF RATIO, LIVING CONDITIONS
• RESTRICTIONS ON SOCIAL CONTROL - FRUMKIN
• HITS PT., BLINDS ATTENDANT GETS 2 HOURS OF SECLUSION
![Page 19: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/19.jpg)
3. RELEASE FROM HOSPITAL
• BURDEN OF PROOF ON STATE FOR WHY SHOULD KEEP IN HOSPITAL
• HEARINGS AT REGULAR PERIODS – EVERY SIX MONTHS OR SO
![Page 20: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/20.jpg)
COMPARE CUCKOO’S NEST
• MORE TRUE PRE-1970’S THAN NOW• NOW MORE LEGAL THAN MEDICAL:
STATE MUST JUSTIFY HPT.• “VOLUNTARIES” WOULDN’T BE THERE
– OUTPATIENT• CHRONICS IN NURSING HOMES• PROBLEM NOW IS LACK OF FACILITIES
![Page 21: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/21.jpg)
REASONS FOR LEGAL CHANGES
• CIVIL RIGHTS MOVEMENT• ECONOMIC PRESSURE TO REDUCE
HOSPITAL POPULATIONS
![Page 22: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/22.jpg)
IV. ECONOMIC
• STATE HOSPITALS VERY EXPENSIVE• DI CLAIMED TO SAVE MONEY• IN FACT, SHIFTS ECONOMIC BURDEN
FROM STATES TO FEDERAL GOV.• FEDERAL WON’T PAY INPATIENT
TREATMENT IN SMH BUT WILL FOR TREATMENT OUTSIDE HOSPITALS
![Page 23: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/23.jpg)
FUNDING FOR TREATMENT
• MEDICAID – POOR; FEDERAL/STATE• MEDICARE - ELDERLY; FEDERAL
PROGRAM• BOTH GO TO PROGRAMS NOT TO
INDIVIDUALS• NEITHER PAYS FOR TREATMENT IN
MENTAL HOSPITALS
![Page 24: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/24.jpg)
SSI
• SUPPLEMENTAL SECURITY INCOME • FEDERAL PROGRAM• TO INDIVIDUALS FOR LIVING
EXPENSES• NEED DISABILITY, LOSS OF
FUNCTION, DURATION
![Page 25: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/25.jpg)
SSI
• NOW MAJOR FUNDING FOR SERIOUSLY MENTALLY ILL
• ABOUT $700/MONTH• GOOD – PROVIDES SUPPORT• BAD – FOSTERS DEPENDENCY AND
DISINCENTIVE TO WORK
![Page 26: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/26.jpg)
RESULTS OF ECONOMIC CHANGES
• NO FEDERAL FUNDING FOR STATE HOSPITAL TREATMENT
• MORE TREATMENT IN GENERAL HOSPITALS
• MORE TREATMENT OF ELDERLY IN NURSING HOMES
• SOME FUNDING FOR COMMUNITY TREATMENT
• MUCH MORE CONSUMER CHOICE
![Page 27: CAUSES OF DI](https://reader034.fdocuments.in/reader034/viewer/2022051821/56815c59550346895dca5d04/html5/thumbnails/27.jpg)
SUMMARY
• MANY CAUSES OF DI• MOVEMENT FROM HOSPITAL TO
COMMUNITY• SOME IMPROVEMENT IN LIVING
CONDITIONS AND CHOICE• MANY GAPS