Incentives and Intentions in Mental Health Policy: A Comparison of the Medicaid and Community Mental Health Programs

Gronfein, William

doi:10.2307/2136752

Cited by 178 publications

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“…Hospitals, community agencies, and clinicians require reimbursement for extensive services to patients, who are often indigent (Gronfein 1985). Relatives desire financial security for their loved ones, health insurance from Medicaid and Medicare, and a lessening of the potentially ruinous financial burden of a long-term psychiatric disorder (Lefley 1987;Hatfield and Lefley 1987;Carpentier et al 1992).…”

Section: Sarahmentioning

confidence: 99%

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

et al. 1997

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Persons with psychiatric disorders comprise the largest diagnostic group of disabled recipients of Supplemental Security Income (SSI) and Social Security Disability Income (SSDI). A 32‐month prospective cohort study of pathways to application for and receipt of SSI and SSDI was conducted among 169 people with major psychiatric disorders who were at an early stage of their illness and who had never applied for or received disability income. Of the three pathways that formed the conceptual basis for the investigation—labeling, impairment, and needs/resources—the latter two emerged as significantly associated with receipt. Individuals with more severe symptoms who were African American, and who were psychologically dependent in a primary relationship and financially dependent on their families, were more likely to become recipients. Enabling and disabling aspects of disability income receipt suggest that it may be replacing prolonged hospitalization as the most enduring social role of persons with severe, persistent psychiatric disorders.

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Section: Sarahmentioning

confidence: 99%

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

et al. 1997

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“…However, the literature does not support this notion of efficiency; deinstitutionalization rarely, if at all, followed reduced demand for inpatient psychiatric care. Instead, ideological rhetoric, welfare programs, and fiscal considerations by states initiated and accelerated the process of deinstitutionalization (Cameron 1978;Gronfein 1985a;Mechanic and Rochefort 1990;Grob and Goldman 2006). Moreover, deinstitutionalization represents a rare social policy that was implemented faster and more extensively than anticipated (Mechanic and Rochefort 1990).…”

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confidence: 99%

Does Deinstitutionalization Increase Suicide?

Yoon

Bruckner

2009

Health Services Research

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Objectives. (1) To test whether public psychiatric bed reduction may increase suicide rates; (2) to investigate whether the supply of private hospital psychiatric beds—separately for not‐for‐profit and for‐profit—can substitute for public bed reduction without increasing suicides; and (3) to examine whether the level of community mental health resources moderates the relationship between public bed reduction and suicide rates. Methods. We examined state‐level variation in suicide rates in relation to psychiatric beds and community mental health spending in the United States for the years 1982–1998. We categorize psychiatric beds separately for public, not‐for‐profit, and for‐profit hospitals. Principal Findings. Reduced public psychiatric bed supply was found to increase suicide rates. We found no evidence that not‐for‐profit or for‐profit bed supply compensates for public bed reductions. However, greater community mental health spending buffers the adverse effect of public bed reductions on suicide. We estimate that in 2008, an additional decline in public psychiatric hospital beds would raise suicide rates for almost all states. Conclusions. Downsizing of public inpatient mental health services may increase suicide rates. Nevertheless, an increase in community mental health funding may be promising.

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“…Although the states were responsible for paying the full cost of keeping patients in state hospitals, they now could now transfer them and have the federal government assume from half to three-quarters of the cost. This incentive encouraged a massive transinstitutionalization of long-term patients, primarily elderly patients with dementia who were housed in public mental hospitals for lack of other institutional alternatives (Goldman, Adams, and Taube 1983;Gronfein 1985;Kiesler and Sibulkin 1987;Kramer 1977).…”

Section: Introductionmentioning

confidence: 99%

Public Policy and Mental Illnesses: Jimmy Carter's Presidential Commission on Mental Health

Grob

2005

Milbank Quarterly

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President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short‐lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.

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Incentives and Intentions in Mental Health Policy: A Comparison of the Medicaid and Community Mental Health Programs

Cited by 178 publications

References 0 publications

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

Pathways to Disability Income among Persons with Severe, Persistent Psychiatric Disorders

Does Deinstitutionalization Increase Suicide?

Public Policy and Mental Illnesses: Jimmy Carter's Presidential Commission on Mental Health

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