NR554 Week 1 Discussion, Problem Identification for Public and Policy Decision Makers

Problem Identification for Public and Policy Decision Makers NAME Chamberlain College of Nursing NR554: Nurse Leader and Healthcare Policy DATE Nursing leaders and bedside staff are often confronted with problems that affect their workflow and ability to deliver best practices to their patients. One example of a policy that has been adopted by many healthcare organizations to reduce confusion and improve efficiency in communication is the use of the SBAR (Situation, Background, Assessment, & Recommendation) tool to ensure clear, concise, and effective communication between professions. Describe a situation or issue that you see within your work environment or local community related to a healthcare issue and describe what you believe the solution would look like. Week 1: Problem Identification for Public and Policy Decision Makers Today the demand for public behavioral health services is extremely high as the crisis in mental health care continues. According to the Agency for Healthcare Research & Quality Statistics, "in 2007, one in eight people, or nearly 12 million hospital emergency department visits, were for mental health disorders, substance use or both" (2010). Increasingly, emergency departments are struggling with the increasing number of mentally ill patients falling through the cracks due to lack of needed mental health services and supports. Patients requiring more intensive psychiatric care are often “boarded” in the ED for additional hours to days as they wait for the transfer process to complete or for beds to become available. This process frequently results in ED overcrowding, which lowers the quality of care for mental health patients and results in higher risks of adverse outcomes for all ED patients. Mental health services delivered through the ED require more than twice the time as the average medical protocol offered in the same setting. Psychiatric boarding can have a significant impact on already scarce ED resources. Boarding mental health patients result in increased nursing and security staffing, has a significant financial impact on ED reimbursement, increases costs associated with unnecessary diagnostic and laboratory tests required by inpatient psychiatric treatment programs prior to accepting a patient from the ED for admission and transfer (The Joint Commision, 2015). Additionally, psychiatric boarding prevents ED beds from being used for new patients and delaying treatment of other ED patients. Causes According to The Joint Commission, Division of Health Care Improvement, "factors contributing to the boarding of psychiatric patients in the ED include a lack of screening tools or evaluations by qualified psychiatric clinicians, requirements for pre-authorization of insurance prior to admission, a lack of appropriate levels of outpatient care, the lack of available mental health services, and the scarcity of qualified professionals to treat psychiatric patients" (2015). Solutions The need for better psychiatric emergency care has sparked action among patient advocates, providers, health systems, professional organizations, and policymakers. The use of telepsychiatry can connect mental health patients with needed care while also decompressing crowded EDs. Benefits to the patients and hospitals have included faster psychiatric consults, earlier diagnosis and treatment, improved ED throughput, fewer inpatient admissions, and better patient and staff satisfaction. A barrier to implementing telepsychiatry include reimbursement. Reimbursement is generally limited by private payers and Centers for Medicare and Medicaid Services. Case Scenario In 2009, South Carolina Department of Mental Health (SCDMH) officials develop a statewide Telepsychiatry Emergency Department Consultation Program to help hospital emergency room patients experiencing a behavioral crisis (“S.C. telepsychiatry ED”, 2013). Telepsychiatry services were implemented in 18 EDs in South Carolina. During a video exchange, a 20-30-minute assessment occurs between the psychiatrist and the patient. Written recommendations are made to the emergency department staff upon conclusion of the assessment. Recommendations may include medication, counseling, discharge to a community referral for continuing treatment, or transfer to a longer-term psychiatric bed for inpatient treatment (“S.C. telepsychiatry ED”, 2013). SCDMH officials have found that since the implementation of the program patients discharged following a consultation had a significantly higher rate of accessing mental health aftercare in the community, thereby reducing their risk of readmission to an emergency department and preventing overcrowding. References Agency for Healthcare Research and Quality. (2010). Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases. Retrieved from The Joint Commission, Division of Health Care Improvement. (2015). Alleviating ED boarding of psychiatric patients. Quick Safety, 19. Retrieved from S.C. telepsychiatry ED consultations promoting timely care, cost savings. (cover story). (2013). Mental Health Weekly, 23(41), 1-7 Response to Peer: Mental health patients that are incarcerated Katherine, Our system is unfair to those struggling with mental illness. The Community Mental Health Act of 1963 prompted the governments to close many state-run psychiatric facilities in the late 1970s. However, the government didn't replace them with community care, and by default, the mentally ill often ended up in the prison system. The prison environment itself is a major obstacle to mental health treatment for inmates incarcerated with a mental health disorder. Prisoners suffering from mental illness often find their condition exacerbated and amplified by their incarceration. Incarceration has negative effects on mental health, including overcrowding, violence, enforced solitude, lack of privacy, lack of meaningful activity, and isolation from social networks. And when their incarceration ends, many mentally ill and drug-addicted prisoners are sent back into the world without basic tools they need to succeed, such as ready access to medication, addiction counseling, or adequate support and oversight. When mentally ill patients are cycled through the justice system, opportunities are missed to link them to treatment that could lead to drastic improvements in their quality of life and public safety. I believe there are more positive solutions to incarcerating individuals with mental illness compared to asylums. The National Alliance on Mental Illness, NAMI, recommends reform mental illness treatment laws and practices, reform jail and prison treatment laws, implement and promote jail diversion programs (i.e. mental health courts), use court-ordered outpatient treatment, nationwide expansion of crisis intervention team (CIT) programs for law enforcement, encourage cost studies, establish careful intake screening, institute mandatory release planning and provide appropriate mental illness treatment (2015). Reference National Alliance on Mental Illness. (2015). Treatment, not jail: It’s time to step up. Retrieved from Response to Peer: Disparities in the availability of well-trained behavioral health professionals among states and between urban and rural areas. Rhonda, Its true mental health care needs are not met in many rural communities across the country because adequate services are not present due to accessibility and availability. The unique geographical and cultural challenges to service delivery in rural America hamper the effectiveness of current delivery models. One innovative approach to minimize the challenge of providing mental health services and expand the mental health workforce is by expanding the use of telepsychiatry or telemental health. The goal of telepsychiatry is to enhance patient access to mental health services in any situation where there is a patient with a psychiatric or mental health need and a psychiatrist is not readily available (Grady, 2012). Although telepsychiatry shows potential is increasing accessibility of mental health services to patients in rural areas and improving patient outcomes, one policy barrier to implementing telepsychiatry is the issue of Medicare reimbursement. As of 2014, the Center for Medicare Services (CMS) does cover telemedicine and telepsychiatry services in many areas. Reimbursement through Medicare is dependent on the location where the consumer is receiving services, known as the originating site. The originating site must be in a rural location deemed a Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA) (Centers for Medicare & Medicaid Services, 2018). In addition, the originating site must be a medical facility such as a hospital, rural health clinic, federally qualified health center, skilled nursing facility or a community mental health center (Centers for Medicare & Medicaid Services, 2018). Reference Centers for Medicare & Medicaid Services, Medicare Learning Network. (2018). Telehealth services: MLN booklet. Retrieved from Grady, B. (2012). Promises and limitations of telepsychiatry in rural adult mental health care. World Psychiatry, 11(3), 199–201.