Term Paper on "Mental Health and Primary Care the World"

Term Paper 12 pages (3532 words) Sources: 1+

[EXCERPT] . . . .

Mental Health and Primary Care

The World Health Organization has no one official or strict definition of mental health in that cultural differences, subjective assessments and professional theories combine to determine what mental health is (Wikipedia 2006). Most experts, however, agree that it refers to how effectively and successfully a person functions. If he feels capable and competent, is able to handle normal levels of stress, maintains satisfying relationships, leads a relatively independent life and can recover from difficult situations, he is said to be mentally healthy. Primary care, on the other hand, is extended by a health care provider, who acts as the first point of consultation for patients. It is usually provided by primary care physicians at community health centers as opposed to hospitals. Some call or associate it with general practice and family medicine. General practitioners in the United Kingdom are physicians who have completed four years of post-medical education, including three years work in a hospital and another year in the community. Family medicine in the U.S.A. is a specialty, which requires a minimum residency and a Board certification. Primary care manages diabetes mellitus, chronic obstructive pulmonary disease or COPD, depression and back pain. Primary care physicians usually do family practice, internal medicine, pediatrics and sometime obstetrics and gynecology (Wikipedia).

II. Status of the Primary Mental Health Care Industry

Incidence

The World Health Organization estimated in 2001 that 450 million people suffered from mental or neurological disorder and that 25% of the world population could expect to experience it within their lifetime (Nierenberg 2002). Mental illness is a universal condition, which affects people of all nations of all social, economic, and cultural backgrounds, although the poor suffer most from a lack of the most basic resources for effective treatment. WHO established a broad scope of mental health disorders, which include autism, Alzheimer's disease, schizophrenia, depression, sleep disorders, addiction and substance abuse, bipolar affective disorder, panic, anxiety disorders, mental retardation and epilepsy. Records showed that almost a third of global disability from all diseases is due to mental disorders, with depression as the most severe and affecting more than 120 people worldwide. Depression accounts for 12% of global disability and was expected to increase by 15% in 2020. It is second only to heart disease in fatality. Depression may be highest during the middle age, but research indicates that it the elderly and children are not immune to it and other mental health problems, such as dementia and Alzheimer's. One in 10 persons in the U.S. suffers from some defect or impairment of psychological development or from some behavioral, emotional and depressive disorders. Rural isolation and poverty make the problem worse. The mentally ill confront extra burden if they are poor, which may explain why the U.S. has five times as many mentally ill prisoners as patients in mental hospitals. Changing norms can have adverse effects on one's mental health. Separation from traditional and comfortable social environments, dependence on a cash economy, overcrowding, pollution, increased violence in cities and eating disorders, especially among girls, have had disturbing effects on populations. Mental illness also often leads to or makes other health problems worse. Those who already suffer from untreated mental disorders often also suffer from chronic or serious conditions, such as cancer, HIV / AIDS, heart disease, diabetes or addition to drugs, tobacco or alcohol. Suicide has been the most tragic consequence of mental illness and statistics showed that close to a million people commit suicide every year and that 10 to 20 million would attempt it. Suicide has been found to be preceded by severe depression or schizophrenia. Farmers in the U.S. were said to be 1.5 to twice likelier than other groups of men to commit suicide on account of economic hardship and loss of small farms. Battered women in the U.S. were also reported to be give times likelier to take their own lives than any other groups of women (Nierenberg)

Current Approaches

Available treatment methods for mental illness differ among regions and socio-economic classes (Nierenberg 2002). Most patients are prescribed psychotropic drugs, such as antidepressants. The sales of such drugs exceeded $13 billion worldwide and studies showed that the number of Americans taking them has grown to more than two-thirds in the last decade and indicated that they were not securing counseling with their drug therapy with mental health professionals. In developing nations, such drugs are not available to the general population and the mentally ill ended up in hospitals or asylums where they are abused or neglected. Few nations have proper mental health programs, even basic services for mental illness. Twenty percent of depression cases never reach or attain remission and recurrence after the first episode was said to be as high as 60%. Schizophrenia is found in women and men in equal rates and affects 24 million people worldwide. Substance abuse has already affected millions of people in the world and it is a distinctively steep problem in developing countries. Epilepsy has affected nearly 50 million people worldwide. Obsessive compulsive disorder is more common than schizophrenia and affects around 2% of the American population. Between 5 and 20% of those afflicted with eating disorders die as a result of complications because of intense fear of weight gain (Nierenberg).

Recognition and Current Response

Primary health physicians are the first line of contact with the patient and therefore have the earliest and best opportunity to recognize mental health problems and to treat them or refer the patient to specialists (Glied 1998). The sad fact is that only about half of all cases of depression are recognized by primary health practitioners and when they do, they do not treat the patients appropriately or refer them to specialists, according to studies. This failure appears to derive from the constraints of primary care practice, wherein primary care physicians are made to deal with several health problems often in a single visit. They must choose only a few to treat and even then, the time is limited for other worthwhile actions, such as counseling, control of smoking and weight control. These physicians also often do not have the adequate training for recognizing and treating mental illness. Or else, they are not very receptive to such health problems even when made aware of the patient's mental disorder. Studies revealed that a physician's attitude was highly linked with the tendency to diagnose or treat mental illness. In addition, there have been new constraints in primary care practice, which was already a time-limited, cost-conscious and managed care environment. Primary care practitioners received lower rates of diagnosis and treatment from health management organizations or HMOs than those paid by fee-for-service organizations. Short consultations are a constraint on the effectiveness and treatment of mental health problems in primary case. The administrative and gate-keeping responsibilities of managed care appeared to have limited the time primary care practitioners have been able to provide in diagnosing and treating these health problems. Patients who are able to secure longer visits are likelier to be better treated, but those who take long gaps between visits are largely unlikely to be treated. Family practitioners are likelier to treat those with mental health problems than are general practitioners and internists. Findings of other researches suggested that physician specialty and practice style were important factors in the diagnosis and treatment of mental health in the primary care level. Patients with Medicare or Medicaid insurance were more likely to obtain treatment than other patients. Being in the 18-64 age bracket, all Medicare beneficiaries qualify because of disability and are likely to suffer from some mental health problems or disorders (Glied).

Policy Initiatives

Cultural differences and the lack of manpower have hampered the service delivery by primary care organizations but policy initiatives have currently been set into place to enhance its development (Pidd 2004).

The New GMS Contract

This contains a comprehensive chronic disease management framework for a range of health conditions (Pidd 2004). Its mental health indicators provide proactive, structured care to those with severe, long-term mental health conditions or disorders and who require or agree to follow up. Frameworks have also been introduced for enhanced services, including frameworks for patients suffering from depression and alcohol abuse. These frameworks require evidence base for the need, the aim of the enhanced service, a service specification of expected practices, accreditation requirements for physicians who would provide the service, and the payments for the service. Many believed that the new contract would be a real and strong incentive to developing primary mental health care Pidd).

General Practitioners and Practitioners with Special Interest program for these practitioners contains a structured framework within which they can develop services according to their special interests (Pidd 2004). General practitioners or GPs with interest in mental health assumed that their participation would include clinical, educational, liaison, leadership and service development. Current indicators do not yet reflect the use of GPSI in mental health services, but it was viewed to be another opportunity in developing primary mental health care (Pidd).

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