Lesson 5: The Health Care System
Attention
Does anyone really care?
When others are suffering, does anyone care?
We are going to look at the mental health care system in this Lesson. We have to recognize that the services provided by the mental health care system are always changing based on evidence based practice, research and health care insurance coverage. Any time when studying something that is ever changing this creates unique challenges and thinking WAY OUTSIDE the box may be required!
Learning Outcomes
Upon completion of this lesson's material, students will be able to:
- Describe the mental health service system and the four major components.
- Contrast the responsibilties of the federal, state, and local mental health systems.
- Define the types of mental health services that are available in the United States.
Teaching
Why is health insurance important in the field of mental health. It is important for a number of reasons. The first is that mental health services are primarily paid for by an individual's health insurance. If an individual does not have health insurance then they either need to access services that are free (they exist but are limited) or have to pay "out of pocket" meaning pay the full cost themselves. Many mental health services are primarily funded by MaineCare which is the name for the Maine Medicaid program. Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.
Please read this webpage about MaineCare (Maine Medicaid) and follow the links about how to apply: https://www.medicaid.gov/medicaid-chip-program-information/by-state/stateprofile.html?state=maine .
Under the Affordable Care Act every American citizen is expected to have health insurance or they will need to a penelty fee to the US Goverment when they file they tax returns. Some of you may have heard the term "Obamacare". There is no insurance called Obamacare, this is just the name given to the fact that everyone needs to have health insurance due to the rules of the Affordable Care Act which was signed into law by President Obama.
Here is a brief video about the essence of the Affordable Care Act:
How Does the Affordable Care Act Work? (https://www.youtube.com/watch?v=vju70I6qSKk)
If you are interested in longer history of Health Care Reform that then lead to the Affordable Care Act you can watch the following video:
ObamaCare: The Affordable Care Act Explained (https://www.youtube.com/watch?v=Dqabs9xysYA)
The Affordable Care Act has created a lot of challenges for individuals who are just above the poverty level but who do not have health insurance provided for them through an employer. The costs they may have to pay for health insurance are very high.If a person has some income or resources (money in saving) they many not be eligible for MaineCare. They then need to explore what other types of health insurance they many be eligible for. They first should explore what is available through their employer. If the employer does not offer an insurance plan then the individual needs to use the Health Care Marketplace.
To learn more about the health insurance situation here in Maine Click HERE (https://www.healthinsurance.org/maine/) to review the health care insurance situation in Maine under the Affordable Care Act.
The next thing I am going to have you do is to enter the Health Care Marketplace. Every state is mandated by the Affordable Care Act to create a Health Care Marketplace. In the marketplace is where an individual can go to find health insurance if they do not work or their employer does not offer an insurance plan.
- Click HERE (https://www.healthsherpa.com) to "shop" for health insurance.
- Go through the intial steps of researching plans until you get to the list of different plans and prices you can access.
- Research the details in different plans to see how they compare in terms of mental health services.
As we look at the costs of the health care, here is an article that looks as the costs of health care as an individual ages. Maine is now the oldest state in the country meaning that Mainers, on average, are older that people who live in other states across the US. This means that the likelihood you will be working with older adults is very high. It is going to be important for you to understand how health insurance works into retirement for both yourself (since you should be always be thinking about how to save for your own retirment) as well as how to help clients be planful about accessing services and health care during their retirments. This article is from August 2016 so I consider the numbers very accurate to the current situation due to the recentness of the article.
Read the following article: http://www.twincities.com/2016/08/27/on-the-money-retired-couples-will-need-260000-for-health-care-investment-firm-estimates/
The most important thing you have is your health. If the statistic is correct, the illness that results in your death, notwithstanding sudden accident or catastrophic organ failure, will result in your spending a signficant amount of time and finances to try to slow down or stop the illness from progressing.
It is estimated that for the case of schizophrenia, 1 in 10 patients (10% of people with the diagnosis of schizophrenia) will act on a behavior that is life threating and at least 1 to 2 of that 10 percent will die from behavior. One of our adjunct faculty members shared this story: Years ago, he was driving on the Brooklyn-Queens Expressway (BQE), returning home from having gone out to enjoy bruch with his wife. He missed hitting someone who was standing in the roadway. This particular individual had been arrested many times before for doing just what he had witnessed him do that day. He was DIRECTING traffic on a blind curve. You would not see him standing in the middle of the road. Hitting him would be a disaster for him, the profession and his wife. In such an accident, you do not run someone over. You run UNDER them. They go into the air and can land on your car. This is why deer, and moose accidents, at least in Maine, are very serious affairs. Animal can actually go through your windshield as could a person if hit a certain way. Why was this man doing "police-duties" on the expressway? Every time he was arrested, he would have gone to Belllevue Medical Center, in Manhattan, for psychiatric evaluation. During assessment at the hospital they would have assess if he was intoxicated, presenting with hallicinations (seeing, feeling or hearing things that are not there) or delusions (believing things that are not true or real) and if he was at risk of harm to himself or others. If he presented without intoxication and did not indicate any signs of mental health issues he may have been released if he "promised" not to return to the expressway. Who would have been there to care about him? We will never really know. If he was homeless and without financial resources including health care coverage then what services might he have had access to. The choices might be limited.
We are living with a "broken-system." A for-profit health care delivery system (many insurance companies are for-profit, their goal is to make money and work hard to reduce costs which may result in denying people medical care). This systme leaves out many, many, many who desperately need help as they enter treatment, need follow up care, speciality services, long term support or relapse prevention.
Assessment
Lesson 5 Quiz
- Describe what you found out about mental health care coverage from looking at ""marketplace" websites and the readings in this lesson. Share what your costs and deductibles would be.
- Persons with mental illness receive their services through the medical health care system. Discuss the relationship of mental illness and the mendical health care system. How do the systems work together and how do they work against each other?
Lesson 5 Assignment
For this assignment you are going write up a script of a scenario that can create a number of ethical and boundary dilemmas. You are going to type up a script using a word processor (Pages, Microsoft Word) and upload this document into Blackboard. Make sure you name is a the top of the script so I know who wrote it.
Here is the situation:
You have client by the name of Darlene Smith. You are Darlene's Community Integration Worker and have been working with her for a few weeks. When you arrive at Darlene's house for your usual Monday at 2:00 p.m. visit you find another person is also visiting Darlene. Darlene lives alone and there has been no one else present for your last 3 Monday visits. Your plan was to clarify Darlene's treatment plan today which includes starting substance abuse treatment, contacting the Maine Tobacco Helpline and scheduling a visit with a psychiatrist to make sure her medications are still appropriate. Now how are you going to talking about these very sensitive subjects with another person here. As you enter you say hello to Darlene and hope she introduces you to her friend. Darlene then introduces you to Frank Reunion. As soon as you hear his name you know he is a former client of the agency you use to work at. You had worked with Frank a couple of times when he was in crisis when you were on call. What do you do?
You need to write out a script like you were having a conversation with Darlene. It can start like this:
(For example the Community Integration Work = Wendy)
Wendy: Hi Darlene, so nice to see you again. (enter her apartment)
Darlene: Hi Wendy. I'm glad you made it today. Come on in. Let me introduce you to my friend Frank Reunion.
Wendy: Hi Frank, nice to meet you. (shake his hand) So Darlene, I know we had a lot of things you wanted to talk about today. We were going to work on your plan and review some other things. What would you like to have us talk about while Frank is here?
Now this is your chance to be creative.... What does Darlene say next? What does Frank say? Do you let Frank or Darlene know you recognize him? What if he says he recognizes you? What do you do during your time together?
Lesson 5 Discussion (for online class only)
What were your thoughts are the "On the Money: Retired couples will need $260,000 for health care, investment firm estimates" article? Do you feel you be ready to retire based on your current savings plan? How might you help clients be realistic about the costs of health care in the short and long term?