4 peer responses – due in 4 hours

 Guided Response: Review several of your classmates’ posts.  Provide a substantive response (minimum of 100 words) to at least two of your peers. Are there any similarities and/or differences between available sources or alternative options?  If so, please state the reasons why this may be the case. 

Qiana’s post:
 
Mental health issues affect many people around the world as well as in the United States. Those that are not insured and are unable to recieve the treament and medications they need are especilly vulnerable. These people are a danger to themselve and others. As seen in the vidoe, many of these people with mental illneses don’t have families or people outside of mental institutions to care for them. Therefore, mental health emergency rooms and mental institutions are running over. (ABC News (Producer). (2003).  The mental health illness I have chosen is Schizophrenia. Schizoprenia is a mental disorder that changes the thought process and impairs the person emotionally. The person may experience hallucinations and be socially disfunctional. (Miller, M. et, al.(2017). 
Many patients with this illness receive state and federal funding. Most receive SSI(Social Security Disability). Social Security Income (SSI) is a federal funded income program that was designed to assist aged, blind or disabled person who cannot work and have little to no income.( https://www.ssa.gov/ssi/).   (Links to an external site.)
These patients have to apply for these benfits whether they be SSI or Social Security Disability. To be eligble for these benefits a person woud have worked a job that was covered and also meet the defintion of disablity layed out by the Social Security Administration. (https://www.ssa.gov/ssi/ (Links to an external site.)). People suffering this illness will need these funds in order to pay for medications and other services to cope with their illness. Patients may need different therapies to manage their symptoms, and outpatient therapies as well such as counseling or substance abuse programs. (Burkholder & Nash(2013). 
The two alternative methods of funding for this population would include  the NAMI(National Alliance on Mental Illness) and Medicare or Medicaid. In the NAMI they are a grass root organization and their funding comes in mainly from an individual contributions, corporate sponsorships, dues and grants. This organization helps to educate, advocate, listen and lead. This organization was formed to help those suffering with mental illness live more productive lives. (https://www.nami.org/About-NAMI). (Links to an external site.) Next would be Medicare or Medicaid which also provide funding resources for those suffering with Schizophrenia. Medicare and Medicaid offer behavioral health services and they are the largest payer for mental healh services in the United States. In order to improve access to healthcare for this population congress passed a law for mental health and substance abuse called the Mental Health Parity and Addiction Equity Act (MHPAEA). (https://www.medicaid.gov/medicaid/benefits/bhs/index.html (Links to an external site.)).These two alternative methods both offer services which help this population cope day to day with the illness of schizophrenia, whether its financing or help with medication or treatment long term. If these requirements are not met these people may fall through the cracks of the system and turn to crime, and even drug abuse because they are unable o recieve the treatment they need and more and more people will end up in mental institutions or mental emergency rooms as seen in th video. 
Referencs:
1. Healthcare resource use in schizophrenia, EuroSC findings (Links to an external site.)
Academic Journal
By: A. Millier; M. Horváth; F. Ma; K. Kóczián; A. Götze; M. Toumi. In: Journal of Market Access & Health Policy, Vol 5, Iss 1 (2017); 2. ABC News (Producer). (2003). Healthcare casualties: The underinsured mentally ill [Television series episode].  In America’s Struggling Healthcare System.  New York, NY: ABC News.  Retrieved from the Films On Demand database.3. https://www.ssa.gov/ssi/ (Links to an external site.)4.https://www.nami.org/About-NAMI (Links to an external site.)5.https://www.medicaid.gov/medicaid/benefits/bhs/index.html 

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Alexandra’s post:

 
In many ways, mental illness is the elephant in the room that no one wants to talk about. It’s implications on society are undeniable, but because we don’t often see people bleeding out, it is easily ignored.  In a recent study, mental illness was estimated to affect between 25.7-38.2% of the population (Bode, Vogel, Walker, & Kröger, 2017), a very significant number. And not all mental illnesses are as apparent as a paranoid schizophrenic off their meds or a manic bipolar. The illness I decided to focus on was Major Depressive Disorder (MDD). MDD differs from seasonal depression or other kinds because it doesn’t really go away. There may be times of the year that are worse than others, but without intervention the person afflicted can go through life in a sort of fog or apathy. And what is more interesting (or sad, depending on your view) is that these people are masters at illusion. A person suffering from MDD can still laugh and smile along with their peers, but the genuine emotion that goes alongside is often absent.
            Due to its long term nature, MDD is very hard for providers to convince their patients to continue treatment. Often, people begin to feel better with appropriate medication, and they will choose to discontinue, or the efficacy of a given combination has lessened due to prolonged exposure (Broder et al., 2019).  Despite being one of the most diagnosed mental illnesses (3.9-6.0% (Bode, Vogel, Walker, & Kröger, 2017, p. 1125)), there isn’t much by way of community resources available. In my situation, there are no mental health facilities within 50 miles, so our primary care providers are responsible with identifying, treating, and maintaining a patients mental health.
            The estimated cost of a patient suffering from MDD can difficult to measure. An uncontrolled episode of MDD can prevent an employee from coming into work. It can present itself with physical symptoms such as lack of appetite, weight gain, or other stress factors, which can lead to more expensive treatments. And perhaps one of the most costly effects is for those who fail to comply with recommended treatment. It can take upwards of 6-8 weeks for antidepressants to alter a person’s mental state meaningfully (Broder et al., 2019), and in some cases alternative medications (which may not be covered by insurance) are the best course. As mentioned in our text book, mental health is big business, with the majority of care paid for my public funding options, with over 1/5 of those suffering from chronic mental conditions being uninsured (Burkholder & Nash, 2014).
            I think one method of funding could be applied to this issue is pooling enough funding to hire a mental health professional for the area, or at least host seminars for our primary care and emergency providers to know what to look for and how to educate their patients on the issue. Another funding option is to find rural grants which are geared towards assisting rural communities in acquiring the necessary care.
References
Bode, K., Vogel, R., Walker, J., & Kröger, C. (2017). Health care costs of borderline personality disorder and matched controls with major depressive disorder: A comparative study based on anonymized claims data. The European Journal of Health Economics, 18(9), 1125-1135. doi:10.1007/s10198-016-0858-2
Broder, M. S., Greene, M., Yan, T., Chang, E., Hartry, A., & Yermilov, I. (2019). Medication adherence, health care utilization, and costs in patients with major depressive disorder initiating adjunctive atypical antipsychotic treatment. Clinical Therapeutics, 41(2), 221-232. doi:10.1016/j.clinthera.2018.12.005
Burkholder, D. M., & Nash, N. B. (2014). Special populations in health care Jones & Bartlett Learning, LLC. Retrieved from https://content.ashford.edu/books/AUHCA430.13.3 (Links to an external site.)

 Guided Response: Review several of your classmates’ posts.  Provide a substantive response (minimum of 100 words) to at least two of your peers. Contrast your research to your peers’ findings in terms of barriers. Are your peers’ recommendations feasible? 

Alexandra’s post:

 
Sadly, as of 2016, Idaho had the 8th highest rate of suicide in the country, (Idaho Health and Welfare, 2018). When the statistics were broken down, it was found that the highest rate of suicide was by adult, using firearms. Fortunately, the rate of homicide in all of Idaho was 33 (ISP, 2019). A major organizational barrier in my community with regards to handling those prone to suicide or homicide is access to mental health care. According to our textbook, there is an organization that was created to help, which in theory sounds wonderful. The Public Health Objectives for the Nation 2020 (PHON) has a goal of “increasing the number of primary care facilities offering mental health treatment services,” (Burkholder & Nash, 2014) as well as increasing the depression screenings within primary care.
            Honestly, having trained primary health care workers is a great start, but to be most effective, I think a trained mental health professional, whose sole purpose is to keep up to date and to train the staff on mental illness would serve even better. Providing incentives for mental health professionals to move to the area, and to show our young adult population what such a career can provide would help increase the interest and hopefully the number of mental health professionals willing to commit to rural health care, which is a challenge in all areas.
            As it stands right now, a person in acute mental distress, at risk of either homicide or suicide is taken to the nearest Emergency Room, and depending on their perceived stability, will be transferred to either a private mental health facility called Canyon View or if they are deemed a risk to others, a state mental facility over 2 hours away. The problem is, there are so few beds, sometimes we have to hold them before a bed becomes available, and there is honestly nothing my facility can do for them.
References
Burkholder, D. M., & Nash, N. B. (2014). Special populations in health care Jones & Bartlett Learning, LLC. Retrieved from https://content.ashford.edu/books/AUHCA430.13.3 (Links to an external site.)
Idaho Health and Welfare. (2018). Suicide in idaho. (). Retrieved from https://healthandwelfare.idaho.gov/Portals/0/Users/145/93/2193/Fact%20Sheet_September%202018.pdf (Links to an external site.)
ISP. (2019). Idaho state police uniform crime reporting. Retrieved from https://nibrs.isp.idaho.gov/CrimeInIdaho/Home/Index

Amanda’s post
 
Over the past 10 years there have been more than 60,000 Californians die form either homicide or suicide, as of 2017 there have been 6, 500, roughly 4, 300 suicides and over 2,000 homicides according to the California Department of Public Health.  In Monterey county where I reside there were 45 homicides in 2017 and 35 suicides.  Monterey county had the highest homicide rate among 10 to 24 years old in 2016, mostly gang violence. Most of the homicides are gang related by to rival gangs nortino and sorrenos, this has effected me personally as well as homicide. Gun violence is a huge issue in Monterey county. Suicided contributes significantly  to mental  health, one of the major barriers is access to mental health facilities. We have four major hospitals in the county I reside in and the beds are always full, there are always people waiting for beds and waiting to be evaluated, it is a huge issue this county faces daily. I know first hand because I work in the Emergency room.  In the Emergency room who hold suicidal patients for up to 3 days, there are only 2 psych facilities in our county., often times they are transferred  to other facilities up to 3 hours away by ambulance. One major financial barrier is lack of finances, lack of insurance, and lack of education on these barriers. Money places a huge role in homicide and suicide, often times people fell they have no hope and no way out of there situations, the only solution for them is suicide and or homicide. 
These two barriers can be reduced by bringing in more psych Physicians, offering incentives to come to certain communities with higher suicide rates and risks can help significantly by getting these patients seen faster freeing up beds in mental health facilities. If healthcare workers all work together and these facilities are staffed properly with the appropriate resources and Physicians needed it will make a difference. Two local resources that are available in Monterey county for suicide/homicide prone individuals are a suicide hotline open 24 hours a day, it offers resources, information, and counseling, it is called suicide prevention service. There is also thee National Alliance on mental illness, there slogan is find help, find hope, they offer support groups as well as family support and resources in program facilities. I believe these resources fully meet the needs of the population, as for the community knowing there is help out there with these places and other places exist is not always the case, in most cases they are young and just do not have the knowledge or resources to know. It my job and the emergency room staff to make sure they are aware that help is out there and hope is not lost. In most cases I see these individuals are strained from there families and friends, healthcare workers in the community can help and be there for them. Homicide personally effected me, my brother was murdered in 2002 by gun violence, it has been a huge struggle in our family and left a huge hole, all though time has moved us on it is still something our family can not shake, is spirit is always with us as well as in our hearts. According to the NAMI (National Alliance on Mental illness) “like any other health crisis, it is important to address a mental health emergency quickly and effectively.” 
Resources:
Burkholder, D. M., & Nash, N. B. (2014). Special populations in health care Jones & Bartlett Learning, LLC. Retrieved fro https://content.ashford.edu/books/AUHCA430.13.3
California Department of Public Health, Center for Health Statistics and Informatics, Vital Statistics Death Statistical Master Files (2008-2017).
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control (2017). Web-based injury statistics query and reporting system (WISQARS). Retrieved from www.cdc.gov/injury/wisqars (Links to an external site.)
“National Alliance on Mental Illness (NAMI) Family-to-Family Education Program“. U.S. Department of Health and Human Services: Substance abuse and Mental Health Administration. Archived from the original on 19 July 2014. Retrieved 21 July 2014.

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