It is important for the people with severe mental illness in the community to receive the right form of treatment, rehabilitation, and support services in the right institution. Getting access to the right agency became difficult and time consuming. This makes the patients to increasingly encounter challenges as they try to access these facilities. Mental Medicare is getting out of the hands of the community- based practices because of the declining reimbursement and federal budget policies (Drake 78). A good percentage of Americans today suffer from mental illness because political and social forces have decided to deinstitutionalize health care services such that everything is taken back to the community. They contend that outpatient have the ability to live a more independent and comfortable life more than the inpatient. This paper seeks to support the fact that institutionalized hospitals are better off as compared to community- based hospitals.
Community-based health care for everyone in the society regardless of their ages, gender, religion or race, provided these persons need healthcare at their homes (Drake 78). The community healthcare encompasses home support, nursing, physiotherapy besides other rehabilitation services. In community health care, nurses would often visit elderly persons at their homes to assist them in medication. At the same time, a home support worker can easily assist a child who is on a wheel chair with certain personal care like bathing. Community health care is thus, facilitated by passion for the job and entirely commitment. For the sake of success, the service entirely has to be accepted by the medical team as the best system to use. To ensure there is efficacy in the administration of duties, there is always a community care Access Centers whose roles include arranging for health and personal support services to attend to the patients’ homes, they also authorize services for the special needs children in their respective schools. Moreover, these centers also manage the admission to long term health care facilities especially for the elderly people in our society. More significantly, the centers will disclose information and referrals about other community agencies and services. Ontario Community Support Association is among the most successful community based systems that have thrived in the American territory. However, being a capitalist community, Community based treatment is deemed to fail in America. The system is surrounded by countless shortfalls and it has encountered a lot of challenges. Below are shortcomings of the community based treatment.
Inconsistent Long Term Treatment
Generally, long term treatment needs commitment and consistency in the administration of the medication. Most of the treatments call for better for a continuous treatment that is framed on a particular timing. The severely mentally ill patient is always given a prescription and a dosage that covers a given to. Some of the doses may take up to months. Some may need daily injection at different times of day. Some of the patients lack commitment to their dosage and needs monitoring. However, community healthcare treatment makes the process of achieving this very difficult due to labor and other constraints. The world is experiencing a shortage of healthcare practitioners while the number of ailments is increasing. This indicates that the number of the patients is day by day becoming more. The healthcare practitioner ratio to patients is also increasing. One doctor is supposed to take care of very many patients at a time. Sometimes these patients may be located in different places yet they need the attention of the same doctor. The divided attention results in inefficiency in the administration of medication to the patients. If proper timing is not done, the healthcare practitioners are most likely to under deliver and sometimes there could be inconsistency of medication. Most patients are not careful in taking their medications. Most of the times the patients view taking their drugs as a punishment and they don’t enjoy taking the drugs. When such patients are under the fate of a community treatment, they will even become lazier since there is no nurse around that may remind them of the medication.
Inconsistence of medication of some of these ailments may result in very chronic conditions that worsen the state of the patients. Such diseases would best be handled under the healthcares services and. Therefore, community treatment remains s to be inefficient and is characterized by these inefficacies. Therefore to avert all these inefficacies, there is a need to address these problems by at least coming up with a newer system that will help us address the challenges brought forth by this system of treatment. An institutionalized medication system would work better.
Provision of health care services needs a lot of funding both by the government and by the private sector. Medical facilities are quite expensive and accountability remains an issue of concern. This accountability can only be made effective if at all there is an organized system to control the funds. Directing finances in an organized centralized system is much easier than directing the finances to a decentralized system that the community treatment provides. Community treatment thus, makes it quite difficult to control the finances. There is lots of recurrent expenditure that is likely to be incurred in a community treatment that could easily be avoided if this system were abolished. The government does not feel the burden and the urgency of catering for the health of people who are at their homes. Knowing those who are sick and generally evaluating the health of the citizens remains is very difficult for the government that promotes community treatment. Therefore, there is a lot of laxity broth forth to the government and this negates the provision of the needed finances to help cater for the medical needs of the citizens. The government does not feel the real weight of the needs of the citizens. vast underfunding then characterizes this system of treatment. Lack of concern to maintain the medical facilities are also rampant is societies that support community treatment. The patients are thus left at the mercy of the nurses and other health practitioners who may be compelled to go beyond the little finances they are likely to be accorded. The government is also seems to under estimate the financial obligations since keeping and retrieval of accurate data regarding the health care obligations. Moreover, the government will under estimate the roles played by the health practitioners. The consequence of these is vast underfunding of the activities conducted by the health care practitioners and in finding the activities of the sector. Lack of trust may also arise since auditing the activities carried out by the health care practitioners is difficult when they work under community healthcare treatment. Under funding remains a threat to the existence of medical services in the society. Financing the indirect expenses remains a challenge to the financiers of medical facilities. Funding alone is not enough; however management of these funds is also important for the health care centers. In most of the community- based health care centers, there is misappropriation of funds. the little
Inability to Force Treatment
Treatment should be sometimes enforced by the health practitioners. The mentally ill are always irrational in their judgment and their reactions maybe unpredictable. In as much as many people have debated about forced treatment and liberty, we can all accept that the rationality of the mentally ill is not right and their judgment is usually impaired. The society must accept that if the mentally ill are left alone to make their own judgment regarding their own life, then they may not make the best judgment ever (Steadman et al 96). We must be protectors of our brothers when they are in need of our support like when they are sick. Giving these people a proper medication therefore, remains the duty of those around these persons. However, when these people are in a faire laissez environment, forcing treatment is like a night mare. It’s quite impractical. The mentally ill need very close attention that can only be achieved when they are placed in an institutionalized healthcare environment. However, when things remain the same in a community environment, healthcare practitioners are likely to experience the challenge of forcing the patients to get treated. Moreover, community treatment may require that the nurses and the doctors reach to the patients at their respective homes (Drake 56). This could be very challenging to the patient who are mentally ill and at the same time hate medication. These patients may do anything possible to lock the health practitioners off their compounds. There are precedent cases where these patients have physically thrown the doctors out of their compounds physically and forcefully. The challenges escalate and patients are even devising new means of keeping their compound hostile to the patients. In real sense, it doesn’t make sense, to go to somebody’s compound and coerce him to heed to your demand and commands especially when they are mentally
Low Number of Hospital Beds
Community based treatment puts much emphasis on outpatient treatment. In this system, it is the doctors that move to the homes of the patients ton offered medication. The patients are attended to on their door steps and little emphasis is placed on the need for inpatient treatment. However, truth be told, there are certain situation when inpatient treatment becomes mandatory. In as much as community treatment calls for more attention on nurses attending to patients outside the hospital, there are certain chronic conditions that cannot be dealt with at home. Therefore, there is still need to agitate for proper beds in the hospitals. Community based treatment has made hospitals to put little emphasis on the provision of beds to hospitals. The attention been directed to other aspects provision of transport facilities to the healthcare practitioners so as to reach for more and more patients. The allocation of funds concentrates on other aspects other than beds in the hospital. However, lack of beds in the hospitals is an indication that the failures of the health sector is escalating to higher heights. There is no single day when the health sector will thrive without beds in the hospitals.
Provision of consistent and long term medication is most relatively cheaper when a person is given an inpatient treatment rather than the outpatient treatment (Goldman et al. 86). However, inpatient is only possible if there are sufficient beds in the hospitals. The hospitals thus, still have the responsibility of giving mor5e and more hospitals to cater for these persons. Therefore, community treatment is seen as an ineffective way of administering medication. T here is also numerous emergencies that occur every day that community treatment can hardly handle effectively. In a situation where there is an accident and or fire outbreak, it is always prudent to rush the victims to a nearby hospital so as to seek medication. In a scenario, beds become a fundamental aspect to be considered. The patients are best attended to in the hospital rather than in their homes if at all they have suffered fatal injuries. However, community based treatment makes achieving this treatment very difficult. In certain situations, the patients may need to be taken to the Intensive care Unit should there condition worsen, where they are bed ridden; however, this is thwarted by the community health care program which puts very little emphasis on bed provision (Olfson 65). Therefore, beds remain a crucial aspect of healthcare and we must accept that hospitals can never do without adequate beds. Lack of beds in a hospital is very dangerous to a society and I feel supporting community treatment must be revised so as to cater for bed provision for patients. This call for another form of treatment knows as institutionalized treatment.
The community treatment is always characterized by poor medical facilities. Less emphasis is put on the equipments used by the doctors to treat the mentally ill. More often than not, these doctors are pushed to the corridor and times they have to use very poor quality equipments to administer to the patients. Very few seem to be interested in the wellbeing of the patients and they will sometimes under deliver. Moreover or there is little room to ask for reinforcement by the doctors.
Inadequate number of specialist doctors in community- based health care centers.
Not every physical in the medical field can provide proper treatment to the mentally- ill patients, instead there are specialists who can provide the best treatment (Olfson 75). In most cases, it is difficult to find adequate number of these specialists especially in community- based health care centers. However, if at all they are there, then their ratio is too low compare to the number of patients that they are supposed to attend to. These specialists are only found in an institutionalized health care centers because these centers have funds that they can use to hire these doctors.
Difficulties in carrying out assessment
Assessment of the health factors improves the efficiency of the operations of the health practitioners. Assessments also determine whether the doctors are using updated methods of treatments and if they keep to their professional standards of measure (Goldman et al. 76). Health ministry should therefore conduct a proper health assessment to evaluate the performance of the doctors and other health practitioners. Assessment also helps very much when it comes to promotion and job appraisal. Information obtained from assessment helps very much in ensuring that a proper and efficient health care provision is guaranteed to the citizens. During the assessments duties and tasks of the healthcare practitioners are always very evaluated by the ministry. It is only through the assessments that standards can be checked and appropriate steps taken to ensure the standards are met. Moreover, job assessment also facilitates confirmation of the ethical standards by the organization. However, the there seem to be difficulty in assessing the performance of the doctors when they are under community healthcare provision (Fitzpatrick et al 45). Assessment would be very costly and under done by the so called assessors. Contrary to this, assessment would be very easy in an institutionalized setting. The assessors will be obliged to perform proper assessment in an institution since all other constraints shall have been eliminated. When proper assessment is done, there will be improved performance by the doctors and the first beneficiaries will be the patients. Though most of the studies have proved that deinstitutionalization of the health care services for the mentally ill has improved has led to quality service delivery, the reality is that it has highly polarized the issue. Individuals getting their treatments in the community- based health care have some deficit in the care that they receive in these kinds of settings, for instance there are no better facilities for vaccinations, routine medical checkup, screening among others. However, some of these services are readily available in the institutionalized health care centers. Moreover, the patients who are living in their communities are characterized by poverty, loneliness, poor living conditions, and easy access to drugs, thus derailing the treatment process. Some of these things can be avoided if at all the patient decided to get treatment in an institutionalized heath care centers and rehabilitation centers. The other factor that make community- based health care center not fit for dealing with cases of the mentally ill is lack of proper management and sufficient funding. The government channels a lot of funds to the institutionalized hospitals; therefore they are in a good position of providing proper management to the institutions. Further, they can hire specialist even outside the country because there are funds. Critics of the community- based mental health care programs posit that residential homes and community- based care service delivery is not well staffed to meet the needs of the mentally ill patients. Notably, community health care centers have shifted the role of taking care of the mentally ill patient to their families yet they do not have the best knowledge to take care of this people (Goldman et al. 65). According to them, family and relative personal contact with the mentally retarded patients is not primary because most of these patients do not have a good reasoning power that can make them value the present of their family members in their lives. What is important is that primary and valuable treatment that these people are supposed to receive from specialist doctors and nurses.
Institutionalization of the mentally ill has had a number of short- comings as much as it is believed to be the best way to deal with these persons; one of them is the absence of hope that this people are going to recover. It is believed that reformed institutions are just like a warehouse where the mentally ill are kept for a long time but there is little hope that they are one day going to get well. Doctors are used to these people, thus they are given little attention as compared to when they could be in a non- institutionalized setting where there are few of them. Further, it is believed that institutionalization of the mental treatment leads to social integration of the sick from the rest of the family. Everyone needs social support from the members of the family, friend and community and this is what is lacking in the institutionalized hospitals, thus it is not easy for these people to receive proper treatment.
When the sick are admitted to the hospitals, they do not have tat close contact with his family which is not the case if at all the treatment was community based. Moreover, the patients, in most case are discharged from the hospital without any proper arrangement or support. This make a larger portion of them ending up homeless or going to the prison. Families can often do a major role in providing the care for their sick, however this is not possible incase the patient is institutionalized. Majority of them who are under continuous long- stay psychiatrist hospitals refuse the help of their family members, which makes it become very difficult to administer proper treatment to them (Goldman, 65). The institutions provide a custody- like care centers because, the mentally ill are isolated from the reach of the outside world and there is no law that these people have broken. In other words, the mentally- ill should be left to interact freely with the rest f the community members. The argument here is that freedom is paramount to any individual especially when there is no part of the law that one has broken (Goldman, 54). Getting care service from an institutionalized is more expensive as compared to community- based hospitals and most members of the society cannot afford the cost. With the increased cases of mentally- ill patient in the United States of America, it is difficult for the community based health care centers to sufficiently provide for these people because of the few number of bed spaces. This problem can be solved in the institutionalized health care hospitals that are commodious and there are many bed spaces. It is worth that there are some mentally- ill patient cases that cannot be dealt with in community hospitals. Some patients are hostile, thus they need places where they can be confined, lest they kill people. These spaces can only be provided institutionalized hospitals.
Institutionalization of the mentally ill is still imperative as much as there are laws that have been put in place to prevent hospitalizing those patients who are not dangerous to the community (Yeager et al 97). Confining a mentally ill person in homes becomes so difficult; this makes most of them remaining homeless. Again, there is always a belief in the society that the mentally ill are dangerous, it is therefore not easy to associate with them at homes. Additionally, there are insufficient facilities in community- based hospitals that can be effectively used in the treatments of the mentally ill. This is because act as primary health care centers, thus they serve a larger population leading to constraints in the facilities. Moreover, there are no specialist doctors who can effectively deal with the problems.
Community- based care it taken to be the most humane way of dealing with the mentally ill in the society; this is because it meets the social needs of the sick. It is imperative that the sick has that close contact with his members of the community, relatives and friends, however this can only be provided in the community based hospitals where the family members can give their support. Further this system is cost effective as compared to the institutionalized system of treatment. Patients of community-based cure services far better than those patients of institutionalized care on a variety of outcome actions, for instance as degeneration rate, impediment or collapse in help-seeking, healing compliance, devotion to medication intake, various admissions to inpatient or housing facilities, homelessness, illegal substance use, and wrong participation. Community- based health care are easily accessible especially in emergency cases. Again they are within the reach of the members of the community.
How reformed institutionalization can be implemented
In the year 2009, the Ministry of Health and Welfare carried out an investigation, with an aim of transforming the welfare of the mentally- ill patients (Yeager et al 86). The report recognizes the fact that mental illness adversely affects the lives of the victims and causes great socioeconomic disadvantages to the sick and their families. The ministry wanted a system that would take care of the welfare and support those people with the mental disorders so they can live healthy life like the rest in the society. In a bid to do this, they recognized that community based care services are do not give the best to the mentally- ill patients, however they cannot be done away with since there is a major role that they play in the community. The committee have expressed a concern whereby they want to create a healthcare system for the mentally retarded persons that can enable them to live a high quality lives without any form of regret. They contended that institutionalization can be done even at the community level. This means that the community-based health care system for the mentally- ill patients can provide primary care to these people. This will enable the patients to have a close contact with their members of the family at the same time have a touch with the outside world and comprehensive quality service delivery is not compromised. The first step that the government through the Ministry of Health can take is increasing the awareness of mental illness to the community. The society must be made to understand psychiatric illness so that they can be in a position to deal with these patients. When people have understating about the mental disorder, they can prevent it at its initial stages so that the number of the institutionalized can reduce. Moreover, there is need to enhance freedom of the mentally- ill persons so that they do not appear as if they are in custody, yet there is no law that they have broken. Another way of implementing reform institutionalization is by improving the facilities in the hospitals. The difference between the community- based hospitals and the institutionalized health care centers is the facilities and the resources in these hospitals, such that if the government can improve the facilities in the community- based health care then there is no difference between the two. One way of doing this is by increasing the number of specialist doctors in the healthcare centers. Moreover, the government and the private health care providers can increase the number of beds in this health care centers so as to meet the increasing demand in the society. It is through institutionalization that the mentally- ill patients can receive the best treatment. The government can initiate this strategy even at the community level so that the demands of most of the sick can be met so effectively.
Overall, severely mentally ill persons are most likely to benefit from institutionalized treatment than in community treatment. The discussion above gives us the advantages that will be best enjoyed by institutionalize treatment and not by community treatment. Right to liberty seems to be a great threat forced treatment to the severely mentally ill but still, we must accept that we must take care of our brothers especially when they need is moist. Shifting from a community based treatment to an institutionalized treatment remains significant to this sector. Shifting from the community treatment will create more attention for the welfare of the patients. The interest of the patients would be catered for under institutionalized treatment and they will definitely benefit from these endeavors (Yeager et al 65). Of the advantages of given herein, reformed institutionalization would result in more hospital beds, more consistent long term treatment, and enforcement that would be of benefit to the mentally ill. As much as it is important to institutionalize the care service to the mentally ill patients, it is important to ensure that these patients live an independent life and receive an expanded comprehensive treatment. The policy should try to be more proactive than reactive so that these patients can benefit out of it.