Lesson 13: Policy Considerations For Special Populations

Lesson 13 Policy Considerations For Special Populationsreadingsnote

This week’s lesson focuses on the particular challenges facing certain groups who have difficulty accessing mental health services. These groups include older adults, people in rural areas, the homeless, LGBTQ individuals, military personnel, and veterans. The readings explore three groups with significant barriers: the LGBTQ community, military personnel, and veterans. While much of the discussion emphasizes issues relevant to Missourians, the concepts are broadly applicable across the United States.

Paper For Above instruction

Access to mental health services remains a critical concern for various vulnerable populations within the United States. Among these, older adults, rural residents, homeless individuals, LGBTQ persons, military personnel, and veterans experience unique barriers that hinder their ability to receive adequate mental health care. Addressing these obstacles requires targeted policies and programs that are tailored to the specific needs of each group while considering systemic issues like stigma, resource limitations, and systemic fragmentation.

Focus on Older Adults

Older adults represent a significant segment of the population with mental health issues, with approximately 20% aged 65 and older diagnosed with mental disorders, including dementia (Karel, Gatz, & Smyer, 2012). Conditions such as depression, anxiety, and cognitive decline are often exacerbated by factors such as chronic illness, social isolation, bereavement, and institutionalization. Despite the high prevalence, access to appropriate mental health care is limited due to several barriers, including stigma, lack of awareness, and inadequate integration within primary care settings (Choi & DiNitto, 2013).

Two notable programs aimed at improving mental health care for older adults include the Geriatric Mental Health Initiative, which emphasizes training primary care providers to recognize and treat mental disorders in elder populations, and community-based outreach programs offering peer support and counseling tailored for older adults. The merits of these initiatives lie in their focus on early detection and reducing stigma, but challenges such as resource scarcity and workforce shortages persist (Friedman & Steinhagen, 2006).

Rural Populations and Telehealth

Rural Missourians face particular barriers to mental health care, including geographic isolation, transportation difficulties, limited availability of specialists, and stigma (Gamm et al., 2002). Approximately 37% of rural health leaders identify mental health as a top priority, yet most rural counties are designated as mental health shortage areas, particularly for geriatric and child psychiatry (Health Resources & Services Administration, 2014). Primary care providers act as the main mental health providers, but they often underdiagnose depression and other mental health conditions due to lack of training or time constraints (Gale & Lambert, 2006; Gamm, Stone, & Pittman, 2003).

Telehealth has emerged as a promising solution, allowing rural residents to access mental health services remotely. Studies indicate that telepsychiatry can be as effective as in-person care and improves access (Hilty et al., 2007). However, barriers such as inadequate broadband infrastructure, reimbursement policy issues, and provider resistance hinder widescale adoption. Policies that expand telehealth reimbursement and improve broadband access are essential for integrating telepsychiatry into rural mental health services (Hilty et al., 2007).

Homeless Population

Homelessness correlates strongly with severe mental illness and substance use disorders, with estimates showing that 20-25% of the homeless population suffers from a serious mental illness, notably higher than the general population (National Institute of Mental Health, 2009). Homeless individuals face barriers such as provider stigma, lack of stable housing, cognitive dysfunction, financial limitations, and transportation issues, all of which impede access to care (Foster, Gable, & Buckley, 2012).

Programs like Housing First, which prioritize providing stable housing coupled with supportive services, have shown promising results. They reduce hospitalizations and improve mental health outcomes by addressing fundamental social determinants. Cross-sector collaborations and integrated mental health and housing services can further mitigate barriers, but funding constraints and fragmented service delivery pose ongoing challenges (Tessler & Dennis, 1989).

Policy Initiatives and Their Merits and Challenges

Two key programs demonstrate efforts to address these challenges: the Mental Health and Rural Community Access Program and the Homeless Behavioral Health Initiative. The Rural Community Access Program invests in telehealth infrastructure and provider training, which has expanded care access; however, issues like digital divide and sustainability remain (Hilty et al., 2007). The Homeless Behavioral Health Initiative integrates mental health services into homeless shelter settings, improving engagement and adherence; nevertheless, funding limitations and systemic coordination issues can hamper long-term success (Gould & Langton, 2002).

In conclusion, tailored policies that enhance workforce capacity, expand technology use, and address social determinants are vital for improving mental health access among these populations. Strategies must be adaptable, adequately funded, and inclusive to effectively overcome existing barriers and promote mental health equity across diverse populations.

References

  • Foster, A., Gable, J., Buckley, J. (2012). Homelessness in schizophrenia. Psychiatric Clinics of North America, 35(3), 519-535.
  • Gale, J. A., & Lambert, D. (2006). Mental healthcare in rural communities: the once and future role of primary care. North Carolina Medical Journal, 67(1), 66-70.
  • Gamm, L., Hutchison, L., Bellamy, G., & Dabney, B. J. (2002). Rural healthy people 2010: Identifying rural health priorities and models for practice. Journal of Rural Health, 18(1), 9-14.
  • Hilty, D. M., Nesbitt, T. S., Kuenneth, C. A., Cruz, G. M., & Hales, R. E. (2007). Rural versus suburban primary care needs, utilization, and satisfaction with telepsychiatric consultation. The Journal of Rural Health, 23(2), 109-115.
  • Karel, M. J., Gatz, M., & Smyer, M. (2012). Aging and mental health in the decade ahead: What psychologists need to know. American Psychologist, 67(3), 201-210.
  • National Institute of Mental Health. (2009). Homelessness and mental illness factsheet. National Institute of Mental Health.
  • HHS Office of Rural Health Policy. (2014). Health Professional Shortage Areas — Missouri. HRSA.
  • Tessler, R. C., & Dennis, D. L. (1989). A synthesis of NIMH-funded research concerning persons who are homeless and mentally ill. National Institute of Mental Health.
  • Gould, T., & Langton, A. (2002). Homelessness in Missouri: The Rising Tide. Jefferson City, MO: Missouri Association for Social Welfare.
  • Unutzer, J., Katon, W., Sullivan, M., & Miranda, J. (1999). Treating depressed older adults in primary care: Narrowing the gap between efficacy and effectiveness. The Milbank Quarterly, 77(3), 377-402.

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