Mental Health


Mental illness is one of the major health issues facing every community. It is the leading cause of disability in North America and Europe, and costs the United States more than a trillion dollars per year in treatment and other expenses. Approximately 20% of Americans adults (about 45 million people) have diagnosable mental disorders during a given year, and about 5% of adults in the United States have serious mental illness, that is, illness that interferes with some aspect of social functioning. Only 38% of those diagnosed with a mental disorder receive treatment. Some of these people require only minimal counseling, followed by regular attendance at supportive self-help group meetings to remain in recovery, while others suffer repeated episodes of disabling mental illness. These individuals have conditions for which they require more frequent medical treatment and more significant community support.

Due to years of funding cuts to public mental health organizations, loss of thousands of inpatient beds at state and county facilities, nationally, hospitals have been challenged by a shortage of psychiatric beds, with some entire counties have zero psychiatric beds. The gaps in service coordination and the lack of access to psychiatric hospital services results in Emergency Departments overcrowded with psychiatric and substance use patients, and excessive holds for these patients. Sometimes, transfers take as long as 2 to 10 days before a bed is available.   


For this unit’s discussion, we will explore community mental health. While, the number of psychiatric beds dramatically decreased over the years, the need for behavioral health services has grown as all levels, long and short-term as a results of increased stress and illness in the community (due to economic conditions, frequent natural disasters, and aging Baby Boomers) and increased acuity and complexity of patients. 

You are the Administrative Director of Emergency Department in a coastal city in Louisiana. You have noticed an increased number of ED visits by children with depression. After a quick search, you found out that your county in fact has 3 times the national average of childhood depression post-Katrina. In general, behavioral health services delivered through the ED require more than twice the time as the average medical protocol offered in the same setting. The negative impact of behavioral health patient overutilization of ED resulted in longer wait times, increased patient frustration, and diminished capacity of clinical staff. Your further research also showed that there is apparent shortage of mental health professionals in the state, lack of community knowledge of available mental health resources, lack of low-income parents’ access to transportation to mental health resources for depressed children, and lack of healthy afterschool activities for children of working parents. 


Prepare recommendations to address the issue of overutilization of the ED by children with depression.   Discuss internal hospital solutions and community collaboration solutions. Include the discussion of the roles of community mental health services and patient centered medical homes (PCMH) in the treatment and prevention of mental illness. Consider the use of telemedicine, comprehensive care management, care coordination, health promotion, transitional care, family support, and referral to social support.

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