Equity and Accessibility Evaluation: Community Mental Healthcare Center

(c) B. Kristine Burneko, APRN, PMHNP-BC, APHN-BC. All rights reserved.

Community Mental Health Center Assessment (2019)

Please note: the name of the specific CMHC analyzed is omitted for privacy.

This assessment will explore the Community Mental Health Center (CMHC) model of mental health care. In part one, the author will examine the history of the CMHC framework and identify two common goals within this framework of mental health care delivery. In part two, the author will examine a CMHC within their local geographic area paying particular attention to the services available to the community, the programs and resources available to support the center, and the accessibility of those services. Finally, in part three, the CMHC will be evaluated using the criteria established in part one – namely, the goals of the CMHC model of care. In conclusion, the author will assess the strengths, barriers, and opportunities presented by the local mental health center to the community.

Part One: CMHC History

Framework

The American Psychiatric Association’s (1981) most recently convened task force report on Community Mental Health Programs provides a concise overview of the CMHC model’s history. The CMHC model emerged as a response to societal changes in America after World War Two, resulting in a push to deinstitutionalize psychiatric care from state hospitals to localized community health centers (American Psychiatric Association,1981). This massive

paradigm shift in mental health care was signed into law in 1963 by Congress (Feldman, 2020).

Two CMHC Goals

According to the same task force report, the primary goal of CMHCs is to provide high-quality, accessible mental health services to a specific population (American Psychiatric Association, 1981). More recent iterations of CMHC goals usually include delivering patient- centered care and interprofessional and inter-organizational collaboration (Jones et al., 2018; Kelly et al., 2019; Özden& Çoban, 2018).

Part Two: A Local Community Mental Health Center

Services, Programs, and Resources

[The Center] began providing Community Mental Health services to adult residents of [Specified] County, Maryland, fifty years ago in 1971 (CMHC, About Us, 2017). This Center has an extensive array of services available for qualified individuals, including three outpatient mental health clinics, residential rehabilitation, crisis services, an assertive community treatment (ACT) team, community-centered psychiatric rehabilitation, day programs, peer support groups, legal aid, translation services, and several vocational support programs (CMHC, Services, 2017). Referral requirements vary based on the program of interest, but the general outpatient mental health clinic requires a client to be 18 years of age or older, enrolled in public insurance, or uninsured (if the client meets specific criteria). (CMHC, Clinic Services, 2017).

Patient Accessibility

People suffering from severe and persistent mental illnesses have an array of options available from this Center: in addition to the clinic and ACT team services, there are three residential treatment options for people diagnosed with Borderline Personality Disorder, people living with dual diagnoses, and people in psychiatric crisis (CMHC, Services, 2017; Residential Crisis Services, 2017). Residents of these facilities receive free transportation services, and providers in the community-based psychiatric rehabilitation program provide home visits (CMHC, Services, 2017).

Part Three: An Evaluation

This Center’s strength lies in the extensive network of services available as well as their size – according to their website, the organization is capable of serving 2,200 individuals at a time or more (CMHC, About Us, 2017). Surprisingly, a need for more funding does not seem to be an issue at this Center ([Specified] County is one of the wealthiest counties in the United States, with a median income of $108,820 (United States Census Bureau, 2019).

Instead, the primary barrier for care is entry into this facility's care system. The center's website only hints at an indecipherable labyrinth of eligibility criteria (a particularly egregious example is here: [http omitted for privacy]. It is unlikely that a person who meets the criteria for service with The Center will have the energy, resources, attention, internet access, and extensive specialized knowledge necessary to apply for these services. Notably, none of the services (other than the outpatient clinic) are available without a referral from a “treating clinician” – which, ironically, is what the client would very likely be seeking.

According to the American Psychological Association’s 2019 Guidelines for Psychological Practice for People with Low-Income and Economic Marginalization, providers

have a range of evidence-based options to increase access to care for these individuals. Many of the guidelines (written for psychologists) pertain to research methodology changes, but some are pertinent to psychiatric care providers, whether physicians, physician assistants, or psychiatric nurse practitioner. These include offering flexible appointment times on nights and weekends, offering alternative delivery methods such as telehealth, and extensive self-interrogation by the therapist regarding social class awareness, bias and stereotyping, and countertransference patterns (American Psychological Association, 2019). This last guideline underscores the critical role of supervisory guidance for any mental health clinician.

Conclusion

The CMHC analyzed in this report offers an impressive spectrum of services for mental health clients in the [Specified] County region. However, the inscrutable process required to become a client prohibits sufficient access to the CMHC. Ample opportunity exists for mental health care providers in this region to improve access services and implement innovative, accessible, and affordable care models that advance equity.

References

American Psychiatric Association. (1981). Taskforce report: Community mental health programs. https://www.psychiatry.org/File%20Library/Psychiatrists/Directories/Library-and-Archive/task-force-reports/tfr1981_CommunityMH.pdf

American Psychological Association. (2019). APA Guidelines for psychological practice for people with low-income and economic marginalization. https://www-apa-org.frontier.idm.oclc.org/about/policy/guidelines-low-income.pdf

[CMHC]. (2017). About Us. https://www.[CMHC].org/about (2017). Clinic Services. https://www.[CMHC].org/clinic

[CMHC]. (2017). Residential Crisis Services. https://www.[CMHC].org/residential-crisis-services

[CMHC]. (2017). Services. https://www.[CMHC].org/

Feldman, J. (2020). Achieving mental health equity: Community psychiatry. Psychiatric clinics of North America, 43: 511-524. https://doi.org/10.1016/j.psc.2020.06.002

Jones, A., Hannigan, B., Coffey, M., Simpson, A. (2018). Traditions of research in community mental health care planning and care coordination: A systematic meta-narrative review of the literature. PLoS ONE 13(6): e0198427. https://doi.org/10.1371/journal.pone.0198427

Kelly, E. L., Davis, L., Mendon, S., Kiger, H., Murch, L., Pancake, L., Giambone, L., & Brekke, J.S. (2019). Provider and consumer perspectives of community mental health services: Implications for consumer-driven care. Psychological Services, 16(4), 572–584. https://doi-org.frontier.idm.oclc.org/10.1037/ser0000244

Özden, S. A., & Çoban, A. İ. (2018). Community-based mental health services, in the eye of community mental health professionals. Journal of Psychiatric Nursing / Psikiyatrie Hemsireleri Dernegi, 9(3), 186–194. https://doi.org.frontier.idm.oclc.org/10.14744/phd.2018.00922

United States Census Bureau. (2019). QuickFacts: [Specified] County, MD. Retrieved April 22, 2021, from https://www.census.gov/quickfacts/[specified]countymaryland.