The Continuum of Care

Human services is intimately linked with care for mentally ill patients. Managers use case management theory in order to “produce apartment dwelling consumers of mental health services” (Floersch, 2002:2). Using this definition of continuum or care sometimes called “community reintegration” case management serves as a means of de-institutionalizing patients and “ensuring shorter hospital stays”; successful continuum of care programs are often measured by their ability or capacity “to divert patients from hospitals to community resources and centers’ (Floersch, 2002:4).

Case management helps link mentally ill clients with social and medical services; it also helps increase independence and promotes independent living among the mentally ill (Floersch, 2002). Among its goals include decreasing the number of necessary hospitalizations each year (Floersch, 2002). To accomplish this many caseworkers rely on case management models based on evaluation studies (Floersch, 2002).

The continuum of care is also referred to as a concept that links the divisions of the Department of Social and Rehabilitation service together, providing clients a means of self support and self care, and refers to the various services that a client may need to move toward self care and a state of “equilibrium” (Floersch, 2002). Educational Requirements Major educational requirements for work in this field include “a bachelor’s degree as the minimum requirement”, and many agencies are now requiring a master’s degree (BLS, 2005).

Specialized training in mental illness may prove beneficial. The bachelor’s degree required is often a bachelor’s in social work, though degrees in psychology or sociology may be acceptable for “entry-level positions” (BLS, 2005). Social services policy or administration degrees are helpful for supervisory positions with government and private agencies (BLS, 2005). Clinical work is often required for managers working in health care settings, as is the case with many mental health workers (BLS, 2005).

Masters programs “typically require 900 hours of instruction” (BLS, 2005). NY State Education law currently governs social work and psychology profession within the state, dictating the requirements for licensing (Cadwalader, Wickersham & Taft, 2005). NY Law and Mental Health Article 9 of the Mental Hygiene Laws in New York governs most of the policies, rules and regulations related to hospitalization and treatment of the mentally ill (TAC, 2004).

Included in these laws include polices regarding admission, examination, issuing of medical certificates, patient records information and voluntary vs. informal admissions (TAC, 2004). Patients must be informed of their rights and of the availability of mental hygiene legal service under 9. 07, and must be provided access to their records via section 9. 11 (TAC, 2004). Patients are also afforded the right to a hearing after involuntary admissions before 60 days has expired under 9.

31 (TAC, 2004). The social work licensure bill S7711-A/A11761-A was recently made law in 2002, taking effect in September of 2004(Cadwaler, Wickersham & Taft, 2005). This law requires the Board of Regents to guide the NY State Education Department in developing standards and administering the law (Cadwaler, Wickersham & Taft, 2005). The law also encourages that social work organizations and schools meet certain standards.

Certified social workers in the state are replaced with the title “licensed master social worker” under the law; with this definition a new scope of practice is defined suggesting that the role of the licensed master social worker includes “professional application of social work theory, principles and methods” to help asses, evaluate and formulate plans of action for mental health patients (Cadwalader, Wickersham & Taft, 2005:5). Funding and Budgetary Concerns Funding comes from various sources. During the early years mental health workers calculated spending using a budgetary approach.

This approach required that caseworkers working with mentally ill patients distribute money and determine individualized family budgets using budgeting techniques (Floersch, 2002). State run institutions gain money from government agents, but still require caseworkers to determine how money is allocated (Floersch, 2002). The New York State Education Agency is heavily involved in licensing and education of mental health workers in the state of New York. The New York State Office of Mental Health and the U. S. Department of Labor also oversees much of the regulations surrounding licensure.

Overview and Major Concerns/Future Sector Current major concerns in the mental health sector are varied. Primary concerns include enabling equitable access to mental health services across all demographic backgrounds, providing patients with access to up to date research and quality care, providing patients information to access regarding “a full range of treatment alternatives”, providing patients the ability to access “the best medications regardless of cost”, ensuring patients have a right to appeal their care and a right to choose among varying managed care plans if reasonable (MHA, 2005).

The state is also concerned with providing patients the right to sue managed care organizations for malpractice when necessary or appropriate (MHA, 2005). Managed care has raised a number of concerns in recent hears with regard to the mental health sector (MHA, 2005). Under managed care most patients are concerned with the fact that their financial and clinical responsibility has been transferred to “protracted mental health treatment protocols” which may involve “overly restrictive interpretations of medical necessity and impose arbitrary limits on the amount of care” (MHA, 2005).

Such limitations may prevent adequate coverage. As such it is vital that social workers are properly trained and can help patients acquire the care they need and overcome any obstacles that may be presented by working with managed care agencies, while still ensuring they have access to the highest quality care possible. In addition case workers have a responsibility to ensure patient rights are maintained and patient confidentiality is maintained in all circumstances. The future of the sector will depend largely at how successful caseworkers are at representing the needs and rights of mental health patients.

It is vital that the case workers are trained in the future regarding the obstacles they may face working with managed care agencies as it is unlikely in the future that managed care organizations will play less of a role in the care and treatment of mentally ill patients. Bibliography : BLS. (2005). “Social Workers – Mental Health Workers. ” U. S. Department of Labor, Bureau of Labor Statistics. 18, December 2005: http://www. bls. gov/oco/ocos060. htm Cadwalader, Wickersham & Taft. (2005). New licensing statue for mental health professionals. ” 19, December 2005: http://www.

cadwalader. com/assets/client_friend/LicensingStatute05-21-04. pdf Floersch, J (2002). “Meds, money and managers: The case management of severe mental illness. ” New York: Columbia University Press. MHA. (2005) “Positions on Mental Health Policy. ” Mental Health Association of Westchester. 19, December 2005: http://mhawestchester. org/advocates/positions50203. asp Treatment Advocacy Center (TAC). (2004, Jan). “New York State consolidated laws. ” New York Mental Illness law. 18, December 2005: http://www. psychlaws. org/LegalResources/StateLaws/NewYorkstatute. htm

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