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Release: Nov. 23, 1999

Researcher: Mental health policies often hamper care facilities

IOWA CITY, Iowa -- Mental health policy on the local, state and national levels has created a treatment system that is challenging for some consumers, according to a recent study led by a University of Iowa researcher.

Rachel Anderson, Ph.D., assistant professor of health management and policy in the UI College of Public Health, noted in a recently published article that policies designed to help develop care facilities for people with mental illness often have unintended effects. Her findings were based on analysis of an intermediate care facility in Illinois.

Anderson's study showed that a small number of patients use mental health services and that the more severely ill residents utilize few services. This suggests that this intermediate care facility focuses mainly on managing symptoms and not on rehabilitating some patients, Anderson said.

"Some important social policies have created a mental health service system with few community-based residential alternatives," Anderson said. "The system creates gaps in which some patients are lost and in which others are reluctant to enter."

The policies that created the problems stem from the push over the past 35 years to deinstitutionalize patients in the public health system. The goal was to create community alternatives to state hospitals, Anderson said. However, nursing homes increasingly replaced state hospitals as residences for many people. Few community facilities were available because government reimbursement policies, such as Medicaid and Medicare, favored placement in nursing facilities over psychiatric facilities.

Previous research on how patients with mental illness fare in nursing homes reflected high levels of medication use and low levels of treatment services, such as individual and group therapy, Anderson said. Nursing home reform in 1987 intended to address this potentially inappropriate care and stimulated the development of residential alternatives commonly known as intermediate care facilities.

"Intermediate care facilities have, in part, replaced the state hospital in Illinois and are intended to serve as rehabilitative institutions for residents with less severe medical needs," she said.

Through her study, Anderson wanted to address a gap in the research related to intermediate care facilities. Few studies had been conducted on these facilities and their residents. To gather information, Anderson interviewed the facility's residents.

Anderson found that intermediate care facilities offer more services than nursing homes, including group therapy and workshops. However, only half of the residents used these services in addition to medication, which all residents received. Moreover, about 20 percent of residents refused mental health service use and about 30 percent simply did not receive any services. The reasons behind these findings require more research, Anderson said.

As part of her study, Anderson diagnosed each participant. Only about 60 percent of these diagnoses matched those found in the medical charts. Anderson said this problem of differing diagnoses is present elsewhere in the mental health field.

"There are understandably questions over the reliability between facilities' and researchers' diagnoses," Anderson said. "This is not necessarily a misdiagnosis, but instead shows the need for reevaluation. Some patients may have been diagnosed 20 years ago and haven't been evaluated since."

But policy changes can address the situation there and at other care facilities, she added.

"Mental health care facilities need a standardized method to identify and understand consumers' needs and strengths," she said. "Our way of developing services right now is built on deficits, sometimes ignoring consumers' strengths. If strengths were considered in treatment planning, consumers may be more likely to use the services offered and receive more appropriate care."

Anderson noted that in New York there are efforts underway to identify the specific needs of consumers and to develop a statewide system of care based on a response to these needs.

"A system that considers individual needs and strengths in treatment decisions is important," Anderson said.

In Iowa, each county assumes responsibility for mentally ill patients. Anderson said there is no overall system of gathering and reporting information on consumer needs such as types of symptoms or levels of functioning.

Anderson's research continues to center on these issues. She is developing an assessment that would measure a patient's strengths that could be incorporated in treatment decisions.

Anderson's findings appeared in the October issue of the journal Psychiatric Services. Anderson collaborated with Dan A. Lewis, Ph.D., professor in the Northwestern University Department of Education and Social Policy and the Institute for Policy Research.