Statement of the Problem
4.6% of the entire Wisconsin population is estimated to have serious mental illnesses (SMI) with 21% of the population having some form of mental illness (Wisconsin DHS, 2014). Many of these patients will randomly be diagnosed with an acute mental problem that requires immediate antipsychotic intervention. Unfortunately, research has shown that an overwhelming majority of antipsychotic medication have at least one metabolic risk factor. Among the common metabolic risk factors for antipsychotic medication is heart attack or a stroke which are potentially fatal unless a patient is within proximity of an intensive care facility. It is on this premise that mental health patients who have been given antipsychotic medication require to be under close supervision by a psychiatric nurse practitioner. Further, the duration of this supervision ought to be long enough to establish compatibility (Wei et al, 2016). In Wisconsin, psychiatric inpatient facilities are extremely expensive and without the pecuniary purview of the poor, who form a majority of mental patients.
The First Possible Solution
The first possible solution for this problem is based on the H.R. 166: Outpatient Mental Health Modernization Act of 2017 (Govtrack, 2017). This entails the concept of partial hospitalization services for mental health patients through the Medicare program. Partial hospitalization is a system developed to cater for patients who require the level of assistance that cannot be offered through normal outpatient services, yet for some reasons are not being fully admitted in the hospital (Govtrack, 2017). Among the major grounds for partial hospitalization is for observation upon commencement of pharmacological treatment regimens. This makes the program seemingly suitable for mental health patients who begin psychopathic treatment as they can be retained in the hospital for up to 24 hours for observation. In the case a critical situation such as a stroke or heart attack arises, the patient’s life can be saved.
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Alternative Solution
The alternative solution is to provide for a 24 hour minimum inpatient care at the expense of the Division of Mental Health and Substance Abuse Service within Wisconsin Department of Health Services. This 24 hour period should begin immediately upon the initial administration of the first dose of antipsychotic medication. The 24 hour monitoring duration will determine if the patient is both reacting properly to the administered antipsychotic and also if there appears to be any life threatening side effect or otherwise. The program should also provide for any intensive care services for any patient who develops metabolic side effects such as heart attack or a stroke. This program should be rolled out in each and every community hospital within the state of Wisconsin and made available indiscriminately to all patients (Butler & Chandrakanth, 2016).
Comparison between the Two Proposed Solutions
The first proposal is limited to individuals over the age of 65 years who fall under the Medicare program and is also limited to partial hospitalization as opposed to full admission. These limitations are however, none-existent in the second proposal which provides for full admission to any and all patients who are put under antipsychotics. The second proposal is limited in that it is pegged upon acquiesce of the authorities running the individual hospitals. In both proposals, the hospitals are the principle winners as there is more revenue available to them. Other winners in the first proposal are patients under the age of 65 who are eligible to Medicare. Any patient not under Medicare is a loser. Patients who also need more attention than can be availed through partial hospitalization also lose. The second proposal has all patients introduced to psychotics as winners with no direct losers.
The most influential actor in the first proposal is the government through the Medicare program as it determines who gets assistance. The second option however, places decision making in the hands of the psychiatrist and the psychiatric nurse practitioner. From a cost benefit ratio perspective, the first proposal will spend relatively less but leave the overall problem mostly unresolved. The second proposal will be more costly than the first one but avoids the opportunity cost of leaving most of the patients in need of post-antipsychotic use care unattended. If these unattended patients develop major metabolic risk factors, they will still cost the government much more in specialized treatment thus the benefit ratio favors the second proposal (Wei et al, 2016) .
The Preferred Solution
With the proliferation of substance abuse among children and young adults, the average age for acute mental patients keeps on dropping. Further, the combination of stresses of life and substance abuse has increased the propensity of new and unexpected mental health complication and mental breakdowns. Many of the patients being rushed to emergency rooms for psychiatric treatment do not even have a history of mental problems and are, therefore, not under any medical insurance programs. Further, these are the same individuals who are in dire need of monitoring upon antipsychotics administration since they are doing it for the first time. Further, it takes several hours for any patient taken to the hospital with an acute psychiatric problem to get properly diagnosed mores o when a decision for pharmacological intervention is necessary. These hours spent in diagnosis will eat into the 24 hour limit for the partial hospitalization program leaving little if any time for evaluation upon antipsychotic administration. It is on this premise that the second proposal takes preference over the first.
The Recommendation
The Wisconsin Division of Mental Health and Substance Abuse Service (WDMHSAS) should give a certified undertaking to pay for a 24 hour admission fee for all patients introduced to antipsychotics. A coordination team for the project should be established by the said WDMHSAS to roll out the program and ensure that all community hospitals are agreeable to it. The admission period should commence immediately upon administration of the first anti-psychotic dose with patients placed under observation by a psychiatric nurse practitioner. Upon recommendation by the psychiatric nurse practitioner in conjunction with the psychiatrist, the patient can be released upon the end of the observation period or alternative terms of admission arrived at.
Resources Necessary for the Proposal
The total number of mental patients in Wisconsin is approximately 1 million with 250,000 having serious mental health problems. The ratio of serious mental patients to total mental patients is therefore 25% (Wisconsin DHS, 2014). Most of these serious patients are however, already under different psychiatric treatment regimens. New psychotic treatments will, therefore, only be limited to normal patients who develop acute mental illness. Under the circumstances, a figure of 210 patients per calendar month making about 2500 patients per calendar year would be feasible. With the average cost of overnight stay at a community hospital averaging at US$2,000 per night, the program would, therefore, come at an annual cost of US$ 5 million per year (Pfuntner et al, 2013). Extra human resources and capital will not be necessary as the program will be held under the current community hospital psychiatric system. A coordination team drawn from WDMHSAS will however, be necessary to roll out and superintend the program.
References
Butler, M. I., & Chandrakanth, J. (2016). Monitoring of extrapyramidal side effects in patients on antipsychotic treatment: a completed audit cycle. Irish Journal of Psychological Medicine , 33 (03), 165-169.
Govtrack. (2017, January 3). Text of H.R. 166: Outpatient mental health modernization act of 2017 (introduced version). Retrieved from https://www.govtrack.us/congress/bills/115/hr166/text
Pfuntner, A., Wier, L. M., & Steiner, C. (2013). Cost for Hospital Stays in the USA, 2010: Statistical Brief # 146. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb146.pdf
Wei Xin Chong, J., Hsien-Jie Tan, E., Chong, C. E., Ng, Y., & Wijesinghe, R. (2016). A typical antipsychotics: A review on the prevalence, monitoring, and management of their metabolic and cardiovascular side effects. Mental Health Clinician , 6 (4), 178-184
Wisconsin DHS (2014). Wisconsin Mental Health and Substance Abuse Needs Assessment. Wisconsin Department of Health Services . doi:https://www.dhs.wisconsin.gov/publications/p0/p00613.pdf
