Comparing the residual model of mental health care in the United States of America with Canada's Industrial Redistributive Model of Mental Health Care
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Many people approach mental health in different ways, some use science or biology, while others prefer to be conservative and use holistic, humanistic or social approaches. All these definitions enable an integration to be made for the benefits of the mentally ill. The mentally handicapped have been in no doubt been the minority in the society and tend to be ignored by the majority in society.
They are seen to have no meaning in society whatsoever. Many families are stigmatized by the presence or birth of a mentally impaired individual in their families. The doctors have been more considerate to them and they have been administering medicines and offering psychiatric help whenever needed. The US and Canada have been having some of the best models for catering for the mental cases with Canada having one of the best healthcare facility, Royal Ottawa hospital, which is recognized all lover the world.
Many models have been used to address the issues of the mental illness among the patients. These models include but not limited to Disease management programs, Models of quality improvement, Onsite mental health professionals (consultation-liaison), Counseling and psychotherapy within primary care, and Organizational or educational interventions. However, this paper will concentrate on discussing and comparing the residual model of mental health care in the United States of America with Canada's Industrial Redistributive Model of Mental Health Care which tend to look alike in administration and social policy.
The residual model of mental health in the United States is seen as expenditures of the mental health care plan not directly related to the services of mental health but related to other programs but the expenditure caters for mental health as a result of remains. The states administrations have expenditure for mental health but in other programs of health. Expenditure for mental health is only reported at one level where it occurred and the grants given for counseling, community awareness, and psychological services should encompass mental illness programs as a subordinate exercise.
The Industrial Redistributive Model of Mental Health Care in Canada is where there is a shift of the mental health practitioners towards preventing emotional disturbances, and drug abuse and alcohol use. The Canadian mental health act is an extension of the drugs and substance abuse act. The practitioners may have mainly change the tactics of mental health to fight drugs and substance acts due to the major involvements in the drugs in causing mental illness like depression. The model also shifts to social welfare which it states that resources should be redistributed to enable social programs run properly (Brown, 1985 p.145).
There are many other models that are involved to care fore the mentally ill. They include; Disease management programs, Models of quality improvement, Onsite mental health professionals (consultation-liaison), Counseling and psychotherapy within primary care, and Organizational or educational interventions. There is rise in arguments on the best models of recovery for the mentally ill;these models are crucial in mental health policy (Buchanan-Barker, 2005 p.34). The models are also important on the practices, and systematic methods of delivering care with respect to chronic illness. There is need to have an integrative approach in order to have progress in high quality recoveries associated with mental health care.
Mental illnesses have no defined recovery process and many patients are monitored even after normal behavior is seen. But as cited by (Lester, & Gask, 2006 p. 407) recovery is achieved when the way of living can be termed as satisfying, hopeful, and contributive even with the limitations caused by the illness. He continues to describe recovery as the development of a new meaning and purpose of the patient’s life as one move or grows from the catastrophic effects of mental disorder. Recently models that take in to consideration the need for internal conditions of hope, healing and empowering the recovering person and the external conditions that facilitate recovery have been developed. The use of modern conceptual models can help to eliminate the gap betweenresearch findings on mental health and policy development.
The use of systematic reviews in medical health care which have been used traditionally for clinical decision making and giving the evidence to policy makers will be a complex agenda. The best would be to use the conceptual models which are abstract representations of complex areas. The models can then assist in the validation of the data from systematic reviews. In the primary care of mental health there is basic prevention and curative measures at the first point of the health care process. Proper mental health care procedures involve passing through five levels and three filters between community and specialist or psychiatrics care. Level one is the general population level, which is followed by the first filter level of illness behavior.
The second level is the psychiatric disorder in primary care clinician, which is followed by the second filter level the recognition by primary care clinician. The third level involves the conspicuous psychiatric morbidity followed by the third filter level the referral to specialist care. The fourth and fifth levels are merged as the specialist care procedures. The major goals of mental health care in primary care would be effectiveness, efficiency, access and equity (Repper, & Perkins, 2003 p.46).
Many mental health institutions have been face with several limitations that the policy makers tend to solve in the models. By offering adequate training including short term courses and guidelines to the staf involved, consultations liaison, collaboration care, replacement and referral. Many institutions either non governmental (NGO’s) or governmental are now rising to offer medical care to the medically impaired.
The historical perspective
In Canada, the Royal Ottawa hospital is the largest provider of specialized mental health services and gets referrals from all over the country. The national psychiatric and mental health nursing community chose to create and participate in a specialty certification program. Some nurses specialized in psychiatric and mental health nursing, which focuses in promoting mental health, preventing mental illnesses, and caring for the clients who have mental illness. This was the tidal model of caring for the patients.
This model emphasized on collaboration and partnerships together with interdisciplinary teamwork and narrative interventions. The registered nurses of Ontario developed practical guidelines for client-centered care. They had recommendations such as: - nurses embrace as foundation to client-centered care, the stated values and beliefs. Respect, human dignity, clients are experts of their own lives, clients as leaders, clients’ goal coordinate car of the health care team, continuity and consistency of care and care givers, timeless, responsiveness, and universal access to care (Buchanan-Barker, 2005 p.220). The RoyalOttawaHospital articulated the vision to be an internationally leading center of excellence in relation to mental and psychiatric health nursing. It aim this through commitment, person centered professional practice and scholarships. The hospital became the first North American hospital to get acquaintance for the tidal model. The model was basically used for mood and anxiety, forensic, and substance use and concurrent disorders.
In United States however the historical perspective of the mental health was a mixture between the biological, neurobiological, and cultural model and the tidal model. The general concept was that the brain was wider than the sky and could accommodate every human experience. Then mental health would be the person sympathetic and engagement with human suffering. There was need for professional responsibility like psychiatrist to control the person. The notion that humans are complex then the need for specialized attention was necessary. The traditional view also saw people being influenced by two separate influences; the nature or biology which were their bodies influenced by hormones and genes and the nurture which were their cultural and life experience. It was the mix between the body, the brain and the thinking. Social implications of mental wellbeing are important and facilities to ensure mental health for all should be a priority in the health sector.
According to Foley, & Gorham, (n.d, p.1) in the article towards a new philosophy of care: perspective on prevention, the history is based on the model of supply and demand, There are 205 million people in the US, at least 5 million are psychotic, 4 million retarded definitely, 9 million are alcoholic, and 25% equivalent to 50 million are estimated to be in need of mental health care. The first step towards the mental illness curbing was in 1961when the Action for Mental Health: the final report of the joint commission on mental illness and health was given. The commission fought for major changes in the structure of mental health services. These changes were mainly blocked by the traditional methods of service offering. The social problem perceptions of the citizens will only change if we talk of social welfare; the residual and the developmental (Foley, & Gorham, n.d. p.2).
The residual view is that social welfare activities should be involved when normal structures of society stops functioning. It views social welfare as the act that is going to bridge the gap resulting from breakdown of society. This residual view can be traced back to the 19th Century individualism and common belief that an opportunity structure for personal gain and needed personal services exists.
The second view defines welfare activities as the frontline and core function of modern industrial society in a positive, collaborative role with all social institutions working towards a better society. The developmental view of social welfare perceives that due to many complexities of modern life, progress for the majority in the society may create several dysfunctions that initially leave behind those who do not have the capabilities to modify their own lives according to these changes.
Many of the very old, the sick, disabled and the young are the groups that will be largely affected when there is a lag in social development. Modern society have programmed these both residual and developments approaches leading to a mix-up. The society then is not able to bridge the gap between the present and the past so it weakens the future, which is the future of their children (Brown, 1985 p.129).
Modern models of mental health care
The biomedical model is expressed as medical care, which involves trying to heal the illness, and focuses on the disease rather than the person. It is generally concerned with what activities are described as normal and the pathological and judgmental sense in the normal acts. It also involves scientifically modes of treatment that is through formal training. It is based on a common understanding of the complexity of human norms.
Modern social models emphasize the interaction of social factors and biological and microbiological factors of the health condition. The surrounding of the individual is analyzed and his involvement in groups and community activities. Experience of social networks that monitor those who are vulnerrable and frail to mental health is also used. It understands and works in collaboration with the civil society to promote the interests of individuals, groups, and communities and criticize and challenge when mental health is detrimental to these interests.
It emphasizes the sharing of knowledge and territory with a range of disciplines and with service users and the general public. It emphasizes empowerment and capacity building at persons’ and society level therefore tolerating and celebrating difference and similarities. It gives equal value on the expertise of service users, and public, but challenges attitudes and practices that may appear oppressive, judgmental and destructive. It enables a critical understanding of power and ranks in the creation of health inequalities and social exclusion. There is commitment to development of the theory and practice and to the evaluation of the process and outcomes (Lester, & Gask 2006 p.408).
States and province comparison
In Alabama the division of mental illness services provides a comprehensive variety of treatment services and supports through six state operated hospital facilities and contract agreements with the community mental health center across the province. The staffs at the mental illness central office provide guidance and support to the continuum of care though its quality improvement, customer relations, community programs, certification, facility management and indigent drug program. The state operated facilities serve over 4000 individuals per year. Certified community based programs serve over 100000 individuals. The mental illness services promotes the recovery based services and involves all stakeholders in its goals setting and prioritizing which are designed to meet the interest of the citizens (Brown, 1985 p.67).
The mental illness state operated facilities include; Bryce hospital, established in 1861 in Tuscaloosa, it is responsible for the provisions of inpatient psychiatrist services for the adults. They serve a specified region in the north central part of Alabama. The Bryce hospital also provides inpatient services for adolescents.
The Greil Memorial psychiatric hospital in Montgomery is responsible for offering inpatient psychiatric services to the south central part of the state. It operates specialized psychiatric units for the deaf. The Mary Starke Harper Geriatric center was established in 1996 in the Bryce hospital campus. Also known as the Harper center is responsible for the offering of psychiatric services to the elderly citizens of the state. The north Alabama regional hospital (NARH) established in 1977 is responsible for offering inpatient psychiatric services to the adults of the northern part of Alabama.
The Searcy hospital established in 1902 in the region of Mt.Vernon is responsible for offering psychiatric services to the adults of the southern part of the state. The Taylor Hardin Secure Medical center established in 1981 offers comprehensive psychiatric evaluations to the criminal courts for the state. It is the one and only maximum security forensic hospital in the state and is operated by the Alabama Department of Mental Health.
In Ontario there is a health insurance plan known as the Ontario Health Insurance Plan (OHIP) which is run by government for the Canadian province of Ontario. The health plan that supports the mental health is the Ontario Mental Health Act (OMHA) it regulates the administration of mental health care. The purpose of the act is to regulate the involuntary admission of people into psychiatric hospitals. The act also allows community treatment order by the attending physician.
The social policy describes the policies which the government uses to enhance welfare and social protection, the development of welfare in society, and the educational or academic study of the social rights or policies. There are three main types of welfare regimes; the corporatist regimes they are work oriented and based on individual contribution, the social democratic regimes those who favor universalism and the liberal regimes that are residua lists. America does not have a well unified or established welfare system.
This is because federalism means that many functions are held by the states including public assistance, social care and various health schemes. Many states have individually funded state facilities and health systems e.g. Alabama, Minnesota, and Hawaii. The US is not liberal but rather pluralistic. There are deviations from the residual model e.g. state schooling, social insurance, or the Administration, which provides health care for majority of the American people. There are also private, mutualisms and corporate furthered interests in welfare provision. This gives very complex and expensive systems (Lemco, 1994 p.87).
They are various ways to compare the social welfare of countries the best comes by first comparing the policy then input, production, operations, and finally the outcomes. The mental health policies of Canada and the US may be different in name but the working is similar. The social outcomes of the policies are same and the majority of the inpatients enjoy the services according to region and not countrywide. In Canada the Americanized system of psychiatric nursing is also practiced. Mental health should be taken seriously in the present so as to reduce damages to the future generation. The mentally ill should also have a right in the society and they should be treated with sympathy and humanity and offered maximum health care to enable them live a normal and fruitful life once they recover. The strength of the society lies with the mental health of the community and therefore it is the responsibility of all health care stakeholders to ensure that the society is mentally secure.
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