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Biomedical subjects

J R Elpers

Publications and source records attributed to J R Elpers.

11 recordsLinked to original sources
PubMed1989

Development and utilization of incentive systems for mental health operations: successful and unsuccessful knowledge utilization in California and Los Angeles.

Based on the effort to develop a comprehensive and effective management system for mental health services in Los Angeles, an incentives model is proposed as a general managerial approach for any mental health organization. The successes and failures of strategies to improve a large state (California) and county (Los Angeles) mental health delivery system are reviewed and evaluated. During a six-year period ending in 1984, using an incentives approach, Los Angeles County services to the seriously mentally ill increased, staff morale improved, hospital utilization decreased, residential treatment facilities increased by six times, and high costs per unit of service fell to competitive levels. Care shifted from the hospital to the community, and regional resources were partially redistributed to become more in line with patient needs. However, severe budget cuts consumed operational economies and political resistance hampered efforts to redistribute regional resources. A radical state-level reorganization is proposed to focus responsibility and to avoid county governance.

California↗
PubMed1989

Public mental health funding in California, 1959 to 1989.

Actual expenditures for local mental health services in California from 1959 to 1989 are analyzed to determine trends in state funding of services. As the locus of authority for mental health services shifted from state to county governments, the relative share of state budget appropriations devoted to mental health steadily dwindled. Since 1973 the public mental health budget has declined by 11.8 percent, and in most years the percentage of state general funds allocated to mental health has decreased. Programs for the developmentally disabled, which are similar in scope and mission to those for the mentally ill but are both funded and directed by the state, have received consistently higher levels of funding. California's practice of decentralizing operating authority for mental health programs while retaining responsibility for funding is seen as detrimental to the quality of public mental health services.

Budgets↗
PubMed1987

Are we legislating reinstitutionalization?

Attitudes and trends in the care of the chronic mentally ill are reviewed historically. The present impetus away from community care and back to hospitalization is examined, with special reference to recent legislative initiatives in California, an early leader in the movement to deinstitutionalization. Options for effective action on behalf of the homeless mentally ill are outlined.

California↗
PubMed1982

How many beds? An overview of resource planning.

Determining the number of beds a community needs for the treatment of psychiatric patients has long been a concern of health planners. Variations in the definition of what constitutes a "bed" and in the mental health systems, environmental and social factors, financial considerations, and planning techniques found in each community all have contributed to making resource planning a difficult and highly localized task. The authors discuss these and other issues that planners must take into account in arriving at an estimated number of beds for psychiatric treatment, and point to the planning efforts of California, Nebraska, and Great Britain as three comprehensive approaches. They caution that there are no definitive answers to the questions posed by resource planning and encourage efforts to better classify resources, to provide more information on service systems, and to first design comprehensive community services before eliminating acute inpatient care beds.

Community Mental Health Services↗
PubMed1978

Management and programmatic constraints on community mental health services.

While the special needs of the mentally ill are discussed in detail by society in general and by federal and state governments in particular, it is the local mental health services that must develop, integrate, and manage resources from federal and state levels and must deal with the constraints and strings attached to those resources. The author divides the constraints into several categories--clinical, administrative, fiscal, and legal--and offers suggestions for dealing with them, drawing in several cases on examples from the state of California. He feels that the control of mental health services must be kept in the hands of those who are knowledgeable about and have an investment in the delivery of those services.

California↗
PubMed1975

California: Orange County's alternative to state hospital treatment.

In the early 1970s Orange County, thtough the Orange County Department of Mental Health, began building a local network of regionalized and centralized services, the goal of which is to provide all needed mental health services locally. Despite budgeting setbacks and temporary program freezes, many of the services are now operating. The author describes those services, their estimated costs and staffing requirements, and the organizational structure established to administer them with a minimum of overlap.

California↗