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Biomedical subjects

S S Sharfstein

Publications and source records attributed to S S Sharfstein.

At least 91 records · Page 5Linked to original sources
PubMed1979

Community mental health centers: returning to basics.

Community mental health centers (CMHCs) have made a significant contribution to making mental health services available to many Americans; in 1977 they served almost two million people. External fiscal constraints and internal service and accountability requirements now test the viability of CMHCs, but the most recent extension of the law allows increased flexibility on implementation, and the President's Commission on Mental Health has reinforced the original purpose of CMHCs by calling for an initiative to give special attention to the needs of children and youth, the elderly, minorities, the chronically mentally ill, and other underserved populations and areas.

Community Mental Health Centers↗
PubMed1978

The aftermaths of deinstitutionalization: problmes and solutions.

Thousands of mentally handicapped patients released from mental hospitals are now living in a variety of community settings. Services to help them remain in community are often fragmented, uncoordinated and limited. Research and experience have highlighted the services they need. Numerous demonstrations have shown that patients can be successfully maintained in community setting. Coordinated services and fixed responsibility for each individual placed are essential.

Adult↗
PubMed1978

Fraud and abuse in psychiatric practice.

A consensus has not yet been reached on definitions of fraud and abuse, particularly the latter. Further, the terms tend to be linked routinely by federal agencies, although abuse is generally understood to relate to inappropriate and fraud to illegal practices. These definitional problems make it difficult to determine what constitutes fraudulent or abusive practice in psychiatry. The authors provide hypothetical examples relevant to psychiatry, noting that in many cases it is still impossible to determine at what point a practice becomes inappropriate or illegal. Criteria must be developed by claims review systems, ethics committees, and PSROs; all those in the mental health field should devote serious attention to these issues.

Crime↗
PubMed1978

Third-party payers: to pay or not to pay.

Insurance companies have traditionally been wary of providing coverage for mental illness for two reasons: 1) they fear that people would bring a mental illness on themselves or would use treatment for self-actualization, and 2) they fear the risk of providing never-ending treatment for "incurable" illness. The author states that the insurers' fears are groundless but suggests that psychiatrists research the utilization and costs of their treatments in insurance plans collaboratively with the actuaries who determine policy and premiums. Retrospective and prospective criteria for outcome and effectiveness of psychiatric treatment must be developed and applied.

Attitude of Health Personnel↗
PubMed1978

Will community mental health survive in the 1980s?

There are now 675 funded community mental health centers (CMHCs), covering almost half the country. Many of these programs were funded in the social optimism of the 1960s and now face a crisis of purpose and funding. Additional requirements imposed by the 1975 amendments to the CMHC act are not matched by additional fiscal resources. Programs are graduating from the federal grant to find that other sources of funds, especially third-party insurance funds, are not replacing the lost federal dollars. There is evidence that CMHCs are changing from clinical/medical programs to social programs; the numbers of persons seeking care who have diagnosable mental illness and of psychiatrists and nurses relative to other staff are decreasing. The issue is whether CMHCs as a national program are headed for extinction or whether there will be new vitality for this program into the 1980s.

Community Mental Health Services↗
PubMed1978

Utilization and cost of mental illness coverage in the Federal Employees Health Benefits Program, 1973.

The authors examine the utilization of mental illness benefits under the Blue Cross/Blue Shield and Aetna plans for federal employees; the latter plan sharply cut back its mental illness benefits in 1975. In 1973 mental illness benefits represented 7.4% of all payments under the Blues plan and 12% under the Aetna plan. The benefit for mental illness treatment under the Blues averaged $12.52 per person covered and was 7.3% of the total benefits for all conditions. Younger enrollees and their spouses tended to receive mental illness benefits primarily for outpatient treatment and children and older adults for hospitalization. These data raise key questions for claims review and peer review activities.

Adult↗
PubMed1977

Problems in analyzing the comparative costs of private versus public psychiatric care.

The authors outline the difficulties in attempting to compare the costs of service in various mental health settings, especially private practice and community mental health centers. Contributing to the difficulties are the differences in the populations served, differences in treatment modalities employed, and the different economic incentives operating in each setting. The authors stress the need for research on cost effectiveness as the basis for valid comparisons of various care settings.

Community Mental Health Services↗
PubMed1976

Community care: costs and benefits for a chronic patient.

The authors analyzed the costs and benefits of community care for a middle-aged chronic woman patient who was receiving care from a neighborhood health center after a total of eight years of hospitalization. Cost comparisons over a three-year period were made between the neighborhood center and a state hospital, the center and a day program of a community mental health center, and the center and the inpatient unit of a community mental health center. Cost of care in the neighborhood center fell from $2110 in the first year to $640 in the third, while costs in the alternative settings increased substantially. The patient's clinical status was rated "much improved" in the community.

Adult↗
PubMed1976

The politics of program evaluation: the mental health experience.

The authors discuss evaluation studies of the community mental health centers program. The emphasize that program evaluation is a political activity to influence the allocation of public resources. They examine its relationship to decision-making, power conflicts, and bureaucratic goals. They point out that the evaluator is seldom totally objective. They also emphasize the increasing use of evaluation by politicians.

Community Mental Health Services↗
PubMed1975

Private psychiatry and accountability: a response to the APA task force report on private practice.

The authors note that the imminence of national health insurance makes it very important to determine the roles, efficiency, and effectiveness of both the private and the public sectors of mental health care. The difficulties in distinguishing public from private care are examined. The authors present estimated distributions of care by type of provider that differ from those of an APA task force report on private practice. They point out the need for objective research on the quality of care in both sectors and on the effectiveness of alternative mental health systems, suggesting that public choices should be made on the basis of correct interpretations of reliable data and accountability to those being served.

Cost-Benefit Analysis↗
PubMed1975

Insuring intensive psychotherapy.

Many private insurance programs that currently cover mental disorders eliminate intensive psychotherapies, including psychoanalysis, from the range of treatment options by placing restrictions on the number of visits covered. The authors examine the economics of intensive psychotherapy coverage and present data indicating that relatively few people in an insurance program with comprehensive mental health benefits use high cost forms of psychotherapy. They conclude that insurance coverage of intensive psychotherapy is feasible but suggest that further study of the goals of intensive treatment, potential demand for it, and the supply of qualified practitioners is needed.

Blue Cross Blue Shield Insurance Plans↗
PubMed1975

Integrating community psychiatry into residency training.

Beginning in 1969 a training program in community psychiatry was developed in a psychiatric hospital that had become a community mental health center with responsibility for a catchment area. Initially the program focused on individual supervision of psychiatric residents in their work with inpatients from the catchment area. The inadequacies of that approach led to assigning residents to spend four hours each week in a comprehensive neighborhood health center. Later they were also assigned to interdisciplinary inpatient teams led by community psychiatry supervisors. The authors describe the evolution of the program, report the results of an evaluation, and present some conclusions about training in community psychiatry.

Attitude of Health Personnel↗