Guest Editorials| Volume 8, ISSUE 2, P96-100, March 2000

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Mental Health Services in Long-Term Care: Still an Unmet Need

      Despite the high prevalence and evidence of underrecognition and undertreatment of mental disorders in residents of nursing homes, pathways for access to mental health services for these vulnerable elderly persons, who today number over 1.5 million, remain poorly understood. We know little more today about the types, availability, or adequacy of mental health services provided in long-term care settings than we did before the implementation of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87) over 10 years ago. We do know that skilled nursing facilities vary widely in the quality of general nursing care provided to residents and the vigor with which they have embraced the national mandate for improvement in mental health care. We also know that their orientation to care remains predominantly medical, supportive, and supervisory; when formal psychiatric services are provided, they follow mainly a consultative, rather than a longitudinal, integrated biopsychosocial model of care. Inadequate detection and treatment of mental disorders remain key issues unresolved by the OBRA provisions, and too many facilities still lack reliable access to qualified specialty providers capable of meeting the needs for expert mental health services. At the same time, punitive regulatory practices highlight potential cases of fraud and abuse

      Department of Health and Human Services Office of the Inspector General: Mental Health Services in Nursing Facilities. OEI-02-00860, May 1996

      instead of fostering comprehensive, patient-centered quality improvement.
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