Voice Over Powerpoint- Public Policy, Advocacy, and Stigma

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Public Policy, Advocacy, and Stigma Related to Mental Health:

Public Policy, Advocacy, and Stigma Related to Mental Health Psychosocial Intervention- OCT 5406

Current Mental Health Policy Environment:

Current Mental Health Policy Environment Inclusion verses Segregation Some Support for Mental Health Parity in regards to insurance coverage Protection of Rights of Mental Health Consumers in regards to housing, commitment, and employment A Safety Net for Basics by providing entitlements that enable rudimentary community life, but may not fund individualized recovery orientated care.

Influence of Values on Policies and Practice:

Influence of Values on Policies and Practice Traditional Values Provider Autonomy Consumer Sovereignty Core Culture of U.S. Medicine World Health Organization (WHO) Perspective

Impact of Policy Decisions on Practice:

Impact of Policy Decisions on Practice 1950’s Increased Mental Health funding and Mental Health Infrastructure 1960’s Deinstitutionalization and the creation of community based services and the civil rights movement 1970’s Patient Rights and the start up of Healthcare Management Organizations 1980’s Funding cuts and M anaged Care 1990’s ADA (1990), Mental Health Parity (1996) and Olmstead Act (1999) 2000’s the new Freedom Initiative 2006 NCD identified six elements for livable inclusive communities for be people with disabilities 2008 The Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equality Act

Administrative structure and funding:

Administrative structure and funding Primary Care Specialty Care Human and Social Service Sector Voluntary Sector Financing Gatekeeping Capitation

Ongoing Policy issues:

Ongoing Policy issues What Will Be Covered? Medical Necessity Biological Illness Versus Problems of Daily Living Who Can Provide Services? Direct Access and Qualified Mental Health Providers How Will Care Be Funded and Allotted? How will evidence based practice be supported in routine practice? How can we deal with challenges of stigma?

Basics of Policy Making:

Basics of Policy Making Policy Formulation Lobbying, Grass-Root Organizations, PACs Policy Implementation Center for Medicare Medicaid Social Security Administration Policy Modification Consumer directed

Policy Impact on Occupational Therapy:

Policy Impact on Occupational Therapy Examine Internal Issues Relative to OT Administration Research Practice Education Examine Outside Influences on OT Practice History Political Economics Social Generate Policy Alternatives Direct Assess Policy Changes Select and Implement Policy AOTA Position Paper Advocacy efforts to modify policy and services models Modify Policy Rule modification

Occupational Justice and Intervention in Public Policy:

Occupational Justice and Intervention in Public Policy Occupation as a Political Issue Occupational Therapy as Social Integration “ Joining With ” Consumers and Their Families on Mental Health Advocacy

Types of Advocacy:

Types of Advocacy Individual : Referring a client for services and making a call on his or her behalf Professional : Participating in Hill Day at the American Occupational Therapy Association to educate policymakers about the occupational therapy profession Program Policy: Meeting with the psychosocial rehabilitation program executive directors to educate him or her about the cost and benefits of occupational therapy services Public Policy : Joining a task force on affordable housing to address access needs for people with disabilities on a limited income.

Four Basic Steps to Prepare for Advocacy:

Four Basic Steps to Prepare for Advocacy Gather information on various proposals that are being put forth Analyze the content in terms of what is included and excluded; means of access; l degree of choice; how it will be funded; and the specifics of each proposal in terms of benefits, who can provide them and where Complete an analysis of pluses and minuses for each proposal from the occupational therapy perspective Be prepared with fact sheets and educational materials on the value of occupational therapy interventions for this population for visits to key stakeholders, such as legislators or representatives of advocacy groups

Social environmental barriers and stigma:

Social environmental barriers and stigma Impact of Stigma on Mental Health Treatment Resistance to discuss concerns with Physicians Limited understanding of Primary Care Providers about the relationship of mental health with general (physical) health Impact of Stigma on Families Stigma by association Effect of the roles of family members and routines of family setting Reduced social supports available Financial and health care planning concerns Pubic Policy Impact of Stigma Going debate about if services can impact all Costs associated with treatment, care and support Questions related to self-determination and empowerment related to the Recovery model

Areas Commonly Impacted by Stigma:

Areas Commonly Impacted by Stigma Affordable, appropriate, and accessible housing Affordable, accessible, reliable, and s afe transportation A physical environment adjusted for inclusiveness and accessibility Work, volunteer and education opportunities Access to key health and support services Opportunities for participation in civic, cultural, social, and recreational activities The issue is discrimination because of stigma of mental illness and ingrained negative attitudes and beliefs about people with diagnosis of mental illness.

Social Environmental Barrier and Stigma:

Social Environmental Barrier and Stigma Stigma and Culture Mental Illness is viewed across most cultures with stigma Need to understand the societal forces that shape the discrimination Be culturally sensitive Consider Double Stigma Stigma and Community Integration Impacts successful community integration Hierarchy related to type of disability Creates opportunities for discrimination based on own beliefs Lack of self-efficacy and self determination Barriers to treatment include long waits, message to employer

Social Supports and Recovery:

Social Supports and Recovery Social Supports as Protective Factors Social support acts as a buffer Belief in the Consumer Need to not give up on one’s self or needs Affirming Social Environments Empowerment through collaborative decision making and self-determination, family education and supports

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