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Erschienen in:

14.08.2024 | Brief Report

Slipping Through the Cracks: Clinicians’ Perspectives on the Gaps in New York City’s Public Mental Health System

verfasst von: Briana S. Last, Madeline Kiefer, Rebecca Mirhashem, Danielle R. Adams

Erschienen in: Community Mental Health Journal | Ausgabe 1/2025

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Abstract

Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City’s public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, “serendipitous finding” approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.
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Literatur
Zurück zum Zitat Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 51(7), 689.CrossRefPubMed Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 51(7), 689.CrossRefPubMed
Zurück zum Zitat Bickman, L., Lambert, E. W., Andrade, A. R., & Penaloza, R. V. (2000). The Fort Bragg continuum of care for children and adolescents: Mental health outcomes over 5 years. Journal of Consulting and Clinical Psychology, 68(4), 710.CrossRefPubMed Bickman, L., Lambert, E. W., Andrade, A. R., & Penaloza, R. V. (2000). The Fort Bragg continuum of care for children and adolescents: Mental health outcomes over 5 years. Journal of Consulting and Clinical Psychology, 68(4), 710.CrossRefPubMed
Zurück zum Zitat Braun, V., Clarke, V., & Hayfield, N. (2017). In J. A. Smith (Ed.), Thematic analysis. SAGE. Braun, V., Clarke, V., & Hayfield, N. (2017). In J. A. Smith (Ed.), Thematic analysis. SAGE.
Zurück zum Zitat Breslau, J., Barnes-Proby, D., Bhandarkar, M., Cantor, J. H., Hanson, R., Kofner, A., Li, R., Malika, N., Mendoza-Graf, A., & Pincus, H. A. (2022). Availability and accessibility of mental health services in New York City. Rand Health Quarterly, 10(1), 6.PubMedPubMedCentral Breslau, J., Barnes-Proby, D., Bhandarkar, M., Cantor, J. H., Hanson, R., Kofner, A., Li, R., Malika, N., Mendoza-Graf, A., & Pincus, H. A. (2022). Availability and accessibility of mental health services in New York City. Rand Health Quarterly, 10(1), 6.PubMedPubMedCentral
Zurück zum Zitat Cornell, P. Y., Halladay, C. W., Ader, J., Halaszynski, J., Hogue, M., McClain, C. E., Silva, J. W., Taylor, L. D., & Rudolph, J. L. (2020). Embedding social workers in veterans health administration primary care teams reduces emergency department visits: An assessment of the Veterans Health Administration program to add social workers to rural primary care teams. Health Affairs, 39(4), 603–612. https://doi.org/10.1377/hlthaff.2019.01589CrossRefPubMed Cornell, P. Y., Halladay, C. W., Ader, J., Halaszynski, J., Hogue, M., McClain, C. E., Silva, J. W., Taylor, L. D., & Rudolph, J. L. (2020). Embedding social workers in veterans health administration primary care teams reduces emergency department visits: An assessment of the Veterans Health Administration program to add social workers to rural primary care teams. Health Affairs, 39(4), 603–612. https://​doi.​org/​10.​1377/​hlthaff.​2019.​01589CrossRefPubMed
Zurück zum Zitat Delgadillo, J., Appleby, S., Booth, S., Burnett, G., Carey, A., Edmeade, L., Green, S., Griffin, P., Johnson, E., Jones, R., Parker, P., Reeves-McLaren, L., & Lutz, W. (2020). The leeds risk Index: Field-test of a stratified psychological treatment selection algorithm. Psychotherapy and Psychosomatics, 89(3), 189–190. https://doi.org/10.1159/000505193CrossRefPubMed Delgadillo, J., Appleby, S., Booth, S., Burnett, G., Carey, A., Edmeade, L., Green, S., Griffin, P., Johnson, E., Jones, R., Parker, P., Reeves-McLaren, L., & Lutz, W. (2020). The leeds risk Index: Field-test of a stratified psychological treatment selection algorithm. Psychotherapy and Psychosomatics, 89(3), 189–190. https://​doi.​org/​10.​1159/​000505193CrossRefPubMed
Zurück zum Zitat Frank, R. G., & Glied, S. (2006). Better but not well: Mental health policy in the United States since 1950. Johns Hopkins University. Frank, R. G., & Glied, S. (2006). Better but not well: Mental health policy in the United States since 1950. Johns Hopkins University.
Zurück zum Zitat Grogan, C. M. (2023). Grow and hide: The history of America’s health care state. Oxford University Press. Grogan, C. M. (2023). Grow and hide: The history of America’s health care state. Oxford University Press.
Zurück zum Zitat Jones, A. L., Kelley, A. T., Suo, Y., Baylis, J. D., Codell, N. K., West, N. A., & Gordon, A. J. (2023). Trends in health service utilization after enrollment in an interdisciplinary primary care clinic for veterans with addiction, social determinants of health, or other vulnerabilities. Journal of General Internal Medicine, 38(1), 12–20. https://doi.org/10.1007/s11606-022-07456-xCrossRefPubMed Jones, A. L., Kelley, A. T., Suo, Y., Baylis, J. D., Codell, N. K., West, N. A., & Gordon, A. J. (2023). Trends in health service utilization after enrollment in an interdisciplinary primary care clinic for veterans with addiction, social determinants of health, or other vulnerabilities. Journal of General Internal Medicine, 38(1), 12–20. https://​doi.​org/​10.​1007/​s11606-022-07456-xCrossRefPubMed
Zurück zum Zitat Konecki, K. T. (2019). Creative thinking in qualitative research and analysis. Qualitative Sociology Review, 15(3), 6–25.CrossRef Konecki, K. T. (2019). Creative thinking in qualitative research and analysis. Qualitative Sociology Review, 15(3), 6–25.CrossRef
Zurück zum Zitat Last, B. S., & Adams, D. (2023). Strengthening the mental health workforce: An exploratory qualitative study of unionized mental health clinicians. In APHA 2023 Annual Meeting and Expo. Last, B. S., & Adams, D. (2023). Strengthening the mental health workforce: An exploratory qualitative study of unionized mental health clinicians. In APHA 2023 Annual Meeting and Expo.
Zurück zum Zitat Last, B. S., Crable, E. L., Khazanov, G. K., Scheinfeld, L. P., McGinty, E. E., & Purtle, J. (2024a). Impact of U.S. Federal loan repayment programs on the behavioral health workforce: Scoping review. Psychiatric Services (Washington D C), appips20230258. https://doi.org/10.1176/appi.ps.20230258 Last, B. S., Crable, E. L., Khazanov, G. K., Scheinfeld, L. P., McGinty, E. E., & Purtle, J. (2024a). Impact of U.S. Federal loan repayment programs on the behavioral health workforce: Scoping review. Psychiatric Services (Washington D C), appips20230258. https://​doi.​org/​10.​1176/​appi.​ps.​20230258
Zurück zum Zitat Lengnick-Hall, R., Williams, N. J., Ehrhart, M. G., Willging, C. E., Bunger, A. C., Beidas, R. S., & Aarons, G. A. (2023). Eight characteristics of rigorous multilevel implementation research: A step-by-step guide. Implementation Science, 18(1), 52. https://doi.org/10.1186/s13012-023-01302-2. Lengnick-Hall, R., Williams, N. J., Ehrhart, M. G., Willging, C. E., Bunger, A. C., Beidas, R. S., & Aarons, G. A. (2023). Eight characteristics of rigorous multilevel implementation research: A step-by-step guide. Implementation Science, 18(1), 52. https://​doi.​org/​10.​1186/​s13012-023-01302-2.​
Zurück zum Zitat Morgan, K. J., & Campbell, A. L. (2011). The delegated welfare state: Medicare, markets, and the governance of social policy. Oxford University Press. Morgan, K. J., & Campbell, A. L. (2011). The delegated welfare state: Medicare, markets, and the governance of social policy. Oxford University Press.
Zurück zum Zitat Saunders, H., Guth, M., & Eckart, G. (2023). A look at strategies to address behavioral health workforce shortages: Findings from a survey of state Medicaid programs. Kaiser Family Foundation. https://tinyurl.com/9s5vhdhh Saunders, H., Guth, M., & Eckart, G. (2023). A look at strategies to address behavioral health workforce shortages: Findings from a survey of state Medicaid programs. Kaiser Family Foundation. https://​tinyurl.​com/​9s5vhdhh
Zurück zum Zitat Weaver, R., Brady, A. M., & West, Z. (2023). Diminishing New York state’s public mental healthcare sector: The impact of austerity and privatization on wages and employment. Cornell University School of Industrial and Labor Relations Worker Institute. https://tinyurl.com/3b7phjzm Weaver, R., Brady, A. M., & West, Z. (2023). Diminishing New York state’s public mental healthcare sector: The impact of austerity and privatization on wages and employment. Cornell University School of Industrial and Labor Relations Worker Institute. https://​tinyurl.​com/​3b7phjzm
Zurück zum Zitat Wiedner, R., & Ansari, S. (2017). Appreciating emergence and serendipity in qualitative research: Resisting the urge to follow set plans. The Routledge companion to qualitative research in organization studies (pp. 343–357). Routledge. Wiedner, R., & Ansari, S. (2017). Appreciating emergence and serendipity in qualitative research: Resisting the urge to follow set plans. The Routledge companion to qualitative research in organization studies (pp. 343–357). Routledge.
Zurück zum Zitat Wolk, C. B., Last, B. S., Livesey, C., Oquendo, M. A., Press, M. J., Mandell, D. S., Ingram, E., Futterer, A. C., Kinkler, G. P., & Oslin, D. W. (2021b). Addressing common challenges in the implementation of collaborative care for mental health: The Penn Integrated Care program. The Annals of Family Medicine, 19(2), 148–156. https://doi.org/10.1097/MLR.0000000000001485CrossRefPubMed Wolk, C. B., Last, B. S., Livesey, C., Oquendo, M. A., Press, M. J., Mandell, D. S., Ingram, E., Futterer, A. C., Kinkler, G. P., & Oslin, D. W. (2021b). Addressing common challenges in the implementation of collaborative care for mental health: The Penn Integrated Care program. The Annals of Family Medicine, 19(2), 148–156. https://​doi.​org/​10.​1097/​MLR.​0000000000001485​CrossRefPubMed
Metadaten
Titel
Slipping Through the Cracks: Clinicians’ Perspectives on the Gaps in New York City’s Public Mental Health System
verfasst von
Briana S. Last
Madeline Kiefer
Rebecca Mirhashem
Danielle R. Adams
Publikationsdatum
14.08.2024
Verlag
Springer US
Erschienen in
Community Mental Health Journal / Ausgabe 1/2025
Print ISSN: 0010-3853
Elektronische ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-024-01333-z

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