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CPH 310 Health Care In The US Question Reflecting on: Variation in Outcomes & Spending Social Determinants of Health, Mental Health/Substance Abuse, Changing Payment Models, and Workforce Challenges, please propose a focused  change to the delivery of care for a specific population of patients. Discuss how the change improves health care value, and raise any ethical concerns that may occur as a result of the change. In grading your papers, we will be looking for: Identify the specific area you will be discussing (e.g. Social Determinants of Health) Describe the change you are proposing Analyze the population you are studying (the more focused, the better!) Discuss how your change improves outcomes that matter and/or promotes affordability Explain the ethical concerns that may arise from your proposed change (e.g. if you propose expanding care access, how does that affect taxpayers)? Answer Introduction: Mental health has always been a topic of interest for the researcher. The complexity of the mental disease and its treatment procedures make it an excellent topic of choice. Far more than any other disease, mental health diseases are subjected to negative judgments and stigmatization by society. Good mental health is integral part of human health and wellbeing (Peritogiannis et al., 2017). Mental health includes emotional, psychological and social wellbeing, which affects the process of thinking and behavior. Research has identified that social environment and personal situation poorly affect the mental wellbeing of the individual. Therefore, the mental illness contributes to 14% of the global disease (Eisendrath et al., 2014). There are social determinants of the mental health that influence the prevalence of mental health disease. These include lifestyle, stress, social exclusion, unemployment, working conditions, food insecurity (Han et al., 2016). The common mental health disorders include bipolar disorder, major depressive disorder, Dementia, schizophrenia, panic disorders, major phobias, obsessive-compulsive disorder, and posttraumatic stress disorder (Keaton, McCann, & Giles, 2017). The prevalence of these diseases are observed in any stage of life irrespective of age and gender but mostly observed among the older population. Therefore, it is essential that the actions should be taken for changing the infrastructure of the health care services in order to improve population mental health and thereby reducing the risk of mental disorders associated with social determinants. This paper will illustrate a plan involving the area of concern, description of the plan, and analysis of the population, how change improves outcomes and affordability, ethical concerns that arise from the proposed changes. Area Of Concern: The area I will be discussing in this part is mental health of the elderly population since the prevalence of mental health issue in the elderly population of US is higher as compared to other countries. Mental health is defined as a state of wellbeing in which every individual realizes his or her own potential for coping with the normal stress of life. Although the mental health illness can be observed in any stage of life, it is more common  in the aging population (Yoon, Coburn & Spence, 2018). Older adults, those aged 60 years or above have important contribution in society as a crucial member of family, volunteer and as active participants in the workplace. While other countries have good mental health and wellbeing, an older adult is at risk of developing the mental disorder, neurological disorder or substance use problem. The World health organization has suggested that the most commonly diagnosed mental disorder is mood disorder, which has affected about 21 million adults in United States, included major depressive disorder, dysthymic disorder, bipolar disorder, anxiety disorder (Ho et al., 2018). Out of 1 in 5 adults in the US experience mental illness in given year. Approximately 1 in 25 adults in The US experienced mental illness in given year that substantially interferes with the life activities (Wang et al., 2016). 6.9% of adults in the US experienced at least one episode of major depressive disorders, obsessive-compulsive disorders and specific phobias (Ho et al., 2018). Amongst 20.2 million adults in the U.S, approximately 50% of the individuals experienced mental illness due to substance abuse (Ho et al., 2018). Therefore, in my opinion, the older population is at major risk of mental health illness that affected their daily activities and social life. Mental health of the elderly population attracted my attention because it is a crucial issue that can be reduced with proper treatment and raising awareness. According to Wynaden et al. (2016), mental health has a huge impact on the physical health. An older individual with chronic pain, heart diseases or mobility issues experienced higher depression as compared to healthy individuals. They have a tendency to isolate themselves from social interactions and they preferred to live in loneliness. The older individual are also vulnerable to  abuse, which includes physical, verbal, psychological, financial, loss of dignity and respect (Fredriksen-Goldsen et al., 2014). Social stigma is another key risk factor that maximizes mental health issues. A considerate number of individuals think that people with psychiatric disabilities living in society lower values due to lack of their mental stability. These thoughts and beliefs are implanted within individuals due to lack of awareness and religion beliefs. According to de Koning et al. (2018), self-esteem suffers which in turn lowers the confidence of the elderly patient. The elderly patient suffer more from social and self-stigma because with growing age, they lose their ability to work activity and therefore, they lose their dignity, values, tend to feel worthless (Beekman, 2016). Although progress in mental health services are fast compared to other and mid economic countries, lack of awareness and priorities contributed to the occurrence of mental illness (Ros et al., 2016). Barriers include existing public health priorities, which influences the funding, lack of proper delivery of mental health care in a primary care setting, lack of mental health perspective in a healthcare setting and fewer numbers of trained health professionals in nursing. Serious mental illness costs America $193.2 billion in lost earnings per year (Rebok et al., 2018). Moreover, the higher cost associated with the diagnosis, treatment of health care system such as medications, physician visits, psychotherapy session, and hospitalization and so on are also major concern. The economic burden also arises due to mobility, mortality, care seeking in workplaces and early retirements due to mental health issues (Montgomery et al., 2018). Proposed Changes For Improving Mental Health: Mental health is a major concern worldwide and requires attention from health care professionals and governing bodies so that every individual has better mental health (Hart & Area, 2017). According to my point of view, since the issue is preventable and manageable with few amendments the mental health of an elderly population in the US can be improved. Therefore, as a mental health awareness combating stigma, enhancing prevention interventions, proper early recognition, stimulating simple and practice interventions within the community can be adopted for the greater good of the population. According to Ryst (2017), a mental health awareness campaign has yield the positive outcome in several countries. Some strategies can be adopted for reducing mental health illness such as governing program, the educational system in hospitals, improved hospitality, health promotions, and mental health care in the community. Despite different initiatives taken by different institutions, the government remains the biggest key player in amending the changes in mental health care sectors (Ros et al., 2016). The mental health of older adults can be improved through the promotion of active and healthy aging through the programs. National and district mental health programs can be designed where education about the mental health and risk factors can be adopted for increasing awareness of the mental health (Hart & Area, 2017). These health promotions also involve creating living conditions and a comfortable atmosphere for the wellbeing of the older population, which will allow elderly people to lead the healthy life (Reeves Parker & Konkle-Parker, 2016) To address the mental health issues in elderly patients, a range of strategies can be adopted in the hospital sectors. These strategies involve the providing training to every health professional for proving elderly care to every patient, accessing advanced technology to determine early symptoms of mental illness, preventing and managing age-related chronic diseases such as cardiovascular disease, strokes, and dementia (Reeves, Parker & Konkle-Parker, 2016). It is often observed that elderly patients whose family members live away from them experience major depressive disorders, anxiety disorder, and post-traumatic stress disorder (Reeves, Parker & Konkle-Parker, 2016). Moreover, due to the lack of adequate knowledge nurses are failed to provide the care and attention patients need in order to overcome the emotional turmoil’s, disorders and phobias. Therefore, according to my perception, development of leadership skills within the health professionals, especially nurse educators can resolve the issue and aid in obtaining a positive patient outcome.Nursing facilities in the hospital for patients with mental illness such as motivational therapy, music therapy can be effective for enhancing mental health and wellbeing (Beekman, 2016).  According to Beekman (2016), shared care with primary care physicians is beneficial to approach with several advantages, which include access to the health facilities for elderly patients, reduction of social stigma through providing daily education to the family members of the patient and having adequate staffs to attend the patient with physical difficulties (Reeves Parker & Konkle-Parker, 2016). Providing security and freedom to the elderly patient who admitted in the hospital for a longer period can reduce their loneliness and issues of mental health (Ho et al., 2018). Majority of the individuals suffered from mental issues due to lack of social attachment and social acceptance (Fredriksen-Goldsen et al., 2014). Social support for elderly individual and their caregivers proved to be beneficial for providing better mental wellbeing and healthy life. Designing sustainable policies for healthy older individuals such as healthy eating and active living can reduce mental illness and provide them with an effective lifestyle (Ros et al., 2016). Moreover, accurate policies and educations of mental health awareness in the workplaces tend to improve the daily performance of the elder patient. Mental health awareness also includes psychological interventions and medication to reduce the global burden of the disease (Ho et al., 2018).  Since the medications such as potential antidepressants have major side effects, which leads to other psychological disabilities, psychotherapies are proved to be effective in curing mental illness. Therefore, psychological interventions such as cognitive behavioral therapy, holistic therapy can be improved in the hospital setting. Since these therapies are costly and require long-term adherence, many individuals with poor economic status tend to avoid the therapies that in turn reduces the number of individuals with healthy mental health (Ho et al., 2018). According to my perception, free of cost services to the poor elderly patient can potentially reduce the economic burden of the mental health illness and provide healthy mental well being to the individuals who live in remote area (Ros et al., 2016). Effective and community based primary mental health for elderly population is effective for mental well being of the patient. The Outcome Of The Proposed Inventions: With the growing burden of the mental health issues in the elderly patient and lack of accurate interventions to reduce, mental health awareness is crucial for the mental wellbeing of individuals, especially older individuals. Mental health issues can be observed in any stage of life but mostly predominate in the older population due to social and environment (Hart & Area, 2017). Therefore, the prime goal of mental health awareness is to strengthen the mental well being of the older population and promotion of mental well being along with the integration of effective strategies into policies and plans (Savva et al., 2017). Since the first priority is an individual well being of the elderly patient, in my opinion, the outcome of the mental health awareness is that the people with good physical and psychological health are optimistic and hopeful about their recovery (Fredriksen-Goldsen et al., 2014). The mental health awareness provides an opportunity to the family members to participate in the process of recovery of mental health illness. The awareness also diminishes the social stigma and false belief of individual and boost self-esteem, the confidence of the individuals (Fredriksen-Goldsen et al., 2014).  Mental awareness increases the knowledge of individuals and community for providing a comfortable environment for the living of elderly patient and this, in turn, reduce the prevalence of mental illness (Reeves Parker & Konkle-Parker, 2016). The awareness increases within the healthcare sectors improve the treatment procedure of the mental illness. Health care practitioners become more aware of the treatment procedure. The cost of health care sectors reduces exponentially because the awareness minimizes the cost required for seeking help from health professionals, the cost of expensive treatment of the health care. The cost of the diagnosis and treatment will minimize because of the awareness in every individual (Hart & Area, 2017).  The nurses and other social caregivers involved in the care of older people reduces the loneliness of the patient, improves the ability to think clearly and improves the perception of daily life. The free of cost treatment to the older patient with lower economical values reduces the mental health problems and provides effective patient-centric care to the patient (Reeves, Parker & Konkle-Parker, 2016). Awareness in the workplaces improves the relationship between employs and employer, increases the daily performance, prevent the loss of the workplace every year. Ethical Concern That May Arise From The Proposed Changes: Since the mental health and well-being is complex, any interventions and implementation of strategy may cause ethical concern (Wilson, 2018). According to my point of view, the ethical challenges may arise during providing education to every individual about mental wellbeing. The prime reason behind it is that individuals with mental illness have different religious belief. Since they have implanted religion beliefs, they feel offended when they made aware of the mental health and well-being (Wilson, 2018). They tend to adhere to their old traditional belief in mental health and refuse to seek other treatment procedures. Ethical challenges may observe during diminishing the social stigma, the majority of the individuals lives with false beliefs and refuse to seek help from the health professionals because of their lack of confidence. Ethical challenges also arise during the government programs and designing the policies, plans due to negligence among governing bodies. The ethical dilemma arises mostly during psychotherapies since it requires long-term interaction between health professionals. The mental health awareness mostly causes ethical dilemma when the participants are from the remote areas because they have different cultural beliefs and they lack adequate sound knowledge about the mental wellbeing. The awareness requires active participation of different volunteers, which can be an ethical concern (Reeves Parker & Konkle-Parker, 2016). Without concrete evidence, healthcare sectors and workplace refuse to arrange a program for promoting well being. This can be an ethical concern for promoting mental well being. Therefore, although mental health awareness proves to give positive outcomes, there is much ethical concern which need to consider in order promoting mental health and wellbeing (Wynaden et al. 2016). Conclusion: Thus, it can be concluded that mental health and wellbeing is crucial for every individual to live healthy lives. Mental health includes our emotional, psychological and social wellbeing, which affects our thinking and behavior. The mental health issues mainly observed due to social and environmental factors that affected the psychological well-being of the individual.  According to accumulated evidence, although mental health issues can be observed at any stage of life, elderly patients are at higher risk of mental health issues. Common mental health issues that affected daily activities involve major depressive disorder, Dementia, obsessive-compulsive disorder. Social isolation, the prevalence of chronic diseases, mobility issues are identified as risk factors for the growing prevalence of mental health disease. Consequently, they lost their dignity, values and tend to feel worthless. Therefore, according to my point of view, mental health awareness can be an effective strategy to reduce mental illness and promote mental health. Mental awareness includes governing programs for promoting health, designing policies, educating health professionals, workplaces. Mental health awareness also reduces the high expenditure of healthcare sectors since it reduces the cost of seeking help. The outcome can be the reduction of the economic burden of mental health, the increase of self-esteem and confidence of the older patient. However, their certain ethics need to consider for mental health awareness for successful mental health awareness in order to promote mental health and well-being. References: Beekman, A. T. (2016). Global mental health for older adults. The American Journal of Geriatric Psychiatry, 24(4), 259-260. de Koning, E. J., Timmermans, E. J., van Schoor, N. M., Stubbs, B., van den Kommer, T. N., Dennison, E. M., … & Cooper, C. (2018). Within-Person Pain Variability and Mental Health in Older Adults With Osteoarthritis: An Analysis Across 6 European Cohorts. The Journal of Pain, 19(6), 690-698. Eisendrath, S. J., Gillung, E. P., Delucchi, K. L., Chartier, M., Mathalon, D. H., Sullivan, J. C., … & Feldman, M. D. (2014). Mindfulness-based cognitive therapy (MBCT) versus the health-enhancement program (HEP) for adults with treatment-resistant depression: a randomized control trial study protocol. BMC complementary and alternative medicine, 14(1), 95. Fredriksen-Goldsen, K. I., Kim, H. J., Shiu, C., Goldsen, J., & Emlet, C. A. (2014). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. The Gerontologist, 55(1), 154-168. Han, B., Compton, W. M., Mojtabai, R., Colpe, L., & Hughes, A. (2016). Trends in Receipt of Mental Health Treatments Among Adults in the United States, 2008-2013. The Journal of clinical psychiatry, 77(10), 1365-1371. Hart, T., & Area, P. (2017). Mental health awareness: not simply adherence to Acts, but about dignity. Ho, E. C., Hawkley, L., Dale, W., Waite, L., & Huisingh-Scheetz, M. (2018). Social capital predicts accelerometry-measured physical activity among older adults in the US: a cross-sectional study in the National Social Life, Health, and Aging Project. BMC public health, 18(1), 804. Keaton, S. A., McCann, R. M., & Giles, H. (2017). The role of communication perceptions in the mental health of older adults: Views from Thailand and the United States. Health communication, 32(1), 92-102. Montgomery, P., Nangia, P., Mossey, S., & Rancourt, S. (2018). Self-perceived Mental Health of Older Adults in Canada. Diversity of Research in Health Journal, 2, 30-49. Peritogiannis, V., Manthopoulou, T., Gogou, A., & Mavreas, V. (2017). Mental healthcare delivery in rural Greece: A 10-year account of a mobile mental health unit. Journal of neurosciences in rural practice, 8(4), 556. Rebok, G. W., Ball, K., Guey, L. T., Jones, R. N., Kim, H. Y., King, J. W., … & Willis, S. L. (2014). Ten?year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. Journal of the American Geriatrics Society, 62(1), 16-24. Reeves, R. R., Parker, J. D., & Konkle-Parker, D. J. (2016). War-related mental health problems of today’s veterans: new clinical awareness. Journal of psychosocial nursing and mental health services, 43(7), 18-28. Ros, L., Meléndez, J. C., Webster, J. D., Mayordomo, T., Sales, A., Latorre, J. M., & Serrano, J. P. (2016). Reminiscence functions scale: factorial structure and its relation with mental health in a sample of Spanish older adults. International psychogeriatrics, 28(9), 1521-1532. Ryst, E. (2017). 26.4 Increasing Mental Health Awareness and Interventions in Rural Schools. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), S344. Savva, L. I., Saigushev, N. Y., Vedeneeva, O. A., Pavlova, L. V., & Rabin, E. I. (2017). Student’s time-awareness formation: self-organized personality as promoting factor for mental health. In THE EUROPEAN PROCEEDINGS OF SOCIAL & BEHAVIOURAL SCIENCES (pp. 858-864). Wang, J., Jia, H., Shang, J., & Kearney, J. A. (2016). Critical association between mental health disorders and medical status: depression intervention use indicates a two-fold risk for subsequent medical events in older American home health care patients. Journal of gerontological nursing, 42(10), 42-55. Wilson, D. (2018). Mental health awareness workshop. Wynaden, D., Tohotoa, J., Heslop, K., & Al Omari, O. (2016). Older adults admitted to inpatient mental health units present with complex mental health care needs which are often compounded by the challenges of living with physical co-morbidities. They are a mobile population and a high risk group for falling during hospitalisation. To address quality and safety concerns around the increased risk for falls, a qualitative research study was completed to obtain… Collegian, 23(1), 129-142. Yoon, E., Coburn, C., & Spence, S. A. (2018). Perceived discrimination and mental health among older African Americans: the role of psychological well-being. Aging & mental health, 1-9.

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