The obvious advantages of a more integrated system for suicide prevention have

The obvious advantages of a more integrated system

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The obvious advantages of a more integrated system for suicide prevention have been well consid- ered, 105 but the fragmentation and gaps in care have proved insurmountable so far. For this reason,
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Continuity of Care for Suicide Prevention and Research 26 The President’s New Freedom Commission on Mental Health recommends “fundamentally trans- forming how mental health care is delivered in America.” A transformed system will be seamless and convenient and built around consumers’ needs. Moreover, “the burden of coordinating care will rest on the system, not on families or consumers who are already struggling because of seri- ous [mental] illness.” 109 Care coordination and care continuity are especially critical the moment that “the chain of surviv- al” links to the emergency department (ED). Regardless of where in medicine the health problem occurs, the ED is the only clinic that accepts all patients, making it central to the organizational structure of mental health and general medical care. Since it is, albeit, a therapeutic way station, the ED must specialize in out-referrals and care maintenance. Out-referrals with high-quality out- comes are achievable more if care is coordinated and continuity is maintained. Section-at-a-Glance: The President’s New Freedom Commission on Mental Health recommends “fundamen- tally transforming how mental health care is delivered in America.” The principles of continuity of care offer a solid foundation for any transformed system. When the prin- ciples of continuity of care are applied properly, a high proportion of successful outcomes are expected. Section-related Recommendation: Make continuity of care principles a major part of the foundation anchoring a transformed system for providing mental health care in America. The National Strategy for Suicide Prevention and Continuity of Care Ever increasing numbers of individuals with mental health and/or substance use disorders visit America’s emergency departments. In 2005 there were an estimated 115.5 million visits to hos- pital EDs. Approximately one-fifth of the U.S. population made one or more ED visits within the prior 12 months. 98 Mental-health-related visits are estimated at over 5.3 million per year, on average, between 1992 and 2001. 110 During the period from 1992–2001, mental-health-related visits saw a 27.5 percent increase. In 2001, there were 23.6 visits per 1,000 ED patients compared to 17.1 in 1992. 111 The actual number of mental-health-related visits may be considerably higher than any current estimate, since 19.3 million visits per year are classified as “symptoms, signs and ill-defined conditions,” 98 and unexplained physical and general medical symptoms are com- mingled more often than not with anxiety and depressive disorders.
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