title: Key stakeholder perceptions regarding acute care psychiatry in distressed publicly funded mental health care markets.
abstract: The role of acute care inpatient psychiatry, public and private, has changed dramatically since the 1960s, especially as recent market forces affecting the private sector have had ripple effects on publicly funded mental health care. Key stakeholders' experiences, perceptions, and opinions regarding the role of acute care psychiatry in distressed markets of publicly funded mental health care were examined. A qualitative research study was conducted using semi-structured thematic interviews with 52 senior mental health system administrators, clinical directors and managers, and nonclinical policy specialists. Participants were selected from markets in six regions of the United States that experienced recent significant closures of acute care psychiatric beds. Qualitative data analyses yielded findings that clustered around three sets of higher order themes: structure of care, service delivery barriers, and outcomes. Structure of care suggests that acute care psychiatry is seen as part of a continuum of services; service delivery barriers inhibit effective delivery of services and are perceived to include economic, regulatory, and political factors; outcomes include fragmentation of mental health care services across the continuum, the shift of mental health care to the criminal justice system, and market-specific issues affecting mental health care. Findings delineate key stakeholders' perceptions regarding the role acute care psychiatry plays in the continuum of care for publicly funded mental health and suggest that public mental health care is inefficacious. Results carry implications for policy makers regarding strategies/policies to improve optimal utilization of scarce resources for mental health care, including greater focus on psychotherapy.
authors.affiliation: Department of Psychology, University of Hawaii, Hilo, Hawaii, USA. frueh@hawaii.edu
authors.forename: B Christopher
authors.initials: BC
authors.lastname: Frueh
authors.forename: Anouk L
authors.initials: AL
authors.lastname: Grubaugh
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Lo Sasso
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Jones
authors.forename: John M
authors.initials: JM
authors.lastname: Oldham
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
mesh_terms: D000208:Acute Disease; D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000191:economics; D003363:Cost Control / Q000191:economics; D003416:Criminal Law / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics; D005380:Financing, Government / Q000191:economics*; D015276:Health Care Rationing / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006742:Hospital Bed Capacity / Q000191:economics; D006778:Hospitals, Psychiatric / Q000191:economics*; D006801:Humans; D007406:Interview, Psychological; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D010343:Patient Admission / Q000191:economics*; D010351:Patient Discharge / Q000191:economics; D011057:Politics; D012017:Referral and Consultation / Q000191:economics; D012051:Reimbursement Mechanisms / Q000191:economics; D014481:United States