Incentive systems for mental health organizations

Administrators of human service organizations have received substantial criticisms in recent years for not applying business-like methods in their daily operations. One common criticism is the failure to use incentives. The authors urge that human service managers operate within a peculiar set of organizational constraints that impinge upon their ability to design incentive systems. Understanding these constraints helps the manager to creatively allocate rewards that meet both individual and organizational needs. The authors suggest a contingency framework to incentive design and illustrate how it can be applied.Anne Gurnack, Ph.D., is Assistant Professor, Institute for Local Government and Human Services, Division of Behavioral Science, University of Wisconsin-Parkside, Kenosha, WI 53141. Dick Schoech, Ph.D., is Assistant Professor, Graduate School of Social Work, University of Texas, Arlington 76019.     

The mental health organizations

The mental health organizations in the mental health phase-in were Oregon's pioneers moving into public managed care. A delicate balance between county mental health authority and private expertise was struck locally to yield a variety of organizational models across the state.     

Developing productivity in mental health organizations

Although the new wave of attention to human services productivity is often motivated by fiscal concerns, a well-balanced approach calls for attention to the organizational processes and clinical practices that yield productivity as well as to numerical measures and bottom lines. This article presents a comprehensive view via a ten-point model of organizational development addressing fiscal, programmatic, technical and interpersonal apsects of productivity development. A case illustration drawn from the Alameda County (California) Mental Health Service is also presented.The author is Associate Director, Outpatient Services, Alameda County Mental Health Services, Oakland, CA.     

Staff development in mental health organizations

Mental health administrators are advised to implement and maintain staff development, despite whatever diminished funding and increased competition their organizations face. Staff development programs allow mental health staff at all levels of education to more effectively serve the individuals and communities in which they work, maintain and increase their skills, and help with their recruitment and retention.     

Potential strategies for sustainably financing mental health care in Uganda

Background

In spite of the pronounced adverse economic consequences of mental, neurological, and substance use disorders on households in most low- and middle-income countries, service coverage and financial protection for these families is very limited. The aim of this study was to generate potential strategies for sustainably financing mental health care in Uganda in an effort to move towards increased financial protection and service coverage for these families.

Methods

The process of identifying potential strategies for sustainably financing mental health care in Uganda was guided by an analytical framework developed by the Emerging Mental health systems in low and middle income countries (EMERALD project). Data were collected through a situational analysis (public health burden assessment, health system assessment, macro fiscal assessment) and eight key informant interviews with selected stakeholders from sectors including health, finance and civil society. The situational analysis provided contextualization for the strategies, and was complimented by views from key informant interviews.

Results

Findings indicate that the following strategies have the greatest potential for moving towards more equitable and sustainable mental health financing in the Uganda context: implementing National Health Insurance Scheme; shifting to Results Based Financing; decentralizing mental health services that can be provided at community level; and continued advocacy with decision makers with evidence through research.

Conclusion

Although several options were identified for sustainably financing mental health care in Uganda, the National Health Insurance Scheme seemed the most viable option. However, for the scheme to be effective, there is need for scale up to community health facilities and implementation in a manner that explicitly includes community level facilities.

     

Current tensions in financing public mental health services

The views expressed in this column are solely those of the authors.     

Survival strategies for community mental health organizations: A conceptual framework

Changing conditions call for each Community Mental Health Center (CMHC) to develop a survival strategy based on its own standards and values. The strategy must contain political, funding, programmatic, structural and role change components. A CMHC must orchestrate its strategy as part of an overall survival plan, but may be constrained by the degree of control it has over programs and resources. Major types of risks associated with entrepreneurial (viz., high control over programs and resources) and restricted models (viz., low control over programs and resources) are reviewed.     

Salutogenic factors for mental health promotion in work settings and organizations

Abstract

Accompanied by an increasing awareness of companies and organizations for mental health conditions in work settings and organizations, the salutogenic perspective provides a promising approach to identify supportive factors and resources of organizations to promote mental health. Based on the sense of coherence (SOC) – usually treated as an individual and personality trait concept – an organization-based SOC scale was developed to identify potential salutogenic factors of a university as an organization and work place. Based on results of two samples of employees (n = 362, n = 204), factors associated with the organization-based SOC were evaluated. Statistical analysis yielded significant correlations between mental health and the setting-based SOC as well as the three factors of the SOC yielded by factor analysis yielded three factors comprehensibility, manageability and meaningfulness. Significant statistic results of bivariate and multivariate analyses emphasize the significance of aspects such as participation and comprehensibility referring to the organization, social cohesion and social climate on the social level, and recognition on the individual level for an organization-based SOC. Potential approaches for the further development of interventions for work-place health promotion based on salutogenic factors and resources on the individual, social and organization level are elaborated and the transcultural dimensions of these factors discussed.     

Salutogenic factors for mental health promotion in work settings and organizations

Accompanied by an increasing awareness of companies and organizations for mental health conditions in work settings and organizations, the salutogenic perspective provides a promising approach to identify supportive factors and resources of organizations to promote mental health. Based on the sense of coherence (SOC) - usually treated as an individual and personality trait concept - an organization-based SOC scale was developed to identify potential salutogenic factors of a university as an organization and work place. Based on results of two samples of employees (n = 362, n = 204), factors associated with the organization-based SOC were evaluated. Statistical analysis yielded significant correlations between mental health and the setting-based SOC as well as the three factors of the SOC yielded by factor analysis yielded three factors comprehensibility, manageability and meaningfulness. Significant statistic results of bivariate and multivariate analyses emphasize the significance of aspects such as participation and comprehensibility referring to the organization, social cohesion and social climate on the social level, and recognition on the individual level for an organization-based SOC. Potential approaches for the further development of interventions for work-place health promotion based on salutogenic factors and resources on the individual, social and organization level are elaborated and the transcultural dimensions of these factors discussed.     

Utilization and coverage of mental health services in health maintenance organizations

Health maintenance organizations (HMOs) generally have very limited coverage of mental health care and have been charged with shortchanging chronic patients in the interests of economy. The authors analyzed 1979-1980 coverage and utilization data from 53 federally qualified HMOs. They found that while coverage is limited and very similar across the spectrum of HMOs, utilization rates vary greatly and do not correlate with extent of coverage. They suggest that management decisions may be critical in determining access to and use of mental health benefits in HMOs.     

Capitation financing of public mental health services for the chronically mentally ill

In the 30 years since deinstitutionalization began the public mental health system has experimented with a variety of financing and management models in the delivery of care to the chronically mentally ill. Currently, capitation methods of payment for public mental health services to the chronically mentally ill are being tested as an alternative to fee-for-service reimbursement. Proponents suggest that capitation will increase service flexibility and produce a variety of better coordinated, more cost efficient services. Opponents believe that capitation will result in reduced care given the absence of treatment protocols and the financial incentives for cost containment. This paper discussed the impact of financing mechanisms and organizational structure on the delivery of mental health care for the chronically mentally ill, provides a review of the pertinent literature, and describes demonstration projects currently underway. Questions are raised as to the potential impact of capitation on the mental health system.This research was supported by a grant from the Pew Charitable Trusts to the University of Pennsylvania and The Community Council for Mental Health and Mental Retardation Inc., and was carried out jointly by the Policy Modeling Workshop of the Wharton School and the Section on Public Psychiatry and Mental Health Services Research of the School of Medicine.     

Inpatient admissions to specialty mental health organizations: Forecasts 1990 to 2010

This paper projects inpatient admissions to specialty mental health organizations for white, nonwhite, and black persons in five year intervals between 1990 and 2010. The authors suggest that it is reasonable to expect significant increases in the number of white, nonwhite, and black inpatient admissions to all specialty mental health organizations, except state and county mental hospitals, during the next 20 years. Among the different specialty mental health organizations, non-federal general hospitals are expected to have the largest increases, and state and county mental hospitals, the smallest.