Health Care

PLEASE USE MY OUTLINE TO WRITE PAPER.
Identify a challenge in your work environment or a professional work environment that influences the quality of services or outcomes provided. In your paper
describe the problem;
describe what may be the cause of the problem;
describe its negative effects on the organization, customers, or individuals;
note who is most concerned by the results (stakeholders); and
recommend three possible solutions to the problem. 3 possible solutions, please use telehealth, charging a cost for missed appointments and develop policies/protocols for missed appointments indicating possible service cancellation.
Support your discussion with at least 3 scholarly sources.

This paper should be 3-4 pages, not including the title or references pages, and should follow APA guidelines.

ANSWER

MCQ1 Paper Part 1

Challenges in the Work Environment

Missed appointments are a major challenge in healthcare, including in mental healthcare facilities. This is one of the challenges faced in my working environment. According to Mental Health America National Organization in 2022 report, “19.86% of adults are experiencing a mental illness. Equivalent to nearly 50 million Americans.” Making the decision to participate in Behavioral Health services, whether it would be psychiatric or psychotherapeutic services, is easier for some people than others. The factors influencing individuals to participate in services or not include financial cost, accessibility, transportation, and social stigma. Insurance coverage remains a struggle for many, 11.1% (over 5.5 million) of adults with a mental illness remain without health coverage (Mental Health America National, 2022). Many Americans depend on their health insurance to subsidize the cost of mental health care. Behavioral health services face many challenges that affect the delivery of care, and one of the main challenges is missed appointments.

Causes of Missed appointments

Social Stigma

Social stigma is one of the main causes of missed appointments among mental health patients. Stigma is when something is associated with negativity. Mental health has been associated with negativity, leading to discrimination among people known to have mental health issues (Miller & Ambrose, 2019). Some patients decide not to attend their appointments because they fear their family or friends will discriminate against them if they find out they sought mental health services. According to the national academies of Sciences et al. (2016), some patients perceive mental health as shameful and negative. The attitudes towards mental health have improved over the years, but people still have negative opinions of mental health, and they sometimes are afraid to disclose their condition to their family and even to their employers.

Transportation

Another cause of no-shows in receiving mental health care is lack of transportation. Some patients come from low-income neighborhoods, and sometimes they do not have the means to get to their appointments. Others live in remote areas, and getting to the hospital for their appointment might sometimes get difficult, leading to them missing their appointments.

Accessibility

Some patients do not have the money to attend follow-up care after being diagnosed with a mental health condition. Although the insurance covers some of the patients, others do not have insurance, and thus they do not have access to cheap mental health services. This is one of the reasons some often schedule a follow-up appointment but do not show up for it because they cannot afford to apply for the services out of pocket (NeMoyer et al., 2022). There is also a disconnect in coordination between primary care systems and mental health systems and a lack of financial means to cover costs such as copays, uncovered treatment types, or cash-only treatment (Mental Health America National, 2022).

Client’s Motivation

Sometimes patients do not show up for their appointments because they are not motivated to seek their mental health treatment. Some patients are in denial about their mental health condition, which could increase missed appointments. The client being motivated and ready to seek help is one step toward getting better. If a patient is motivated, it reduces the number of missed appointments. Patients and their caregivers should also have trust towards each other. If there is a lack of trust between the patient and the caregiver, the patient is likely going to keep missing appointments. Client’s unrealistic expectations of the therapeutic process can also affect their motivation; the clinician’s role is to educate on the progress and prognosis of mental illnesses. Client’s maturity level can also affect how ready they are to maintain commitment. A study by Roberts et al., 2022 found that barriers to seeking or maintaining mental health treatment for individuals 13-24 years old included a lack of connection with the clinician and the expected changes experienced by individuals in this age group (career, school, or work).

Negative effects on the Organization

Missed appointments do not only affect the patient’s mental health and their progress in recovering. They also have an effect on the organization. Missed appointments lead to losses. This is because the hospital or the mental health facility is not able to bill for services if the patients are not attending the sessions. This makes the organization struggle as time is wasted on the scheduled appointments, and there is also no money to pay for other needs. Organizations under State or County contracts are required to meet some quotas, and if they do not meet the assigned quotas, they risk losing contracts. The organization also misses out on the opportunity to offer its patients a better quality of life if they keep missing their appointments.

Most Affected Stakeholders

Missed appointments have a sort of domino effect when it comes to affecting people surrounding the patients who miss their appointments. Some of the people affected are family members. If the patient misses their appointment, they have lower chances of getting better, which spills over to their family as they have to keep dealing with a mentally unwell relative. Healthcare providers are also affected as they fail to offer care to their patients.

Three Possible Solutions

Missed appointments do not affect patients only thus, the need to put measures in place to reduce the number of missed appointments. One of those solutions is telehealth. Telehealth enables patients who do not have transportation, or those who do not have readily available mental health facilities to attend their mental care appointments online (Adepoju et al, 2022). This reduces the cost of transportation and could also be a motivator as these appointments will be kept private and, nobody has to know they have a mental health condition.

Another method of reducing the number of missed appointments is charging a cost for missed appointments. This method might be unfair to patients from low-income households, but it will also hold accountable the patients who simply ignore their appointments (Miller & Ambrose, 2019). It also could act as a motivator as the patients will ensure they do not miss their appointments to avoid being charged for missing an appointment. This will also increase accountability as patients will be keen to cancel their appointments earlier if the conditions are unavoidable and schedule them for a later time.

The third solution is developing policies and protocols for missed appointments that indicate that the service will be canceled. Patients should be informed that if they miss more than two appointments they will no longer be able to receive care and, they will have to start the process over. This is a motivator as most would rather continue and finish their sessions than start.

References

Adepoju, O. E., Chae, M., Liaw, W., Angelocci, T., Millard, P., & Matuk-Villazon, O. (2022). Transition to telemedicine and its impact on missed appointments in community-based clinics. Annals of medicine, 54(1), 98-107.

Mental Health America National Organization, (2022). The State of Mental Health in America, Retrieved on July 28, 2022, Retrieved from https://www.mhanational.org/issues/2022/mental-health-america-adult-data

Miller, M. J., & Ambrose, D. M. (2019). The problem of missed mental healthcare appointments. Clinical schizophrenia & related psychoses, 12(4), 177-184. 10.3371/CSRP.MIAM.112316

NeMoyer, A., Cruz-Gonzalez, M., Alvarez, K,. Kessler, R.C., Sampson, N.A., Greif Green, J.,  & Alegría, M., (2022) Reducing racial/ethnic disparities in mental health service use among emerging adults: community-level supply factors, Ethnicity & Health, 27:4, 749-769, DOI: 10.1080/13557858.2020.1814999

Roberts, M., Jones, J., Garcia, L., & Techau, A. (2022). Adolescents’ perceptions of barriers and facilitators to engaging in mental health treatment: A qualitative meta‐synthesis. Journal of Child and Adolescent Psychiatric Nursing, 35, 113–125. https://doi.org/10.1111/jcap.12354