Challenges for the Next Phase of Integrated Medicaid Care in OR


From The Lund Report: “Access to the current disease-centered system of mental health care will almost certainly mean worse outcomes for many people than if they had never entered the system. There is a ghost in this machine — and that is the way in which so much is organized around the use of psychiatric medications. And it is certainly a perfect fit for the medical model that Medicaid is built on.

But it, too, is reinforced by several misconceptions. Psychiatric drugs, especially their mid- to long-term use, are a major contributor to serious health problems that should get much more attention in a truly integrated care system. Most antipsychotics, for example, are known to cause metabolic syndromes with dramatic but typical weight gains of 50-100 pounds or more. This is complicated by poor nutrition, lack of exercise, poverty, and increased vulnerability to accidents.

How knowledgeable and prepared to deal with these considerations are the state’s system planners and policymakers? What about most mental health and physical health care providers themselves?  Will this second round at transforming health care address these concerns and provide education and training in how to address them? Will it establish process and outcome measures to require provider systems to reduce the dramatic life expectancy losses? Will the exorbitant cost of psychiatric medications be assessed? Will the Oregon Health Authority be courageous enough to take on special interests that have an investment in the status quo?”

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  1. This was an excellent article by Bob Nikkel. I’m surprised the Lund Report gave Mr. Nikkel a chance to say such critical things about psychiatry. He actually mentions the fallacy of the chemical imbalance theory. This is sure to rock a few boats at OHA! My comment is awaiting moderation approval. I hope that people respond not by mindlessly defending the the current paradigm of mental health care in Oregon with the usual rhetoric but with real facts and real evidence. Mr. Nikkel certainly gave people something to think about. We shall see what follows.

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