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HCA 4303, Comparative Health Systems 1

Course Learning Outcomes for Unit VII

Upon completion of this unit, students should be able to:

1. Examine the approaches to mental health in a healthcare system for both a developed country and a
developing country.

Reading Assignment

Chapter 15: Prevalence and Management of Behavioral Health Care

Unit Lesson

In this unit, we will discuss mental health and behavioral health on the global level. Each country, region, and
culture approaches the treatment of mental issues slightly differently. Many countries utilize the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders to determine what is and what
is not a mental illness. Once a person receives a diagnosis treatment, it often consists of both psychotherapy
and pharmacotherapy (Love-Scott & Prather, 2012, p. 218). This treatment is typically paid for under most
insurances or National Health Systems throughout the world. There may be a co-pay depending on the
person’s financial status. Mental health delivery systems typically consist of complex and highly specialized
treatment modalities depending on the nature of the issues (addictions, mood disorders, eating disorders,
depression, anxiety, schizophrenia, etc.).

In these settings, the role of the non-clinical healthcare administrator is to remain objective and provide the
non-clinical, business-related, strategic-level leadership. The mental health team is typically led by a
psychiatrist. This is a physician who has completed medical school and several additional years of training in
the diagnosis and treatment of mental illnesses. The psychiatrist is also able to conduct a thorough physical
examination to determine if there are other medical issues contributing to the mental or behavioral issues. In
addition to this comprehensive medical assessment, most psychiatrists are also trained in counseling
techniques. More recently, psychiatric nurse practitioners and physician assistants have been added to the
mental health team and provide more routine medical assessment and follow-up including patient education
and making adjustments to medications.

The mental health team also includes psychologists and social workers, most with advanced degrees and
special preparation. Their training often includes extensive hours of supervision by experienced mental health
practitioners. Naturally, the vast majority of their training and experience is in the clinical realm. This sets the
stage for an ongoing discussion with the mental health field about the best preparation to lead mental health
programs. Prior to the1960s, there were very few medications or treatments for mental illness. Therefore,
most people with mental illnesses were either cared for in the family home, became homeless, or were
confined to asylums where treatments such as electroshock therapy were used to alleviate the most severe
symptoms. These facilities were most often directed by psychiatrists.

After the 1960s, non-medical clinicians began to emerge as the primary leaders in community mental health
programs. In the 1980s, as the vast majority of mental health care had moved from the psychiatric institutions
to outpatient care, day programs, group homes, and similar programs, and it made sense to promote non-
medical clinicians into leadership roles. However, since very few clinicians have extensive training in the field
of healthcare management, the emergence of managed care and continual financial constraints have
prompted an increase in the number of non-clinical, mental health administrators. Traditional, business-
focused healthcare administrators bring necessary skill sets in areas such as budgeting, billing, plant
operations, facility management, planning, policy writing, and personnel issues.


Behavioral Health in Developed
and Developing Countries

HCA 4303, Comparative Health Systems 2



However, few academic programs in healthcare administration devote time in their curriculum to managing
the mental health facility, very few organizations exist to address the unique needs of mental health
administrators, and very little research exists on the topic. The primary orientation that healthcare
administrators are missing related to the mental health service line is in the unique issue of confidentiality and
the stigma of mental illness. Whereas for the most part a culture would not hold a person accountable for a
physical condition, such as multiple sclerosis, Parkinson’s disease, or kidney stones, there is still a belief that
when a person is diagnosed with schizophrenia, depression, anxiety, or a personality disorder, they are weak
and could have prevented the occurrence.

This lingering stigma impacts the way mental health organizations operate and affects everything from
marketing and billing for the services to ensuring that offices are arranged with the therapist closest to the
door for easy egress. It also requires the understanding of soundproofing room but ensuring windows are
available to decrease the risk of allegations of inappropriate touch. It also impacts the need to arrange the
entrance and waiting area for maximum privacy. Learning the mechanics of mental health administration is
much easier than making a meaningful contribution to the people involved in the global fight in at least 20
countries to decrease or eliminate the social stigma and discrimination faced by those with a mental illness
(Sartorius, 2007).

There is a long history of research documenting unfavorable public opinion about mental illness (Wahl, 2012).
West (2010) states that unfavorable public opinion ranges from believing that people with eating disorders are
“different” to believing that all people with schizophrenia or depression are dangerous. According to Sartorius
(2007), this stigma is the main obstacle to the provision of care for people with mental illness. He defines the
stigma of mental health as the negative attitude based on prejudice and misinformation that is triggered by a
marker of illnesses such as odd behavior or mention of psychiatric treatment. This ranges from generalized
mistrust to more extreme avoidance of the person with a mental illness. This may be direct or indirect such as
when people with a similar illness are referred to as “nuts” or “psycho” in their presence (Wahl, 2012). Others
face blatant discrimination in job searches, attempting to rent an apartment, or admission to college or training

Although clearly some healthcare personnel and even mental health professionals hold some of these same
stereotypical beliefs, the vast majority understand that there is a strong biological and genetic link in mental
illnesses (Wahl, 2012). The goal for a healthcare administrator is to understand the stigma that exists around
the entire topic of mental illness and suicide for the country you are studying. As pointed out by Lovett-Scott
and Prather (2012, p. 218), the prevalence of mental illness globally is high, and in certain parts of the world,
the stigma against people with mental illnesses and their families prevents them from seeking treatment or
disclosing the information in fear of basic rights violations.

In your assessment this week, you will take a look at the various issues surrounding the mental health and
behavioral health systems in both a developed and a developing country. You will be asked to provide a
comparative analysis of such issues as the prevalence of mental health providers, the overarching beliefs of
the culture, and their funding sources. The goal is to see that countries handle this issue differently; although,
there is a stigma in the vast majority of countries. You will then be asked to write a short report on your
findings. The key to this assignment is recognizing that even the developing countries have positive aspects.
A strong healthcare administrator is never reluctant to benchmark best practices and attempt to replicate what
is already working instead of reinventing a wheel.

HCA 4303, Comparative Health Systems 3




Lovett-Scott, M., & Prather, F. (2014). Global health systems: Comparing strategies for delivering health
services. Jones and Bartlett Learning.

Sartorius, N. (2007). Stigma and mental health. The Lancet, 370, 811–812.

Wahl, O. F. (2012). Stigma as a barrier to recovery from mental illness. Trends in Cognitive Sciences, 16(1),


West, K. (2010). Rethinking “mental health stigma.” European Journal of Public Health, 1–2.

Key Terms

1. Behavioral health
2. Biases
3. Mental health
4. Misperceptions
5. Stigmas
6. Treatment options

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