| Standard |
Village
|
Mental health benefits
integrated into medical care |
Mental health benefits "carved out"
from medical plan |
Broad pool
of
potential
consumers |
Defined
target group of seriously mentally ill |
| Gatekeeping
to mental health service from generalist M.D. |
Gatekeeping
by DMH approval, often self-referred |
Services
primarily given
to broad population, very
little serious M.I. |
Services
only for SMI, perhaps restricted to "high-users" |
Medical
model focus on
symptom relief and treating
illness |
PSR model
focus on helping people recover and integrate into community |
Menu of
services pre-
determined mostly
traditional MH services |
Menu of
services extremely flexible based on an individual's needs |
| Services
usually time limited |
Services
usually of indefinite duration |
Providers
are a combination
of program staff and
contracted services -- may
be badly fragmented |
Providers almost
exclusively program staff – strongly integrated |
Case
managers have
relationships to providers,
act to restrict and regulate
service delivery and
increase "red tape" |
Case
managers have personal relationships with consumers, act to access
service delivery and decrease "red tape" |
Clinical and
financial needs negotiated between case
manager and consumer.
Attempt to provide array or spectrum of services
delivered according to predetermined set of
regulations centered
around "medical necessity"
– "regulated care" |
Clinical and
financial needs negotiated between case manager and consumer.
Attempt to provide integrated, comprehensive services delivered
based on ongoing assessment of client needs/wants –
"designed care" |
| Accountability
for providing services that are authorized |
Accountability
for consumer quality of life outcomes |
Clinical
staff must obtain
approval and authorization
for service decisions for consequences |
Clinical
staff empowered to make service decisions and accept
responsibility |
Consumers
and families use grievance process and appeal
to impact program decisions |
Consumers
and families directly involved in program development |
