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The Role of a Full Continuum of Psychiatric Care

Background

1. Which category of hospitalization increased between 2005 to 2014?

A. Mental health / substance use conditions

B. Neonatal intensive care unit

C. Coronary care unit

D. All of the above


2. The Mental Health Parity and Addiction Equity Act, the Comprehensive Addiction and Recovery Act, the 21st Century Cures Act, and other federal and state initiatives have been enacted largely in response to growing recognition by the public and policymakers that:

A. Inefficient and ineffective care delivery is costly.

B. Discriminatory practices produce poor outcomes for a large and vulnerable population.

C. Both (A) and (B).

D. None of the above.


3. Most mental health beds in the United States today are located inside state hospitals.

A. True

B. False


How We Got Here

4. Medicaid reimbursement has been prohibited for treatment of individuals aged 22 to 64 hospitalized in psychiatric facilities of more than _____ beds, a provision known as “the institutions of mental disease (IMD) exclusion.”

A. 8

B. 16

C. 24

D. 32


5. Subgroups of state hospital patients have become underserved or unserved and cycle in and out of acute care settings or migrate to jails, prisons, homeless shelters, and similar settings, a trend that has come to be known as “trans-institutionalization” or “cross-institutionalization.”

A. True

B. False


6. Which of the following is widely recognized as a symptom of system failures, including the lack of a full continuum of accessible psychiatric care?

A. Psychiatric boarding, in which children and adults presenting in EDs are held for days and even weeks awaiting an open community hospital bed.

B. ED “streeting,” in which ED patients are discharged without supports.

C. Forensic wait-listing, in which defendants spend weeks or even months in jails awaiting a state hospital bed.

D. All of the above.


Introducing “Taylor”

7. Which of the following is a common element of serious mental illness and its treatment in the service delivery system?

A. Disruptive hand-offs between service providers and at specific age cutoffs.

B. Irregular adherence to medication and other treatment in adulthood.

C. Behaviors that frighten others even when not intended to be dangerous.

D. All of the above.


Mental Illness in the Criminal Justice System

8. During an encounter with law enforcement, risk of injury or death is _____ times greater for those with serious mental illness compared to members of the public without serious mental illness.

A. 6

B. 8

C. 16

D. 28


9. Which of the following is the most commonly practiced psychiatric crisis response?

A. Default law enforcement crisis response

B. Specialized police response

C. Collaborative police-based / mental health response

D. Mental health-based response


10. State mental health directors report that court-ordered restoration services are the single greatest source of pressure on state hospital bed supplies.

A. True

B. False


11. Which of the following are the priorities in correctional systems?

A. Confinement, security, and treatment

B. Confinement and security

C. Confinement and treatment

D. Security and treatment


12. Recent government data indicate that only four in five jails provide any form of psychiatric treatment to inmates.

A. True

B. False


Mental Illness in the Emergency Department

13. Studies of boarding patterns indicate that psychiatric patients who have the most extreme symptoms or are the most suicidal often wait the longest for admission or are discharged without care because of the difficulty of matching them to beds.

A. True

B. False


Psychiatric Hospitalization

14. The majority of state and county beds are reserved for voluntary patients.

A. True

B. False


15. The median length of stay for an acute episode in 2014 was:

A. 77 days

B. 42 days

C. 7 days

D. 3 days


Transitional Beds

16. All of the following have access to transitional beds, except for:

A. Individuals and private providers.

B. Those referred by the public mental health system.

C. Those referred by hospitals.

D. All of the above have access to transitional beds.


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