Help For The Severely Mentally Ill

Deinstitutionalization has progressed since the 1950's. It has been successful for many individuals, but it has been a failure for others. The failure of the system is shown by the drastic increase in homelessness, suicide, and violent acts among persons with severe mental illness.   Deinstitutionalization has hurt the mentally ill so seriously that there are many who are increasingly re-admitted to hospitals. It is common to find persons who have been hospitalized 15-20 times over a 10 year period. There are more persons with mental illness in jails and prisons than there are in state hospitals.

In the 1950's, new treatment beliefs which put into practice short-term and community based treatments. However, the community supports which were necessary to maintain persons with severe mental illness in the community have not been developed in most communities. Also, the legal development of an environment  which has often been described as independent living for all patients, regardless of whether the setting is based on a clinical foundation

About 2.8% of the US adult population suffers from severe mental illness in a year. Among these persons, there are those who do not respond to traditional community treatment. It is estimated that this high risk group includes an estimated 1,000,000 individuals. Unfortunately, research of this group has been neglected. The most severely disabled have been forgotten by society, and by most mental health advocates,

Medical illnesses frequently go undiagnosed and untreated among persons with severe mental illness. The degree to which medical problems interfere with treatment and rehabilitation efforts and the danger that the presence of mental illness creates in the management of medical disorders has not been researched adequately.  Clients are often unable to communicate their symptoms and give a coherent account because of their psychiatric illness and the illness may become severe before it is recognized and treated. Medical problems may also result as a consequence of the poor health habits of these persons and the side effects of medications. For example, many persons with severe mental illness are overweight from side effects of their medications. This and heavy smoking leads to additional cardiac risks.  

The most commonly cited medical diagnoses were arthritis, hypertension, and diabetes.  Medical problems were frequently made worse by lack of a protective setting.  Bad health habits and side effects of medications are commonly contributing to poor physical health.

Many people with a diagnosis of severe mental illness also have a diagnosis of substance abuse disorder.  These people may self medicate because symptoms of the illness are not under control or as a way to deal with their social isolation. Consequences include noncompliance with medications, frequent re-hospitalization and homelessness. The occurrence of substance abuse may be caused by a variety of factors, including lack of case management and social isolation.   The consequences of noncompliance account for at least 40% of all episodes of schizophrenia relapse and for at least one-third of all in-patient treatment. The reasons clients do not take their medication are varied and may include lack of insight, side-effects of medications and inadequate structure and support within the environment that surrounds them.  Lack of insight into the illness was often associated with noncompliance.  Discharging the client prematurely from the hospital or removing the ill person from a highly structured setting resulted in noncompliance.  Noncompliance resulted in a progressively lower level of functioning.

The duration of stays in hospitals has become shorter under managed care standards. . Patients are often diverted from a familiar hospital to an available bed in another hospital where staff is unfamiliar to them. Stability and consistency is a requirement of quality care.

Recent studies of persons with schizophrenia point out that about one-third will attempt suicide, and about 1 in 10 will complete suicide. The suicide rate for those with mood disorders is 15%. This is in contrast to the suicide rate for the general population which is 1%.  Of those who attempted suicide, most had made 2 or more attempts.  Many are primarily male, single, unemployed and often live alone. They also have chronic, relapsing illness which requires frequent hospitalization; have poor response to their medications and feel hopeless about their future.  Suicide and attempts were attributed to lack of adequate services and medication non-compliance.

A fact that is seldom discussed but alarmingly true is that the death rate is significantly higher for those who are severely mentally ill than it is for the general population.  It has been established that individuals with schizophrenia die at a younger age than do individuals who don't have schizophrenia. The largest single contributor to this statistic is suicide which is 10-15% as compared with 1% in the general population. Also contributing to early death are poor health habits including heavy smoking, obesity and alcohol abuse. The presence of undiagnosed and untreated diseases; heart disease and diabetes, account for a significant number of those who die young. Homelessness also increases the mortality rate because of increased susceptibility to accidents and diseases.

There is a need for both a structured and long-term care environment for these high risk people.  Research indicates that many persons with schizophrenia lack the ability to create their own internal structure.  If placed in the community in a living arrangement without sufficient structure they may quickly decompensate and return to the hospital or to the streets.  Medication supervision was identified as the most important on-site service.

 The federal Medicaid exclusion of institutions of mental diseases is a major barrier to the development of long term care facilities with adequate structure and support services for individuals suffering from severe mental illnesses. This law has become a major barrier to the availability of economical long-term settings which can provide structure and professional supervision and should be abolished.

Cognitive Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) is an experiential supported treatment that focuses on patterns of thinking that are unsuitable to a situation, function or purpose and the beliefs that cause of this sort of thinking.  A person who is depressed may have the belief, that they are worthless, and a person with a phobia may have the belief, that they are in danger.  While the person holds these beliefs with conviction, with a therapist’s help, the individual is encouraged to view such beliefs as a proposed explanation for a phenomenon rather than facts and to test out such beliefs by running experiments. Furthermore, the persons are encouraged to monitor and log thoughts that pop into their minds (called automatic thoughts) in order to enable them to determine what patterns in thinking may exist and to develop more adaptive behavior.  People who participate in CBT can expect their therapy to be problem-focused, and goal-directed.

Studies have shown its usefulness for a variety of problems, including mood disorders, anxiety disorders, personality disorders, eating disorders, substance abuse disorders, and psychotic disorders.

CBT has been shown to be as useful as antidepressant medication for individuals with depression and demonstrated that it can a prevention of relapses. Patients receiving CBT for depression are encouraged to schedule activities in order to increase the amount of pleasure they experience. Also, depressed patients learn how to restructure negative thought patterns in order to interpret their environment in a less prejudiced way.  For Bipolar Disorder it is used with medication treatment and focuses on education about the disorder and understanding signs and triggers for relapse. Studies indicate that patients who receive CBT in addition to medication treatment have better results than patients who do not receive CBT as an added treatment.

CBT is a useful treatment for anxiety disorders. Patients who experience persistent panic attacks are encouraged to test out ideas they have related to the attacks, and to develop more realistic responses to such beliefs.  Patients who experience obsessions and compulsions are guided to expose themselves to what they fear and convictions surrounding their fears are identified and modified. The same is true for people with phobias. Those in treatment are exposed to what they fear and ideas that have served to maintain such fears are targeted for alteration.\

 CBT for schizophrenia has been used in the United Kingdom. While this treatment continues is not used much in the United States, the results from studies in the United Kingdom have has the interest in therapists in the U.S., and more therapists are using this treatment now. In this treatment, patients are encouraged to identify beliefs and their impact and to engage in experiments to test their belief.   The focal point of the treatment is on thought patterns that cause suffering and also on developing more realistic interpretations of events.  Delusions are treated by developing an understanding of the evidence the person uses to support the belief and encouraging the patient to recognize evidence that does not support the belief.  With verbal auditory hallucinations patients are encouraged to utilize coping mechanisms to test the controllability of auditory hallucinations.

CBT’s focus on thoughts and beliefs are applicable to a several issues.  CBT has achieved popularity both for therapists and patients

Hope for the Severely Mentally Ill?

Deinstitutionalization has progressed since the 1950's. It has been successful for many individuals, but it has been a failure for others. The failure of the system is shown by the drastic increase in homelessness, suicide, and violent acts among persons with severe mental illness.   Deinstitutionalization has hurt the mentally ill so seriously that there are many who are increasingly re-admitted to hospitals. It is common to find persons who have been hospitalized 15-20 times over a 10 year period. There are more persons with mental illness in jails and prisons than there are in state hospitals.
In the 1950's, new treatment beliefs which put into practice short-term and community based treatments. However, the community supports which were necessary to maintain persons with severe mental illness in the community have not been developed in most communities. Also, the legal development of an environment  which has often been described as independent living for all patients, regardless of whether the setting is based on a clinical foundation
About 2.8% of the US adult population suffers from severe mental illness in a year. Among these persons, there are those who do not respond to traditional community treatment. It is estimated that this high risk group includes an estimated 1,000,000 individuals. Unfortunately, research of this group has been neglected. The most severely disabled have been forgotten by society, and by most mental health advocates,
Medical illnesses frequently go undiagnosed and untreated among persons with severe mental illness. The degree to which medical problems interfere with treatment and rehabilitation efforts and the danger that the presence of mental illness creates in the management of medical disorders has not been researched adequately.  Clients are often unable to communicate their symptoms and give a coherent account because of their psychiatric illness and the illness may become severe before it is recognized and treated. Medical problems may also result as a consequence of the poor health habits of these persons and the side effects of medications. For example, many persons with severe mental illness are overweight from side effects of their medications. This and heavy smoking leads to additional cardiac risks.  
The most commonly cited medical diagnoses were arthritis, hypertension, and diabetes.  Medical problems were frequently made worse by lack of a protective setting.  Bad health habits and side effects of medications are commonly contributing to poor physical health.
Many people with a diagnosis of severe mental illness also have a diagnosis of substance abuse disorder.  These people may self medicate because symptoms of the illness are not under control or as a way to deal with their social isolation. Consequences include noncompliance with medications, frequent re-hospitalization and homelessness. The occurrence of substance abuse may be caused by a variety of factors, including lack of case management and social isolation.   The consequences of noncompliance account for at least 40% of all episodes of schizophrenia relapse and for at least one-third of all in-patient treatment. The reasons clients do not take their medication are varied and may include lack of insight, side-effects of medications and inadequate structure and support within the environment that surrounds them.  Lack of insight into the illness was often associated with noncompliance.  Discharging the client prematurely from the hospital or removing the ill person from a highly structured setting resulted in noncompliance.  Noncompliance resulted in a progressively lower level of functioning.
The duration of stays in hospitals has become shorter under managed care standards. . Patients are often diverted from a familiar hospital to an available bed in another hospital where staff is unfamiliar to them. Stability and consistency is a requirement of quality care.
Recent studies of persons with schizophrenia point out that about one-third will attempt suicide, and about 1 in 10 will complete suicide. The suicide rate for those with mood disorders is 15%. This is in contrast to the suicide rate for the general population which is 1%.  Of those who attempted suicide, most had made 2 or more attempts.  Many are primarily male, single, unemployed and often live alone. They also have chronic, relapsing illness which requires frequent hospitalization; have poor response to their medications and feel hopeless about their future.  Suicide and attempts were attributed to lack of adequate services and medication non-compliance.
A fact that is seldom discussed but alarmingly true is that the death rate is significantly higher for those who are severely mentally ill than it is for the general population.  It has been established that individuals with schizophrenia die at a younger age than do individuals who don't have schizophrenia. The largest single contributor to this statistic is suicide which is 10-15% as compared with 1% in the general population. Also contributing to early death are poor health habits including heavy smoking, obesity and alcohol abuse. The presence of undiagnosed and untreated diseases; heart disease and diabetes, account for a significant number of those who die young. Homelessness also increases the mortality rate because of increased susceptibility to accidents and diseases.
There is a need for both a structured and long-term care environment for these high risk people.  Research indicates that many persons with schizophrenia lack the ability to create their own internal structure.  If placed in the community in a living arrangement without sufficient structure they may quickly decompensate and return to the hospital or to the streets.  Medication supervision was identified as the most important on-site service.
 The federal Medicaid exclusion of institutions of mental diseases is a major barrier to the development of long term care facilities with adequate structure and support services for individuals suffering from severe mental illnesses. This law has become a major barrier to the availability of economical long-term settings which can provide structure and professional supervision and should

Abandoned Hospitals Abandoned Lives

How changing a federal law can repair the damage for millions of mentally ill people.

In many states the government closed the state psychiatric hospitals. In some states, they are promising to reinvest the savings that come from closing state psychiatric hospitals in community based services. In some states, this worked, In other states, the hospitals closed and the community-based services were not funded.

The psychiatric hospitals closed before the community based services were built. And the consequences were, we ended up trading real services for worthless promises. There are still over 1.000,000 individuals with who need some form of long term care. This is because they are unwi9lling to be treated, do not respond to treatment or are suffering from side effects.

There was intense pressure on states to close psychiatric hospitals due to a  very important provision of Medicaid law referred to as the Institute for Mental Disease Exclusion or IMD.   Individuals between 21 years old and 65 years old who live in institutions which specialize in the treatment of psychiatric disorders IMDs are excluded for Medicaid benefits.  

The IMD exclusion was included in Medicaid legislation because the federal government did not want to pick up what had been a state responsibility: caring for individuals in this category. But the IMD Exclusion has had the exact opposite effect: it forces states to release people out of hospitals so the state can get reimbursed from the federal government for their care in the community.

In order for states to access the federal Medicaid funds, the individual has to reside outside the psychiatric hospital, no matter how sick or inappropriate the discharge is.  We see a trend for hospitals to release individuals sicker and quicker and without appropriate access to community based care. This form of deinstitutionalization is being done for one reason.. It has nothing to do with the new treatments, or treatment in the least restrictive environment, or patient needs and wants. It is a way to turn non Medicaid eligible individuals into Medicaid eligible individuals so the state can gain access to federal dollars for their care.

Repealing the IMD exclusion will still allow the states to close hospitals and discharge individuals. And it will still allow them to invest in community-based services. But the motivation for the closures will be in the best interest of the patient and not greed among the states.  

 These are pictures of some of the major psychiatric hospitals that have been closed since deinstitutilization took effect.  Thousands are still homeless, on the streets of the cities, or dead.
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T%hese pictures come from an informative website called  Edgewood.com It has the history of the local hospitals that once help millions of people and served with pride and dignity.  The loss of these hospitals is a loss to society.

Is this what is the future?  Mental Hospitals have come a long way since the 1980’s.  The population of mentally ill inpatients has been drastically cut; unfortunately they have been displaced and are found in jails and homeless shelters, or wandering the streets.  For some of us who are not so severe there are alternatives but does the future hold more hospitals being built in order to bring adequate care to the severely mentally ill?  Outpatient clinics can only do so much and non compliance is a number one issue.  The community residences are not the answer; there is little interaction between people with mental disorders and the surrounding community of people without a disorder.  Isolation becomes a problem with the person not having contact with anyone besides the people they share the dwelling with; case managers; doctors and therapists.  Is it better to create more hospitals again to bring better care to those in need or are hospitals the past with no further use to the mentally ill. 

Depression In Older Americans

Everyone feels the blues or sad at times.  It is a natural part of life. But when the sadness persists and interferes with everyday life, it may be depression. Depression is not a normal part of growing older. It is a serious mental illness but like heart disease or diabetes it can be treated.

Depression is a serious illness affecting approximately 15 out of every 100 adults over age 65 in the United States.  When depression occurs in late life, it sometimes can be a relapse of an earlier depression. But when it occurs for the first time in older adults, it can be brought on by another illness. When someone is already ill, depression can be both more difficult to distinguish and more difficult to bear.

Sadness associated with normal grief is different from depression. A sad or grieving person can continue to carry on with daily activities. The depressed person has symptoms that interfere with their ability to function normally for a prolonged period of time.

Depression in the elderly is not always easy to identify. It sometimes is difficult for a depressed older person to describe how they are feeling.  Older Americans come from a time when depression was not understood to be a biological disorder and medical illness.  Some elderly fear being labeled or worry that their illness will be seen as a character weakness, or a sign on senility.

Someone suffering from depression can not just "get over it." Depression is a medical illness that must be diagnosed and treated a psychiatrist. Untreated, depression may last months or even years.

Left to itself depression can; lead to disability; worsen symptoms of other illnesses; lead to premature death; result in suicide.   When it is properly diagnosed and treated, more than 80 percent of those enduring depression return to their normal life with a complete recovery.

The most common symptoms of late-life depression include:  persistent sadness; feeling slowed down; excessive worries about finances and health problems; frequent crying; feeling worthless or helpless; weight changes; pacing and restlessness; difficulty sleeping; difficulty concentrating; physical symptoms such as pain or gastrointestinal problems.   One frequent sign of depression is when people withdraw from their regular social activities.

Another important sign is that they often neglect their personal appearance, or may begin cooking and eating less. Like many illnesses, there are varying levels and types of depression. A person may not feel hopeless or helpless, but may exhibit symptoms such as difficulty sleeping, weight loss, or physical pain with no apparent explanation. This person still may be depressed.  But, those same symptoms also may be a sign of another problem; only a doctor can make the correct diagnosis.

Sometimes depression will occur for no apparent reason.  This can be because the disease often is caused by biological changes in the brain.   In older adults, there usually are reasons for the depression. As the brain and body age, natural biochemical changes take place. Changes as the result of aging, medical illnesses or genetics may put the older person at a greater risk for developing depression.

Chronic illness is the most common cause of depression in the elderly. But even when someone has a chronic illness such as arthritis, it is not natural to be depressed.

The development of depression often has a trigger.  People can pinpoint one specific event that triggered their depression, such as the death of a partner or loved one, or the loss of a job through layoff or retirement.  When a normal period of sadness or grief leads to a prolonged, intense grief then it requires medical attention.

For the older person, medical illnesses are a common trigger for depression, and often depression will worsen the symptoms of other illnesses.

Medical illnesses may hide the symptoms of depression. When a depressed person is preoccupied with physical symptoms resulting from a stroke, gastrointestinal problems, heart disease or arthritis, they may confuse the depressive symptoms with symptoms of an existing physical illness, or may ignore the symptoms.

Most depressed elderly people respond to treatment with little trouble. In fact, there are highly effective treatments for depression in late life. Common treatments include:  psychotherapy; antidepressant medications; electroconvulsive therapy.

Psychotherapy can play an important role in the treatment of depression with, or without, medication. This type of treatment is most often used alone in mild to moderate depression. There are many forms of short-term therapy that have proven to be effective.

Antidepressants work by increasing the level of neurotransmitters in the brain.  Many feelings, including pain and pleasure, are a result of the neurotransmitters' function. When the supply of neurotransmitters is imbalanced, depression may result.

A frequent reason some people do not respond to antidepressant treatment is because they do not take the medication properly. Missing doses or taking more than prescribed and so they relapse.   Stopping the medication too soon often results in a relapse of depression.

 Typically, it takes four to 12 weeks to begin seeing results from antidepressant medication. If after this period of time the depression does not subside, the patient should consult their doctor for a change in medications or dosage. Antidepressant drugs are not habit-forming or addictive.

Electroconvulsive therapy is a treatment that many people have a dread of.  ECT is a safe, fast-acting and effective treatments for severe depression. It can be life saving. For the person who has a life-threatening depression that is not responding to antidepressant medication or for the person who cannot tolerate the medication; ECT is the most effective treatment.

The treatment of depression demands patience and determination by the patient and the physician. Sometimes several different treatments must be tried before full recovery.

Suicide is more common in older people than in any other age group.  Persons over age 65 account for more than 25 percent of the nation's suicides.   Suicide attempts or severe thoughts or wishes by older adults must always be taken seriously.

It is important to remember that depression is a highly treatable condition and is not a normal part of growing older. Therefore, it is critical to understand and recognize the symptoms of the illness.   An older person who is diagnosed with depression also should know that there are professionals who specialize in treating the elderly; geriatric psychiatrists have the training to know what treatments will be better suited for an older patient.

Depression and African Americans

Clinical depression is more than life’s ups and downs.   It is normal to feel sad when a loved one dies, or when you are sick, going through a divorce, or having financial problems. But for some people the sadness does not go away, or keeps coming back. If your blues last more than a few weeks or cause a great effort to perform daily life activities, you may be suffering from clinical depression.

Clinical depression is not a personal weakness, it is a common, yet serious, medical illness. Clinical depression is an illness that affects your mood, thoughts, body and behavior. Without treatment, symptoms can last for weeks, months or years. Appropriate treatment can help most people who have clinical depression.

Clinical depression can affect anyone; regardless of race, gender, age, creed or income. Every year more than 19 million Americans experience some type of depressive illness.  Researchers find that African Americans in are particularly at risk for mental illness. Depression deprives people of the enjoyment found in daily life and can even lead to death.  Depression is not a normal part of life for any African American, regardless of age or life situation. Depression has often been misdiagnosed in the African American community.

 The myths and stigma that about depression creates confusion, and can keep people from getting proper treatment.  The earlier treatment begins; the more effective it can be.

Many factors can contribute to clinical depression, including:  negative thinking patterns; biological and genetic factors; other medications; other illnesses; and situational issues. Some people have a number of these features seem to, while others have a single factor that can cause the illness.

 Some people become depressed for no apparent reason.  Depression is dangerous, some people attempt to cope with their negative feelings with self-medication through the abuse of alcohol or illegal drugs, and this only leads to more problems.

Clinical depression can be treated:  like other illnesses such as heart disease or diabetes, clinical depression is treatable with the help of a doctor.  Over 80 percent of people with depression can be treated successfully and achieve full recovery.

Because of cultural differences, depression symptoms may show up differently among African Americans.  If you or someone know needs help for depression the following list of symptoms may be beneficial. If you experience any of these symptoms for longer than two weeks, if you feel suicidal, or if the symptoms interfere with your daily routine, see your doctor.

A persistent sad, anxious feeling, or excessive crying; reduced appetite and weight loss or increased appetite and weight gain; persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain; irritability, restlessness; decreased energy, fatigue; feelings of guilt, worthlessness, helplessness, hopelessness, pessimism; sleeping too much or too little, waking early in the morning and are unable to go back; loss of interest or pleasure in activities, including sex; difficulty concentrating, remembering, or making decisions; thoughts of death or suicide, or suicide attempts.

The most common treatment for clinical depression is with antidepressant medication and\or psychotherapy. The choice of treatment depends on how severe the depressive symptoms are and the history of the illness. Research shows that the use of medication for more severe episodes of clinical depression is the most effective. Antidepressant medication acts on the chemicals of the brain related to depression.   Antidepressant medications are not habit-forming. It may take up to eight weeks before you notice an improvement. It is usually recommended that medications be continued for at least four to nine months after the depressive symptoms have improved. People with chronic or recurrent depression may need to stay on medication to prevent or lessen further episodes. People taking antidepressants should be monitored by a doctor to ensure the best treatment with the fewest side effects. Do not stop taking your medication without first talking with your doctor even if you feel better.

Psychotherapy: Psychotherapy can help teach better ways of handling problems by talking with a therapist. Therapy can be effective in treating clinical depression, especially depression that is less severe.

 A patient support group can be very helpful during the recovery process. Support group members share their experiences with the illness, learn coping skills. Take care of yourself. Get plenty of rest, exercise, stay away from alcohol and drugs, and eat regular, well-balanced meals.

If you don’t have insurance or can’t afford treatment, your community may have publicly-funded mental health centers or programs that charge you according to what you can afford to pay. Life can be fulfilling again! With proper diagnosis and treatment, clinical depression can be overcome. The roads that leads to recovery are in reach don’t waste your life in misery.

Suicide in America

In 1995, the national death statistics showed suicide as the ninth-leading cause of death in the America; 1.3 percent of all deaths in America were reported as suicide.  The death statistics for heart disease was 32%, and 23% from cancer of all deaths for that year.

Suicide rates are typically the number of deaths per 100,000 persons, the number of people in the population and its age distribution.  American suicide rates vary from state to state. The Western states have the highest rates. The lowest rate is for the District of Columbia.

In America suicide rates vary dramatically by age, gender, and racial group. White males commit suicide at a rate higher than black males and white and black females.   The rates for black males have been rising, especially those ages 15 to 25.  In the age group with the highest rate of suicide is with older white males. This is also true in other countries.

In America, the most common method of suicide is the use of guns, which is reported for 60% of all suicide methods. Of all deaths with guns, about 80% are committed by white men.

Findings from psychological autopsy studies, where the person’s state of mind prior to the suicide is determined through interviews and medical history, indicate that about 90% of persons who completed suicides in all age groups had a diagnosable mental or substance abuse disorder.  Having a mental or substance abuse disorder does not mean that someone is at high risk for suicide; the majority of people with these disorders do not die from suicide.  Substance abuse and behavior problems such as conduct disorder are more common among adolescent suicides, while depression without substance abuse is the most common pattern among older adults.

To study risk for suicide among persons with mental or substance abuse disorders a follow-up on people who have been hospitalized for such a disorder. The high-risk group is identified and risk factors are recorded prior to the person’s death.  However, not all persons with mental or substance abuse disorders are hospitalized, not all hospitals keep the same records, and different studies use different methods.

The results when it comes to estimating the particular rates of suicide for people with certain mental or substance abuse disorders or determining what risk factors, in addition to the disorder, played a role in the suicide were not exact.   Most researchers agree that persons with schizophrenia have a much higher risk of suicide than the general population; the estimates have ranged from 2% to 15%.   In some studies, younger males with schizophrenia appear seem to be most at risk, while other studies find that women with schizophrenia commit suicide as frequently as men.

Persons with depression, some studies have found psychotic symptoms to increase risk for suicide, while others have not found any evidence for this risk.  In addition to the mental or substance abuse disorders, there are other factors that have been researched to find if they increase the risk for suicide. These include having a second mental or substance abuse disorder;  history of sexual abuse; hostile temperament; history of previous suicide attempt; hopelessness; inability to carry out activities of daily living; stressful life events such as the loss of a close relationship and change in doctors.

Suicide is believed to be preventable, compared to other causes of death suicide it is a rare occurrence and in contrast to the occurrence of mental and substance abuse disorders.   Trying to predict suicide using as all known risk factors, researchers are still unable to predict who will and who will not commit suicide. There are circumstances where talking about suicide is very appropriate and helpful. If an individual who has survived a family member’s suicide needs to talk about suicide and receive support then it is beneficial; however sometimes the thought or act can be brought about by planting the seed in a person’s mind.  Doctors need to assess persons in distress for their suicide potential in order to take steps to minimize the suicide risk.  But there is always the chance for the person to become a higher risk by talking about disturbing emotions at an inappropriate time.

The best prevention of suicide would appear to be improving treatments for mental and substance abuse disorders and being more vigilant in screening for suicide risk among persons with these disorders.

Much more research is needed to test prevention programs to improve attempts to avert a suicide act.  Diagnosing a person that is at risk as quickly as possible; while avoiding implanting the idea by triggering emotions or situations that can be disturbing for the person.   Proven programs and practices that prevent suicide should be implemented by the healthcare professional.

Unfortunately suicide occurs too many times.  High risk persons should be evaluated frequently for the chance of them committing suicide.  During the past few decades much has been done to prevent suicide but the  danger still exists for some persons. 

Co-ocurring Disorders and their Effect on the Mental Health System

The consequences are harsh. Persons with a co-occurring disorder have a greater tendency for violence, medication noncompliance, and failure to respond to treatment than a person with just substance abuse or a mental illness. These problems also affect families, friends and co-workers.
Having a mental illness and a substance abuse disorder together frequently leads to overall poorer functioning and a greater chance of relapse. The person is in and out of hospitals and treatment programs without lasting success. People with dual diagnoses also tend to have tardive dyskinesia and physical illnesses more often than those with a single disorder, and they experience more episodes of psychosis.
People with mental illnesses often are more susceptible to co-occurring disorders as a consequence of their mental illness they may find themselves living in neighborhoods where drug use exists.  Some people find themselves more easily accepted by groups whose activity is based on drug use. Some may believe that a drug addiction is more acceptable than one based on mental illness.  People with co-occurring disorders are also much more likely to be homeless or in jail.
The on and off treatment alone currently given to non-violent persons with dual diagnosis is costly.  Violent or criminal persons, no matter how are dangerous and also costly. Society has to pay for jailed or hospitalized persons.   Those with co-occurring disorders are at high risk to contract AIDS, a disease that can affect society at large. Costs rise even higher when these persons, as those with co-occurring disorders have been shown to do; constantly renter healthcare and criminal justice systems again and again. Without the establishment of more integrated treatment programs, the cycle will continue. 
The constant noncompliance with treatment is a factor in the disability rates of the government system.  Homeless shelters are full of persons who refuse treatment and the homeless rate is increasing daily.  With substance abusers develop mental disorders because of the continuous substance abuse the impact on the heath system becomes a revolving door of treatment, relapse and then again seeking treatment.  Without adhering to a treatment plan and maintaining a consistent medicine regime for their problem the health care team sees a same patients repeatedly with no improvement of symptoms or worsening of symptoms.  The drugs have to be increased in order to be beneficial and the cost increases greatly.  A lot of patients go off of medication because of the high cost of medication and the absence of insurance to cover it and the cycle goes on with the burden of cost to society.
Changes in the system need to be made to help the number of people with mental illnesses and are trying to maintain their mental health with treatment and are finding it difficult to manage to comply with treatment because of the monetary cost.  Until the person can accept their problems and conform to the mental health treatment plan there will be more abuse of the system and less help available for patients seeking help.

Substance Abuse Common Signs

Using alcohol or drugs does not mean that a person has a substance use disorder.  But, if a person’s use leads to problems at work or at home, or causes damage to their health, has probably become a problem and they should consider professional help.

Alcohol

Men who drink five or more standard drinks in a day and women who drink 4 or more in a day are at increased risk for alcohol-related problems.  About 3 out of every 10 American adults drink at levels that increase their risk, which may include hypertension, bleeding ulcers, sleep disorders, depression, stroke, cirrhosis of the liver, and some cancers.

There are two main alcohol disorders: alcohol abuse and alcohol dependence.  Alcohol abuse is less severe, but can lead to physically risky behavior, interpersonal problems, inability to function appropriately at home or work, and legal troubles.  Alcohol dependence is more severe and is characterized by preoccupation with drinking, inability to cut back, and symptoms of physical need and withdrawal, including increased tolerance.

Symptoms of alcohol dependence can include: drinking alone or in secret; being unable to limit the amount of alcohol you drink; not remembering conversations or commitments, blacking out; making a ritual of having drinks before, with or after dinner and becoming annoyed when this ritual is disturbed or questioned; lack of interest in activities and hobbies that used to bring pleasure; feeling a need or compulsion to drink; irritability when your usual drinking time nears, especially if alcohol isn't available; keeping alcohol in unlikely places at home, at work or in the car; legal problems or problems with relationships, employment or finances; having a tolerance so that you need an increasing number of drinks to feel the effect; physical withdrawal symptoms such as nausea, sweating and shaking.

People who abuse alcohol may experience many of the same signs and symptoms, however alcohol abusers don't feel the same compulsion to drink and usually don't experience physical withdrawal symptoms.

There are many signs, both physical and behavioral, that indicate drug use. Each drug has its own symptoms or side effects. Some signs of drug abuse are:  sudden change in behavior; sudden mood swings; withdrawal from family members and/or longtime friends; carelessness about personal grooming; loss of interest in hobbies, sports, and other favorite activities; changes in sleeping patter; red or glassy eyes; runny nose

Marijuana some signs are: a heightened sense of visual, auditory and taste perception; poor memory; increased blood pressure and heart rate; red eyes; decreased coordination; difficulty concentrating; increased appetite; slowed reaction time; paranoid thinking.

Barbiturates and Benzodiazepines may show as:  drowsiness; slurred speech; lack of coordination; memory impairment; confusion; slowed breathing and decreased blood pressure; dizziness; depression

Amphetamines, methamphetamine, cocaine are all stimulants. Signs and symptoms of use and dependence on these drugs include:  euphoria; decreased appetite; rapid speech; irritability; restlessness; depression as the drug wears off; nasal congestion and damage to the mucous membrane of the nose in users who snort drugs; insomnia; weight loss; increased heart rate, blood pressure and temperature; paranoia

 Synthetic compounds, such as Ecstasy, which has both amphetamine-like and hallucinogenic effects, are included in this category.  Signs and symptoms of designer drug use vary depending on the drug. The symptoms and signs vary according to the drug abused.

Use of hallucinogens produces different signs and symptoms depending on the drug. The most common hallucinogens are LSD.
Signs and symptoms of LSD use include:  hallucinations; greatly impaired perception of reality, such as hearing colors; permanent mental changes in perception ; rapid heart rate; high blood pressure; tremors; flashbacks, a re-experience of the hallucinations — even years later

Signs and symptoms of PCP use include: hallucinations; euphoria; delusions; panic; loss of appetite; depression; aggressive, possibly violent behavior

Inhalants

The signs and symptoms of inhalant use vary depending on what substance is inhaled. Some commonly inhaled substances include glue, paint thinners, correction fluid, felt tip marker fluid, gasoline, cleaning fluids and household aerosol products.  When inhaled, these products can cause brief intoxication and a decreased feeling of inhibition. Long-term use may cause seizures and damage to the brain, liver and kidneys. Inhalant use can also cause death.

Narcotic, painkilling drugs produced naturally from opium or made synthetically, including heroin, morphine, codeine, methadone and oxycodone.  Signs and symptoms of use and dependence on these drugs include:  reduced sense of pain; sedation; depression; confusion; constipation; slowed breathing; needle marks (if injecting drugs)

While these are not all of the signs and symptoms they are enough to see if there is a chance of substance abuse and or addiction.  If you or someone you know show any of these signs it is imperative to seek professional help.  Substance3 addiction can lead to serious health complications and or death.  If you see any of the see any of these signs in a family member or friend consult an authority figure and seek help for the individual.  Treatment for substance3 abuse is available and the results are favorable if caught in time recovery can be complete and the individual can live a rewarding life free from addiction.

Post Traumatic Stress Disorder

Post traumatic stress disorder is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience.  Sufferers experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event, and are exquisitely sensitive to normal life experiences.  Although this condition has likely existed since human beings have endured trauma, Post traumatic stress disorder has only been recognized as a formal diagnosis since 1980.  In World War I, symptoms that were generally consistent with this syndrome were referred to as combat fatigue. Soldiers who developed such symptoms in World War II and many troops in Vietnam who had symptoms of what is now called post traumatic stress were diagnosed as having post Vietnam syndrome. Post traumatic stress has also been called battle fatigue and shell shocked

Post traumatic stress disorder usually results from prolonged exposure to a traumatic event or series thereof and is characterized by long-lasting problems with many aspects of emotional and social functioning.

Untreated post traumatic stress can have devastating, consequences for victim’s functioning and relationships, their families, and for society. Symptoms in women with post traumatic stress disorder who are pregnant include having other emotional problems, poor health behaviors, and memory problems. Women who were sexually abused at early ages are more likely develop post traumatic stress disorder and borderline personality disorder. Babies who are born to mothers who suffer from this illness during pregnancy are more likely to experience a change in at least one chemical in their body that predisposes the child to develop post traumatic stress disorder later in life. Individuals who suffer from this illness are at risk of having more medical problems, as well as fertility problems. Emotionally, a person may have to struggle more to achieve as good an outcome from treatment than people with other emotional problems. In children and teens, post traumatic stress disorder can have significantly negative effects on their social and emotional development, as well as on their ability to learn.
Treatments usually include psychological and medicine.  Education on the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness.
Teaching people with post traumatic stress disorder practical approaches to coping with what can be very intense and disturbing symptoms has been found to be effective.   Helping the person learn how to manage their anger and anxiety, improve their communication skills, and use breathing and other relaxation techniques can help individuals gain a sense of mastery over their emotional and physical symptoms.  Therapy by having the person recall their traumatic experiences using images or verbal recall while using the coping mechanisms they learned is sometimes beneficial.
Medications that have shown to be effective for managing this disorder include mood stabilizers; as well as mood stabilizers that are also antipsychotics. Antipsychotic medicines seem to be most useful in the treatment in those who suffer from agitation, dissociation, paranoia, or brief psychotic reactions. The antipsychotic medications are also being increasingly found to be helpful treatment options for managing the disorder when used in combination with an antidepressant.
Families of individuals, as well as the person, may benefit from family counseling, couple's counseling, and Parenting classes.   Family members may also be able to provide a history about the person; for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization that people with the illness are unable or unwilling to share.
The sleep problems have been found to be alleviated by; rehearsing adaptive ways of coping with nightmares, training in relaxation techniques, positive self-talk, and screening for other sleep problems.

Some ways that are often suggested for patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and other survivors for support.  Reducing stress by using relaxation techniques : breathing exercises, positive imager, actively participating in treatment as recommended by professionals, increasing positive lifestyle practices, exercise, healthy eating, distracting oneself through maintaining  a healthy work schedule if employed, volunteering, and decrease  negative lifestyle practices like, social isolation, working to excess, and self-destructive or suicidal behavior.

Dual Diagnosis

Dual diagnosis occurs when someone has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently.

Sometimes the mental illness occurs first. This can lead people to use alcohol or drugs that make them feel better temporarily. Sometimes the substance abuse occurs first; that can lead to emotional and mental problems.   Often the psychiatric disorder develops first.  In an attempt to feel better, in an attempt to control mood changes, silence the auditory hallucinations; deal with emotional turmoil; this can lead people to use alcohol or drugs that make them feel better temporarily.  When a person with emotional symptoms drinks or uses drugs; doctors call this self-medication.  Frequent self-medication may eventually lead to physical or psychological dependency on alcohol or drugs.  If it does, the person then suffers from not just one problem, but two.  In adolescents, however, drug or alcohol abuse may merge and continue into adulthood, which may contribute to the development of emotional difficulties or psychiatric disorders.  In these cases, alcohol or drug dependency is the primary condition.  A person whose substance abuse use has become severe may develop symptoms of a psychiatric disorder:  perhaps episodes of depression, manic rage, hallucinations, or suicide attempts.

To get better, someone with a dual diagnosis must treat both conditions. First, the person must go for a period of time without using alcohol or drugs. This is called detoxification; rehabilitation for the substance abuse and treatment for the mental disorder.  Both illnesses should be treated concurrently.  For any substance abuser, however, detoxification should take place under medical supervision.  It can take a few days to a week or more, depending on what substances the person abused and for how long.  Doctors are able to give hospitalized substance abusers medications which can significantly ease withdrawal symptoms.  When detoxification is done under medical supervision, it’s safer and less traumatic.

Once detoxification is completed, dual treatment; rehabilitation for the alcohol or drug problem and treatment for the psychiatric problem is started and a maintenance treatment plan is established.

Rehabilitation for a substance abuser usually involves individual and group psychotherapy, instruction on alcohol and drugs, exercise, proper nutrition, and participation in a recovery program. 

Treatment for a psychiatric disorder depends upon the diagnosis.  For most disorders, individual and group therapy as well as medications are utilized.  A support group of other people who are recovering from the same condition has shown to be effective. 

The more that is known about dual diagnosis, it is easier to understand how substance abuse can coexist with another psychiatric condition.  A person with dual diagnosis can improve once proper care is given.  By seeking out information, you can learn to recognize the signs and symptoms of dual diagnosis and possibly help someone live a healthier and rewarding life.

Bulimia Nervosa An Eating Disorder

Bulimia nervosa is an eating disorder characterized by frequent episodes of binge eating, followed by frenzied, painful attempts to avoid gaining weight.

When you are suffering with bulimia, life is a constant conflict between the desires to lose weight or stay thin and the overwhelming urge to binge eat.  You do not want to binge eat you know the guilty and shame but time and again you gorge on food.

After the gluttony is over, you panic set and to undo the binge, you resort to drastic measures such as taking ex-lax, inducing vomiting, or trying to over exercise in an effort to burn the calories off.

Bulimia does not necessarily involve purging physically eliminating the food from your body by throwing up or using laxatives, enemas, or diuretics. You can undo your binges by fasting, exercising to excess, or going on crash diets.  You are   possibly suffering from bulimia or another eating disorder if the following applies to you: Are you obsessed with your body and your weight; does food and dieting dominate your life; are you afraid that when you start eating, you wilt be able to stop; do you ever eat until you feel sick; do you feel guilty, ashamed, or depressed after you eat; do you vomit or take laxatives to control your weight?

Bulimia is destructive cycle of binging and purging.  Dieting is a trigger.  But the more strict and rigid your diet, the more likely it is that you will become even more obsessed, with food. When you starve yourself, your body responds with unrelentless cravings its way.

As the tension, hunger, and deprivation increase, the compulsion to eat becomes uncontrollable a forbidden food is eaten; a dietary rule is broken.  After having a small dish of ice cream, you feel failure and the binge begins again.  The relief from binging is brief. Soon after, guilt and self-loathing set in. And so you purge to make up for binging and regain control.

Purging is not effective for getting rid of calories, which is why most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating will remove all of the calories consumed. This is because calorie absorption begins the moment you put food in the mouth. Laxatives and diuretics are even less effective.  You may weigh less after taking them, it is due to water loss, not true weight loss.

Signs of binge eating are:  Inability to stop eating; eating until the point of physical discomfort and pain; wanting to eat in privacy; eating unusually large amounts of food with no obvious change in weight; alternating between overeating and fasting.

Being bulimic is putting your body and life at risk. The most dangerous side effect of bulimia is dehydration due to purging. Vomiting, laxatives, and diuretics can cause electrolyte imbalances in the body.  Low potassium levels trigger a wide range of symptoms ranging from lethargy and cloudy thinking to irregular heartbeat and death. Chronically low levels of potassium can also result in kidney failure.

There is no single cause of bulimia. While low self-esteem and concerns about weight and body image play major roles, there are many other factors that can be a cause. People suffering with bulimia and other eating disorders in have trouble managing emotions in a healthy way. Eating can be an emotional release people binge and purge when feeling angry, depressed, stressed, or anxious.

One thing is certain. Bulimia is a complex emotional issue. Our cultural emphasis on thinness and beauty can lead to body dissatisfaction, particularly in young women bombarded with media display of an unrealistic physical ideal.  People who think of themselves as useless, worthless, and unattractive are at risk for bulimia. Things that can contribute to low self-esteem include depression, perfectionism, childhood abuse, and a critical home environment.  Women with bulimia appear to have a higher incidence of sexual abuse. People with bulimia are also more likely than average to have parents with a substance abuse problem or psychological disorder.  Bulimia is often triggered by stressful changes or transitions, such as t puberty, going away to college, or the breakup of a relationship.  

If you are living with bulimia, you know how frightful it feels to be so out of control. Realizing that you are harming your body just adds to the concern. But recovery is possible. You can learn to break the binge and purge cycle and develop a healthier attitude toward food and your body.

Taking steps toward recovery is tough.  If you are the thought is there for getting help for bulimia, you are on your way to  healing.  The first step in bulimia recovery is admitting that your relationship to food is distorted and out of control.  The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

Treatment for bulimia is much will succeed when you stop dieting.  By eating normally, you can break the binge-and-purge cycle and still reach a healthy, attractive weight.  To stop the cycle of bingeing and purging, it iss important to seek professional help early, follow through with treatment, and resolve the underlying emotional issues that caused the bulimia in the first place.

Because poor body image and low self-esteem are the crux of bulimia, therapy is an important part of recovery.   Cognitive-behavioral therapy is the most common therapy for treatment of bulimia.  Cognitive-behavioral therapy targets the unhealthy eating behaviors of bulimia and the unrealistic, negative thoughts that fuel them. Here is what to expect in bulimia therapy:   Breaking the binge-and-purge cycle; changing unhealthy thoughts and patterns; solving emotional issues.  Targeting emotional issues that caused the eating disorder in the first place such as; relationship issues, underlying anxiety and depression, low self-esteem, and feelings of isolation.  With treatment, support from others, and smart self-help strategies, you can overcome bulimia and gain true self-confidence.

Anorexia Nervosa An Eating Disorder

Anorexia nervosa is an eating disorder with three key features: refusal to maintain a healthy body weight; an intense fear of gaining weight; a distorted body image

Because of the terror of becoming fat or revulsion with how your body looks, eating becomes very stressful. What you can and cannot eat is basically all you can think about.

Thoughts about food and your body may take nearly all of your day.  There is little time for friends, family, and other activities that are pleasurable.  Life becomes a quest for thinness and persistent desire to lose weight.

And no matter how you lose no matter how thin you become, it can never be enough.

People with anorexia often deny having a problem; in reality anorexia are a serious and a life threatening eating disorder.  However treatment and recovery is possible. With proper management you can break the self-destructive pattern and regain health and self-confidence without anorexia.

There are two types of anorexia.   The restricting type of anorexia,  where weight loss is achieved by restricting calories and extreme exercise; and the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Some signs of anorexia are:  you feel fat even though people tell you that you are not;  you are terrified of gaining weight; you lie about how much you eat or hide your eating habits from others; friends or family concerned about your weight loss, eating habits, or appearance.   You diet, compulsively exercise, or purge when you are feeling overwhelmed or bad about yourself; you feel in control when you go without food, over-exercise, or purge.

 Food and weight is not what the crux of anorexia. Eating disorders are extremely complicated. The food and weight-related issues are symptoms: things like depression, loneliness, insecurity, pressure to be perfect, or feeling out of control; contribute to the disorder. Things at the heart of an eating disorder have no bearing on how much you eat or do not eat.  There is a need that the eating disorder meets in you life.

The important point to understand is that anorexia meets a need in your life.  You may feel powerless some parts of your life, and what you can control is what you eat.    Saying no to food may make you feel dominant at least for a short time.  Anorexia may also be a way of distracting yourself from unmanageable emotions. When you spend most of your time thinking about food, dieting, and weight loss, you do not have to face other problems in your life or try to control problematical emotions.  Dieting and weight loss cannot change the negative self-image that is the foundation of anorexia. To identify the emotional need that self-starvation fulfills and finds other ways to meet it is the only way to recovery.

The first priority in anorexia treatment is treating any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so troubled that you no longer want to live. You may also need to be hospitalized until you reach a more ideal weight. Outpatient treatment is an option when you are not in immediate medical danger.

A second part of anorexia treatment is nutritional counseling. A nutritionist or dietician will teach you about healthy eating and proper nutrition. The nutritionist will also help you with meal plans that include enough calories to reach or maintain a normal, healthy weight.

Counseling is critical to anorexia treatment. Its goal is to discover the negative thoughts and feelings that at the heart of your eating disorder and replace them with healthier, less distorted ideas and build confidence.  Counseling will teach you how to deal with difficult emotions, relationship problems, and stress in a productive, non self-destructive, way.

 The thought of gaining weight is can be extremely frightening; especially if you are being forced and you may be tempted to resist. But research shows that a more normal body weight is when starting treatment; the greater your chance of recovery, getting to a healthy weight is the priority in the treatment goal.  Your fear of gaining weight is a symptom of your anorexia.

Anorexia is often a symptom of extreme emotional distress and develops out of an attempt to manage emotional pain, stress, and/or self-hate.  In order to overcome the distress that is the core of anorexia the primary goal should be treating the medical, psychological symptoms and build and maintain a foundation of positive and  affirmative convictions to sustain the normal weight and end the old eating habits; purging and self denial of anorexia.

Obsessive Compulsive Disorder

A person with Obsessive Compulsive Disorder (OCD) suffers from severe, recurrent, thoughts (obsessions) or rituals (compulsions), which they feel they cannot control. Rituals such as hand washing, counting, checking, or cleaning are often performed to keep from having or stop obsessive thoughts.   By performing these rituals, they only get temporary relief, and not performing them increases anxiety. Left untreated, obsessions and the need to perform rituals can take over a person's life. Obsessive Compulsive Disorder is a chronic, relapsing illness. However, effective treatments have been developed to help people with OCD.

Research shows that OCD is an abnormal functioning of brain circuitry, in a part of the brain called the striatum. OCD is not caused by problems or attitudes learned in childhood such as an emphasis on cleanliness; or a belief that certain thoughts are dangerous or unacceptable. People with OCD have patterns of brain activity that differ from people with other mental illnesses or people with no mental illness at all.  Patients with OCD treated with both behavioral therapy and medication produce changes in the stria

Treatments for OCD have been developed through research.  These treatments which are a combination od medications and behavioral therapy are often effective. Several medications have been proven effective in helping people with OCD.   It is often a trial and error if one drug is not effective, others should be tried.  A type of behavioral therapy known as exposure and response prevention for treating OCD has been shown to be effective.  With this type of therapy a person is deliberately and voluntarily exposed to whatever triggers the obsessive thoughts, and then is taught techniques to avoid performing the compulsive rituals and to deal with the anxiety.

Obsessive Compulsive Disorder is often accompanied by depression, eating disorders, substance abuse, or other anxiety disorders.  When a person also has other disorders, OCD is more difficult to diagnose and treat.  Symptoms of OCD can also coexist and may even be part of a number of other mental disorders.