Getting Out of the Rut

In a rut of depression or missing a High?  Wishing you was more productive and creative?  Well you are it is only a temporary feeling of missing something that is still within you.  Start a new project; read a poem; write a poem.  Delve into the arts try writing a short story; learn a new languague.  Broaden yopur horizons take photos nature soothes the thoughts that race and portraits can  introduce new people into your life.

Get into yourself for a while and get in tune with the emotions you feel and write them into a Blog.  I was going through a similar period of feeling nonproductive and a little disgusted with me for not doing what I normally enjoyed.  What did I do?  I started blogging I am now the proud owner of 2 websites and over 100 blogs all written within 6 months time.  Blogging is a great way to share what you know; learn what you do not know.

Another thing which I find very helpful is joining online support groups all the advantages of therapy with less cost and the without the time restriction of having to keep appointments.  You can login whenever you want to feel like writing at 3 am the groups are at your disposal.  Medication has also proved to be helpful with soothing my tired mind and getting rid of the negative thoughts that cloud my perspective on life. 

Get rid of the worries and disappointments by meditating at least twice a day and you will begin to see yourself as the person you are.  Anger management can be found on the internet just learning that there are people like you, who experience the same feelings can often bring you a step closer to your goals.  Make goals in life even if it to clean the baseboards in your house any goal will work to your advantage and give you something to do; keep track of you achievements and failures and you will see where you may be able to improve your life.

Don’t feel alone I found through research, which is always a constructive way to spend your time, a list of famous Bipolars.  While it is not complete and I cannot account for the accuracy you are not alone.  Millions of people have and still go through the same thing that you do.  The mood swings plague many people and have since the beginning of time.  Take thoughts off of yourself for a while and you will see improvement in your life.  And get back to a rewarding gratifying life.

Famous Bipolars ·  Abraham Lincoln (leader) ·  Adam Ant (musician) ·  Agatha Christie (writer) ·  Axl Rose (musician) ·  Buzz Aldrin (other) ·  Drew Carey (actor) ·  Carrie Fisher (actor) ·  Edgar Poe (writer) ·  Gordon Sumner (Sting) (musician) ·  Hans Christian Andersen (writer) ·  Heinz Prechter (entrepreneurs) ·  Isaac Newton (other) ·  Jane Pauley (other) ·  Jean-Claude Van Damme (actor) ·  Jim Carey (actor) ·  Jimi Hendrix (musician) ·  John Dally (sporting stars) ·  Jonathan Hay (sporting stars) ·  Kay Redfield Jamison (other, writer) ·  Kurt Cobain (musician) ·  Larry Flynt (entrepreneurs) ·  Liz Taylor (actor) ·  Ludwig Boltzmann (other) ·  Ludwig Van Beethoven (musician) ·  Marilyn Monroe (actor) ·  Mark Twain (writer) ·  Maurice Benard (actor) ·  Mel Gibson (actor) ·  Micheal Slater (sporting stars) ·  Napoleon Bonaparte (leader) ·  Ozzy Osbourne (musician) ·  Patricia Cornwell (writer) ·  Patrick Joseph Kennedy (leader) ·  Patty Duke (actor) ·  Plato (other) ·  Ralph Waldo Emerson (writer) ·  Rene Rivkin (entrepreneurs) ·  Robert Downey (actor) ·  Robin Williams (actor) ·  Sinead O'Connor (musician) ·  Sophie Anderton (other) ·  Stephen Fry (actor) ·  Ted Turner (entrepreneurs) ·  Tim Burton (writer, other) ·  Tom Waits (musician, actor) ·  Thomas Stearns Elliot (writer) ·  Vincent Van Gogh (other) ·  Virginia Woolf (writer) ·  Winston Chruchill (leader) ·  Wolfgang Armadeus Mozart (musician)

What is Your Role in Treatment

Expect everything and anything.  Be prepared to answer questions, discuss your problems, and learn about what the problem may be.  For the initial visit you should have a history of yourself, including medical problems, medications you have taken and are currently on, a family history of members who have had the same or another mental problem.  Be prepared to answer questions that at first you may be uncomfortable answering but will help the doctor to make a diagnosis.

After the diagnosis learn everything you can about your disorder; do research; question your doctor to find what the medication is and what side effects to watch for.  Learn what the medications are supposed to do and keep a journal on any out of the ordinary feelings.  Get in touch with your feelings about having mental disorder; you can be angry, sad or happy at finding that there is a treatment for it.  It is natural to have feelings of anger and a grieving process is something you feel when you learn you have an illness for which there is no cure and chronic.  Write down what you are feeling and show it to the doctor.  He can reassure you, remember he will be your main support contact, and treat him as if he is your best friend.  Some doctors encourage questions about where they went to school, how long they have been practicing, if you don’t feel comfortable with this one doctor ask to be referred to another it is your choice.  Choosing a doctor is difficult at first and finding the right doctor and therapist if needed sometimes takes time but you are in control.

Learn the treatment plan often one visit is enough for a correct diagnosis and the treatment that will help in the fastest easiest way.  Make sure your goal for treatment is the same as your treatment team.  Ask for options to what the doctor plans and if there are alternative treatments such as a different medication or your preference of a male or female therapist remember your goal is to get well.  Study your medication look it up in the various resources at the Library find all you can know about what to expect.

Once you decide which medications may work the best for our, we are all different individuals and medication works differently for every person; the expected results may not come with just one medication you may need to combine medications.  Having a mental illness takes work finding the right drug or combination of drugs takes time.  Give yourself time to heal do not stop your medication because you feel better or worse.  Contact the doctor for any unpleasant side effects there may be a way to avoid them your dosage may have to be adjusted.  Taking medication for a mental disorder is often trial and error.  Never stop a medication once you have started it without approval of the doctor relapses come with noncompliance.

Keep your appointments do not skip because you woke up on the grumpy side of the bed, besides being disruptive to the doctor’s schedule it is crucial for the doctor to know how you are responding to medication and or therapy.  Ask questions if you do not understand something that they have said sometimes the meaning is different in the medical field than to the layman.  Your doctor and therapist are there to help you on your road to recovery try not to place obstacles in the way of treatment.

Compliance is the answer to the medication regime.  Sticking to your treatment plan may seem hard at first but as it progresses you will feel more confident at handling triggers that may come your way and overall feel better at helping to help yourself.

Follow advice but keep a record of how the medication is making you feel; discuss any new symptoms; gain the knowledge to go back to living your life better than it was.  With the right treatment recovery for most people is achievable take time to heal you.

Discrimination and the Mentally Ill

 Stigma and discrimination are the principal obstacles to treatment for the mentally ill. For the most severely ill, there are other stumbling blocks to treatment, the laws that prevent treating individuals that need higher care; the IMD exclusion law is one such law.  Failure to recognize and treat these persons until they become dangerous although preserving their constitutional rights violates their right to treatment. These laws and our failure to treat individuals with schizophrenia and manic-depressive illness are the utmost discrimination against those with mental illnesses.
 

 Stigma is created by the headlines which depict the mentally ill, during times of crises, committing violent crimes and not by the statistics which show that a large number of them have been released from hospitals without the proper treatment time that it takes for stabilization of their disorders.
 

 The negative attitudes toward people with mental illnesses increased greatly after people read newspaper articles reporting violent crimes by the mentally ill according to studies that have been done.  It is futile and out of place to expect the stigma of mental illness to be changed by the news and entertainment media with pleas to help the severely mentally ill. 
  

 The government must tackle over 30 years of the disastrous deinstitutionalization policy if they hope to win the battle of mental illness stigma and solve the nation's mental illness crisis. Hundreds of thousands of defenseless Americans are living a pitiful existence on city streets, underground in subway tunnels or in jails and prisons because of the misguided efforts of civil rights advocates to keep the severely ill out of hospitals and therefore out of treatment.
  

 These grievously ill persons in our cities are grim reminders of the failure of deinstitutionalization. They are seen huddling in the cold in makeshift cardboard box dwellings, carrying on conversations with invisible companions, wearing filthy, rags for clothing, urinating and defecating on sidewalks or threatening passersby. They frequently are seen on stretchers as victims of suicide or violent crime, or in handcuffs for committing violent acts against others.
  

 All of this occurs while government officials who in blind ignorance do nothing but punish those without the insight to help themselves; without the right to long term treatment to be stabilized in a setting less harsh than the streets. The consequences of failing to treat these illnesses are devastating peoples lives until they become soothing less than human in the publics eyes.  Americans with untreated severe mental illnesses represent less than one percent of our population, and yet they commit almost 1,000 homicides in the United States each year. At least one-third of the estimated 600,000 homeless suffer from schizophrenia or manic-depressive illness, and 28 percent of them forage for some of their food in garbage cans. About 170,000 individuals are in prison and suffer from these illnesses, costing American taxpayers billions per year.
  

Delaying treatment only results in permanent damage, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms.  Persons suffering from severe psychiatric illnesses are frequently victimized.  Studies show that many women with untreated schizophrenia have been raped. Suicide rates for these individuals are 10 to 15 times higher than the general population.

The inadequate psychiatric hospitals and the closure of the state hospitals have only served to compound the devastation. Most state laws today prohibit treating individuals over their objection unless they pose an immediate danger to themselves. Most of the people who are untreated do not have the insight to know that they need treatment; not being aware that they have an illness causes them to refuse the treatment that could end their misery,

 It has been proven that outpatient compliance is effective in ensuring treatment compliance; the challenge remains in getting them to utilize what is their answer to their problem without the revolving-door syndrome of hospital admissions, readmissions, abandonment to the streets and incarceration that plague those not receiving treatment.

Adequate care in psychiatric hospitals for long term treatment also must be available. A large number of the 3.5 million people suffering from schizophrenia and manic-depressive illness require long-term hospitalization which means hospitalization in state psychiatric hospitals. This critical need is not being met, since we have lost most of our state psychiatric hospitals since 1955.

 It is time to reform the laws that prohibit long term hospitalization for those in need.  People with mental illnesses are not to be blamed for having a disorder; they should not be penalized for an illness that is through no fault of their own.  The discrimination and stigma against the mentally ill must be cleared from the minds of the ignorant public.  Their fellow citizens are being denied the right to a life free from shame and turmoil; that deserve a life with dignity and equality.

The Chronic Mentally Ill

Who are the chronic mentally ill; individuals who suffer from one of several diseases affecting the brain, the most essential part of human beings. The causes are still unknown, but are probably multiple. There is no cure, but, effective treatment does exist. People with serious mental illness are significantly functionally impaired by the illness for an indefinite period of time. At least 1% of the population has a serious mental illness. The problems of these persons and their families are compounded by centuries old stigma, the prejudice still persists.

Symptoms of chronic/serious mental illness:

Acute symptoms: Distorted perceptions; loss of contact with reality; delusions; hallucinations; disordered; disorganized and confused thinking; unstable and inappropriate emotions. ; Bizarre behavior; impaired judgment.

Residual or deficit symptoms, several of these usually present most of the time: vulnerability to certain kinds of stress; extreme dependency sometimes combined with hostility; difficulty with interpersonal relationships; deficient coping skills; poor transfer of learning; fear of new situations; restricted emotional response and lack of enjoyment; reduced speech and impaired abstract thinking; reduced ability to pay attention; slowness; apathy; lack of motivation; phobic avoidance of situations; sensitivity to stimulation.

 Common for anybody who learns that they have a serious, chronic, incurable illness:

General stress response with fear; grief; denial and impatience; anger; guilt and self-blame; depression; hopeless, helplessness; regression to earlier levels of functioning; preoccupation with self; immaturity.

This includes loss of normal role functioning and normal family, community functioning. Social breakdown syndrome can be a side effect of any treatment that removes the person from their usual social environment.

Coping and adaptation what is hoped for and is a possible outcome of treatment, rehabilitation, family support and self-help. Acceptance and hope; interest in the illness and its treatment active cooperation with treatment and rehabilitation; lifestyle modifications is what is attempted to achieve.

In general, patients need:

Indivilualiged treatment; Continuity of relationships with staff with a smooth transition between, and coordination among, programs and treatment components.

.Patient education and full understanding about the illness and its treatment; leading to informed consent; responsible patient role; safe and comfortable care and surroundings with adequate privacy and desired amount of contact with others; plans for crises; support and education of family and significant others.

 Compliance with care with appropriate medication by a psychiatrist and treatment team who understand the illness and its treatment; careful monitoring of beneficial effects and side effects. Elimination of unnecessary drugs; alcohol, caffeine, marijuana, etc.; symptom monitoring by patient and others.  Adequate rest and regular, planned, exercise; a balanced, nutritional diet.

:

A therapeutic teamwork with a person which involves support; varying degree of support depending on need, respect, reality orientation is the goal of therapy.

Being actively, comfortably and purposeful busy; a relaxed atmosphere; a regular daily routine; including evenings, weekends and holidays; behavioral approach using natural consequences. Minimization of the handicap. If alcohol/drug use is a problem, attention to dependencies should be integrated with other treatment; psychosocial and occupational rehabilitation. Communication and problem solving skills for patient and significant others; construction of supportive social network; prevent or reverse social breakdown syndrome;  help with daily living; money management, transportation, housing, etc.

All of these issues need to be addressed in order for the person to live a more fulfilling, rewarding life.  Chronic sever mental illness can be managed with as little stress and debilitating effects as possible.  With the cooperation of the person, doctor and treatment team long term hospitalization can be avoided.

A Step Towards A New Future

The Senate Finance Committee in September 2009 amended its version of health reform legislation to partially roll back current Medicaid policy prohibiting reimbursement to inpatient facilities known as institutes of mental disease (IMD).

The amendment, filed by Sen. Olympia Snowe, allotted $75 million for three-year demonstration projects in up to eight states that would allow federal Medicaid matching payments for emergency psychiatric treatment in psychiatric hospitals that provide services to Medicaid beneficiaries between the ages of 21 and 64.

 Currently, psychiatric hospitals are required to provide these emergency services under the Emergency Medical Treatment and Active Labor Act, but they cannot receive federal matching payments because of the rules prohibiting IMDs from receiving federal Medicaid reimbursement.

Only privately owned and operated psychiatric hospitals would be eligible to participate in the demonstration projects.  The services eligible for federal payments under the demonstration projects are limited to emergency psychiatric treatment and stabilization.

The crisis stabilization unit is in effect an emergency room for psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals. Laws in many jurisdictions providing for long term involuntary commitment require a commitment order issued by a judge within a short time, after 72 hours, the evaluation period, of the patient's entry to the unit, if the patient does not or is unable to consent

Mental hospitals, also known as psychiatric hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their goals and methods. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. While others may specialize in the temporary or permanent care of residents who as a result of a psychological disorder, require routine long term assistance and treatment in a specialized and controlled environment.

These types of institutions vary widely in side, shape, focus, and funding. Some focus on long term care, while others are set up for criminals who have been diagnosed with a mental condition.

Every state within the United States of America has at least one publicly funded mental hospital and many states contain at least one mental hospital that is privately funded. While the funding for these hospitals may be different, both public state hospitals and private mental hospitals both use the same techniques in helping their patients.

This one step ahead toward repealing the old, outdated Medicaid law that is discriminating against mentally ill people.  With this there needs to be reform and a total abolishment of the law which prohibits Medicaid beneficiaries to receive the health care they need. 

While no one can predict the future this amendment shows the day of deinstititulization even if well intentioned people thought they were working for the benefit of the patient.  Some people need long term or permanent mental health care; it is a fact of life. 

 Whether it because of noncompliance; inability to adhere to a treatment plan; or just plain non response to medication there has to be a place for the mentally ill beside33s the streets, shelters, and jail cells.

The Government's Stand On Severe Mental Illness

 The discovery and marketing of the first, effective anti-psychotic medication Thorazine, in 1955 unleashed deinstitutionalization, the moving of patients out of psychiatric hospital settings and into the community. Deinstitutionalization increased more rapidly following the enactment of Medicaid and Medicare in 1965. While in state hospitals, patients were the financial responsibility of the states, but by discharging them, the states transfered the monetary responsibility to the federal government.

When enacting Medicaid, the federal government specifically excluded payments for patients in state psychiatric hospitals and other institutions for mental diseases, or IMDs, for 2 reasons to promote deinstitutionalization; and to put costs back to the states which were viewed by the federal government as responsible for this type of care.  The states transferred a huge number of patients from state hospitals to nursing homes and the community where Medicaid reimbursement was available.

Impoverished persons who need treatment in a hospital can count on Medicaid to pay for diseases of the heart, and most other body organs. Medicaid will not cover the individual if they are between the ages of 21 and 65 has a disease in his or her brain and needs care in a psychiatric hospital. The Federal government's Institute for Mental Disease Exclusion prohibits Medicaid from covering any treatment, even non-psychiatric, in state and private psychiatric hospitals and other IMDs.

For the most severely mentally ill, private insurance is fundamentally meaningless. Because of their illnesses, most individuals with the severest forms of brain disease are unemployed and private insurance is something that they cannot afford. While the federal government seeks equality for treatment of lesser forms of mental illness by private insurers, it continues to discriminate against those with severe mental illnesses by denying them coverage under Medicaid when they require hospitalization in a psychiatric hospital.  

The federal government reimburses states for between 50 and 80 percent of treatment under Medicaid. Because treatment in an IMD is excluded from Medicaid reimbursement, the states have a major financial incentive to limit treatment in psychiatric hospitals. This is the force behind deinstitutionalization as states force patients out of the hospitals and into Medicaid eligible services where the federal government to take up most of the cost, even though treatment may be unsatisfactory, more costly and less effective.

Approximately 500,000 individuals were inpatients in state psychiatric hospitals when the Medicaid program started, compared with fewer than 60,000 in 1999. Hospital closures have actually in recent years.  About forty state hospitals completely shut their doors between 1990 and 1997, and many more closures were planned.

As state psychiatric hospitals improved in quality, it became increasingly common to discharge patients from relatively good hospitals with active rehabilitation programs and institutionalize them in nursing homes, general hospitals with markedly inferior psychiatric care and no rehabilitation programs at all. States save state funds, but institutionalized patients pay a considerate price for the substandard care.

Costs in general hospitals are generally $200 per day more than the costs in public psychiatric hospitals. These additional costs are of little importance to the states; since federal Medicaid dollars are paying the majority of the bill; the states' costs are lower and that is the maximum of their concern. Evidence shows that general hospitals admit psychiatric patients with less severe illnesses, but turn away those who are more seriously ill. Inpatient stays for people with serious brain disorders are typically shorter in general hospitals, which puts the person's ability to stabilize on medication in jeopardy.

Medicaid's denial of coverage results in homelessness, incarceration, victimization and even death for many people; who are extremely ill and are unable to care for themselves. Of the 4 million Americans with schizophrenia and manic-depression, approximately 50 percent are not being treated on any given day. There are currently more than 250,000 mentally ill people locked up in the jails and prisons.  Another 100,000 to 200,000 mentally ill are homeless, and 28% eat from garbage cans. More than ten percent will die from suicide. Others will commit acts of violence against family, friends and even unfamiliar persons.

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.