Looking for Light in the Mental Health Care Wilderness

Paul Raeburn writes poignantly of his experiences as a father helping raise three children, two of whom suffer from mental illness-a son with bipolar disorder and a daughter with depression. His account will elicit a shudder of recognition from clinicians with institutional or agency experience and will resonate with the many parents struggling to get help for distressed children from managed care and the medical profession.

Raeburn's son Alex, a fifth grader, "detonated" one day upon learning that his art lesson had been cancelled. Screaming in fury, he ran through the halls at school, smashing the glass on a clock with his fist, barreling through the front door, and leading the school staff and police officers on a chase through the neighborhood. The cops wrestled him down, yelling, punching, and kicking, packed him into a squad car, and drove away.

The accounts of this incident and of the many that follow are replete with details familiar to those who work with bipolar children:

seizurelike rages that give way to exhaustion, sleep, and a subsequent total lack of recall
agitated or rambunctious behavior in class
oppositionality and reckless defiance
risky and rebellious impulsivity
threats to kill
a mysterious decline in academic abilities despite superior intelligence
dark, brooding malevolence interspersed with creativity, brilliance, and sweetness

With the skepticism of a veteran observer, Raeburn traces the family's journey through a maze of hospitals, physicians, therapists, and medication cocktails. Just as age, maturity, and possibly blind luck seem finally to be allowing Alex to regroup, the Raeburns' daughter, Alicia, then in sixth grade, becomes symptomatic and is found to be swallowing handfuls of pills and cutting herself. Once again the family is driven back to the hospitals and practitioners who worked with Alex.

Through the years the Raeburns continue to find the results of treatment frustrating and at best mixed-a pharmacological cornucopia, substance abuse, involvement with the juvenile justice system, and therapists who blame parenting skills, intramarital conflict, and, in Alicia's case, the trauma of rape rather than brain chemistry. Perhaps inevitably, given the severity of the stressors, the Raeburns' marriage dissolves. The parents go their separate ways. Raeburn writes unflinchingly about the loss of his marriage and his own experience of psychotherapy.

New Trends in Mental Health Care

I've been writing about the hurdles that the mental health care system has been facing since the recession struck the country. What I haven't written about is where this whole thing is going and which trends are surfacing.

The trend these days is to shift from "monster units" that house 20 or more people to Community Based and Teaching Family Programs.

On one hand, having smaller case loads makes programming easier and the number of behavioral incidents get substantially reduced by having less crowded buildings. If it's hard to live with just one person under the same roof, imagine living with 20 (with psychological issues). Moreover, staffing big units is not always an easy task and supply of qualified staff has surprisingly shrunk during the past months. We were expecting a surge in demand due to the recession but for some reason (unknown to me) this hasn't happened.

Another advantage of having smaller units is that the stress levels that staff are subject to are greatly reduced (which helps decrease turn-over rates) as a consequence of having fewer incidents and a slower paced environment.

Even though the legal client to staff ratio is 8:1 big units need to have at least a 5:1 ratio to ensure proper coverage during crisis situations and daily programming. This greatly impacts budgets and is one of the main problems that service providers are having across the country. Unfortunately there's no way of reducing FTEs without affecting service quality, the latter being often the loser in this battle since budgets are the priority. I think this is mainly why funding agencies are pushing towards more home-like settings.

Additionally, mental health care facilities have been reticent to expand their community based programs for a simple reason: less beds means less money. But empty beds are starting to pile up so it makes no sense keeping a big building fully operational if you are going to operate at half capacity. It's a waste of resources. Furthermore, if you think about it, TFP and Community based programs give more flexibility and are better suited for growth. If you plan to expand your business it's easier to buy a small house or sign in a family for a TFP than building a big facility from scratch. You are also not constricted to available (physical) space on your campus or center, thus there's basically unlimited possibilities for expansion.

Having smaller units also means lower maintenance costs, and the opportunity to develop more and more diverse programs to fit the different populations.

Something that cannot be stressed enough is the importance of having a homogeneous population in each building. Usually, the bigger the unit the more diverse the conditions it serves. This can make daily activities a nightmare since clients' preferences and needs greatly vary. By having small and homogeneous groups this can be avoided.

While some organizations have reacted faster to the new environment and are currently expanding at a frantic pace, others have been more skeptical and tried to stay on course, crashing into the reality wall. They have realized that the near future doesn't look so bright and therefore, they have started to lay out plans to expand into the community. The fate of some will depend on how fast they can deploy. Other organizations, which enjoy a big enough financial cushion, will have time to make this transition in a tidy manner.

Fernando Tarnogol is an Argentinean psychologist, currently working as Program Coordinator at the Devereux Foundation in West Chester, Pennsylvania.

Mental Health Care

Mental Health Care is concerned with the diagnosis and treatment of mental illness. There are various facets to mental illness. The most heard and common are Alzheimer's disease, schizophrenia, dementia etc.These generally stem out of depression. Let us try and analyze how and why depression sets in.

Depression is one of most common mental illness and can be cured by timely mental health care. It can include both emotional and physical symptoms. Both types are controlled by chemicals called neurotransmitters. Depression does have other symptoms which we usually associate with emotional distress; such as unexplained aches and pains, or digestive problems.

The first step in Mental Health care is to find out how and why these illness occur.Everyone feels down at times, but long-term or severe symptoms may indicate a mood disorder, such as major depression which is also called clinical depression. Dysthymia is a less severe form. Bipolar disorder which was formerly known as manic depression involves alternating episodes of depression and mania. Postpartum depression occurs within a year of childbirth.

Although emotional symptoms have traditionally been used to detect depression, research shows that physical symptoms are also very common and should not be overlooked. The body has nerve pathways that determine how it handles pain sensations and emotions.

The spinal cord is the central 'street' along which the messages go back and forth to the organs, nerves and cells. These messages are relayed by neurotransmitters in the brain, and regulate emotions and sensitivity to pain. However when these neurotransmitters go out of balance, a person can become depressed and is more likely to feel pain or other physical symptoms.

The next step in mental health care is to find out the ways of checking whether an individual is under Depression. The following is the checklist: Is the individual in an irritable mood much of the time? Has he/she lost interest or the pleasure in life? Is the person experiencing constant feeling of excessive guilt? Is there a reduced level of concentration and significant weight gain or weight loss when he/she is not actually dieting?

The other symptoms which can be related to depression are:Unexplained lack of sleep, excessive sleepiness and fatigue. Excessive restlessness or complete listlessness,Recurrent thoughts of suicide,Difficulty in managing diabetes or other chronic illness,Aches or pains that don't improve,Digestive problems, headaches, backaches, chest pain or occasional dizziness and Family history of depression.

The mental health care for the above discussed is to consult a doctor if one manifests five or more of the above symptoms.

Depression and related mental ailments is a biological illness. It needs attention as much as any other illness. Patients need support and patience from friends and family members, while counseling and medication can be treatment options. Medication should be taken as directed by a doctor and may be continued for weeks or months to prevent recurrences.

Mental Health Care Outreach and Social Media

If you work in the mental health field, you are a natural born communicator. Can we all agree that there is no counseling without a true command of language? After all, psychiatrists, counselors and social workers must all be well versed in BOTH, the spoken and written word to succeed within their chosen career fields.

Counseling sessions are based on active listening skills and the ability to successfully organize and summarize what the client shares. In addition, everything learned from each client session must be converted to accurate, comprehensive and concise progress notes. The data is often admissible in legal proceedings, so the mental health professional must be able to use an economy of words which express a multitude of thoughts and details. Let's also just remind everyone that professionalism and field credibility also requires neatness, flawless spelling and grammar and attention to proper syntax.

So, where does Social Media enter in to a discussion about listening, thinking, talking, writing and detail orientation?

Social Media Represents the "New World" of Opportunity for Everyone

Social Media is an important form of communication these days. It is becoming a communication tool of choice for many mentally ill clients, especially when they wish to communicate - anonymously - with others to avoid positive

identification and attached stigma. Mental Health professionals are increasingly spending their counseling time instructing their clients in the safe and productive use of Social Media, for this purpose. The chief goal is ALWAYS to protect the vulnerable from exploitation.

The mental health professional is also using Social Media as a way to gain additional professional knowledge as well as to network with others in his own field; including the many that live and work a great distance away.

There are also new opportunities for degree work and certification through online universities and professional organizations, respectively. There are moderated and open forums for career-related discussions on a variety of professional topics developed to advance the field of mental health care.

Plenty of collegial relations and friendships have been forged in the online world, often leading to one-to-one telephone conversations and live meetups. Face-to-face meeting have always been the goal of Social Media, which is designed as an enabler and not a replacement for physical human interaction.

Job information has been exchanged and employment interview offers are often tendered online. And, then there is the research that keeps the mental health care professional up to date on the changes taking places in his field from day to day. Some of the research and anecdotal contributions are the product of practitioners, just like you and me, who choose the Internet as a place to publish our work and share it with the world. We no longer need to wait for third parties to publish what we write.

Forget the Yellow Pages. You Must be Active in Social Media to


There is another area in which the worlds of mental health care and Social Media often come together - marketing and outreach. Can any nonprofit or private business afford not to avail themselves of the benefits offered through Social Media? I think not. Why? Because, the collective Social Media audience is huge and diverse. We need the kind of visibility and name recognition that the Internet can lead us to.

Most everyone that we need to connect with is already online, with more and more people showing up daily. Facebook, alone, is already at or nearing 600 million users. Confidently, there is no one on earth that does not know - at least - a single person with a Facebook profile.

Marketing and outreaching others in Social Media need not take a huge amount of resources, either. In fact, the entire effort can be limited to just a few platforms and a limited amount of posts on a consistent basis. This is resource allocation, well positioned.

Are you LinkedIn?

All professionals in any field belong on LinkedIn. Create a profile with your credentials, contact information and over time, as many business references as you can gather. Take some time to join some professional groups and pose and answer career-related questions among the group members. There is a lot to learn from others and much one can share to prove his field expertise. It is such expertise that builds professional credibility and helping relations over time. Such relationships are invaluable when it comes to creating all sorts of professional opportunities including business partnerships, client referrals and employment offers. Do not discount the value of LinkedIn as a premier Social Networking platform for mental health care professionals.

Are you Facebooking?

Facebook is another place where the people we need and wish to "talk" to are a great deal of the time. Sure, it is a place where one must be especially careful not to embarrass himself among his friends or professional colleagues, but it is a place where using good posting discretion can balance the fun with the serious. The common denominator is "value." Bring value to others and garner their respect and loyalty.

Facebook does have a business side, too. The Facebook business page offers a place to create and foster community, client and professional relations through providing value to some and offering an outlet for others to do the same. A few well placed posts about happenings in the mental health care field on your Facebook business page and a few more quality posts and comments on the pages of others you seek to have an audience with and you are on your way to growing a successful Facebook presence. Just remember that on Social Media, it's not all about you. Value for others, FIRST. You have the right to pitch your own endeavors about 15% of the time. Do not try and sell in Social Media; work harder to impress. Being respected and liked will get you the opportunities you are looking for.

Have you Blogged, Today?

Blogging is also a great tool to become better known. Show you are an expert in something and share it wherever you can. One or two 400 - 500 word blog posts per week, can quickly establish a professional as an expert that others want to hear from regularly. Invite others to write for your blog, too. Guest bloggers are refreshing and help give the impression that your blog is important enough for others to take the time and contribute to. Their followers will come to read their posts and have a chance to read yours. Often newspaper and magazine writers read the blogs, so don't be surprised when you receive offers to publish your contributions in their print and online publications. This is good for you and your business, because their readers are probably your own target audience.

When did you last Tweet?

Do you need to tweet? Twitter can be effective if you can develop a targeted and convertible following. Building such a dedicated following takes much work. You want to create a following of credible mental health care gurus; respected field publications; a pool of mainstream field nonprofits and for-profit; federal, state and local government leaders; supportive local businesses and potential client groups. Retweeting others and replying to their tweets is just as important as tweeting your own materials. Again, you must limit tooting your own horn to about 15% of your tweets. Tweet value and seek to connect with others. If you can build relations and take them off-line, you are succeeding.

Are you in Constant Contact with your Primary Audience?

Lastly, look into using an E-mail service such as Constant Contact to keep your audience up to date. Send out a monthly newsletter; issue announcements such as new hires and business expansions; announce your Social Media presence: and even create event invitations and holiday E-cards for your contacts. The more you can get your name in front of others, the better it is remembered. Just don't overdo it. Strike a balance by using all of your Social Media tools, timely and appropriately.

This is a very exciting time for mental health care professionals. Their appropriate use of Social Media can do many wonderful things for them; their professions; their businesses and organizations; and the clients they serve.