Depression Can Be Killed - Avail the Mental Health Care Ways

Out of the many health problems associated with people, there is yet another kind of sickness. This is the mental sickness, which finds its cure in the mental health care. There can be a wide variety of reasons due to which people may undergo depression. A depressed State of mind is something that can have its impact on the physical health as well. The mental health care is directed towards making people realize that life is to be happy. They can feel the positive energy rising high within them. The mental health care is extended towards those people who find it hard to meet the difficulties of life. As A result of this, they start feeling the helplessness that they have been exposed to. This makes it very difficult for such people to carry on with life.

There can be different reasons behind a person getting into such imbalanced state of mind. It may happen due to an unsuccessful marital Relationship, loss of someone very close or failures in the field of career. Present day, even students Undergo this problem due to the excessive pressure put on them for competing with the demanding world. In case of the situations wherein
They fear to meet people who hold high expectations; they get into the depressed state of mind. However,it is not something that has no remedy. Just like any other problem, it can also be dealt with the mental health care. This includes taking good care about the happiness of people. Health care includes boosting up the confidence of people suffering from this kind of problem. The people having depressed state of mind are exposed to wider persecutions of life.

In some cases, the meditation is also a part of the mental health care so as to get a focused approach to solve any kind of problem. In case, proper mental health care is not provided to the person, he may even attempt to commit suicide. The best approach is to let him speak out his heart. A person who takes the aid of mental health care May feel the need to come out of his sad state of mind. As a result of this, he will even make efforts at his end to come out of this depressed state. The Responsibility of health care is to tell him ways to heal himself. An integral part of the health care is to understand the feelings of this person. This will help him to get proper guidance. As a result of the unhappy mind, one generally tends to shirk all meals. This may effect his health. Mental health care also takes care to give him good nutrition.

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Lack of Parity in Treatment in the Mental Health Care Field

A bill was recently passed in the House of Representatives to insure that there existed parity among mental health patients and physical health patients regarding treatment. However, this parity shows only a lack of fair treatment, when it comes to me and my fellow mental health consumers and the way we are treated by the medical system as a whole. We are suppose to have the same affordable services available to us, as well as the high standard level of care with concern to customer satisfaction, that all people receive. This should be the case whether payments are through private or public insurances, which give us the opportunity to receive these services.

Perhaps it's the stigma regarding mental health that still exists. This stigma exists not only among the general public but also within the ranks of mental health treatment teams, which include doctors, nurses, social workers, and many others. On the other hand, it could be that the "powers that be" do not see an impending need for the type of care we need and the undoubtable existence of it being a life and death situation, as is often the case with physical needs. Not only do we hurt emotionally with our pain, but we hurt physically as well. The stress that is placed on us, through poor hospital conditions and a broad use of a non- thorough- plan aimed at treating the individual as a whole in order to produce recovery, is something that should be looked at closely in regards to policy.

First, in looking at the members of the treatment team, who provide our care, it is evident to me through my experience, while receiving services as a consumer and witnessing the implementation and behind the scenes talk of my coworkers while working as a peer provider, that the stigmas are far reaching; and, we are often looked at as a thorn-in-the side of the health care system. As a consumer, I have experienced the rude and disconcerting, downgrading talk from mental health techs and nurses, when even a simple question is asked. Doctors will often give you a ten minute window of time when you are describing what you are experiencing; and, when you do ask a question in regards to your care, you often do not receive an answer in a way which is concurrent with the active involvement that you as a consumer should have in your health care plan. I have experienced caseworkers who do not return your phone calls, because they feel that you are nothing but a bother; and I have experienced a social worker who tells you that if it was up to him you would never be released from the hospital. These are a few of the many ways in which we, as consumers of a mental health system, are treated. Many consumers feel that we have no way of giving customer feedback, nor do we feel that our feedback would be considered to be of any meaning to anyone, even if it was received.

If actually investigated, individuals with even the hardest of hearts would break down to tears as they looked at the facilities and the conditions that we must bear as consumers, while attempting to recover from an episode of psychosis, depression, or another label. They would find hospitals with beds that are nothing more than cots with a thin foam pad on which to sleep. They would find a ward that holds upwards to fifty people with nothing more than two short hallways and a small dayroom area. When the opportunity arises to go outside, it consists of nothing more that walking back and forth on a concrete catwalk with bars above and on the sides and only thirty feet of walking space allowable. In some facilities, the shower must be shared with all fifty people on that ward. It is unkempt and unsanitary, most of the time, and consumers often have to use the shower with no hot water and very little soap. With these conditions, consumers have difficulty maintaining a good quality of hygiene.

These are just a few conditions that can be compared to a hospital room shared by two patients, while in a facility treating physical health problems. As for the food, well, I just won't even go there.

As you can see, the lack of parity is clear and nothing ever seems to be done about it. No quality, unified training for the health professionals exists. I have not seen any upgraded facilities, and there still remains no consumer input into our treatment. This leaves many consumers still far away from the goal of recovery. And, a new rise of consumers have developed who have suffered not only these poor standards of care, but they have also been forced to receive injections, medications, and electroshock treatments ordered by the court. These individuals are now calling themselves "psychiatric survivors." In my opinion, such treatment takes away the very liberties which the court is supposed to protect.

11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

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.