Treatment Methods

Mental Health Screenings

~ foreverwell ~ Leave a comment
Depression Screen pic 5.20..jpg
Image Courtesy of: Mental Health America 

When it comes to mental health, the first step is elusive for many when speculating that there may be problems developing for themselves. What to do?

It is recommended to go to the family doctor to talk about any issues or feelings that are troublesome. Some symptoms may be medical related, so it is always best to go to your doctor and include them in your recovery journey. The doctor will have guidance on where to begin in the search for treatment.

There are several other sources to augment what the doctor says. For example, in the case of those that want to do self-exploration, and may find it difficult to initially speak to their doctor, or don’t have a current doctor, there are other options.

Nationwide many health related organizations have available tools. One such organization is Mental Health America (MHA). Their Mental Health Screening link is found here.

Follow the information on the page. Resources and suggestions are included. The results of the screening test may rule, in or out, a mental health challenge.

If doing an internet search, “Mental Health Assessment,” and the “name of your town” will bring up local resources, government mental health services, or the recently implemented retail pharmacy treatment centers.

A recent important article related to May being Mental Health Month, is “Walgreens hopes to screen 3 million on mental health by next year” announces that local pharmacies will soon be providing screenings.

Considering the month of May is Mental Health Month, it is a good time to inquire about a screening. Many organizations, local, state, and federal departments are focused on awareness to the public in May and encouraging those interested to take the first step!

Standing in the Way of One’s Own Help

~ foreverwell ~ Leave a comment

Road Block

There are just about as many ways to get help, as there are methods of help. All of these are need based, and the need is determined at the hands of someone else. Author Todd Essig’s article “Help for Consumers Shopping the Confusing Online Mental Health Marketplace” written for forbes.com, discusses the complications with relying on online help. The two issues raised in this article are: “There is neither adequate assessment nor professional accountability.” These issues are not only present in the online help platforms available, but also in real life, as people who face mental illness inadvertently stand in their own way.

When it comes to online help, there is no limitation to where a therapist can hold their practice. Without respective boarders, any insurance or protective measures cannot be controlled. Essig illustrates this point in saying “But for now, adequate professional accountability for potentially unethical actions is lacking.” While a therapist may carry good insurance, the insurance is typically only regionally applicable. While regulations and requirements for online treatment are being developed as the process becomes more commonly practiced, there are far too many holes and gray areas to fully ensure that a therapist will be held accountable through a broadly applied online platform.

Unethical action can sometimes be intentional, although it can also be the result of error. In the case of virtual treatment; it may be as simple as a misunderstanding of the patient’s symptoms, or worse, a result of the fact that people can easily edit themselves. Author Joe Madden hits the nail on the head in his article “I tried to Fix my Mental Health on the Internet” when saying “The fact that you can edit messages before sending them means you’re unlikely to blurt out something unguarded and revealing in the heat of the moment.” While online, the editing is in the form of messages, in person, the editing is in the form of personal character. This “editing” is what often makes people their own roadblock from getting adequate help.

When someone decompensates, or has a complete breakdown and loses the ability to control their psychological and physical functions, it is an ultimate low point. They are most certainly not themselves. The typical process is for them to go to the local ER and be assessed. Upon completion of an assessment, they are either sent away with a suggestion to see an outpatient psychiatrist, or admitted to the hospital’s psychiatric department. It is a very different situation if the person does not want help, and a friend, family member, or someone nearby calls 911 for help. The police can utilize a law referred to as 5150 to bring the unstable person to certain psychiatric facilities that have a license for evaluations.  Once a doctor has assessed the patient, they can be admitted with or without their consent on a 72-hour hold. During that time, they are monitored by trained staff, medications may be administered to assist them in regaining stability, and ultimately a plan is put into motion for what will happen after their time in the hospital is up. This is a process that is evidence based and  has been vetted over years of law and regulation development.

With online treatment the person is self determining the severity of their situation, and making decisions on how to be assessed and treated. The instability of an emergency situation can be very dangerous time for self-assessment as perception of reality is very skewed, and clear thinking is essentially impossible. If one is not facing an emergency when seeking online help, they still have the  capability to edit themselves. Editing means censoring their actions and mannerisms before they respond to the online service. The virtual treatment censorship is a two way street, in that the doctor can also sensor themselves and act outside their scope of knowledge. An online atmosphere removes the in person capacity to monitor the patient in real time, and treat them with adaptable evidence based skills.

On one hand, the problem of professional accountability lies more in the hands of virtual treatment that can be complicated waters to navigate on the internet. Debates on regulation and licensing for online services are being developed. On the other hand, the problem of continual assessment applies to both virtual and in person treatment. Self editing and censorship of one’s behaviors presents a huge problem, when the resulting treatment becomes based upon the façade, rather that true reality. Skewed treatment may result in the person being denied access to evidence based programs designed to help them get stable and have long term success in their life.

The above referenced articles evaluate the advantages and dis-advantages of online treatment, while acknowledging that rules and regulations for online help are being developed currently. This presents a buyer beware market. The person seeking help would be wise to explore in person treatment as well online treatment. The severity of their condition should be one of the final determinants of the type of treatment to seek out. It is essential to remember that mental illness is not a one size fits all.The goal should always be to make sure every person who faces a mental illness receives the best possible care for their specific situation.

Police Officer’s Dilemma, Encounters with the Mentally Ill

~ foreverwell ~ Leave a comment

Police Officer

Police throughout the nation have intensive training before becoming officers. That is as it should be for such a complicated job. What is not very well known is most locals only provide 4 hours of training on encountering the mentally ill.

Mental Illness is such a complex human condition that psychiatrist go three additional years after medical school. The lack of baseline training provided regarding mental illness, is a very discouraging fact, and an unfair allocation of training priorities to police officers. An encounter with a symptomatic person is a challenge with most times a good result. These situations can also get out of control in an instant resulting in outcomes such as arrests, beatings and sometimes death.  Prior to 1988 the norm was for the family and advocates to get outraged, the press to focus on the incident, and then with the passage of time it would fade away, until the next negative encounter.

Fortunately, in 1988 the Memphis Police Department had the foresight to develop at Crisis Invention Training (CIT) that included 40 hours with the goal of creating a jail diversion prior to arrest.  Finally, a police officer who was under trained had a professional focus 40-hour quality training.

Adoption of CIT training across the country has been steady, but not ubiquitous. Being trained in CIT doesn’t guarantee the prevention of a negative outcome, but it does increase the chances of a positive outcome. Studies have shown CIT to be effective.  The infrastructure supporting CIT has grown more professional each year. The future gets better as more CIT officers will be encountering these precarious situations.

Jail diversion and treatment is essential. An act of advocacy for those reading this article is to contact your local NAMI.org affiliate and inquire if the local police department has CIT training. If not, or if the percentage of officers trained is not 100% then ask how you can help. Contact your board of supervisors.

There have been so many recent news stories that have come to the conclusion that the criminal justice system has become the country’s answer to dealing with mental health that it is now common knowledge.  CIT training is one piece of the solution puzzle for assisting this vulnerable population.

While many have claimed that the criminal justice system is the countries answer to mental health at this point, author German Lopez recently published an article examining the true ramifications of the claim. In the article, “How America’s Criminal Justice System Became the Country’s Mental Health System,” Lopez examines several cases where police officers have responded to deal with scenarios of mental illness.

Officers respond to calls involving people who face both diagnosed and undiagnosed mental illnesses every day. It is important to remember what a police officer’s job is when they respond to such a call. When an officer arrives on scene, it is their job to uphold the law, and keep all citizens including themselves safe. Officers do go through extensive training to learn how to make these quick decisions, and what the best case scenario is. At the same time, the basic education they receive does not necessarily pertain to symptomatic mental illness.

When faced with someone who has decompensated and is in a state of complete mental breakdown, there is an immediate need for the officer to regain control to ensure that the person does not hurt themselves or anyone around them. In Lopez’s article, this critical moment in the decision making process is where one of two things occurs, either: “officers blasted him twice with a Taser, shocking him with 50,000 volts of electricity each time,” or “A police officer with training for mental health crisis, approached Kevin…this officer talked softly, reasoned with him, and finally, convinced him to get into the car-no violence necessary.” (vox.com.)  Kevin is the same vulnerable person facing mental illness that went through both of these traumatic experiences.

The first experience of being tased, should not be the norm.  It is the product of a cop making what they considered to be the best decision to regain control. Having a trained officer who responds to the situation with their voice rather than physical action, will go much further in that person’s recovery. Providing officers with education gives them knowledge about various illnesses, and how they may be evident in people’s behavior, as well as the best methods for making quick decisions on how to handle the situation. The proof of how well education works lies in the outcomes.

For Kevin, the person who went through both of the above encounters, it was because of the second officer’s communication and decision to take Kevin to the hospital that he was able to get help. He was able to fight the charges against him at the time, and best of all, “With proper care and medication, Kevin has not had a dangerous run-in with police in nearly 10 years since.” (vox.com) That right there speaks for itself. Kevin has been able to remain in control of himself through care and medication, and has not gotten violent to require police intervention in a decade.

There are thousands of Kevin’s out there, thousands of people who wind up in jail because of the disease they struggle with. These are people who courts deem unfit to stand trial, yet there is nowhere for them to go and not enough education out there to help police officers as they respond to the same call for the same person over and over again.

When a mentally ill person does commit crime, they are responsible.  The solution is treatment before trouble. Through education, programs such as CIT, and the modern therapeutic treatment model, it is possible to allow police officers to do their job more effectively.  By giving them knowledge of how to react to someone who is facing a mental illness, and providing them with tools and supports for where to take the person to get the best help, it is possible to reduce the chances of an immediate repeat situation and ultimately hopefully keep that person from entering the cycle of being in and out of jail.

Schizophrenia’s Future in Connection to the C4 Gene

~ foreverwell ~ Leave a comment

Schizophrenia

Schizophrenia by definition: According to the Surgeon General’s Report titled Mental Health, “Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect, and sense of self. The array of symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions).” (Page 269-270).

A January 29th CNN story covered the topic of a recent research discovery regarding schizophrenia, which we are using for this article to bring awareness to promising news. The article states: “This new study’s hypothesis is that people with schizophrenia have a variation of a gene called C4 that creates two varieties of proteins: C4-A and C4-B. Looking at the genes of 64,000 people, those who struggled with schizophrenia had C4 genes that produced overactive forms of the C4-A protein.”

What does that mean exactly? What the research suggests is that people with schizophrenia who carry these genes have a problem with a natural process in the brain called “synaptic pruning”. The gene C4 is also involved with regulating the immune function. The brain has cells that act like a cleaner to help the brain get rid of clutter. As one develops and learns things, these cells remove the redundant or weak connections between synapses. Synapses are like intersections on roads that carry information through the brain. After a good street cleaning, what’s left behind are clearer intersections and stronger, healthier connections.

Do this study’s findings mean a cure is in sight? Unfortunately, not exactly. It does bring scientists closer to treatment improvements. While should not be discounted that schizophrenia is a very complicated disease with much to learn still; there is a real victory here in considering that as more research is completed, it is a possibility that one-day schizophrenia may not disrupt people’s lives to the point that they cannot function. This is fantastic forward progress when considering what schizophrenia can be observed as in the public in this day and age.

The Schizophrenia that the public observes could be: That person passed walking down the street today who is carrying on a complete conversation with themselves. A person with these symptoms is often avoided by individuals or parents being protective of their children to the point of scurrying to the other side of the sidewalk, tightly holding their child’s hand, and reminding them to stay away from strangers. On another occasion, maybe there was a person standing in the middle of a busy intersection as you wait for the stoplight to go from red to green. Would you believe that a distortion of reality, in the form of voices in one’s head, told them to stand there?

Would you accept the fact that those same voices convinced that person to not eat last night’s dinner because it was poisonous? Even more relevant, consider the fact that the very same voice alienated that vulnerable person from life around them. In reality, these people are in a fragile state of illness and have yet to receive the help they need. According to CNN’s article, “The World Health Organization estimates that one in two people living with schizophrenia do not get any treatment.” Lack of treatment can result from not being diagnosed, or lack of adequate resources, both issues which can hopefully be amended as new knowledge is found about the C4 gene and its relationship to schizophrenia.

The Mayo Clinic claims on their information page for schizophrenia that: “Schizophrenia is a chronic condition, requiring lifelong treatment.” Of course this is not a newly discovered disease, there are thousands of treatment options out there, although not one specific treatment that works every single time. With a recent study completed, there is a renewed sense of energy being invested to complete more testing, which can only improve the treatment models.

How do these people begin to get help? Family, friends and advocates cannot necessarily go and talk about how the voices aren’t real; considering the person’s version of reality indicates there is no help needed.  Instead, they will either live in a disordered life of instability that is controlled by possible voices and hallucinations; or potentially get picked up by local police for disturbance of the peace, in turn worse if they have committed a crime at the will of the voices. There is a substantial chance that the person will go into the justice systems as just another criminal. In the best case scenario, the police will will see they pose a threat to themselves, or others, resulting in the order of a 5150, which means being admitted to a psychiatric hospital to be observed for 72 hours, then get help. For that smaller number of people that get the chance to receive help, current treatment methods such as transitional housing and medication, are only the beginning; just at the discovery of the C4 gene’s connection to schizophrenia is to finding improved treatment methods.

While people can continue to use the supports and services that currently exist, scientist now have a better grasp on possible starting points to examine schizophrenia in future studies. In truth, this study brings a new light to the improvement of schizophrenia diagnosis and treatment in the real world.

References

Christensen, Jen. “Discovery One Step Closer to Cause of Schizophrenia- CNN.com.” CNN. Cable News Network, 29 Jan. 2016. Web. 29 Jan. 2016

Mayo Clinic Staff. “Schizophrenia.” www.mayoclinic.org. Mayo Clinic, 24 Jan. 2014. Web. 29 Jan. 2016.

U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. http://profiles.nlm.nih.gov/ps/access/NNBBHS.pdf Web. 1 Feb. 2016