Medical & Mental Health Co-Occurring Disorders

As medical professionals, nurses see it all. They are the front-line of medicine, triaging and assessing, organizing and directing care, initiating treatment, connecting with the patient and briefing the physician.

Talk to a few nurses and if they are candid, they will say they have an acute sensitivity to their patient's needs. Ask a few nurses about their scope of practice in the outpatient office? in the ER?, on the unit?, and if candid they will say, their responsibilities are great. But ask most medical nurses about what to do with a patient with both medical issues and mental health needs and if they are candid they will likely say, "I wish I knew more".

So why is it that cross-training nurses in the fundamentals of co-occurring medical and mental health disorders is limited? There is a move towards health integration initiatives and education and cross training so that we can provide more efficient, affordable, and effective person-centered care. This movement is imperative for our patients who deserve to be treated holistically and for the health care system that is struggling to manage out of control costs.

Behavioral Managed Care - Friend or Foe?

We realize many medical and mental health clinicians are frustrated with managed care. There is this assumption that managed care plans are only interested in restricting or refusing services to gain profits. There are many arguments and philosophies that could be discussed regarding this topic but the reality is, whether we “like or dislike” managed care, it is here. This is the system that we have to work with and managed care continues to grow.

Today more than: three-quarters of commercially insured persons, 12 percent of Medicare beneficiaries, and almost 40 percent of Medicaid beneficiaries get their health coverage from managed care enterprises. The State of Florida recently signed a waiver with the federal government to start Medicaid Managed Care Programs. Michigan has had Medicaid Managed Care for 10 years. Medicare enrollees in Managed Care Systems continue to increase as well. Our elders and disabled populations who are insured through Medicare will be choosing Medicare Prescription Drug Plans that are distributed through Managed Care Organizations in the next couple of months.

How do we learn to navigate the system and work within the system to get our patients and clients what they need?

Crisis in the Morning

I stumble down to make coffee to realize that there are no coffee filters. Urghh...!!!!! I am still asleep - I can't be faced with such a crisis early in the am...I decided to reuse.
I am a tree hugger through and through.

This reminds me of many times when I was sippin' my coffee (is there a pattern here..You psychologists reading this..Stop that...Oh wait, I'm a psychologist) while covering the mental health triage phones and the phone rings.

How can I help you?..."I'm depressed and I don't think there is any reason to go on."

Ok, Now I know that there is a divine being because this is exactly the reason I need to be awake and the reason the coffee is brewing in the morning. If I wasn't awake before I answered the phone, I am now!

I listen..She talks...I listen...She talks...Did I say, "I listen?" In my responses to her I express my concern and validate her feelings. I'm in the groove now, calm and focusing only on the caller. "So you are feeling sad and angry with your boyfriend who left after being together for 5 yrs." She says with an emphatic, "Yeah! He really pisses me off".

We discuss her support system friends and family. I ask her more about her thoughts of wanting to be dead. She says, "I don't know how to go on."

I talk with her about ways to cope with her feelings and how to go on. (Talking to friends, getting out, physical activity, soothing activities, writing and coming in to see someone)

She agreed to come in and see someone that day and she says as we were finishing up...emphatically, "I don't need him anyway!"

Ok...That's not the full conversation but bits and pieces...and sometimes more restrictive interventions are required.

A no coffee filter crisis or the lonely, depressed and in pain caller crisis...hmm...Both are manageable. Crisis can be seen as an opportunity for growth for all of us.

I now know I can reuse coffee filters. The question is for how long?

Bipolar Disorder Statistics and General Information

We all have experienced times of moodiness in our lives and up and downs. We have feelings of sadness, anger, irritibiltiy and excitement. These are normal feelings for a human being. By contrast, BiPolar I Disorder is a serious recurrent and possibly fatal disorder. The emotions and symptoms experienced by someone diagnosed with BiPolar I Disorder are so severe that they often cause significant impairment in the persons ability to function and maintain a stable lifestyle. BiPolar I Disorder can be successfully treated with psychological and pharmological interventions.

Here are some statistics from the Diagnostic and Statistical Manual for Mental Disorders:
More than 90% of individuals who have a manic episode go on to have future episodes.
The average is 4 episodes in 10 years. Interval between episodes tends to decrease as individual ages.
5 to 15% of individuals with bipolar I have 4 episodes within a year -– rapid cycle.
10 to 15% of adolescents with recurrent major depression go on to develop Bipolar I Disorder.
Bipolar I incidence is equal in men and women----euphoric mania followed by depression. Prevalence of 0.4 to 1.6% in community samples.

BiPolar Disorders have become the new fad diagnosis of the last couple of years. There are many complicating factors and varibles that make the diagnosis of BiPolar difficult to assess at times. BiPolar I Disorder is a serious mental illness and a thorough and comprehensive assessment is required for proper diagnosis.

Those who commit suicide visit a physician before death

66% of those who commit suicide visit a physician less than 1 month prior to their death. This means that two-thirds of all successful suicides had an opportunity for early detection and intervention by a medical professional. People who commit suicide are more likely to see their primary care physician than a mental health professional. As mental health professionals it is important for us to recognize and be aware of the research and statistics available so that we can effectively assist in interventions. It is imparative that the helping professionals work together to provide education and training for what can be a fatal disease.