Societal Impact of Mental Illness

The National Institute of Mental Health provides research data on the impact of mental illness on “established market economies”. The data expresses impact in terms of the economic consequences due to mental illness and associated mortality and disability. The findings of this research project mortality and disability until the year 2020.

Facts

• Major depression is the leading cause of disability (measured by the number of years lived with a disabling condition) worldwide among persons age 5 and older.


• For women throughout the world as well as those in established market economies, depression is the leading cause of DALYs. In established market economies, schizophrenia and bipolar disorder are also among the top 10 causes of DALYs for women.

DALYS refer to Daily Adjusted Life Years. DALYs measure lost years of healthy life regardless of whether the years were lost to premature death or disability. Various mental health diagnoses are considered in relation to this measurement.

For further explanation and review of detailed findings, link to: NIMH

Motivation and Personal Responsibility

Do you want to be successful? Do you want to move from the doldrums of a life with little meaning or satisfaction?

If your answer is YES! The 10 Foundations of Motivation is a great book to help you organize your thoughts and get you moving in the right direction. Shawn Doyle describes that the first step is finding out what your purpose is? Why are you on this earth? Who are you truly meant to be? What are you passionate about?

We all generally have the same wiring, it is what we decide to do with this wiring that makes the difference between finding ourselves at age 50 and wondering what we have accomplished in life and finding ourselves smiling at age 50 with continued enthusiasm for our life’s-work, knowing that we are fulfilling our purpose.

I have been fortunate to be remotely connected to a program called Peace Jam. Nobel Peace Laureates volunteer their time to youth to instill within our youth the belief that we can all make a difference. I have had the opportunity to hear several Nobel Peace Laureates speak and every one of them has been very clear about one thing. You and I are no different than them. (Nobel Peace Laureates - Archbishop Desmond Tutu, Jody Williams, Máiread Corrigan Maguire, etc.) They just decided to take action in something they believed in.

Find out what moves you emotionally, mentally, spiritually and physically. You may need some alone time to do this. You may need to work at it – writing down ideas or asking friends and family what moves you? You may already know your dreams but for whatever reason lost sight of them years ago.

No one can do this for you. We are responible for our own choices and career decisions. You can make a difference! You can make those dreams come true. Do you want to be a private practice clinician? Do you want to run your own business? Do you want to be an educator or a writer? Get Motivated, if there is a will there’s a way. Get Started...the world is waiting for you! You have what it takes!

Therapy....Why People Quit

Rates of premature termination from therapy vary from agency to therapist. In some agencies early treatment termination rates are above 50%. Termination may occur after the initial session or later in the course of treatment. There exist multiple variables effecting early termination of treatment, many which may be prevented through effective educating clients about the expectations of treatment.

Discussing openly the specific treatment goals, timeliness for treatment, communicating about differences, conflicts or disagreements in the therapy process and other potential treatment-ending reasons is key to preventing termination and improving treatment outcomes. Communication, including with your therapist, is vital to the overall success in treatment. To learn more about why people drop out of therapy, see Dropping out of Psychotherapy

Customer Driven Health Plans, The Answer?

CDHPs are a fairly new resurrecting of the old indemnity insurance plan (high deductibles) with a broad PPO choice. How does it actually improve choice and the overall health care system? Dr. Enthoven’s is quoted in Managed Care Matters that CDHPs do not address the concerns of chronic illness, prevention, costs or quality of services. It does give customers choice which is very important to customers.

How do we balance choice, evidenced – based treatments, quality providers, affordability, and access, etc? How do with provide service excellence at an affordable price? What barriers are there to a more healthy and productive system? I cannot answer these questions but I think it’s imperative to start seek answers. What about fewer health care plans? Could we become more consistent with service delivery and monitoring of data, prevention efforts, improved management of chronic illness?

What creative ideas do you have to provide this type of delivery system?

Here Comes the Sun

If you live in the Midwest or other geographic areas that experience low natural sunlight this time of year, you may be experiencing symptoms of Seasonal Affective Disorder. It usually strikes during autumn and often continues through the winter when natural light is reduced. Seasonal Affective Disorder or SAD can present with low to high levels of depressed mood, appetite and sleep changes, general feelings of malaise and sadness, low energy, low motivation, difficulty concentrating and even thoughts of suicide. Not all people in low light areas experience SAD; others experience significant symptoms that interfere with their day-to-day functioning.

Effective ways of managing low-light mood symptoms can range from visits to the tanning salon to seeking counseling and medication treatment. A possible alternative to resorting to prescribed medications may involve Light Therapy. This form of therapy consists of spending blocks of time bathed in light from a special full-spectrum light source, called a light box. Individuals can purchase their own light boxes or some counseling centers offer Light Therapy as part of their services. Light Box

One Man's Medicine is another Man's Poison

As is the case with most things, too much of a good thing can become unhealthy. In the case of prescription medications for the treatment of Attention Deficit Disorder and other impulse-control disorders, medications like Ritalin, Metadate, Strattera and Adderall have become popular and effective in the treatment of these disorders. These amphetamine-derived substances have a paradoxical or opposite effect on people that truly suffer from attention and impulse control deficits, acting to calm, focus and regulate their hyperactive behaviors and attention to tasks. When used responsibly many individuals are able to function more effectively and productively in their work, school and relationships.

On the other hand, when medications such as these are inappropriately used, taken to achieve the true amphetamine response, it can become dangerous and contribute to a more habitual pattern of substance abuse. View this recent article with regard to Adderall in particular and the phenomenon occurring on some college campuses. Prescription for Abuse

"Compassion Fatigue"

I heard this phrase a couple of months ago. You know, it was on one of those seminar flyers that fill you mailbox. “Compassion Fatigue” caught my eye. I had to chuckle to myself…what is it? Basically, the conference was about “burn out” in helping professions (mental health, nursing, medical and spiritual). Are you tried of hearing the same old story? Have you lost your patience, “lost that lovin’ feeling”? Are you spent because you have been seeing clients back to back and you have nothing left!! Do you want to scream, “Stop calling me”?!! You threaten that you are going to “lose it”.

If you are feeling this way, maybe it’s time for some self-compassion. How are you taking care of yourself? We are all the same. We all have feelings, we all need support, and we all need breaks, to breathe the sun of a warm day and the smell of warm bread. We all respond to these things as human beings. Have compassion for yourself. This is where it starts…if it means taking a day to go to a seminar to remind yourself that you are not alone, you are important, you are making a difference and you can ask for what you need then do it! Often times I have found myself in this space, when I have been doing some particular duty for too long without a change. If you can make a change, even if it’s small (flex hours, swap duties with someone else that would like some variety in their job duties, TAKE a break and do all the things you tell your clients to do for themselves) this might help. You will be happier and so will the people you are working with.

Dialing Up Mental Health Interventions

Psychiatric News notes through research completed that patients with anxiety and depression were significantly impacted by telephone –based interventions by a care manager that reduced their use of the emergency room visits and the patients also showed a decrease in symptoms of depression and anxiety 12 months post intervention.

Dialing up mental health continues to be an intervention that being used and researched. This research indicates that telephone interventions can be a successful treatment. Care managers can develop a relationship, show concern and emotional support, discuss ways the patient can manage their symptoms through evidenced based practice interventions such as Cognitive Behavioral Therapy (assisting patients in understanding faulty and irrational thinking and assisting patients with changing thought patterns to be more rational and realistic) Disease Education and other Interventions.

Medicaid Behavioral Managed Care - The Future

Medicaid behavioral managed care has been around for almost a decade in Michigan and around the United States. By 2012, Medicaid will provide 60 percent of public behavioral health funding and managed care will be the major vehicle to delivering behavioral health services. This study indicates that it will be here for years to come.

Programs that have been implemented into the mainstream have effectively improved clinical and financial outcomes and have been able to be more creative. Programs that have been implemented poorly have shown fragmented care and poorer clinical outcomes. For behavorial managed care programs to be successful, implementation of these programs will require adequate funding, good utilization data, a flexible mindset and an administrator dedicated to continuing to implement managed care cultural change into the mental health systems.

Cognitive Behavioral Therapy

Helping people to become empowered and effective in the management of their own emotional well-being is not a novel idea. Taking responsibility for one’s own life, being accountable, “taking the bull by the horns”, however we say being the master of one’s own destiny, the principles and techniques contained with the Cognitive Behavioral Therapy (CBT) model can assist all individuals become better able to understand, recognize and intervene in the management of their own life. Cognitive Behavioral Therapy is becoming an evidence-based treatment practice in the treatment of depression, anxiety, substance abuse and other mental health illnesses as well.

The Beck Institute in Pennsylvania, pioneered by Aaron Beck the founder of Cognitive Behavioral Therapy, continues to research, teach and train clinicians in CBT worldwide. The fundamental principles of CBT can help individuals “learn” how to identify certain maladaptive thoughts & emotions, analyze these thoughts & feelings to recognize them as maladaptive, develop tools/skills to modify their thinking and consequently implement more adaptive/healthy behaviors are some general key concepts of CBT. Visit their website for more information. Beck Institute.

Evidenced Based Treatments for Patients with Borderline Personality Disorder

Like the majority of personality disorders, Borderline Personality Disorder is a disorder that has generally been resistant to conventional mental health treatment. Borderline Personality Disorder is described in the DSM IV as a pattern of instability in interpersonal relationships, self-image, affects and marked impulsivity, beginning by early adulthood and present in a variety of contexts.

Dialectical Behavior Therapy (DBT) has been researched and found to be statistically the most effective treatment for this profound and disabling disorder. Marsha Linehan, the founder of DBT has a variety of specific treatment strategies are described in Linehan's book (Linehan 1993a).

Before a patient will be taken on for DBT, she will be expected to commit to a number of undertakings:
1. To work in therapy for a specified period of time (Linehan initially contracts for one year) and, within reason, to attend all scheduled therapy sessions.
2. If suicidal or parasuicidal behaviors are present, she must agree to work on reducing these.
3. To work on any behaviors that interferes with the course of therapy ('therapy interfering behaviors').
4. To attend skills training (Core mindfulness skills, Interpersonal effectiveness skills, Emotion modulation skills and Distress tolerance skills)

DBT is a vital part of any clinical mental health workers tool box. Marsha Linehan has several books and workbooks available as well as DBT trainers to assist learning the skills of DBT. These skills and therapies are clinically effective for Borderline Personality Disorder but also can be used for with many clients who suffer from mood disorders as well. As we seek to improve our skill base as clinicians having this in your tool box will increase your confidence in treatment difficult to treat disorders.

Study Addresses Nurse Health Problems

Provided by: Canadian PressWritten by: JOHN WARD Dec. 11, 2006

OTTAWA (CP) - Everyone has heard stories of overworked, stressed-out nurses, but a new Statistics Canada study has put flesh on the anecdotal bones, confirming many of the complaints.
In fact, the study suggests that the job is making nurses sick. The study surveyed nearly 19,000 nurses between October 2005 and January 2006, including registered nurses, licensed practical nurses and registered psychiatric nurses.

It found that about 10 per cent were injured on the job in the previous year, whether they were stuck by needles or even physically assaulted by patients.

About 37 per cent reported they had experienced pain serious enough to prevent them from carrying out their normal daily activities in the year before the survey and three-quarters of them blamed job factors.

The survey links work stress, low autonomy and lack of respect to health problems among nurses. It says job strain was strongly related to fair or poor physical and mental health.

"For example, 17 per cent of nurses who perceived high job strain reported 20 or more sick days in the past year, compared with 12 per cent of nurses who perceived less job strain."

That's no surprise to Andrea Baumann, director of the Nursing Health Services Research Centre at McMaster University.

"We've seen along with firemen and policemen a sort of high job strain because of the intensity of the work," she said. "The intensity of the work is increasing because of the shortened stays, sicker patients and fewer staff.

The survey found that many of the country's 314,900 nurses were expected to work regular overtime. Half of them put in an average of four hours a week in unpaid overtime. As well, many nurses have more than one job.

The study, conducted in concert with Health Canada and the Canadian Institute for Health Information, also found that nurses were more likely to report high stress levels at work than people in the general work force.

The researchers defined work stress as occurring when job responsibilities outpaced a worker's ability to decide how to perform the tasks required of them.

"It's too few nurses for too many patients," said Lisa Little, senior nursing consultant with the Canadian Nursing Association.

"I think 67 per cent say there's too much work for one person, they can't provide the quality of care that they want, there's not enough time to do what's expected.
"All of those kinds of things, I think, are all feeding into what we're seeing in terms of their health."

The statistics agency said nearly a third (31 per cent) of female nurses were classified as having high job strain while the figure for all employed women was 26 per cent.

Nurses were also more likely to report depression than people in the general work force.