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.

Formerly a senior writer and editor at Business Week with years of experience covering science and medicine, Raeburn is no stranger to research. He has mined his family’s medical records and has interviewed-and quotes-not only Alex and Alicia but also their brother, Matt, and other parents and children. He writes:

As I began the research for this book, I became increasingly aware of the scandalous disregard with which we treat our mentally ill children. Children and adolescents with psychiatric disorders are among the most neglected and mistreated members of our society. Of the millions of American children with emotional problems, only one in five receives any medical care… But the problems with mental health care cut across the economic spectrum… Treatment of children’s psychiatric disorders is often abysmal. The diagnosis is missed. The children are given the wrong drugs, or the right drugs in the wrong doses. They are offered little or nothing in the way of counseling and psychotherapy. They are admitted to psychiatric hospitals repeatedly, and discharged under the orders of insurance companies after only a few days or a week, long before a diagnosis can be made or an effective treatment established. Many of the few children receiving care lose it abruptly when their insurance runs out, which happens much sooner for mental illness than it does for diabetes, heart disease, or any other ailment. Some parents are forced to give up their jobs to become full-time care managers for their children. Some lose their jobs, because they can’t get their work done while they are being called away to emergency rooms, school classrooms, police stations, hospitals, and juvenile detention centers to attend to their children.

Convulsed by the torment of their children’s illnesses, many parents attempt to conceal their struggle and out of shame or embarrassment. But as Raeburn so accurately observes, the medical system and the nation are failing us all. The suffering of sick children amounts to a public health crisis that demands attention: “The longer the epidemic remains hidden, the longer it will continue.”

This wise and informed account of the horrors of medical care for mental illness among some of our youngest citizens and their families is must reading for mental health professionals and parents with troubled children. “What we found,” Raeburn says, “was a splintered, chaotic mental health system that seemed to do more harm than good.” Many therapists will readily agree. Now is the time for us social workers, parents, and ordinary Americans to take action. By failing to respond to the needs of the nation’s children, after all, we jeopardize our collective future. In the process, we disrespect the children we once were.

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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.

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Suicide Prevention Through Better Mental Health Care

Better mental health care and ease of access :

We need to find ways to make life less difficult for people who struggle with mental illness. No one should have to choose between needed medicine and food or shelter.
We all deserve to have our basic needs met with respect and acceptance. Mental illness is not the person’s fault any more than cancer or heart disease is. This is hard for most of us to understand.
What we see of mental illness is just the tip of the iceberg.

Many more people suffer silently. We can’t see mental illness, it comes to our attention when it is not treated effectively. Sometimes that makes us uncomfortable, and forces us to look at the results of our personal priorities.
Mental health care and suicide prevention should be obvious public health goals. Medicines are getting better and better at keeping depression controlled, but the enjoyment and satisfaction of everyday life is more than just “getting by” emotionally. Suicide means ending your life on purpose. Suicide prevention means making living look better than dying.

Lots of people with depression, and other mental health problems, find new lives with the right mental health care. Others don’t have the same opportunities.
Suicide looks like the best or only choice for them. We can’t stop all of the hardships of their lives, but suicide prevention has to include making better mental health care more available.

How to help yourself and your loved ones get better mental health care:

Learn the warning signs of depression.

If the depression is mild and not upsetting sleep, appetite, concentration or irritability, look for a licensed counselor, social worker or psychologist.
If there are any of the following,
frequent crying or anger outbursts, or crying for no reason, or loss of temper at little things
unusual irritability, snappiness, impatience, criticism of others
poor concentration, follow through, or are more easily distracted
avoiding family and friends, saying ‘no’ to most invitations or suggestions
trouble falling asleep, (longer than 20″-30″), staying asleep (should be getting usual sleep or 6-8 hours a night), or sleeping too much ( more than 2 hours longer than usual), or waking up and not getting back to sleep
panic attacks, with physical signs like fast heart beat, shortness of breath, shaking, sweating, dizziness, nausea, chest tightness or chest pain, numbness or tingling in hands or feet
thoughts of death or suicide
new or increased use of alcohol or recreational or prescription drugs
All of the above persons can do counseling, but a person will probably also need someone who can prescribe medication.
Choosing the right Mental Health Professional assures better mental health care for everyone.
Learning more about depression helps you to get better mental health care for yourself and your loved ones. You will pick up on it sooner, and do something about it before it gets disabling.
Thoughts of suicide don’t usually come on suddenly, so noticing depression early and getting help can stop a lot of suffering. Spread the word, help stop the epidemic of suicide.
Of course, suicidal thoughts or attempts always deserve immediate attention.
If you are currently suicidal, please call 911, your local suicide hotline or one of the national suicide hotlines at 1-800-SUICIDE or 1-800-273-TALK

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Study Identifies Factors Leading to Discontinuation of Treatment for Opioid Addiction

Earlier considered as a scourge specific to military veterans, opioid addiction has today spread to each section of the society. Surprisingly, the crisis has largely engulfed teenagers, women or older adults. Addiction to opioids, including heroin, morphine and prescription pain pills, has led to severe physical and mental health problems among Americans, apart from creating a burgeoning and dangerous black market of illegal drugs on the streets.

Results from the 2015 National Survey on Drug Use and Health (NSDUH) revealed that of the 20.5 million people aged 12 years or older who were diagnosed with substance use disorders, 2 million were addicted to prescription pain relievers and nearly 591,000 were hooked on heroin.

Getting rid of opioid addiction is tricky due to the involvement of medication. Additionally, opioid addiction recovery treatment requires long-term engagement in therapy for its success, which many fail to follow. Disengagement from treatment has become a norm in people undergoing recovery from an addiction to opioid drugs.

Until recently, a majority of people addicted to prescription pain relievers were treated with buprenorphine. However, a recent study published in the Journal of Substance Abuse Treatment has pointed out that many patients undergoing the treatment process tend to give up midway owing to various reasons, such as unemployment, belonging to a particular race or an acute hepatitis C infection.

What causes disengagement from opioid addiction treatment

According to the study by the researchers from the Boston University (BU), individuals with opioid use disorder are more likely to disengage from treatment programs if they are black or Hispanic, unemployed, or have hepatitis C. Buprenorphine – Subutex and Suboxone – is the most widely used drug for the treatment of opioid addiction due to its efficacy in reducing the rates of heroin and prescription opioid use. Additionally, it reduces the chances of “risky behaviors” that are associated with development of co-morbidities such as HIV or viral hepatitis infection.

As part of the study, the researchers evaluated more than 1,200 patients treated at office-based addiction treatment (OBAT) program between 2002 and 2014 to identify the patient-specific factors associated with retention in the treatment program for longer than one year. Factors such as age, gender, race/ethnicity, education level, employment, infection with hepatitis C virus, co-morbid psychiatric conditions, and prior or current use of drugs or alcohol were specifically evaluated.

Highlighting some important disparities in treatment outcomes (especially racial/ethnic), the study observed, “Older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year.”

The study plays a key role in understanding the potential of opioid agonist buprenorphine to treat opioid addiction at a time when Americans are fighting a tough battle against prescription drug abuse. The study is expected to open newer avenues of treating opioid addiction, apart from encouraging patients to complete the recovery program.

Treating opioid addiction through effective therapeutic interventions

Like any other addiction, opioid abuse is also a brain disease that needs to be treated immediately. Prescriptions for opioid medications written by doctors has resulted in unprecedented level of opioid addiction in the country. While institutions at the federal level are making efforts to address the issue by sharing guidelines on the nature and extent of prescription to physicians, it is important to identify alternate therapeutic interventions that are more effective.

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Cost of Alcohol Abuse is Far Greater Than Drug Abuse in California, Says Study

The misuse and abuse of alcohol and drugs can have various repercussions, not only on the individuals doing that and their families, but also on the society as a whole. One of its major consequences is financial burden. Besides causing health complications and raising concerns for public safety, alcohol and drugs cost the United States billions of dollars every year.

Like the impact, the economic cost of these substances varies immensely from one place to another. In fact, the cost of alcohol misuse is relatively far greater than the cost of drug misuse in most counties in the U.S. Since studies related to economic and social costs of alcohol and drug abuse are generally conducted at the state and national levels, this allows policymakers to better assess the problems within their jurisdiction and come up with countermeasures.

Similarly, a study, led by author Ted Miller and conducted at the Prevention Research Center of Pacific Institute for Research and Evaluation, sought to find out the consequences of alcohol and drug misuse in California and was published in the journal Alcoholism: Clinical and Experimental Research (ACER).

Alcohol abuse cost California $129 billion in 2010

The study highlighted the eye-opening economic burden of alcohol and drug related problems on the Californian taxpayer’s money across all 58 counties and 50 midsized cities. It was found that alcohol-related problems are more prevalent and costlier than drug-related problems in California. Moreover, both costs and repercussions varied greatly from one place to another. Some other findings are as follows:

While alcohol-related problems cost $129 billion in 2010, which comes to $3,450 for every Californian, drug-related problems cost $44 billion in the same year.
The highest per capita cost ($7,819) of alcohol problem was more than three times the lowest per capita cost ($2,588). Among the counties with drug-related problems the per capita cost varied between $608 and $3,786.
The rates of alcohol and drug-related problems were found to be higher in the Californian cities. The highest per capita cost of alcohol-related problems in a city was $10,734, 11 times higher than the city with the lowest costs. Among the cities, the highest per capita cost of drug-related problems was $7,159, almost 19 times higher than the city with the lowest cost.

Correspondingly, the breakup of alcohol and drug-related costs are as follows:

Crashes and accidents under the influence of alcohol cost $26 billion in 2010.
Of the $10 billion cost borne due to violence associated to substance use, 73 percent was attributed to alcohol, while the remaining 27 percent was attributed to drugs.
Of the $127 billion expenditure incurred due to other illnesses and injuries, 73 percent of the costs resulted from alcohol-related problems. Similarly, 82 percent of the $4 billion cost incurred due to nonviolent crimes were attributed to drug abuse.
74 percent of $2 billion incurred due to treatment expenditure was attributed to drug-related problems.

The study authors believe that the findings can assist policymakers and help the state in planning and allocating resources for substance abuse problems. In addition, this study provides a crucial tool for predicting and averting alcohol and drug-related problems, as well as a crucial means to plot localized cost estimates.

According to Dr. Miller, “Efficient funding of substance abuse prevention, enforcement and treatment hinges upon understanding the variation of alcohol and other drug problems from place to place. Because estimated costs combine data across many health and social issues, they provide an effective, comprehensible, and comprehensive measure for use in understanding how communities shape their distinctive social environments and for monitoring the effectiveness of our intervention strategies.”

Avoid the death trap

In 2010, problems related to alcohol and drugs in California led to 22,281 and 5,533 deaths, respectively. In addition, crimes related to alcohol and drugs were responsible for 350,000 and 164,000 deaths, respectively. These large and unsettling numbers are pertaining to only one of the 50 U.S. states, signaling a far greater magnitude of the problem.

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