Health Insight

Archive for the ‘Mental Health’ Category

You walk into a moderately business office sit down a chair in a well-dressed lobby and wait for your name to be announced. Finally, it comes and you are assessed by an intake worker, finally sent to a therapist a week later, and then recommended to the staff psychiatrist. In this short time, you were diagnosed with Bipolar, Depression, which is an element of bipolar, and posttraumatic stress disorder.

You also have a history of Diabetes, High-Blood Pressure, and Allergies. Now the doctor is not aware of the inflammatory fiber nerve disease underlying the symptoms. You continue to visit the mental health experts complaining constantly of your symptoms, and they begin treating you like a Hypochondriasis. (Someone occupied with health issues and most times are exaggerated)…you begin feeling confused, disappointed with the therapist, and decide to go to see a physician that finds a fiber nerve disease, which proves that you complaints are valid.

However, you were already given prescriptions for psychotic and depressive symptoms. You begin taking the medications and suddenly your insurance policy stops payment on the drug Effexor XR. Suddenly, you explode feeling aggressive, wanting to kill, wanting to die, wanting to harm and there is no explanation since these feelings has never occurred to this magnitude before you took the antidepressants prescribed. Now the problem has increased and you are searching desperately for an answer, yet you find nothing. What went wrong you might ask?

Well, Effexor XR is given to patients with depression and bipolar symptoms. Since Effexor is said to target the brain chemicals increasing the Norepinephrine and Serotonin in the brain, it is claimed to eliminate symptoms of depression and bipolar. Now Effexor XR is notorious (once the medication is stopped abruptly) for increasing behaviors including, suicidal thinking, impulsive behaviors, violent outburst and so forth.

The Prescription has caused increase in Blood making it a bad deal for patients with High-Blood Pressure. Now you went to the therapist to fix a problem and your problems has increased dramatically at it is all because of health care, mental health, medical, and so on. You start feeling that it cannot get any worse, but the doctors continue increasing your medicines prescribing Tenormin (Atenolol) for your pain and after prescribing numerous doses of inflammatory prescriptions, which lead to stomach disorders, you are now taking meds to control your stomach. Moreover, it does not stop here. Next, you are given Impramine HCL for pain, Tramadol for pain, and rotated between antidepressants finally prescribed Effexor XR again.

If you are feeling alone you are not, since many times doctors, mental experts, and health care providers make this mistake excessively many times to count. It is ludicrous to go to mental health experts all to find severe complications exploding your life and you are the one to blame, when in reality these experts made a serious mistake. Since the mental health expert obviously had no choice but to eliminate Hypochondriasis, and claim that they were only searching for answers to the problem (making excuses) you finally say I am searching for another mental health expert, since you have no idea what you are doing.

You go to the next office; sit, wait, and when you are called you talk to an intake worker, then a therapist, and finally a psychiatrist. You go through the same procedures wondering if these experts are smarter than the other experts you just left, and soon find yourself on Effexor XR, Impramine HCL, Tramadol, and a variety of other medications.

I told you people what happen before you tell the experts, yet they ignore your cries and tell you to take your medications as prescribed. Are we fixing problems or are we adding to the many problems we face every day. Some mental diagnoses were later proven a medical problem or central nervous interruption that created a series of symptoms delusional to mental health experts, believing that the patient was mentally ill.

Caught in a web of testing and despair we often fight to find a reason that our minds are tricking us into acting out of accordance to the so-called normal. The solution is right in front of them in most cases, yet everyone is turning their heads and looking for another answer.

There is a lot of prospect in community-based mental health careers both in the state of Maryland and all over the country. This is because for years now, there has been a lot of emphasis on prevention and reduction of inpatient hospitalization for all illnesses, including mental illness. This might primarily have been intended for cost control, it has also facilitated quality and access. The second reason why career prospects in community mental health are many is that there is currently a severe shortage of mental health workers in all sectors. The 2007 Maryland Mental Health Workforce White Paper revealed that the number and complexity of mental health problems experienced by children and their families have increased over the past decade. It further said, “At least one in five children and youth, or 20%, experience a mental health disorder. The crisis of mental health in the United States is such that 75-80% of youth with mental health diagnoses receive no services, and services received are often inadequate”. Thirdly, there is inadequate diversity among the few mental health workforce. For example, 28% of Maryland population is of ethnic minority but only 12% of mental workforce is of ethnic minorities. Furthermore, there is an acute shortage of African American males in mental health workforce.

 1. Outpatient Mental Health Clinics (OMHC)

Outpatient mental health clinics provide therapy, counseling, medication management, social skills teaching, and case management services to individuals with severe and chronic mental health problems. Career prospects available in OMHC include:

Therapists and Counselors: New regulations require therapists and counselors in OMHC to have a minimum of a Masters degree and a license (such as LGSW, LCSW, LCSW-C, LGPC, LCPC, RNC, APRN/PMHN) in nursing, social work, psychology, counseling, or psychiatric rehabilitation. Also, an RN without a Masters degree but with an RNC from ANCC can be employed as a therapist. Salaries are very attractive.

2. Psychiatric Rehabilitation Programs (PRP)

PRP programs are an extension of the services provided to the patient in the OMHC. A PRP may stand alone or be an additional service to an OMHC. The purpose of PRP is to promote the rehabilitation, integration and improved quality of life for the patient at home, school, work and community. It aims at helping the patient to function at his or her optimum best in life. The counseling can be done at the Program office (onsite) or at the patient’s home (offsite). PRP counseling could be about a wide range of topics, including anger management skills, social skills, assertiveness skills, medication compliance, coping with symptoms, managing peer pressure, taking a bus, determining bus route, drug and alcohol, gang prevention, sex education, STD education, accessing community resources such as food stamps, affordable housing, bus pass, ID card, driver’s license, job search, preparing for job interview, keeping a job, improving attention in school, completing homework and school projects, respect of authority, etc.     

Even though a mere one-year work experience in a mental health setting or having an AA degree qualifies one to be a PRP counselor, PRP programs prefer to employ persons with a BS degree in any health or mental health related field such as nursing, social work, counseling, psychology and rehabilitation. PRP counselors are usually paid $14 or more per counseling session. Each client receives 2 to 8 counseling sessions per month.

3. Expanded School-Based Mental Health (ESBMH)

In addition to the school clinic, some schools also have an ESBMH clinic. A therapist assigned from an OMHC manages each of such clinics. Apart from providing therapy to troubled kids sent to the therapist’s office from the class or principal’s office, the therapist also serve as a resource person to the school staff regarding particular children, issues or topics related to mental health. 

4. Crisis Response Programs (BCRI, BCARS)

Mental health professionals are also needed in crisis centers where services are provided for anyone in mental health crisis. The two main centers in Baltimore are Baltimore Crisis Response, Inc. (BCRI) and Baltimore Child and Adolescent Response System (BCARS). For employment inquiries, please call 410-433-5255. There are positions that do not need a Masters degree.

BCARS website provides the following information about what they do: 

BCARS is a mobile crisis response service that provides emergency contact with mental health professionals throughout the city. Dedicated crisis clinicians staff the program as part of a continuum of clinical care provided by the Catholic Charities.  The Johns Hopkins Division of Child and Adolescent Psychiatry provide psychiatric consultations to the program.  BCARS assists children and families facing psychiatric and psychosocial crises by providing hospital diversion and immediate intervention and respite. For information or assistance, please call the BCARS hotline (410) 752-2272. It is available 24-7. 

BCRI web site provided the following information: about what they do:

HOTLINE: The telephone crisis “hotline” (410-752-2272) is available 24 hours a day and is staffed by trained counselors who have the ability to provide information and referral to the network of human services in the Baltimore metropolitan area. The counselors also provide supportive counseling, dispatch emergency assistance and link callers with more intensive BCRI services.  In FY 2004 – 34,852 and FY 2005 – 30,257 calls were received on the Hotline.

MOBILE CRISIS TEAMS: Mobile crisis teams are comprised of mental health professionals including psychiatrists, social workers and nurses who can be dispatched to community locations to provide immediate assessment, intervention and treatment. Teams operate from 7:00am till midnight seven days per week. Currently the teams average over 2000 responses per year.

IN HOME SUPPORT: Persons experiencing a mental health crisis can often be maintained in the community through regular visits from the BCRI mobile crisis teams. An average of 350 people a year is cared for in this manner.

RESIDENTIAL CRISIS BEDS: Baltimore Crisis Response, Inc. operates 18 psychiatric crisis beds. Crisis beds are not new to Maryland. However, since its inception, BCRI has operated with an average length of stay of 4.5 days compared with the historical statewide average of 16.5 days.

PUBLIC EDUCATION AND TRAINING: BCRI provide public and professional education and training on a wide range of mental health related topics including: suicide prevention, crisis intervention, mental illness, and stigma.  Training has also been provided to members of the Baltimore City Police Negotiation Team, over 3,000 patrol officers, Housing Police and Sheriff’s officers. Through special grants and contracts, BCRI has provided training to Baltimore City Public School teachers and guidance counselors, clergy, 911 operators, shelter care staff and others.  Public education is also provided via a cable television program called “Mental Health Matters”.  This program provides practical information regarding mental health issues and community resources.  BCRI has also offered professional training conferences, workshops and symposia.

ADDICTIONS SERVICES: In response to the growing need for addictions treatment services BCRI has expanded and now provides a 10-day residential detoxification program for chemically addicted and dually diagnosed persons.  There are currently 16 beds operated for this purpose.

5. Group Homes

Direct care staff and counselors are needed in group homes to manage, care and support the residents in the areas of activities of daily living, behavior management, life progress, and community living. Employment preference is usually given to individuals who have a degree related to health or mental health. Salary rates are very attractive. New regulations now mandate each group home especially for children to be managed by a Program Administrator (PA) who must possess at least a BS degree in any field but preferably in a health or mental health related field. Program Administrators are very well paid, depending on their education and experience and the size and intensity of the group home. 

6. Private Practice

There are a lot of prospects for licensed mental health professionals with at least a Masters degree to establish their own private practice. The practice could be in the area of clinical, research, educational, or consultancy.

We live in a complicated world requiring complex skills. We must prepare our children to cope and to compete. They need reading, social studies, science and math more than ever, but they also need social skills, problem solving, superior reasoning and good mental health. There is a societal need to reduce the incidence of violence in our schools, as well.When children and teens are focused on problems at home or within themselves, they often do not do well in school. School success and good mental health are intrinsically tied together. Additionally, school success and good mental health are linked to life success. Identifying those youth who are in need of help can reduce suffering and improve mental health, school success, and life success. Good mental health aids development, learning, interpersonal relationships, and the ability to cope with stress more effectively.Approximately 1 in 5 children & adolescents (20%) experience the signs and symptoms of a mental health disorder during the course of a year. These children are estimated to have severe emotional or behavioral problems that significantly interfere with their daily functioning. Yet, less than one-third of the children under the age 18 with a serious disturbance receive any MH Services. Often the services they do receive are inadequate or inappropriate (Children’s Defense Fund). Ten percent of children in any given classroom (3/30) are ready to learn at the curriculum level (Dr. Adleman & Dr. Taylor UCLA School Mental Health Project).?Only 16% of all children receive any mental health services. Follow through for children receiving mental health services in school is much greater than those referred to community services. Of the 16% that receive MH services, 70-80% receive that care in a school setting (healthinschools.org), yet less than 10% of all school districts in the United States currently have an established School Based Mental Health Program (Center for School Mental Health Assistance, Dr. Mark Weist 2001, University of Maryland).To assess the effectiveness of school based mental health (SBMH) services in reducing emotional, school, home, and behavioral problems of youth, Robert Schmidt, MA and Kathryn Seifert, Ph.D. collaborated on the evaluation of outcomes for a SBMH program for a rural mid-Atlantic School district. Coordination of mental health services with educators, Department of Social Services, the Department of Juvenile Services, and the Development Disabilities program contributed to the program’s success.The project began in 1999 with a Federal grant to the school district and the project is ongoing. Youth were referred to the project from teachers, guidance counselors, parents, student self-referrals and other agencies such as the Departments of Social Services and Juvenile Services and Law Enforcement. The student’s scores on the Devereaux, BASC, CARE and several school measures such as absenteeism, disciplinary referrals, violence related suspensions, and other suspensions were measured at the beginning of services and at the beginning and end of each school year.From 1999 to 2004, 36% youth were referred because of symptoms of depression, 26% because of family problems, and 24% because of behavior problems. Examples of reasons for referral to the program included: crying in class, child can’t stay focused, student found out mom is terminally ill, youth’s parents going through divorce, and recent sexual abuse. There were 84 referrals to the program in 1999, compared to 437 students in 2002 and 239 students in 2003. Peak referral times were in October and February. Youth in the transition years of sixth and ninth grades were referred to the program most often. In 2000, 2,132 mental health sessions were provided, in contrast to an amazing 15,763 sessions in 2003.A group of 632 students who participated in the program showed significantly improved attitudes toward teachers and school, mental health symptoms, and self-esteem during and after services. Students participating in SBMH in years one and two had significantly better school attendance (56 and 57% increase) when compared to non-participants (66 and 59% decrease). Additionally for the group of participants, absenteeism increased 44% before participation and decreased 53% during participation.Students had a significant (40%) decrease in disciplinary referrals when compared to non-participants (20% decrease). Participants in years one and two had a significant decrease in suspensions (32% and 27%) from school when compared to non-participants (33 and 16% increases). Parents reported that their children were having significantly fewer problems after receiving services. Youth self-reported significantly improved commitment to school, interpersonal relationships and self-esteem, as well as fewer stress related problems. Students reported significantly reduced school maladjustment and clinical maladjustment and improved attitude toward parents and emotional well-being.Evaluation of the success of the program revealed several key components. One important component was having a central school/mental health coordinator to be an organizer, ombudsman, problem solver, program evaluator, and coordinator of the two systems. Additionally, the mental health service must be an integral part of the school system, not just an adjunct or add-on. Mental health staff need to communicate and attend meetings with school personnel. Mental health professionals can provide workshops and consultation to teachers, guidance counselors, and administrative staff.Funding for the project came from mental health third party billing and grant funding. Supplemental funds allowed mental health professionals to attend meetings, consult with school personnel, and provide services for children and youth who do not meet medical necessity criteria of their insurance companies. It is also important to include families as an essential part of the program.In a time when all programs are struggling to cope with funding cuts, collaborative programs, such as this one can make services more efficient and cost effective. Many families of troubled youth are involved in more than one service, in addition to the school. Coordination of multiple services is beneficial to the families and helps improve outcomes for youth.This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in violence and other behavior problems at home and at school. The study is ongoing and a second site has been added.