What is a Mental Illness?
[dropcap]The[/dropcap] National Alliance on Mental Illness (NAMI) defines mental illness as “a condition that impacts a person’s thinking, feeling or mood and may affect his ability to relate to others and function on a daily basis.” One’s mental wellbeing may be influenced by a number of factors: genetics, environment and lifestyle are just a few. Traumatic events may affect an individual’s mental state, as may “biochemical processes and basic brain structure.”
Statistics from NAMI indicate that “1 in 5 adults experiences a mental health condition annually, and 1 in 20 lives with a serious mental illness, such as schizophrenia or bipolar disorder;” however, recovery is possible.
Mental health illnesses may be classified as chronic or acute. Chronic mental health issues, according to Bob Burchfield, psychiatric nurse and system director of behavior services for Baptist Health, are profound and persistent, adversely affecting one’s daily routines. An acute mental health issue is an exasperation of symptoms that go beyond the baseline.
“A person in this category may hear voices and live somewhat normally with that, but cannot sleep, at which point the symptoms intervene with their lives and medications are no longer effective,” Burchfield said. “To address this, we would document the behavior, noting the symptoms and adjust or change his medications.”
Dr. Pedro Delgado, psychiatrist at the University of Arkansas for Medical Sciences, explained mental illness as clusters.
“[Midrange] mental health issues are less severe, they may be chronic but not disabling,” Delgado said. “Examples of this are mild depression and anxiety. Acute disorders happen abruptly in response to an event, such as witnessing a mass shooting or [becoming a rape victim], and there’s a likelihood that these issues will go away with treatment as they are caused by stress or distress.”
He said most people who experience a trauma may experience an acute phase, however, the majority of these individuals get better. Others may never come of out it and experience post-traumatic stress disorder on a long-term basis.
It’s important to understand that each of us may experience heightened stress due to things such as bereavement, a change in job status or an issue with our health; however, if you experience long-term symptoms, have panic attacks or begin to use other measures or substances to cope, it’s important to get help. Without it, the symptoms could become chronic.
“For instance, if you’re depressed for more than a month, you could be having a major depressive episode. It’s important to seek professional assistance from someone who understands and can teach you coping strategies,” he said.
An acute mental illness for example, Burchfield said, may be episodic. For instance, a 65-year-old man whose wife recently died of cancer receives a diagnosis of prostate cancer and becomes suicidal, though he has no history of mental illness.
“The difference here isn’t the diagnosis, but the symptoms the patient is experiencing,” said Stephanie Graves, program manager for Baptist Health Behavior Services.
“Yes, a person can have chronic depression and not be suicidal, however, an incident — such as a cancer diagnosis — can become a crisis and cause an acute situation. Let’s say a patient is being treated for severe depression. [He is managing well and living normally,] then the holidays come and it’s a new year. He may enter the New Year thinking, I’m just tired of living like this and become suicidal. He may require a change in medication. Or in both situations, hospitalization may be required for treatment.”
Burchfield also shared a scenario involving a computer engineer who suffered from obsessive–compulsive disorder. “Y2K was a trigger for him. His family became concerned; they said he wasn’t eating, sleeping or functioning normally. However, when Jan. 1, 2000 came and there were no nuclear warheads, no airplanes falling from the sky, and computers didn’t crash worldwide, he was fine. He simply needed to get through that acute phase.”
When to Seek Help
While many individuals may be able to live normally with treatment, lack of funds and health insurance are barriers. Others, Burchfield said, are ignorant of what’s available.
“A lot of people simply don’t know what treatment options are available. Others simply don’t know what is going on with them or their loved one. They know something isn’t quite right but may not know the symptoms that would drive you to seek treatment or they may not know where to turn.”
Graves echoed this. “I get five to 10 calls each week asking for guidance. People who ask, ‘Where do I go?’ ‘What can I do?’ ‘Who should I call?’ ‘Should I bring my [loved one] to the hospital?’”
Dr. Melissa Powell, a psychiatrist, recommends starting with your primary care physician. “He or she knows you, knows the most about you medically speaking and can make a recommendation. He can help you determine if you should seek help and if you’re not functioning properly, if your relationships become problematic, or if you’re having a difficult time and people around you notice, he or she can refer you to a medical professional.”
Are you concerned about a loved one, friend or coworker? Powell offered this advice: “If you have a good relationship with the person, you might gently approach him and say something like ‘I noticed you were teary-eyed at the meeting …’ or ‘You raised your voice and that’s not something you normally do.’ Ask, ‘Can I help? Why don’t you talk to your doctor?’ or ‘Have you considered seeing a therapist?’”
“Many times, we’re just overwhelmed with life. We have too much stress, and no one teaches us how to handle stress. It’s good to see a therapist. Your primary care physician can help determine if you should see a licensed clinical social worker (LCSW) or a psychiatrist. If needed, the LCSW will recommend another mental health professional.”
She said psychiatrists offer a different level of care. “Psychiatrists are medical doctors and can prescribe medications that can be beneficial.”
Powell said you should seek professional help if:
- you aren’t sleeping.
- you don’t have an appetite or find that you have a much bigger appetite than normal.
- you cannot concentrate.
- you lose interest in your hobbies and things that bring you joy.
Types of Treatment
The types and duration of treatment varies based on the type of mental disorder. Someone who suffers from anxiety disorder, mood disorders or psychiatric disorders experiences things differently. Their understanding of life is distorted and delusional. A mood disorder is a disturbance in one’s ability to maintain a stable mood; it’s a long-lasting alteration in one’s emotional state or one could experience a period of depression and abnormal euphoria, Delgado explained. This person will need extended care.
Contrast that with a rape victim. While he or she may have to deal with the trauma throughout his or her life, the treatments will be largely supportive, such as individual or group therapy. “While this is an acute issue, he or she will get better and you can expect him or her to get better and return to normal,” Delgado said. “Treating the resulting anxiety with a combination of therapy and if needed sleep and/or anxiety medications, generally speaking, may be necessary in the short term.”
During inpatient care, patients participate in therapy, receive medical treatment and nonmedical therapy. Individuals are referred to inpatient care when they pose a danger to the safety of themselves or others, according to Delgado.
“A person who can’t meet his basic needs, has delusional ideas that may lead to hurting others or themselves requires care in a safe place to receive treatment. Many times inpatient care will begin in a hospital, however, most people aren’t there long enough to make a real impact.”
Individuals who have eating disorders, such as anorexia or bulimia, substance abuse issues (including alcohol and drugs) and personality disorders may also require long-term, inpatient care. Once a patient is stabilized, he may be referred to a residential/inpatient facility, then to intensive outpatient care and finally to outpatient therapy.
Kristin Agar is a licensed clinical social worker and professionally trained interventionist. While she provides psychotherapy, she often recommends clients begin their road to recovery in a more structured manner. There are several levels of treatment available, she explained, and the level of care is based on an assessment of what an individual needs to get better.
One of the first issues addressed in treatment is the individual’s physical state. “[Often a person who has experienced a crisis], hasn’t been caring for himself. So he may require sleep and proper nutrition,” Agar said. “Treatment will involve addressing emotional, mental and physical needs.”
“During residential or inpatient treatment, patients live at a facility and adhere to very strict and structured schedules. Their days are filled with activities,” she said.
This includes skills groups, during which patients learn about their disease and recovery. They learn about the physicality of their mental wellbeing, how to eat and rest properly, and participate in individual and group therapy learning any number of skills including how to deal with the emotions that trigger [episodes] or that triggered them to use if they are addicts. They’ll learn how to deal with stress, anxiety, depression and life issues.
“Most inpatient treatments include some type of spiritual component, not necessarily religion, but something that includes a higher power and the ability to reach outside of self,” Agar said. “After all, you cannot cure the problem [or address the issue] with the same thinking that created it.”
Inpatient or residential treatment typically lasts 30 days or so; however, Agar said some facilities offer long-term programs for up to two years.
Intensive outpatient treatment entails therapy for three to four hours daily for four to six weeks or up to three months. Typically, patients receive support services, which may include medication management, and participate in individual and group therapy sessions, including family therapy; they’ll learn coping and recovery skills; receive nutrition education and more.
Outpatient therapy includes much of the same on a less-frequent schedule. Agar often recommends patients also participate in support groups such as Alcoholics Anonymous, Narcotics Anonymous or faith-based recovery groups. She pointed out that the totality of an individual’s life must be addressed.
“You cannot treat just the addiction [or just the trigger that caused crisis]. The goal is to help people find long-term recovery, and to do this, the individual’s family must participate in therapy as well. You cannot treat the patient alone, because the stressors are still out there. Crises and addiction are hard on an individual’s family. They are sick and wounded as well. Recovery needs to be family focused.”
It’s also important to recognize someone experiencing or recovering from a mental health crisis or addiction is experiencing an illness. Agar said, “We must remember he or she is sick and needs help. Society is often quick to judge. But these aren’t bad people. They simply need help.”
[dropcap]If[/dropcap] you are taking medication for a mental health or addiction issue, your physician will prescribe medicine based on his knowledge and training as a medical professional. If you are interested in being part of a clinical trial, you may indicate this idea to him.
According to the U.S. Food and Drug Administration’s website, fda.gov, drugs that undergo preclinical testing must undergo a rigorous evaluation process, which includes scrutiny about everything about the drug, including the design of clinical trails.
A clinical trial enlists volunteers who fit characteristics defined by the trial’s researchers to answer specific questions about health. The trials are carefully conducted and are the safest and most effective way to find new treatments.
They are administered according to a protocol, which describes the study in full detail, outlines the type of volunteers who may participate, and details the outcomes that will be measured. Every participant in a clinical trial must agree to follow the protocol.
Participants may gain access to beneficial new treatments; receive expert medical care for the condition being studied; and help others by contributing to medical research and treatment advances.
Is There a Doctor in the House?
[dropcap]Doctors[/dropcap] at CHI St. Vincent are taking a new approach to mental health and primary care, a holistic approach that will, hopefully, help more Arkansans get the assistance they need quickly and conveniently.
“We are working to have mental health professionals in primary care physicians’ offices,” said Dr. Shannon Greenfield, Ph.D., director of CHI St. Vincent’s Outpatient Behavioral Health. “For instance, if a patient is visiting his primary care physician, or PCP, and mentions that he is experiencing symptoms such as depression, anxiety or substance abuse, the PCP could then say, ‘We have someone here in the office who may be able to help you with that.’”
Taking this “ounce of prevention is worth a pound of cure” approach represents a paradigm shift, Greenfield said. Right now, PCPs must refer their patients to mental health professionals, and it’s then up to the patients to follow up. He estimates that up to half of those patients don’t follow through, which means they don’t receive care that could actually be vital.
“Imagine, if the patient is there in the office and doesn’t even have to leave the room [to be seen by a mental health professional]. This would increase the chances that they receive the needed help quickly and without having to face the perceived stigma associated with seeking treatment for mental health issues at a separate clinic. It’s a holistic, mind-and-body approach that is taking place nationwide,” Greenfield said.
CHI St. Vincent has piloted the program in two Little Rock family practice clinics thus far. Greenfield is careful to point out that this is a developmental program and that they will need to increase personnel before the program can be fully active.
“We’re also looking to increase the use of screening measures,” he said. “Right now, doctors are screening patients for depression. We’re also looking for screenings for anxiety and substance abuse.”