What are the disease facts of mental illness?
- People with mental illness experience problems with cognitive, emotional, or behavioral function; these conditions are associated with distress and/or impaired functioning.
- About one in five people will have a diagnosable mental disorder during the course of a year.
- Mental illness can have many causes, can affect people of all races, ethnic groups, sexes, ages, and income levels, and includes a wide spectrum of severity.
- Mental illness often permeates the fabric of a person’s life, affecting relationships and the ability to carry out daily activities.
- Mental illness is largely a chronic illness.
- Many people with mental illness feel stigmatized, ostracized, or patronized by other people; these perceptions may be true or may be symptoms of the illness itself.
- In the 1940s and 1950s, new approaches to treatment helped support the growing recognition that mental illness is a medical condition.
- Since the 1980s, a number of newer medications (atypical antipsychotics) have been developed that are effective in treating additional symptoms and have an improved side-effect profile.
- People with mental illness face challenges that compromise their quality of life, ability to function, and ability to seek and receive treatment.
- People with mental illness often find relationships difficult to maintain because their ability to interact at a personal and intimate level is compromised by their disorder.
- People with mental illness may have feelings ranging from self-loathing to the belief that they are the only ones who see the “true” world as it really exists.
- Some people with mental illness take solace or comfort in their symptoms and therefore resist treatment.
- Of the 30,000 Americans who commit suicide each year, 90% suffer from serious mental illness.
- Because managed care has encouraged greater access to patient medical records, more opportunities exist for breaches of privacy.
- Cost-based restrictions have forced many patients to receive alternative medications that may be less effective, or have more side effects, than those initially prescribed by the physician.
- In the workplace, people with mental illness may have difficulty shutting out distracting stimuli, concentrating for long periods, and responding to changes.
- Many people still regard mental illness as a stigma, an attitude that creates powerful barriers to the ability of patients and families to seek help or treatment.
- Much of the stigma associated with mental illness can be traced back to myths and stereotypes about mental illness; common stereotypes in television and movies portray people with mental illness as being violent, pitiable, incompetent, or laughable.
- Many people with mental illness are unable to adhere to long-term treatment because they feel it is disruptive to their life or believe they can handle the illness without help from others.
- People with some mental disorders, such as schizophrenia, may lack the insight to understand and manage their own disease.
- The waxing and waning clinical course of mental illness and the length of time between evaluations often means that people do not seek or receive proper treatment for extended periods.
- Community-based mental health treatments available for people with chronic mental illness include Training in Community Living (TCL), Program for Assertive Community Treatment (PACT), clubhouses, and group homes.
- The most common comorbid psychiatric disorders seen with serious mental disorders are depression, anxiety disorders, obsessive-compulsive disorder, and substance abuse. The most common substances are cigarettes and alcohol.
- Combination drug therapy for comorbidity can be effective but must be customized to yield the most effective result while minimizing or eliminating adverse effects.
- Two components of an acute episode of mental illness are 1) the first-time diagnosis and 2) acute exacerbation of a previously diagnosed disorder.
- Important principles for handling acute episodes include protecting patients from themselves (e.g., through hospitalization) and assessing the patient for cause of the episode, including the possibility of nonadherence to medication.
- Mental disorders are one of the top 10 causes of disability in the US and other developed countries.
- In 1990, the total cost of mental health services in the US was $148 billion; about $69 billion of this was from direct costs, and $79 billion was from indirect costs. About 25% of hospital admissions in the US in 1998 were due to a psychiatric diagnosis.
- With respect to acute care, the two greatest expenses are inpatient hospitalization and loss of productivity.
- During the past two decades, advocacy organizations have had a widespread impact on the mental health market.
- Advocacy groups can form alliances with numerous groups and organizations, including research institutes (e.g., NIMH and NARSAD), commercial websites, employers, and pharmaceutical companies.
- Advocacy groups can influence the marketplace by demanding responsiveness from providers to use, or stop using, treatments and by educating patients about the importance of treatment adherence.
Both NAMI and NMHA supported the schizophrenia Patient Outcomes Research Team (PORT) Treatment Recommendations, the first science-based guidelines for schizophrenia treatment. - The most common types of alliances between pharmaceutical companies and advocacy groups include pharmaceutical funding of advocacy group conventions, lobbying efforts, and collaborative programs with mental health care team members.
- Other collaborative opportunities for pharmaceutical companies include helping advocacy groups work with physicians and mental health care team members to develop educational programs in their community.
- One way to establish credibility with mental health care providers during sales calls is by understanding and displaying an interest in the objectives of advocacy groups.
- You can also establish credibility by using the appropriate terminology based on the preference of different members of the mental health care team.
- Advocacy groups help raise public awareness, reduce the stigma of mental illness, provide support for patients, improve service delivery and care, and change public policy.
Advocacy for health care in general owes its origins to the Civil Rights movement in the 1960s, which helped improve health care availability to all people, regardless of ethnic background.- Over the past two decades, the advocacy movement has promoted changes in public attitude, resulting in improved relationships with providers, improved treatment access, increased funding, and new research into the causes of mental illness and its treatment.
- NAMI is a grassroots advocacy organization consisting of consumers, families, and friends of people with serious mental illnesses, including schizophrenia, major depression, and bipolar disorder. It has more than 220,000 members and works on the national, state, and local level.
- NMHA is the country’s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. It has 340 affiliates in the US and has played a key role in the recent passage of mental health and disability acts.
- NDMDA is America’s largest patient-directed, illness-specific organization. Its mission is specifically dedicated to depression and manic-depression. It has more than 800 patient-run support groups in the US and Canada.
- NARSAD is the largest non-government, donor-supported organization that distributes funds for brain disorder research. It was founded through combined efforts of NAMI, NMHA, NDMDA, and the Schizophrenia Foundation.
- Other important advocacy groups include Schizophrenics Anonymous (SA), the Antipsychiatry Coalition, and other survivor groups.
- Peer advocacy groups consist of former patients who help other patients with the same illness.
- Family advocacy groups work with patients with mental illness, their families, and the community to promote public awareness and improve access to treatment programs and various services.Advocacy groups have profoundly impacted the lives of patients and families by de-stigmatizing mental illness, increasing public sensitivity about mental illness, fostering patient empowerment, and lobbying at national and local levels to change policy.
- Serious mental illnesses are usually treated by a multidisciplinary team of mental health care providers. Community clinics, long-term care services, and hospitals also play a key role.
- Psychiatrists are medical doctors trained in psychiatry who are often the leaders of the mental health team and who are the key prescribers of medication and/or psychotherapy.
- Primary care physicians (PCPs) are sometimes the first health care professionals to see a person with mental illness. While they may play a role in treatment, for serious mental disorders such as schizophrenia they are more involved in refilling prescriptions.
- Residents and fellows are licensed physicians who are receiving specialized training. The responsibility for their decisions ultimately lies with a supervising psychiatrist.
- Physician’s assistants may be allowed to perform many of the physician’s roles when caring for patients with mental illness (e.g., some PAs have prescribing privileges).
- Nurse practitioners may manage medication, educate the patient and families, write prescriptions (in some states), and participate in psychological interventions under the direction of a specialist.
- Psychiatric nurses coordinate patient care in the hospital and community, help in long-term management, ensure that patients adhere to their treatment, provide patient education, and bridge the relationship between patient and physician.
- Allied clinical therapists (occupational, social, physical, and recreational therapists) help patients develop and improve various skills at home, work, or school, and in leisure activities.
- Social workers help patients form relationships with family members and community resources. They also can provide general counseling and psychotherapy.
- Case managers oversee all aspects of a patient’s care by coordinating service delivery and ensuring continuity and integration of services.
- Counselors are trained in interview and social management techniques and can help patients and their families through difficult situations.
- Psychologists are nonphysicians who provide psychotherapy to patients, but who refer patients to a psychiatrist or family doctor for prescribing medication.
- Hospital pharmacists dispense medications, attend rounds, and monitor patients for possible drug interactions. Clinical pharmacists work outside the pharmacy, play a key role in drug decision-making, and are also usually part of the Pharmacy and Therapeutics (P&T) Committee. Community pharmacists dispense medications, educate patients about medications, and monitor patients for adverse effects.
- Family members and friends help patients by providing emotional support, helping them make/keep appointments, monitoring medication use, and managing their life affairs.
- The prescription pathway describes how patients with acute or chronic mental illness enter facilities and receive prescriptions (usually from a psychiatrist). Factors that can influence or act as obstacles along the pathway include mental health care team members, managed care organizations, patients and families.
- Key mental health care team members who influence the prescription pathway are pharmacists and psychiatric nurses. Other influential team members may include allied clinical therapists, social workers, case managers, counselors, psychologists, patients, and families.
- Patients may not adhere to their treatment because they don’t understand why it is needed, can’t afford it, or feel so improved that they don’t believe it’s is needed any longer. Team members who can help with adherence include the psychiatrist, pharmacist, PCP, and family members.
- Educational programs may be produced by pharmaceutical companies, advocacy groups, and medical institutions. The most valuable information covers the patient’s specific disease, details about medication being prescribed, and the risk of adverse events.
Mental Health AdvocacyWhat advocacy groups support people with mental illness and their families? What is the origin of Mental Health Advocacy? What are the major Advocacy Groups for People with Mental Illness? |
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