Improving the sad state of mental health care in the United States

[Holly3278]

It is known that mental health care in many parts of the United States is very poor quality. This is incredibly sad because for one thing, suicide is a common problem. It would not be so common if depression and other mental illnesses that cause suicidal thoughts were better treated. This is not to mention the effects that having other mental illnesses like schizophrenia can cause to a person’s livelihood and ability to cope with every day life.

One of the sad things about mental health care in the United States is that there is a severe shortage of mental health professionals. Often times a patient must wait several weeks, if not months, before they can have an initial appointment with a psychiatrist or other mental health professional. This should not be the case. We need more mental health professionals so that better and speedier care can be offered to those with mental illness.

There are many other sad facts about the quality of mental health care in the United States. The system drastically needs to be reformed. But what can we do to reform it? That is what I want to discuss with others on this thread. But first, here are some links related to what I am talking about:

samhsa.gov/federalactionagenda/NFC_FMHAA.aspx

ahrq.gov/legacy/research/mentalhth.htm

ncbi.nlm.nih.gov/pubmed/19745741

nami.org/Template_itstime.cfm?Section=Its_Time

 

[littlenothing]

What you say is true. After managed care came about, though, its very hard to get treated (name removed by moderator)atient. And there simply aren’t enough psychiatric providers. Some insurance plans don’t cover counseling well or wont cover the kind that is needed, either. Its awful that so many just can’t get help because that’s the way the system is designed, and I think its going to worsen.

I guess that was more of a ramble. Sorry! The only “fix” I could possibly suggest would be for insurers to cover psych more and general practice to feel more comfortable doing more psych.

 

[Michael19682]

Debilitating mental illness used to be attributed to demons. I think as the sources you gave should point out, it is largely stigma which causes people to not seek treatment or to try and get away from it once it begins to work for them. The less people seek treatment and stick with it, the less treatment will be available. Also, treatment budgets are strained everywhere, and these conditions are usually chronic. I’m not speaking as one inexperienced in my topic…Your sources say the same thing.
When you boil it right down to the bone, mental illness represents an existential problem and as Catholics we know that holding up our cross is the best way to help ourselves and society. Those things which knock down our crosses or make them heavier are the same enemies of mental illness.
It’s such a huge topic; cases need to be handled on an individual basis. I think that the fish school mentality – that you need to cast a net to draw them in to treatment-- has led to the herding of these people in big clinics and homes where large scale intervention can be applied.

 

[Monte_RCMS]

This is just a very brief summary of a few of the issues that impede improvements in the sad state of mental health care:

Learning to become a mental health professional is extremely expensive and time consuming and emotionally exhausting. You are looking at ten years for all of the courses and internships and exams … plus recurring training / continuing education … plus legal / professional certifications.

The bureaucracy, alone, is enough to drive practitioners out of the field.

And there are “norms” that turn out to be either ineffective or counter-productive.

The costs of having a practice are enormous … rent, for example.

And liability insurance.

And the risks of entrapment. [Some practitioners insist to video-tape EVERY session AND insist on having one or two witnesses or chaperones present for every session.]

And bizarre phone calls. [alleged suicide threats]

Some practitioners have to take defensive preventive measures, such as having all their calls screened in advance. Or having to defend against other “competing” practitioners who have political clout.

Clients who have been over-medicated … ten or more prescriptions, for example … with consequent organ damage. Or over-use of SSRI’s, for example, that turn minor problems into full-blown psychotic episodes. [A lot of those mass killers turn out to have been on SSRI’s.]

Professional and personal burnout are really big issues for mental health professionals. Professionals who work with clients having end-of-life issues suffer the most.

And the income turns out to be minimal.

Some practitioners find the only way they can make a decent income is to teach … and that has huge risks all of its own.

Some practitioners are starting to insist on cash-pay ONLY … because reimbursement is so low that they cannot even meet basic expenses.

 

[Monte_RCMS]

Sometimes, there are “misdiagnoses” … differing opinions … someone said to be schizophrenic turned out to have a simple speech defect … reciting simple poetry to build oral skills and participating in speech groups … Toastmasters … for free … allowed that person to finish school and get a job.

Sometimes, merely learning some basic coping skills is helpful … not therapy … but merely unlearning some trained-in passive victimization behavior and learning how to deal with uncertainty … coping … is extremely helpful.

As Scott Peck wrote … “Life is difficult, but once you realize that life is difficult, then it is not so difficult any more.”

Recognizing unrealistic expectations is helpful sometimes as well … one person wanted a 9-5 office job as a union organizer … but the work was ALL travel and ALL nights and weekends; no office work … zero.

 

[Holly3278]

What you say is true. After managed care came about, though, its very hard to get treated (name removed by moderator)atient. And there simply aren’t enough psychiatric providers. Some insurance plans don’t cover counseling well or wont cover the kind that is needed, either. Its awful that so many just can’t get help because that’s the way the system is designed, and I think its going to worsen.

I guess that was more of a ramble. Sorry! The only “fix” I could possibly suggest would be for insurers to cover psych more and general practice to feel more comfortable doing more psych.

You are right. Obamacare should have included something that required all health insurance providers to provide adequate coverage of mental health services as well as other services such as dental and optometry services which I believe are also things that some insurance providers do not adequately cover.

Debilitating mental illness used to be attributed to demons. I think as the sources you gave should point out, it is largely stigma which causes people to not seek treatment or to try and get away from it once it begins to work for them. The less people seek treatment and stick with it, the less treatment will be available. Also, treatment budgets are strained everywhere, and these conditions are usually chronic. I’m not speaking as one inexperienced in my topic…Your sources say the same thing.
When you boil it right down to the bone, mental illness represents an existential problem and as Catholics we know that holding up our cross is the best way to help ourselves and society. Those things which knock down our crosses or make them heavier are the same enemies of mental illness.
It’s such a huge topic; cases need to be handled on an individual basis. I think that the fish school mentality – that you need to cast a net to draw them in to treatment-- has led to the herding of these people in big clinics and homes where large scale intervention can be applied.

You are right. I think a l lot of people avoid treatment because of the stigma associated with mental illness. I used to be afraid to tell people about the fact that I have Borderline Personality Disorder and Major Depression for fear that people would think I have multiple personalities when that is not what Borderline Personality Disorder is.

Anyway, I think one solution is that we could have mass produced advertisements on television that give facts on mental illness. You’ve seen those small infomercials which are about the same length as a regular commercial but which primarily provide information about something, right? Well, why can’t we produce more of those things but make them about mental illness so as to help reduce stigma? I also think that there should be a short section on mental health covered in health class for all high schoolers. When I was in high school they did not mention mental health at all as far as I can remember.

Another thing I think that would help solve the problem of people refusing to seek treatment would be some sort of rule that either mandates or strongly encourages all primary care physicians as well as nurse practitioners to do a regular mental health screening at checkups of each patient. This should be done regardless of their risk factors for mental illness. Depression, as an example, is an extremely common mental illness and a lot more people would receive treatment if this were done.

This is just a very brief summary of a few of the issues that impede improvements in the sad state of mental health care:

Learning to become a mental health professional is extremely expensive and time consuming and emotionally exhausting. You are looking at ten years for all of the courses and internships and exams … plus recurring training / continuing education … plus legal / professional certifications.

The bureaucracy, alone, is enough to drive practitioners out of the field.

And there are “norms” that turn out to be either ineffective or counter-productive.

The costs of having a practice are enormous … rent, for example.

And liability insurance.

And the risks of entrapment. [Some practitioners insist to video-tape EVERY session AND insist on having one or two witnesses or chaperones present for every session.]

And bizarre phone calls. [alleged suicide threats]

Some practitioners have to take defensive preventive measures, such as having all their calls screened in advance. Or having to defend against other “competing” practitioners who have political clout.

Clients who have been over-medicated … ten or more prescriptions, for example … with consequent organ damage. Or over-use of SSRI’s, for example, that turn minor problems into full-blown psychotic episodes. [A lot of those mass killers turn out to have been on SSRI’s.]

Professional and personal burnout are really big issues for mental health professionals. Professionals who work with clients having end-of-life issues suffer the most.

And the income turns out to be minimal.

Some practitioners find the only way they can make a decent income is to teach … and that has huge risks all of its own.

Some practitioners are starting to insist on cash-pay ONLY … because reimbursement is so low that they cannot even meet basic expenses.

Yeah unfortunately becoming a mental health professional or operating a mental health clinic can be extremely expensive. There are also a ton of other things making it difficult as you mentioned. Something needs to be done to address these issues otherwise the shortage of professionals is just going to remain and not get much, if at all, better.

 

[Michael19682]

Monte_RCMS:

This is just a very brief summary of a few of the issues that impede improvements in the sad state of mental health care:

Learning to become a mental health professional is extremely expensive and time consuming and emotionally exhausting. You are looking at ten years for all of the courses and internships and exams … plus recurring training / continuing education … plus legal / professional certifications.

In dead agreement; largely because it has been over complexed by the greedy who have a social stake in keeping Christ and the simplicity of compassionate care out of treatment. Real treatment is free, effective, and converts the treated into a helper. “Professional” and “Expert” is the problem.

And the risks of entrapment. [Some practitioners insist to video-tape EVERY session AND insist on having one or two witnesses or chaperones present for every session.]

And bizarre phone calls. [alleged suicide threats]

How could a skilled “professional”, knowledgeable of protocol, be entrapped? What crime are we talking about? And bizarre phone calls? There are statutes against reporting false emergencies already on the books.

 

[Auntie_A]

Education is so important. Families and community need to know how to spot problems early and get help so the young person has a chance.

I saw a training film on how to work with mentally ill people when they are in crisis. It was directed at law enforcement and mental health professionals. The patients were interviewed after their crisis, trying to explain how they felt and which approach felt least threatening to them. It was helpful to observe how someone approached them calmly rather than loudly and aggressively.

Discerning how to approach a person with a specific diagnosis is a challenge. Police have an especially tough time in this regard and have been known to shoot a mentally ill person. I wish there was a better way, maybe shoot a tranquilizer?

The other problem is that when drugs and alcohol are used to self-medicate, then the person’s mental state alters more and more, making it harder to reach a stable state of recovery. Certain substances can cause a psychosis.

I wish we could get out of the dark ages with mental health. It is so stigmatized that people lie, avoid, and cover up. We all need to see that our body chemistry could fall out of balance, requiring medical and psychological care.

Support and educational groups like NAMI are lifesavers.

 

[Monte_RCMS]

In dead agreement; largely because it has been over complexed by the greedy who have a social stake in keeping Christ and the simplicity of compassionate care out of treatment. Real treatment is free, effective, and converts the treated into a helper. “Professional” and “Expert” is the problem.

How could a skilled “professional”, knowledgeable of protocol, be entrapped? What crime are we talking about? And bizarre phone calls? There are statutes against reporting false emergencies already on the books.

Catholic hospitals have been closing left and right because of government mandates.

Entrapment is easy. Prosecutors’ offices have professionals who do that for a living. Clients, real or ringers, plead and demand assurances over the phone claiming emergency or special situations. They wear down the practitioner.

 

[Monte_RCMS]

You are right. Obamacare should have included something that required all health insurance providers to provide adequate coverage of mental health services as well as other services such as dental and optometry services which I believe are also things that some insurance providers do not adequately cover.

You are right. I think a l lot of people avoid treatment because of the stigma associated with mental illness. I used to be afraid to tell people about the fact that I have Borderline Personality Disorder and Major Depression for fear that people would think I have multiple personalities when that is not what Borderline Personality Disorder is.

Anyway, I think one solution is that we could have mass produced advertisements on television that give facts on mental illness. You’ve seen those small infomercials which are about the same length as a regular commercial but which primarily provide information about something, right? Well, why can’t we produce more of those things but make them about mental illness so as to help reduce stigma? I also think that there should be a short section on mental health covered in health class for all high schoolers. When I was in high school they did not mention mental health at all as far as I can remember.

Another thing I think that would help solve the problem of people refusing to seek treatment would be some sort of rule that either mandates or strongly encourages all primary care physicians as well as nurse practitioners to do a regular mental health screening at checkups of each patient. This should be done regardless of their risk factors for mental illness. Depression, as an example, is an extremely common mental illness and a lot more people would receive treatment if this were done.

Yeah unfortunately becoming a mental health professional or operating a mental health clinic can be extremely expensive. There are also a ton of other things making it difficult as you mentioned. Something needs to be done to address these issues otherwise the shortage of professionals is just going to remain and not get much, if at all, better.

In my opinion, the burnout and ambush / entrapment issues are almost beyond solving.

NOBODY wants to even touch the SSRI issue.

 

[iseekwisdom]

i’m a psychiatry trainee in the UK and i have often wondered if the US system is more open to integrating one’s Catholic faith into their mental health care… is this the case?
I’ve thought about trying to transfer to the US if so!

 

[Holly3278]

In my opinion, the burnout and ambush / entrapment issues are almost beyond solving.

NOBODY wants to even touch the SSRI issue.

I agree with you on the burnout and ambush/entrapment issue.

But as far as the SSRI issue goes, I am not sure what you are talking about. Would you please care to explain? Thanks in advance.

i’m a psychiatry trainee in the UK and i have often wondered if the US system is more open to integrating one’s Catholic faith into their mental health care… is this the case?
I’ve thought about trying to transfer to the US if so!

Well, I can only speak from experience here and the little personal knowledge that I have. But anyway, I do know that when I went to therapy they asked before I started if I wanted spirituality involved and I said yes. My therapist was a liberal Christian but she did not know much about Catholicism. Thankfully I was able to educate her (which I enjoyed doing because its a spiritual work of mercy to instruct the ignorant) and she was more than willing to learn my perspective and to help me using my perspective. It would have been much better had she actually been a devout Catholic herself but nevertheless, the therapy was helpful.

Also, I do know that the American Psychiatrist Association has rules concerning homosexuality and transgenderism. For example, transgenderism is no longer considered a mental illness unless the transgendered person feels that it affects them in a bad and unwanted way. I am not entirely sure how this would relate to Catholic spirituality and its involvement in therapy but I am sure it could have at least some effect.

 

[Monte_RCMS]

I agree with you on the burnout and ambush/entrapment issue.

But as far as the SSRI issue goes, I am not sure what you are talking about. Would you please care to explain? Thanks in advance.

Well, I can only speak from experience here and the little personal knowledge that I have. But anyway, I do know that when I went to therapy they asked before I started if I wanted spirituality involved and I said yes. My therapist was a liberal Christian but she did not know much about Catholicism. Thankfully I was able to educate her (which I enjoyed doing because its a spiritual work of mercy to instruct the ignorant) and she was more than willing to learn my perspective and to help me using my perspective. It would have been much better had she actually been a devout Catholic herself but nevertheless, the therapy was helpful.

Also, I do know that the American Psychiatrist Association has rules concerning homosexuality and transgenderism. For example, transgenderism is no longer considered a mental illness unless the transgendered person feels that it affects them in a bad and unwanted way. I am not entirely sure how this would relate to Catholic spirituality and its involvement in therapy but I am sure it could have at least some effect.

Holly,

If you do a Google search for " SSRI mass killing " , there are a lot of excellent articles on the psychological damage done by those SSRI drugs.

Here is just one of the articles. But there are many.

infowars.com/mass-murders-and-the-ssris-connection/

mass-murders-and-the-ssris-connection/

It is also important to do some internet research on the APA and how they “devise” some of their evaluations … they seem to be very open to political correctness and seem to bend and yield to non-professional pressure groups; look up the voting numbers when they downgraded homosexual behavior.

Also visit this link and click on the Vortex: “Born This Way”

churchmilitant.tv/daily/?today=2013-04-11

You can also print out a transcript there for further study.

Michael Voris has discussed the subject on several occasions.

 

[Monte_RCMS]

i’m a psychiatry trainee in the UK and i have often wondered if the US system is more open to integrating one’s Catholic faith into their mental health care… is this the case?
I’ve thought about trying to transfer to the US if so!

There are “value free” and “not value free” psychiatrists and psychologists and counselors.

In general, “value free” are “secular” and in general, if you were Catholic, you might state that you are “not value free”.

Might want to contact …

catholictherapists.com/

And also do a google search for " catholic psychologists "

Also for a Catholic program, contact:

IPS Online Education

online.ipsciences.edu/

And they have a resident program as well as on-line.

ipsciences.edu/

 

[iseekwisdom]

There are “value free” and “not value free” psychiatrists and psychologists and counselors.

In general, “value free” are “secular” and in general, if you were Catholic, you might state that you are “not value free”.

Might want to contact …

catholictherapists.com/

And also do a google search for " catholic psychologists "

Also for a Catholic program, contact:

IPS Online Education

online.ipsciences.edu/

And they have a resident program as well as on-line.

ipsciences.edu/

thanks - i know about IPS already but hadn’t checked out the catholictherapist site before, so that was helpful. IPS is abit too expensive for me at the moment, it sounds great though. i’ve already subscribed to the online lectures.

 

[Monte_RCMS]

thanks - i know about IPS already but hadn’t checked out the catholictherapist site before, so that was helpful. IPS is abit too expensive for me at the moment, it sounds great though. i’ve already subscribed to the online lectures.

Do a Google search for " Dr. Paul Vitz " … he has written and spoken extensively on Catholic approaches to psychology.

 

[Ridgerunner]

I’m no expert at this, but I have observed two things that seem very problematic to me:

1. The lack of competent intermediate term facilities. I know a woman who, years ago, suffered from extremely severe depression. Eventually, she went to a psychiatrist. After just a few minutes, he checked her into a very competent facility and set her up with an excellent psychologist. She was in the facility for thirty days. It took that long to balance her meds just right and for the psychologist to make a good start at unwinding some of the compensatory thought processes she had developed over the years. The psychologist followed up with her, outpatient for a time, then released her. Her recovery was excellent.

Undoubtedly, very wealthy people can still afford that sort of thing, but you would not be able to do it now as an ordinary person.

1. The lack of long-term facilities or even any governmental interest in providing them. The emphasis now is on “mainstreaming” extremely sick people or people with severe developmental disabilities. The cost of “mainstreaming” is very high. But if a person has a loved one with a mental illness that is refractory to casual treatment or a mental developmental disability, combined with any kind of violent tendencies, it is incredibly hard to find a facility anywhere that will provide them with care. They’re shutting them all down.

 

[littlenothing]

i’m a psychiatry trainee in the UK and i have often wondered if the US system is more open to integrating one’s Catholic faith into their mental health care… is this the case?
I’ve thought about trying to transfer to the US if so!

I sincerely doubt that. We are discouraged from anything but a general support of spiritual beliefs of the patient regardless of what they are. We are not supposed to bring up religion, but only respect their right to have spiritual beliefs.

 

[littlenothing]

i’m a psychiatry trainee in the UK and i have often wondered if the US system is more open to integrating one’s Catholic faith into their mental health care… is this the case?
I’ve thought about trying to transfer to the US if so!

I don’t know if my post went up. My computer kindof froze. Anyway, I doubt the system in the US is more accepting of religion. We are encouraged to respect the beliefs of others and address them only if they bring it up-usually by getting a chaplain. We are not supposed to bring it up.

 

[Auntie_A]

re: iseekwisdom post:

When I have had to seek a counsellor or psychologist for patients or loved ones, I usually ask: What is your religion, if any? How do you feel as a therapist about those of us who use our faith as part of overcoming our health problems, not just using cognitive awareness, behavioral modification, medication, etc? Their answer helps us know if we can work with them or not. Some atheistic types have actually been more “workable” (than their theistic counterparts) by keeping their hands off any religious issue and allowing the patient to use the healing tools as they wish. Some religious therapists have been too invested in using prayer and faith to the point that the patient feels invaded and overwhelmed by their presumptions. Also I have encountered some therapists who believe that having a religious belief equals being a rabid fanatic and that is always a good time to say “no thanks”.