Mental Health Information

Mental illness affects at least one in four families. There is still no cure. The social stigma for the affected individual and family may be devastating and may undermine acceptance of the illness and hinder treatment and recovery.

By the end of Fiscal Year 2000, more than 430,000 consumers were enrolled in the Ohio Multi-Agency Community Services Information System (MACSIS). About 30% of the enrollees are classified as severely mentally ill with diagnoses such as schizophrenia, bipolar disorder or severe depression that result in hallucinations and delusions, disordered thinking, irrational fears, or suicidal ideations.

Ohio is a nationally recognized leader in mental health reform. Legislation passed in 1988 required each ADAMH board-managed, local mental health system to establish community supports including residential, crisis, vocational, case management and family support services as part of the community mental health plan. These reforms have given Ohio the strongest community system of any large state.

Many of the problems and costs of mental illness can be eased by greater sharing of experience and knowledge between and among clients, families, clinicians and the public. Closer cooperation between families and mental health professionals will result in better outcomes and more efficient and compassionate care for those with mental illness. The fundamentals of mental health and mental illness can be found in the Surgeon General's Report released in 1999.

The American Psychiatric Association has defined mental illness as an illness that affects or is manifested in a person's brain. It may impact the way a person thinks, behaves, and interacts with others.

The term "mental illness" actually encompasses numerous psychiatric disorders, and just like illnesses that affect other parts of the body, it can vary in severity. Many people suffering from mental illness may not look as though they are ill or that something is wrong, while others may appear to be confused, agitated, or withdrawn.

It is a myth that mental illness is a weakness or defect in character and that sufferers can get better simply by "pulling themselves up by their bootstraps." Mental illnesses are real illnesses--as real as heart disease and cancer--and they require and respond well to treatment.

The term "mental illness" is an unfortunate one because it implies a distinction between "mental" disorders and "physical" disorders. The cause of mental illness may vary or be unknown. Research shows that there is much "physical" in "mental" disorders and vice-versa. For example, the brain chemistry of a person with major depression is different from that of a non-depressed person, and medication can be used (often in combination with psychotherapy) to bring the brain chemistry back to normal. Similarly, a person who is suffering from hardening of the arteries in the brain--which reduces the flow of blood and thus oxygen in the brain--may experience such "mental" symptoms as confusion and forgetfulness.

In the past 20 years especially, psychiatric research has made great strides in the precise diagnosis and successful treatment of mental illnesses. Improved therapies and medications allow mental disorders to be treated as successfully as other medical illnesses. Where once mentally ill people were warehoused in public institutions because they were disruptive or feared to be harmful to themselves or others, today most people who suffer from a mental illness--including those that can be extremely debilitating, such as schizophrenia --can be treated effectively and lead full lives.

Mental illnesses are often referred to as "disorders" since diagnosis is related to the identification of a consistent set of symptoms, characteristics and/or behaviors. For additional information please visit our “Related Links” section.

Diagnosis

Mental illness can strike anyone at any time, occurring in all cultures, races and socioeconomic classes. Most often, severe mental illnesses are diagnosed in young people between the ages of 16-25. The most severe and disabling forms of mental illness are schizophrenia, manic-depressive (bipolar) illness and severe depression.

At present, there are no cures for severe mental illness. Today's treatment encourages services that rely less on hospitalization and more on a combination of medication (if appropriate) to control symptoms, brief and intensive outpatient therapy and long-term, low-cost maintenance and support. Some of the more common forms of treatment include supportive counseling, self-help groups, cognitive-behavioral social skills training, personal therapy, therapeutic contracting, case management, and multiple family therapy. Additional services such as housing, vocational training, income assistance, and other community services provide the support and stability necessary to promote recovery.

Diagnosis is essential for planning treatment and supportive care, establishing a prognosis, and preventing related disability. The diagnosis of mental disorders is often believed to be more difficult than diagnosis of general medical disorders since there is no definitive injury, laboratory test, or abnormality in brain tissue that can identify the illness. The diagnosis of mental disorders relies on the patient's reports of the intensity and duration of symptoms, signs from their mental status examination, and clinician observation of their behavior including functional impairment. These clues are grouped together by the doctor or therapist into recognizable patterns known as syndromes. When the syndrome meets all the criteria for a diagnosis, it constitutes a mental disorder. For additional information please visit our “Related Links” section.

Treatment

Mental illness is common in the U. S. today. More than 20% of Americans, aged 18 and older, live with a diagnosable mental disorder in any given year. A wide range of mental disorders have been and continue to be identified as more individuals and their families seek professional help with their problems. In the U. S., the most frequently reported disorders include: depression, schizophrenia, bipolar(manic-depression), and obsessive-compulsive disorder (OCD).

Mental illnesses are often classified or grouped according to certain common features:

Adjustment Disorders
Anxiety Disorders
Cognitive Disorders: Delirium, Amnesia, and Dementia
Disorders Caused by Medical Problems
Dissociations in Memory, Identity, or from Reality
Drug and Alcohol Abuse Disorders
Eating Disorders
Feigned Mental Illnesses
Impulse Control Disorders: Gambling, Aggression, etc.
Infant, Child, and Adolescent Disorders
Mental Disorders That Mimic Physical Disorders
Mood Disorders
Paraphilias and Gender Identity Disorders
Personality Disorders
Psychoses: Schizophrenia, Other Very Sever Disorders
Sexual Disorders
Sleep Disorders

Treatment and recovery are based on an accurate diagnosis of the mental disorder. Mental disorders are treatable, contrary to what many think. A wide variety of treatments are available to decrease symptoms. In fact, for most mental disorders, there is generally not just one but a range of treatments that have proven helpful. Most treatments fall under two general categories, psychosocial and pharmacological. A combination of the two, known as multi-modal therapy, can sometimes be more effective than each individually.

Psychological Treatments for Mental Disorders

The types of treatments for mental disorders are plentiful. Medications, psychotherapies, and electro convulsive therapy are but a few. Within the psychotherapies alone, there are many. Psychological treatments and psychotherapies have been quite successful in the treatment of mental health disorders. There are many that can be used to help clients, but here we will briefly discuss the few most widely used within the United States.

A. Psychoanalysis
The most widely recognized of the individual therapies is psychoanalysis. This type of treatment believes that what's in the client's unconscious causes the disorder or trouble the client is experiencing. By allowing the client to speak freely and by the therapist making interpretations, the unconscious becomes conscious thus, making behavior change possible.

B. Cognitive Therapy
Cognitive Therapists believe that the way a client feels and what a client does is related to the way that client thinks. Cognitive Therapists believe that identifying maladaptive thought patterns and changing them will result in changes in mood and behavior. The therapist and the client work as a team and the client is always encouraged to reinterpret situations and decide if those interpretations actually fit what happened. It's believed that by constantly reinterpreting situations, the client's set of beliefs are changed and become more adaptive.

C. Behavior Therapy
Behavior therapy is designed to change a client's behavior directly. It is not concerned with gaining insight into the origin of problems (psychoanalysis) or changing thought patterns (cognitive therapy). Nonetheless, behavior therapy is often combined with another therapy to maximize the client's benefit (see D). The basic theory behind behavior therapy is that behaviors increase and become stronger when they are reinforced and they ultimately decrease when they are punished. An example of behavior therapy is something known as systematic desensitization. This is an excellent way to treat phobias.

Systematic desensitization slowly reduces fear by gradually introducing the feared object to the client. The client stays relaxed during the procedure so that his/her fear never becomes uncomfortable. Eventually, the client fears the object no longer. In addition to the treatment of phobias, behavior therapy can also be used to treat issues like anxiety, depression, relational, and sexual. With behavior therapy, any client that has a mental disorder and that disorder involves maladaptive behaviors, a client that is physically capable of behavior change may possibly benefit.

D. Cognitive-Behavioral Therapy
Cognitive-Behavioral therapy aims at changing the client's thought patterns or the way the client thinks about his or her problem. By changing thought patterns, behavior is changed directly or changed as a result of the new thought patterns. This type of therapy has been tested and found to improve that functioning of depressed people, alone or with a medication(s).

E. ECT (Electro Convulsive Therapy)
This is an extremely controversial treatment. Although ECT in it's earlier form caused considerable negative effects (i.e. severe memory loss, broken bones), today when used with anesthetic and muscle relaxant, it's very successful in treating depression. Nonetheless, mental health professionals recommend ECT when most other treatments have failed.

F. Summary
It is critical that families and consumers find out about which types of therapies are offered because the wrong type of therapy is as bad as the wrong type of medication. Do not hesitate to ask for evidence that a therapy works. Clients and families have choices in all aspects of their or their loved ones' mental health care. Medications used to treat mental disorders fall into four general classes:

1. Antipsychotics
These medications are used primarily to help with the symptoms of schizophrenia. They are effective in reducing psychotic symptoms like hallucinations and delusions. These medications calm a psychotic person, but they do not cure him or her. Therefore, clients typically continue taking the antipsychotic medications for long periods of time. Antipsychotic medications do have some side effects such as muscular spasms, tremors, rigidity, involuntary and purposeless movements of the mouth, neck, hands, feet, etc. Based on the side effects, the amount of antipsychotic medications to be used should be set at minimal levels. Nonetheless, the benefits of these medications are much greater than their possible risks.

Some types of antipsychotic medications:

Clozaril
Prolixin
Thorazine
Stelazine
Risperdal
Seroquel
Zyprexa
Haldol
Mellaril
Abilify
Geodon

By using antipsychotic medications, the actions of the neurotransmitters, dopamine and/or serotonin are inhibited.

II. Antidepressants
Antidepressants work well with many depressive disorders and they may be categorized into three distinct classes. The tricyclics and the tetracyclics (class 1) are chemical structures with either a 3-ring chemical structure (tricyclic) or a 4-ring chemical structure (tetracyclic). The ultimate goal of the tricyclics is to help block the reabsorption of two neurotransmitters in the brain, norepinphrine and serotonin. On the other hand, the ultimate goal for the tetracyclic is to block to reabsorption of norepinphrine and not the serotonin. A second class of antidepressants is known as monoamine oxidase inhibitors or MAOIS. This class of antidepressants serves to counteract the effect of monoamine oxidase, which breaks down the neurotransmitters, norepinephrine and serotonin. When more norepinphrine and serotonin are available to excite neurons, the mood of most depressed clients improves. The third and final class of antidepressants is serotonin-specific reuptake inhibitors, SSRIS. These medications prevent the reuptake of serotonin. Since the serotonin remains it is able to stimulate neurons in the brain. Like most psychoactive medications, antidepressants also have side effects. Common side effects are dry mouth, constipation, anxiety, heart and circulatory symptoms. Most of the side effects are infrequent and as for the intended effects, they may prove to be dramatic and life enhancing.

Some types of Antidepressant medications:

Elavil
Serzone
Effexor
Pamelor
Luvox
Prozac
Zoloft
Celexa
Paxil
Wellbutrin

III. Anticycling Agents
Anticycling agents are medications that are frequently used for the treatment of bipolar (manic depression) disorder. One common anticycling agent is lithium, but it doesn't work as quickly as a newer medication known as Depakote. Another plus to Depakote is that it doesn't require blood tests like lithium. It is however, unclear the action of the anticycling agent when dealing with neurotransmitters within the brain. Some common side effects are upset stomach, diarrhea, frequent urination, weight gain, acne, and nausea. Clients should always follow medical advice when taking any medications.

Some types of anticycling agents:

Lithium
Depakote
Tegretol

IV. Hypnoanxiolytics
Hypnoanxiolytics or anti-anxiety medications are used primarily for calming fear and anxiety. The most popular drugs used to treat anxiety are benzodiazepines. These medications are thought to enhance the action of the neurotransmitter called GABA. By increasing GABA's effectiveness, over activity in the brain decreases which tend to decrease anxiety. Some common side effects of anti-anxiety medications are drowsiness, impulsiveness, confusion, and dizziness. One side effect that could lead to serious problems is the addiction power of benzodiazepines. The addiction is usually mild and short lived. However, gradual reduction of the dosage is recommended when anxiety is no longer present or the anxiety is no longer present.

Some types of Anti-Anxiety Medications:

Paxil
Luvox
Ativan
Valium
Xanax
Buspar
Klonopin

For additional information please visit our “Related Links” section.

Housing

A primary objective of Ohio's mental health system is to assist and support consumers on a path to recovery. While there is no consensus on the definition of recovery, mental health professionals agree that people can and do recover from serious psychiatric disability and describe it as a process of empowering individuals with hope and self-esteem to find new meaning and purpose in their lives. This process of empowerment aims to enhance each person's ability to function more successfully and independently in the personally valued roles he or she has chosen, and in all of the environments in his or her life. The concept of recovery implies that people can begin to heal not just through individual therapy or medication or self-help, but also by learning skills that apply to every aspect of their lives. Recovery does not imply curing the mental illness, but learning to work within and beyond the limits of the disability so that basic human needs for relationships, housing, family, a satisfying job, access to education, and decent pay can become realities.

Permanent, quality housing of choice is a critical component in the process of recovery for any individual with a disabling mental disorder. A variety of options may be available to provide consumers with housing in the community. The Ohio Department of Mental Health provides the local ADAMH Board with Housing Assistance Program (HAP) funds for special loans and rental subsidies. In twelve board areas around the state, ODMH funds Project for Assistance in Transition from Homelessness (PATH) to provide outreach services to homeless individuals with severe mental illness to engage them in mainstream mental health, health, and housing services. The federal government through the Department of Housing and Urban Development (HUD) provides funding to local communities with a comprehensive strategy to address housing and homeless services for those in poverty. For additional information please visit our “Related Links” section.

Employment

Recovery is a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by the illness. Recovery in a major mental illness does not usually mean 'cure'. Rather, it means a kind of adaptation to the illness that allows life to go forward in a meaningful way. The adaptive response is not an end state, it is a process in which the person is continually trying to maximize the fit between his or her needs and the environment.

Satisfying work with adequate pay to support the desired level of independent living is a critical component in the process of recovery for any individual with a disabling mental disorder. Like all workers, people with severe mental illness can benefit greatly from the security and self-sufficiency that come with stable and fulfilling employment. In addition to providing a living, work gives people a sense of belonging and community. It also creates a network of friends and colleagues.

Getting and Keeping a Job

Many communities have resources to help people with mental illness acquire the skills needed to find and keep a job. Supported employment, which can include vocational training or retraining and job coaching, is one way that people with mental illness can make their way into the work world. Models of supported employment include individual placement and support (IPS) and clubhouses. The Employment Intervention Demonstration Program, a new initiative funded by the Center for Mental Health Services in the Substance Abuse and Mental Health Services Administration, is studying ways to help consumers keep competitive jobs, real work for real wages, in the real world.

Taking the First Steps

For people with severe mental illness who are just entering the workforce, there are a few ways to start their job search. They may ask their therapist, social worker, case manager, or psychiatrist to recommend a supported employment agency. They can ask friends to recommend helpful programs. Consumer advocacy organizations often offer employment guidance or can refer people to agencies in their community.

State and local governments have local employment service agencies. Most also have vocational rehabilitation agencies that can help people with mental illness acquire new skills and be successful in the job market.

Equal Protection Under the Law: The Americans with Disabilities Act (ADA)

The ADA mandates that all people have a fair chance to pursue their dreams. The Act prohibits businesses that employ 15 or more people from discriminating against a qualified candidate on the basis of his or her disability, including mental illness. Businesses must make reasonable accommodations such as adapting training materials and providing flexible work schedules or routines for qualified people with disabilities

Self-Talk and Self-Help

Job-hunting can be exhausting and, at times, discouraging. Here are 10 tips for achieving success, either in searching for a new job or returning to an old one.

View barriers as mere inconveniences or challenges you can solve.
Don't let past setbacks derail your new effort.
Develop a personal vision and strategy for getting a job.
Understand your illness and its symptoms so you can develop ways to minimize its effect on your job success.
Learn as much as possible about your rights under the Americans with Disabilities Act (ADA), about State and local programs, and about effective job-hunting strategies.
Ask family and friends for support and encouragement.
Find a supported employment agency that has a proven track record and is sensitive to mental health consumer issues.
Discover the power and worth of developing healthy, interdependent relationships.
Understand employers' motivations.
Change your attitude. Don't let pride or fear keep you from saying and doing what you need to do.

For additional information please visit our “Related Links” section.

Getting Help

Since the 70's, mental health services continue to be impacted by the growing influence of consumer and family organizations. These organizations which represent consumers living with mental illness and their families have been responsible for developing many important goals: preventing discrimination, overcoming stigma, promoting self-help groups, and promoting recovery from mental illness. These consumers and families developed and continue to play an active role in organizations like NAMI (National Alliance for the Mentally Ill), NMHA (National Mental Health Association), and OAMH (Ohio Advocates for Mental Health) for social support, advocacy, research (www.qrsinc.org), and public awareness of mental illness. By taking an active stance in their own treatment or the treatment of their loved ones, individuals feel a sense of empowerment.

The National Alliance for the Mentally Ill (NAMI) is an organization whose mission is to assist family members and consumers get the information they need. They also provide local programs and support groups to help family and significant others deal with the anger, frustration and emotional stress associated with coping with the mental illness of loved ones. NAMI has over 1000 state and local affiliates and more than 203,000 members in all 50 states.

For additional information please visit our “Related Links” section.

Eligibility

Eligibility for services varies by county of residence and your income. To learn more about the requirements to receive services please contact your local provider. Click here to find a provider in your county.

Client’s Rights

The Ohio Departments of Mental Health (ODMH) and Ohio Department of Alcohol and Drug Addiction Services (ODADAS) want to ensure that quality services are available to all Ohioans within their communities. The Departments work in partnership with local ADAMHS boards and behavioral healthcare providers to promote recovery and to respect the rights of people and the safety of the community.

To assure that the rights of clients are respected, client advocates have been identified at each local board and for each certified provider in the state. The mission of the client advocates is:

To clearly inform clients of their basic and legal rights
To promote recovery
To promote client choice and participation in decisions affecting their lives
To ensure the availability of quality advocacy to all persons receiving services in the public system

Your rights are specified in the Community Client Rights Statements published by ODMH. You may contact your client rights advocate at your local ADAMH board or behavioral health provider.