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
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
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others may appear to be confused, agitated, or withdrawn.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
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
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
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
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
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.
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:
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:
By using antipsychotic medications, the actions of the neurotransmitters,
dopamine and/or serotonin are inhibited.
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:
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:
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:
For additional information please visit our “Related
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
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
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
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
- Don't let past setbacks derail your new effort.
- Develop a personal vision and strategy for getting a
- 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
- Discover the power and worth of developing healthy, interdependent
- 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
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
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.
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
- 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