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Definition of Mental Health

Mental health is sometimes thought of as simply the absence of a mental illness but is actually much broader. Mental health is a state of successful mental functioning, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and one’s contribution to society. Source: Healthy People 2010

A rich overview of all aspects of mental health in the U.S. and  is Mental Health; A Report from the Surgeon General (Dec.1999): http://www.surgeongeneral.gov/library/mentalhealth/home.htm


Approximately 20 percent of the U.S. population are affected by mental illness during a given year; no one is immune. Of all mental illnesses, depression is the most common disorder. More than 19 million adults in the United States suffer from depression. Only about 22% of those people have received treatment.  Major depression is the leading cause of disability and is the cause of more that two-thirds of suicides each year.  

Everyone gets "the blues" occasionally and feels pessimistic, sad, apathetic, withdrawn, and has low energy. These bouts are usually of short duration and characterized by overcoming the cause of the problem. Some people, however, suffer from severe or clinical depression, the average episode of which lasts four months. More than half of people with one episode of major depression will have a second (Peg Shea, Missoula County Blue Ribbon Commission II, 1995). Symptoms of severe depression require professional treatment with medication, psychotherapy, or both. 

Impact of Depression

A person with a depressive disorder is often unable to fulfill the daily responsibilities of being a spouse, partner, or parent. The misunderstanding of mental illness and the associated stigmatization prevent many persons with depression from seeking professional help. Many people will be incapacitated for weeks or months because their depression goes untreated.

Depression is also associated with other medical conditions, such as heart disease, cancer, and diabetes as well as anxiety and eating disorders. Depression has also been associated with alcohol and illicit drug abuse. An estimated 8 million persons aged 15 to 54 years had coexisting mental and substance abuse disorders within the past year. The total estimated direct and indirect cost of mental illness in the United States in 1996 was $150 billion.

Treatment of Depression

Depression is treatable. Available medications and psychological treatments, alone or in combination, can help 80 percent of those with depression. With adequate treatment, future episodes of depression can be prevented or reduced in severity. Treatment for depression can enable people to return to satisfactory, functioning lives.

Populations With High Rates of Depression

Serious mental illness clearly affects mental health and can affect children, adolescents, adults, and older adults of all ethnic and racial groups, both genders, and people at all educational and income levels.

Adults and older adults have the highest rates of depression. Major depression affects approximately twice as many women as men. Women who are poor, on welfare, less educated, unemployed, and from minority populations are more likely to experience depression. In addition, depression rates are higher among older adults with coexisting medical conditions. For example, 12 percent of older persons hospitalized for problems such as hip fracture or heart disease are diagnosed with depression. Rates of depression for older persons in nursing homes range from 15 to 25 percent.

Source: Healthy People 2010

Publicly Funded Mental Health Services and Missoula Kids

It is not news that during the last few years, Missoula providers have struggled with statewide implementation of a managed care-mental health system. Services have been more fragmented. Clients have been overwhelmed with constantly changing and overly bureaucratic rules, regulations and changes in eligibility. The 1999 Montana legislature canceled the contract with Magellan as of July 1, 1999; the state will assume risk and the MT Pacific Foundation will manage the system. Local providers are still in the dark until the system stabilizes and becomes clearer. Meanwhile, providers and families are unsure about which services will be covered, future medication reimbursement policies, and the status of current unpaid receivables. There is anxiety over the immediate future among client families—whether or not a mental health provider will be available the next month, whether or not they will be able to get their medications, and whether or not they will be eligible for services. Private providers have generally dropped out of providing services due to reimbursement problems, and a core group of agencies is carrying an increasing burden and attempting to buffer the impact felt by clients. One positive recent development is that eligibility went from 150% of poverty for severely emotionally disturbed (SED) youth to 200% of poverty on March 1, 1999. Following is a sketch of the main elements of youth related mental health services:

Missoula County Public Schools

MCPS provides mental health programs for K-12. MCPS partners with the Western MT Health Center, provides in service training for their teachers on behavioral management, employs school counselors, and provides additional programs in various schools. Estimated numbers of youth in MCPS mental health programs: pre school- 8, Lewis and Clark Elementary- 8, Rattlesnake Middle School- 13, Meadow-Hill Middle School- 15, Hellgate High- 16, Big Sky High- 17, Sentinel High- 36 (larger program ability)

Western MT Mental Health Center

Note: the following services are about 65% Medicaid, 35% state assisted, and some pro bono.

CDC Specialized Family Care- 27 children who receive Medicaid through the waiver program receive support services such as respite, homemaking, transportation, and environmental modifications.

Children’s Case Management- serve severely disturbed youth and their families with intensive Level II (home-based, clinical) and Level I (assessment, planning, wrap around services) case management.

Day Treatment Program (in schools)- A collaborative effort between WMMHC staff, teachers, and parents to provide mental health services to youth in the school setting. The programs are capped at 12 and numbers of participants fluctuate. In the eight programs 96 SED youth participate.

Summer Day Treatment- The summer program provides continuity of the programs goals through the summer. The focus is recreational therapy. Starting in late June, the 30-day program runs until early August.

Med Clinic Program at St. Patrick Hospital                Dr. Kary Aytes (Child Psychologist) and an RN provide care for about 200 youth. The doctor sees kids once a week, which enables a child to have an appointment once every four weeks. (40 to 50 youth on the waiting list) (Jim Parker 728-6817)

Missoula Youth Homes

MYH served 432 youth in 1997. With seven homes and programs, MYH provides care to those youngsters in need of care outside their homes. MYH serves 45 youth in their foster care program. There are 20 adolescents and 8 late in age youth in residential treatment programs. They also serve about 3 youth per month in respite care for crisis stabilization.

Friends to Youth                                                         Each year more than 200 youths and their families are served by FTY programs dealing with a variety of problems including, physical and sexual abuse to parent/child conflicts and mental illness.

St. Patrick Hospital Mental Health Center Adolescent partial hospitalization program provides acute care, medication intervention, short-term partial hospitalization, group therapy, and protection for those who are suicidal.

The Casey Family Program Provides educational, psychological, and physical support to children in the program. In 1995, CFP served 40 children and provided foster homes for 25 kids.

Aware Aware provides residential treatment care for 20 severely emotionally disturbed youth between the ages of 12-18. There are two houses for each gender as well as, a transitional house. Youth at Aware are wards of the state and Aware is their legal guardian.

Definition of SED

  • from birth to age 18
  • who currently or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria within DSM-III-R,
  • that resulted in functional impairment, which substantially interferes with or limits the child's role or functioning in family, school, or community activities. (Federal Register, 1993)

Data Regarding SED Youth In WMMHC Case Management

  1. youth    males 63%          females 38%

95% father with mental illness and CD diagnosis

73% mother with mental illness and CD diagnosis

20% previous hospitalization

22% youth as substance abuse problem

41% youth has been to youth court

34% in previous foster care.

Diagnosis (in order of most prevalent): ADHD, oppositional defiant, mild depression, major depression, PTSD (Note: low number of psychotic disorder cases)



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