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
Depression
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pessimistic, sad, apathetic, withdrawn, and has low energy.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
- 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)
|
