New Trends in Mental Health Care

I’ve been writing about the hurdles that the mental health care system has been facing since the recession struck the country. What I haven’t written about is where this whole thing is going and which trends are surfacing.

The trend these days is to shift from “monster units” that house 20 or more people to Community Based and Teaching Family Programs.

On one hand, having smaller case loads makes programming easier and the number of behavioral incidents get substantially reduced by having less crowded buildings. If it’s hard to live with just one person under the same roof, imagine living with 20 (with psychological issues). Moreover, staffing big units is not always an easy task and supply of qualified staff has surprisingly shrunk during the past months. We were expecting a surge in demand due to the recession but for some reason (unknown to me) this hasn’t happened.

Another advantage of having smaller units is that the stress levels that staff are subject to are greatly reduced (which helps decrease turn-over rates) as a consequence of having fewer incidents and a slower paced environment.

Even though the legal client to staff ratio is 8:1 big units need to have at least a 5:1 ratio to ensure proper coverage during crisis situations and daily programming. This greatly impacts budgets and is one of the main problems that service providers are having across the country. Unfortunately there’s no way of reducing FTEs without affecting service quality, the latter being often the loser in this battle since budgets are the priority. I think this is mainly why funding agencies are pushing towards more home-like settings.

Additionally, mental health care facilities have been reticent to expand their community based programs for a simple reason: less beds means less money. But empty beds are starting to pile up so it makes no sense keeping a big building fully operational if you are going to operate at half capacity. It’s a waste of resources. Furthermore, if you think about it, TFP and Community based programs give more flexibility and are better suited for growth. If you plan to expand your business it’s easier to buy a small house or sign in a family for a TFP than building a big facility from scratch. You are also not constricted to available (physical) space on your campus or center, thus there’s basically unlimited possibilities for expansion.

Having smaller units also means lower maintenance costs, and the opportunity to develop more and more diverse programs to fit the different populations.

Something that cannot be stressed enough is the importance of having a homogeneous population in each building. Usually, the bigger the unit the more diverse the conditions it serves. This can make daily activities a nightmare since clients’ preferences and needs greatly vary. By having small and homogeneous groups this can be avoided.

While some organizations have reacted faster to the new environment and are currently expanding at a frantic pace, others have been more skeptical and tried to stay on course, crashing into the reality wall. They have realized that the near future doesn’t look so bright and therefore, they have started to lay out plans to expand into the community. The fate of some will depend on how fast they can deploy. Other organizations, which enjoy a big enough financial cushion, will have time to make this transition in a tidy manner.

Suicide Prevention Through Better Mental Health Care

Better mental health care and ease of access :

We need to find ways to make life less difficult for people who struggle with mental illness. No one should have to choose between needed medicine and food or shelter.
We all deserve to have our basic needs met with respect and acceptance. Mental illness is not the person’s fault any more than cancer or heart disease is. This is hard for most of us to understand.
What we see of mental illness is just the tip of the iceberg.

Many more people suffer silently. We can’t see mental illness, it comes to our attention when it is not treated effectively. Sometimes that makes us uncomfortable, and forces us to look at the results of our personal priorities.
Mental health care and suicide prevention should be obvious public health goals. Medicines are getting better and better at keeping depression controlled, but the enjoyment and satisfaction of everyday life is more than just “getting by” emotionally. Suicide means ending your life on purpose. Suicide prevention means making living look better than dying.

Lots of people with depression, and other mental health problems, find new lives with the right mental health care. Others don’t have the same opportunities.
Suicide looks like the best or only choice for them. We can’t stop all of the hardships of their lives, but suicide prevention has to include making better mental health care more available.

How to help yourself and your loved ones get better mental health care:

Learn the warning signs of depression.

If the depression is mild and not upsetting sleep, appetite, concentration or irritability, look for a licensed counselor, social worker or psychologist.
If there are any of the following,
frequent crying or anger outbursts, or crying for no reason, or loss of temper at little things
unusual irritability, snappiness, impatience, criticism of others
poor concentration, follow through, or are more easily distracted
avoiding family and friends, saying ‘no’ to most invitations or suggestions
trouble falling asleep, (longer than 20″-30″), staying asleep (should be getting usual sleep or 6-8 hours a night), or sleeping too much ( more than 2 hours longer than usual), or waking up and not getting back to sleep
panic attacks, with physical signs like fast heart beat, shortness of breath, shaking, sweating, dizziness, nausea, chest tightness or chest pain, numbness or tingling in hands or feet
thoughts of death or suicide
new or increased use of alcohol or recreational or prescription drugs
All of the above persons can do counseling, but a person will probably also need someone who can prescribe medication.

Choosing the right Mental Health Professional assures better mental health care for everyone.
Learning more about depression helps you to get better mental health care for yourself and your loved ones. You will pick up on it sooner, and do something about it before it gets disabling.
Thoughts of suicide don’t usually come on suddenly, so noticing depression early and getting help can stop a lot of suffering. Spread the word, help stop the epidemic of suicide.
Of course, suicidal thoughts or attempts always deserve immediate attention.
If you are currently suicidal, please call 911, your local suicide hotline or one of the national suicide hotlines at 1-800-SUICIDE or 1-800-273-TALK

Pitfalls of Using Health Insurance For Mental Health Care

Because of the unfortunate stigma still attached to mental health conditions, people should think twice before using their health insurance to pay for visits to a mental health professional, such a marriage and family therapist, a psychologist or psychiatrist.

If you do have health insurance coverage, your first reaction might be to think, “Well, if I’ve got insurance, why shouldn’t I use it? That’s what it’s there for.” And, most of the time, that’s true. I know I’m certainly grateful for my health insurance when I go to the doctor or dentist.

But it gets more complicated when it comes to mental health care because of negative associations attached to psychological disorders. For example, people probably think differently about an individual who has a physical condition such as a thyroid disorder versus someone who has a psychological condition such as major depression.

The reality is, if you want to get your insurance company to pay for your mental health care, the mental health care provider has to give you a serious psychological diagnosis or the insurance company won’t pay for the treatment.

For instance, many insurance companies won’t pay for someone seeing a therapist for couples counseling or for “normal bereavement” following a loved one’s death. So your mental health care provider needs to find a serious diagnosis that legitimately describes your situation and that will be acceptable to your insurance company. But, once you have that diagnosis, the big issue becomes confidentiality.

Here’s how that works. When you’re seeing a therapist and paying for it yourself, the information you discuss in session stays in the room for the most part. The therapist doesn’t share the information with anyone else, except when they’re required to report child abuse or elder abuse or a handful of other situations covered by law or their profession’s code of ethics. So the vast majority of the time, the information you share with your therapist stays just between the two of you, and you can feel completely free to share all the deep problems that brought you to the therapist’s office in the first place.

However, your sessions won’t be so private any more if your insurance company is paying for all or part of your mental health care, because your diagnosis then becomes part of your health record and it’s no longer confidential. That could be detrimental to you in the future.

For example, let’s say your therapist diagnoses you with major depressive disorder, which is a very common diagnosis. Think about how people view other people who are seriously depressed. They generally have certain expectations of how depressed people behave.

So having that diagnosis in your health record could affect your ability to get a job in the future. It could be an issue in a child custody battle or other legal problems, especially since law enforcement agencies can access your insurance information at any time. A serious mental health diagnosis could cause problems if you tried to obtain other health insurance or life insurance in the future. Those are just a few examples of situations to think about.

The other issue with using insurance benefits for mental health care is that the insurance company might place limitations on the number of sessions you can obtain or require that you get pre-approval from your primary care physician. Some insurance companies are very generous and allow weekly sessions until your problem is resolved, and they don’t interfere very much in the therapeutic process. But some companies place a limit on the number of sessions they’ll cover in a given year, and that frankly might not be enough to resolve some serious or longstanding problems.

But, to me at least, those pragmatic challenges of trying to get your insurance company to provide adequate mental health coverage pale in comparison to the confidentiality issue I was talking about earlier. Confidentiality really is the Number One thing you should consider when you’re deciding whether you want to use your health insurance to cover mental health care.

Renee Haas is a licensed marriage and family therapist and a life coach. She specializes in helping people enhance their relationships, especially doing couples counseling and working with individuals who are having relationship difficulties with a partner, child, parent, boss or other significant people in their lives. She serves therapy clients in California, either in her Moorpark office or via phone or webcam. She works with coaching clients anywhere via phone or web cam.

Nine Recommendations to Increase Continuity of Mental Health Care For Schizophrenia Patients

Continuity of therapy is a vital component of quality care for people with serious mental illnesses and must be given more attention by consumers themselves, family members, advocates, providers, administrators, and researchers alike. At the moment, there is an important opportunity to develop a national consensus statement on the principles and practice standards that should form the basis of a continuum of therapy designed to provide realistic assurance that consumers can access vital medications when and where they are needed. Important strides have been made in identifying the specific factors which promote continuity of therapy – it is time to seize this important opportunity as yet another stepping stone to achieving the transformation of America’s mental health care system for the benefit of consumers and their families, our communities, and our Nation. A roundtable of mental health experts has developed a set of nine recommendations for enhancing continuity of medication therapy for persons with schizophrenia or serious mental illness, including schizophrenia. They are as follows:

Mental Healthcare Recommendation #1 –

Encourage collaborations between hospitals and community-based organizations. Use fiscal incentives to foster collaborations including the standardization of information and shared electronic health records.

Mental Healthcare Recommendation #2 –

Use a quality improvement approach to enhance continuity of therapy by benchmarking at the organizational level performance and outcomes standards regarding continuity of care.

Mental Healthcare Recommendation #3 –

Ensure all consumers have a level of care management for the transition from inpatient to community. Care management services should be reimbursable by all payers and the disincentives to providing it should be removed.

Mental Healthcare Recommendation #4 –

Hospitals and community providers should focus on the “Pull Model” of transition from inpatient to outpatient care. The Pull Model focuses on involving community-based providers in the transition planning process from the beginning. Provider organizations should focus on staff competency in engagement and strategies and motivational interviewing.

Mental Healthcare Recommendation #5 –

Accreditation standards should be aligned to address and improve continuity of therapy in treating serious mental illness. This may include developing standards to ensure evidence of an active process of care management and transition between levels of care, a quality review of the success of transition plans, and measuring engagement.

Mental Healthcare Recommendation #6 –

Consumers and their families should be educated about the benefits of maintaining their personal health care history. Ensuring that consumers have detailed information about their illnesses and treatment history will help ensure that providers have access to the information they need to provide appropriate care in a timely manner. The options here range from simple paper and pencil logs and medication histories to electronic records on memory sticks.

Mental Healthcare Recommendation #7 –

Consumer-driven recovery planning should include and the appropriate and necessary use of hospitalization. More thoughtful use of inpatient services could lead to a reduction in emergency room use and ultimately to a decrease in the number of hospitalizations.

Mental Healthcare Recommendation #8 –

Parties who collect data about mental health services and performance should share it with appropriate stakeholders in usable and timely ways. Many payers and public entities collect both population and individual specific information about mental health consumers and services. Population-based data should be shared with all stakeholders, including families and consumers to aid in enhancing the system of care.

Mental Healthcare Recommendation #9 –

There should be meaningful involvement of consumers and their advocates in all levels of system delivery and evaluation. Global involvement of consumers and their advocates in the care delivery process is essential. Examples include using peer specialists as part of a treatment team, active involvement in policy and planning, as well as involvement in developing and implementing performance measurement and evaluation.

Applying these Mental Healthcare Recommendations –

While we have learned that maintaining continuity of therapy has a positive impact on consumer outcomes, the barriers and other impediments to ensuring this continuum of care have been long entrenched in mental health and related care systems. An unacceptably high number of people with serious psychiatric issues – including schizophrenia, depression and bipolar disorder – are “falling between the cracks” in the transition between acute inpatient settings and the community causing harm and disruption in their own lives and those of their families and often bringing their recovery process to a halt.

A continuity of therapy initiative is likely to decrease inappropriate use of emergency room services by consumers with schizophrenia or other serious mental illnesses by assuring consistency in the disease management approach used by all community provider organizations. Both of these likely outcomes of continuity of therapy provide cost reductions for the hospital and cost offset for the investments in continuity of therapy initiative and related therapies.

Mental Health Care Outreach and Social Media

If you work in the mental health field, you are a natural born communicator. Can we all agree that there is no counseling without a true command of language? After all, psychiatrists, counselors and social workers must all be well versed in BOTH, the spoken and written word to succeed within their chosen career fields.

Counseling sessions are based on active listening skills and the ability to successfully organize and summarize what the client shares. In addition, everything learned from each client session must be converted to accurate, comprehensive and concise progress notes. The data is often admissible in legal proceedings, so the mental health professional must be able to use an economy of words which express a multitude of thoughts and details. Let’s also just remind everyone that professionalism and field credibility also requires neatness, flawless spelling and grammar and attention to proper syntax.

So, where does Social Media enter in to a discussion about listening, thinking, talking, writing and detail orientation?

Social Media Represents the “New World” of Opportunity for Everyone

Social Media is an important form of communication these days. It is becoming a communication tool of choice for many mentally ill clients, especially when they wish to communicate – anonymously – with others to avoid positive

identification and attached stigma. Mental Health professionals are increasingly spending their counseling time instructing their clients in the safe and productive use of Social Media, for this purpose. The chief goal is ALWAYS to protect the vulnerable from exploitation.

The mental health professional is also using Social Media as a way to gain additional professional knowledge as well as to network with others in his own field; including the many that live and work a great distance away.

There are also new opportunities for degree work and certification through online universities and professional organizations, respectively. There are moderated and open forums for career-related discussions on a variety of professional topics developed to advance the field of mental health care.

Plenty of collegial relations and friendships have been forged in the online world, often leading to one-to-one telephone conversations and live meetups. Face-to-face meeting have always been the goal of Social Media, which is designed as an enabler and not a replacement for physical human interaction.

Job information has been exchanged and employment interview offers are often tendered online. And, then there is the research that keeps the mental health care professional up to date on the changes taking places in his field from day to day. Some of the research and anecdotal contributions are the product of practitioners, just like you and me, who choose the Internet as a place to publish our work and share it with the world. We no longer need to wait for third parties to publish what we write.

Forget the Yellow Pages. You Must be Active in Social Media to


There is another area in which the worlds of mental health care and Social Media often come together – marketing and outreach. Can any nonprofit or private business afford not to avail themselves of the benefits offered through Social Media? I think not. Why? Because, the collective Social Media audience is huge and diverse. We need the kind of visibility and name recognition that the Internet can lead us to.

Most everyone that we need to connect with is already online, with more and more people showing up daily. Facebook, alone, is already at or nearing 600 million users. Confidently, there is no one on earth that does not know – at least – a single person with a Facebook profile.

Marketing and outreaching others in Social Media need not take a huge amount of resources, either. In fact, the entire effort can be limited to just a few platforms and a limited amount of posts on a consistent basis. This is resource allocation, well positioned.

Are you LinkedIn?

All professionals in any field belong on LinkedIn. Create a profile with your credentials, contact information and over time, as many business references as you can gather. Take some time to join some professional groups and pose and answer career-related questions among the group members. There is a lot to learn from others and much one can share to prove his field expertise. It is such expertise that builds professional credibility and helping relations over time. Such relationships are invaluable when it comes to creating all sorts of professional opportunities including business partnerships, client referrals and employment offers. Do not discount the value of LinkedIn as a premier Social Networking platform for mental health care professionals.

Are you Facebooking?

Facebook is another place where the people we need and wish to “talk” to are a great deal of the time. Sure, it is a place where one must be especially careful not to embarrass himself among his friends or professional colleagues, but it is a place where using good posting discretion can balance the fun with the serious. The common denominator is “value.” Bring value to others and garner their respect and loyalty.

Facebook does have a business side, too. The Facebook business page offers a place to create and foster community, client and professional relations through providing value to some and offering an outlet for others to do the same. A few well placed posts about happenings in the mental health care field on your Facebook business page and a few more quality posts and comments on the pages of others you seek to have an audience with and you are on your way to growing a successful Facebook presence. Just remember that on Social Media, it’s not all about you. Value for others, FIRST. You have the right to pitch your own endeavors about 15% of the time. Do not try and sell in Social Media; work harder to impress. Being respected and liked will get you the opportunities you are looking for.

Have you Blogged, Today?

Blogging is also a great tool to become better known. Show you are an expert in something and share it wherever you can. One or two 400 – 500 word blog posts per week, can quickly establish a professional as an expert that others want to hear from regularly. Invite others to write for your blog, too. Guest bloggers are refreshing and help give the impression that your blog is important enough for others to take the time and contribute to. Their followers will come to read their posts and have a chance to read yours. Often newspaper and magazine writers read the blogs, so don’t be surprised when you receive offers to publish your contributions in their print and online publications. This is good for you and your business, because their readers are probably your own target audience.

When did you last Tweet?

Do you need to tweet? Twitter can be effective if you can develop a targeted and convertible following. Building such a dedicated following takes much work. You want to create a following of credible mental health care gurus; respected field publications; a pool of mainstream field nonprofits and for-profit; federal, state and local government leaders; supportive local businesses and potential client groups. Retweeting others and replying to their tweets is just as important as tweeting your own materials. Again, you must limit tooting your own horn to about 15% of your tweets. Tweet value and seek to connect with others. If you can build relations and take them off-line, you are succeeding.

Are you in Constant Contact with your Primary Audience?

Lastly, look into using an E-mail service such as Constant Contact to keep your audience up to date. Send out a monthly newsletter; issue announcements such as new hires and business expansions; announce your Social Media presence: and even create event invitations and holiday E-cards for your contacts. The more you can get your name in front of others, the better it is remembered. Just don’t overdo it. Strike a balance by using all of your Social Media tools, timely and appropriately.

This is a very exciting time for mental health care professionals. Their appropriate use of Social Media can do many wonderful things for them; their professions; their businesses and organizations; and the clients they serve.