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More On Treatment
The goals of treatment are to reduce symptoms of emotional disorders; improve personal
and social functioning; develop and strengthen coping skills; and promote behaviors that
make a person's life better. Psychosocial rehabilitation, biomedical therapy,
psychotherapy, and behavioral therapy are basic approaches to treatment that may help a
person over come problems. There are many specific types of therapies that may be used
alone and in various combinations.
One very effective treatment for persons with mental illness is psychiatric, or
psychosocial rehabilitation. This treatment philosophy, which is often coupled with
medication therapy, emphasizes consumer strengths and has been shown to reduce
hospitalizations.
There is a strong emphasis on activities which are integrated into the normal life of
the individual and the community, and have real, tangible outcomes. Through this process
an individual learns and practices coping strategies which help to offset the effects of
the mental illness and allow a person to live more independently. The services may be
provided within a facility or they may be provided off site, integrated into the normal
community settings of the individual. Coordination with other mental health treatment
services, both inpatient and outpatient, is provided. In addition to the treatment
services, many psychiatric rehabilitation agencies also offer housing services, education,
and vocational rehabilitation services to address the effects of the illness in all
aspects of the individual's life.
Outcome Research and Cost Effectiveness
Outcome research in psychiatric rehabilitation consistently demonstrates the
effectiveness of this approach. A number of studies examining the impact of participation
in psychiatric rehabilitation services have reported consistent findings:
* Significant reductions in psychiatric hospitalizations
* Increased level of functioning and level of independent living
* Increased client satisfaction
* Increased rate of employment
In a review of 35 studies, Dion and Anthony (1987) found psychiatric rehabilitation
interventions reduced rehospitalization, and positively affected employment, skill
development, client satisfaction and the amount of time spent in the community. The
reduction of hospital utilization, as subjects participate in psychiatric rehabilitation
and case management services, is a particularly well documented and consistent finding in
many studies (Arana, Hastings and Herron, 1991; Bond et al, 1990; Bond et al, 1989; Bond
et al, 1988; Witheridge et al, 1982; Stein and Test, 1980; Beard, Malamud and Rossman,
1978; Becker and Bayer, 1975; Wolkon, Karmen and Tanaka, 1971).
Psychiatric rehabilitation serves those persons most at risk of long term
institutionalization. The cost effectiveness of these services is demonstrated not only in
significantly lower hospitalization rates, but in reduced utilization of community
treatment over time, and increased employment. Savings in other federal programs, such as
Supplemental Security Income, also result when an individual is able to go to work.
Psychiatric rehabilitation is a necessary component of health care for persons with
serious and persistent mental illness. It is an effective and cost efficient treatment
intervention. Without psychiatric rehabilitation services, persons with serious and
persistent mental illness are at higher risk for institutionalization, incarceration, and
homelessness.
More information on psychiatric rehabilitation is available from: International
Association of Psychosocial Rehabilitation Services 10025 Governor Warfield Parkway, #301
Columbia, MD 21044-3357 (410) 730-7190.
Treatment with mediations has benefited many patients with emotional, behavioral, and
mental disorders and is often combined with therapy. The medication that a psychiatrist or
other physician prescribes depends on the nature of the illness being treated as well as
on an assessment of the patient's general medical condition. During the past 35 years,
many psychotherapeutic medications have been developed and have dramatic changes in the
treatment of mental disorders. Today there are specific medications to alleviate the
symptoms of such mental disorders as schizophrenia, bipolar disorder, major depression,
anxiety, panic disorder, and obsessive-compulsive disorder.
Electroconvulsive treatment (ECT) is another biomedical treatment that can help some
patient. It is generally reserved for patients with severe mental illness who are
unresponsive to or unable to tolerate medication or other treatments. While ECT is most
commonly indicated in the treatment of major depression, often with psychosis (delusions
or hallucinations), it is also used in selected cases of schizophrenia. Severe reduction
in food and fluid intake with little physical movement (catatonia), or overwhelming
suicidal ideation, where urgency of response is important, are reasons for considering ECT
as treatment of choice. Modern methods of administering ECT employ low "doses"
of electric shock to the brain along with general anesthesia and muscle relaxants to
minimize the risk and unpleasantness to patients.
Psychotherapy is accomplished through a series of face-to-face discussions in which a
therapist helps a person to talk about, define, and resolve personal problems that are
troubling. Psychotherapies generally appear to be more effective and appropriate than
medications or ECT for less severe forms of emotional distress.
Short-term psychotherapy, lasting for several weeks or months, is used when the
problem seems to result from a stressful life event such as a death in the family,
divorce, or physical illness. The goal of the therapist is to help the patient resolve the
problem as quickly as possible. Often it takes only a few visits. Long-term psychotherapy,
lasting several months to several years, emphasizes the study of underlying problems that
started in childhood.
The following is a list of a few types of psychotherapy:
Psychodynamic psychotherapy, which may be either long- or short-term, examines
important relationships and experiences from early childhood to present in an effort to
analyze and change unsettling or destructive behaviors and to resolve emotional problems.
One form of psychoanalysis, a long-term, intensive therapy that emphasizes how the
patient's unconscious motivations and early patterns of resolving issues are important
influences in his or her present actions and feelings.
Interpersonal therapy focuses on the patient's current life and relationships
within the family, social, and work environments.
Family therapy involves discussions and problem-solving sessions with every
member of a family-sometimes with the entire group, sometimes with individuals.
Couple therapy aims to develop a more rewarding relationship and minimize
problem through understanding how individual conflicts get expressed in the couple's
interactions.
Group therapy involves a small group of people with similar problems who, with
the guidance of a therapist, discuss individual issues and help each other with problem.
Play therapy is a technique used to establishing communication and resolving
problems with young children.
Cognitive therapy aims to identify and correct distorted thinking patterns that
can lead to troublesome feelings and behaviors. Cognitive therapy is often combined
effectively with behavioral therapy.
Behavioral therapy uses learning principles to change troublesome thinking patterns
and behaviors systematically. The individual can learn specific skills to obtain rewards
and satisfaction. Such an approach may involve the cooperation of important persons in the
individual's life to give praise and attention to desirable changes. Behavioral therapy
includes as array of methods such s stress management, biofeedback, and relaxation
training.
Some treatments, called "adjunctive," are used in combination with other
therapies, and sometimes they are used alone. They include occupational, recreational, or
creative therapies, as well as some that focus on special education. A mental health
professional can help a client find the kind of therapy, or combination of therapies, that
is suited to his or her situation.
Helping professionals work in a variety of settings, such as mental health centers,
outpatient clinics, private and group practice, general hospitals, psychiatric hospitals,
nursing homes, and prisons. They also work in residential treatment centers, partial care
organizations, family or social service agencies, and the psychiatric departments of
university medical centers or teaching hospitals.
A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to
practice medicine, and completed a year of internship and 3 years of specialty training. A
board-certified psychiatrist has, in addition, practiced for at least 2 years and passed
the written and oral examinations of the American Board of Psychiatry and Neurology.
Psychiatrists can evaluate and diagnose all types of mental disorders, carry out
biomedical treatments and psychotherapy, and work with psychological problems associated
with medical disorders. Psychiatrists can prescribe medications. Child psychiatrists
specialize in working with children; geriatric psychiatrists concentrate on helping the
aged.
Psychologists who conduct psychotherapy and work with individuals, group, or families
to resolves problems are called clinical psychologists, counseling psychologists, or
school psychologists. They work in many settings-for example, mental health centers,
hospitals and clinics, schools, employee assistance programs, and private practice. In
most states, a licensed clinical psychologist has completed a doctoral degree from a
university program with specialized training and experience requirements and has
successfully completed a professional licensure examination.
The field of psychology also includes those who specialize in such areas as testing,
community organization, industrial relations, and laboratory research.
Psychiatric nursing is a specialized area of professional nursing practice that is
concerned with prevention, treatment, and rehabilitation of mental health-related
problems. These nurses are registered professional nurses who have advanced academic
degrees at the master's degree level or above. They conduct individual, family, and group
therapy and also work in mental health consultation, education, and administration.
Psychiatric (or clinical) social workers have master's or doctor's degrees in social
work, have completed a field supervision program, and are licensed/certified. In addition
to individual, family, and group counseling and psychotherapy, they are trained in
client-centered advocacy. This includes information, referral, direct intervention with
governmental and civic agencies, and expansion of community resources.
A clinical mental health counselor provides professional counseling services that
involve psychotherapy, human development, learning theory, and group dynamics to help
individuals, couples, and families. The promotion and enhancement of healthy, satisfying
life styles are the goal of mental health counselors, whether the services are rendered in
a mental health center,business, private practice, or other community agency. Clinical
mental health counselors have earned at least a master's degree, and several years'
clinical supervision is required before they are certified by the National Academy of
Certified Clinical Mental Health Counselors.
These individuals assist persons with severe mental illness, including some who may be
homeless, to obtain the services they need to live in the community. Most persons with
severe mental illness need medical care, social services, and assistance from a variety of
agencies, including those dealing with housing, Social Security, vocational
rehabilitation, and mental health. Because such services are uncoordinated in many areas,
case managers provide a critical function to monitor a person's needs and assure that
appropriate agencies get involved. In many instances they also act as advocates for the
client. case managers can be nurses, social workers, or mental health workers and can be
associated with mental health centers, psychosocial rehabilitation programs, or other
agencies.
Copyright © 1996 by Mental Health Association of Orange County. All
rights reserved.
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