- What is Mental Illness?
- When should I use mental health or substance abuse services?
- What is the difference between a psychiatrist, a psychologist, and a social worker and how do I decide which one is right for me?
- What is the difference between psychiatrists and clinical social workers?
- How can I get services? Whom should I contact?
- What can I expect from my insurance plan?
- How can I enhance my insurance?
- Whom will I see?
- Why is the choice of provider so important?
- Can a therapist share what I have said during therapy?
- What are the steps for choosing a therapist?
- How can I get treatment for a family member who has a mental illness, but is refusing treatment?
- How is the Federal Government involved in providing mental health services?
- How is the Government involved in suicide prevention efforts?
- How can I find and access mental health treatments and services?
- Where can I find information about mental health disorders?
- Where can I find mental health statistics?
- Why are so many people with serious mental illnesses homeless?
- Why are so many people homeless?
- What do we know about people with serious mental illnesses who are homeless?
- How can we end homelessness for people with serious mental illnesses?
- What can I do if I feel my employer, or a potential employer, has discriminated against me because of my mental disability?
- Where can I find more information about rights and protection and advocacy for persons with significant mental illnesses (adults) or significant emotional impairments (children)?
Q: What is Mental Illness?
A: Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD), and borderline personality disorder. The good news about mental illness is that recovery is possible.
Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.
In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups, and other community services can also be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends, and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery.
Here are some important facts about mental illness and recovery:
- Mental illnesses are biologically based brain disorders. They cannot be overcome through “will power” and are not related to a person’s “character” or intelligence.
- Mental disorders fall along a continuum of severity. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 Americans — who suffer from a serious mental illness. It is estimated that mental illness affects 1 in 5 families in America.
- The World Health Organization has reported that four of the 10 leading causes of disability in the US and other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.
- Mental illnesses usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
- Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives; The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
- The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.
- With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence. A key concept is to develop expertise in developing strategies to manage the illness process.
- Early identification and treatment is of vital importance; By ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized.
- Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.
Q: When should I use mental health or substance abuse services?
A: If stress, or interpersonal or job-related tension, is interfering with your daily life or if a medical condition is causing you mental anguish, you may want to seek mental health care. If habitual use of legal or illegal substances is negatively affecting your health and/or your daily life, you should seek treatment for substance abuse. In either circumstance, you should seek care as soon as possible, before you feel that you can no longer cope with the situation. These problems are just as important, and treatable, as medical problems.
Q: What is the difference between a psychiatrist, a psychologist, and a social worker and how do I decide which one is right for me?
A: Mental health services are provided by several different professions, each of which has its own training and areas of expertise. When faced with serious mental illness, finding the right professional for yourself or a loved one is a critical ingredient in the process of diagnosis, treatment and recovery.
Mental Health Professionals: Who They Are
Mental health services are provided by several different professions, each of which has its own training and areas of expertise. Finding the right professional(s) for you or a loved one can be a critical ingredient in the process of diagnosis, treatment, and recovery when faced with serious mental illness.
Types of Mental Health Professionals:
- Psychiatrist – a psychiatrist is a physician with a doctor of medicine (M.D.) degree or osteopathic (D.O.) degree, with at least four more years of specialized study and training in psychiatry. Psychiatrists are licensed as physicians to practice medicine by individual states. “Board certified” psychiatrists have passed the national examination administered by the American Board of Psychiatry and Neurology. Psychiatrists provide medical and psychiatric evaluations, treat psychiatric disorders, provide psychotherapy, and prescribe and monitor medications.
- Psychologist – some psychologists have a master’s degree (M.A. or M.S.) in psychology while others have a doctoral degree (Ph.D., Psy.D., or Ed.D.) in clinical, educational, counseling, or research psychology. Most states license psychologists to practice psychology. They can provide psychological testing, evaluations, treat emotional and behavioral problems and mental disorders, and provide psychotherapy.
- Social Worker- Social workers have either a bachelor’s degree (B.A., B.S., or B.S.W.), a master’s degree (M.A., M.S., M.S.W., or M.S.S.W), or doctoral degree (D.S.W. or Ph.D.). In most states, social workers take an examination to be licensed to practice social work (L.C.S.W. or L.I.C.S.W.), and the type of license depends on their level of education and practice experience. Social workers provide various services including assessment and treatment of psychiatric illnesses, case management, hospital discharge planning, and psychotherapy.
- Psychiatric/Mental Health Nurse – Psychiatric/mental health nurses may have various degrees ranging from associate’s to bachelor’s (B.S.N.) to master’s (M.S.N. or A.P.R.N) to doctoral (D.N.Sc., Ph.D.). Depending on their level of education and licensing, they provide a broad range of psychiatric and medical services, including the assessment and treatment of psychiatric illnesses, case management, and psychotherapy. In some states, some psychiatric nurses may prescribe and monitor medication.
- Licensed Professional Counselors – Licensed Professional Counselors have a master’s degree (M.A.) in psychology, counseling or a similar discipline and typically have two years of post-graduate experience. They may provide services that include diagnosis and counseling (individual, family/group or both). They have a license issued in their state and may be certified by the National Academy of Certified Clinical Mental Health Counselors.
Q: What is the difference between psychiatrists and clinical social workers?
A: Two kinds of therapists warrant special note: psychiatrists and clinical social workers. Psychiatrists are medical doctors and can prescribe medication. Clinical social workers are trained in client-centered advocacy and can assist you with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people “navigate the system.” Clinical social workers and many other mental health professionals cannot write prescriptions. However, nurse practitioners that specialize in psychiatry and mental health can prescribe medication in most states.
Q: How can I get services? Whom should I contact?
A: Call your insurance plan, or your company’s benefits administrator, and ask for a verbal and written description of what coverage is provided for behavioral health treatments. Many insurers offer coverage for mental health (MH) services and/or substance abuse (SA) treatments; some only cover substance abuse if it co-occurs with mental illness. If you plan to use MH or SA benefits through your insurance plan, you may be required to get a referral from your regular doctor before you can receive services.
Additionally, your employer may offer an employee assistance program, or EAP. An EAP is a resource provided either as part of, or separate from, employer-sponsored health plans. Usually EAP visits are free, but the number of visits may be limited. Preventive care measures such as health screenings, mental health or substance abuse screening, and/or wellness activities will be provided. An EAP may not include all services and programs, but many provide aid to employees and their families for substance abuse, stress, depression, and other mental health issues. EAP visits are confidential; information discussed in these visits will not be shared with your employer.
If you do not have access to an EAP or employer-sponsored health insurance, you may qualify for Medicare or Medicaid services. To determine your eligibility for these and other government programs, and to determine what kinds of coverage are provided, contact the Centers for Medicare and Medicaid Services (CMS), www.cms.gov, at 1-877-267-2323 (TDD: 1-866-226-1819) and your State’s department of insurance. On the web, you can find contact information for your State’s department of insurance onhttp://www.naic.org/state_web_map.htm. You can also find contact information for your state’s mental health program from the National Association of State Mental Health Program Directors at http://www.nasmhpd.org/members.cfm.
Your State mental health agency will be helpful in telling you how mental health services in your State are funded. In publicly funded mental health centers, such as those run by State, city or county governments, the cost of many services is calculated according to what you can afford to pay. So, if you have a lack of funds, services are still provided. This is called a sliding-scale, or sliding-fee, basis of payment. In addition, States, which often work with Federal programs, such as Medicaid, provide financial assistance to eligible individuals or families. Information about medical and health care assistance is available at your county/city social services departments, health and human services department, or Social Security office.
Q: What can I expect from my insurance plan?
A: Insurance coverage for mental health (MH) and substance abuse (SA) benefits differs among plans, employers, and States. State laws may require insurers to provide a standard, minimal offering of MH and/or SA benefits although insurers are free to provide additional coverage. In general, mental health benefits are not as extensive as medical/surgical benefits and will require higher deductibles and co-payments in addition to any regular, fixed payments.
The following are common types of managed care health insurance plans:
- HMO, Health Maintenance Organization – A plan that provides a selected set of health care services from doctors or health care providers within its network. These plans highlight preventive services.
- FFS, Fee-for-Service – A health plan in which consumers may use any health care provider they choose. Providers are paid a fee for each health care service performed; the plan will either pay the doctors directly or will reimburse you for the cost of the service after you have filed an insurance claim. Fee-for-service plans are a type of indemnity insurance.
a. PPOs, Preferred Provider Organizations, are sometimes referred to as fee-for-service plans. PPOs differ from FFS plans in that they use a network of providers and usually charge lower fees.
- POS, Point-of-Service plan – A plan that operates under a FFS plan and/or a HMO.
a. Under a HMO, a POS allows consumers to visit health care providers outside the HMO’s network as well as providers inside the network. Using a provider outside the network requires will result in higher copayments and deductibles, and you may have to file a claim for reimbursement.
b. Under a FFS plan, consumers can visit the provider of their choice. There may or may not be a network of providers – if there is a network, consumers are usually offered lower copayments and/or no deductible to see a provider within the network.
Q: How can I enhance my insurance?
A: You are eligible for a Medical Savings Account, or MSA, if you work for a business with 50 or less employees and have high-deductible employer-sponsored health insurance. Self-employed individuals are also eligible for MSAs if they have a high-deductible insurance plan. MSAs are accounts that can be used along with your health insurance plan only if your plan has a high deductible and is your only health insurance plan. “High” is defined as a $1,600 deductible or more annually per individual, and $3,200 or more annually per family. Before reaching this deductible, all medical costs, except for insurance premiums, can be paid from the consumer’s MSA (insurance premiums can be paid by the MSA if the consumer is between jobs and not collecting state or federal unemployment benefits). Contributions to the MSA are tax-exempt and the consumer gets to keep any account money that is not spent. Money in the MSA can be withdrawn for non-medical expenses, but those withdrawals are subject to a 15 percent tax.
A FSA, or Flexible Spending Account, is similar to an MSA, but FSAs do not have to be used with high-deductible insurance plans. These accounts are also open to anyone whose employer offers them. However, with a FSA, consumers do not get to keep their unspent account money and money can not be withdrawn for non-medical expenditures.
Q: Whom will I see?
A: When you seek Mental Health and or Substance Abuse treatment, you will see a variety of health care professionals. You may also deal with a case manager from the insurance company or treatment facility. Depending on the type of your insurance, a case manager (CM) may, in conjunction with your health care provider, assess your health needs, refer you to a specialist, coordinate the services that you will receive, and/or follow up on your treatment. In some cases, you may only speak with the CM over the phone; in others, the CM may be a qualified practitioner that you will actually visit. A qualified practitioner is any practicing health care professional licensed by the State to treat patients and provide health services.
The qualified practitioners that you may see during the course of your treatment include the following:
- Primary care provider (PCP), the physician who provides you with basic health care services;
- Physician assistant, a trained professional who provides health care services under the supervision of a licensed physician;
- Clinical psychologist, a professional with a doctoral degree in psychology who specializes in therapy;
- Psychiatrist, a professional who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness;
- Clinical social worker, a professional with an advanced degree in social work who provides services for the prevention, diagnosis, and treatment of mental and behavioral disorders;
- Registered nurse, a trained professional with a nursing degree who provides patient care and administers medicine;
- Nurse practitioner, a registered nurse who works in an expanded role and manages patients’ medical conditions.
Anyone of these qualified practitioners is referred to as a specialist if he or she has received advanced education in a particular area of health care such as mental illness or substance abuse. Your PCP should communicate with your specialist(s) to monitor your progress and to make sure that you are not receiving any treatments that may react with other medicines or disrupt any other health conditions.
Q: Why is the choice of provider so important?
A: Therapy is a collaborative process, so finding the right match-someone with whom you have a sense of rapport-is critical. After you find someone, keep in mind that therapy is work and sometimes can be painful. However, it also can be rewarding and life changing.
Q: Can a therapist share what I have said during therapy?
A: You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.
Q: What are the steps for choosing a therapist?
A: Here are the steps…
- See your primary care physician to rule out a medical cause of your problems. If your thyroid is “sluggish,” for example, your symptoms-such as loss of appetite and fatigue-could be mistaken for depression.
- After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.
- Get two or three referrals before making an appointment. Specify age, sex, race, or religious background if those characteristics are important to you.
- Call to find out about appointment availability, location, and fees. Ask the receptionist:
- Does the mental health professional offer a sliding-scale fee based on income?
- Does he or she accept your health insurance or Medicaid/Medicare?
- Make sure the therapist has experience helping people whose problems are similar to yours. You may want to ask the receptionist about the therapist’s expertise, education, and number of years in practice.
- If you are satisfied with the answers, make an appointment.
- During your first visit, describe those feelings and problems that led you to seek help. Find out:
- What kind of therapy/treatment program he or she recommends;
- Whether it has proven effective for dealing with problems such as yours;
- What the benefits and side effects are;
- How much therapy the mental health professional recommends; and
- Whether he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.
- Be sure the psychotherapist does not take a “cookie cutter” approach to your treatment-what works for one person with major depression does not necessarily work for another. Different psychotherapies and medications are tailored to meet specific needs.
- Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy. After your initial visit, take some time to explore how you felt about the therapist.
- If the answers to these questions and others you come up with are “yes,” schedule another appointment to begin the process of working together to understand and overcome your problems. If the answers to most of these questions are “no,” call another mental health professional from your referral list and schedule another appointment.
Q: How can I get treatment for a family member who has a mental illness, but is refusing treatment?
A: People generally have the right to consent to, or refuse, treatment. However, under certain conditions – such as when a person is considered a danger to self or others – he or she may be required to seek or receive treatment. This can include involuntary civil commitment, which can be for either outpatient or inpatient treatment, as well as forced medication. Laws about commitment vary by State.
Q: How is the Federal Government involved in providing mental health services?
A: The Federal Government provides numerous resources for the prevention and treatment of mental health problems. Additional information about Government services and programs is available on the following web sites:
Q: How is the Government involved in suicide prevention efforts?
A: The Department of Health and Human Services (HHS) considers suicide a significant public health problem and is involved in prevention activities. You may be interested in knowing about an innovative public/private collaboration, the National Strategy for Suicide Prevention, which directs necessary prevention services and programs. Federal collaborators include the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Institutes of Health, the Office of the Surgeon General, and the SAMHSA (all components of HHS). The private collaboration includes advocates, clinicians, researchers and suicide survivors. Information on this initiative is available at http://mentalhealth.samhsa.gov/suicideprevention.
Q: How can I find and access mental health treatments and services?
A: Decisions regarding the admission, treatment, and care of people with emotional problems are made at the local and State levels, so the types of available services, and how those services are funded, vary by State. Your doctor or someone at your local mental health center can refer you to a licensed therapist who is registered and affiliated with his/her same professional association. This Mental Health Services Locator may also be of help:
Q: Where can I find information about mental health disorders?
A: The National Mental Health Information Center provides free publications on mental health topics. You can order publications by calling the Information Center at (800) 789-2647, sending an email with your mailing address to firstname.lastname@example.org, or placing an online order at http://nmhicstore.samhsa.gov/publications/ordering.aspx.
Q: Where can I find mental health statistics?
A: The National Mental Health Information Center does not have specific statistics, although our web site does provide access to Mental Health, United States, 2000 (CMHS publication number SMA01-3537, available free of charge from the Information Center). This publication provides mental health statistics about service utilization, financing, treatments, individuals with mental illness, and mental health practitioners.
Q: Why are so many people with serious mental illnesses homeless?
A: Here are some reasons why…
- Their symptoms are often active and untreated, making it extremely difficult for them to meet basic needs for food, shelter, and safety.
- These individuals are impoverished, and many are not receiving benefits for which they may be eligible.
- Up to 50 percent have co-occurring mental illness and substance use disorders.
- People with serious mental illnesses have greater difficulty exiting homelessness than others. They are homeless more often and for longer periods of time than other homeless populations. Many have been on the streets for years.
Q: Why are so many people homeless?
A: The reasons that people become homeless are as varied and complex as the individuals themselves. Several structural factors contribute greatly to homelessness:
There are several individual factors that may increase a person’s risk for becoming homeless and remaining homeless for a longer period of time:
- Untreated mental illness can cause individuals to become paranoid, anxious, or depressed, making it difficult or impossible to maintain employment, pay bills, or keep supportive social relationships.
- Substance abuse can drain financial resources, erode supportive social relationships, and make exiting from homelessness extremely difficult.
- Co-occurring disorders. Individuals with co-occurring mental health and substance use disorders are among the most difficult groups to put in stable housing and treat. This is due to the limited availability of integrated mental health and substance abuse treatment in most locations.
- Other circumstances. People may become homeless for a variety of other reasons, including divorce or separation, domestic violence, chronic or unexpected health care expenses, release from incarceration, or release from foster care.
Q: What do we know about people with serious mental illnesses who are homeless?
A: Here is what we know…
- The majority of people with serious mental illnesses who are homeless had prior contact with the mental health system, either as an inpatient or outpatient. These experiences were not always positive; they may have been hospitalized involuntarily or given treatment services or medications that did not benefit them.
- The symptoms of mental illness, combined with the hygiene problems associated with homelessness, result in many untreated physical health problems such as respiratory infections, dermatological problems, and risk of exposure to HIV and tuberculosis.
- These individuals typically are long-term citizens of the communities in which they are homeless.
- The social support and family networks of these individuals usually have unraveled. Those who are members of families often have lost regular contact with their relatives or are no longer equipped to be primary caregivers.
- These individuals are twice as likely as other homeless people to be arrested or jailed, mostly for misdemeanors. They are often good candidates for diversion programs that enable them to go from jail to more appropriate treatment, support, and housing.
Q: How can we end homelessness for people with serious mental illnesses?
A: Research has provided much information about what services and practices are effective in ending homelessness for people with serious mental illnesses. Key findings show:
- Outreach, whether in shelters or on the street, is effective. Given the opportunity, most homeless people with serious mental illnesses are willing to accept treatment and services voluntarily. Consistent outreach and the introduction of services at the client’s pace are key to engaging people in treatment and case management services. A consistent, caring, personal relationship is required to engage people who are homeless in treatment.
- Integrated mental health and substance abuse treatment provided by multidisciplinary treatment teams can improve mental health, residential stability, and overall functioning in the community. Regular assertive outreach, lower caseloads, and the multidisciplinary nature of the services available from these teams are critical ingredients that lead to positive treatment and housing outcomes.
- Supportive services to people in housing have proven effective in achieving residential stability, improving mental health, and reducing the costs of homelessness to the community. Supported housing is preferred by many homeless people with serious mental illnesses. Many people who are homeless with serious mental illnesses can move directly from homelessness to independent housing with intensive support and attention.
- Prevention. Homelessness among people with serious mental illnesses can be prevented. Discharge planning that helps people who are leaving institutions to access housing, mental health, and other necessary community services can prevent homelessness during such transitions. Ideally, such planning begins upon entry into an institution, is ready to be implemented upon discharge, and involves consumer input. Providing short-term intensive support services immediately after discharge from hospitals, shelters, or jails has proven effective in further preventing recurrent homelessness during the transition back into the community.
Q: What can I do if I feel my employer, or a potential employer, has discriminated against me because of my mental disability?
A: The Americans with Disabilities Act (ADA) is a legal tool to fight discrimination. Any person who believes he or she has experienced employment discrimination based on a psychiatric disability has a right to file an administrative “charge” or “complaint” with theU.S. Equal Employment Opportunity Commission (EEOC) or with a State or local anti-discrimination agency. Such individuals also may file a lawsuit in court, but only after filing an administrative charge. For information on how to file a discrimination charge, the publication Filing an ADA Employment Discrimination Charge: Making It Work for Youmay be helpful.
Q: Where can I find more information about rights and protection and advocacy for persons with significant mental illnesses (adults) or significant emotional impairments (children)?
A: The National Council on Disability and the National Urban League have published A Guide to Disability Civil Rights Laws that may be of assistance to you. In addition, theNational Mental Health Information Center has a “Know Your Rights” publication that is available in both English and Spanish.