Alethea Merelos, Amanda Jones, Lia Poeder, Lori Hansen, Miranda Sweet, & Sarah Dobbs

MENTAL HEALTH

INTRODUCTION

According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA), in 2007, about 11% of adults (23.7 million people) experienced serious psychological distress, such as anxiety and mood disorders, that resulted in functional impairment that impeded one or more major life activities.The two most common types of mental illness are mood and anxiety disorders.

We identified 3 key issues that impact access and use of occupational therapy services for people with mental illness:1.  Social stigma2.  Governmental policies3.  OT in mental health, currently

SOCIAL STIGMAS

STIGMAS

Are Americans comfortable having a romantic partner who has an illness?

47% are comfortable having a romantic partner with depression

23% are comfortable having a romantic partner with bipolar or schizophrenia

27% are comfortable having a romantic partner who is being treated for drugs/alcohol

Comparison: 87% are comfortable having a romantic partner who has diabetes.

STIGMAS

• Society generally has a negative perception of mental illness.  This stigma is a barrier that discourages people from seeking treatment, especially in rural areas

• Internal and external sources of bias to identifying oneself as a person with mental illness and seeking treatment

STIGMAS

• Lack of education about the medical basis of mental illness, its behavioral symptoms, and treatment. According to the Surgeon General, "There needs to be a change in society's perception of mental illness through greater availability of effective treatment options, provider attitude toward recovery for individuals with mental illness, and public awareness that mental illness is not only common but treatable."

• Mental health reform is not currently a priority of our federal government

GOVERNMENT POLICIES

CURRENT NATIONAL LEGISLATION

• Americans with Disabilities Act of 1990

• Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act of 2008

• Patient Protection and Affordable Care Act of 2010

MEDICAID REGULATION

Federal:

•Low-Income Individuals•Eligibility Groups•Children

• Early and Periodic Screening and Diagnostic Treatment Benefit

State:

•Essential Health Services•State Plans•Specific Eligibility

MISSOURI MEDICAID MENTAL HEALTH SERVICES

Current:

•Regular appointments: 30 days•Urgent, non-life threatening: 24 hours – 1 week•4 visits per year•More than 4 requires approval•Includes drug and alcohol abuse

Upcoming:

•Fiscal efficiency•Social Service, Health and Senior Service and Mental Health consolidation•Predicted 600 million dollar cut

UPCOMING FEDERAL LEGISLATION

• Community Choice Act (HR1670)

• The Mental Health in Schools Act of 2009 (H.R. 2531)

CASE STUDY: SAM

This is Sam. Sam is six years old and in the first grade. He has been acting out in class lately, and the teacher is concerned. He has difficulty organizing his school activities, easily distracted, forgetful, does not appear to be listening to others, and is having difficult time keeping attention to tasks, specifically during class time. His mother has been notified and together, they have decided to consult an OT about Sam’s problems. Sam is exhibiting early signs of inattentive ADHD. What can the OT do to help Sam adjust to school performance?

OTs in school settings can only work with kids who have been recommended by special education programs. If Sam’s early signs are not enough to get him into the special education program, he will not receive any OT therapy. This shows that children in need of OT assistance aren’t always guaranteed treatment. Even though ADHD can be regulated by medication, Sam will benefit from OT therapy by addressing preventative coping strategies. For example if Sam recognizes that he is starting to lose focus in class, he can be taught strategies to refocus his attention on what is important. OTs can help address Sam’s social and educational occupational goals required for excellent participation.

OT IN MENTAL HEALTH

MENTAL HEALTH PROFESSIONALS

• Psychiatrists: Conduct diagnostic evaluations and prescribes medications

• Psychologists: Focus on psychological and behavioral components of mental illness

• Social Workers: Focus on inadequate housing, health, and vocational concerns.

• Occupational Therapists: Concentrate on clients’ meaningful activities (i.e. shopping, budgeting, time management, public transportation)

WHAT ARE THE ISSUES?

1.) High prevalence of mental health disabilities

•57.7 million Americans have been diagnosed with a type of mental disorder

•72% of those with mental illness lack options of rehabilitation, primarily a result of unemployment

•Mental illness declared the leading cause of disability

•Without therapy in occupational activities, most people with mental illness struggle with ADLs and IADLs

WHAT ARE THE ISSUES?

2.) Decline of OTs in mental health field

•Burnout: Lack of resources, nature of clients during therapy, lack of supervision and training, lack of rewards and career structure, lack of professional identity, & lack of a clear occupational therapy role)

•Lack of positive opportunities

•Workload

•Insufficient time

•Dysfunctional treatment teams

WHAT ARE THE ISSUES?

3.) Lack of adequate training

•Occupational therapy student education is standard and not necessarily applicable or appropriate for practice in mental health settings

•Not prepared to practice

•Inconsistency of what is to be expected

HOW CAN THE ISSUES BE ADDRESSED?

1. Increase awareness

•OT has its origins in mental health settings, but have declined due to advances in new areas

•Educate clients and family members of importance of OT services

•Reinforce participation being meaningful within mental health setting

HOW CAN THE ISSUES BE ADDRESSED?

2.) Advocate for Funding

•Increased financial support will allow those who cannot afford OT and healthcare services to receive therapy

•Increase funds for supporting literature

HOW CAN THE ISSUES BE ADDRESSED?

3.) Expand the literature

•Secure a role for OT in mental health; show purpose of OT practices in mental health

•Conduct single-case design studies

•Will lead to increase in funds/grants

HOW CAN THE ISSUES BE ADDRESSED?

4.) Exposure to mental health in education

•Increased exposure through fieldwork or observation requirements

•Learn about benefits of working in treatment teams in the area of mental health

AOTA

“AOTA supports the inclusion of the profession of occupational therapy as a core mental health profession“

“In addition to intervention for persons with mental illness, occupational therapy practitioners contribute to the promotion of mental health, which refers to a positive state of functioning reflected by the presence of four characteristics: (1) positive affective or emotional state (2) positive psychological and social function (3) productive activities (4) resilience in the face of adversity and the ability to cope with life stressors.”

  “Goals of occupational therapy are twofold: (1) to promote mental health and well-being in all persons with and without disabilities and (2) to restore, maintain and improve function and quality of life for people at risk for or affected by mental illness.”

POSITION/RECOMMENDATIONS

Think back to Sam…Is AOTA’s stance on occupational therapy in mental health being applied to his situation?

What we recommend: •Focus on prevention of mental illness and its debilitating effects on functioning, rather than treating illness in hospitals/institutions once the condition becomes acute•Support legislation to develop comprehensive mental health programs in schools•Advocate for increased OT presence in community settings:  schools, community centers, nursing homes; educate on positive coping skills and wellness, in addition to ill health•Provide education in communities on the symptoms of mental illnesses and early signs that someone is struggling•Consult with people living with mental illness about outstanding needs that aren't being met and therefore prolonging their condition

FOR MORE INFORMATION

www.issuesinmentalhealth.weebly.com