The Patient Centered Approach to Treating Patients Suffering with Schizophrenia and other Serious Mental Illnesses

Last Updated on Monday, 17 October 2011 01:22 Written by Natural Health Team Monday, 17 October 2011 01:22

Health Information about The Patient Centered Approach to Treating Patients Suffering with Schizophrenia and other Serious Mental Illnesses

Background -

One aspect of the mental health Access and Retention Initiative involves using transaction data to identify non-engaged patients. These patients may be defined as those having diagnoses including schizophrenia, schizoaffective disorder or bi-polar disorder and who, during the pre-pilot period missed 30% or more of their scheduled individual therapy appointments and/ or medication management follow-up appointments. Once these patients are identified, their provider staff will be identified and will pilot one or more strategies intended to improve patient engagement.

The purpose of this article is to outline some potential ‘engagement improvement’ strategies as a basis for pilot staff “self assessment” (i.e. where do individual pilot staff stand with regard to current use of the strategies), “strategy selection” (i.e. which strategies do the pilot staff believe might improve retention among their identified pilot cases) and “identification of training/ support” for strategy implementation. Since the no-show / cancellation rates for the selected ‘non-engaged’ pilot patients will have occurred in the context of current practice, site teams are encouraged to pilot strategies not currently in use or not consistently in use.

Person Centered Approach Engagement Strategy -

Of the strategies routinely discussed for improving the attendance of mental health patients (including those suffering with schizophrenia, schizoaffective disorder or bi-polar disorder), the person centered approach is probably the one most likely to generate a lasting change in patient level of engagement. However, it also involves the broadest and most significant change in practice for providers who do not currently embrace and use the approach. Also, since a meaningful person centered approach begins with the assessment and service plan, it is difficult to implement ‘mid stream’ for patients already in service for some time, unless there is willingness to revisit the assessment and plan.

While many provider organizations claim to embrace a person centered approach, a review of actual case records often does not support this. Many providers confuse Person Centeredness with “treating the patient respectfully” or “listing patient strengths” in the assessment. To gain a good understanding of the “Person Centered Approach” to actual practice, you are referred to the book, “Treatment Planning for Person — Centered Care” by Doctors Neal Adams and Diane M. Grieder.

In a nutshell, the Person Centered Approach is ultimately about producing better outcomes and not about “being respectful” which is something that should be a ‘given’ in any orientation to service. Particularly germane to the topic of ‘engagement’ is the impact of person centered care on patient motivation. Ultimately, if the mental health treatment plan and the services provided offer little of inherent value to the patient, why would we expect engagement? If, in a patient’s experience, the connection between what goes on in treatment or rehabilitative sessions and something of real value to the patient is weak or non-existent, the best we can hope for is blind compliance and not engagement.

While transitioning to a true person centered approach takes a significant commitment of time, training and process support, what follows are some key questions that can be asked about current practice that can help focus some immediate transition efforts.

1. Does the current clinical assessment identify meaningful patient strengths, preferences and personal goals, and do the patient and all staff currently working with the patient know what these are?

2. Does the assessment conclude with identified needs that are meaningful to the patient’s personal goals and reasons for seeking treatment, and do they make sense to the patient.

3. Can the patient, without significant prompting, articulate the current goal(s) and objectives in his/her service plan?

4. Is there one integrated service plan, with relatively few current goals and objectives? (multiple plans and numerous goals/objectives are confusing to the patient and staff)

5. Can all staff that work with the patient know and articulate the current goal(s), objectives, and relevant patient strengths in the service plan (at least those that pertain to the intervention they are providing — including group interventions)?

6. Do the patient’s current service plan goals reflect (sound like) things the patient wants as opposed to things others (e.g. the provider) want for the patient?

7. Are the current objectives in the service plan meaningful, measurable changes in the patient’s skills, functional capabilities, symptoms, etc that clearly relate to ultimate achievement of a goal of importance to a patient?

8. Does the patient believe the objectives in the service plan are achievable in a reasonable amount of time?

9. Where possible are the objectives stated in positive (hopeful) language as opposed to using the “dead man standard” (i.e. if a person died he/she would accomplish the objectives)?

10. Does the service plan mention specifically what patient strengths can be employed to help achieve a goal and associated objective(s)?

11. Does the service plan articulate the interventions (not just services) that are planned to help the patient achieve the objectives?

12. Do the patient and staff clearly understand how the interventions and services planned will help achieve the objectives?

Providers are generally familiar with the “Golden Thread” concept as it relates to documentation linkage and medical necessity. Person Centeredness, involved making that Golden Thread obvious and meaningful in the everyday patient-provider relationship. While the above questions by no means reflect the entire person centered process, they can be objectively applied to help assess the current level of person centered practice.

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Barriers to the Treatment of Schizophrenia and other Serious Mental Illnesses

Last Updated on Saturday, 15 October 2011 01:20 Written by Natural Health Team Saturday, 15 October 2011 01:20

Health Information about Barriers to the Treatment of Schizophrenia and other Serious Mental Illnesses

In 2005, a mental health study was commissioned to examine the extent of the problem of discontinuation of therapy and treatment for patients experiencing mental illnesses, including schizophrenia, bipolar disorder and depression. The study examined the factors that influenced whether these patients followed through with the full course of prescribed medications or not. As part of the study, 76 in-depth qualitative interviews were conducted with a panel of inpatient hospital psychiatrists and discharge planners and outpatient (community mental health center) psychiatrists and intake coordinators from across four states. The respondents stated that, on average, 50 percent of consumers discharged from inpatient facilities do not appear for their initial intake appointment at the outpatient/community-based program to which they were referred.

Several factors were identified on the system, program/provider, and individual levels that were related to such a poor rate of continuity of therapy for approximately half of the study participants.

System Level Health Care Barriers –  

>> The system is fragmented and fractured.
>> The basics of the discharge and intake processes are similar across states; however, the flow of communication varies significantly by state and consumer profile.
>> Certain prescribed psychotropic medications do not appear on hospital formularies, thus creating transition issues for consumers both within inpatient settings and post-discharge.

>> Financing and cost considerations.   

Facility/Program Level Health Care Barriers -

>> The role of inpatient short-stay hospitals is clearly defined as triage, stabilization and, discharge.
>> Most outpatient facilities see their responsibility for the continuum of care beginning only when the consumer actually shows up for intake.
>> Neither setting (inpatient or outpatient) is appropriately set up to ensure continuity of care.
>> Communication breakdown between settings.
>> Psychiatrists from both inpatient and outpatient settings report they very rarely interact with patients experiencing mental illnesses in the other setting.
>> Most communication between inpatient and outpatient facilities takes place between the inpatient discharge planner (typically a social worker) and the outpatient intake coordinator (typically a case manager).
>> These respondents, the primary conduits of information flow between settings, characterize their work environment as “overburdened” and “overworked.”
>> Unless specifically mandated or required, processes pertaining to discharge or intake are unlikely to be put in place, let alone followed consistently; when policies exist, they tend to be idiosyncratic to the particular facility.

Provider and Individual Level Health Care Barriers. -

>> It was very clear that many consumers, upon discharge, were not completely stabilized and had little specific awareness of their medications beyond the name(s).
>> Issues faced by consumers including: stigma, side effects from medications, co-occurring disorders, homelessness, lack of transportation, and lack of support systems.
>> Consumers acknowledged they were provided information about their medications at discharge, but report the information was given in very general terms (e.g. “this will make you feel stable”) and there was little recall regarding details.

Obviously, steps must be taken to improve the continuity of care for mental health patients. This can only be achieved by addressing and removing these barriers on all levels. Mental health professionals agree that removing these barriers is a reality that can, and should, be realized today.

I like to see whole families with mental illness. Look at this family of wild horses passing thru unlimited space notice no barriers pure freedom by DOCTOROFMINDMD these are wild horses passing thru
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The Continuity of Medication Therapy for the Treatment of Schizophrenia & Other Serious Mental Illnesses

Last Updated on Sunday, 9 October 2011 04:20 Written by Natural Health Team Sunday, 9 October 2011 04:20

Health Information about The Continuity of Medication Therapy for the Treatment of Schizophrenia & Other Serious Mental Illnesses

When taking into account the complex nature of mental illnesses and the multiplicity of treatments and services that are needed by people in search of recovery, continuity of care and the coordination of treatment and services are important factors in assuring quality of mental healthcare. More specifically, given the important role that medications play in allowing for symptom reduction or alleviation and the ability of consumers to participate in vocational, educational, and other rehabilitative activities, ensuring continuity of therapy in the form of access to medications must receive a higher priority.

In the context of mental health, continuity of care is defined as “a process involving the orderly, uninterrupted movement of patients among the diverse elements of the service delivery system” (Bachrach, 1981). While we know that continuity of care, including continuity of medication, are important, we also know however, that systems designed to serve mental health consumers experience serious shortcomings when it comes to the level and depth of communication, cooperation, and coordination of treatment and services that are necessary to avoid service fragmentation and discontinuity.

After discharge from inpatient settings, individuals are often placed on long waiting lists for community-based services only to have their intake and clinical appointments scheduled weeks apart. They often find that their treatment history has not been transferred from one provider to another or that they have an insufficient supply of medications causing, in too many cases, chaos and confusion that leads to an interruption, if not a discontinuation, of care. As an illustration of the seriousness of this issue, one study conducted by Janssen (2005) found that an alarming 50 percent of consumers diagnosed with schizophrenia who were discharged from a sample of psychiatric hospitals were lost in transition. In other words, they did not reappear in the community-based programs to which they were referred.

Medication is frequently a cornerstone of treatment for people with serious mental illnesses (Lieberman, et al., 2004), not only providing for symptom reduction or alleviation, but also allowing for participation in rehabilitative, educational, and vocational programs. If we cannot guarantee continuity of medications, how can we hope to achieve recovery?

Recent federal statistics confirm an over-representation of persons with mental health disorders in our jails and prisons, and the Institute of Medicine describes our nation’s emergency rooms as overcrowded and dysfunctional when it comes to meeting the needs of patients who present mental health issues. Many communities have insufficient access to crisis and acute care beds. At the same time, policymakers and payers are increasingly calling for higher quality in healthcare with demonstrable improvements in consumer outcomes.

The results of this lack of system and services coordination and potential abatement of therapy can be disastrous and cause crises for consumers and their family members, with results including re-hospitalization and/or increased demand for other community services such as emergency room care or police involvement. Research continues to verify that appropriate follow-up care can help in reducing the need for re-hospitalization and it can also be helpful in identifying consumers needing more intense services before they reach a point of crisis (Boydell, et al., 1991).

The costs of poor care transition among service settings are high, yet many State policymakers and elected officials are unaware of the financial burden that their States bear due to a lack of continuity. Clearly, the field must respond to these problems in a proactive way.

The concepts of service fragmentation and discontinuity of care are not new issues to the behavioral health field. State mental health authorities, county administrators, and local providers have struggled with these challenges, but have yet to find and apply wide-scale, appropriate solutions.

In 1963, the landmark Community Mental Health Centers Act was passed in response to a national goal of moving people out of institutions and into communities where they were to be served by locally-based treatment and service providers. This Act led to the establishment of more than 750 federally funded community mental health centers (CMHCs) across the country.

The push for deinstitutionalization and the downsizing and closing of psychiatric hospitals came about due to a number of factors, including the development of a number of new antipsychotic medications, the emergence of a consumer rights movement, the recognition that the vast majority of people with mental illnesses did not need to be hospitalized for years on end,. According to the World Health Organization, deinstitutionalization was complex and should have led to “the implementation of a network of alternatives outside psychiatric institutions.” The report goes on to lament that these networks never developed due to a lack of appropriate community services and funding (World Health Organization, 2001).

In the 1980s, direct federal funding of CMHCs was ended and replaced with a federal block grant to State mental health authorities. These shifts to State-based block grants came about, in part, due to the premise that States were better positioned to meet local needs, coordinate services, and more efficiently administer service delivery programs than the federal government.

In April 2002, President George W. Bush created, by Executive Order, the “President’s New Freedom Commission on Mental Health.” President Bush said in his address announcing the Commission, “Our country must make a commitment: Americans with mental illness deserve our understanding, and they deserve excellent care” (Commission Final Report, 2003). The New Freedom Commission identified stigma, unfair treatment limitations and financial requirements, and fragmentation of the delivery system as areas of weakness in the current mental healthcare system. The New Freedom Commission recommended “complete transformation” of the mental health system in America. Six goals were identified to serve as the foundation for this transformation:

1. Americans understand that mental health is essential to overall health.

2. Mental healthcare is consumer and family driven.

3. Disparities in mental health services are eliminated.

4. Early mental health screening, assessment, and referral to services are common practice.

5. Excellent mental healthcare is delivered and research is accelerated.

6. Technology is used to access mental healthcare and information.

One of the fundamental problems with the U.S. mental health system, as reinforced by the Commission’s final report, is the fragmentation of treatment, services, and supports. Accompanying this fragmentation are myriad financing and funding sources that include complex eligibility and reimbursement mechanisms. Failure to ensure continuity of care, including continuity of medications, for people with mental illnesses is the direct consequence of systems, services, and funding fragmentation.

Continuity of therapy initiatives are 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 approaches and medications used by professionals and provider organizations that are part of the continuum of care. In addition to this financial and service system resource benefit, continuity of therapy initiatives provide consumers with stability by assuring access to required treatment components in all settings. And, for community hospitals, continuity of therapy initiatives provide another very tangible benefit–the relationships, process, and infrastructure for an overall discharge planning function for all consumers with mental illnesses.

REASON . This documentary is no longer available via . BBC I Player as last known . or via . Documentary section of website . History Of The Mad House . is a documentary of . a time line . appoach to mental health issues . going back over 100 years ago . & How Some Progress has been achieved .
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Schizophrenia Mental Health Diagnosis And Daily Functioning

Last Updated on Saturday, 1 October 2011 01:21 Written by Natural Health Team Saturday, 1 October 2011 01:21

Health Information about Schizophrenia Mental Health Diagnosis And Daily Functioning

People are generally afraid of the idea of schizophrenia and there are a lot of misconceptions. There are over two million Americans with this mental illness and a number of medications to help treat it. It often can appear in the late teens or twenties for individuals and is very difficult for the whole family as well as the individual that suffers from it.

There is a beautiful video by Jill Taylor who discusses her own stroke as well as her interest in becoming a brain researcher in order to understand schizophrenia due to her brother’s diagnosis with this illness. She is an innovator in understanding the way the brain and mind function.

Symptoms can include confusion, delusions and hallucinations. There can be isolating tendencies and withdrawal habits from others.Depression and anxiety may be quite high and it is easy to get overhelmed. Cognitive problems can manifest in the areas of decision making, attention and the capacity to learn. Delusions can be chronic and one may think that an electronic gadget is communicating with them through waves or that they are constantly being watched by someone. It is painful to see someone shaping their behavior based on delusions that dominate the mind. Some people with medication are able to lessen these disturbing thoughts and not believe them to the degree that they had in the past.

Sometimes people with this diagnosis can show little affect and have a type of flat tone with little excitement. Dr. Laing worked with schizophrenics in the UK and had a radical approach with this population. He saw many aspects of our society and environment as insane and that believed it could be worked with as a journey into the inner self. His views were seen as controversial but many in the seventies appreciated his spiritual and existential approach to this problem. He saw the patient is resorting to this behavior as a coping mechanism and that it grew from an inner despair.

Most people with schizoprhenia are not able to work and many qualify for disability in the United States. The intrusion of audio or visual hallucinations, problematical thought patterns and mood liability makes daily functioning a challenge and work responsibilities can often be impossible to sustain with any regularity. There have been many advances in medications and counseling is often used to help identify underlying triggers. Family support is important and there may also be hospitalizations required when symptoms are intense or there is lack of medication compliance.

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A True Story Of Schizophrenia And Substance Abuse From A Community Mental Health Network In Denver, Co

Last Updated on Monday, 12 September 2011 04:21 Written by Natural Health Team Monday, 12 September 2011 04:21

Health Information about A True Story Of Schizophrenia And Substance Abuse From A Community Mental Health Network In Denver, Co

It has been an incredibly long and painful journey for “Nicholas,” 21, and his family, but today Nicholas is living proof that with the right treatment and support, it is possible to recover from a crippling mental illness, schizophrenia, and substance abuse.

Although Nicholas most recently has been seen at Arapahoe/Douglas Mental Health Network as an outpatient since the spring of 2005, his struggles with what ultimately would be diagnosed as a severe form of schizophrenia began in high school. With trouble escalating at school and home during his sophomore year, it was clear something was terribly wrong with Nicholas, who had been a straight-A student. It was the beginning of a journey that would result in periodic months’-long hospitalizations for Nicholas in no less than six different facilities across the Denver metro area.

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The disturbing memories that shadow that path bear witness to the severity of his illness.

“I believed I was Jesus at one point,” he adds, shaking his head. There were times when Nicholas was hospitalized that he had to be placed in a locked room because he was so out of control. His bizarre behavior included trying to eat cereal with a toothbrush. And there were days that he was sure “Elizabeth” wasn’t his real mother. Even so, she came to see him all the time, refusing to give up hope.

Nicholas was lucky to have the unwavering support of his mother and 15-year-old sister. Nicholas’ closest friends are now his mother and sister, whom he credits for helping make his recovery possible.

Because he also faced issues with substance abuse, Nicholas was referred to ADMHN’s Aquarius Center, which effectively treats adults challenged by chemical dependency and mental illness.  “Nicholas is doing extremely well,” says his clinical case manager. “I’ve seen him really mature during the time we’ve worked together. He is determined to get his life back on track.” 

Nicholas’ active partnership in his recovery combined with his personal strengths and resolute spirit has made this success possible. He is diligent about taking his medications and remains drug-free.

He is looking forward to resuming his studies and meeting new friends at Arapahoe Community College in the spring and eventually hopes to transfer to a four-year school to finish his degree, possibly in criminal justice.

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