MENTAL HEALTH PROFESSIONALS
Any of the following may be involved in assessment and planning for treatment and care. Each has a specific task but is also a part of the treatment team. The duties and responsibilities will vary in different agencies.
Psychiatrists are physicians (MD or DO) with specific expertise in psychiatry. Psychiatrists typically have received four years of medical training, and then another four years of specialty training in psychiatry. They assess, make the diagnosis, and prescribe medications and possibly other treatment. They work with the treatment team to plan for care in the hospital and after discharge. They may provide psychotherapy, wither individual or through group counseling.
Advanced Registered Nurse Practitioners
(ARNP’s) are nurses who have completed graduate study in psychiatric nursing. Under Florida law, ARNP’s can make diagnoses and prescribe all
medications (except controlled substances) under the supervision of a licensed physician.
Psychiatric nurses have specific training in psychiatry. They generally have major responsibility for direct care in the hospital, day treatment programs or community mental health clinic. They may also conduct individual or group counseling.
Mental Health Counselors – These individuals are social workers who are licensed and regulated by the Board of Clinical Social Work, Marriage and
Family Therapy and Mental Health Counseling. These individuals work with the consumer, family and the community in the context of the persons total life situation. This individual serves as a liaison between the treating agency and the family.
Case Managers coordinate care and services in the community for the individual living with mental illness. They assist in obtaining housing, rehabilitation services, and income programs such as SSI and SSDI. They generally work for community mental health centers or an agency under contract with the community mental health services program. The term case manager is sometimes used interchangeably with social worker, although education, experience, and responsibilities are somewhat different.
Clinical psychologists may be involved in administering diagnostic tests and formulating the diagnosis, and may have other responsibilities similar to those described for psychiatric nurses and social workers.
COMMUNITY MENTAL HEALTH CENTERS (CMHCS)
Because serious mental illness is likely to require treatment over a long period of time, or an entire lifetime, most persons with such disorders will use the services of their local community mental health center. CMHC’s may be involved in the initial assessment. The entry point for services may be by appointment with an intake worker, through crisis or psychiatric emergency services, through the commitment process, or by referral from a jail or homeless shelter.
Once a person is determined to be eligible for services, a case manager is ordinarily assigned to assist with such services as crisis intervention, income
support, rehabilitation services, and link to counseling (therapy) and outreach services. CMHC’s may also offer residential and vocational services to
eligible individuals. There may, in addition, be a family education program to provide support and information to family members.
Payment for CMHC’s is based on ability to pay. Most CMHC’s are Medicaid providers.
Hospitals may be used for emergencies, for voluntary or involuntary hospitalization, or for treatment stabilization in a behavioral health center. If the hospital choice is private care rather than obtaining services through a community mental health center, there are several things to consider. Private insurance may cover a short hospitalization. Check carefully to see how much of the cost is covered. Most policies have very limited coverage for psychiatric problems. Medicaid may cover hospitalization. The community mental health case manager can assist with applying for Medicaid and locating hospital facilities that accept Medicaid payment.
Community mental health centers may have a crisis residential services that provide an alternative to hospitalization in an acute episode.
Families that maintain contact and responsibility for their relative who is mentally ill are a vital part of the treatment team, and should seek responses
to the following after hospitalization:
- Explain the diagnosis.
- Share the treatment plan.
- What specific symptoms are most disconcerting? What do they indicate?
- How are these symptoms being monitored?
- What medications have been prescribed?
- What side effect should be expected? Which of those are of concern?
- Has the doctor discussed the diagnosis, medications and treatment plan with the patient?
- Has the patient been instructed individually or in class about his or her illness, management of symptoms and the medications prescribed? Do you feel the patient understood the explanation?
- How often will the patient be able to see those in charge of the treatment plan?
- What steps should be taken to ensure the treatment plan will be continued after discharge?
- What appropriate housing and services are available?
- What should be done if an emergency occurs after discharge?
Serious mental illness is usually a long-term condition; families should plan ahead even if they are fortunate enough to have to deal with only a few
episodes. Families who have lived with mental illness for a long time often describe how carried away they were at the time of the first episode and
how they sometimes imprudently committed themselves to expensive treatments in expectation of cure that was never to be realized. What most individuals do need is early medical diagnosis and effective treatment, a safe stable place to live, and a chance to develop or relearn social and vocational skills.
Some of the best places to look for support and services, over a long period of time, is through a local and state NAMI organizations, local community mental health centers and behavioral health clinics and centers. If services do not seem to be available, you may need to speak up, contact advocacy groups and state elected representatives, or even seek legal advice.
The ability of the person with the mental illness and his/her family to learn about the illness and take responsibility for identifying and managing the symptoms is important in progressing towards a productive and meaningful life. An understanding of the mental illness, symptoms and treatment,
social skills training, and problem solving should be a part of both inpatient and outpatient care. ICCD clubhouses and drop-in centers can also play an
important role through peer education, support, and socialization.