Serious Mental Illness: How Can We Help?

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    Serious mental illness affects us all in some way. What can we do, as professional nurses to help make a difference in our families, in our work place, in our community and in our nation?

    Serious Mental Illness: How Can We Help?

    Serious Mental Illness: How Can We Help?


    Ed called me to ask if we could have coffee and talk. As his long-term friend and a Faith Community Nurse, I was happy to oblige and we set up a time. When we got together he told me the difficult story of his brother whose wife has serious mental health issues. This was the fifth time she had made a serious attempt to kill him-each time the process escalated and her attempts were more serious. Near tears, Ed went on to tell me the sad story of how he was unable to help his brother despite his best attempts. His brother would go through the complicated steps necessary to get her committed, she would stay in a facility for a total of maybe two weeks, be released, have nowhere to go, plead to come home and the process would begin again-he ever hopeful that "this time would be different" and she appearing to adjust her paranoid, schizophrenic ideation/bipolar behavior for short bursts of time before falling back into the physical, emotional and spiritual abuse. Additionally, Ed's brother found himself unable to prosecute her criminally, simply lacking the emotional strength to send her to jail.

    The cyclical nature of the pattern left everyone exhausted and also mentally distressed-the wife who lives in the grip of severe mental illness, the husband who is a victim and displays all the classic signs of victimization, their teenage daughter who simply wants her mother to "go away," and the extended family who vacillates between despair and hope with every cycle of violence and reconciliation.

    What are the statistics on the prevalence of serious mental health problems? Of course, it is hard to know exactly as 1 in 5 of us has some type of mental health crisis at some point in our lives. But the more serious, destructive types of mental health illnesses are smaller in number:

    • 1.1% of adults in the U.S. live with schizophrenia.(NIMH >> Schizophrenia)
    • 2.6% of adults in the U.S. live with bipolar disorder.(NIMH >> Bipolar Disorder)


    However, these serious mental health problems have a disproportionately large effect
    on those around them. Mary Nicholas, MSW, Professor of Social Work at Mississippi
    College states, "Mental illness destabilizes the workforce, the family, society in general, the educational system, even churches." The societal impact that one person with severe untreated mental illness can have is difficult to quantitate.

    Ed went on to express his frustration with the emergency room as the access point for mental health evaluation and crisis. He detailed occasions where his sister-in-law was evaluated and sent home for unknown reasons. As professional nurses, we all know how hard it is to find a placement for someone in crisis. The options are few and often the chronically mentally ill have run through their money, run out of support systems, and have very few options. Additionally, the family system is so ill that their own issues become part of the problem.


    How can nurses be part of turning this situation around?

    Nicholas says, "I see a lack of funding. I don't think it's a lack of interest but I think we need to
    educate our people in authority regarding what mental health issues are and the devastation they can cause in our society when these diseases go untreated."

    She goes on to point out some possible avenues forward:

    1. Vote. One of the most important things we can do is participate in the election process and even go further than that by keeping our legislators informed and talking with them about mental health concerns.
    2. Longer inpatient stays. I'm not advocating for institutionalization, but I am advocating for longer term treatments. The current standard of 13 days is simply not adequate. It's not enough. There has to be a place between being institutionalized for life and doing the "express treatment" mentality. Mental health issues are not a quick fix. They are not a single layer issue either. It's not just getting them stabilized, it is also dealing with all the devastation they have done while they have been unstable.
    3. Acknowledge and address shame. If a person suffering from mental illness can be stabilized and get on medication, there is often a sense of shame in dealing with the past. This can be exacerbated by the culture of secrecy surrounding mental health and mental health treatment. As a society, we have to be more open about mental health, de-stigmatize it and give people tools to deal with the shame, including paths toward self-forgiveness and reparations.
    4. Holistic care necessary. The approaches have to be holistic, long-term and team-oriented. Identifying the problem and finding medication is only a first step and maybe the easiest part of the process. The individual, family and societal support system necessary to move toward solutions is complex.


    I listened carefully to Ed as he unburdened himself of more details of his family's terrible ordeal. He said, "Being mentally ill does not mean you are not smart. In this case and others like it, the person in question knows her rights. She knows how to use them to defend herself and in some ways, to perpetuate the problem. She is functional-just in very harmful, hurtful ways."

    The National Association for the Mentally Ill (NAMI) helps to advocate for both the mentally ill and for their families. They provide support groups and connection to other resources and work with the mentally ill, their families members and professionals. I referred my friend to NAMI and he was able to attend group and get more connected.

    What is your experience with the seriously mentally ill in the community? What do you see that is helpful? How can professional nurses move beyond identifying problems and become part of addressing solutions long term? What is going on in your community that is successful?

    Joy Eastridge, BSN, RN, CLMFCN
    Last edit by tnbutterfly on Apr 20
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    16 Comments

  3. by   canoehead
    Well, when it takes at least two weeks for medications to work, and the average stay is 13 days...
  4. by   VivaLasViejas
    I am a disabled nurse who lives with bipolar I disorder, and I appreciate what you've written here. As a mentally ill person, I think funding for mental health is a major factor in the failure of the healthcare system, but I also believe stigma is the main problem. Society devalues people who live with MI and it's easier just to look the other way...until there's a mass shooting. That's when the politicians and the public come out of the woodwork and blame all violent crimes on the mentally ill. The truth is, we are far more likely to be the victims of crime than the perpetrators.

    That's not to say that mentally ill individuals like the woman in your article shouldn't take responsibility for their behavior, even when sick. I have done a good many rash and foolish things when I was manic, and some of the damage was irreparable. But I do the best I can, and I don't use my illness as an excuse. It sounds like the wife needs to own her (rhymes with "it") and work to get stable. However, I don't think jail is the answer; a few months in a place where she can be confined AND get her meds straightened out would benefit her. In jail she probably wouldn't receive treatment and would more than likely get worse.

    That's another issue: mental patients and police, many of whom are not trained in crisis prevention. It seems that the number of incidents involving psychiatrically ill people being shot and killed by LEOs is rising, including one near where I live in Oregon. There needs to be universal crisis prevention training for all LEOs, both during academy and through recurring inservices. That means money, and it has to come from *somewhere*.

    I wish I knew what the answer is. I wish I knew how to make society CARE. I hope by continuing to raise awareness that we can make that happen someday. Thank you for this article.
  5. by   pixierose
    Our mental health system is so broken.

    We need longer IP stays, as many times in our ED someone will get d/c from a mental health facility ... and wind right back in the ED days, sometimes hours later.

    But. We have so few IP placements. Our patients in the ED can wait up to 3, sometimes 4 WEEKS, for something to open up. Our social workers find placements states away, which families often reject due to lack of ease of transportation. Meanwhile, they languish in the ED setting...

    Insurance companies can be no help either, because they can deny a placement, or a treatment. Sometimes they deny right up to the last minute.

    It's sickening. I wish I knew the answer. There just isn't enough outrage.
  6. by   Susie2310
    I agree that lack of funding for mental health care and social stigma towards mental illness are two of the main reasons that mental illnesses go undetected/under-treated/untreated.

    Even when funding for mental health care is available, access to a mental health care provider is often very difficult to obtain. It is common to see health care facilities display large adverts for their services, with photos of smiling, healthy looking people; I have yet to see the same health care facilities advertise in this way for mental health services. The message is given to people that mental health needs are not a mainstream health problem, and that those who have such needs are not normal and shouldn't be able to access care in the normal way.

    Education is important too. Community outreach efforts that help people to become aware of mental illnesses and encourage and tell people how to seek help are necessary.

    There are numerous types of mental health problems. I think that becoming active politically in large numbers is necessary in order to demand increased funding for mental health care. I think de-stigmatizing mental illness through media campaigns that show people with severe mental illness to be "one of us", which they are, is necessary. Having "drop-in" mental health centers where people can go to casually without having to receive an eligibility referral from their health care provider would make it much easier for people to seek help. These are places to start.

    With sufficient medical and social resources and a good medical and social support system, people with severe mental illness can be helped. Without these resources, severe mental illnesses often just continue to get more and more severe, until the person finally may behave criminally and enter the criminal justice system (where they may receive some help for their mental illness), or may die from the physiological consequences of their illness, or may attempt or commit suicide/homicide.
    Last edit by Susie2310 on Apr 22
  7. by   jeastridge
    Quote from VivaLasViejas
    I am a disabled nurse who lives with bipolar I disorder, and I appreciate what you've written here. As a mentally ill person, I think funding for mental health is a major factor in the failure of the healthcare system, but I also believe stigma is the main problem. Society devalues people who live with MI and it's easier just to look the other way...until there's a mass shooting. That's when the politicians and the public come out of the woodwork and blame all violent crimes on the mentally ill. The truth is, we are far more likely to be the victims of crime than the perpetrators.

    That's not to say that mentally ill individuals like the woman in your article shouldn't take responsibility for their behavior, even when sick. I have done a good many rash and foolish things when I was manic, and some of the damage was irreparable. But I do the best I can, and I don't use my illness as an excuse. It sounds like the wife needs to own her (rhymes with "it") and work to get stable. However, I don't think jail is the answer; a few months in a place where she can be confined AND get her meds straightened out would benefit her. In jail she probably wouldn't receive treatment and would more than likely get worse.

    That's another issue: mental patients and police, many of whom are not trained in crisis prevention. It seems that the number of incidents involving psychiatrically ill people being shot and killed by LEOs is rising, including one near where I live in Oregon. There needs to be universal crisis prevention training for all LEOs, both during academy and through recurring inservices. That means money, and it has to come from *somewhere*.

    I wish I knew what the answer is. I wish I knew how to make society CARE. I hope by continuing to raise awareness that we can make that happen someday. Thank you for this article.
    Thank you so much for your thoughtful response and for sharing your personal experiences. I hope that your generosity of spirit will encourage others to truly care--the answer to any long term and sustainable successes in treating MI. Gratefully, Joy
  8. by   jeastridge
    Quote from Susie2310
    I agree that lack of funding for mental health care and social stigma towards mental illness are two of the main reasons that mental illnesses go undetected/under-treated/untreated.

    Even when funding for mental health care is available, access to a mental health care provider is often very difficult to obtain. It is common to see health care facilities display large adverts for their services, with photos of smiling, healthy looking people; I have yet to see the same health care facilities advertise in this way for mental health services. The message is given to people that mental health needs are not a mainstream health problem, and that those who have such needs are not normal and shouldn't be able to access care in the normal way.

    Education is important too. Community outreach efforts that help people to become aware of mental illnesses and encourage and tell people how to seek help are necessary.

    There are numerous types of mental health problems. I think that becoming active politically in large numbers is necessary in order to demand increased funding for mental health care. I think de-stigmatizing mental illness through media campaigns that show people with severe mental illness to be "one of us", which they are, is necessary. Having "drop-in" mental health centers where people can go to casually without having to receive an eligibility referral from their health care provider would make it much easier for people to seek help. These are places to start.

    With sufficient medical and social resources and a good medical and social support system, people with severe mental illness can be helped. Without these resources, severe mental illnesses often just continue to get more and more severe, until the person finally may behave criminally and enter the criminal justice system (where they may receive some help for their mental illness), or may die from the physiological consequences of their illness, or may attempt or commit suicide/homicide.

    Thank you for outlining some of the challenges and proposing some considerations for paths forward. If all of us band together to work toward change, we can make a difference. Joy
  9. by   jeastridge
    Quote from pixierose
    Our mental health system is so broken.

    We need longer IP stays, as many times in our ED someone will get d/c from a mental health facility ... and wind right back in the ED days, sometimes hours later.

    But. We have so few IP placements. Our patients in the ED can wait up to 3, sometimes 4 WEEKS, for something to open up. Our social workers find placements states away, which families often reject due to lack of ease of transportation. Meanwhile, they languish in the ED setting...

    Insurance companies can be no help either, because they can deny a placement, or a treatment. Sometimes they deny right up to the last minute.

    It's sickening. I wish I knew the answer. There just isn't enough outrage.

    It is possible that talking about it, writing about it, sharing about it may be a starting point. Joy
  10. by   curiousMD
    As a psychiatrist, I cannot emphasize a holistic approach enough. There's such a mentality of "there's a pill for that" that all parties are guilty of. Good quality therapy as well as other lifestyle factors are powerful augmenting agents and minimize polypharmacy. I'm also outraged at the stigma towards mental illness. I hear it in the tones of healthcare workers, even physicians and people in general. In the process of establishing my practice, I was looking for office space and after I disclosed I am a psychiatrist, you could tell some people were not thrilled to rent the space. Well news broadcast to all of you, psychiatric illness is VERY prevalent and if anything, those with a psychiatric condition have been statistically demonstrated to more likely be VICTIMIZED than be predators due to their vulnerability. It's a shame...

    Quote from pixierose


    Insurance companies can be no help either, because they can deny a placement, or a treatment. Sometimes they deny right up to the last minute.
    I love advocating for my patients. There should be CME for psychiatrists with how to work with insurance companies and obtain affordable medication for patients. Not to toot my own horn, but I've gotten good at doing PAs. Even the ones that rejected, for cases where I felt the medication was necessary, I kept sending letters (I've generated some templates so I'm not always starting from scratch) and persistence does pay off. There's also many other ways to get medications affordably. For example, did you know that brand name Abilify is actually cheaper than generic? If you go to the brand name website, use the $5 copay card and then buy larger tabs to cut in half, that's $2.50/month which for many insurance companies is cheaper than what the insurance pays for generic. There's also charity/low cost copay programs for people who have a household income of less than 100k for those working, but don't get great insurance coverage .
    Last edit by curiousMD on Apr 22
  11. by   Penelope_Pitstop
    I was an ACT nurse for a year and a half. For those of you unaware of the ACT model, it is a governmentally funded, social services based community treatment model that uses an interdisciplinary approach to give those afflicted with severe persistent mental illness tools to live in the community (lower level of care than group home) vs. institutions.

    The issues I saw again and again:
    - in the inpatient hospitals, word would get around quickly that ACT could get you housing. So, what happened again and again? our new clients would receive their housing, then not care about recovery or treatment anymore
    - malingerers. While rare, they take on the role of a black hole and suck out the energy of the entire team, allowing others to slip through the cracks
    - "natural supports" (family, friends outside of the treatment team) do NOT exist for the most part with these folks. This is one of the factors preventing more stability and less acuity
    - in the younger population, dual diagnoses are rampant and unfortunately there isn't really a care delivery model that exists to manage the substance abuse part with the persistent mental illness part
    - this population is financially disadvantaged due to inability to work, or incapability to hold a job, or there not being an employer who is willing to hire a person with severe persistent mental illness
    - the medications taken by these folks (especially the antipsychotics) have terrible metabolic side effects

    oh man, I didn't mean to go on and on...anyway, I realize that my knowledge base is very specific as I've never worked inpatient, in a group home setting, or partial program or anything. But that's the reality of community mental health treatment in the Mid Atlantic

    As for me, I have atypical depression and OCD. My biggest issue has been stigma. My ex believed that any psychotropics were no different than being drunk and therefore were not something a Christian should be taking. And, outside of personal stigma, I had a manager who informed me that my mental illness was not in line with being a critical care nurse. (Nope, wasn't in writing and no witnesses, darn it.)

    Annnnd that's enough from me.
  12. by   curiousMD
    Quote from Penelope_Pitstop
    - in the inpatient hospitals, word would get around quickly that ACT could get you housing. So, what happened again and again? our new clients would receive their housing, then not care about recovery or treatment anymore
    - malingerers. While rare, they take on the role of a black hole and suck out the energy of the entire team, allowing others to slip through the cracks
    That is also a drag and it ruins things for those who are motivated.
  13. by   jeastridge
    Quote from curiousMD
    As a psychiatrist, I cannot emphasize a holistic approach enough. There's such a mentality of "there's a pill for that" that all parties are guilty of. Good quality therapy as well as other lifestyle factors are powerful augmenting agents and minimize polypharmacy. I'm also outraged at the stigma towards mental illness. I hear it in the tones of healthcare workers, even physicians and people in general. In the process of establishing my practice, I was looking for office space and after I disclosed I am a psychiatrist, you could tell some people were not thrilled to rent the space. Well news broadcast to all of you, psychiatric illness is VERY prevalent and if anything, those with a psychiatric condition have been statistically demonstrated to more likely be VICTIMIZED than be predators due to their vulnerability. It's a shame...



    I love advocating for my patients. There should be CME for psychiatrists with how to work with insurance companies and obtain affordable medication for patients. Not to toot my own horn, but I've gotten good at doing PAs. Even the ones that rejected, for cases where I felt the medication was necessary, I kept sending letters (I've generated some templates so I'm not always starting from scratch) and persistence does pay off. There's also many other ways to get medications affordably. For example, did you know that brand name Abilify is actually cheaper than generic? If you go to the brand name website, use the $5 copay card and then buy larger tabs to cut in half, that's $2.50/month which for many insurance companies is cheaper than what the insurance pays for generic. There's also charity/low cost copay programs for people who have a household income of less than 100k for those working, but don't get great insurance coverage .
    I appreciate your comment, especially "As a psychiatrist, I cannot emphasize a holistic approach enough. There's such a mentality of "there's a pill for that" that all parties are guilty of." So true and hard for us all to combat even within ourselves because we all want so badly for MI to get better. Thank you for your work in advocacy. I would encourage you to apply to do a seminar at the annual meeting or other CME venue. Your post is encouraging. Joy
  14. by   jeastridge
    Quote from Penelope_Pitstop
    I was an ACT nurse for a year and a half. For those of you unaware of the ACT model, it is a governmentally funded, social services based community treatment model that uses an interdisciplinary approach to give those afflicted with severe persistent mental illness tools to live in the community (lower level of care than group home) vs. institutions.

    The issues I saw again and again:
    - in the inpatient hospitals, word would get around quickly that ACT could get you housing. So, what happened again and again? our new clients would receive their housing, then not care about recovery or treatment anymore
    - malingerers. While rare, they take on the role of a black hole and suck out the energy of the entire team, allowing others to slip through the cracks
    - "natural supports" (family, friends outside of the treatment team) do NOT exist for the most part with these folks. This is one of the factors preventing more stability and less acuity
    - in the younger population, dual diagnoses are rampant and unfortunately there isn't really a care delivery model that exists to manage the substance abuse part with the persistent mental illness part
    - this population is financially disadvantaged due to inability to work, or incapability to hold a job, or there not being an employer who is willing to hire a person with severe persistent mental illness
    - the medications taken by these folks (especially the antipsychotics) have terrible metabolic side effects

    oh man, I didn't mean to go on and on...anyway, I realize that my knowledge base is very specific as I've never worked inpatient, in a group home setting, or partial program or anything. But that's the reality of community mental health treatment in the Mid Atlantic

    As for me, I have atypical depression and OCD. My biggest issue has been stigma. My ex believed that any psychotropics were no different than being drunk and therefore were not something a Christian should be taking. And, outside of personal stigma, I had a manager who informed me that my mental illness was not in line with being a critical care nurse. (Nope, wasn't in writing and no witnesses, darn it.)

    Annnnd that's enough from me.

    Thank you for sharing. There are no easy answers, are there? I hope that your post and others like it can help us all as we search for creative ways to move forward. Joy

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