Mind Matters: The three Rs are respect, re-education and recovery – part 2

November 26, 2018

Editor’s note: The column is the second in a two-part series. The first half of this column was published on Nov. 12.

Second, we realize that not just education, but re-education, is necessary to move us forward into the 21st century as we provide mental health services. We know that we operated based on old school paradigms for many years, and that some of these no longer apply. We realize that evidenced based medicine utilizing the best available science, modern assessment tools, more accurate measurements, and realistic progress towards obtainable goals are the pillars that support modern mental health treatment.

What are some of these old school paradigms? There have long been stories, legends and superstitions about mental illness, what causes it and why people might have it. In the distant past, people were thought to be medically flawed, have supernatural afflictions, to be possessed by demons, or even to be cursed or have roots of one sort or another placed on them by someone who wished them harm. The treatment of mental illness has been passed from Shaman to root doctor to family physician to priest to exorcist to therapist to psychiatrist and others over many centuries.

Education about mental illness has also gone from pillar to post as the years have gone by. Unfortunately, some education has been based on biases, discriminatory practices, financial considerations, along racial lines, or even on political principles or party preference.

Now, we do not want to continue the old ways of educating people about mental illness any more than we want to continue drilling holes in people’s skulls to release demons or injecting insulin to induce therapeutic comas. The science and studies around mental illnesses such as depression, bipolar disorder, and schizophrenia are growing yearly. Evidenced based treatment is being touted as the gold standard for our interactions with children, adolescents, adults and families who come to our facilities looking for help. When a certain diagnosis is made, what are the medical treatments that have been proven in double blind, placebo controlled studies to work, how often, how for what exact population? How long should it take the treatment to work, and how long should it be continued? For children with ADHD, does medication alone work, or should counseling be provided as well? Should that counseling be individual or include family members? Should it be on site at a mental health center, or should it be provided in the school where the child spends a large part of his day? How do we best assess, monitor and evaluate ongoing progress (or lack of it) as a treatment modality is used? What are the specific, reasonable, attainable goals for treatment?

We are rethinking what it means to be healthy today and that includes mental health. We are getting out in the community, presenting this new knowledge about treatment of mental illness at school meetings, in churches, at local fairs, at health fairs, and via articles in the newspaper. I have personally written over thirty articles for two local S.C. newspapers since June 2017 about subjects from stigma to suicide to aging to kids and technology, trying to get the word out about what real world issues exist in the treatment of mental illness today. We do not want to simply educate. We want to re-educate based on current knowledge about what really excellent mental health treatment is all about.

Third, what about recovery? Does it exist? What does it look like? How do we help those who suffer from mental illnesses get there and stay there? Recovery involves a thorough assessment, accurate diagnosis, and excellent treatment. It includes measurement of change, monitoring of progress, anticipation of pitfalls and side effects of treatment, long term planning, action to maintain wellness and a recovery plan in case of recurrence of symptoms.

Some mental health illnesses may be one time episodes, while others may last months and others years. Some illnesses are lifelong. Does that mean that some measure of recovery is not possible in those more severe illnesses? Absolutely not! The key to excellent treatment is a thorough assessment, an accurate diagnosis and efficient, effective interventions. At ABMHC we strive to meet all these standards by the use of our “no wrong door” policy, quick interventions for emergencies, timely follow ups after a hospital admission, medical assessment as soon as possible and medical treatments that complement the psychological treatment that patients get at the center. Once acute care has been completed, then we implement measurements and monitoring to insure that the treatment is working and the client is getting better.

In addition, it is important to anticipate the possibility of inadequate or incomplete treatment, relapse, or recurrence. This does not always happen, of course, but should always be considered in treatment planning, especially for long term illnesses.

Planning may include having a WRAP (Wellness Recovery Action Plan) in place, a power of attorney or payee set up if needed, or other provisions for assistance if needed during times of crisis.

The bottom line as we go forward into the twenty first century to provide services to the citizens of our two counties? Anyone, even those who suffer from a longstanding or recurring illness, can strive for and achieve measurable degrees of wellness and recovery. There is hope.

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