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Adult Mental Health
Vision
Travis County will be a community where all people of all cultures have
access to preventative and healing mental health services that enable them
to live healthy and productive lives.
Summary
When faced with the ongoing problems and routine stresses of life, everyone
gets the blues or feels anxious from time to time. Human emotions are common
responses to loss, failure, or disappointment; however, when these emotions
become prolonged or exaggerated, they can begin to interfere in major areas
of an individual's life, socially, at home or at work, with family or friends.
Access to mental health services in such instances can offer people options
for improving their ability to function day to day. Beyond these situational
reactions, some people experience pronounced disturbances in the way they
think, feel, and relate. The more severe and persistent mental illnesses
are complex, physiological brain disorders that require significant medical
and/or psychological intervention. Examples of severe and persistent mental
illnesses are schizophrenia, major depression, manic-depressive (bipolar)
disorder, obsessive-compulsive disorder, phobias, panic disorder, and post-traumatic
stress disorders. While mental disorders cut across all socio-economic, racial,
gender, and ethnic groups, some mental disorders such as conduct and eating
disorders, dementia, and Alzheimer's affect special populations such as children
and adolescents, women, the elderly, and individuals infected with HIV. (NIMH,
1997)
Because the mental health needs of people in Travis County are broad, the
continuum of services should range from helping people cope with the stresses
of life to treating serious mental illness. The continuum of care should
consist of a full range of primary and ancillary services that will address
the full spectrum of mental health needs and measurably improve the overall
mental health of the community. Guiding principles for the delivery of mental
health services within the continuum include:
- culturally and linguistically appropriate services provided
by qualified professionals;
- cost-efficient and effective services which produce improved
outcomes;
- services tailored to the individual needs and developmental
stages of clients and their families;
- provision of services within therapeutic indoor and outdoor
environments; and
- services provided holistically so that the full range of mental,
physical, and spiritual health needs of individuals are addressed concurrently.
Characteristics of populations that are at-risk of needing the range of
mental health services include the following:
Persons with Poor Personal Skills such as adults who:
- do not have the resources, ability, or willingness to make good life
choices personally or professionally;
- have poor parenting skills;
- lacked positive role models when they were growing up;
- demonstrate inadequate/unproductive5 coping behavior; and
- have poor self esteem.
Persons with Barriers to Accessing Services. Such barriers may include:
- stigma attached to having mental health needs;
- inaccessible, non-inclusive service systems;
- inability to pay for services;
- lack of parity in insurance coverage for mental illnesses versus other
physical illnesses;
- lack of insurance coverage for mental illnesses which are not considered
as legitimate as other mental illnesses;
- lack of proactive, prevention, and early intervention services; and
- brain/thought disorders6 for whom rights and choice issues are complicated
for persons with mental health needs.
Persons who have unresolved issues from past trauma or have experienced
more recent trauma. This includes adults who:
- are experiencing or experienced partner abuse or child abuse;
- are in the elderly population and experiencing abuse;
- experience feelings of physical insecurity and who are not safe in their
homes, workplaces, neighborhoods, or community;
- experience disruptions in family relationships;
- have unresolved issues from traumatic events, e.g. witnessing a death,
experienced recently or in the past; and
- have thoughts of committing suicide.
Persons living in environments which are not conducive to good mental health
or having their mental health needs met. This includes adults:
- who feel isolated and/or estranged from the larger community;
- with mental health problems who are incarcerated instead of being treated
or do not receive mental health services while incarcerated;
- who have family members with a mental illness and/or other serious, chronic
health problems or disabilities;
- living in poverty, including those who are homeless, un/underemployed,
or un/undereducated;
- transitioning between children's and adult services who are not well
served by either program area;
- transitioning from institutions (hospital, jail, prison, foster care,
etc.);
- experiencing vocational and/or social environments which produce high
stress;
- experiencing discrimination and/or intolerance; and
- experiencing major life changes and/or role conflicts.
Persons who have co-occurring health conditions . This includes adults:
- who have a genetic predisposition to mental health problems;
- with substance abuse problems; and
- with other chronic health problems and/or disabilities (e.g. mental retardation).
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Critical Conditions
- Mental disorders are far more common than cancer, diabetes, heart disease
or arthritis. While cardiovascular disease, for example, affects only 20%
of the population, mental disorders affect 22% of the population nationally.
(National Institute of Mental Health "NIMH") This translates to
approximately 150,400 persons in Travis County when taking into consideration
general population figures for 1997.
- Every four to five days a Travis County resident takes his or her own life.
Suicides in Travis County totaled 84, representing a suicide rate of 12.7
per 100,000 and a decrease of 11% from 1993. Males accounted for approximately
80% of suicides in Travis County in 1994. (Texas Department of Health, 1994)
In attempting suicide, males use more lethal methods than women and thus
more often succeed in ending their lives.
- More hospital beds are occupied by people with serious mental illness than
with any other disease. The annual cost of treatment exceeds $67 billion,
more than 11% of the nation's total health care bill. When taking into account
added costs of social services, disability payments, lost productivity and
premature death, cost figures total about $150 billion. (NIMH)
- About 11% of persons affected by mental disorders seek mental health treatment.
(NIMH)
- One in four families will have a loved one with a mental illness nationwide.
The majority (60%) of persons with mental illness live with their families
and nearly 40% of persons with schizophrenia, one of the most disabling and
emotionally devastating illnesses, live with their families. Families caring
for persons with mental illness experience many stresses including financial
burdens, emotional upheaval, and other everyday problems associated with
living with someone who is seriously ill. (NIMH)
- Nearly two out of three people do not know that mental illnesses have physiological
causes, and one in four think people bring depression upon themselves. (Poll
by the National Depressive and Manic-Depressive Association)
- Misconceptions about mental illness have lead to neglect of this major
public health problem including limited access and lack of parity in insurance
coverage. Most health insurance plans do not offer equal coverage for mental
disorders and are more restrictive. For example, while medical coverage may
have a lifetime limit of $1 million, typical mental health coverage might
be limited to 20 visits with a counselor or psychologist and $50,000 over
a person's lifetime. (National Alliance for the Mentally Ill)
- Having either an alcohol or mental disorder increases a person's risk of
having the other diagnosis. Co-occurrence of mental illness and substance
abuse (dual diagnosis) is well documented. Thirty-seven percent (37%) of
persons with alcohol dependence also have a major psychiatric disorder. Fifty
percent (50%) of persons with a major psychiatric disorder are also dependent
on drugs or alcohol. Persons with schizophrenia, bi-polar disorder or anti-social
personality disorder have the highest incidence of dual diagnosis. (Regier
D., et al., 1990) Alcoholics, for example, are about six times more likely
to have manic depressive disorders and four times more likely to have schizophrenia.
(National Community Mental Healthcare Council, 1996)
- Persons with mental illness comprise 40% to 60% of the homeless population.
Based on an estimate of 6,000 homeless people, there are approximately 2,400
to 3,600 homeless mentally ill in our community. (ATCMHMR; Austin-Travis
County Homeless Coalition, 1996)
- About 24% of Travis County residents report that they accomplish less than
they would like as a result of emotional problems such as feeling depressed
or anxious. (Seton, 1995)
- A little over 15% of Travis County residents report that they do not do
work or other activities as carefully as usual as a result of emotional problems
such as feeling depressed or anxious. (Seton, 1995)
- In the past two years, 11% of Travis County residents were treated by a
mental health professional for an emotional or family problem. (Seton, 1995)
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Desired Community Impacts
A. Increase the number of people who make choices which increase personal
productivity, life satisfaction, and unity with the community.
B. Increase the number of people who are aware of, can afford, and feel free
to seek services to protect or enhance their well-being.
C. Reduce the impact of trauma on individuals and their communities.
D. Increase the number of people experiencing an increased sense of security.
E. Increase the number of people who cope productively with high stress environments.
F. Decrease the negative impact of health conditions on the mental well-being
of individuals.
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Strategies
A. Community Partnerships and Collaboration
Establish and ensure ongoing communication and active collaboration among
community stakeholders in implementing the Community Action Network Plan.
B. Ongoing Data Collection and Assessment
While respecting client rights, ensure efficient use of resources and effectiveness
of services through ongoing collection and analysis of data relevant to
adult mental health issues.
C. Community-Wide Awareness and Education
Increase community awareness about mental health issues through a community-wide
campaign using mechanisms such as public service announcements and educational
activities designed for youth programs, schools, service clubs, religious
organizations, major employers, policy making bodies, providers, and
other appropriate groups. Topics may include but should not be limited
to the following:
- factual information about mental illnesses;
- impact of mental illness on the lives of individuals and families;
- capabilities of persons with mental illness;
- treatment options;
- signs, symptoms, and risk factors; and
- benefits of prevention and early intervention (e.g. cost savings in
criminal justice system).
D. Comprehensive Continuum of Care
Ensure services address the specific needs of individuals and families
by offering a diverse, coordinated range of service options which allow
for early and appropriate intervention.
E. Service Coordination
Ensure efficient use of resources and appropriate referrals by establishing
mechanisms for exchanging information among providers.
F. Advocacy
Ensure community involvement and strategic use of data to influence decisions
regarding public policy, funding, access, and equal treatment.
G. Best Practices
Improve the effectiveness of service delivery through the identification
of successful strategies and openness to innovative models of care.
H. Training and Credentialling
Identify and create opportunities to exchange information, train professionals
on best practices, and credential providers to ensure the best service
and to broaden the base of community resources.
I. Planning
Using continuous and meaningful input from consumers, family members, and
other stakeholders, guide decision-making pertaining to coordination
and delivery of services, collaboration, and funding priorities.
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Outcomes
A. Increased number of adults and their family members who are aware of
mental health issues;
B. Increased number of adults and their family members with the knowledge
and skills to recognize risk factors of mental illness;
C. Increased number of adults and their family members who receive information
about available services;
D. Increased number of adults and their family members with the knowledge
and skills to access mental health services;
E. Increased number of adults and their family members receiving and reporting
they have received appropriate and comprehensive mental health services;
F. Increased number of adults demonstrating adequate, productive coping behavior;
G. Increased number of adults showing measured improvement in parenting knowledge
and skills;
H. Increased number of adults who actively participate in community life;
I. Increased number of adults who serve as positive role models;
J. Increased number of adults who feel safe in their communities;
K. Increased number of adults reporting achievement of personal and treatment
plan goals;
L. Increased number of adults showing measured improvement in mental health
status and functioning;
M. Increased number of adults who remain stable and in the community;
N. Increased number of adults and their family members reporting increased
satisfaction with services;
O. Decreased number of adults and their family members reporting difficulty
in accessing appropriate and comprehensive mental health services;
P. Decreased number of adults whose mental health status has negatively impacted
their lives, including their ability to work;
Q. Decreased number of adults who attempt or commit suicide.
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