Nearly every major policy statement on mental health in the last decade, ranging from the Surgeon General?s Report to the President?s New Freedom Commission on Mental Health, has begun with the tenet that mental health is central to overall health and more recent reports have added a corollary-physical health is central to mental health.
Improving the treatment of mental and substance use disorders in primary care settings and improving the medical care of people with serious mental health (MH) and substance use (SU) disorders served in behavioral health (BH) settings has been a growing area of focus over the last decade. The goal of achieving quality of services and outcomes on both sides of the primary care/behavioral health interface is gaining long overdue attention and emphasis. This paper seeks to review the history, structure, and current developments of care at the primary care/behavioral health interface. It focuses on care in the public sector, where high rates of comorbidity, regulatory burdens, and lack of resources create particular challenges in providing care at that interface.
There are two sides to the primary care/behavioral health interface-the first is the presence of people in primary care that need MH/SU services. By 2003, 54% of people with mental health issues were served in the general medical only sector rather than within or in combination with the specialty mental health sector. Mood disorders are the seventh most costly health conditions in the United States, but rank second in the most disabling health conditions, reflecting both a high burden and potential under-funding of those conditions in the United States.1 Many initiatives have focused on treating depression because of the broad scope of the problem (more than 19 million Americans each year), the degree to which it has been under-recognized and under-treated in primary care settings, and the growing understanding of the impact of depression on other chronic health conditions.
The other side of the interface is the issue of primary healthcare for people served in specialty mental health settings. Recent reports demonstrate that people with serious mental illness die, on average, 25 years earlier than their age cohorts in the general population. This is a serious public health problem for the people served by public mental health systems. 60% of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.2 Many of the risk factors for these “natural causes” of chronic disease/death, such as smoking, obesity, and inadequate medical care, are modifiable.
We know the successful models of care for addressing MH/SU issues in primary care and have promising models for addressing the healthcare needs of people with serious mental illness. We know that providing stepped care according to specific program models will result in improved outcomes for those served. We know that both public and private policy and financing mechanisms function as barriers to implementing what is known clinically.
Improving care at the primary care/behavioral health interface will require that the MH/SU and medical systems of care begin to more fully embody the tenets noted above and create a health system that is person-centered. Moving from today?s fragmented, disease-focused system to this sort of person-centered system will require work by multiple stakeholders in these systems and, as with any collaborative endeavor, some degree of sacrifice and loss of control. However, moving towards a more collaborative system of care will ultimately yield gains to consumers, communities, and society that far outweigh these sacrifices.
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Mental Health i-am-not-different-from-you.blogspot.com 1. Individuals suffering from mental health problems are no different from you and me. 2. Individuals who may be suffering from mental health problems should be advised to seek help immediately. There is no shame in seeking treatment to improve ones quality of life. Hotline for Mental Health Illness in Singapore: SOS – Samaritans of Singapore 1800-221 4444 (24 hours) Singapore Association for Mental Health 1-800-2837019 SAMH Counselling Services 1800-2837019 Mount Elizabeth – Charter Helpline 1-800-7389595 Institute of Mental Health 6389 2222 Family Service Centre 1800 838 0100 Caregivers’ Association of the Mentally Ill 6782 9371 Other information source: 1. Singapore association of mental heath: www.samhealth.org.sg 2. Silver ribbon ( Singapore) www.silverribbonsingapore.com 3. Institute of mental health hospital www.imh.com.sg
Help answer the question about Mental Health Disorders
What's my problem? (Mental Health disorders)?What's my problem? (Mental Health disorders)?
I have been aware that something about me is amiss ever since childhood and I still don't know what my problem is.
Just about everything has been suggested and/or diagnosed at some point with a variety of "disorders" including depression, ADD, social anxiety disorder, High Functioning Autism, Asparagers, I forget what else honestly but it probably leaving me worse off than where I started, a common problem in psychology because there is too many unknowns about the mind to go about labeling people the way we do). Furthermore, one of the major flaws I have learned is that each disorder has way too many symptoms to the point that it makes it easy to apply just about any disability to an individual, but never really finding the right one.
But anyway, what I do know for certain is that I am AWFUL in social situations and a complete embarassment to myself and EVEN THOUGH I have enough awareness of what I do wrong in these situations, I still can't seem to change it naturally or even force it. Examples of this include not "getting" jokes so i might sort of half assed pretend that I do, forcing eye contact in conversation frequently, electing to be alone far more often than hanging out with friends, no ability to engage in small talk whatsoever. As a result I do have a tendency to withdraw as a learned defense mechanism. It is NOT that I would prefer to avoid social situations, but rather I am such a social cripple and as a result I have learned to do withdraw or disconnect even though I would love to be join in, associate myself with other people better, engage in conversations that everyone else is involved in.
Everyone I know or have met labels me as "shy" but my problem isn't holding back in a conversation due to fear of judgment from others like many others think. No, my problem is having nothing to say, no place, lack of interest (that I'll try to force at times), etc. Lets just put it this way, I have the same problems around the people I am most comfortable with, so lets dismiss the whole "shy" thing here. I will admit, however, that I am often extremely nervous as a result of feeling disconnected from others but I have never suffered from a panic attack. and so I ask you guys out there: What IS wrong with me? Any psychology buffs have an answer to my case or am I bound to live with the knowledge that I have a problem that is impossible to ever get an accurate diagnosis for because of the factors i mentioned in the 1st paragraph?
I appreciate everybody's insight here. Each and every answer here was helpful and if I could select multiple "best answers" here I definetely would. Something I want to add, however, to those who suggested depression and anti-depressants is that this all started with a shrink that I started seeing during a time when I didn't feel I needed one at all! My family decided that their problems at the time were effecting me when it really wasn't, and in the end of it all I was prescribed Prozac by a psychiatrist, and it did nothing but send me down a path of confusion for the last 7-8 years where I have been prescribed to all sorts of BS and I really believe that it is because of this that I am where I am today… and now feeling like I have more mental issues than ever. Like the last answer suggested, maybe a good shrink would have helped, but maybe not. Basically I'm saying from personal experience is be careful if you decide to seek medical help because it might just leave you worseOff
About Author
Linda Rosenberg -
About the Author:
Linda Rosenberg leads the National Council for Community Behavioral Healthcare in treating children, adults and families with mental illnesses and addiction disorders across the country. She holds faculty appointments at several schools of social work. http://www.thenationalcouncil.org/
