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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.
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- 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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