Co-Occurring Disorders and Behavioral Health Services

Co-Occurring Disorders and Behavioral Health Services Jasmina Vuksanovic Co-Occurring Disorders and Behavioral Health Services Co-occurring disorders exist â€Å"when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from a single disorder.†1 It has also been defined as the co-occurrence of â€Å"two or more psychiatric disorders.†2 Depending on the disorders involved, comorbidity may be homotypic, which involves disorders from the same diagnostic group, such as alcohol use and drug use, or heterotypic, which involves disorders from different diagnostic groups, such as alcohol use and depression.2 Prevalence and Demographic Factors Major depressive disorder (MDD) is one of the most prevalent mental disorders in the United States, affecting approximately 6.7% of U.S adults each year.3 Alcohol use disorder (AUD), defined as both alcoholism and harmful drinking, is also prevalent in the United States and often co-occurs with MDD. AUD affects approximately 17 million Americans each year.4 Although research has not established a definitive etiological risk factor for both MDD and AUD, there are several proposed theories as to the association between these two disorders. Studies have shown that depressive symptoms may emerge during periods of heavy drinking and withdrawal.5 Continued heavy alcohol use may be a precursor to stressful life events, which in turn increases the risk of depression.5 Conversely, individuals battling depression are likely to drink heavily in order to cope with the depression, which in turn increases the risk of developing AUD.5 Among those with AUD, women have higher depression than men, as do Whites, compared to racial and/or ethnic minorities.5 In the general population, alcohol dependent men have a 24.3% lifetime prevalence of major depression, whereas alcohol dependent women have a 48.5% lifetime prevalence of major depression.5 In clinical samples, the lifetime rates of co-occurrence for women range from 50% to 70%.5 Co-occurrence of AUD a nd MDD is also associated with increased morbidity, mortality, functional impairment, and risk of suicide.6 Another co-occurring disorder of interest is schizophrenia and substance use disorder. Schizophrenia is a chronic illness associated with hallucinations and disorganized behavior, while the most common substances of abuse are alcohol, cannabis, and cocaine.1 Schizophrenia affects approximately 1% of Americans, and approximately 50% of individuals diagnosed with schizophrenia also suffer from a co-occurring substance use disorder.7 When compared to individuals who suffer from schizophrenia only, dually diagnosed individuals have lower adherence to treatment, increased risk of HIV, higher hospitalization rates, are more prone to violent behavior, and are more likely to commit suicide.7 Schizophrenia runs in the family. If one parent has schizophrenia, the risk of a child developing the disorder is 13%; if both parents have schizophrenia, the risk increases to 46%.8 Schizophrenia does not discriminate and affects men and women equally. Symptoms often begin between the ages of 16 and 30 and does not commonly occur in children or adults older than 45 years.8 Additionally, individuals diagnosed with schizophrenia and a substance use disorder often experience onset earlier in their life than do those who suffer from schizophrenia only.8 Service Delivery Barriers and Strategies to Overcome These Barriers The fragmented health care system poses a huge barrier for individuals seeking care for co-occurring disorders. Due to this fragmentation, patients are not able to receive comprehensive and coordinated care for addiction services and mental health care. Of those struggling with co-occurring disorders, â€Å"8.5 % of individuals receive treatment for both disorders; 38.4 % receive treatment for one or the other disorder; and 53 % receive no treatment at all.†1 One strategy for overcoming this barrier is by integrating mental and physical health care delivery. Combining mental and physical health funds to pay for services would not only increase access to coordinated care, but it would streamline the coding and billing process through the use of common codes. It would also create a network of mental and physical health providers, who would all be responsible for well-being of each patient, thus encouraging coordinated care. A second barrier is the stigma associated with mental illness, which impedes help seeking. This barrier can be combated by educating patients about the resources available for treatment and the overall importance of a healthy mind and body. Businesses should do more to educate employees about mental health benefits, as many may not be familiar with them. Establishing behavioral health clinics, such as the WestBridge Clinic, would provide the compassionate care many individuals with co-occurring disorders are in need of and would likely encourage these individuals to seek treatment. A third barrier is one that is faced by Medicare patients as same day separate billing for mental health and medical care is not covered under Medicare.†1 With the oncoming demographic shift, this segment of the population cannot be ignored. Though this is a more difficult barrier to overcome, policy changes should be made to ensure the elderly have access to mental health services in the primary care setting. Increasing the scope of practice for clinical staff may be a feasible strategy for overcoming this barrier. Implications for Behavioral Health Throughout this course we have learned that organizational leaders and clinical staff must exhibit a certain level of commitment to providing quality care in order to effectively treat dually diagnosed individuals. As we see look at Accountable Care Organizations, the benefits of coordinated care become even more apparent. The ACA shifts the focus to evidence-based practices, which will become integral for more effective treatment and improvement in service delivery of co-occurring disorders. Adequate screening methods and health assessments by primary care providers are the first step in the treatment and recovery process1 and will undoubtedly lead to improved detection rates and treatment of dually diagnosed individuals. It is essential for clinicians to understand the epidemiology of all disorders a person is suffering from to ensure correct and effective treatment is received. Service delivery can be expected to improve with an increase in more knowledgeable clinical staff. Clini cians must be knowledgeable about possible interaction of the two disorders and how both can be treated, rather than just one. However, as long as stigma continues to surround the topic of mental health, there will continue to be hesitation by mentally ill individuals to seek treatment. As a society, we must take the necessary steps and encourage help seeking by those suffering from a mental illness.   References Levin BL, Hennessy KD, Petrila J (Eds.).Mental Health Services: A Public Health  Perspective, Third Edition.New York: Oxford University Press; 2010. Falk D, Yi H, Hiller-Sturmhofel S. An epidemiologic analysis of co-occurring alcohol and  drug use and disorders. Alcohol Research Health. 2008; 31(2): 100-110. National Institute of Mental Health. Available online at  http://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed February 19 2014. National Institute on Alcohol Abuse and Alcoholism. Available online at  http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics. Accessed February 19 2014. Conner KR, Pinquart M, Gamble SA. Meta analysis of depression and substance use among  individuals with alcohol use disorders. Journal of Substance Abuse Treatment. 2009; 37: 127-137. Riper H, Andersson G, Hunter SB, et al. Treatment of comorbid alcohol use disorders and  depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction. 2013; 109: 394–406. Green AI, Noordsy DL, Brunette MF, et al. Substance abuse and schizophrenia:  Pharmacotherapeutic intervention. Journal of Substance Abuse Treatment. 2008; 34: 61– 71. National Institute of Mental Health. Available online at  http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Accessed February 19 2014. QUESTION #3 Is Mental Health a Public Health Issue? Among U.S. adults age 18 years and older, an estimated 26 percent suffer from a diagnosable mental disorder each year, and for young adults, mental disorders are the leading cause of disability.1 Mental illness also bears a heavy burned on the global economy. The WHO estimates that 14% of the global disease burden is attributable to mental illness.2 Among the twenty most significant causes of disease burden worldwide are depression (3rd), alcohol use disorder (7th), bipolar disorder (12th), schizophrenia (14th), and substance abuse disorders (20th).2 Compared to all health expenditures, mental health and substance abuse expenditures have been decreasing since 1986, and are estimated to account for 6.9% of the nation’s health care expenditures in 2014.3 Mental illness increases the risk of developing a physical illness, communicable and non-communicable disease, and intentional and unintentional injury.2 To decrease prevalence of mental illness and its adverse effects on overall health of individuals, it is necessary to integrate mental health service delivery into the nation’s public health system. The public health system encompasses a broad array of topics, which creates opportunities for integration of mental health services through community education, epidemiologic surveys, health screening and assessment, ensuring adequate access to care, identifying risk factors and determinants of health, focusing on prevention and early intervention, and promoting sharing of information among health care providers.3 Traditionally, mental and physical health have been treated in two separate service delivery systems. However, majority of adults diagnosed with a mental disorder to not seek treatment, and those who do, seek treatment within the primary care sector, rather than a specialty behavioral health care sector.3 Integration of the mental and physical service delivery systems leads to better health outcomes in primary care, home health care, and long-term care setting, as well as increased mental health care access, rates of treatment, improved treatment adherence, enhanced clinical and functional outcomes, and greater cost-effectiveness.3 Among older adults suffering from depression, integration of physical and mental health services has shown a decrease in health care dollars spent on care, improved survival, and improved quality of life.1Among individuals suffering from substance abuse disorders, integrated care leads to lower â€Å"hospitalization rates, inpatient days, emergency room u se, and medical costs.†3 One example of an integrated health care delivery system is the Veterans Health Administration, the nation’s largest integrated health care system. Zeiss identified five key reasons for this integration. First, patients prefer to receive mental health care in the same setting as primary care, as they are most familiar and comfortable with their primary care provider.4 Second, primary care providers often fail to diagnose or misdiagnose a mental illness, especially in older patients who may have other health conditions.4 Integrating care can increase detection and accuracy of diagnosis. Third, patients are more likely to seek treatment for a mental illness when a diagnosis is determined in primary care and when care is available in the primary care setting.4 Of importance is the difficulty of primary care referral to mental health providers.4 Studies have shown an astounding 75% of patients fail to follow through with the referral and therefore do not get the mental health trea tment, whereas 90% receive treatment when it is provided by the primary care provider.4 Fourth, integrated care allows for information sharing among providers. Of highest importance is information relating to the patient’s diagnosis and treatment options. It allows both health providers to provide ongoing care and treatment to the patient, without overlap of information, or exchange of misinformation among the providers. Fifth, screening for mental illness in the primary care setting may lead to reduction in the stigmatization of mental illness as it will be viewed as one of many steps of a health assessment provided to all primary care patients.4 These findings have been echoed through other studies, as we have learned throughout the course of the semester. Implications for Behavioral Health Mental illness affects a significant proportion of the U.S. population and the importance of efficient treatment cannot be understated. Integrating mental health services into the traditional public health delivery system and increasing collaboration and information sharing among providers of different disciplines is a key aspect of delivering holistic care. Through course lectures, reading assignments, and videos, we have learned that populations at higher risk of developing a mental illness are more likely to delay treatment, or not seek treatment at all, receive lower quality care, and have higher rates of co-occurring illness and morbidity. The traditional health care model emphasizes preventive care and early treatment, which must be a primary focus for mental health services as well, in order to keep the population healthy, lower the prevalence of mental illness, and maintain an affordable health care system. The number of mental health facilities and organizations providing me ntal health services and treatment has decreased from 3,942 in 1990 to 3,130 in 2008,1 thus the need for integration is essential. In order to create a holistic healthcare system, we must break down the existing barriers between the mental and physical health care delivery sectors. References Levin BL. Week #3 Lecture: Mental Health Systems.2014. 1-11. Levin BL. Week #2 Lecture: Epidemiologic, Historical, Legislative Perspectives.2014: 4-  15. Levin BL, Hennessy KD, Petrila J (Eds.).Mental Health Services: A Public Health  Perspective, Third Edition.New York: Oxford University Press; 2010. Zeiss AM, Karlin BE. Integrating mental health and primary care services in the Department of  Veterans Affairs health care system. Journal of Clinical Psychology in Medical Settings. 2008; 15:73–78.

Buried Child Essay

It represents the fragmentation of the American nuclear family in a context of disappointment and disillusionment with American mythology and the American Dream, the 70s rural economic slowdown and the breakdown of traditional family structures and values. It reflects the universal frustrations of American people. The postmodern style of this play incorporates surrealism and symbolism. Surrealism is part of the play. The use of symbols such as the rain and the corn give the play a symbolist element. The humor is also an essential element. All these stylistic elements give the play a postmodern feel. Eclecticism and skepticism have also to do with postmodernism. Dodge + Halie = Tilden and Bradley Tilden has son Vince whose girlfriend is Shelly The character of Ansel: he is the son that Halie idolizes as an All-American hero despite his death. Tilden and Bradley: both failed their parents’ expectations. Both are expected to take over the farm or at least care for their parents in their old age. However both are handicapped: Tilden emotionally and Bradley physically. They are unable to care for their parents and thus unable to carry out the American Dream. Tilden: he has no purpose, no direction in his life. He had sex with his mother. (Vince) Bradley: aggressive, lost his leg. He Is emasculated by the removal of his leg. Dodge: felt the failure of the farm and the family. He failed to make the farm successful. He is an alcoholic. He has been emasculated by his son and the infertility of his fields. The Priests reflects the breakdown of morality and ethics in America. The act of incest and the murder breakdown the family values. It’s a dysfunctional family.

Teen Suicide Is The Third Leading Cause Death For High...

Over the years teen suicide has increased tremendously. According to Michael Jellinek, â€Å"the adolescent may feel they have no choice but to end their intense internal suffering or to solve a hopeless dilemma by ending it all†(Preventing Teen Suicide). According to the Center of Disease Prevention, â€Å"suicide is the third-leading cause of death for high school students after car accidents and homicides†(Bratsis). Everyday teens are faced with internal struggles and challenges that are difficult to cope with and sometimes seem unbearable to live with. Many teens do not fully understand how their words, actions and behaviors affect certain individuals. Various subtypes classify the cause behind an individual’s decision to commit suicide. There are many causes for teen suicide such as emotional neglect, mental disorders, psychical and emotional abuse, and drug and alcohol abuse; however, the leading cause of teen suicide is individuals struggling with bullying , depression, and the overwhelming aspects of life. Addressing these three leading causes and encouraging teens to discuss how they are feeling could help decrease teen suicide rates. The following articles touch on teen suicide and the ongoing problems leading to this phenomenon. In Michael Bratsis’ article, â€Å"Preventing Teen Suicide† individuals are enlightened on the high rate of teen suicide. In the article Bratsis includes a study that offers statistics of teenagers that have considered suicide, attempted suicide, orShow MoreRelatedThe Importance Of Suicide Prevention1498 Words   |  6 Pagesdefinition of suicide is the act of intentionally causing one’s own death. Suicides happen every day and the emotional impact such an act has on individuals, families, and communities is devastating and tragic. Unfortunately, suicide has become a much bigger social issue than society likes to admit. Many people seem to think of teenage years as their happiest years in life but what others do not know is that someone can be suffering from pain caused by an emotional or environmental issue. Suicide preventionRead MoreTeen Suicide Is A Complicated Tragedy1476 Words   |  6 Pages Teen Suicide Suicide is always a complicated tragedy that leaves people with many questions and few answers. When a teen commits suicide, everyone is affected, family members, friends, classmates, teachers, neighbors, and even outsiders. Teen suicide rates have had a major increase over the years. It has been proven to be the third leading cause of death for 15 to 24 year olds (APA â€Å"Teen Suicide is Preventable†). 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The actual definition of suicide is â€Å"the action of killing oneself intentionally†. The act of suicide is a serious matter, and is particularly prevalent among teens and young adults. The best way to prevent teen suicide is through informing people of its existence, and educating them on the warning signs and prevention methods. In this essay I will explain why suicide is a major public health problem through statistics, show theRead MoreInformative speech outline Essay1391 Words   |  6 Pagesï » ¿Title: Suicide Among Teenagers Specific purpose: To inform my audience on some of the causes on teen suicides.    I. Introduction A. Attention Material: It has been verified on April 19th, 2013 by the Center for Disease Control that for youths between the ages of 10-24, suicide is the third leading cause for death in the United States. (Center for Disease Control: Teen Suicide Statistics, Chart number 1) B. Tie to the audience: Teenagers taking their own life has always been an idea hardRead MoreTeen Suicide : The Most Prized Award Winner842 Words   |  4 PagesTeenage Suicide As an exceptional athlete, the most prized academic award winner, a proud brother and a loving son: recently a student of Northern California attempted Suicide. But why? He had it all. He had the grades, the athletic skills, the trophy the popularity, what made him so unhappy? Unfortunately this was based on his ethnicity, which so happened to be Hispanic. A minority student in a community that prided himself on the absence of over racial conflict. The racism of his peers had beenRead MoreTeen Suicide Essay881 Words   |  4 PagesTeen Suicide Suicide is a growing problem in American culture. Sadly, teens are affected the most. Teen suicide is increasing rapidly. â€Å"About 5,000 teens in the United States kill themselves each year† (Peacock, 4). Suicide among teens is a serious and devastating crisis. More teens are taking their lives today than ever before. Teen suicide does not affect one specific type of teen; it affects any type of teen. There are a variety of reasons teens resort to committing suicide. Many people are workingRead MoreSetting Up Sucide Prevention Programs1427 Words   |  6 Pageseducation programs, but suicide, the third leading cause of adolescent deaths (Caine 1), is practically ignored. Many schools only offer hot lines for suicidal students. While some schools have implemented suicide prevention programs and the government has recognized teenage suicide as a growing problem, effective solutions need to be discovered and funded to prevent these catastrophic deaths. The U.S. federal govern ment should develop and fund suicide prevention programs in high schools, while focusing

Love Of Gatsbys Entire Life - Free Essay Example

Sample details Pages: 3 Words: 922 Downloads: 9 Date added: 2019/03/26 Category Literature Essay Level High school Tags: The Great Gatsby Essay Did you like this example? Gatsby has all that money can buy, but it wont guarantee you the heart of the girl you love. Wealth and accomplishment attracted Gatsby. In the novel The Great Gatsby, F. Scott Fitzgerald shows the money will not fully buy you the happiness you need. As they are all hungry for wealth, they all have their own characteristics that make them different. Due to this, they all presumed to be someone they are not. Jay Gatsby is around protagonist that tried to accomplish everything for the wrong reason, he became mysterious, wealthy and obsessive. Jay Gatsby, a bootlegger, starts off as a mysterious concrete character. As many didnt know Gatsby opened about his past and told Nick that, James Gatz- that was really, or at least legally, [Gatsbys] name (98). Everyone knows him as Jay Gatsby, became successful and wealthy, though it results in him to close up on most people he loves. This causes everyone to judge and critic on what kind of business he does. Who is he? I demanded. Do you know Hes just a man named Gatsby. Where is he from, I mean? And what does he do? (49). Don’t waste time! Our writers will create an original "Love Of Gatsbys Entire Life" essay for you Create order Wealth comes with a lot of questions and rumors, Hes a bootlegger, said the young ladies, moving somewhere between his cocktails and his flowers. One time he killed a man who had found out he was the nephew to Von Hindenburg and second cousin to the devil (61). During Chapter 5 Gatsby somewhat tells Nick about what his business is and invites him to work with him, but was never confirmed until Chapter 7, Tom exposes that Gatsby built up his wealth by selling illegal alcohol with Meyer Wolfsheim. Jay Gatsby became successful; however, not everyone approves, may cause rumors, but his reasoning for it all is Daisy. A bootlegger, a person that sells illegal alcohol, was what they considered Gatsby because he was so wealthy. His home was described as, the one on my right was a colossal affair by any standardit was a factual imitation of some Hotel de Ville in Normandy, with a tower on one side, spanking new under a thin beard of raw ivy, and a marble swimming pool and more than forty acres of lawn and garden (5). The inside of his house was even better, We went upstairs, through period bedrooms swathed in rose and lavender silk and vivid with new flowers, through dressing-rooms and pool rooms, and bathrooms with sunken baths intruding into one chamber where a dishevelled man in pajamas was doing liver exercises on the floor (91). However, Gatsby was not always blessed with money, in his younger years he struggled. He worked to get where he got, he got Cody to acknowledge for that, he was a wealthy copper mogul and rode out to warn him about a storm. When Cody died, he left Gatsby $25,000, but Codys lover didnt let him claim his inheritance. Gatsby committed to becoming a wealthy and successful man. As everyone knows, because Gatsby has been in love with Daisy for a long time, he would do anything to be with her. They first meet in 1917, Gatsby quickly fell in love with Daisy for her beauty and wealth. He knew if daisy knew about him being poor she wouldnt be interested, so he committed to making another life to impress her. They promised to wait for each other, but Daisy couldnt wait, so she married Tom. In a conversation between Nick and Jordan, she says, It was a strange coincidence, I said. But it wasnt a coincidence at all. Why not? Gatsby bought that house so that Daisy would be just across the bay (147) , not everyone does that for a loved one. Gatsby got to be in her presence after 5 years, He had passed visibly through two states and was entering upon a third. After his embarrassment and his unreasoning joy, he was consumed with wonder at her presence. He had been full of the idea so long, dreamed it right through to the end, waited with his teeth set, so to speak, at an inconceivable pitch of intensity. Now, in the reaction, he was running down like an overwound clock (113); being nervous was an understatement. He was confident that Daisy loves him, he even stood up to Tom, Your wife doesnt love you, said Gatsby. Shes never loved you. She loves me She never loved you, do you hear? he cried. Shes only married you because I was poor and she was tired of waiting for me. It was a terrible mistake, but in her heart she never loved anyone except me! (130). Daisy was Gatsbys past, present, and future. She moved on but Gatsby died with his one wish of her Daisy being his, his obsession for Daisy was as much about his obsession for another, better life. Overall, Gatsbys traits of being mysterious, wealthy, and obsessive make him who he is today, his determination to win back the heart of the woman he loves. F. Scott Fitzgerald used the knowledge he already knew and made a well- known character that would do anything for a woman. He dreamt about always being with her his whole life, but he died without her. Like Gatsby we all fall in love, he would have done anything to be with her but got killed for protecting a woman that couldnt decide. Gatsby knew what he was doing, but love is bigger than anything, he struggled to get Daisy, yet we all dont win.