face graphic, healing the invisible, mental health disorders
It’s 2016 and mental illness is discussed on billboards, TV, and social media—leaps and bounds beyond the stigma it carried 60 years ago. “I wouldn’t call what we had before 1970 a mental health system,” says Sue Abderholden, executive director for the National Alliance on Mental Illness Minnesota (NAMI MN). In 1955, nearly 560,000 people in the United States were institutionalized for mental illness when medication or therapy would have been enough. By 1977, that number dropped to 160,000 as more specialty clinics opened, medicine to treat more disorders was created, and public education increased through funding and legislation. While progress has certainly been made, there is still a long way to go when diagnosing and caring for people with mental health disorders such as depression, anxiety, and other serious conditions.
According to NAMI, one in five adults experiences mental illness each year. Which means you likely know someone affected. Mental disorders often have invisible symptoms, making it critical to understand the challenges in these disorders, treatment options, and what ongoing mental health management looks like. Minnesota’s mental health care system is working hard to reduce the stigma of mental illness and provide care, but these clinics and hospitals are the first to admit that more people need treatment than there are places, funding, or doctors to help them.
Anxiety and Depression
Anxiety and depression are the most common mental disorders in the United States and in Minnesota. NAMI estimates that 168,000 Minnesota adults and 56,000 children live with a serious mental illness. While bouts of anxious or depressed feelings are normal, being bogged down with either or both for several weeks or months at a time is characteristic of a disorder.
“Anxiety and depression are prevalent among all ages and genders and can affect individuals and families differently, but they’re highly treatable if we can identify the symptoms and connect people to the support and treatment they require,” says Todd Archbold, chief operations officer at PrairieCare, a mental health system with multiple metro locations for children, teens, and adults. The first step for patients is meeting with a primary care doctor to discuss symptoms, lifestyle, diet, and family history to begin a treatment plan.
For many, medication, regular talk therapy, or both may be the only treatment needed. Cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) during talk therapy sessions are effective treatments for anxiety and depression. Annie Pope, vice president of clinical services at Nystrom & Associates, says most therapists at her clinic use CBT: “It identifies the relationship between a person’s thoughts, feelings, and behaviors and then works on changing negative thoughts to produce positive or healthy behaviors and feelings.” CBT breaks down distorted thought processes that accompany many mental disorders so the patient can distinguish healthy thought and feeling patterns from unhealthy ones.
Meanwhile, DBT is used for patients experiencing more severe issues. “DBT is primarily used in treatment of individuals who are suicidal, engaging in self-harming behaviors, or are diagnosed with borderline personality disorder,” says Pope. If left untreated, sometimes a continued cycle of negative thoughts and actions can result in patterns of violent behavior, which can make a person feel out of control and powerless.
“DBT uses mindfulness techniques to put choice back into the lives of clients—it teaches them to slow down and observe concerning experiences . . . noting all they can, including their impulses to act,” says Dr. Steve Girardeau, director of clinical services at Mental Health Services. “Then they describe and understand feelings, thoughts, and impulses they have in response to the experience.” From there, Girardeau explains that patients are empowered to choose new, healthier responses to their experiences, which restores confidence and emotional self-regulation.
Eating Disorders and Substance Abuse
Eating disorders, substance abuse, and mental illness often coexist and can be treated together. “Eating disorders or substance use disorders can often be how an individual is coping with underlying depression or anxiety,” says Pope. According to the Anxiety and Depression Association of America, roughly two-thirds of people with an eating disorder also suffer from an anxiety disorder during their lifetime. At St. Paul’s The Emily Program, patients receive therapy for eating disorders in an in- or outpatient setting, and they have access to therapies that build and reinforce healthy cooking and meditation, along with yoga. “Depression, anxiety, and eating disorders, as well as substance abuse, likely all impact similar regions of the brain and often have risk and protective factors in common,” says Dr. Jillian Lampert, chief strategy officer at The Emily Program. Treating the whole patient, not just the disorder, is crucial to lifelong health.
Disordered eating can affect anyone of any age, gender, sexuality, or race, but there are some common traits. “People at risk for eating disorders often have temperamental traits such as attention to detail, perseverance, high sensitivity to environmental and emotional stimuli, and impulsivity,” says Lampert, adding that the brain wiring for these traits in combination with society’s portrayal of body image and unrealistic food portions can lead to unhealthy relationships with food.
The Emily Program determines which category a person falls into: anorexia nervosa, bulimia, binge eating, compulsive overeating, and other specified eating disorder. Treatment options depend on the person, his or her disorder, and its severity, and they range from outpatient therapy groups and weekly one-on-one sessions to inpatient resident care. “Many people only need outpatient care, but 35 to 40 percent will need a higher level of care. Eating disorder recovery takes time—the average person is with us for six to 24 months, moving between the levels of care as it fits their needs,” Lampert says, including physical therapy and education to build and reinforce positive life skills.
There are many commonalities between certain mental disorders and substance abuse. “Individuals with social anxiety disorder are very self-conscious and have difficulty socializing,” says Dr. George Dawson, staff psychiatrist at Hazelden Betty Ford Foundation. “So some will notice that alcohol allows for very easy communication, and that may lead to a problem with alcohol or tranquilizing medications.” At Hazelden, patients reside in an environment focused on healing and recovery, through detoxification, medical services, addiction treatment, and mental health services.
Anxiety and depression can also increase as a result of addiction. “The cycle of addiction is initially fueled by very positive reinforcement in the form of euphoria, followed by a withdrawal phase,” says Dawson. “During the second phase, anxiety, depression, irritability, mania, delirium, and sometimes hallucinations and delusional thinking can occur.” These effects can be isolating, but Hazelden’s group therapy approach connects new patients with those who are further along to inspire and problem-solve in the context of the 12-step model. Whether plagued by a mental disorder, addiction, distorted eating, or a combination of these, the symptoms aren’t always visible and those afflicted may be afraid to admit they need help or feel alone, making loved ones important advocates.
For those battling mental health issues and their loved ones, it’s important to remember that help is available. “We believe a full recovery is possible, and we know that some people will have to manage the disorder longer and more intensely than others,” says Lampert. Understanding the disorder and addiction, seeking treatment, and learning tools to manage symptoms are keys in successful long-term maintenance.
Accepting the Challenge
While mental health disorders and addiction are better understood today than they were 60 years ago, there is still room for improvement. “The struggle for all states, including Minnesota, is access to care,” says Joseph Clubb, vice president of operations at Allina Mental Health and Addiction Services. “Minnesota has always been a leader in high-quality care for those struggling with a mental health condition or addiction.” But there’s still work to do. The bottom line is funding, which could expand the number of temporary and long-term treatment facilities and clinics and add to the state’s lineup of mental health care specialists.
Temporary housing is a critical step in long-term health success; it’s where people who’ve completed hospital treatment go to gain therapeutic tools they’ll need to change unhealthy patterns and behaviors as they transition back to daily life. It’s also where Abderholden agrees the local mental health care system is lacking: “About half the people staying at Anoka County [mental health hospital] don’t need to be there—we’re spending $1,300 a day for these people . . . and we have people backed up in community hospitals waiting to get into Anoka.”
In the meantime, Minnesota’s hospitals and clinics are finding more ways to expand treatment and care at all levels. “Hovander House [a Regions program] is where patients that no longer need hospital-level care are treated while waiting to get into a group home,” says Dr. Michael Trangle, senior medical director, behavioral health services at HealthPartners/Regions Hospital. “This has saved between 1,300 and 1,400 bed days per year and allowed more patients waiting in our emergency department to get into an inpatient bed sooner.”
More may soon improve. In April, Governor Dayton made a $177 million funding proposal for Minnesota mental health treatment centers and psychiatric hospitals—which are severely underfunded and struggling with negligent patient care and inadequate provider safety. Though the proposal’s funding has yet to be dispersed, the takeaway is that Minnesota’s mental health care issues were brought to a legislative level. And local mental care facilities and hospitals are doing more to help adults, and kids, experiencing mental illness.
“When a child or adolescent is admitted to the inpatient unit, they receive 24/7 care and support with therapeutic programming and schooling—PrairieCare is one of the only hospitals in the region that offers a fully integrated classroom,” says Jen Holper, marketing director at PrairieCare. Kids aren’t missing an education while they’re receiving care, which Holper estimates is an average of seven to 10 days. Adults receive inpatient care for 20 to 30 days.
For adults experiencing an emergency mental health crisis, Trangle says they’re stabilized with inpatient treatment until they’re not at risk of hurting themselves or others, and then they’re either transferred to a partial hospital program that meets five days a week for five hours, referred to an outpatient clinic, or discuss other options.
In January 2017, Allina’s Unity Hospital will combine with Mercy Hospital and change its name to Mercy Hospital – Unity Campus. “With a single robust, consolidated program on one campus, patients have access to enhanced inpatient and outpatient services, which are key to maintaining health,” says Clubb. Patients transitioning from inpatient hospital care to lower-level care within the same campus, as well as those with chemical dependency, can receive help all in the same place, making progress easier for patients.
A quick way to receive care is to pick up the phone. “[HealthPartners is] using technology like the internet, texting, and telephone to care for patients with anxiety and depression so that it’s convenient for the patient,” says Trangle. As more health systems embrace the efficiency of technology, more patients can receive the care they need.
Though there’s plenty of work left to do to break down the stigma around mental illness, add programs to treat and educate, and develop more mental health care hospitals and clinics, Minnesota recognizes these issues and is making progress. If you or a loved one is suffering from a mental illness, eating disorder, or addiction, there is help.
Local Support Resources
NAMI MN: 651-645-2948
Crisis Connection: 612-379-6363
The Emily Program: 888-364-5977