Abstract:
Mental illness is painful, debilitating, and costly. In
recent years, the major Axis I mental disorders have been demonstrated to be
biological in origin. Data acquired through the latest imaging techniques
are compelling. The NIMH, National Institutes of Health, the apex federal
repository of worldwide medical information, affirms these findings and has
deemed these disorders as being treatable with biological interventions,
i.e. drug therapy, ECT, rTMS, VNS, and other techniques. Recently, a New
Jersey Medicaid regulation has placed a limit on how long a patient may stay
in a partial hospitalization program to two years. Mental illnesses can take
longer than this to be treated effectively, so as to allow the patient to be
discharged to a less intensive program or returned to mainstream society.
Today, psychiatry is not yet armed with biological tests that can determine
which treatment is to be effective for a given individual. The consequence
of this is that it can take more than two years using trial-and-error
techniques to discover what treatment will stabilize the patient or bring
them to remission. Treatment becomes much more complicated and protracted
when more than one drug is necessary to achieve patient stability and
prepare them to be placed in less rigorous partial care programs. The cost
to society to support an insufficiently treated individual whom must remain
using entitlements, including Medicaid, is enormous. An estimated 40 million
people in the
Psychiatric Disorders:
Background
Previous to the work of Emil Kraeplin in the early
1900’s, psychiatric disorders were considered to be of psychological origin
and the result of personal weaknesses or characterological pathology. He is
often considered to be the father of biological psychiatry. Unfortunately,
very few people took the compendium of his work seriously until well after
his death. With the discovery of lithium in 1947 by John Cade, a biological
treatment specific to manic depression, now known as bipolar disorder,
demonstrated a possible biological etiology for this illness. Lithium was
eventually approved by the FDA in the
The National Institutes of Health (NIH) represents the clearinghouse for worldwide medical research. Their summation after years of study is the following:
“Bipolar disorder, also known as manic-depressive illness, is a
brain disorder that causes unusual shifts in a person's mood, energy, and
ability to function.”
“Research indicates that
depressive illnesses are disorders of the brain.”
NIMH Public Inquiries
Voice (301) 443-4513; Fax (301) 443-4279
TTY (301) 443-8431
Bipolar Disorder was chosen as an example of a mental illness to demonstrate the biological underpinnings of the major Axis I mental illnesses, their chronic course, and the need for indefinite treatment with the goal of stabilization. It is very difficult to predict in advance for any one individual the course and intensity of treatment required to reach this objective. The other major mental illnesses, regardless of how induced or triggered, are perpetuated by the errant brain function that results from psychosocial stress, acute trauma, or even spontaneously and without precipitating stressors. Major Depressive Disorder (Unipolar Depression), in particular, is a difficult clinical syndrome to evaluate properly. Unfortunately, the English language provides us with only one word, “depression”, to describe many things. It is a frequent mistake that a healthy person who experiences normal depression from time to time will assume that their depression is experientially the same as someone suffering from Major Depressive Disorder. This is tragic, for what, then, would be the difference between these two people? From the healthy person’s perspective, the mentally ill person is doing something wrong to deal with the same depression that they have always been successful at dealing with. This is a pervasive cognitive distortion that still exists throughout society, despite all the attempts by the NIH, the media, and advocacy groups to educate people that Major Depressive Disorder is not the same as transient feelings of sadness.
Another reason Major Depressive Disorder is difficult to understand is that the clinical definition includes a spectrum of etiological contributions from the solely biological to the predominantly psychological. Most of these depressions fall somewhere in the middle, with contributions of both the biological and the psychological. It is therefore necessary to treat the biological in a way similar to Bipolar Disorder, a process that may take years to discover the right permutation of medications. One must also take into consideration the many prior years of depressive thinking that this disease leaves in its wake. Although it is possible to process and correct this negative thinking to a limited extent if severely depressed, once the depression is treated successfully, psychological treatments become much easier to learn and practice.
Examples of major mental illnesses with a recurrent or chronic course:
1.
Major
Depression (Unipolar Depression)
2.
Bipolar
Disorder (Manic Depression)
3.
Dysthymia
(Minor Depression)
4.
Seasonal
Affective Disorder (SAD)
5.
Schizophrenia
6.
Schizoaffective Disorder
7.
Obsessive-Compulsive Disorder (OCD)
8.
Post-Traumatic
Stress Disorder (PTSD)
9.
Generalized
Anxiety Disorder (GAD)
10.
Panic Disorder
(PD)
It is unrealistic to think that these illnesses are globally curable within two years upon the initiation of treatment. They tend to be treated biologically through trial-and-error, with each permutation of drug combinations or drug dosage adjustments to be given a minimum of 3-4 weeks to evaluate clinically. If the clinical treatment algorithm is not allowed to be completed by the physician of one mental health program, the patient is forced to start over again with another. This would then be a common result of a two year limitation in the treatment-resistant populations as is often seen in partial hospitalization programs. People would be forced to leave a partial hospitalization program prematurely after only two years. This very often costs society more money, as they drift from program to program, end up homeless, drain housing programs, never become gainfully employed, rely on government subsidies, endanger the solvency of Medicare and Medicaid, and allows the patient to continue to suffer from a painful illness.
What do these partial
hospitalization programs do anyway?
Community Connection is a partial
hospitalization program located in
To be a progressive leader in providing a multi-disciplinary adult psychiatric outpatient services. To respond to a client’s self-determined goals in a manner that promotes personal growth and leads to successful community involvement and lessened professional interventions.
The Adult Partial Hospitalization Program provides therapeutic and educational services to meet the needs of clients who are chronically mentally ill, have prolonged disability due to major psychiatric illness or diagnosed with MICA (Mentally Ill Chemical Abuser).
The program includes three distinct group treatment components: mental health treatment, pre-vocational rehabilitation and substance abuse treatment.
Led by a multi-disciplinary staff, full day or half-day programs provide structure and treatment necessary to return to work, school or less restrictive levels of care.
Many clients successfully transition through the intensive full time program to obtain employment, enter school, or continue vocational training. Aftercare services are coordinated by a professional case manager.
Directed by a psychiatrist, our services are provided by a multi-disciplinary team that include social workers, case managers, certified alcohol and drug counselors, registered nurses and psychiatrists.
The Program serves as a mental health resource center that provides:
Program Fees
Individual insurance providers should be contacted to establish coverage. Most insurance companies and Medicaid supply coverage for partial hospitalization.
Clients without insurance, depending on financial circumstances of the individual, may be eligible for charity care.
Community Connection can assist in this process.
Confidentiality
Our program is strictly voluntary. All services and inquiries are confidential.
It is much less expensive in the long run to treat a patient to remission and have him return to mainstream employment than it is to have his condition recur perpetually and require government entitlements and charity care for the rest of their lives. Such an existence of pain and suffering is not necessary. It is conceivable that the otherwise treatable chronically ill will float from partial hospitalization to partial care programs indefinitely.
To facilitate the application of an optimal therapeutic treatment for the patient and provide for the state the most financially efficient operation, it is recommended that Medicaid be returned to an effective resource for the mentally ill by affording treatment in a partial hospitalization program for more than two years. Whereas partial hospitalization offers an aggressive and closely monitored treatment, partial care programs depend on the retention of this stability. It is not the mission of partial care programs to establish an effective medical treatment. Instead, they rely on the partial hospitalization programs to establish the stability necessary for the patient to glean benefit from the partial care programs, where the goal is to provide for the reintegration of the patient into mainstream society and achieve financial independence through vocational rehabilitation.