Mental health success starts with early intervention
It took hitting rock bottom before James Carpenter knew he needed long-term professional help with his mental illness.
He was charged with a misdemeanor in June 2007 and faced possible legal punishment. But there was another option: try to graduate from the 22nd Judicial Circuit of McHenry County Mental Health Court.
“Things were pretty bad for me, and my mental health symptoms were overwhelming,” said Carpenter, 34, who declined to elaborate on his condition. “Something had to be done. I knew it would benefit my life and get things going in a positive direction.”
He completed the program designed for nonviolent defendants with a mental illness in less than two years, and prosecutors dropped the charge. He underwent social and rehabilitation at Pioneer Center for Human Services, as well as vocational training programs. He now helps others as a recovery specialist at Pioneer Center.
Despite declining state funding and what pending health care reform will mean for their agencies, area service providers agree that mental health success stories such as Carpenter’s are common.
Their top priority, they said, is to find ways to provide solutions and push early intervention, because professionals say it is the most important step in coping with mental illness.
Area service providers work with parents and local schools to identify the signs of mental health problems in children as early as possible.
At the McHenry location of the Rosecrance Health Network, staff members teach parents the proper ways to handle mentally ill children.
“It is easier to work with the family to help monitor or change expectations,” Director Chris Gleason said. “It’s hard to reason with a young child, and parents need to realize every situation is different.”
More group situations are introduced, often around age 8, that can include teaching social skills, such as how to react with peers and family.
“There is no lightswitch solution to this issue,” said Rick Kirchoff, president of the National Alliance on Mental Illness in McHenry County. “The earlier someone seeks care, the quicker they’re going to realize the success of treatment, and the more successful treatment will be.”
State funding cuts mean early intervention programs for children younger than 5 no longer exist at Pioneer Center. It instead runs school-based prevention programs, where staff educate students and teachers about what they can do and existing resources.
“Students and teachers have to know what the problem is and learn how to handle certain situations,” said Ronica Patel, director of behavioral health at Pioneer Center. “They need to know it’s OK to ask for help.”
The in-between years
For mentally ill teenagers, the focus shifts to teaching specific strategies targeted at handling certain situations, Gleason said, including educating about warning signs and suggesting possible behavioral changes.
That includes cognitive behavioral therapies that help them break situations down, he said, and involves coaching and real-life scenarios. It also includes taking what the client does well and incorporating it elsewhere. Medication also may be prescribed.
“Their environments are enforced by so many different factors,” Gleason said. “We spend a lot of time on where their mental health symptoms are presenting the most and try to intervene.”
At Pioneer Center, more traditional therapies are used as patients get older, such as crisis management or weekly outpatient visits.
Residential care is offered in five group homes, which also includes work with the homeless.
“We use the group homes to teach them how to live independently,” Patel said. “We find that a lot of the homeless people struggle with mental illness. That needs to be dealt with first.”
Treating adults with mental illness is similar to treating adolescents – the major difference being that they’ve already been through more, Gleason said.
As patients get older, Gleason said, a combination of treatments, such as medication and therapy, often work best. Therapy, for instance, can become not just talking about what’s going on, but how a person interacts outside of therapy.
Pioneer Center focuses on target-specific services, helping adults manage symptoms to become more functional.
“We usually see a drop in clients once they reach 22 years old because they feel they can manage the symptoms, and then they come back around age 30 because they couldn’t maintain,” Patel said. “They just aren’t used to being on their own.”
Pioneer is also in the midst of changing its philosophy to provide services in the community, instead of always at its facility.
“The more clients are exposed to the real world, the better they will be able to deal with their mental illness,” Patel said.
Those struggling with mental illness who are in trouble with the law also have options to seek help, including McHenry County Mental Health Court.
Since its inception in 2007, 117 defendants have been accepted into the program and 47 have graduated. Of those 47, seven have committed crimes again. There were 40 active participants as of May.
Each participant is assigned a team of a clinician, a nurse and a probation officer, as well as a mental health professional, that completes an assessment of the defendant and creates a treatment plan approved by a judge.
The individual has to meet the detailed requirements and attend required court appearances to update the judge on how well he or she is doing.
“It’s a community solution to a community problem,” said Scott Block, Mental Health Court coordinator. “It’s like bowling with bumpers; the team serves as the bumpers and by the time you are done, you won’t need them anymore because you will be able to do it on your own.”
Judge Gordon Weech has presided over the Mental Health Court since its inception. The program provides options for nonviolent offenders with a mental illness who could previously be sentenced to only jail or probation.
“It wouldn’t be long until we would see them again,” Weech said. “Now, once they get treatment, we give them the tools to understand their illness better and provide them with resources to make the right decisions once they are out.”
While solutions exist, a lack of funding and looming health care reform remain major hurdles to providing them.
Millions in state funding for mental health services have been slashed in recent years, and the money provided to local agencies usually is delayed, causing them to do more with less.
The budget for the state fiscal year that starts July 1 was held flat compared with the previous year, said Judith Gethner, executive director of Illinois Partners for Human Service.
“There is a real feeling of relief and reprieve for what could have been,” Gethner said.
But the celebration is fleeting. Lawmakers cannot count on the surge in state revenue that happened in April that provided the state an extra $1.5 billion, and know the budget will be reduced by $5 billion to $6 billion when an income-tax increase is scheduled to expire in January 2015.
Legislators’ continued inability to reform the state’s pension systems, which have a $97 billion unfunded liability that grows by $17 million a day, doesn’t help, either.
“If there is an increase in pension obligation, no reform could increase liability next year,” Gethner said. “On top of a tax increase going away and no windfall, we are walking into a perfect storm for next year’s budget.”
Federal health care reform will implement a managed-care model in 2014, opening the door for hundreds of thousands of Medicaid recipients to receive mental health and substance abuse services.
The Affordable Care Act also will require more insurance companies and organizations to cover mental health services, and also requires another portion of the public to buy health care coverage.
“More people than ever will have health insurance to cover their [mental health] issues,” Gethner said. “There are a lot of exciting things happening, and there will be multiple payment models for these agencies that they have never seen before, opening up a whole new slew of clients to treat.”
“We are hoping [these changes] open up a whole new population that is eligible for service,” Patel said. “That will allow more clients in the fee-for-service model.”
Area service providers say targeting specific care and not depending on one revenue stream is the best practice when it comes to providing services.
“Unfortunately, I don’t think we’re in the position where we have unlimited resources, but we have to be cautious not to fall into the fallacy that money will solve everything, either,” Schroll said.
“What we have to do is to prioritize care,” he said. “We believe at times, that care will be limited. We promote the use of evidence-based and evidenced-informed practices.”