Navigating the Mental Health System
The mental health system in Dane County is fragmented and often confusing. It is actually several systems operating side-by-side.
Sometimes they overlap, sometimes they operate in isolation from each other.
So if you're feeling adrift, having difficulty finding the services you or your loved one needs, you're not alone.
THE PRIVATE CARE SYSTEM - mainly serves those covered by health insurance or those who can afford to pay for services. It is made up of Health Maintenance Organizations (HMOs), hospitals, and care providers operating on their own.
THE PUBLIC SYSTEM is supported by government funding. For school-age children, some services are available through the school system, and you can inquire about these services from your school's psychologist or counselor. Some additional resources are listed among our resource links below.
The public adult-care system is mainly for those with the lowest resources and highest needs - those who cannot afford private care, those on disability, and those who have run into trouble with the law. Much of this care is provided through the Mental Health Center of Dane County, a nonprofit organization under contract to Dane County. The MHCDC provides some services directly and subcontracts with other nonprofit agencies for services. Unfortunately, funding of MHCDC usually falls short of meeting the demands on the agency, so it has to give highest priority to the most urgent needs. There are waiting lists for most services. The public system also includes the Madison Public Health Department and Mendota Mental Health Institute.
NONPROFIT, EDUCATIONAL, SUPPORT, AND ADVOCACY GROUPS, like NAMI (The National Alliance on Mental Illness) and NAMI Dane County offer information and free or inexpensive support services for those with mental illnesses and their families. NAMI's activities include support groups, classes and seminars, public education,and advocacy for better laws and mental health services. These groups can help you navigate the mental health system. Many non-profit support services for low-income people in general, such as emergency housing and food, may be useful to persons with a mental illness.
All of these systems are aimed at treating or supporting individuals in the community. A person in crisis may be admitted to a hospital, but area hospitals are not equipped to provide more than temporary care. Mental illness may lead to use of addicting substances such as tobacco, alcohol, or illegal drugs. The individual may rely on these substances to alleviate symptoms. But alcohol or drugs can make a mental illness worse and more difficult to treat. The illness and the addiction are best treated together, but because of the fragmentation of the health care system, this may be difficult to achieve.
CHANGING APPROACHES TO MENTAL ILLNESS
The law no longer permits individuals to be hospitalized without their consent - except in rare cases. The asylums where non-criminal patients could be committed against their will are gone. However, mentally ill individuals who get into trouble with the law may be ordered to undergo treatment or may be institutionalized for shorter or longer periods of time at Mendota Mental Health Institute. It is possible to force a mentally ill person to receive treatment if that person poses a threat to others or to themselves, but the legal requirements are fairly strict.
Treatments have changed dramatically over the last 25 years. Years ago, mental illness was widely seen to be caused by poor upbringing, family tensions, or simply lack of character. The main treatment was "talk therapy," where the patient met with a psychiatrist or psychologist over a long period and discussed his or her feelings and thoughts, childhood, family relationships, dreams, etc. The idea was to uncover and deal with the supposed underlying causes of the illness. This type of treatment often was beneficial, but could last years and was often not effective in dealing with more acute forms of mental illness. Mental illness has increasingly come to be seen as a brain disorder like other brain disorders such as Alzheimer's disease.
Like Alzheimer's, heart disease or breast cancer, it seems to have a genetic component and can crop up from generation to generation. Stress, especially traumatic stress, can sometimes trigger mental illness, but often mental illness occurs in people leading happy, ordinary lives.
The person with a mental illness has both physical and mental symptoms. For instance, depression can produce "physical" symptoms like tiredness, vague aches and pains, and loss of weight, along with "mental" symptoms like apathy, feelings of despair or anger, and inability to concentrate. |
Modern Treatments for Mental Illness
Medications developed over the past two decades can often effectively treat even severe mental illness. The most publicized medications are lithium for bipolar disorder (manic-depression) and Prozac for depression, but there are many others. A combination of medications may be needed. In some cases, electro-convulsive therapy (ECT) may be useful. Medications and ECT are not effective in all cases, and sometimes have serious side effects, but they have allowed many people to return to their daily routines.
"Talk therapy" still is important in treatment, but the emphasis these days is on helping the person develop coping skills - for example, learning how to deal with anger or fears. The most effective treatment for mental illness seems to be a combination of medication and talk therapy.
The psychiatrist (who has a medical degree) is given the role of diagnosing the illness and prescribing medication, while therapy is handled by a psychologist or social worker. The psychiatrist may see the patient only for 20 minutes once or twice a month or less often to check on how the medications are working.
Health insurance usually covers medications but often limits the amount of talk therapy it will cover. NAMI is working to expand insurance coverage for all treatment for mental illness. Research and practical experience show that exercise, good nutrition, and support from family and friends are helpful to recovery. Support groups like those offered by NAMI are very helpful for many persons with a mental illness. NAMI groups are facilitated by persons who themselves have coped with mental illness and know what group members are going through. For some individuals, meditation, prayer, and/or attending religious services can be helpful. |
The Role of Families
Family members are often on the front line in dealing with the illness, and many times find themselves confused and unprepared to cope. They need their own lines of support. NAMI provides education for family members through its free classes taught by people who themselves have dealt with mental illness in loved ones. It offers continuing support through free support groups for spouses, siblings, and parents. These are also facilitated by persons with personal experience of the challenges encountered by family members.
In addition, NAMI offers the Family to Family Education Program, a national curriculum for family members of adults with a mental illness. NAMI Dane County offers this program twice yearly. There is no charge, but pre-registration is required.
Important things you can do for a loved one with a mental illness include:
a Loving and supporting the efforts of the family member to recover. Just "being there" and holding out hope is important for recovery over the long term.
a Treating your loved one as an individual, not as an illness.
a Learning as much as you can about the illness to better understand what your loved one is going through, and what can help.
a Helping your loved one find the way through the labyrinth of the mental health system.
a Assisting in filling out various forms required for such things as applying for disability,
a Serving as an advocate for your loved one in dealing with the system.
a Keeping records of the illness, providers, medications and their effects, employment, etc. when the loved one is unable to do this.
*Where the family can afford it, providing financial assistance, housing, etc. if the ill person is unable to be self-supporting. If the loved one is this ill, he or she may be eligible for disability benefits.
*Advocating for better laws, fairer insurance, and increased funding for research into causes and treatments through organizations like NAMI.
None of this means the family must be a "punching bag" for abusive or other damaging behavior brought about by the illness. Families should set reasonable, clear boundaries for behavior in the home. Since each family's situation is different, no one set of guidelines applies to all. |
Resources
Consumers of mental health services and their families have a variety of needs. We hope this resource guide can help you in finding assistance. A valuable source of information is United Way 2-1-1. Simply dial 211. (608-246-4357 from outside Dane County or from a cell phone.) United Way can help guide you to appropriate resources.
Much of this information has been drawn from directories prepared by United Way of Dane County, the Madison Ecumenical Center of Church Women United in Madison, the Arc-Dane County, and the Dane County Bar Association. NAMI Dane County is grateful for their assistance. We strive to be accurate but cannot be responsible for mistakes or outdated information.
If you find mistakes or know of other resources you feel should be listed, please contact NAMI Dane County at 249-7188 or namidane@chorus.net. |
|
|