Co-Occurring Disorders and Behavioral Health Services

Co-Occurring Disorders and Behavioral Health ServicesJasmina VuksanovicCo-Occurring Disorders and Behavioral Health ServicesCo- fadering pains exist when at least sensation and only(a) 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 two or more psychiatric disorders.2 Depending on the disorders involved, comorbidity whitethorn be homotypic, which involves disorders from the same diagnostic group, such as intoxicant use and drug use, or heterotypic, which involves disorders from different diagnostic groups, such as alcohol use and first gear.2Prevalence and Demographic FactorsMajor depressive disorder (MDD) is one of the most prevalent psychological disorders in the United States, affecting approximately 6.7% of U.S adults each year.3 Alcohol use disorder (AUD), defined as twain 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.4Although research has not established a definitive etiological jeopardy factor for both(prenominal) MDD and AUD, there be several proposed theories as to the association between these two disorders. Studies have shown that depressive symptoms may erupt during periods of heavy drinking and withdrawal.5 Continued heavy alcohol use may be a precursor to stressful liveness events, which in turn increases the risk of depressive disorder.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 world, alcohol dependent men have a 24.3% lifetime prevalence of study 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 and MDD is also associated with increased morbidity, mortality, functional impairment, and risk of suicide.6Another co-occurring disorder of interest is schizophrenia and substance use disorder. Schizophrenia is a chronic complaint associated with hallucinations and disorganized behavior, while the most common substances of exclaim 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 sermon, increased risk of HIV, higher hospitalization rates, are more prone to rampageous behavior, and are more likely to commit suicide.7 Schizophrenia runs in the family. If one parent has schiz ophrenia, 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.8Service Delivery Barriers and Strategies to Overcome These BarriersThe fragmented wellness deal system poses a huge barricade for individuals seeking grapple for co-occurring disorders. Due to this fragmentation, patients are not able to receive comprehensive and coordinated care for addiction services and cordial health care. Of those struggling with co-occurring disorders, 8.5 % of individuals receive discourse for both disorders 38.4 % receive treatment for one or the other disorder and 53 % receive no treatment at all.1 One outline for overcoming this barrier is by integrating intellectual and somatic 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 intimately-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 thought 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 old have access to mental health services in the principal(a) care setting. Increasing the scope of practice for clinical staff may be a feasible strategy for overcoming this barrier.Implications for Behavioral HealthThroughout this course we have learned that organizational leaders and clinical staff must butt a certain level of commitment to providing quality care in order to in effect(p)ly treat dually diagnosed individuals. As we see look at accountable Care Organizations, the benefits of coordinated care become even more appa rent. The ACA shifts the focus to evidence-based practices, which leave 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 deplorable from to ensure correct and effective treatment is received. Service delivery can be expected to improve with an increase in more educated clinical staff. Clinicians 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 melodic theme of mental health, there will continue to be hesitation by mentally ill individuals to seek treatment. As a society, we must take the inevitable steps and encourage help seeking by those suffering from a mental illness.ReferencesLevin BL, Hennessy KD, Petrila J (Eds.). psychic Health Services A Public HealthPerspective, thirdly Edition.New York Oxford University Press 2010.Falk D, Yi H, Hiller-Sturmhofel S. An epidemiologic analysis of co-occurring alcohol anddrug use and disorders. Alcohol Research Health. 2008 31(2) 100-110.National Institute of Mental Health. Available online athttp//www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed February 19 2014.National Institute on Alcohol Abuse and Alcoholism. Available online athttp//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 amongindividuals with alcohol use disorders. Journal of bosom Abuse Treatment. 2009 37 127-137.Riper H, Andersson G, Hunter SB, et al. Treatment of comorbid alcohol us e disorders anddepression with cognitive-behavioural therapy and motivational interviewing a meta-analysis. Addiction. 2013 109 394406.Green AI, Noordsy DL, Brunette MF, et al. Substance abuse and schizophreniaPharmacotherapeutic intervention. Journal of Substance Abuse Treatment. 2008 34 61 71.National Institute of Mental Health. Available online athttp//www.nimh.nih.gov/health/topics/schizophrenia/index.shtml. Accessed February 19 2014.QUESTION 3Is 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 ruin 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), schizophren ia (14th), and substance abuse disorders (20th).2Compared 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 nations 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 nations unexclusive health system.The public health system encompasses a broad array of topics, which creates opportunities for desegregation 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 share-out of info rmation among health care providers.3Traditionally, 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 hospitalization rates, i npatient days, emergency room use, and medical costs.3One example of an integrated health care delivery system is the Veterans Health Administration, the nations 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 compound 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 a nd therefore do not get the mental health treatment, 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 patients 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 HealthMental illness affects a significant proportion of the U.S. population and the importance of efficient treatment cannot be understated. Integrating me ntal 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, interlingual rendition 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 birth control device 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 mental health services and treatment has rock-bottom 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 vivacious barriers between the mental and physical health care delivery sectors.ReferencesLevin 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 HealthPerspective, Third Edition.New York Oxford University Press 2010.Zeiss AM, Karlin BE. Integrating mental health and primary care services in the Department ofVeterans Affairs health care system. Journal of Clinical Psychology in Medical Settings. 2008 157378.