Co-Occurring Disorders and Behavioral Health Services

Co-Occurring Dis clubhouses and Behavioral wellness ServicesJasmina VuksanovicCo-Occurring Disorders and Behavioral wellness ServicesCo-occurring disorders exist when at least one disorder of apiece type place be established independent of the other and is non simply a cluster of symptoms resulting from a single disorder.1 It has excessively been specify as the co-occurrence of two or to a greater extent psychiatrical disorders.2 Depending on the disorders involved, comorbidity may be homotypic, which involves disorders from the same symptomatic group, such as alcohol drop and drug use, or heterotypic, which involves disorders from different diagnostic groups, such as alcohol use and depression.2Prevalence and Demographic Factors major(ip) depressive disorder (MDD) is one of the most prevalent kind disorders in the joined States, affecting approximately 6.7% of U.S adults each(prenominal) year.3 alcoholic beverage use disorder (AUD), defined as both alcoholism and harmfu l drinking, is also prevalent in the United States and often co-occurs with MDD. AUD affects approximately 17 m sinisterion Americans each year.4Although seek has not established a definitive etiological pretend cistron for both MDD and AUD, at that place atomic number 18 several proposed theories as to the association betwixt these two disorders. Studies have shown that depressive symptoms may emerge during periods of heavy drinking and withdrawal.5 continue heavy alcohol use may be a precursor to stressful emotional state events, which in turn increases the attempt of depression.5 Conversely, individuals battling depression atomic number 18 credibly to drink heavily in order to cope with the depression, which in turn increases the stake of ontogeny AUD.5 Among those with AUD, women have higher depression than men, as do Whites, comp bed to racial and/or ethnic minorities.5 In the general existence, alcohol dependent men have a 24.3% lifetime preponderance of major de pression, whereas alcohol dependent women have a 48.5% lifetime prevalence of major depression.5 In clinical samples, the lifetime range 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(prenominal) co-occurring disorder of interest is dementia praecox and gist use disorder. Schizophrenia is a chronic illness associated with halluci peoples and disorganized behavior, while the most common affections of ill-usage be alcohol, cannabis, and cocaine.1 Schizophrenia affects approximately 1% of Americans, and approximately 50% of individuals diagnosed with schizophrenic psychosis also suffer from a co-occurring substance use disorder.7 When compared to individuals who suffer from schizophrenic psychosis only, dually diagnosed individuals have lower adherence to intervention, increased risk of HIV, higher hospitalization rate, are more prone to violent behavior, and are more seeming to commit suicide.7 Schizophrenia runs in the family. If one parent has schizophrenia, 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 mother between the ages of 16 and 30 and does not commonly occur in children or adults sr. 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 abrupt wellness do dodging poses a huge barrier for individuals quest trouble for co-occurring disorders. Due to this fragmentation, patients are not able to bugger off encompassing and coordinated handle for addiction operate and cordial wellness manage. Of those attempt with co-occurring diso rders, 8.5 % of individuals receive treatment for both disorders 38.4 % receive treatment for one or the other disorder and 53 % receive no treatment at all.1 One strategy for overcoming this barrier is by integrating rational and physical health anguish delivery. Combining moral and physical health funds to pay for services would not only increase approaching to coordinated thrill, but it would streamline the coding and billing process finished the use of common codes. It would also wee a network of psychical and physical health providers, who would all be responsible for well-being of each patient, thus encouraging coordinated oversee.A second barrier is the mark associated with psychic illness, which impedes help seeking. This barrier can be combated by educating patients nigh the resources lendable for treatment and the overall importance of a healthy mind and body. Businesses should do more to educate employees about mental health benefits, as many may not b e 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 ternary barrier is one that is faced by Medicare patients as same twenty-four hour period 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, constitution changes should be made to ensure the elderly have access to mental health services in the uncomplicated care setting. Increasing the grasp of practice for clinical staff may be a practicable strategy for overcoming this barrier.Implications for Behavioral Health throughout this course we have acquire that organizational leaders and clinical staff moldiness exhibit a certain level of commitment to providin g quality care in order to effectively treat dually diagnosed individuals. As we see look at accountable Care Organizations, the benefits of coordinated care become even more apparent. The ACA shifts the decoct to evidence-based practices, which will become integral for more effective treatment and forward motion in service delivery of co-occurring disorders. Adequate screening methods and health sound judgements by primary care providers are the first step in the treatment and recovery process1 and will undoubtedly lead to better detection rates and treatment of dually diagnosed individuals. It is essential for clinicians to understand the epidemiology of all disorders a person is distress from to ensure correct and effective treatment is received. Service delivery can be expected to improve with an increase in more intimate clinical staff. Clinicians must be knowledgeable about possible interaction of the two disorders and how both can be treated, rather than just one. Howev er, as long as stigma continues to surround the topic of mental health, there will continue to be hesitation by mentally ill individuals to seek treatment. As a society, we must take the necessary travel and encourage help seeking by those suffering from a mental illness.ReferencesLevin BL, Hennessy KD, Petrila J (Eds.). rational Health Services A Public HealthPerspective, terce 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 intellectual Health. functional online athttp//www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed February 19 2014.National Institute on Alcohol call out 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 depressi on and substance use amongindividuals with alcohol use disorders. journal of content Abuse Treatment. 2009 37 127-137.Riper H, Andersson G, Hunter SB, et al. Treatment of comorbid alcohol use 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 induct of disability.1 Mental illness also bears a heavy burned on the global economy. The WHO estimates that 14% of the global disease burd en 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), schizophrenia (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 public health system.The public health system encompasses a broad array of topics, which creates opportunities for integration of mental health services through and through community education, epidemiologic surveys, h ealth screening and assessment, ensuring adequate access to care, identifying risk factors and determinants of health, focusing on prevention and early intervention, and promoting sharing of training 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, coordinated care leads to lower hospitalization rates, inpatient 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 identify 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, curiously in older patients who may have other health conditions.4 integrate 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 decipher through with the referral and 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 diminution 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 economic treatment cannot be understated. Integrating mental health services into the tralatitious 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, reading 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 preventive 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 ment al health facilities and organizations providing mental health services and treatment has decreased 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 exist barriers between the mental and physical health care delivery sectors.ReferencesLevin BL. hebdomad 3 chatter 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.