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Career Prospects in Community-based Mental Health in Maryland

Filed Under : Mental Health by Health and Beauty
Sep.9,2011

Career Prospects in Community-based Mental Health in Maryland

There is a lot of prospect in community-based mental health careers both in the state of Maryland and all over the country. This is because for years now, there has been a lot of emphasis on prevention and reduction of inpatient hospitalization for all illnesses, including mental illness. This might primarily have been intended for cost control, it has also facilitated quality and access. The second reason why career prospects in community mental health are many is that there is currently a severe shortage of mental health workers in all sectors. The 2007 Maryland Mental Health Workforce White Paper revealed that the number and complexity of mental health problems experienced by children and their families have increased over the past decade. It further said, “At least one in five children and youth, or 20%, experience a mental health disorder. The crisis of mental health in the United States is such that 75-80% of youth with mental health diagnoses receive no services, and services received are often inadequate”. Thirdly, there is inadequate diversity among the few mental health workforce. For example, 28% of Maryland population is of ethnic minority but only 12% of mental workforce is of ethnic minorities. Furthermore, there is an acute shortage of African American males in mental health workforce.

Outpatient mental health clinics provide therapy, counseling, medication management, social skills teaching, and case management services to individuals with severe and chronic mental health problems. Career prospects available in OMHC include:

Therapists and Counselors: New regulations require therapists and counselors in OMHC to have a minimum of a Masters degree and a license (such as LGSW, LCSW, LCSW-C, LGPC, LCPC, RNC, APRN/PMHN) in nursing, social work, psychology, counseling, or psychiatric rehabilitation. Also, an RN without a Masters degree but with an RNC from ANCC can be employed as a therapist. Salaries are very attractive.

PRP programs are an extension of the services provided to the patient in the OMHC. A PRP may stand alone or be an additional service to an OMHC. The purpose of PRP is to promote the rehabilitation, integration and improved quality of life for the patient at home, school, work and community. It aims at helping the patient to function at his or her optimum best in life. The counseling can be done at the Program office (onsite) or at the patient’s home (offsite). PRP counseling could be about a wide range of topics, including anger management skills, social skills, assertiveness skills, medication compliance, coping with symptoms, managing peer pressure, taking a bus, determining bus route, drug and alcohol, gang prevention, sex education, STD education, accessing community resources such as food stamps, affordable housing, bus pass, ID card, driver’s license, job search, preparing for job interview, keeping a job, improving attention in school, completing homework and school projects, respect of authority, etc.

Even though a mere one-year work experience in a mental health setting or having an AA degree qualifies one to be a PRP counselor, PRP programs prefer to employ persons with a BS degree in any health or mental health related field such as nursing, social work, counseling, psychology and rehabilitation. PRP counselors are usually paid or more per counseling session. Each client receives 2 to 8 counseling sessions per month.

In addition to the school clinic, some schools also have an ESBMH clinic. A therapist assigned from an OMHC manages each of such clinics. Apart from providing therapy to troubled kids sent to the therapist’s office from the class or principal’s office, the therapist also serve as a resource person to the school staff regarding particular children, issues or topics related to mental health.

is a mobile crisis response service that provides emergency contact with mental health professionals throughout the city. Dedicated crisis clinicians staff the program as part of a continuum of clinical care provided by the Catholic Charities. The Johns Hopkins Division of Child and Adolescent Psychiatry provide psychiatric consultations to the program. BCARS assists children and families facing psychiatric and psychosocial crises by providing hospital diversion and immediate intervention and respite. For information or assistance, please call the BCARS hotline (. It is available 24-7.

web site provided the following information: about what they do:

HOTLINE: The telephone crisis “hotline” ( is available 24 hours a day and is staffed by trained counselors who have the ability to provide information and referral to the network of human services in the Baltimore metropolitan area. The counselors also provide supportive counseling, dispatch emergency assistance and link callers with more intensive BCRI services. In FY 2004 – 34,852 and FY 2005 – 30,257 calls were received on the Hotline.

MOBILE CRISIS TEAMS: Mobile crisis teams are comprised of mental health professionals including psychiatrists, social workers and nurses who can be dispatched to community locations to provide immediate assessment, intervention and treatment. Teams operate from 7:00am till midnight seven days per week. Currently the teams average over 2000 responses per year.

IN HOME SUPPORT: Persons experiencing a mental health crisis can often be maintained in the community through regular visits from the BCRI mobile crisis teams. An average of 350 people a year is cared for in this manner.

RESIDENTIAL CRISIS BEDS: Baltimore Crisis Response, Inc. operates 18 psychiatric crisis beds. Crisis beds are not new to Maryland. However, since its inception, BCRI has operated with an average length of stay of 4.5 days compared with the historical statewide average of 16.5 days.

PUBLIC EDUCATION AND TRAINING: BCRI provide public and professional education and training on a wide range of mental health related topics including: suicide prevention, crisis intervention, mental illness, and stigma. Training has also been provided to members of the Baltimore City Police Negotiation Team, over 3,000 patrol officers, Housing Police and Sheriff’s officers. Through special grants and contracts, BCRI has provided training to Baltimore City Public School teachers and guidance counselors, clergy, 911 operators, shelter care staff and others. Public education is also provided via a cable television program called “Mental Health Matters”. This program provides practical information regarding mental health issues and community resources. BCRI has also offered professional training conferences, workshops and symposia.

ADDICTIONS SERVICES: In response to the growing need for addictions treatment services BCRI has expanded and now provides a 10-day residential detoxification program for chemically addicted and dually diagnosed persons. There are currently 16 beds operated for this purpose.

Direct care staff and counselors are needed in group homes to manage, care and support the residents in the areas of activities of daily living, behavior management, life progress, and community living. Employment preference is usually given to individuals who have a degree related to health or mental health. Salary rates are very attractive. New regulations now mandate each group home especially for children to be managed by a Program Administrator (PA) who must possess at least a BS degree in any field but preferably in a health or mental health related field. Program Administrators are very well paid, depending on their education and experience and the size and intensity of the group home.

There are a lot of prospects for licensed mental health professionals with at least a Masters degree to establish their own private practice. The practice could be in the area of clinical, research, educational, or consultancy.

Dr. Samson Omotosho has worked as a professor of nursing in many universities in Nigeria and the US for more than 30 years. He is currently a psychiatric nurse practitioner and the director of Optimum Health Systems, Inc., an outpatient mental health clinic and psyciatric rehabilitation program.

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11 Points for Mental Health Care Reform

Filed Under : Mental Health by Health and Beauty
Aug.28,2011

11 Points for Mental Health Care Reform

Due to greater understanding of how many Americans live with and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges Mental health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform. .

: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients .

: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental health and substance use performance measures that will be used to improve delivery of mental health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

: Federal and state HIT initiatives need to reflect the importance of mental health and substance use services and include mental health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

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Mental Health Therapies and Characteristics

Filed Under : Mental Health by Health and Beauty
Aug.22,2011

Mental Health Therapies and Characteristics

Introduction

Mental health’ properly describes a sense of well-being: the capacity to live in a resourceful and fulfilling manner, having the resilience to deal with the challenges and obstacles which life presents. Mental health ‘problems’ or ‘difficulties’ are terms that can be used to describe temporary reactions to a painful event, stress or external pressures, or systems of drug or alcohol use, lack of sleep or physical illness; this terminology may also be used to describe long-term psychiatric conditions which may have siginificant effects on an individual’s functioning.

Mental health is more than just the absence of mental illness. It includes how you feel about yourself and how you adjust to life events. However, the National Mental Health Association cites 10 characteristics of people who are mentally healthy.

Therapies

Couples Counseling and Family Therapy: These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness-such as how to deal with feelings of anger or guilt.

Cognitive therapy or cognitive behavioural therapy: Based on the fact that the way we feel is partly dependent on the way we think about events (cognition). It also stresses the importance of behaving in ways which challenge negative thoughts – for example being active to challenge feelings of hopelessness. Although it may sound like common sense, CBT is more than just positive thinking. Research suggests that it can be effective for people with both severe and moderate depression.

Psychotherapy-is the general term for an interaction in which a trained professional, usually a therapist or analyst, tries to help a patient by following a certain psychological theory or school of thought, to address problems based on emotional suffering, behavioral problems, or a disorder. Through a bond of trust that is developed between therapist and patient, the patient can achieve goals in therapy, such as the elimination of negative behavior and an improvement in well-being.

Body-mind therapy combines the strengths of “talk” therapy with bodywork, such as touch, postural alignment, or exercises to increase body awareness. Also known as mind-body or somatic therapy, it helps people “become deeply aware of their bodily sensations as well as their emotions, images and behavior. Clients become more conscious of how they breathe, move, speak, and where they experience feelings in their bodies.” This increased awareness about how the body holds physical stress and emotional injury informs and directs the therapy process, allowing clients to work through patterns of limitation that are not often resolved on the level of the mind alone.

Characteristics

They feel good about themselves.

They do not become overwhelmed by emotions, such as fear, anger, love, jealousy, guilt, or anxiety.

They feel comfortable with other people.

The ability to enjoy life

Flexibility

Self-actualization

They have lasting and satisfying personal relationships.

They feel comfortable within himself about them.

They like people and trusts them and expects them to like and trust him.

They face their problems; shape their environment.

They do not fear the future, but plan ahead, setting realistic goals.

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Nine Recommendations to Increase Continuity of Mental Health Care for Schizophrenia Patients

Filed Under : Mental Health by Health and Beauty
Aug.16,2011

Nine Recommendations to Increase Continuity of Mental Health Care for Schizophrenia Patients

Continuity of therapy is a vital component of quality care for people with serious mental illnesses and must be given more attention by consumers themselves, family members, advocates, providers, administrators, and researchers alike. At the moment, there is an important opportunity to develop a national consensus statement on the principles and practice standards that should form the basis of a continuum of therapy designed to provide realistic assurance that consumers can access vital medications when and where they are needed. Important strides have been made in identifying the specific factors which promote continuity of therapy – it is time to seize this important opportunity as yet another stepping stone to achieving the transformation of America’s mental health care system for the benefit of consumers and their families, our communities, and our Nation. A roundtable of mental health experts has developed a set of nine recommendations for enhancing continuity of medication therapy for persons with schizophrenia or serious mental illness, including schizophrenia. They are as follows:

Encourage collaborations between hospitals and community-based organizations. Use fiscal incentives to foster collaborations including the standardization of information and shared electronic health records.

Use a quality improvement approach to enhance continuity of therapy by benchmarking at the organizational level performance and outcomes standards regarding continuity of care.

Ensure all consumers have a level of care management for the transition from inpatient to community. Care management services should be reimbursable by all payers and the disincentives to providing it should be removed.

Hospitals and community providers should focus on the “Pull Model” of transition from inpatient to outpatient care. The Pull Model focuses on involving community-based providers in the transition planning process from the beginning. Provider organizations should focus on staff competency in engagement and strategies and motivational interviewing.

Accreditation standards should be aligned to address and improve continuity of therapy in treating serious mental illness. This may include developing standards to ensure evidence of an active process of care management and transition between levels of care, a quality review of the success of transition plans, and measuring engagement.

Consumers and their families should be educated about the benefits of maintaining their personal health care history. Ensuring that consumers have detailed information about their illnesses and treatment history will help ensure that providers have access to the information they need to provide appropriate care in a timely manner. The options here range from simple paper and pencil logs and medication histories to electronic records on memory sticks.

Consumer-driven recovery planning should include and the appropriate and necessary use of hospitalization. More thoughtful use of inpatient services could lead to a reduction in emergency room use and ultimately to a decrease in the number of hospitalizations.

Parties who collect data about mental health services and performance should share it with appropriate stakeholders in usable and timely ways. Many payers and public entities collect both population and individual specific information about mental health consumers and services. Population-based data should be shared with all stakeholders, including families and consumers to aid in enhancing the system of care.

There should be meaningful involvement of consumers and their advocates in all levels of system delivery and evaluation. Global involvement of consumers and their advocates in the care delivery process is essential. Examples include using peer specialists as part of a treatment team, active involvement in policy and planning, as well as involvement in developing and implementing performance measurement and evaluation.

While we have learned that maintaining continuity of therapy has a positive impact on consumer outcomes, the barriers and other impediments to ensuring this continuum of care have been long entrenched in mental health and related care systems. An unacceptably high number of people with serious psychiatric issues – including schizophrenia, depression and bipolar disorder – are “falling between the cracks” in the transition between acute inpatient settings and the community causing harm and disruption in their own lives and those of their families and often bringing their recovery process to a halt.

A continuity of therapy initiative is likely to decrease inappropriate use of emergency room services by consumers with schizophrenia or other serious mental illnesses by assuring consistency in the disease management approach used by all community provider organizations. Both of these likely outcomes of continuity of therapy provide cost reductions for the hospital and cost offset for the investments in continuity of therapy initiative and related therapies.

In addition, the continuity of therapy initiative provides the community hospital with another very tangible benefit. The continuity of therapy initiative provides the relationships, process, and infrastructure for an overall discharge planning functionality for all consumers with mental illnesses. This discharge planning functionality is a new, and critical, element in modern behavioral health standards that began in 2007.

Linda Rosenberg is the president and CEO of the National Council for Community Behavioral Healthcare. TNC specializes in lobbying for research toward the diagnosis and treatment of mental illnesses. Lean more at www.thenationalcouncil.org.

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