Mental health care remains a challenge

Most of the time when people don't feel well, they don't hesitate to see a doctor.

Mental health providers wish people had the same comfort level about seeking help when it comes to the services they provide.

Dawn Pappas, Jean Greseth, Heidi Brown and Shawn Anderson of the Upper Mississippi Mental Health Center (UMMHC) in Park Rapids say mental illnesses are treatable but people need to take that first step.

Perhaps, they agree, the first step isn't to make the appointment but to distinguish today's practice from myths lingering from the past.

For example, many people can be helped in one or two therapy sessions. The average is 10. "It is not true that they have to come the rest of their lives," said Pappas, clinic social worker and office coordinator.

Society still has an attitude that someone with a mental illness should pull themselves up by their own bootstraps. "That's blaming the victim," said Anderson.

Brain research has proven that much of the time there is an organic link. "The more information we get, the more we know no one chooses to have a mental illness, but we run into that bias a lot," said Greseth, a clinic supervisor and social worker.

"We also know now that child abuse affects brain development," Greseth added.

Myths about people with mental illness also may prevent them from seeking help.

The UMMHC staff shudder at the attitudes expressed when people in the Akeley area met with officials about homes opening there to take care of patients from Ah-Gwah-Ching. Most people with mental illness are no more dangerous than anyone else, they say. "In fact, they're more vulnerable to exploitation and crime," said Anderson.

Scams can seem tempting to these people, said Brown, who is also a clinical supervisor and social worker. "They think they've won the lottery."

Sometimes they meet us at the door with a stack of mail, Anderson added, or they buy things they can't afford and lose their credit. Poor credit can ripple down to problems getting an apartment - even homelessness. "It can seem overwhelming," Anderson said.

With proper intervention, treatment and medications, most people are able to work and want to work, Anderson said. "The good life isn't getting $450 a month (on Social Security disability)."

They also would rather be home than in a hospital or an institution. "It's been decades since people with mental retardation were removed from institutions," Greseth noted.

It's taken this long to recognize people with mental illness will be better off in their communities, too, she said. "It's a tremendously slow process."

Other barriers that may keep people from taking the first step are transportation and finances.

Help with the bureaucracy

Referrals to UMMHC come from physicians, friends, family, spouses, schools and social services. Some are court ordered.

The source for the referral may determine who pays. Sometimes insurance carriers will cover treatment or financial help may be available if long-term treatment is necessary.

Anyone who is eligible for Medical Assistance, including residents of Hubbard and Becker counties, may participate in a relatively new program called Adult Rehabilitative Mental Health Services (ARMHS).

Anderson coordinates seven ARMHS workers at UMMHC. They help provide skills training in areas such as preventing relapse and hospitalization, communicating with others, gaining access to community resources, accessing and arranging transportation services, finding and maintaining employment and much more.

Key to the success of ARMHS is that it takes the burden off families and friends because staff help clients navigate the bureaucracy.

"It can be exhausting for families," said Pappas, "and clients can have their own insecurity so it's nice to have somebody with them."

"Hubbard County Social Services is very supportive," Greseth said. "We all work hard to help people access services."

For instance, some clients who are eligible for the new Medicare drug benefit got steered in the wrong direction. It is difficult to know how to choose a plan since patients may have to try four or five different anti-depressants before finding one or a combination that work.

Choosing a plan can take a long time and can be frustrating, said Pappas, but staff can help. Psychiatrists and physicians can file an appeal if the coverage needs to be changed.

It is the case, Pappas and the others said, that those on MinnesotaCare were caught when mental health coverage was discontinued for counseling, but sometimes their prescriptions are covered.

Others who are among the "working poor" also may make too much for the sliding fee (co-pays based on income), but Pappas encourages people to try because counties have some money to help them access services.

Across the board services

Although clients often land at UMMHC's door with multiple problems in addition to mental illness, Pappas said she is amazed at their resiliency. "When a lot of basic needs aren't met on a day-to-day basis that causes stress too."

Greseth credits Cornerstone apartments in Park Rapids with helping people break the cycle.

Pappas said one client had been living with other people for months and months before receiving ARMHS services. Once the client had a place to live, he told her it was the first time he could sleep and get to work everyday and on time.

"People can be productively employed if there's some stability," said Pappas. "Most of the time they're wanting to have a job to feel productive."

"They almost inevitably come to that conclusion, but it can be difficult and discouraging," Anderson added.

"We're getting better at intervention and treatment medications are better," said Greseth.

According to the National Alliance on Mental Illness (NAMI), 80 percent of those suffering from bipolar disorder and 65 percent of those with major depression respond quickly to treatment.

"Newer classes of medications can better treat individuals with severe mental illnesses and with far fewer side effects," NAMI states.

"Combined with treatment, the vast majority of people recover and lead normal lives," Greseth said. "It's a lot better than it used to be even for those with what's regarded as disabling mental illness.

"No one needs to suffer needlessly," she said.

"With treatment, the prognosis is really good for the vast majority of people," Pappas added.

"A lot of people don't want to take medications, so they avoid all treatments," Pappas explained. "Sometimes just talking will work.

"We hope if you know somebody who might be eligible, there is a place to go to have their questions answered and there are services available," Pappas said.

Also on staff at UMMHC are clinical supervisors and social workers Don Turk and Deb Farrell, and Cindy Stedje, a psychiatric nurse.

UMMHC also offers chemical dependency and other services for recovery from addictions, including gambling. Additional services available are assessment, psychological testing, individual and group therapy and medications evaluation and management as well as family based services, domestic violence treatment, anger management classes and sex offender treatment.