Moving Mountains in Mental Health

by Liz Scoville

Increased public awareness has reshaped the way society deals with mental health, erasing stigmas and opening doors to new treatment methods.

One in five U.S. adults—nearly 44 million people—will experience a mental illness in any given year, reports the National Alliance on Mental Illness (NAMI), while nearly 10 million Americans live with a serious mental illness. It’s an issue affecting children and adults alike—regardless of culture, race, ethnicity, gender or sexual orientation—and it comes with serious consequences, including increased rates of homelessness, incarceration, drug abuse, suicide and disease. It’s also responsible for an estimated $193.2 billion in lost earnings every year, according to a report from The American Journal of Psychiatry and the U.S. Surgeon General.

Despite these numbers—and lingering stigmas surrounding the issue—great strides have been made in recent years. With public awareness on the rise, policymakers at the local, state and federal levels have begun to treat mental illness as a primary concern of public health. From the criminal justice system to the U.S. Congress, the nation is witnessing a dramatic shift in its approach to mental health issues.

Mental Health and Addiction
Addiction in its many forms, whether substance abuse or behavioral in nature, is rapidly gaining traction as a significant health concern requiring psychological treatment. Not only are addictive disorders dangerous on their own, there is often comorbidity (multiple health conditions occurring concurrently) between addiction and other mental illnesses. More than 10 million U.S. adults have comorbid mental health and addiction disorders, creating a vicious downward spiral as the entwined conditions reinforce one another, says Dr. Kirk Moberg, Medical Director of the Illinois Institute for Addiction Recovery at UnityPoint Health – Proctor.

“They both have to be treated,” he explains, citing the example of alcohol addiction and comorbid depression. “If the addiction isn’t treated, the alcohol will continue to result in depressive symptoms. If the depression isn’t treated, the depressive symptoms will be a trigger for relapse for the alcohol. So they have to be isolated and treated separately.” Meanwhile, long-time stigmas and misunderstanding surrounding addictive disorders remain battles to be won. Those who observe addiction—rather than experience it directly—often don’t understand that it is a legitimate, challenging disease. “A lot of people believe that addicts are just an immoral bunch of people, and if they just would ‘get right,’ they would be fine,” Dr. Moberg notes. “Or that they’re weak… and if they would just put their fist down and say ‘I’m not going to drink again’ or ‘I’m not going to use again,’ then that’s all there is to it… When you’ve got 90 percent [of people] who can go to a restaurant, drink a glass of wine and not order a second one—or put the drink down when they feel they’ve had enough—they have a hard time understanding why the other 10 percent just can’t do that.”

Fortunately, the tide appears to be shifting. A number of addiction disorders were newly recognized in the American Psychiatric Association’s latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)—the authoritative source for psychiatric diagnoses in the U.S.—while efforts both locally and nationally have arisen to tackle the dramatic rise in heroin and opioid abuse.

Last year, for example, Peoria Mayor Jim Ardis launched the Mayor’s Community Coalition Against Heroin with a series of public discussions to educate the community and brainstorm strategies to deal with local addiction trends. At the national level, Rep. Tim Murphy of Pennsylvania—a licensed clinical psychologist—is spearheading efforts to pass new mental health legislation, while Peoria Rep. Darin LaHood, a long-time mental health advocate, recently participated in roundtables on the importance of legislation targeting substance abuse treatment and recovery.

The widespread recognition of addiction as a serious mental disease has been pivotal in sparking progress, says Dr. Moberg. “There is a community interest in addiction, where there hasn’t been in the past. I think the heroin overdose crisis and the prescription opioid overdose crisis have really mobilized the country.”

Mental Health and the Justice System
Nearly one in four state prisoners has a recent history of a mental health condition, according to NAMI. In the juvenile justice system, 70 percent of incarcerated youth have at least one mental health condition, while 20 percent have a serious mental illness. In fact, the largest mental health hospital in the country isn’t a medical facility at all—it’s the Cook County Jail. According to the Cook County Office of Mental Health Policy and Advocacy, the majority of these inmates were imprisoned for nonviolent offenses closely associated with their mental health issues, and would be far better served by treatment rather than incarceration.

“Some people become very symptomatic and end up having contact with the law,” explains Mike Kennedy, president and CEO of Peoria’s Human Service Center. “They do something that is criminal in nature, and the police don't have a better option, so they take them to jail. Jail unto itself is not particularly rehabilitating; its intent is to protect society. But a lot of individuals who are incarcerated are there because there are not positive alternatives for them."

The high rate of inmates with mental illness, alarming on its own, is exacerbated by the fact that most never gain access to the treatment they need. Fortunately, government and social service organizations are taking note. The Human Service Center, for example, works with the Federal Bureau of Prisons to assist former inmates transitioning back into the general population, offering outpatient treatment for mental health and substance abuse issues as a condition of release.

In the public sector, specialized mental health courts allow jailed individuals to redeem their criminal behavior by participating in mental health treatment programs. The Peoria County Mental Health Court has provided this service since 2010, while Tazewell County opened its own Mental Health Court in December 2016. With additional alternatives to incarceration, Kennedy hopes more people can receive the treatment they need to get back on their feet—and stay out of the criminal justice system for good: “because if they don’t… more than likely they’re going to go back [to prison] again.”

Enhancing Local Resources
Despite greater awareness of mental health issues and better resources for treatment, there remains a significant shortage of mental health professionals across the country. The U.S. Health Resources and Services Administration has declared more than 4,600 Health Professional Shortage Areas—a term encompassing medical and public facilities, population groups and geographic areas—as deficient in mental health resources, including nearly three dozen in Greater Peoria and its surrounding counties.

To tackle this concern, local organizations are looking for ways to provide the necessary services. The University of Illinois College of Medicine at Peoria (UICOMP), for example, started a residency program in 2011 to train medical residents on mental health specialties, preparing them for a career track in psychology, psychiatry or related disciplines.

Dr. Ryan Finkenbine, chair of the Department of Psychiatry and Behavioral Medicine at UICOMP, says these efforts prepare healthcare professionals to better communicate with patients and educate the community at large, revealing resources that may have been untapped due to perceived stigmas or apprehension about seeking help. “We teach the residents to respect individual preferences, rights and privacy,” he notes. “At the same time, we sometimes will encourage them to share this problem, not to combat stigma directly, but rather to help them… have the resources around them—family [and] community, rallying around them.”

Elsewhere, UnityPoint Health – Peoria, which offers the widest range of mental health and addiction services in the region, recently announced additional new investments in its facilities and programs. In 2017, the health system will embark on a multi-year, multimillion-dollar program to increase capacity and expand programming. The Child and Adolescent Behavioral Health Center will undergo a redesign to provide a more comfortable environment for patients and their families, while the concept of a telehealth psychiatry program is being explored to provide access to those without local mental health resources, such as residents of rural areas.

In addition to facility improvements, UnityPoint is introducing new outpatient services for both mental health and addiction recovery, bridging the transition from inpatient treatment to outpatient illness management, as well as providing opportunities for mental health education and the prevention of substance abuse relapse. By enhancing its services, adolescent and adult patients will receive strong support through the recovery process, with treatment options including detoxification, day treatment, aftercare, and individual, group or family therapy.

UnityPoint’s emphasis on mental health, alongside similar community efforts, is highlighting the medical nature of the disease, leading to reduced stigma and increased awareness. “I think things have changed,” notes Dr. Moberg about local attitudes on addiction and mental illness. “We’re like a big cruise ship—turning the ship takes some effort and it’s a slow process… [but] I think it’s changing attitudes.”

New Challenges… and Hope
In recent years, new technologies and social trends have left their mark on the mental health community, sometimes for the worst. The rise of the internet—and social media in particular—has added a host of new societal challenges, from cyberbullying to internet addiction and other related issues.

According to a 2014 study published in JAMA Pediatrics, cyberbullying has greatly increased the risk of suicidal thoughts and attempts among children and adolescents, while internet gaming disorder, listed as a “condition for further study” in the DSM-5, is garnering additional attention from the American Psychiatric Association. Meanwhile, the explosive popularity of social media is thought to instigate envy for others’ good fortune—which can lead to depression or even cause psychiatric disorders, though the research is far from clear. “It’s evident in any kind of social situation,” explains Dr. Moberg. “There’s always somebody who has a little more than you do—or a lot more than you do. And you may be seeing that on social media on a bigger scale.”

But the internet also brings clear benefits, such as enhanced access to mental health resources and support groups for those with unique mental health conditions. The community-based nature of social media provides an opportunity for close, empathetic connections, says Dr. Finkenbine, sparking a network of support and education that is likely to have a long-term impact on how mental health is viewed and treated. “I think we’re merging into a time where patients now can have better access to information,” he explains. “It’s too early to consider whether [social media] has caused some kind of broadly social difficulty… I think it may be something that will evolve, just like the rest of social communication over time.”

A more concrete problem faced by mental health professionals involves the lack of financial resources for treatment, leaving some unable to care for their mental illness. “Is the need and demand there? Absolutely,” Kennedy notes. “We’re trying to find more ways to efficiently serve these people. But unless [we] have a financial means to support it… you’re going to be challenged by those kinds of things.”

In response, the pendulum of federal legislation has swung in favor of mental health awareness, preventive services and increased funding. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) ensures that mental health and addiction disorders are treated the same as other diseases by insurers, while the Comprehensive Addiction and Recovery Act, signed into law last July, provides states with grant programs, resource flexibility and overdose treatment training to combat substance abuse. In addition, the Affordable Care Act, which built on the MHPAEA, greatly expanded the coverage of mental health and substance abuse services—though the future of those provisions in the new Congress is uncertain.

Meanwhile, alongside improved medications and the development of new psychotherapeutic techniques, new technologies are bringing a different approach to treatment. Transcranial magnetic stimulation (TMS), which delivers magnetic pulses to the region of the brain that involves mood, has been shown to ease the symptoms of depression. It’s painless and the side effects are minimal, making TMS therapy an option for those hesitant to take medication, or who have had little success with antidepressants or psychotherapy. UnityPoint Health – Peoria currently offers TMS treatment, enriching the resources available for area residents seeking relief from mental illness.

Though there remains a long way to go, increased public awareness has reshaped the ways society deals with mental health, erasing stigmas and opening the doors to new treatment methods. With continued focus, the response to mental illness is looking brighter on the horizon in Greater Peoria and beyond. “I do see hope at the end—that we will have a different attitude,” Dr. Moberg asserts. “At least in our local community, and I hope the whole country.” iBi

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