Holistic Care for Those with Mental Illness

Recently, the Illinois Medicaid program limited prescription drug coverage for several medications because of the high expense of the drugs in a move to control spending in mental health care. This policy change allows most of those already receiving Medicaid prescription assistance to be grandfathered in, and consumers prescribed the drugs not on the state's preferred list may still receive those medications with authorization.

Many mental health advocates have cried foul, but their concern for people with mental illness misses a key point. Until now, the State allowed physicians to prescribe any psychotropic medication regardless of the cost. Taxpayers should appreciate that allowing a physician to prescribe every expensive psychotropic medication does not readily translate into helping those with a mental illness. The perfect drug does not always hit the bulls eye. Research has shown that for those with severe and persistent mental illness, recovery comes not solely by finding a well-tolerated, effective drug. Persons with mental illness must be part of a system of care designed to meet their needs for housing, employment and reintegration into the community.

Proponents of the cost-cutting correctly say it will help the state manage fiscal responsibility in health care, forcing providers to find lower-cost and equally effective options for those with mental illness. Still, a larger issue remains for persons coping with mental illness. The state, while cutting spending for certain drugs, must prioritize the "wrap-around" services that community behavioral healthcare can provide. These services include supports for housing, therapeutic and outreach services, physical healthcare, and employment services. Good treatment means inspiring people to make important and rewarding contributions to society.

With this in mind, the state should continue to prioritize a holistic and cost-effective approach to addressing mental illness that doesn't simply throw money towards pharmaceutical companies promising the next big thing in mental health treatment. However, without proper therapeutic care such as community support and physical healthcare, along with housing assistance to prevent homelessness and employment services to help those with mental illness find and keep a meaningful job, even the most expensive, innovative and trustworthy drugs will have less overall effect to prevent the negative outcomes of long-term mental illness.

-- Steve Weinstein, M.D., Chicago

Chicago Tribune September 12, 2011 

Nation's Jails Struggle With Mentally Ill Prisoners

(FROM NPR) Three hundred and fifty thousand: That's a conservative estimate for the number of offenders with mental illness confined in America's prisons and jails.

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City and Cook County Jail in Illinois.

"We have a criminal justice system which has a very clear purpose: You get arrested. We want justice. We try you, and justice hopefully prevails. It was never built to handle people that were very, very ill, at least with mental illness," Judge Steve Leifman tells Laura Sullivan, guest host of weekends on All Things Considered.

COMPLETE ARTICLE

For more than 10 years, Thresholds has worked with those exiting incarceration from prison and jail to prevent recidivism and serve those with mental illness to ensure they are able to integrate back into the community through housing supports, psychiatric and therapeutic care, physical healthcare and employment opportunities through our Supported Employment Program. Thresholds was awarded the Gold Achievement Award from the American Psychiatric Association for its work with the Jail and Prison Project (now known as the Justice Project). For more information, view this article.

About the Eric Poulson Thresholds Bike Club

The Thresholds Bike Club was launched in 2005 with the donation of 50 mountain bikes for the exclusive use of those we serve, our “members,” as a means of exercise, inexpensive transportation, and social integration. Members are outfitted with a free mountain bike, helmet, and lock for their personal use, with staff providing training and safety checks, ongoing maintenance, and coordination of agency group rides and area biking events. Bikes and club costs are underwritten by the generous support of the Rebecca Susan Buffett Foundation and PricewaterhouseCoopers. The Club has grown to more than 500 adults. Many of our members also have joined the Thresholds Walking Club, which was established for similar reasons as well. Each member receives money for athletic shoes, a pedometer and pedometer log.  

The Bike Club has exceeded expectations in many ways, particularly in the area of health and wellness. A growing body of research suggests people with serious mental illness die 25 years than the general population, primarily by treatable conditions such as diabetes and cardiovascular disease. Moreover, antipsychotic medications have become highly associated with weight gain, diabetes, dyslipidemia, insulin resistance and the metabolic syndrome, all of which makes regular exercise especially critical for this population. Anecdotally, Bike Club members report weight loss, increased stamina, and reduced stress and anxiety.  

The majority of Thresholds’ members also live well below the National Poverty Line; most do not own a car and mass transit remains cost-prohibitive. Lack of transportation is a major barrier in both treatment and community integration of individuals with psychiatric disabilities. For many, their bike is their most valuable possession, serving as reliable transportation to work, school, or necessary medical appointments. Scheduled group rides and participation in area biking events also has created strong social ties among the members.

Thresholds Receives Prestigious Pacesetter Award from Hitachi Foundation, Annapolis Coalition Groups Laud Thresholds' Commitment to Staff Development in Clinical Best Practices

CHICAGO – Thresholds, Illinois’ largest and oldest provider of services to people with severe mental illness, announced it has been awarded a Behavioral Health Pacesetter Award. The award, created by The Annapolis Coalition on the Behavioral Health Workforce and Hitachi Foundation, sought to identify practices that strengthen business performance, improve work-life, skills and advancement among direct support employees, and improve client outcomes based on services and supports.

The Coalition created the initiative to develop the business case for supporting lower wage employees, many of whom are unlicensed staff holding a bachelor’s degree or less and provide essential client services on a day-to-day basis.

Debbie Pavick, the interim CEO for Thresholds and a social worker with a 30-year history with the organization, called the news of the award exciting and significant for the industry.

“We are delighted and thrilled to get such a prestigious award from The Annapolis Coalition,” Pavick said. “It is a tribute to our leadership staff who work tirelessly to mentor those entering the workforce at Thresholds in best clinical practices. On the flip side, it also shows the tenacity of those staff that come in at an entry level and receive training and education that allows them to rapidly become leaders themselves.”

Pavick was one of those featured in a comprehensive case study prepared by The Coalition as part of the award. She came to Thresholds as an entry level, community support specialist some three decades ago and ascended to a leadership position as Senior Vice President of Clinical Operations . Last month, she was named Interim CEO of Thresholds.

“Many new staff come to Thresholds with only a bachelor’s degree, and some haven’t yet finished,” Pavick said. “We encourage staff to continue training and education, so that we can mold leaders to deliver the best clinical services to persons with mental illness. This improves outcomes and efficacy, but more importantly, it creates a workforce that is loyal, challenged and very smart when it comes to service delivery.”

The case study cited that behavioral healthcare organizations have a particular need when it comes to training staff. It is estimated that 40 percent of direct service employees lack advanced professional degrees, but these workers have some of the most demanding day-to-day assignments with consumers, spending more time with those consumers than any other segment of the workforce.

At Thresholds, 67 percent of its direct clinical workforce has a bachelor’s degree or less.

The Annapolis Coalition lauded Thresholds’ use of embedded consultation in its work in substance abuse treatment for persons with severe mental illness as one of the clinical areas where Thresholds exceeds. Utilizing a best practice called Integrated Dual Disorders Treatment, the case study by The Coalition highlighted Thresholds’ willingness to train entry level staff in administering the practice.

“We have very high fidelity to the practice of Integrated Dual Disorders Treatment,” Pavick said. “Thresholds has focused diligently on cross-training staff in the assessment and treatment of substance abuse conditions. We also focus on employees’ strengths, motivations and personal goals. Because we use a model of embedded consultation versus classroom training for staff, we can improve outcomes, give immediate feedback, and most importantly, be more productive with our members.”

Thresholds’ commitment to the practice also has been recognized by the American Psychiatric Association when the group awarded Thresholds a Silver Achievement Award for its work in residential care for those with co-occurring substance abuse disorders in 2004.

The Annapolis Coalition is a non-profit organization dedicated to improving the recruitment, retention, training and performance of the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field. As part of this effort, it seeks to strengthen the workforce role of persons in recovery and family members in caring for themselves and each other, as well as improving the capacity of all health and human service personnel to respond to the behavioral health needs of the individuals they serve.

Hitachi Foundation is an independent nonprofit philanthropic organization established by Hitachi, Ltd. in 1985. Its mission is to forge an authentic integration of business actions and societal well being in North America. The Foundation’s strategic focus through 2013 is on discovering and expanding business practices that create tangible, enduring economic opportunities for low-wealth Americans, their families, and the communities in which they reside—while also enhancing business value. At its core, the Foundation is on a path toward discovery, committed to investments that enhance what society can learn about socially sustainable business practice and corporate citizenship.