Seeing a psychologist or other mental health professional isn't an unusual thing; in fact it's relatively common. Nearly three in ten U.S. adults (29%) report that they have received treatment or therapy from a psychologist or other mental health professional. The survey also found that younger adults are more open to seeking mental health treatment than those over 50 and that many adults are not discouraged from seeking treatment because of stigma or fear of others finding out.
Additional results of a nationwide study of 2,529 U.S. adults surveyed online between April 7 and 15, 2008 by Harris Interactive® in conjunction with the American Psychological Association are as follows:
-- Men (28%) and women (30%) are equally likely to have received treatment or therapy from a psychologist or other mental health professional;
-- Generationally, adults 65 and older are the least likely to have received treatment (17%) followed by those 50 - 64 years old (25%). Younger adults are more likely to have received therapy, especially those in their 20's (34%), and 30's (36%);
-- Financial considerations are the leading barrier to receiving care, either through lack of insurance coverage (52%) or concerns over cost (42%).
Why do People Consider Treatment?
People seek treatment for help with a variety of the challenges that life presents.
-- The most common reason, mentioned by nearly six in ten adults (59%), is depression and anxiety. In fact, nearly eight in ten (79%) who had received treatment in the past cited depression and anxiety as a reason they might seek treatment in the future;
-- Other common reasons for which people would consider seeking therapy include trauma and post-traumatic stress (42%), relationship problems with family members or others (37%), grieving for a loved one (35%), and stress that causes physical problems such as stomach or back pain (30%);
-- The reasons for seeking treatment differ by gender and age. Women are more likely than men to consider therapy for trauma (47% vs. 36%), family or relationship problems (40% vs. 33%) and grieving for a loved one (42% vs. 28%);
-- Older adults (65 and above) are the least likely to have received therapy, yet they are most likely to consider it for help adjusting and recovering after a serious injury or medical procedure (35%). They are also as likely as younger adults to consider treatment when grieving for a loved one (38%).
What Prevents People from Seeking Treatment?
When U.S. adults are asked to consider why they or others might not seek treatment from a mental health professional, responses fall into two main categories lack of knowledge about the process and access to care.
-- Two-thirds (68%) of U.S. adults mention one or more factors related to a basic lack of understanding about the treatment process itself - lack of confidence in the outcome (34%), lack of knowledge about how to find the right professional (31%), or not knowing if it's appropriate to seek help (28%);
-- Sixty-seven percent of respondents cited access to care as a reason why they or others might not seek treatment, with half (52%) noting cost and 42% reporting lack of insurance;
-- Interestingly, concerns over stigma or privacy, though mentioned by more than half of adults (56%), are mentioned less commonly than access or knowledge of the process as reasons not to seek mental health treatment. Specifically, one-quarter of adults (26%) mention stigma as a reason for not seeking treatment, 22 percent mention concerns about what others might think of them, 19 percent are concerned about people finding out and 15 percent mention concerns about confidentiality.
-- While men and women are equally likely to have actually gone to therapy they differ in what they perceive as the barriers to treatment. Women are more likely to mention issues related to access (72% vs. 62% of men) while men are more likely to cite factors related to lack of knowledge about the process (71% vs. 64% of women). They are equally likely to consider stigma or privacy a barrier to treatment (58% vs. 55%).
According to Dr. Richard Millard, Group President of Harris Interactive, "It's a paradox of sorts that therapy for mental health has become commonplace and rather normal, even though a sizeable proportion of Americans say it's either difficult to afford, or hard to understand how it works".
American Life and Mental Health Care
Millions of Americans have received treatment from a mental health professional, yet many continue to face problems of access, lack of understanding or perceived stigma. These survey results suggest that providing adequate insurance coverage for mental health issues and educating the public about treatment effectiveness may help improve access to care for those in need of psychological services
Methodology
This study was conducted online within the United States between April 7 and 15, 2008, among 2,529 adults (aged 18 and over). Figures for age, sex, race, education, region and household income were weighted where necessary to bring them into line with their actual proportions in the population. Because the sample is based on those who agreed to participate in the Harris Interactive panel, no estimates of theoretical sampling error can be calculated. Full data tables and methodology for this study can be found at http://www.harrisinteractive.com.
These statements conform to the principles of disclosure of the National Council on Public Polls
About Harris Interactive
Harris Interactive is a global leader in custom market research. With a long and rich history in multimodal research, powered by our science and technology, we assist clients in achieving business results. Harris Interactive serves clients globally through our North American, European and Asian offices and a network of independent market research firms. For more information, please visit http://www.harrisinteractive.com.
American Psychological Association
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.
Monday, October 6, 2008
Treatment of Children with Mental Disorders
A booklet with answers to frequently asked questions about the treatment of mental disorders in children — includes a medications chart. (2004)
A Note to Parents
There has been public concern over reports that very young children are being prescribed psychotropic medications. The studies to date are incomplete, and much more needs to be learned about young children who are treated with medications for all kinds of illnesses. In the field of mental health, new studies are needed to tell us what the best treatments are for children with emotional and behavioral disturbances.
Children are in a state of rapid change and growth during their developmental years. Diagnosis and treatment of mental disorders must be viewed with these changes in mind. While some problems are short-lived and don’t need treatment, others are persistent and very serious, and parents should seek professional help for their children.
Not long ago, it was thought that many brain disorders such as anxiety disorders, depression, and bipolar disorder began only after childhood. We now know they can begin in early childhood. An estimated 1 in 10 children and adolescents in the United States suffers from mental illness severe enough to cause some level of impairment. Fewer than one in five of these ill children receives treatment. Perhaps the most studied, diagnosed, and treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD), but even with this disorder there is a need for further research in very young children.
This booklet contains answers to frequently asked questions regarding the treatment of children with mental disorders.
Questions and Answers
Q: What should I do if I am concerned about mental, behavioral, or emotional symptoms in my young child?
A: Talk to your child’s doctor. Ask questions and find out everything you can about the behavior or symptoms that worry you. Every child is different and even normal development varies from child to child. Sensory processing, language, and motor skills are developing during early childhood, as well as the ability to relate to parents and to socialize with caregivers and other children. If your child is in daycare or preschool, ask the caretaker or teacher if your child has been showing any worrisome changes in behavior, and discuss this with your child’s doctor.
Q: How do I know if my child’s problems are serious?
A: Many everyday stresses cause changes in behavior. The birth of a sibling may cause a child to temporarily act much younger. It is important to recognize such behavior changes, but also to differentiate them from signs of more serious problems. Problems deserve attention when they are severe, persistent, and impact on daily activities. Seek help for your child if you observe problems such as changes in appetite or sleep, social withdrawal, or fearfulness; behavior that seems to slip back to an earlier phase such as bed-wetting; signs of distress such as sadness or tearfulness; self-destructive behavior such as head banging; or a tendency to have frequent injuries. In addition, it is essential to review the development of your child, any important medical problem he/she might have had, family history of mental disorders, as well as physical and psychological traumas or situations that may cause stress.
Q: Whom should I consult to help my child?
A: First, consult your child’s doctor. Ask for a complete health examination of your child. Describe the behaviors that worry you. Ask whether your child needs further evaluation by a specialist in child behavioral problems. Such specialists may include psychiatrists, psychologists, social workers, and behavioral therapists. Educators may also be needed to help your child.
Q: How are mental disorders diagnosed in young children?
A: Similar to adults, disorders are diagnosed by observi">Medications Chart in this booklet shows the most commonly prescribed medications for children with mood or anxiety disorders (including OCD).
Stimulant Medications
There are four stimulant medications that are approved for use in the treatment of attention deficit hyperactivity disorder (ADHD), the most common behavioral disorder of childhood. These medications have all been extensively studied and are specifically labeled for pediatric use. Children with ADHD exhibit such symptoms as short attention span, excessive activity, and impulsivity that cause substantial impairment in functioning. Stimulant medication should be prescribed only after a careful evaluation to establish the diagnosis of ADHD and to rule out other disorders or conditions. Medication treatment should be administered and monitored in the context of the overall needs of the child and family, and consideration should be given to combining it with behavioral therapy. If the child is of school age, collaboration with teachers is essential.
Antidepressant and Antianxiety Medications
These medications follow the stimulant medications in prevalence among children and adolescents. They are used for depression, a disorder recognized only in the last 20 years as a problem for children, and for anxiety disorders, including obsessive-compulsive disorder (OCD). The medications most widely prescribed for these disorders are the selective serotonin reuptake inhibitors (the SSRIs).
In the human brain, there are many “neurotransmitters” that affect the way we think, feel, and act. Three of these neurotransmitters that antidepressants influence are serotonin, dopamine, and norepinephrine. SSRIs affect mainly serotonin and have been found to be effective in treating depression and anxiety without as many side effects as some older antidepressants.
Antipsychotic Medications
These medications are used to treat children with schizophrenia, bipolar disorder, autism, Tourette’s syndrome, and severe conduct disorders. Some of the older antipsychotic medications have specific indications and dose guidelines for children. Some of the newer “atypical” antipsychotics, which have fewer side effects, are also being used for children. Such use requires close monitoring for side effects.
Mood Stabilizing Medications
These medications are used to treat bipolar disorder (manic-depressive illness). However, because there is very limited data on the safety and efficacy of most mood stabilizers in youth, treatment of children and adolescents is based mainly on experience with adults. The most typically used mood stabilizers are lithium and valproate (Depakote®), which are often very effective for controlling mania and preventing recurrences of manic and depressive episodes in adults. Research on the effectiveness of these and other medications in children and adolescents with bipolar disorder is ongoing. In addition, studies are investigating various forms of psychotherapy, including cognitive-behavioral therapy, to complement medication treatment for this illness in young people.
Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat co-occurring ADHD or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.
Q: What difference does it make if a medication is specifically approved for use in children or not?
A: Approval of a medication by the FDA means that adequate data have been provided to the FDA by the drug manufacturer to show safety and efficacy for a particular therapy in a particular population. Based on the data, a label indication for the drug is established that includes proper dosage, potential side effects, and approved age. Doctors prescribe medications as they feel appropriate even if those uses are not included in the labeling. Although in some cases there is extensive clinical experience in using medications for children or adolescents, in many cases there is not. Everyone agrees that more studies in children are needed if we are to know the appropriate dosages, how a drug works in children, and what effects there are on learning and development.
Q: What does “off-label” use of a medication mean?
A: Many medications that are on the market have not been officially approved by the FDA for use in children. Treatment of children with these medications is called “off-label” use. For some medications, the off-label use is supported by data from well-conducted studies in children. For instance, some antidepressant medications have been shown to be effective in children and adolescents with depression. For other medications, there are no controlled studies in children, but only isolated clinical reports. In particular, the use of psychotropic medications in preschoolers has not been adequately studied and must be considered very carefully by balancing severity of symptoms, degree of impairment, and potential benefits and risks of treatment.
Q: Why haven’t many medications been tested in children?
A: In the past, medications were not studied in children because of ethical concerns about involving children in clinical trials. However, this created a new problem: lack of knowledge about the best treatments for children. In clinical settings where children are suffering from mental or behavioral disorders, medications are being prescribed at increasingly early ages. The FDA has been urging that products be appropriately studied in children and has offered incentives to drug manufacturers to carry out such testing. The NIH and the FDA are examining the issue of medication research in children and are developing new research approaches.
Q: Does the FDA approve medications for different age groups among children?
A: Yes. However, this is based on the data provided to the FDA by the drug manufacturer and the policies in effect at the time of approval. For example, Ritalin® is approved for children age 6 and older, whereas Dexedrine® is approved for children as young as 3. When Ritalin® was tested for efficacy by its manufacturer, only children age 6 and above were involved; therefore, age 6 was approved as the lower age limit for Ritalin®.
Q: Can events such as a death in the family, illness in a parent, onset of poverty, or divorce cause symptoms?
A: Yes. When a tragedy occurs or some extreme stress hits, every member of a family is affected, even the youngest ones. This should also be considered when evaluating mental, emotional, or behavioral symptoms in a child.
Treatment Methods
The goals of treatment are to reduce symptoms of emotional disorders; improve personal and social functioning; develop and strengthen coping skills; and promote behaviors that make a person's life better. Biomedical therapy, psychotherapy, and behavioral therapy are basic approaches to treatment that may help a person overcome problems. There are many specific types of therapies that may be used alone or in various combinations.
Biomedical Therapies
Treatment with medications has benefited many patients with emotional, behavioral, and mental disorders and is often combined with other therapy. The medication that a psychiatrist or other physician prescribes depends on the nature of the illness being treated as well as on an assessment of the patient's general medical condition. During the past 35 years, many psychotherapeutic medications have been developed and have made dramatic changes in the treatment of mental disorders. Today there are specific medications to alleviate the symptoms of such mental disorders as schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and obsessive-compulsive disorder.
Electroconvulsive Treatment
(ECT) is another biomedical treatment that can help some patients. It is generally reserved for patients with severe mental illnesses who are unresponsive to or unable to tolerate medications or other treatments. While ECT is most commonly indicated in the treatment of major depression, often with psychosis (delusions or hallucinations), it is also used in selected cases of schizophrenia. Severe reduction in food and fluid intake with little physical movement (catatonia), or overwhelming suicidal ideation, where urgency of response is important, are reasons for considering ECT as treatment of choice. Modern methods of administering ECT employ low "doses" of electric shock to the brain along with general anesthesia and muscle relaxants to minimize the risk and unpleasantness to patients.
Psychotherapy
Psychotherapy is accomplished through a series of face-to-face discussions in which a therapist helps a person to talk about, define, and resolve personal problems that are troubling. Psychotherapies generally appear to be more effective and appropriate than medications or ECT for less severe forms of emotional distress.
Short-term psychotherapy, lasting for several weeks or months, is used when the problem seems to result from a stressful life event such as a death in the family, divorce, or physical illness. The goal of the therapist is to help the patient resolve the problem as quickly as possible. Often this takes only a few visits. Long-term psychotherapy, lasting from several months to several years, emphasizes the study of underlying problems that started in childhood.
The following is a list of a few types of psychotherapy:
Psychodynamic psychotherapy, which may be either long- or short-term, examines important relationships and experiences from early childhood to the present in an effort to analyze and change unsettling or destructive behaviors and to resolve emotional problems. One form of psychodynamic psychotherapy is psychoanalysis, a long-term, intensive therapy that emphasizes how the patient's unconscious motivations and early patterns of resolving issues are important influences in his or her present actions and feelings.
Interpersonal therapy focuses on the patient's current life and relationships within the family, social, and work environments.
Family therapy involves discussions and problem-solving sessions with every member of a family -- sometimes with the entire group, sometimes with individuals.
Couple therapy aims to develop a more rewarding relationship and minimize problems through understanding how individual conflicts get expressed in the couple's interactions.
Group therapy involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.
Play therapy is a technique used for establishing communication and resolving problems with young children.
Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to troublesome feelings and behaviors. Cognitive therapy is often combined effectively with behavioral therapy.
Behavioral therapy uses learning principles to change troublesome thinking patterns and behaviors systematically. The individual can learn specific skills to obtain rewards and satisfaction. Such an approach may involve the cooperation of important persons in the individual's life to give praise and attention to desirable changes. Behavioral therapy includes an array of methods such as stress management, biofeedback, and relaxation training.
Other Treatments
Some treatments, called "adjunctive," are used in combination with other therapies, and sometimes they are used alone. They include occupational, recreational, or creative therapies, as well as some that focus on special education. A mental health professional can help a client find the kind of therapy, or combination of therapies, that is best suited to his or her situation.
Rehabilitation Services -- Community Support Programs
Many individuals with severe mental illness find it difficult to work, learn, socialize, and live independently outside a controlled setting. To help in these matters, community support programs offer rehabilitation services, either through freestanding programs that are similar to clubs, or through mental health centers. These agencies offer a variety of activities to assist clients in learning skills that will help them to live and work independently and productively in the community. For information on community support programs, contact your local or state mental health agency.
The Helping Professionals
Helping professionals work in a variety of settings, such as mental health centers, outpatient clinics, private and group practice, general hospitals, psychiatric hospitals, nursing homes, jails, and prisons. They also work in residential treatment centers, partial care organizations, family or social service agencies, and the psychiatric departments of university medical centers or teaching hospitals.
Who They Are -- What They Do
Psychiatrists
A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to practice medicine, and has completed a year of internship and three years of specialty training. A board-certified psychiatrist has, in addition, practiced for at least two years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Psychiatrists can evaluate and diagnose all types of mental disorders, carry out biomedical treatments and psychotherapy, and work with psychological problems associated with medical disorders. Of the mental health professionals, only psychiatrists can prescribe medications. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.
Psychologists
Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical psychologists, counseling psychologists, or school psychologists. They work in many settings -- for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. In most states, a licensed clinical psychologist has completed a doctoral degree from a university program with specialized training and experience requirements and has successfully completed a professional licensure examination.
The field of psychology also includes those who specialize in such areas as testing, community organization, industrial relations, and laboratory research.
Psychiatric Nurses
Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental-health-related problems. These nurses are registered professional nurses who have advanced academic degrees at the master's degree level or above. They conduct individual, family and group therapy and also work in mental health consultation, education and administration.
Social Workers
Psychiatric (or clinical) social workers have master's or doctor's degrees in social work, have completed a field supervision program, and are licensed/certified. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources.
Mental Health Counselors
A clinical mental health counselor provides professional counseling services that involve psychotherapy, human development, learning theory, and group dynamics to help individuals, couples, and families. The promotion and enhancement of healthy, satisfying lifestyles are the goals of mental health counselors, whether the services are rendered in a mental health center, business, private practice, or other community agency. Clinical mental health counselors have earned at least a master's degree, had supervised experience, and passed a national examination before they can be certified by the National Board for Certified Counselors, Inc. (NBCC).
Case Managers and Outreach Workers
These individuals assist persons with severe mental illness, including some who may be homeless, to obtain the services they need to live in the community. Most persons with severe mental illness need medical care, social services, and assistance from a variety of agencies, including those dealing with housing, Social Security, vocational rehabilitation, and mental health. Because such services are uncoordinated in many areas, case managers provide a critical function to monitor a person's needs and assure that appropriate agencies get involved. In many instances they also act as advocates for the client. Case managers can be nurses, social workers, or mental health workers and can be associated with mental health centers, psychosocial rehabilitation programs, or other agencies. Case management and outreach services are frequently provided by teams that may include people who are recovering from a mental illness who function as peer counselors, case management aides, or outreach workers.
Mental Health Research and Services
The core mission of the National Institute of Mental Health is to understand, treat and prevent mental illness. Research into the kinds of mental health services that will support this mission plays an important role. The Center for Mental Health Services provides national leadership in mental health care delivery and policy development to facilitate accessible, comprehensive and quality mental health and support services. The institute and the center, in cooperation with consumer and family groups, professional organizations and other federal and state agencies, work to advance the application of scientific findings and practice-based knowledge to improve the range of effective prevention and treatment services.
Mental Treatment and Therapy Guide
Warning Signals
Many people are not sure how to judge when professional help for mental problems may be needed. There are some behaviors that may be signs of trouble:
1. Is the person acting differently than usual? Could this change be linked to something that has happened recently? Any event, such as the death of a close relative, loss of a job, marital break-up, or even something positive -- like a job promotion -- can trigger a troublesome emotional reaction.
2. Does the person complain of episodes of extreme, almost uncontrollable, anxiety or "nervousness"? One sign of an emotional problem is "free floating" anxiety that is unrelated to a normal concern, such as a child's illness or a backlog of bills.
3. Does the person become aggressive, rude, and abusive over minor incidents or talk about groups or individuals "out to get me"? If such remarks are made in all seriousness, and if violent behavior occurs, it is likely that help is needed and should be sought.
Any of these symptoms, if they persist or become severe, may suggest a need for professional help. Fortunately, early identification and treatment of the problems causing this behavior often can make these symptoms disappear.
What to Do in Emergency Situations
If a person becomes violent, gets completely out of control, or tries to commit suicide, there are several things you can do:
1. In a dangerous or violent crisis, call the police. Often the police are the best equipped, most available resource, especially when violence has occurred or when there is a strong possibility that the person may do physical injury to self or others. Once the emergency situation has been brought under control, if the troubled individual is already in treatment, call his or her therapist.
2. In a nonviolent crisis, contacting other resources may be the best choice. For example, if an individual hasn't eaten for a substantial period of time and has become weak and dehydrated, call his or her physician or therapist. If the person doesn't have one, get him or her to a hospital emergency room where there are doctors on duty -- even if you have to call an ambulance to get there. Look in the Yellow Pages under "Ambulance," or call the fire department or rescue squad. Look under the list of emergency numbers in the front of your phone book or call the operator if you can't find a number in a hurry.
Emergency room doctors will treat injuries resulting from violence, a suicide attempt, or a drug or alcohol overdose. They may also be able to provide temporary help for an emotional problem, even if they are not mental health specialists. In addition, they will be able to tell you where and how to get further help.
If the person in crisis is a member of a church, synagogue, or temple, you may choose to call the minister, priest, or rabbi. Many members of the clergy are trained to deal with emergencies, or they can refer you to other sources of help.
You may choose to call a mental health or crisis hotline, drug hotline, suicide prevention center, "free clinic," or Alcoholics Anonymous chapter, if your area has such services. Their telephones are often staffed around the clock. Look for a number in the list of emergency or community service numbers in the front of your phone book, or you can find a listing in the white-pages section of the Yellow Pages under "Suicide," "Mental Health" or "Alcoholics Anonymous," or ask the operator for help.
Another option would be to call the nearest mental health center. If it is not listed that way in the phone book, look under "Hospital," "Mental Health," or "Physicians" in the Yellow Pages. Mental health centers generally provide a wide range of services. Included in these are:
1. 24-hour emergency service -- day or night service available at hospitals or other mental health clinics.
2. Outpatient care -- a person goes into the center's clinic for treatment that has been set up on a regular appointment basis.
3. Inpatient service -- a person stays at the hospital where care is provided.
4. Partial hospitalization -- a person might spend occasional days, nights, or weekends at the center, living at home and going to work as much as possible.
5. Consultation, education, and prevention services -- assist schools, community organizations, institutions, and businesses in dealing with mentally ill persons and in developing programs that help in the understanding and prevention of emotional disorders.
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