mental health

Overview: Historically, in the United States mental health centers developed in the 1970’s under federal legislation to provide outpatient mental health care. Programs provided mostly individual, couple, family and group counseling and psychotherapy in traditional models based on psychoanalytical approaches. On the other hand, inpatient psychiatric treatment facilities ("mental hospitals"), had served as the depository of the seriously and severely mentally ill population for more than two hundred years. These state run hospitals were typically located in rural and remote areas, with the unfortunate policy of "out of sight, out of mind." Little effective treatment occurred. Few patients were released to the community. At the same time that mental health centers were being created, three national trends developed to impact state mental hospitals, in a society wide process since referred to as "deinstitutionalization." Within fifteen years, instead of thousands of patients at large state psychiatric hospitals, facilities were downsized to serve 200-300 inpatients. The advent of potent new psychotropic medications, the patients rights movement spurred on by national civil rights legislation to release patients no longer benefiting from inpatient involuntary treatment, and the concern over the cost of rising inpatient treatment lead to the mass exodus of psychiatric patients from state hospitals. Unfortunately, many of these individuals were released with no plans for their continued support. Mental health centers had focused on treating individuals with less severe conditions and were not prepared for the long term management of a very large number of these more severely ill people. During the 1980’s a transition of mental health care in the public sector lead to the development of a wide variety of specialized programs and a focus on the seriously and persistently mentally ill consumer. Earlier trends continued to evolve. New classes of medications with a demonstrated effectiveness with previously unaffected patients, increased emphasis on patients’ rights, and even greater concern over the cost of inpatient care resulted in a nationwide trend to build community based mental health care systems. Now we have a wide variety of support and specialized programs which insure that most seriously mentally ill individuals can remain at home within the community. The state psychiatric hospital (the Southwestern Virginia Mental Health Institute, Marion) now shares our goal of returning patients to the community after shorter lengths of stay.

TYPES OF MENTAL HEALTH SERVICES

Crisis Services: Many times our first contact with someone not familiar to our agency occurs through crisis services. This program provides 24 hour a day every day of the year response to individuals and families experiencing a crisis or emergency situation as a result of a mental illness, emotional disorder, substance abuse, or mental retardation issue. Sometimes the situation may reach the point of a concern for the welfare or safety of the person in crisis or for the family. There are processes available which our staff oversee for intervention in an imminent situation to obtain necessary mental health care.

Outpatient Services: These services are what most people think of when they talk about "counseling and psychotherapy." Outpatient services are provided in the office by graduate level ( masters or doctorate) clinical social workers, psychologists and counselors. Beginning in November 1993 as a result of changes within the state of Virginia to replace general state funding with Medicaid, we were required to prioritize our service population to individuals who meet service eligibility guidelines. This means that we no longer see individuals, couples or families for the older styles of traditional counseling for personal, marital or family related problems. Users of our services must now have an identifiable and diagnosable mental illness or emotional problem, as specified in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). Outpatient approaches are now of a shorter duration and are often "solution focused" or based on other brief models of behavior modification or rational emotional therapies. Outpatient services are provided at four different locations: Main Center (adjacent to SVCC), Tazewell County Satellite Office (Tazewell), Russell County Satellite Office (Lebanon), and at the Buchanan County Satellite Office (Grundy),

Case Management Services: Starting in 1982 at CMCS, based on the concept of providing full resource coordination to patients being discharged from the state hospital, the role of the case manager was created. Rather than being focused on direct psychotherapy or counseling, the case manager assesses the consumer's needs for housing, medical care, employment, etc. and seeks to help the individual obtain these resources. This approach is long term and indefinite, with efforts prioritized to those at risk of rehospitalization. Case management services include hospital liaison and discharge planning. The community mental health program maintains responsibility for the consumer as the person enters the psychiatric hospital and while an inpatient, the case manager works with the family, inpatient staff and community services board programs to insure an effective plan to return to the community. During the life long course of a serious mental illness, the individual affected may have a number of short term hospitalizations, but will primarily reside in the community. It is the connection to the community based program over the long run which insures the person’s stability.

Psychosocial Rehabilitation Services: In the 1940’s a group of New York City ex-mental patients, as they were called then, got together to form a self help association, which they named the Fountain House. This program model is based on a role emphasis of "member" of a active organization, the clubhouse, rather than a passive and dependent role of "patient, who is someone who must be taken care of, usually within a hospital. This program model is the commonly accepted standard for day support programs for individuals with a severe and persistent mental illness. Through socialization activities and meaningful work, members are encouraged by their peers and support staff to develop their functioning skills and to become as independent as possible. Usually, in this model there is a "transitional employment program" which works with local businesses to place program members into "slots" supported by the clubhouse staff. However, in our area of high unemployment, the TEP model has not proven possible. Instead, our four clubhouse programs (Ark House, in Richlands, Va; The Tazewell House, located in the town of Tazewell; O.U.R. House, in Grundy, Va.; and Clinch Mountain House, in Lebanon, Va.) have developed "mini-businesses" to provide employment opportunities to members. The Tazewell House operated the Piggy Bank Café, (which has now closed) a restaurant on Main Street in Tazewell. O.U.R. House operates the Thangs Store, a thrift store in Grundy. The Clinch Mountain House operates a laundry service.

Support Services: These services assist consumers in locating and managing their personal residences. Targeted to individuals being released from the Southwestern Virginia Mental Health Institute, staff insure that all basic living needs are met and help train and support the consumer with activities of daily living, such as grocery shopping, doctors appointments, etc. A supervised apartment program located in Richlands, provides safe, decent and affordable housing to mental health service consumers

Psychiatric Evaluation and Medication Management: CMCS employs psychiatrists who conduct psychiatric evaluations and provide medication management. Consumers seen for these services must also be involved in at least one other program, as we do not provide a medication only service. The biological component of major mental illnesses is addressed within this program. Psychiatric services provide the latest effective medications which are an essential element in an overall plan of care.