Dual diagnosis aka Co-Occurring mental health conditions and substance abuse disorders affect nearly 14 million Americans each year. Of those only 19% receive the appropriate treatment for both conditions, with the vast majority bounced among different treatment systems and facilities that treat one of the conditions but not the other. Few treatment programs specialize in treating complex co- occurring or dual diagnosis disorders. Nationally, research continues to reveal that people with co-occurring or dual diagnosis disorders need a specialized form of treatment, referred to as integrated services.

Treatment systems for mental health and addiction have historically been and will continue to be separated systems of care. While many research studies have been performed on mental health issues and addictions separately, it has only been within recent years that a few studies have emerged on people who struggle with both conditions in unison. This emerging research identifies that traditional separated systems of care not only alienate the patient from the treatment, but they also result in much poorer outcomes than those experienced by patients with single disorders.

According to researchers and ever more surprising, we are just now learning from these studies that treatment programs designed to treat a specific disorder only are actually only capable of treating the minority of those in need where, in fact, up to 65.5% of patients with a substance abuse disorder had at least one mental disorder as well and 51% of patients with a mental disorder had at least one substance abuse disorder. We are also learning that these poorer outcomes result as much from these separate and contradictory systems of care as from the diagnoses themselves with people who have co-occurring conditions comprising the majority of the 10 percent of people using over 70 percent of the country’s healthcare resources

Some of children had mental issues and they were shunned, ignored. There was another general threat that dashed through the lives of Cho, Klebold and Harris. They were “outsiders”. They were quiet. They kept to themselves. They were “different” by the way they dressed and acted.

So why can’t people learn when such behavior might be the sign of simmering anger, resentment and a penchant for violence? We’ve already learned that many violent people begin by torturing and killing animals.

Near the end of his life, Cho only seemed to have one friend, and when he began acting in a way that made her nervous, she dropped him fast. Warnings about him from fellow students helped in her decision. It was just another negative event in his life.

Yet, his fellow dorm members seemed to accept him into their midst, despite his oddness. Cho, on the other hand, was content to isolate himself from the crowd – to be alone. This was his social anxiety disorder at work. It was his way of protecting himself from humiliation, embarrassment and stress. At this point, we don’t know what other mental illness he might have had, but schizophrenia has been tossed around lately.

Klebold and Harris had each other, to feed off each other’s anger and resentment, to plan their revenge on those who they believed had wronged them in some way. Together, they steered clear of their fellow students, opted out of team events and social gatherings.

Their peers saw them as odd, a duo who liked to dress in black, who avoided any close encounters with other students. They were loners who were isolated from the rest.

Mental Illness and Education

Could the other students have done more? Would it have helped if they better understood mental illness? Could they have made a difference by taking more interest in or an alternate approach to Cho, Klebold and Harris?

It’s understandable that the other students would not get close to them because their actions did not encourage friendship. It is also understandable why students would fear Cho and warn others about him.

It’s now revealed that Cho had several issues in his background that contributed to his mental illness. His parents believed he was autistic, yet he proved to be intelligent. He did not speak well. He was “different” because of his race. He was bullied. And who knows what else he had to deal with during his short life. What demons occupied his mind and where did they come from?

What home life did the three have? Was it a loving environment? Was it a negative or a positive one? Did it encourage open communication where the boys could discuss their concerns, their worries, their issues without fear of retribution or misunderstanding?

For decades, mental illness was a condition people avoided. If they had family members with a mental illness, they were shunned, hidden from society. They were an embarrassment.

Fortunately, much of that stigma has been removed, but there lingers a general fear of people with mental illness. The fear is mostly based on the lack of understanding and knowledge.

When we don’t grasp why a person is acting a certain way, they make us uncomfortable. We can’t help but wonder what’s going on in their minds. We ask ourselves whether that person just prefers to be alone or are they dangerous.

As teens who are looking to enjoy life, we tend to avoid situations that make us uncomfortable or nervous. We avoid people who ‘bring us down’, who are negative, sad, depressed, angry.

Mental illness is a convoluted subject with many theories. Even therapists and mental health researchers don’t know everything. They can’t tell whether a person will become violent, although they might have some inclination as to which conditions are more prone to it.

Despite all that we now know about mental illness, it’s hard to believe that we still know so little. Therapists study and practice for years before they fully understand all the ins and outs, how to differentiate one condition from another, and how to predict their actions. Clearly, the general public can’t be expected to understand as much as the professionals, but there is a level that they can reach.

In light of the increasing incidents of violence, schools are now working hard to figure out how to protect their students from another outbreak, but no one seems able to agree on the proper solution. They’re discussing such things as putting locks on classrooms and dorm buildings.

They’re implementing a better emergency alert system so they can let everyone know when there’s a problem. Part of that will include teaching the students what to do when it does happen.

But these are just Band-Aid solutions. The real solutions lie in spotting the problems before they escalate into violent behavior.

How do we do that?

We make people more aware of signs and symptoms that can indicate a student might need help. Set in place a confidential system for reporting concerns. Put together an investigation team (nurses, therapists and counselors) who have a thorough knowledge of such matters and can do a proper examination and take appropriate steps to find solutions for the individual.

Educate parents in teen behavior patterns so they can spot when their child is not acting normally. Teach them how to approach and respond to their children in a proactive way that does not alienate the teen.

Parents need to understand the development of teen growth – what they go through as they adapt to their new world as adults and leave behind their childhoods. In this method, they will be better able to identify when things have gone twisted and intervention is essential. There’s much to be educated about parenting, and mental illness and mental health is a large part that seems to be omitted.

What is called ‘The Blasted terror barrier’?

Have you ever seen your beloved stuck in his spot in your head lights? Just frozen they are unable to move? He is struck with terror and can not move from his spot even if it means he gets squished and dies.

This is what sort of happens to us, we get caught in the bright lights of life, which is our past and how we’ve always acted! We can now break through the terror barrier and move from out of those lights and then we won’t get squished by the past and we then move on past the terror barrier, unto a new reality which is free from terror!

You may be asking your self how do I break all these bad habits and be frozen in the past or the way we have been taught to act in certain situations. First we have to find a way that works for us, to get past the terror barrier. It was put to me in these certain terms, now don’t laugh, it sounds so simple that I even said what the hell, this can’t be it! IF YOU DO THE THING, YOU WILL HAVE THE POWER, IF YOU DON’T DO THE THING, YOU WON’T HAVE THE POWER!

Can you it really be that simple? Yes and no is my answer. For thirty six years of my life I fought the terror barrier and have just recently found out how to break this nasty little wall of terror. The good thing for you is, you will now have a blue print to overcome this terror barrier, which I struggled with for my whole life!

What is our first step in overcoming the terror barrier? Self relation that a terror barrier does truly exist and that you are affected by it every day it literally takes control over you. Now what do you think chances of beating are? If you can’t do this step you sure as hell aren’t going to go to the next step, so if you disagree that there is no terror barrier, then please stop reading this book right now, and send it back for a full refund.

Now what is our next step in overcoming the terror barrier? Recognition that you are helpless over the terror barrier right now, but there is hope and recognize that hope is always there and will always be there and you can tap into the universal power that is one with God. Now once you get a handle on this step you will find out that you can use this and apply it to any situation in your life.

Relentlessness’ pursuit of your goal or dreams, if you get knocked down, get back up and try it again the only way you are considered a failure is if you stop trying. If you but will continue to try then each failure or not getting the right results you want, moves you one step closer to your dreams.

Just because you don’t make on your first try don’t sweat it, you can make it on the second or third time and this is a given. Robert Kiosks says you will fail nine times out of ten, but it’s the tenth one that makes you a millionaire. So being rent less in your pursuit of any dream or goal, will get you that much closer, each time you fail or you do not get the desired Results you are that much closer to your desired results. So being a failure is not so bad because the more you fail the closer you are getting to what you want. So be rent less in your pursuit of your dreams and goals and know that next failure gets you one step closer to your desired results.

Now we have covered the three a r’s, Recognition, Realization, Relentlessness. What is next? Well it sort of goes like this. Zig Ziglar says that failure is an event not a person.
So who cares if you fail that is not you, which is just some event that got you one step closer to your desired results. So please know when you are failing that is not who you are, it is just something that happened to you, it is an event. Your time will come and before you know it you will overcome that terror barrier!

Now do you see that with these three action steps you get closer and closer to overcoming your terror barrier? Well you should because every step gets you closer to your goals. Now you will sometimes erect wall that keep you in the place where you are at. I bet you are saying no way why would I do that? Let me explain.

Every time you think you are getting to where it is you want to go. POW everything falls apart and you have to stay where you are at. Why is this so, the brain knows that it is much easier to stay where you are then to do all the work required to get to the next level.

We erect barriers that weren’t normally going to be there. We self sabotage your plans and we don’t even know this. Now once we understand that this is what we are doing, we can find a way to stop it. How? In the above steps we have just given an outlined view and you will be well on your way to beat the thing we call the nasty terror barrier and this will stretch your realism. A vast new world welcomes you to live healthy life!

The community mental heath team is available to assist the people who are suffering from mental illness. The first port of call for anyone who thinks that they are suffering from some kind of mental health problem is your doctor who will be able to recommend the right sort of help.

The community mental health team consists of a number of professionals who are trained in their specific areas and can include psychiatrists, psychologists, occupational therapists, social workers, and of course the community psychiatric nurse or CPN. Some specific problems or issues that can arise in addition to existing mental health problems or which can exacerbate or trigger mental health problems and which might need extra consideration include: Financial problems; Physical disabilities; Housing issues; Divorce or relationship problems and Childcare issues.

Certain kinds of mental health problems may result in different needs and may therefore require some specialist help to deal with and these can include: Elderly depression and dementia; Child or Teen depression; Postnatal depression; Bipolar disorder and  Schizophrenia.

Obviously, finding one person fully qualified and skilled in all of these areas just isn’t possible so the community mental health team work together in order to ensure that the best advice and support is available as many of the professionals involved will be trained in specialist areas that allow them to offer a better service to people suffering from specific problems. So who is likely to be involved in the community mental health team?
Psychiatrist

Patients can be referred to a psychiatrist by their doctor. After an initial assessment, the psychiatrist will recommend a suitable course of treatment and medication. If a mental health problem is particularly severe then they are also able to recommend that the individual be detained in hospital for a period of time. However, this is a last resort and also requires the approval of another doctor and a social worker who all agree that this is the best option for an individual concerned either for the individual’s safety or for the safety of others.

Psychologist

Psychologists have an understanding of human behavior, emotions and how the mind works and although they cannot prescribe medication they can offer various types of psychological therapies. Patients can be referred to them by the doctor or other members of the community health team.
The Key Worker

People suffering from mental health problems will usually be assigned a key worker, which can be anyone in the community mental health team. The key worker ensures that the individual gets the right kind of help that they need. They will regularly assess the progress of an individual and report back to the rest of the team.

Community Psychiatric Nurse or CPN

The key worker will often be a CPN who will usually make regular visits to people with mental health problems in their own homes. They offer an important lifeline for people who are feeling isolated and alone with their mental health problems or who are experiencing particular difficulties. They are aware of the many issues surrounding mental health and can listen as well as help people talk through their problems in a setting in which they feel comfortable.

The CPN will liaise with and work closely with other members of the team to make sure that any practical support and assistance is offered when needed. They monitor medication, make sure the individual knows how to take their medication and they also look out for additional symptoms or side effects of that medication. The family and loved ones of a person suffering from mental health problems often need additional support in order to understand mental illness and to be able to cope with it, the CPN can offer practical advice and guidance.

Occupational Therapists

Occupational therapists help individuals to cope with practical issues on a day to day basis in areas such as dressing, toileting and feeding themselves and can help individuals regain some control of their lives.

Social workers

Social workers can ensure that an individual gets access to various social services that will improve their quality of life and that they may be entitled to such as home help, respite care and perhaps admission to day or residential centres. They can also offer assistance in dealing with housing needs, financial difficulties or other social problems.

The best care

Many other people can be involved in the community mental health team including various support workers, therapists, counselors, and of course loved ones. Together they all make sure that the individual suffering from mental illness gets the best care possible. Each team member can make an important contribution to the individual’s excellence of life and can help them not only to cope with their sickness on everyday basis but to recover control over their lives and integrate with the rest of the community in a optimistic and creative way.

Professionals are finding evidence-based practices to improve outcomes related to services, when are resources are scarce and troubles. Evidence is emerging that school-based mental health services are powerful and cost efficient way to improve school performance and mental health and reduce behavioral troubles. To assess the effectiveness of school based mental health (SBMH) services to provide these outcomes in students from Pre-K - 12th grades, Robert Schmidt, M.Ed. and Kathryn Seifert, Ph.D. collaborated on the evaluation of outcomes for a SBMH program for a mid-Atlantic rural school district.

The project began in 1999 after a Federal grant was awarded to the school district. The children’s scores on the Devereaux, BASC, CARE and several school measures such as absenteeism, disciplinary referrals, and suspensions were measured from the beginning of services and at the beginning and end of each school year. Youth were referred to the project from teachers, guidance counselors, parents, student self-referrals and other agencies such as the Departments of Social Services and Juvenile Services of which resulted in 1,247 SBMH referrals during a five-year period.

Mental Health Services for Students

From 1999 to 2004, 36% of these students were referred because of symptoms of depression, 26% because of family problems, and 24% because of behavior problems. There were 84 referrals to the program in 1999, compared to 437 students in 2002 and 239 students in 2003. Peak referral times were consistently observed during the months of October and February. Youth in the transition years of sixth and ninth grades were referred to the program most often. More Caucasian females participated in the project than any other ethnic/gender group. In 2000, 2,132 mental health sessions were provided, in contrast to an amazing 15,763 sessions during the 2003/04 school year.

A group of one hundred thirty-two students who participated in the program showed significantly improved attitudes toward teachers and school, decreased mental health symptoms, and increased self-esteem after one year of services. From the 2001 to the 2002 school year, students participating in SBMH had significantly improved school attendance (from approximately 4600 to 4200 days absent). One hundred seventy-eight students had a significant (49%) decrease in disciplinary referrals and violence related disciplinary referrals from the 2001 to the 2002 school year. One hundred thirty-four participants had a significant decrease (54%) in suspensions from school. Parents of 103 students reported that their children were having significantly fewer problems after receiving services. Ninety-nine youth self-reported significantly improved commitment to school, interpersonal relationships and self-esteem, as well as fewer stress related problems. Two hundred fifty students reported significantly reduced school maladjustment and clinical maladjustment and improved attitudes toward parents and emotional well-being.

This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in the initial presenting mental health symptoms, violence and other behavior problems at home and at school. Other school-based mental health services must be provided, expanded, studied, though these services and study enter into its sixth year. This project provides a framework to improve the health of student.