Three types of treatment
Mental health care has access to three different types of treatments that work; Medication, Therapies, and Rehab Services. A combination of all three of these options usually creates the best results for anyone struggling with mental illness.
In total, we have access to 30 antidepressants, 20 anti-psychotics, 7 mood stabilizers, and 6 ADHD medications. These are generally effective for short-term reduction of symptoms, however, they often require days and weeks to reduce symptoms.
A new substance that we are still learning about is ketamine – it takes hours instead of weeks for symptoms to reduce, which is very exciting.
With medication, we expect clients to partially respond to the treatment. It is not a “cure”. The goal with medication is to reduce disability and increase functionality so that the client may return to work or have access to enough resources to be utilizing additional treatment protocols that they were unable to access without medication.
Usually, suicide risk is highest when people regain some functionality after being depressed (often this is a few days-weeks after they’ve started medication). They become well enough to form a plan for suicide. Often, profesionals predict this happening and so additional medication will be prescribed here and therapy will start.
Therapy is one-on-one work with a licensed practitioner. Therapy has evolved a lot over the years and is no longer a sit on a couch and spill your feelings session. It involves learning skills like reframing, emotional regulation, revealing, and general introspection. Therapy sessions often involve a combination of tools such as CBT, recreational therapy, DBT, education, trauma release methods, etc. A good therapist also understands medication and will use precise therapeutic techniques to address different symptoms. Recently, therapy has expanded into the virtual space, and we are excited to see how that continues to evolve the field.
Similar to physical therapy after an injury, recovering from a psychotic episode can take months of work in order to rebuild your life and repair your psyche. Rehab services consist of assertive community teams that address education, employment, family therapy, and personalized care. Rehab services have an equal to surpassing impact on mental health to medication. Unfortunately, rehab services are not covered by most insurance providers in the USA. Currently, this option is only available to 5% of the population who have a severe mental illness.
Symptoms not addressed by current treatment options
Currently, we do not have treatment solutions for fixed delusions, some schizophrenic symptoms such as lack of affect, poverty of thought, lack of motivation, memory loss, negative bias, or deficits in executive function such as judgment or long-term planning.
Changes we need to make in our approach
Our current treatment focus in mental health is typically short-term symptom reduction for long-term illnesses. We have invested in short-term care options such as acute care and detox facilities and have dropped our long-term care resources from over 350 inpatient beds for every 100,000 people in the 1950s, to 21 inpatient beds per 100,000 people (NIMH). This is problematic of course – it can create dependency on these short-term services, burn out therapists, put a large burden on families and communities, and prohibits true, long-lasting recovery.
Mental illness is also often treated as chronic, rather than episodic. Mental illnesses are cyclical in nature and often will “go away” and then come back. Making sure a client has access to robust resources repeatedly throughout their life is essential for long-term success of each patient. Often one psychotic episode can throw a client into a lifetime of debt, put them behind in their career, initiate divorce, etc. We need to streamline the approach for relapse so that these patients don’t have to start over every time they relapse. Solutions can look like utilizing electronic health records, having robust discharge plans, and having insurance pay for acute care for a mental illness the same way they do for acute physical care.