MENTAL HEALTH TREATMENT

What Parents Need to Know About Treatment
Mental Health Professionals
Working with Your Mental Health Professional
Medication
Hospitalization

WHAT PARENTS NEED TO KNOW ABOUT TREATMENT

Most communities provide a variety of treatment programs and services for children and adolescents. No one service or program is best. In fact, it may take time to find the right mix of services and programs for your child that will help at the developmental stage is at. As children grow and change, their needs change and how they respond to program interventions change as well.

When you first suspect that your child might benefit from treatment, he should be evaluated by a mental health professional. Part of the professional’s job is to evaluate your child’s mental health status and to make a recommendation about the kinds of services that will help your child. Children’s services span a wide range, from outpatient counseling to inpatient care in a hospital or locked facility. The professional should include you in any decision about services. The professional may have to get an approval from your insurance company or from Medicaid before any services can be provided.

Long term hospitalizations for mental health problems are usually not covered under most insurance policies, and hospitalization is not always the best treatment option for your child. Also, hospitalizations can be very expensive. If you live in a community where mental health hospitalization is not available, you may have to travel long distances to visit your child. Make sure you know what benefits your insurance policy covers, and include this in your decision. Communities differ in the range of services they offer. If you live in a rural area, you may not have local access to inpatient or hospital mental health programs. As a parent, make sure you ask what programs are available in your community. If you feel like you haven’t received enough information from your mental health professional, do research on your own.

A brief description of the kinds of services that may be offered to children and families include the following. (check with your insurance policy or carrier, because not all services are covered under all policies).

Parents should always ask questions when a professional recommends mental health treatment for their child or adolescent. Questions parents should ask include:

• What kind of treatment will be provided and by whom?
• How long will my child be in this level of treatment?
• What is the cost? How much of the cost will be covered by my insurance or Medicaid?
• What are the advantages and disadvantages of this particular service or program?

If your are uneasy about the answers you get, or still have questions yourself, get a second opinion about the best type of program for your child or adolescent. Talk to your PCP or ask your community mental health center for a referral to a mental health provider who can provide a second opinion. Many insurance policies pay for second opinions, but some don’t. If your insurance policy does not pay for second opinions, be prepared to pay out of your own pocket.

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MENTAL HEALTH PROFESSIONALS

Finding the right professional can be a daunting task for families. Your want to make sure that the professional you choose has the right qualifications to treat your child. You want professionals who have experience in working with children and adolescents. Some professionals may also have more specific qualifications, such as working with eating disorders, or counseling gay and lesbian youth. Ideally, you want to find a provider who has the special clinical skills to meet your child’s specific needs. Most insurance companies can give you some information about your treatment professional if you call their customer service number. If your child is Medicaid eligible, you can find out about your mental health professional’s credentials and specialty by calling the number listed on your Medicaid card.

The following professionals may be involved in the evaluation, treatment planning and care of your child or adolescent. Each has a specific specialty, but is also part of the treatment team. The duties and responsibilities will vary in different agencies:

• Psychiatrists are physicians (M.D. OR D.O.) with specific training in psychiatry. A psychiatrist will evaluate, make the diagnosis, and prescribe medications. Sometimes, a psychiatrist will give other kinds of treatment as well. They work with the treatment team to plan the care while your child is in the hospital and after discharge. Some psychiatrists also provide psychotherapy (counseling), either with your family, or with groups. The only other type of professional who can prescribe medication is a nurse practitioner.
• Psychologists have special training to evaluate and treat emotional disorders. In most states, a person who is licensed to practice clinical psychology has a Ph.D. Psychologists do psychological testing to help them make a diagnosis. They may also provide individual, group and family therapy. A school psychologist is trained to deal with behavior problems in the school setting. They are also trained to administer intelligence aptitude and achievement test. They may have other responsibilities similar to those described for psychiatric nurses and social workers.
• Psychiatric nurses have specific training in psychiatry. They generally have major responsibility for direct care of children and adolescents in a hospital setting, day treatment programs, and community mental health center clinics. They may also provide individual, group and family counseling.
• Social workers work with the individual, family and community to coordinate care in many areas of a person’s life. Children and adolescents may be involved with numerous systems and care coordination is very important. He or she may offer individual, family or group counseling. The social worker can serve as liaison between the family and the agency providing treatment.
• Counselors have special training in counseling principles to help their clients find solutions to problems. Licensed Professional Counselors (LPC’s) and Licensed Marriage and Family Therapists (LMFT’s) are trained to work with families and family issues. Both LPC’s and LMFT’s have master’s degrees.
• Case managers coordinate care and services in the community. They help their clients get services from other community agencies. They generally work for a Community Mental Health Center or an agency under contract to Community Mental Health.
• Indigenous healers are individuals who know about traditional healing practices. Many families have found practices such as curanderismo and Native American healing practices to be extremely helpful.

Choosing a mental health professional

• When choosing a provider, it is important that you know about your mental health provider’s credentials. If you are part of an HMO, or your child is Medicaid eligible, the work will have already been done. Most HMO’s and Medicaid programs credential their providers. This means that they have guidelines for the professionals who practice within their network. In order for a provider to be part of their network, the provider must show proof of education and licensing, the provider must have spent a minimum amount of time in his or her practice (usually 3 years), and must have had any malpractice claims resolved.
• If your child is not Medicaid eligible, or part of an HMO, contact the state licensing board for the professional’s discipline (social work, psychology, medical doctor, etc.) to verify their licensing.
• Ask the professional for his or her background and experience.
• Get a second opinion if you feel uncomfortable about the diagnosis or treatment that is prescribed.
• It is just as important to feel comfortable with your therapist as it is to have a therapist with good credentials. If you or your child don’t relate well to the therapist, find another one.
• Cost should be taken into consideration. Treating mental health and behavioral disorders can create financial burdens for the entire family. Financial problems can add to the already existing problems. Ask questions about cost upfront. If the mental health professional refuses to talk about cost, find one who will.

In the first meeting with your provider, there are also some questions you can ask to get an idea of her understanding of children’s and teen’s issues. The Federation of Families for Children’s Mental Health suggests you ask your provider the following questions:

• "How long have you been counseling families like mine?"
• ‘What can you contribute to my family’s well being?"
• "How often are you willing to meet with me and my family?"
• "Are you willing to work with other service providers along with my family friends as a partner?
• "Do you have any concerns about my family’s problems?"
• "Are you willing to talk to me about my child’s issues?"
• "Do you mind that I want to be involved in all the planning and decision-making about my family?"

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WORKING WITH YOUR MENTAL HEALTH PROFESSIONAL

You may remember taking your child in for an ear infection. The treatment was fairly simple. After an evaluation, the doctor prescribed a medication, and told you to go in for a follow-up in two weeks. If the medication was given properly, that usually cleared up the problem. For mental health problems, the treatments are not as clear-cut as the treatments for medical problems. This is because the causes of mental health problems are not as clear-cut. In fact, mental health problems may be caused by several factors, acting together. For example, the causes of depression may be a combination of physical problems, family problems, and problems with adjusting to a new school.

For these reasons, it is important to be patient and work with your mental health professional. Sometimes it may take weeks or even months before you see any changes. Medications used to treat mental health problems take time to work. Therapy that requires a person to talk about their problems also takes time. While it is important for you to be patient, it is also important for you to be open and honest about what you think is best for your child. The mental health professional has special training, but the bottom line is that you know what’s best for your child and for your family. If a certain medication or other treatment is not working, be assertive and let the mental health professional know.

Once your child is in therapy, it is important to evaluate the experience. The reality is that some therapists work better with some families. It is just as important to have a good personality match with your therapist as it is to have one with expertise in a certain area. Evaluate the treatment experience by asking yourself the following questions:

• Do I feel the mental health professional is genuinely concerned about my family and me?
• Does he keep his appointments?
• Does he concentrate on my child’s problems or does he spend time talking about his own feelings and problems?
• Do I feel comfortable raising any issues with him?
• Is he available when my family is in a crisis?
• Am I using the mental health professional appropriately and getting the most out of therapy?
• If I disagree with the mental health professional does she listen to me? Do I feel good about these interactions?
• Is he helping me to solve problems for myself? Is he encouraging my family to grow and change at a pace that is comfortable?

If you answered more "no’s" than "yes’s" it may be time for you to find another therapist.

The best treatment experience will happen when the family, the child and the professional work together. If you feel like the professional is ignoring your needs or your opinions, find another professional. It may take one or two tries before you find a good match.

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MEDICATION

Parents may be concerned when their doctor recommends medication for their child or teen. Many questions arise: "What are the side effects," "Will the medication damage my child’s body,?" "Will my child get hooked on the medication?" "Does this mean my child is crazy?" When parents don’t know the answers to these questions, they may keep their child from getting the best possible treatment.

Medication can be an essential part of treatment for mental health problems. Many behavioral and mental health problems have a medical cause, so they respond well to medications. Most medications prescribed for mental health problems are safe. They have been well researched and have been used by millions of people. Most are not addictive, and if given properly, will not change your child’s personality or intelligence. Taking medication is not a sign of weakness, but rather, a sign that you and your child are working to improve your child’s mental health.

Before your doctor prescribes medication for a mental health or behavioral problem, she should do a complete physical and mental health assessment. In addition to medication, you and your child should also be involved in other kinds of programs such as counseling, behavior management and parent education. Medication works best when it is used in combination with other mental health treatments. After your child has been prescribed the medication, she should be closely evaluated by a physician or a nurse practitioner.

Medication for mental health problems fall into several categories:

Stimulant medications are used to treat disorders such as ADD and ADHD. Examples of these medications include Ritalin and Cylert.

Antidepressant medications are used to treat depression. They may also be used to treat panic attacks, eating disorders, obsessive compulsive disorders, posttraumatic stress and other disorders not listed here. Examples include SSRI’s such as Prozac, Zoloft, and Paxil; atypical antidepressants include Wellbutrin and Serzone; and tricyclic antidepressants include Elavil, Tofranil and Pamelor. Newer antidepressants have fewer side effects and act more quickly to treat the depression. An older class of anti-depressant medication, MAO inhibitors, are rarely prescribed because they can have dangerous interactions with common foods.

Antipsychotic Medications are used to treat the symptoms of psychotic disorders such as schizophrenia. They may also be used to treat the muscle twitches ("tics") in Tourette’s Syndrome and may help to reduce aggressive behavior. Examples include: Haldol, Thorazine, Mellaril, and Prolxin. Newer anti-psychotic medications have fewer side effects and include Clozaril, Risperdal and Zyprexa.

Mood Stabilizers and Anticonvulsant Medications are used to treat bi-polar disorder and some of the severe mood swings in other psychotic disorders. The most commonly used mood stabilizer is Lithium. Medications that are used to treat convulsive disorders have also been helpful in stabilizing moods. Examples of these medications include Depakote, Tegretol and Neurontin.

Anti-anxiety medications are used to treat people with anxiety disorders such as panic disorder, and generalized anxiety. Examples include Valium, Librium and Xanax. Diphenhydramine (Benadryl) has also been used to treat anxiety.

Other medications may be helpful in treating your child’s symptoms. Scientists don’t understand exactly the action of a medication on the brain, so some medications that are used to treat medical illnesses have been used to manage symptoms of mental health disorders. Likewise, mental health medications have been used to treat other medical problems. This point serves to illustrate that you need to be patient when your doctor is prescribing medications. It may take time to find exactly the right medication in the right dosage.

Herbal remedies –If you do choose to use herbal remedies to treat your child’s mental health disorder, check with your doctor or pharmacist first. Many people believe that herbal preparations are safe because they are found in nature. That’s not always true. Many of them contain powerful drugs and can have serious side effects or even be toxic. Some can interact with medications your child may already be taking.

Talking To Your Doctor about Mental Health Medications

If your psychiatrist recommends your child take medication for his mental health or behavior problems, there are several things you should ask your doctor:

• What mental health symptoms does the medication treat?
• When and how should the medication be taken?
• When should we notice a change in behavior or feelings as the result of the medication?
• What side effects do I need to watch out for?
• What are the short term and long term effects of the medication?
• What other medications or foods interact with the medication?
• Are there any toxic or allergic side effects that I should report immediately?
• What actions can I take to lessen the side effects?

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HOSPITALIZATION

There may come a time when the best treatment for your child or teen is in a psychiatric hospital. If your doctor or therapist recommends that your child goes into the hospital, and it is not a mental health emergency, there are several questions you should ask:

• Are there any less restrictive therapies that can provide the same result?
• What is the expected outcome of hospitalization?
• How much will this cost? Will my insurance cover it? What out-of-pocket expenses will I be responsible for?
• How will I be included in the treatment?
• How will my child’s education continue while he’s in the hospital?
• What recreational or social opportunities will be available for my child?
• What are the visiting policies?
• How will my child be transitioned out of the hospital back home?
• Can special dietary problems be accommodated?

The prospect of a psychiatric hospitalization can be very traumatic for the entire family. Having the answers to some of these questions can help.

Involuntary Hospitalization

An involuntary hospitalization is a court order that orders a person to be hospitalized in an inpatient psychiatric facility. There are laws that regulate who and under what conditions someone can be committed to a hospital. In Colorado, an involuntary commitment may also be referred to as an M-1, or a 27 – 10. In order for a person to be involuntarily hospitalized, he or she must meet the Colorado Revised Statute, Article 10, Title 27 Care and Treatment of Mentally Ill definition of mentally ill. The statute defines someone as mentally ill if:

The person has a substantial disorder of cognitive, volitional or emotional processes that grossly impairs judgement or capacity to recognize reality or control behavior.

M-1 or Mental Health Hold

The actual Mental Health Hold (M-1) may be invoked when a person appears to be mentally ill and because of the mental illness, the person appears to be

• An imminent danger to him or herself
• An imminent danger to others
• Gravely disabled.

In order to be classified as gravely disabled; a person has to meet one of the following two criteria:

1. The person is in danger of serious physical harm due to his (or her) inability or failure to provide food, clothing, shelter, medical care or lacks judgement in management or resources or social relations to the extent that his health or safety is significantly endangered and lacks the capacity to understand this.
2. His (or her) care and support by family members or other similar relationships is going to be terminated and the following conditions are present:

• The person has chronic schizophrenia, affective, delusional or other disorder with psychotic features.
• The person has been hospitalized in an inpatient setting at least two times in 36 months with periods of at least 30 days between admissions.
• The person is exhibiting a deteriorating course of symptoms behavior substantially similar to those preceding hospitalization
• The person is not receiving treatment essential to her health or safety.

Voluntary Hospitalization:

Colorado law provides that anyone who is 15 or older may seek treatment, with or without the consent of his or her parent or legal guardian. However, the person who provides treatment may, with or without the consent of someone who is 15 or older, advise the parent or legal guardian of the services the child needs or the services given.

A child who is younger than 15 who is seeking voluntary hospitalization must have an independent interview. The independent interviewer, who must be a professional person, will interview the minor and do a careful investigation.This investigation includes talking with the parent or legal guardian, school, associated agencies and others. Based on these interviews, the professional must determine that the minor is mentally ill and needs to go into the hospital. The professional also must determine that placing the minor in a less restrictive treatment setting/program is inappropriate, unavailable and that hospitalization will be helpful.

If the child is a ward of the Department of Social Services, (DSS) the child must have a Guardian Ad Litem or a petition to appoint one must be filed with the court.

For a minor who is 15 or older, his parent or his legal guardian may make an application for voluntary hospitalization. A minor who is older than 15, who has his parents or legal guardian’s consent and who also has the recommendation of a professional person doesn’t need an independent interview for voluntary hospitalization but the minor has to be advised of his right to refuse to sign an admission consent and his right to revoke the consent later.

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