Mental Health - Part 1

Summary

This section provides information on how to access the Community Mental Health Center (CMHC) system and also discusses some of the reasons that a request for mental health services for individuals with disabilities might be desired. The warning signs for suicide and depression are also listed. Population: Any age or ability.

Overview

There are a number of reasons why a person with disabilities may need to request mental health services, including: the need for a psychiatric evaluation to see if a mental health condition exists, an assessment of behavior disorders, to follow up on possible warning signs for suicidal behavior, how to respond to stress reactions to critical incidents (such as the terrorist attack on 9-11) and ordinary life stresses. It may be that some signs or symptoms are part of the ?normal? reaction to stress and can be handled at home with simple interventions. However, sometimes the signs or symptoms an individual with disabilities experiences may require mental health treatment, in the form of counseling and/or medication. While children may have mental health needs, other symptoms of mental health may not appear until adulthood.

Access to Mental Health Services

Most Community Mental Health Centers (CMHC) serve both children and adults. Valley Mental Health, in Salt Lake County, is the only CMHC large enough to have a free-standing "Children's Outpatient Unit."

The process for getting services from the community mental health centers (CMHC) is similar across the State. (A list of centers is in the Resource Section of this section.) On the first call to the CMHC main number, let the receptionist know you are requesting an Intake appointment for yourself or your family member. This request begins the Screening process, which will determine whether you will then be scheduled for a formal Assessment. The receptionist will ask a few screening questions about your address (to determine whether or not the person is eligible). You will also be asked about billings issues, such as insurance and Medicaid/Medicare eligibility, so you will want to have this information on hand. If you are uninsured, you will be asked to pay something for the services on a sliding scale.

After the phone screening, you may be given an appointment for an Assessment, which will determine which services are needed, and whether these services are available from this provider at this location. The Assessment is not a guarantee of further services, but will determine whether or not your need can be met by this provider.

Denial of Services

You may not be given an appointment for an Assessment; you may be told that you or your family member is not eligible for these services. If your request cannot be met at this location, or from this type of provider, you can request a full and respectful explanation of the reasons for the denial of services. For this explanation, you may need to be referred to someone at the center besides the receptionist and you may request this. Mental health funding can sometimes specifically exclude certain groups, such as those with developmental disabilities or traumatic brain injury.

Ideally, you should receive some information about where to go next to make your request. If you are fortunate enough to have Division of Services for People with Disabilities (DSPD) services, your Support Coordinator may help you locate other alternatives for the services you need. If you are on the waiting list for DSPD services, you may want to ask your DSPD intake worker if DSPD 'service brokering' funds are available to help with your situation.

If you have DSPD services, the Medicaid Home-and-Community-Based Waiver (HCBW) may fund some mental health treatment, such as medication management or counseling. You can check with your Support Coordinator to find out whether these services are available to you through DSPD funding. If so, you may be able to choose from a list of individual or private providers, instead of the community mental health centers. There is one specialized mental health treatment unit for people with disabilities, called the UNI-Home Project. This is administered by the University of Utah Hospital and has contracts with both DSPD and Valley Mental Health, the CMHC for Salt Lake County.

In the past, people have found that getting referrals from the field of disabilities to the field of mental health and vice versa has been difficult, and it may seem like there is no interaction between the two. This has come about because the funding for each of these fields comes from different sources and they each have their own set of guidelines and restrictions, which are in place to prevent overlapping services. Sometimes the professionals in one system do not have the skills required to diagnose people in the other system. For instance, some CMHC?s have professionals trained to treat the problems associated with intellectual disabilities, but many do not. While there may be a need for a person with disabilities to take medication to help with mental health issues, finding a psychiatrist that is familiar with all of these needs may be difficult; especially in rural areas. Some rural CMHC?s will accept clients with disabilities for ?medication management only,? which you can request.

Evaluations

Outside the CMHC's, an evaluation may be done by private providers through the Medicaid or the waiver funding, through private pay, or sometimes may be covered by insurance. You may request an evaluation directly, or through your DSPD Support Coordinator, if you have one. The difficulty may be finding the professional who is trained to do psychiatric evaluations for a person with intellectual disabilities. In order to qualify for mental health services, the person with a disability must have a separate mental illness, not necessarily connected with intellectual or developmental disabilities. This is called ?dual diagnosis?, meaning that there are two conditions present: the intellectual/developmental disability and the mental illness. It is not always easy to tell the difference between the symptoms of an intellectual disability and the symptoms of mental illness. People with disabilities may not be able to communicate their needs in appropriate ways, and their symptoms may appear to be mental health issues when they may be a result of being unhappy with their circumstances or symptoms of their disability. It is important to distinguish whether or not the problems may be solved with medication or may respond better to behavioral interventions, meaning changes in the person?s environment. You may find it helpful to make a log of behaviors over time, with times of day, triggering events, the people involved, and any other facts that you feel may be pertinent. Very often, it is the behavioral interventions that are most needed, but these are not usually part of the training of the CMHC providers. They are found more readily in Qualified Mental Retardation Professionals (QMRP?s) with specialized behavioral training.

Sometimes, family members may be reluctant to fully describe the symptoms of the person?s behavior for fear that they may be blamed. Family members will be most helpful to the evaluation process if they describe the situation in detail and even admit feeling trapped in a never-ending cycle of negative behaviors. Health care professionals should not blame family members for these behaviors, but should assist them in learning how to prevent them.

If the situation involves physical harm and/or property damage, there is a greater likelihood that you will get a prompt referral for mental health treatment. Aggressive behavior (such as hair pulling, body scratching, bullying, destruction of property, etc.) or withdrawn behavior (such as frequent crying, preference to be alone, easily frightened, etc.) may be curtailed by using anti-anxiety or anti-depressive medications or by using more effective behavior management techniques. Sometimes an in-patient stay in a psychiatric facility for observation is required. This option is very expensive and often unavailable unless there is evidence that the person will do harm to themselves or others.

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