Cognitive-Behavioural Therapy

Some people believe that our brain becomes inactive when we sleep. If that were so then we should not have any dreams. Dreams are evidence that our mind remains active, even when we are asleep. This simply means that our mind is active 24 hours a day without any rest at all. Just imagine how our bodies would behave if we were to go through 24 hours of physical activity.

Although research may show that 30% of mental illness may occur without a trigger of stress, it also shows that a majority – 70% – of mental illnesses occur with stress. The research may have failed to look at the other 30%, mentally ill who may not be ‘acknowledging’ stress at a given moment. This gives us a pessimistic view of mental illnesses. We are made to believe that we can do nothing about them. We are also told that mental illnesses occur because of our genes, our upbringing, our personality, our temperament, our lifestyle and we can do nothing about them. Stress or no stress, we are told, if we have all these factors loaded in our personal history, we are prone to have a mental illness. Some psychiatrists adhere to this belief strongly. This belief is then put across authoritatively as the “gospel truth” of science. Naturally, this brings up a sense of low self-esteem and helplessness in the person who is suffering with the illness. We are then made to believe that medications are man-made answers to mental illness, which is a curse of nature.

Prayer, which was until recently considered unscientific, has now been shown to have beneficial effects on patients.1 Similarly, the current belief in psychiatry is that mental illnesses can be treated by medical professionals only and the person who is mentally ill has no control over their lives. The medical system works in a way in which the doctors themselves have limited choices other than prescribing drugs. The patient has no choices worth mentioning. From the legal perspective, a person who is mentally ill is considered not capable of taking any responsibility for their actions. This is one of the most unfortunate aspects of mental illnesses. People who are mentally ill also have a sense of responsibility in many areas of their lives.

The role of emotions in mental illnesses has been totally ignored by scientists. Yet researches do show that separation from mother,2 losses3 – including deaths,4 traumatic events, especially when they occur over the previous three months5 can trigger mental illnesses. What has been looked at is the history of such events in a person’s life. What is ignored is the emotional upheaval it causes in a person’s body and mind. Emotional expression ameliorates the effects of trauma.6 Repetitive upheavals in the body are simply not forgotten. Release of emotions by emotional expression explains the role of counselling and confession. We tend to believe, erroneously, that everything will settle with time. Things do settle with time – but not everything. It is these issues and their emotional effects, that cause mental illnesses and psychosomatic illnesses. It is obvious that whenever we undergo any emotional experience, our nervous and hormonal systems are shaken-up. The nervous system and the hormones together control the activities of various parts of the body. If the neurohormonal expression is allowed to go through completion, a physiological calmness occurs in the body. This has a scientific basis.7

For people who attend church regularly, a common experience is the sense of calmness on entering a church. Coupled with music, incense and sermons spoken in a low, soft tone, a sense of calmness dwells on the person. There is scientific evidence to suggest that going to church helps a person remain healthy.8 More interesting is the fact that there is little research to state that music or aromatherapy help to bring about mental health. Yet experience shows that they have a calming effect. Only recently have papers started to be published in scientific journals bridging the gap between spirituality and science.9 It has now been researched that people who are religious in orientation have a lower rate of strokes than those who are not religious.10

The whole area of mental illness is about losing a sense of freedom. When we find ourselves bound to emotional issues of our life, that we cannot rid ourselves of, we lose our freedom of thinking. This creates stress in our mind and our body bears the brunt of it. This loss of freedom brings up a sense of fear or a sense of helplessness. Both such feelings bring up a sense of insecurity. A person loses confidence in their own worth. Self-esteem becomes low. With lack of confidence and low self-esteem, comes poor decision-making. A person suffers with all these conditions when suffering with a mental illness. This changes the behaviour of the person. The behaviour is affected by the way the person feels and thinks. If the person feels fear for a long time, the chances of becoming phobic and paranoid increase. Withdrawal from social situations occurs. The family members observe the person to be unwell. Such a person is then asked to see a doctor. With the person’s self-esteem low, vulnerability increases. This does not mean however, that the person becomes totally irresponsible towards their own well-being. Many times the person wants to do ’something’ to get better, but the health system has limited resources to offer much in terms of growth of the person, except medication. When a mentally ill person goes to seek help – confidence, self-esteem and sense of freedom are already lost. Instead of helping the person become independent, there is a tendency to make the person dependent on medication.

Medication plays its role in controlling the condition or state of illness. It does nothing to improve the quality of life permanently. To improve their quality of life, the person needs to take responsibility for their own well-being. This is encouraged in some of the organisations, which are being run by the sufferers themselves. GROW is an example of such an organisation. Are there any alternatives to medication in mental conditions? A doctor can only prescribe drugs to “control” the mental condition. The current trend in some other parts of the world is to encourage people suffering with mental illnesses to take responsibility for their own well-being, along with medication. Psychotherapy11 and self-help is encouraged. The usage of medication in such situations is minimised or eliminated.

In psychiatry, we know that the suicide rate among physicians is higher than in the general population and psychiatrists are at a greater risk among physicians, than other specialists.12 Research shows that psychotherapy is more economical than medication alone in treating mental illness.13 Conditions like schizophrenia are also being treated without medication in some parts of the world.14 It is also a known fact that the more positive the attitude we have, the more balanced are the chemicals in our body.15 This would be more acceptable for those who see the positive role of religion on mental health. Some authors have suggested that the medicine of the future is going to be “prayer and Prozac.”16 Mental health is a preventative activity. Do we need to suffer first before we take steps to deal with it? If we could only assume responsibility for our own mental health, we may not have to suffer. The best medicine in this case is certainly prevention.

We live in a free society. The freedom to suffer is also one kind of freedom. We also have the freedom to look for answers to minimise our suffering.

REFERENCES

You do not have to suffer mental stress and depression alone. Instead, you should seek professional help and learn how a mental health counselor can change your life. Mental health statistics show that twenty-eight percent of Americans can actually benefit from counseling, although only a third of them will actually look for one.
A mental health counselor can effectively improve your mental health by working through your past and present issues. Using writing techniques, reading aloud what you wrote, and by talking, you can identify the source of your anxiety and learn how to overcome them effectively. Counseling gives you valuable tools to handle daily problems and long-term relationships. A good counselor can be a real lifesaver.
Whatever you do for a living, everyone today experiences different levels of stress at work and at home. Some people deal with stressful situations by over eating, or abusing drugs and alcohol. However, counseling sessions can provide way healthier solutions to everyday troubles that cause you to feel depressed and anxious. A benefit of mental health counseling is that you are approaching your problems naturally through therapy, instead of using prescribed medications.
Sometimes, you need an outsider to listen and provide objective opinions on your issues. A mental health counselor is one such person who is trained to give you such valuable advice. It is their job to help you deal with the problems that are causing an upset in your life. Your counselor can also recommend other medical professionals to address all the physical problems that you may be experiencing. This is important as your physical well being significantly affects your mental health.
How a mental health counselor can change your life is by giving you the motivation and energy you need to lead your life in a more optimistic manner. No one can really understand how you feel unless you are willing to open up and share thoughts and feelings. Counseling therefore effectively helps reduce the symptoms of anxiety disorders such as irrational fear, heart palpitations, and difficulty in concentrating, speaking, and sleeping. Signs of depression include fatigue, hopelessness, constant crying, and loss of interest in normal activities, headaches, and thoughts of suicide.
Through counseling, one can gain new perspectives on managing issues that occur in our daily lives, as well as pick up social skills to better handle them mentally and emotionally.
A mental health counselor can help you understand your personal habits and behaviors, and find real contentment by analyzing if what you are doing it is best for you. Mental health counselors strive to stay up to date on the latest developments in mental health care. Their education and practice has exposed them to many theories and procedures on developing good mental health. So, their professional experience will definitely be useful in helping you recover from all your mental problems.
Suffering from mental disorders can be very stressful and tiring. It takes a strong person to admit his or her problems and actively seek treatment for them. Seeking out a counselor does not mean that you are less capable than others as you are simply getting help when you need some. As such, learning how a mental health counselor can change your life will enable you to better utilize their expertise to solve your problems efficiently.

According to the Substance Abuse and Mental Health Services Administration, an estimated two-thirds of the young people who need mental health services aren’t getting them. The time is now for a career in child and adolescent mental health.Mental Health Career ProfileEstablish and maintain interpersonal relationships, discover private, and very often hidden, information, and then use that information to potentially save someone’s life. If you believe a meaningful career is about more than just a paycheck, mental health could your profession. With a growing population and the identification of new disorders, the field is ripe for growth and discovery.Child and adolescent mental health services typically focus on a variety of mental, emotional, and substance abuse issues kids experience daily. This may mean working with patients as individuals or in group settings in order to find answers to developmental difficulties. Working environments may include hospitals, clinics, schools, as well as mental health facilities.A Career at the Competitive EdgeWhy mental services? In a word, diversity. One of the primary benefits of a career in this profession is that you’re typically not restricted to a predictable track. There are multi-level tiers that cater to a variety of interests and education levels. Many of the niches overlap, which can allow you to explore your preferences. A few of your options include:• psychiatry occupational therapy • clinical psychology • psychiatric nursing • social services • psychotherapy • language developmentFlexibility is another key benefit. A surprising percentage of mental health professionals are self-employed, working within their own established practice or as a freelance consultant. Because mental health is such an in-demand profession, graduates may find that they can create their own schedules, deciding when and how much to work based on their own professional and personal obligations.Mental Health in the NumbersWhen most people think of mental health, the psychologist usually comes immediately to mind. And it can be a good place to start when looking at the growth potential in the field of child and adolescent mental health. The Bureau of Labor Statistics reports that psychologists alone held 166,000 positions in 2006. And employment of psychologists projected to increase by 15 percent through 2016–that’s faster than the national average. Also, psychologists working in elementary and secondary schools enjoyed one of the higher annual mean salary levels at $66,040.To Follow This Career PathWhile all professionals in the mental health field typically possess a bachelor’s degree in a pertinent subject, students wishing to be competitive for the top jobs should pursue a specialist’s or doctoral degree in psychiatry, psychology, or counseling. For example, if you have your sights set on serving in an educational setting, a specialist (EdS) degree in school psychology traditionally requires 3 years of full-time graduate study plus a 1-year full-time internship.The requirements for potential psychologists are usually more stringent. Geri Fox, Director of Psychiatry Undergraduate Medical Education with the University of Illinois at Chicago, encourages board certification by completing two years of child and adolescent psychiatry training in addition to earning board certification in general psychiatry.

2009 is a critical year. Promised economic recovery and healthcare reform legislation are opportunities for meaningful financial commitments to mental health and addictions services and mental healthcare organizations are offering a practical actionable agenda: – The integration of primary care services in behavioral health settings: The Healthcare Collaborative Project brings together behavioral health and primary care organizations offering a bi-directional approach for care. The need for behavioral health services in primary care is widely accepted. But the integration of primary care services in behavioral health settings remains controversial despite the fact that individuals with serious mental illness appear to have the worst mortality rates in the public health system. Therefore, mental healthcare organizations are actively pursuing single points of accountability to enhance continuity of care for this underserved population. – Cost-based-plus financing that supports service excellence: People want and deserve quality services but quality services depend on skilled staff. Low salaries have created – and are perpetuating – a recruitment, retention, and quality crisis for behavioral healthcare. We need a workforce of skilled staff delivering nationally recognized practices within organizations that live by the rule “If you don?t measure it, you can?t improve it.”For mental healthcare organizations, healthcare reform is an opportunity to bring “parity” to public mental health services by ending the second class status of community mental health and addiction providers in America?s safety net.- Federal mental health funding stream dedicated to mental health and integrated treatment services for the uninsured: The uninsured have exceptionally high rates of untreated mental illnesses with co-occurring addiction disorders and there is no safety net. State plans to cover the uninsured have all but disappeared and federal universal coverage plans may well be incremental. We have large numbers of individuals with treatable mental illnesses and addictions in our overburdened emergency rooms, in jails, and on the streets with no access to services that can engage them, treat them and return them to work. We must stop denying our economy productive taxpayers and wasting human lives. – Eligibility for social security disability for people with addiction disorders: Addiction has come a long way from the days when it was perceived as merely a failure of will. Today, there is growing public awareness and acceptance of addiction as a chronic, relapsing condition that requires continual monitoring and management, as do other chronic illnesses like diabetes, asthma, and hypertension and yes, mental illness. If we accept addiction as a chronic illness then we must advocate that people with addiction disorders be eligible for disability support. – Funds to support investments by behavioral healthcare organizations in information technology: We talk about information technology and service transparency, but behavioral healthcare organizations that move forward to automate their clinical systems get no support, funding, or technical assistance. We and those we serve cannot continue to be marginalized. Healthcare reform and economic recovery will depend upon the expansion of information technologies and behavioral health providers must be included. – Expansion of research-based education and prevention practices: There are mental health and addiction prevention and education programs that work. These include research-based prevention initiatives that reduce the risk of childhood serious emotional disturbance by treating maternal depression, the Nurse-Family Partnership Program that has an array of consistent positive effects across multiple trials, and Mental Health First Aid – an evidence-based mental health literacy program. Now we must adequately fund and support the spread of these interventions to communities across the country.

Most of us suffer from mental health problems, though in varying degrees. Although mental ill-health affects so many people, there is still no proper definition as to what mental health problems are and what methods are needed to recover. It is reported that at least 1 in 10 young people and around 1 in 4 adults experience mental health problem at some time in their lives. Mental health can mean a wide range of symptoms and disorders – like depression, anxiety, self-harm, violent tendencies, schizophrenia and various types of mania. The mental health problems can develop at any time in one’s life and each person’s experience can be unique and can last from several weeks to even a lifetime.

People suffering from mental ill-health will think, feel or behave abnormally. This can be confusing not only for them but can affect their relationships, their work or education, and their social life. Having a mental health problem can create difficulties for all family members, friends, and the people they interact with. Mental health problems are usually caused by a variety of factors including breakdown in a relationship, death of a family member or a close friend, bullying, abuse, divorce, separation from parents or loved ones, stress born of a person’s current situation. Mental health can happen suddenly without prior indications or get built up over time.

When people first begin to experience mental health difficulties they may not be able to fathom what is happening. In several instances, people tend to deny that anything is wrong with them or even suppress information. Their reasons for doing this could be embarrassment, a sense of shame or fear of other people’s reactions. There is no denying the fact that mental health results in social stigma. Please remember that there is a lot of support available to help people recover from mental health problems – in terms of counseling, therapy, medication and treatment in hospital. Different treatments are recommended for different types of mental illnesses. With the right support, the majority of people with mental health problems will surely recover.

Mental health saps your energy, hope, ambition and drive, sometimes making it difficult to do even the normal day-to-day activities. Although overcoming depression may not be quick or easy, it certainly is not impossible. Feeling completely better may take time, but you can get there if you make positive choices for yourself each day and draw on the support of your loved ones. Recovering from depression calls for positive action but taking action when you’re depressed is hard. Some simple things you need to do are physical exercise, eating right food and rating regularly, sleeping at least for six hours, going out for walks in open areas, interacting with loved ones, avoiding loneliness, refusing to think negatively etc. . You probably already know that these things will help you overcome depression but following these rules are not easy when you are depressed. This is the Catch-22 situation of depression recovery. The symptoms of depression such as fatigue, despondency, incoherent thinking, and low self-esteem make it difficult to take the necessary steps to recovery. A realistic recovery plan therefore involves taking responsibility for the choices and changes you do have control over and avoiding the things you cannot control.

All forms of mental illnesses are treatable if the patient receives competent professional care. Psychologists are among the licensed and highly trained mental health providers with years of experience studying depression and helping patients recover from it. Unfortunately, there is some social stigma associated with seeking help for emotional and mental health problems as feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. Persons suffering from mental health who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen mental health. The importance of obtaining timely professional health care is the need of the only answer for mental maladies.

Mental health disorders and mental illnesses affect a greater number of children and juveniles than many people are aware of. These emotional and behavioral disorders can have profound negative effects on the growth and development of children, especially when they go unnoticed and untreated. A greater proportion of children and youth in the child welfare and juvenile justice systems have mental health problems than children and youth in the general population. -50% of children and youth in the child welfare system have mental health problems. -67% to 70% of youth in the juvenile justice system have a diagnosable mental health disorder.Prevalence Estimates of Mental, Emotional and Behavioral Disorders In Young People DISORDER                                            PERCENTAGE OF YOUNG PEOPLE AFFECTED Learning D/O:                                                                5% Substance use / addiction disorder:                                  10.3% CD:                                                                              3.5% ODD:                                                                            2.8% ADHD:                                                                           4.5% Anxiety Disorders (various):                                             8% Unipolar Disorder:                                                           5.2% One or more disorders:                                                   17% (D/O = Disorder; CD = Conduct Disorder; ODD = Oppositional Defiant Disorder; ADHD = Attention Deficit Hyperactivity Disorder Source: Preventing Mental, Emotional and Behavioral Disorders Among Young People, 2009. National Research Council and Institute of Medicine, of the National Academies.)Early Detection and Intervention are CriticalThe onset of major mental illness may occur as early as 7 to 11 years old. -Research supported by the National Institute of Mental Health indicates that half of adults with MEB disorders were first diagnosed by age 14 and three fourths were diagnosed by age 24.   -Factors that predict mental health problems can be identified in the early years, with children and youth from low-income  households at increased risk for mental health problems.  Age at Onset of First Symptom of Full Psychiatric Disorder, by Age 21 DISORDER                        AVG. AGE OF FIRST SYMPTOM            AVG. AGE OF FIRST DIAGNOSIS ADHD:                                            Age 5                                                 Age 5 ODD:                                              Age 5                                                 Age 10 CD:                                                Age 6                                                 Age 11 Anxiety Disorders (Various):              Age 7                                                 Age 8 Depression:                                     Age 12                                               Age 15 Substance Abuse:                             Age 14                                               Age 15 Substance Dependence:                    Age 16                                               Age 17 Any Psychiatric Diagnosis:                  Age 9                                                 Age 11 (Source: Preventing Mental, Emotional and Behavioral Disorders Among Young People, 2009. National Research Council and Institute of Medicine, of the National Academies) Obstacles to Access and Quality in Mental HealthcareSeveral federal commissions and workgroups federal task forces have documented the need for improved and expanded mental health services for children and youth. -It is estimated that less than 1 in 5 of these children receive the appropriate needed treatment   -Only 15% of youths who had difficulties had parents that actively talked to a health care provider or school staff about their child?s emotional or behavioral difficulties.  There is not adequate financial support for quality services to prevent and treat mental health problems of children and youth. Many child mental health services are not covered by managed care payers. In 2007, 3.1 million youths, (12.5 percent of 12 to 17 year olds) received treatment or counseling for problems with behavior or emotional disturbances in specialty mental health settings (which include inpatient and outpatient care).Effective Treatment and Prevention ExistsClear windows of opportunity are available to prevent MEB disorders and related problems before they occur. An intervention before a disorder manifests itself is possible and offers the best opportunity to protect young people. Effective prevention includes strengthening families by targeting problems, strengthening individuals by building resilience and skills, preventing specific disorders by screening individuals at risk, promoting mental health in schools and promoting mental health through health care and community programs. The key to most approaches is to identify risks (biological, psychological and social factors) that may increase a child?s risk of MEB disorders.

Improving the Mental Health System

According to a news release that was dated May 9, 2006, the “Standing Senate Committee On Social Affairs, Science and Technology” in Canada recommended the creation of a Canadian Mental Health Commission that will be responsible for significantly upgrading the Canadian mental health system. As stated by Senator Michael Kirby, the Chair of the Committee, “The Senate Committee is committed to improving the range, quality and organization of health and support services that are required by the tens of thousands of Canadians who are living with mental illnesses and addictions.”

Funding The Proposed Change

Based on an extensive three-year study on mental health and addiction, the Committee determined that it will cost $5.36 billion over a 10-year period for this mental health system upgrade. Where will these funds come from? According to the Committee, the revenue will come from raising the excise tax on alcoholic drinks by 5 cents per drink.

Part of the rationale for the 5-cent increase per drink was obviously the goal of raising the needed funds for the proposed changes in the mental health system. Another justifying factor for the price increase, however, was the fact that since each alcoholic drink will cost more, Canadians will be more inclined to drink lower-alcohol products such as beer and wine instead of liquor.

Let’s Do the Math

At first glance, this proposal seems to make sense. Why shouldn’t those who drink help finance a program that will provide them with a better mental health system? Why not let those who are part of the “problem” become part of the “solution”? This logic seems sound until you do the math. If $5.36 billion is needed to help finance the upgraded mental health system, then how many drinks will have to be consumed in a ten-year period to reach $5.36 billion dollars? The answer: 107,200,000,000 drinks. That’s 107 billion, 200 million drinks.

To arrive at how many drinks this is per year, all we have to do is divide this number by 10 (for the ten-year program) and the result is 10,720,000,000. This is still a huge number that fortunately can be “massaged” even more. According to The World Factbook website, the population of Canada was estimated to be 33 million people in 2006. Dividing 10,720,000,000 by 33,000,000 equals 325. Putting this in terms that the average person can understand, every man, woman, and child in Canada will have to consume 325 alcoholic drinks per year for the next ten years to finance the new mental health system! Simply put, these numbers are not realistic.

More Flaws

The “logic” of this proposed mental health program also breaks down when it is examined more deeply. For instance, why would people drink lower-alcohol products such as beer if the increased excise tax applies to all alcoholic drinks? To help understand this better, let’s use an example. Let’s say that the average shot in Canada currently costs $3.00 and the average beer costs $1.00. Based on the proposed price increase, if Joe drinks an average of 5 shots per week, his weekly average alcohol expenditure will be $15.25. When the numbers are calculated, this figures out to be 1.7% more than Joe would have spent before the proposed tax increase. Let’s do a similar exercise with beer. Based on the projected price increase, if Pete drinks an average of 5 beers per week, his weekly average alcohol expenditure will be $5.25. When the numbers are calculated, this figures out to be 5% more than Pete would have spent before the proposed tax increase. The point: since the proposed price increase affects higher-alcohol products (such as shots) proportionately less than their lower-alcohol counterparts (such as beer), why would Canadians switch to lower-alcohol products?

Alcohol and Mental Health

Another question. What if tens of thousands of Canadians, realizing that drinking alcohol is not good for their “mental health,” significantly reduce their alcohol intake or quit drinking alcoholic beverages altogether? Where will the money come from to offset this lack of revenue? In a similar manner, what if thousands upon thousands of Canadians who drink alcoholic beverages decide that they don’t want to pay the extra excise tax and, as a result, stop drinking alcoholic beverages? If this happens, where will the government get the money needed to transform the mental health system? In other words, does the Canadian government have a realistic “plan B” for this major transformation?

A Logical Contradiction

From a different perspective, isn’t it rather ironic that those who drink alcoholic beverages will pay for the revamped mental health system? Isn’t there a contradiction in logic somewhere in this proposal? Stated differently, if tens of thousands of Canadians have mental illnesses or are addicted to alcohol or drugs, wouldn’t the government want Canadians to drink LESS alcohol in order to reduce the existing alcohol abuse, alcoholism, and alcohol-related mental health problems? Yet according to the current mental health proposal, from strictly a financial standpoint, it would appear that the Canadian government is banking the entire mental health system upgrade on historical data that strongly suggests that Canadians will continue to drink at their current or even higher levels of consumption.

Budgetary Miscalculations

What happens, for instance, if there are cost overruns in the proposed mental health system? There are, of course, two “easy” solutions to this problem: increase the excise tax on each drink or motivate Canadians to drink even more alcoholic beverages. Either “solution,” however, is predicated on the fact that in order to “work,” the upgraded mental health system needs to be funded by Canadians who continue to drink alcoholic beverages.

Conclusion

It appears logical to conclude that the Canadian mental health system is in need of a major overhaul. As with most comprehensive government programs, however, the issue of funding becomes a major obstacle to overcome. The proposed Canadian mental health system upgrade is no exception. Based on the reasons given above, it seems obvious that the Canadian government needs to come up with alternate sources of revenue generation for this worthwhile project. Indeed, to point out one of the major “flaws” in the current proposal, consider the following question: When is more drinking a “good thing?” Answer: when it finances a nationwide mental health system upgrade. Something tells me that Andy Rooney from “60 Minutes” would have a lot of fun with this.

Copyright 2007 – Denny Soinski. All Rights Reserved Worldwide. Reprint Rights: You may reprint this article as long as you leave all of the links active, do not edit the article in any way, and give the author credit.

There is a lot of prospect in community-based mental health careers both in the state of Maryland and all over the country. This is because for years now, there has been a lot of emphasis on prevention and reduction of inpatient hospitalization for all illnesses, including mental illness. This might primarily have been intended for cost control, it has also facilitated quality and access. The second reason why career prospects in community mental health are many is that there is currently a severe shortage of mental health workers in all sectors. The 2007 Maryland Mental Health Workforce White Paper revealed that the number and complexity of mental health problems experienced by children and their families have increased over the past decade. It further said, “At least one in five children and youth, or 20%, experience a mental health disorder. The crisis of mental health in the United States is such that 75-80% of youth with mental health diagnoses receive no services, and services received are often inadequate”. Thirdly, there is inadequate diversity among the few mental health workforce. For example, 28% of Maryland population is of ethnic minority but only 12% of mental workforce is of ethnic minorities. Furthermore, there is an acute shortage of African American males in mental health workforce.

 1. Outpatient Mental Health Clinics (OMHC)

Outpatient mental health clinics provide therapy, counseling, medication management, social skills teaching, and case management services to individuals with severe and chronic mental health problems. Career prospects available in OMHC include:

Therapists and Counselors: New regulations require therapists and counselors in OMHC to have a minimum of a Masters degree and a license (such as LGSW, LCSW, LCSW-C, LGPC, LCPC, RNC, APRN/PMHN) in nursing, social work, psychology, counseling, or psychiatric rehabilitation. Also, an RN without a Masters degree but with an RNC from ANCC can be employed as a therapist. Salaries are very attractive.

2. Psychiatric Rehabilitation Programs (PRP)

PRP programs are an extension of the services provided to the patient in the OMHC. A PRP may stand alone or be an additional service to an OMHC. The purpose of PRP is to promote the rehabilitation, integration and improved quality of life for the patient at home, school, work and community. It aims at helping the patient to function at his or her optimum best in life. The counseling can be done at the Program office (onsite) or at the patient’s home (offsite). PRP counseling could be about a wide range of topics, including anger management skills, social skills, assertiveness skills, medication compliance, coping with symptoms, managing peer pressure, taking a bus, determining bus route, drug and alcohol, gang prevention, sex education, STD education, accessing community resources such as food stamps, affordable housing, bus pass, ID card, driver’s license, job search, preparing for job interview, keeping a job, improving attention in school, completing homework and school projects, respect of authority, etc.     

Even though a mere one-year work experience in a mental health setting or having an AA degree qualifies one to be a PRP counselor, PRP programs prefer to employ persons with a BS degree in any health or mental health related field such as nursing, social work, counseling, psychology and rehabilitation. PRP counselors are usually paid $14 or more per counseling session. Each client receives 2 to 8 counseling sessions per month.

3. Expanded School-Based Mental Health (ESBMH)

In addition to the school clinic, some schools also have an ESBMH clinic. A therapist assigned from an OMHC manages each of such clinics. Apart from providing therapy to troubled kids sent to the therapist’s office from the class or principal’s office, the therapist also serve as a resource person to the school staff regarding particular children, issues or topics related to mental health. 

4. Crisis Response Programs (BCRI, BCARS)

Mental health professionals are also needed in crisis centers where services are provided for anyone in mental health crisis. The two main centers in Baltimore are Baltimore Crisis Response, Inc. (BCRI) and Baltimore Child and Adolescent Response System (BCARS). For employment inquiries, please call 410-433-5255. There are positions that do not need a Masters degree.

BCARS website provides the following information about what they do: 

BCARS is a mobile crisis response service that provides emergency contact with mental health professionals throughout the city. Dedicated crisis clinicians staff the program as part of a continuum of clinical care provided by the Catholic Charities.  The Johns Hopkins Division of Child and Adolescent Psychiatry provide psychiatric consultations to the program.  BCARS assists children and families facing psychiatric and psychosocial crises by providing hospital diversion and immediate intervention and respite. For information or assistance, please call the BCARS hotline (410) 752-2272. It is available 24-7. 

BCRI web site provided the following information: about what they do:

HOTLINE: The telephone crisis “hotline” (410-752-2272) is available 24 hours a day and is staffed by trained counselors who have the ability to provide information and referral to the network of human services in the Baltimore metropolitan area. The counselors also provide supportive counseling, dispatch emergency assistance and link callers with more intensive BCRI services.  In FY 2004 – 34,852 and FY 2005 – 30,257 calls were received on the Hotline.

MOBILE CRISIS TEAMS: Mobile crisis teams are comprised of mental health professionals including psychiatrists, social workers and nurses who can be dispatched to community locations to provide immediate assessment, intervention and treatment. Teams operate from 7:00am till midnight seven days per week. Currently the teams average over 2000 responses per year.

IN HOME SUPPORT: Persons experiencing a mental health crisis can often be maintained in the community through regular visits from the BCRI mobile crisis teams. An average of 350 people a year is cared for in this manner.

RESIDENTIAL CRISIS BEDS: Baltimore Crisis Response, Inc. operates 18 psychiatric crisis beds. Crisis beds are not new to Maryland. However, since its inception, BCRI has operated with an average length of stay of 4.5 days compared with the historical statewide average of 16.5 days.

PUBLIC EDUCATION AND TRAINING: BCRI provide public and professional education and training on a wide range of mental health related topics including: suicide prevention, crisis intervention, mental illness, and stigma.  Training has also been provided to members of the Baltimore City Police Negotiation Team, over 3,000 patrol officers, Housing Police and Sheriff’s officers. Through special grants and contracts, BCRI has provided training to Baltimore City Public School teachers and guidance counselors, clergy, 911 operators, shelter care staff and others.  Public education is also provided via a cable television program called “Mental Health Matters”.  This program provides practical information regarding mental health issues and community resources.  BCRI has also offered professional training conferences, workshops and symposia.

ADDICTIONS SERVICES: In response to the growing need for addictions treatment services BCRI has expanded and now provides a 10-day residential detoxification program for chemically addicted and dually diagnosed persons.  There are currently 16 beds operated for this purpose.

5. Group Homes

Direct care staff and counselors are needed in group homes to manage, care and support the residents in the areas of activities of daily living, behavior management, life progress, and community living. Employment preference is usually given to individuals who have a degree related to health or mental health. Salary rates are very attractive. New regulations now mandate each group home especially for children to be managed by a Program Administrator (PA) who must possess at least a BS degree in any field but preferably in a health or mental health related field. Program Administrators are very well paid, depending on their education and experience and the size and intensity of the group home. 

6. Private Practice

There are a lot of prospects for licensed mental health professionals with at least a Masters degree to establish their own private practice. The practice could be in the area of clinical, research, educational, or consultancy.