What exactly is meant by the term “mental health”?
“Mental health” is a term that encompasses every aspect of a person’s wellbeing: emotional health, social welfare, and psychological health. The way that a person thinks, behaves, and feels is impacted by their mental health; specifically, it can determine how people interact with other people, choose to respond to stressors, and how they live their lives. From childhood, mental health and wellness deeply affect a person’s choices and development, and there can be signs from very early on that someone is experiencing mental health symptoms that negatively impact their ability to function healthfully in the world.
The good news is that because mental health symptoms are exceedingly common, there are a wide range of treatment services available that are effective. Early identification of symptoms and treatment are recommended to minimize the negative, long-term consequences of untreated mental health symptoms.
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Is there a difference between “co-occurring disorders” and “dual diagnosis”?
There are a number of different terms used to describe someone who is struggling with both a substance use disorder and a mental health disorder. In some cases, these terms are meant to highlight a specific mental health issue or to identify which disorder is believed to be the primary problem for the patient. The terms “co-occurring disorders” and “dual diagnosis” are interchangeable, and additionally, there are a number of other terms and acronyms that can indicate someone who is living with both drug or alcohol abuse or dependence as well as a mental illness, including:
- Comorbid disorders
- Dually diagnosed or dually disordered
- Mentally ill chemically dependent (MICD)
- Mentally ill substance abuser (MISA)
- Mentally ill chemical abuser (MICA)
- Mentally ill substance using (MISU)
- Substance-abusing mentally ill (SAMI)
- Chemically abusing (or addicted) mentally ill (CAMI)
- Individuals with co-occurring psychiatric and substance disorders (ICOPSD)
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Why do mental health disorders develop?
There is no one particular cause for any mental health disorder. In most cases, it is a combination of events and situations that contribute to the development of symptoms, which are not constant. Some possible contributing factors to the development of mental health disorders include:
- Genetics: If one or more people in the family struggle with a certain mental health issue, it is more likely that others in the family will as well as compared to the general public.
- Trauma: Sexual abuse, physical assault, as well as experiencing or being exposed to trauma (e.g., natural disaster, war, terrorist attacks, homicide, etc.) can contribute to the experience of mental health symptoms.
- Biology: In some cases, levels of hormones or the function of certain neurotransmitters can impact how a person feels, thinks, and behaves.
- Injury or infection: Damage to mental health and cognitive function can occur after certain infections or injury.
- Substance abuse: Heavy use of drugs or alcohol can create or worsen certain mental health symptoms.
Additionally, exposure to lead and other toxins in the environment, prenatal exposure to chemicals or substances, and poor nutrition may be connected to the development or worsening of mental health issues.
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Can substance abuse cause a mental illness?
Absolutely. Substance use and abuse are contributing factors for the development of an underlying mental illness that has yet to manifest, and they can also worsen a current mental health issue. The National Center for Biotechnology Information (NCBI) says that the following substances may cause mental health issues:
Additionally, NCBI reports that the following mental health disorders can be caused or worsened by substance abuse:
- Persisting dementia
- Persisting amnestic disorder
- Sleep disorder
- Psychotic disorder
- Mood disorder
- Perceptual disorder
- Sexual dysfunction
- Anxiety disorder
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Who is qualified to diagnose a co-occurring disorder?
Mental health professionals, especially psychiatrists and psychologists, may be best equipped to diagnose a mental health disorder. They may also be able to identify a substance abuse disorder, though a family physician or any medical doctor may be able to diagnose substance abuse and addiction.
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What added difficulties are there in treating multiple issues at the same time?
Treating a single mental health disorder or substance abuse alone can be difficult enough, but when there are two or more disorders, there may be even more challenges to face along the way. It is very important that the patient undergo a thorough evaluation and assessment period at the onset of treatment to identify all disorders at play and to determine how they are impacting the patient. In order to help the patient stop abusing drugs and alcohol, it will be necessary to address such issues:
- Retention for substance abuse treatment as well as mental health treatment (e.g., continuing to take medication and take part in therapy)
- Relapse on drugs or alcohol
- Relapse on damaging and/or self-harming behaviors associated with the mental health disorder(s)
- A patient’s willingness to meet treatment program requirements
- Conflicting demands from multiple agencies
- Increased need for support and education of family members
Often a patient who is living with co-occurring disorders will have a higher likelihood of repeatedly leaving and returning to a treatment program. Relapse may be a more pressing and frequent issue, and family members may need more intensive education and support assistance so they can better understand the nature of the illnesses facing their loved one and how they can best help.
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Where do people seek treatment for a co-occurring disorder?
People living with co-occurring disorders are encouraged to seek treatment at a program that has the resources to effectively treat both disorders at the same time. Thus enrolling in a drug rehab program that provides minimal mental health treatment beyond relapse prevention and basic support will not be sufficient to help the patient manage ongoing mental health symptoms and will in turn negatively impact his ability to avoid relapse for the long-term.
Dual diagnosis rehabilitation programs should be able to offer:
- Medical detox, if needed
- Medical supervision to address any complications that arise during detox
- Evaluation to determine the exact nature of all co-occurring mental health issues including learning disorders, behavioral disorders, mood/personality disorders, vice addictions, and others
- A unique treatment plan prioritizing a comprehensive therapeutic schedule that addresses the issues most pressingly facing the patient in recovery
- Flexibility in treatment to account for changing treatment goals as well as progress made
- Flexibility in scheduling to lengthen the time spent in treatment in order to stabilize fully if necessary
- Ongoing support after rehab is complete through aftercare support
In short, a dual diagnosis rehab program should be able to provide the patient with everything he or she needs to make a strong start in independent living in recovery.
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Is mental illness something that can be cured?
Unfortunately, no. Neither drug or alcohol addiction nor any mental health disorder can be cured at this time; there is also no vaccine in place to prevent substance use disorders or mental illness in those who exhibit a high number of risk factors.
There are, however, a number of evidence-based treatments and therapies that have been proven to be effective in the treatment of dependence upon a range of substances as well as in the treatment of different mental health symptoms and disorders. For example, antidepressants are an excellent way for some patient to manage symptoms of anxiety or depression, and behavioral therapies have helped millions of patients to learn how to avoid relapse in addiction recovery and manage their mental health issues as well.
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How do medications help treat a mental illness?
Medications can be a hugely effective part of stabilizing a patient living with a mental health disorder and in managing ongoing mental health symptoms. Some people need only take them for a short time in recovery, especially if their symptoms were created or exacerbated by substance abuse, while others find it beneficial to continue taking medications for the purposes of long-term management of symptoms.
Different people experience medications differently, and thus it can be a process to determine the most effective medication, combination of medications, and/or doses for each individual. Factors that will affect this process include:
- The specifics of the mental health disorder and symptoms experienced by the patient
- Gender, age, and physiology of the patient
- Use of other medications and supplements being taken to address medical issues
- Existence of other medical disorders and their symptoms
- Functionality of the liver and kidneys
- Whether not the patient adheres to the medication dosage and schedule
- Use of substances, including alcohol, cigarettes, and others
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Can you die from a mental health issue?
A mental health disorder can be deadly if it is the cause of self-harming behaviors. Suicidal thoughts or actions can result in suicide, for example. An estimated 30,000 people in the US die by their own hand each year, making suicide the 11th leading cause of death.
Also, eating disorders characterized by starving oneself or severely limiting the intake of necessary nutrients and vitamins can result in death due to the body’s systems being shut down.
Additionally, untreated mental health issues that contribute to the use of illicit substances and other risky behaviors can contribute to a deadly accident (e.g., car accident, burning, drowning, etc.) or becoming the victim of a homicide.
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What is the history of treating mental illness?
Mental illness and substance abuse have likely played a role in human history since the dawn of man. Like substance abuse treatment, the history of mental health treatment goes back centuries and has changed rapidly and drastically in that time:
- 400 BC: Hippocrates identifies mental health issues as diseases that can be treated physiologically as opposed to an indication that the person had angered the gods or was possessed by demons.
- Middle Ages: Muslim Arabs built asylums for mentally ill people and continue to approach the disorders somewhat scientifically.
- 1407: Facilities are likely designated for the treatment of the mentally ill in Spain.
- 1600s: Mental health patients are frequently housed with criminals and disabled people and often abused and treated poorly.
- Late 1700s: Reforms in the treatment of mental health patients begin in some parts of Europe.
- 1840s: Dorothea Dix works to reveal the treatment conditions and poor housing for mentally ill people and to establish 32 state hospitals solely for the treatment of people significantly impaired by mental health disorders.
- 1883: Emil Kraepelin begins to research mental health disorders. His distinction between schizophrenia and bipolar disorder stands today.
- 1800s: Nellie Bly, a reporter for New York World, poses as a mental health patient in order to expose the continuing inhumane treatment inside mental health hospitals in the United States. Her report triggers increases in funding and support for the improvement of treatment and conditions.
- 1900s: Sigmund Freud, Carl Jung, and others create the original treatments for mental health issues.
- 1930s: Medication, surgery, and electro-convulsive therapy are utilized to treat patients living with mental illnesses like schizophrenia. The practice of lobotomy, or removal of part of the brain, begins.
- 1938: Doctors begin using electroshock therapy to induce convulsions to treat schizophrenia, but the practice is more effective in treating depression.
- 1946: The National Mental Health Act is signed by President Harry Truman and creates the National Institute of Mental Health (NIMH) to research the brain and behavior with the goal of reducing the rate of mental health disorders.
- 1949: Lithium is used to treat psychosis. NIMH officially opens its doors.
- 1950s: Antipsychotics are utilized to help manage symptoms of psychosis. Behavioral therapy is developed.
- 1960s: Many patients are released from mental health facilities. Some fare well due to the use of antipsychotics while others end up homeless due to a lack of care. The Mental Retardation Facilities and Community Mental Health Centers Construction Act is passed to establish federal funding for community-based mental health treatment services.
- 1990s: A new batch of antipsychotic medications is implemented in treatment and proves to be even more effective in the treatment of schizophrenia.
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