Psychology

Suffering from a mental illness tends to result to stigmatization and banishment of the individuals affected. Not only is the patient affected but also the family members. This causes individuals and families to avoid coming out to seek help thus worsening the situation. This was the trend in most American communities in a few decades ago. Whenever the mentally ill got a chance to get treated, they were usually completely hospitalized for long thus adding up the ostracism (Fink  Taskman, 1992). The state of events has however changed from late 20th century with the community taking part in helping people with serious mental illnesses to regain acceptance and recover substantially. There have been massive benefits of having community services for serious mental illness patients, the family and the community at large. Professionalism in the community centers has proven to be indispensable in achieving the best results to patient.

This paper discusses the treatment of serious mental illnesses in todays community. The first section of the paper explores the history of serious mental illness treatment centers and community services. Various advantages and disadvantages of caring for patients with serious mental illnesses at the community centers are as well discussed. The last section looks into the likely future of treatment for the seriously mentally ill persons.

History of serious mental illness treatment centers and community services
Before exploring the history of the serious mental ill services, it is worth stating which illnesses are considered as serious mental illnesses. According to Community Health Network (2010), a serious mental illness is any psychotic or mood disorder which renders a person impaired as far as functioning is concerned. The person may not be able to handle activities of daily living in addition to inability to have meaningful interpersonal relationships. It is also common to have such a person experience concentration problems with adapting to change proving difficult. Some of the well known serious mental illnesses include schizophrenia, major depression, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder (Community Counseling Associates, 2010). The main impetus that led to the establishment of community services and treatment centers for the serious mentally ill patients was the observation that mentally ill patients did not cope well after finishing hospitalization.

Serious mental illness treatment centers and community services can be traced back to the 1960s. Institutionalizing serious mentally ill patients was the best option to the large section of the American society. Psychiatrist hospitals and detention centers were the order of the day as mentally ill persons were being isolated from the community. Those who recovered would be brought back to their home settings but the coping mechanism for the patient, family and the community was not sufficient. There was need to shift the pattern of care to incorporate the whole community in bettering the lives of serious mentally ill patients. A research carried out by Arnold Max, Leonard Stein and Mary Ann Test in Mendota State Hospital in the late 1960s on how mentally ill patients coped when they go back to the community after hospitalization paved the way for community services. These researchers found out that most of the gains that patient had acquired during hospitalization would be easily lost once the patients joined the community. The extension of hospital services into the community as proposed by the researchers led to the establishment of the Assertive Community Treatment (NAMI, 2010).

The Assertive Community Treatment (ACT) although known by other terms such as the Program of Assertive Community or Mobile Treatment Teams as per the state or the locality has characteristic goals. The ACT has several key goals. It is the aim of the ACT to reduce or eradicate all the symptoms that go with mental illnesses. Since mental illnesses are characterized by recurrent episodes, the ACT aims at reducing or totally preventing the episodes. It is also within the main goals of ACT to improve the quality of life of mentally ill patients as well as meet their basic needs. As such, they intend to help the patients recover and start living independently eventually lessening the burden the caretakers have. Assertive Community Treatment takes the services directly to the patient in the home and community which is provided in a customized way (NAMI, 2010).

It is important to note that there is a difference between a mere case management and community treatment for severe mental illnesses. A traditional case management model for severe mental illnesses entailed linking patients to treatment services and not practically providing the services. However, a modern model such as the assertive community treatment is a wholesome treatment package that is delivered to the patients premises or community. The services are also available for the patient in a 24 hours a day basis. In other words, it is like moving the hospital to the patients compound. The ACT as a case management model for serious mental illness patients is available to patients who are likely to require hospitalization thus requiring treatment and monitoring for a long period of time (Bedel, Hunter  Corrigan, 1997).

Governance has greatly influenced the treatment of the serious mentally ill patients through enacting of various legislations. These have been aimed at reducing segregation and incorporating mentally ill patients in the communities. For instance, the U.S. Supreme Court in 1999 in Olmstead v L.C. stated that it is discriminatory to segregate the serious mentally ill patients in institutions. As such, the community has had to find ways of incorporating the mental patients and helping them to recover. The above move by the Supreme Court was out of the view that a significant percentage of the old Americans suffer from mental illness (SAMHSAS, 2010). It is important to note that serious mental illnesses meant that the patient must be institutionalized. SAMHSAS (2010) indicates that among the old Americans suffering from serious mentally illnesses, 89 percent of them were in nursing homes even after being deinstitutionalized from state psychiatrist hospital. This meant that community services were not working out and this may have led to the focus on the Nursing Home Reform Act of 1987 which looked into the Preadmission Screening and Resident Review. This made some States to encourage community services to deal with some of the serious mentally ill patients.

The integration of the serious mental illness patients into treatment centers and community services faced various challenges in the 1990s. Community based-treatment among other support services was not a priority for the government or even the health care providers. Institutional-based services were readily available yet the move was towards deinstitutionalization. The older adults with severe mental illnesses seemed to suffer most in the nursing homes which never provided community support. It must however be noticed that the deinstitutionalization process has come with the mandated community-based mental health treatment for severe mental illness patients. The ACT services as among the modern facilities and services for serious mentally ill patients has great benefits to the patient, the family and the whole society.

Advantages in treatment at community centers
Providing treatment for serious mental illness in a community set up under the modern ACT model gives the patient wholesome benefits. In the ACT program, the patient has the opportunity to get the services of a psychiatrist, psychologists, nurses, social workers, counselors, case managers among other professionals (Community Health Network, 2010). The various features of an assertive community treatment ensure that the patient reaps these benefits to the full. The ACT is organized in a team and each member of the team provides the patient with the best possible care. All the services are provided in a 24 hour a day 7 days a week basis meaning that help is available continuously. In addition to providing clinical care, the ACT team provides basic care such as providing food, shelter as well as social support. The ability to customize the type of care provided as per individual needs in addition to assertive follow up is effective in bringing great outcomes for the patient (Kent  Burns, 1996). Furthermore, the ACT program is most suitable for serious mental illness patients as the team takes treatment to the patients who may not be able to follow treatment plans.

To ensure that the treatment provided is effective and fruitful, the patient is assigned a case manager who is usually a leader of the ACT team. The case manager has thorough familiarity with the patients condition as well as the treatment options that may be available. As the leader of the team, the case manager is able to ensure that all treatment option for the patient (if heshe is an outpatient) are explored before deciding on an expensive hospitalization treatment option. Another advantage of having a case manager is that heshe is able to impact adaptive social skills to the patient with the environment of the patient in mind (Bedel, Hunter  Corrigan, 1997). Establishment of a therapeutic relationship is very essential in treating mental conditions. This being one of the main roles of the case manager, the client gains immensely in achieving therapeutic benefits (Kent  Burns, 1996). As such, the client copes well with the environment in which they are.

There are three general aspects in which the patient benefits from community services such as the ACT. These may be treatment benefits, rehabilitation benefits and support services. The treatment benefits come in form of psychotherapy or pharmacotherapy with the latest options being applied. Hospitalization is also offered where it is absolutely necessary. Individual therapy also comes into play with group therapy being offered in case there is need to treat substance abuse. Rehabilitation takes into account cognitive-behavioral therapy as well as supportive therapy. Here, the patient can get supported employment or schooling. Family members and caretakers of the patient also gain by being offered education and skills to empower them to handle the patient appropriately as well as coping skills. If a patient has children, the ACT comes in to bring together the children with their families. Since severe mental illnesses is characterized by stigma in judicial representation, inability to manage finances as well as housing among other services, ACT is very useful in offering these support services (NAMI, 2010).

Community-based treatment services for serious mental illness patients as with the case of ACT makes the client benefit from the services of paraprofessionals which would otherwise have been missed. Bedel, Hunter and Corrigan (1997) argue that the treatment team can incorporate paraprofessionals and trained consumers who are more aware of the clients community. Since the level of coping of the mental health professionals may not cope with the clients environment such as in terms of social status, it may be hard for himher to impact the patient successfully. A paraprofessional acts as a middleman connecting the patient and the health professional such as a psychologist. This is meant to improve the outcome of the patients condition.

Within the community service program, it is also possible to offer group therapy in addition to individual therapy. The therapist is able to assess the needs of each client and consequently advise for either individual or group therapy. Cognitive-behavioral social skills are among the great benefits that can be delivered through a group therapy. It is appreciated that most serious mental illnesses have a good prognosis when social skills training is provided. Individual therapy is particularly preferred when the patients condition requires them to understand their own internal processes eventually helping the patient become participative in the treatment process. It is also a powerful way towards problem solving in individuals. For instance, schizophrenic individuals may be helped to come to terms with hallucinations and delusions through individual therapy. Individual therapy can follow either personal therapy model or problem-solving model (Bedel, Hunter  Corrigan, 1997).  

In case of group therapy, it is best to apply it when the expected outcome is either the client getting problem-resolution skills or communication skills. Group therapy has the benefit of reducing costs involved as well as helping the patient interact with others who have a similar condition. The groups are composed of eight to ten patients and can either be a time-limited group or an openended group. A time-limited group therapy is terminated once the clients have attained a set of expected outcomes. They are also preferable for dealing with acute symptoms. On the other hand, open-ended group therapy will have a wide range of expected outcomes and is conducted over a long period of time. A severe mental illness patient is therefore able to benefit by not only learning social skills but also applying them in real life. In the community setting, the patients get to learn how to incorporate into the community smoothly thereby greatly improving the social life of the patient (Bedel, Hunter  Corrigan, 1997).

Some of the outpatient services that a patient with severe mental illness gains through community centers include residential services and support services. Residential services are mainly provided for patients who cannot live independently. The residential services can be provided in the form of group homes, cluster apartments or semi-independent living programs. These clinical and cognitive-behavioral skills are taught in these residential settings just as it would happen in the clients home. A client whose condition is severe and requires hospitalization is also provided with inpatient care (Community Health Network, 2010). Serious mental illness patients stand to gain from clinicians who are skillful and knowledgeable in mental illnesses with most of them having studied to at least master degree level.

Psychiatrist rehospitalization is among the greatest benefits of having a patient get the ACT services. The rate of the rehospitalizations is also reduced significantly when compared to patients receiving care under old case management models or no ACT at all. According to Scott and Dixon (1997), ACT has the potential to reduce inpatient days by half. This is despite the fact that patient care is provided throughout at home. It is important to note that inpatient days are reduced only if the patient is a regular rehospitalization patient. Most caretakers and family members also cite that they get more satisfied with the treatment provided through community services. The introduction of mandated treatment for serious mental illnesses is also seen as a positive step that has been appreciated by many. In New Zealand for instance where treatment for serious mental illness patients is involuntary, it has been identified that family members as well as mental health professionals appreciate this move (Gibbs, Dawson  Mullen, 2006).

The economic advantage of opting for community services versus institutionalization is not very significant. It is however appreciable that the costs are lower than those that would be incurred by having most of the serious mentally ill patients incarcerated for crimes, suicide, unemployment or homelessness, (NAMI, 2010). According to Monahan, Swartz and Bonnie (2003), the likelihood of a serious mental illness person being incarcerated is five times higher than their likelihood of being hospitalized. There are a lot of inmates who are patients of serious mental illnesses and this increases costs. Patients who have not been incorporated in community service centers have been reported of committing murder. California enacted the Laura Law in 2003 while New York enacted the Kendras Law in 1999 thus facilitating mandated community-based treatment.

Although treatment centers and community services have a wide range of advantages in treating serious mental illnesses, they are still not comprehensive in this process. It has been identified that the benefits of ACT programs are evident only when the services are being provided with erosion of the gains occurring after withdrawal. This is mainly for patients with frequent rehospitalization. As such, the care must be provided throughout the patients life. In such a situation, the costs may rise up than expected. The advantage is that it is possible to have such patients receive less demanding community care as long as they are in stabilized states (Scott and Dixon, 1997). The future of treating these patients is therefore partially held by the identification of patients who may fit in the less intensive care. Novel pharmacological options that are able to completely cure these illnesses perhaps by using customized pharmacotherapy would reduce suffering in serious mental illnesses.

Conclusion
Treatment for serious mental illness patients has moved from discriminatory hospitalization to a point where the community is being involved. By introducing assertive community treatment, it has been possible to deliver treatment benefits to patients such that integration has been easy. The patient, family and caretakers, mental health professionals and the community at large can count gains by accepting the serious mental illness diseases and providing them supportive care. Despite the progressive made so far, it is still worth to look into ways of having serious mental illness patients recover and enjoy life like everyone else. Psychopharmacotherapy research must therefore be advanced towards this end.