Clinical Mental Health Counseling PDF

SECTION III PRACTICE ISSUES Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved....

SECTION III PRACTICE ISSUES Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  CHAPTER 6 COMMUNITY-BASED MENTAL HEALTH COUNSELING, RECOVERY MODELS, AND MULTIDISCIPLINARY COLLABORATION ELIAS MPOFU | JUSTIN WATTS | QIWEI LI | NGOZI JANE-FRANCES CHIMA ADARALEGBA | PATRICK IGBEKA This chapter considers community-based mental healthcare practices for optimal functioning of people in their communities. First, we address community mental health in the context of the activities and participation to which people aspire, regardless of their specific mental health impairment; within this context, their personal factors are considered as well as the lived environment. Second, we discuss mental health recovery models for satisfying personal and community functioning. Finally, we identify types of collaborative community mental Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. healthcare practices and offer associated evidence. The following Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are addressed in this chapter: CACREP 2016: 2F1.b, 2F1.c, 2F3.d, 2F3.h, 2F5.k, 5C2.a, 5C2.c, 5C2.e, 5C3.d CACREP 2009: 2G2.a, 2G3.g LEARNING OBJECTIVES After reviewing this chapter, the reader should be able to: 1. Define mental health in the context of community; 2. Differentiate between mental health functioning and diagnosable mental health disorders; López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  120 Section III Practice Issues 3. Discuss mental health needs in the context of community; 4. Evaluate the roles of activity and participation in the restoration and maintenance of mental health issues; 5. Characterize the nature of recovery in the context of community mental health needs; and, 6. Discuss collaborative mental healthcare models. INTRODUCTION Community-based mental health services offer structure and support to individuals with mental health issues in order to help them achieve an optimal level of functioning. Levels of functioning can be enhanced when communities provide a foundation for achieving a sense of being for and with others (Mantovani, Pizzolati, & Gillard, 2017). Community is more than just a place where people live; it is a space in which people construct their lives for and with others who share broadly common values/interests and goals/actions for realizing life goals (Mitchell & Haddrill, 2006). Communities provide social capital resources for health and well-being, along with other important resources aimed at meeting the mental health needs of community members. For instance, communities that are socially disadvantaged have fewer physical and social resources, which greatly inhibits participation in both physical and social activities (Sheffield & Peek, 2009). Meaningful personal and community function- ing is premised on healthy mental functioning and on the capacity of community members to carry out basic self-care and successfully engage in major life domains (Table 6.1). For many decades, mental healthcare practices have privileged clinical psychiatric care with little regard for community-oriented mental healthcare (Rosen, O’Halloran, Mez- zina, & Thompson, 2015). There is presently a major shift toward community-oriented mental healthcare, which aims to support people with specific mental health conditions Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. in order to foster the greatest quality of life possible within communities (Fairweather, Cressler, Meissner, & Maynard, 2013; Mpofu, 2015). Despite the significance of com- munity mental healthcare services, there is currently an enormous gap between mental health needs and available resources in the community setting (Thyloth, Singh, & Sub- ramanian, 2016). LEGAL AND PROFESSIONAL ISSUES The community mental health movement started in 1963 in the United States after Pres- ident John F. Kennedy signed the Community Mental Health Act (CMHA; Dixon & Goldman, 2003). Prior to this act, many individuals with disabilities and mental illness were isolated in asylums that failed to provide treatment or any type of productive activ- ities for those who were institutionalized (Substance Abuse and Mental Health Services Administration [SAMHSA], 2013). The CMHA provided a comprehensive foundation López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 121 for community-focused mental healthcare in every U.S. state. This Act served as a spring- board for advanced training for mental health practitioners, increased research on men- tal health and mental illness, influenced an emphasis on prevention, and ultimately led to deinstitutionalization, which has resulted in the decongestion of large state mental hos- pitals, thus placing the responsibility of mental healthcare on the community (Dixon & Goldman, 2003). In 2008, Senator Edward Kennedy and Representative Patrick Kennedy oversaw updates to the CMHA of 1963 by implementing the Mental Health Parity and Addiction Equity Act, which requires that insurance agencies treat mental health and substance use disorders in the same fashion that other illnesses and diseases are addressed. These updates were intended to address concerns due to fragmented service delivery and issues related to certain disorders “falling through the cracks” of the healthcare system. These pivotal pieces of legislation have set the foundation for many advances in community sys- tems of care in providing equitable treatment for individuals with mental health issues, in addition to new legislation in addressing current concerns related to mental health coverage for individuals with and without insurance coverage, Medicare, or Medicaid. Changes in policies and the involvement of nongovernmental institutions and organ- izations have contributed to the current, improved state of community-based mental health services. Currently, community mental health programs attempt to assist people in meeting their mental health needs for everyday functioning (Drake & Latimer, 2012). These programs also strive to attain full social and economic inclusion (Nieminen et al., 2012; Seebohm, Gilchrist, & Morris 2012). The World Health Organization’s International Classification of Functioning, Disabil- ity and Health (WHO ICF, 2001) defines mental health functions as being comprised of two major domains: global and specified. Global mental functions refer to predispositions of consciousness, awareness, social engagement, and temperament that are important for everyday functioning. A person’s general sense of mental health well-being defines his or her sense of connectedness or belongingness (Mitchell & Haddrill, 2006). Specified Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. mental functions refer to individual attention, memory, emotion, and perception, which include mental and personality disorders. Disorders of specified mental health functions account for approximately 13% of the global burden of disease (Ng et al., 2014). Those with disorders of specified mental health functions typically require treatment, care, and support by mental health providers, family, and significant others (Corrigan, Druss, & Perlick, 2014). Community life also influences the prevalence and severity of specific mental health functions, as with the management of psychiatric illness. The quality of lived social and physical environments influences both the physical and mental health of individuals and their significant others. For instance, perceptions of social and physical safety, housing, transportation, and distribution of human ser- vices influence the mental health well-being of residents (Kelly, Perkins, Fuller, & Parker, 2011). Communities with high levels of physical illness also demonstrate high rates of mood disorders, such as depression and anxiety (Methley, Campbell, Cheraghi-Sohi, & Chew-Graham, 2017). López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  122 Section III Practice Issues ACTIVITY AND PARTICIPATION IN COMMUNITY MENTAL HEALTH People’s mental health influences the activities in which they choose to engage, along with the degree to which they participate in their communities. According to the WHO ICF (2001), the term “activity” involves execution of a task or action by an individual (e.g., riding a bicycle or walking). The term “participation” refers to involvement in a life situation that broadly encompasses key areas of everyday life. Individuals might have limitations regarding participation in certain activities that may be a result of general or specified mental health conditions. The WHO ICF (2001) defines participation restric- tions as challenges an individual may experience that limit involvement in certain life situations. The WHO ICF also defines nine domains of activities and outlines examples of actions essential to participate in these activities (Table 6.1). The first set of four domains and functions cover activity functions, whereas the latter set of five domains cover participation functions. There is an interplay between activ- ity limitations and participation restrictions in the community context (Figure 6.1). For instance, engagement in leisure-time physical activity, such as playing sports, is associ- ated with higher levels of mental health (Marlier et al., 2015). Similarly, when individuals are community engaged, they tend to have higher levels of general mental health. Case Illustration 6.1 is illustrative. TABLE 6.1 The World Health Organization’s International Classification of Function- ing (WHO ICF) Activities and Participation DOMAINS EXAMPLES OF ACTIONS/TASKS Activities Learning and applying knowledge Basic learning, applying knowledge General tasks and demands Recreation and leisure, undertaking multiple tasks, carrying out daily routine Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. Communication Conversation and use of communication devices and techniques Mobility Carrying, moving, and handling objects Self-care Washing oneself, eating, dressing Participation Domestic life Caring for household objects, household tasks Interpersonal interactions and General and specific interpersonal relationships relationships Major life areas Education, economic life, and employment Community, social, and civic life Community life, recreation and leisure, and religion SOURCE: Adapted from World Health Organization. (2001). International Classification of Functioning, Disability and Health. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/42407/ 9241545429.pdf;jsessionid=25740D4E9A37B6B253A5D6ECEFD82007?sequence=1 López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 123 Relationship Between Levels of Physical Activity and Mental Health Recovery 200 150 Recovery 100 50 Low Moderate High 0 Levels of Physical Activity FIGURE 6.1 Interaction between physical activities and levels of mental health. CASE ILLUSTRATION 6.1 ANNA: COMMUNITY INVOLVEMENT AS A TREATMENT FOR SPECIFIC MENTAL HEALTH FUNCTIONS Anna is a 34-year-old female who recently joined a volunteer organization that engages in community improvement projects to keep neighborhoods and parks clean and beautiful. She has made a few friends through the organization and maintains several hours a week in volunteering while also attending social events through the organization. Prior to her engagement with the organization, Anna was experiencing depressed mood for most of the day. She reported losing interest in most activities, and experiencing increased fatigue, difficulty sleeping, and difficulty concentrating on anything. When she initially was diag- nosed with Major Depressive Disorder, Anna reported that she “no longer had the interest Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. or energy to do anything.” She began to withdraw from friends and started to have issues at work. A close friend encouraged her to join the volunteer organization. Over time, this began to give her a sense of purpose and connection, which has helped her to begin address- ing her symptoms, in addition to seeking counseling and other supports. She noted that “it’s nice to get up and get moving, meet new people, and feel a sense of pride for accomplishing something and making my community beautiful.” The case of Anna exemplifies the presentation of specified health functions involving emotion regulation. It also demonstrates the fact that community engagement may be a partial solution for thought and mood disorders through the restoration of a sense of be- longingness and agency involving others. Traditional mental healthcare has prioritized treatment and care for emotional functions with psychopharmacological medications and intensive cognitive behavioral therapies at the relative neglect of informal engagement in community activities, which would treat the specific mental health functions while also enhancing the person’s overall functioning. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  124 Section III Practice Issues Activities and Community Mental Health Functions An individual’s degree of mental health functioning has a major impact on the degree of engagement in basic life activities. However, the relationship between mental health func- tioning and community engagement is bidirectional. The ability to perform general tasks in and withstand the demands of community settings is associated with the general mental health functions of energy and drive. For instance, mobility limitations, such as difficulties in using public transportation due to mental health impairment, may result from reduced mental health functions (Stegenga et al., 2012; Thorpe et al., 2011). Similarly, mental health condition limitations from a specified emotional disorder, such as depression and anxiety, would affect the ability to complete tasks on time and to manage and develop interpersonal relationships (Carrière et al., 2011; Norton et al., 2012). Conversely, consistent physical exercise is linked to reduced depression (Hamer, Stamatakis, & Steptoe, 2009). Participation and Community Mental Health Functions As previously noted, community participation influences both global and specific mental health functions. For instance, participation in domestic life activities improves an indi- vidual’s confidence and encourages a sense of fulfillment and belonging in the commun- ity (Firth et al., 2016). One’s global (general mental health) and specific mental health functions (mental disorders) influence the quality of one's interpersonal/interactional relationships. Successful community living depends on global (general) mental health functions and/or well-managed specific health functions or disorders. Conversely, people with lower engagement in major life domains of work, education, and employment may be restricted in their general psychosocial functioning. Participation in community, social, and civic life is related to healthy functioning with mental health disorders. For instance, a study by Tjonstrandi, Bejerholm, and Eklun (2011) found that people with psychiatric disabilities who had more opportunities to socialize at community day centers had superior mental health functioning. Similarly, improvements in cognitive and intel- lectual functioning are associated with availability of physical activity resources, such as Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. recreational centers and parks (Clarke, Weuve, Barnes, Evans, & Mendes de Leon, 2015). Community Environment and Mental Healthcare Community mental health outcomes are shaped by interactions between people and the environments in which they live, work, and play (Clarke & Nieuwenhuijsen, 2009). As noted previously, both physical functioning and the social–environmental context influ- ence health and well-being. The WHO ICF (2001) considers the environment to be com- prised of an individual’s natural surroundings (including those that are human made), technology, support and interpersonal relationships, as well as political systems and pol- icies. The environment either can act as a barrier to or can assist in facilitating posi- tive mental health functioning of individuals (WHO ICF, 2001). A healthy community environment fosters social interactions, nurtures social capital, and provides a sense of belonging for the community (Wong, Yu, & Woo, 2017). By contrast, some communities may lack a supportive, nurturing environment and may be full of chronic psychosocial López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 125 stressors that are likely to have a negative impact on the global mental health functions of individuals (Ilies, Aw, & Lim, 2016). As noted previously, social capital and social support consistently help to improve people’s mental health (Rothon, Goodwin, & Stansfeld, 2011). Higher rates of positive social interactions and consistent social inclusion have a positive impact on the mental health of an individual (Wong et al., 2017). Individuals who work in environments with greater social support from supervisors and colleagues and who experience greater job security often report improvement in mental health functioning. In addition to the social environment, the physical environment (e.g., buildings, transportation, and accessibility of recreational facilities) also can affect global health functions, specifically psychosocial and intellectual functions. For instance, while accelerated urbanization may contribute to livable communities and overall improved health of some residents (Chen, Chen, Landry, & Davis, 2014), it may also result in homelessness for others, which can have an adverse effect on the mental health of community members. Policies and programs that involve a strict focus on the individual have yielded insignificant results when compared with community-oriented policies that utilize community resources and social capital, as the quality of mental health reported by com- munity members is affected by these social factors (Marmot, Friel, Bell, Houweling, & Taylor, 2008). For example, home allocation services in Australia, Canada, and the United States have reduced homelessness and associated mental health problems among citizens (Metraux, Cusack, Byrne, Hunt-Johnson, & True, 2017). Public housing pro- grams in the United States have an opportunity to create people-friendly communities where members enjoy superior health and a lower prevalence of chronic physical health diseases. In 1996 the U.S. Congress passed legislation that created parity in mental health cov- erage with the intent to meet the increasing demand for mental health services to indi- viduals within the community. This amendment is known as the Mental Health Parity Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. Act (MHPA) of 1996. Prior to this act, individuals with mental health needs were not covered by insurers or experienced dollar limitations on coverage that limited access to mental healthcare. Congress passed the Mental Health Parity and Addictions Equity Act (MHPAEA) in 2008, which was a revision to the MHPA. This act required that health insurers, who covered mental health treatment, provide the same level of benefits for mental and/or substance use treatment and services as they did for medical/surgical care. The MHPAEA did not mandate coverage for mental health diagnoses and sub- stance use disorders. This Act only required that the financial requirements and treat- ment limitations were no more restrictive than the predominant financial requirements and treatment limitations for medical and surgical benefits covered by the plan. The Affordable Care Act (ACA) of 2014 mandated that most individual and small group health insurance plans cover mental health and substance abuse treatment. The ACA was needed for the purposes of streamlining mental health support services provided by managed healthcare organizations, unlike CMHA, which was utilized primarily for promoting community living with mental health diagnoses. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  126 Section III Practice Issues RECOVERY AND MENTAL HEALTH FUNCTIONS The conceptualization and treatment of mental illness has undergone a dramatic change over the last several decades. As opposed to describing mental illness as a chronic (long- term), degenerating (worsening) disease, research and treatment efforts have started to understand these issues through the lens of recovery and rehabilitation (Jenkins & Carpenter-Song, 2005). The focus is shifting from primarily symptom alleviation to recovery; this shift in research and service provision involves a sustained effort to restore factors that individuals perceive to be essential to their own mental health and well-being (Sklar, Groessl, O’Connell, Davidson, & Aarons, 2013). The process of recovery from mental illness is multifaceted and unique to each individual, as the resources that an individual has or may need will vary drastically from person to person. Recovery from mental health-related issues involves a process by which an individual utilizes a combi- nation of personal assets and available resources to restore and maintain mental health (Crowley, 2000; Deegan, 1996; Jacobson & Curtis, 2000). Sources of recovery or social/recovery capital include personal assets (e.g., psycho- logical resilience, empowerment, or learned resourcefulness) and environmental factors (social support and community mental health; Brown & Baker, 2018; Cloud & Gran- field, 2008; Ellison, Belanger, Niles, Evans, & Bauer, 2018; SAMHSA, 2013). For instance, SAMHSA (2012) has outlined 10 guiding principles that support recovery from men- tal health and substance-related issues. These guiding principles involve the following components: (a) person centered (i.e., the concept of recovery is highly individualized and distinct for each individual), (b) empowerment (i.e., the individual has agency over decision-making and control over his or her life), (c) hope (a belief in one’s capacity to recover), (d) self-direction (i.e., an individual has the autonomy to determine his or her goals for recovery), (e) strengths based (i.e., recovery builds on many different cap- acities and coping abilities), (f) respect (i.e., dignity, lacking stigma, and free from dis- crimination), (g) responsibility (individual accountability for one’s life), (h) peer support (mutual support from peers), and (i) holistic (recovery involves mind, body, spirit, and Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. community). In addition to these components of recovery, SAMHSA (2012) also out- lined the following four dimensions of recovery: (a) health (overcoming and managing one’s disease), (b) home (having a safe, stable place to live), (c) purpose (having fulfilling life roles that contribute to a meaningful life), and (d) community (interaction with the environment, a sense of connectedness). “Recovery capital” is a concept that initially was introduced in the addictions field (Cloud & Granfield, 2008) and that now has major implications for the field of men- tal health. In essence, recovery capital involves personal or environmental resources that can support an individual’s recovery from substance use or mental health-related issues. Recovery capital, in essence, works much like a bank account; the more resources individuals have at their disposal, the more likely they are going to be able to navigate distressing situations and, ultimately, increase the likelihood of recovery. Examples of recovery capital include any of the following: (a) social capital (i.e., social resources such as friends, family, and peer support groups), (b) physical capital (i.e., acceptable housing, financial assets, and transportation), (c) human capital (i.e., skills, knowledge, López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 127 health, mental health, and employment skills), and (d) cultural capital (i.e., cultural and environmental conditions that contribute to well-being; Brown & Baker, 2018; Cloud & Granfield, 2008). These factors also provide a springboard from which practitioners, who are working with individuals with mental health-related issues, may identify areas that may be lacking in order to facilitate growth and support for individuals. Integrated Recovery-Oriented Model (IRM) IRMs are collaborative models that are designed to increase access to comprehensive mental health services. These models focus on an individual’s changing needs for recov- ery, in addition to facilitating contact with comprehensive services that are designed to enhance the holistic needs of clients with mental health-related issues. IRMs are intended to restore, maintain, and augment functioning with collaborative restoration of skills, competencies, and active community reconnection (Liberman & Kopelowicz, 2005). The three key components of the IRM—healing, empowerment, and responsibility—have shown evidence for effectiveness (Slade et al., 2014). Healing is a process of recovery that results from individuals increasing their capacity to cope with mental health issues in the context of community living. Healing is associated with enhanced self-care practices, such as accepting a wellness lifestyle. Empowerment involves self-determination related to recovery goals, and it entails developing and achieving a sense of courage to take risks and deal with issues as they arise. Finally, a sense of responsibility for personal recovery is a profoundly social process, based on capitalizing personal strengths and social connect- edness (Wehmeyer, Kelchner, & Richards, 1996). With IRMs, these personal and social functions are achieved promoting dignity, respect, trust, and love of self and community. Activity and Participation for Recovery Individuals in recovery are able to experience enhanced mental health functioning, engage in preferred activities, and participate in community living events. For instance, engagement in learning and applying knowledge allows individuals to benefit from edu- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. cation and employment. Activities are vital in battling the high levels of social isolation and low levels of community engagement that often are experienced by people in men- tal health recovery (Townley, Kloos, & Wright, 2009). An increase in community activ- ities can elevate existential, functional, and social levels of engagement while potentially decreasing psychiatric symptoms and distress. For instance, a person in recovery is capa- ble of engaging in domestic activities, which also could assist him or her with maintain- ing and promoting mutually beneficial interpersonal relationships. Personal factors such as race, gender, age, educational level, and coping style must be taken into consideration concerning activity and participation in recovery. While race, gender, and age describe an individual’s identity, educational level and coping style can have an influence on the recovery process with regard to a person’s ability to master, min- imize, or tolerate stress and conflict. In addition, recovery models may work differently for people from diverse ethnic and cultural backgrounds, who are at differing stages of recovery and may be experiencing different types of mental illness. Case Illustration 6.2 is illustrative. López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  128 Section III Practice Issues CASE ILLUSTRATION 6.2 ANGELA: ACKNOWLEDGING SYMPTOMS OF ANXIETY AND SHIFTING FOCUS ONTO HEALTHY ACTIONS Angela is a 23-year-old female who recently lost her mother to cancer. Angela and her mother were very close, and her mother served as her main source of social support over the years. When Angela was 15 years old, she was diagnosed with generalized anxiety dis- order (GAD). She constantly worried about situations, had difficulty relaxing and sleeping, and tended to be nervous and on edge, especially in social situations. At times, her anxiety was severely debilitating. After her mother died, she noticed that her symptoms increased dramatically; she attempted to control situations that were impossible to control, in order to bring some sense of relief and predictability to her life. Upon meeting with a clinical mental health counselor, she was able to identify several aspects of her life that needed to change in order for her to begin to address her symptoms. First and foremost, she identified that she had little social support. She then decided to reach out to family, to join a support group for young adults who are grieving the loss of a parent, and to start to go to counsel- ing. She also began to read a bit more about anxiety and to meet with a doctor to discuss her symptoms. She learned that anxiety is a disorder with physiological, psychological, and biological underpinnings that can be treated. This knowledge inspired hope. She also started to work on finding purpose and meaning through her mother’s loss and started to volunteer for a local cancer support organization providing transportation for patients to medical appointments. It is important to identify several aspects of the recovery process in relation to Angela’s case. She had dealt with anxiety for several years, but after her mother’s passing, her symp- toms worsened. She noticed that she was trying to control different aspects of her life; from her perspective, if things were predictable, her anxiety tended to decrease (her mother’s un- timely death likely contributed to this, as fear of another significant event greatly increased Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. her anxiety). She quickly learned that many aspects of her life were not within her control. A key aspect of Angela’s recovery was utilizing this form of control in a positive manner, by shifting her focus onto aspects of her life that she could control. In this case study, social support, connectedness, and seeking counseling and consultation related to her disorder were all significant aspects of her recovery process, in addition to gaining hope that recovery was possible. She also found meaning and purpose in helping others who had gone through similar circumstances to her mother; focusing on others’ needs shifted the focus from her own situation in a positive way. MULTIDISCIPLINARY COLLABORATION Collaborative mental healthcare services are aimed at mental health function recovery, therein addressing the person’s activity limitations and participation restriction, in the context of his or her lived environment and considering personal factors. To achieve López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 129 these positive outcomes related to mental health, the use of multidisciplinary and inter- disciplinary models provides the best promise for comprehensive healthcare services to people with mental health issues. Multidisciplinary collaborations, in the context of community mental healthcare, involve mental healthcare services that are provided by multiple professional or paraprofessional workforces who collaboratively work to serve individuals at the community level (Schultz et al., 2014). The significance of multidisciplinary collaborations in mental healthcare arises from the fact that people with mental health issues may have co-existing physical conditions that require services from different healthcare professionals. Receiving services from multiple health providers at different locations can be quite costly. This fragmented type of service delivery often leads to duplicated services and gaps in service provision, as there is frequently little or unclear communication among treatment team members (team members may include clinical mental health counselors, medical doctors, psychologists, occupational therapists, nurses, social workers, community health workers, family mem- bers, and patients). Those with serious mental health needs typically experience bar- riers to mental healthcare that stem from the division between community-based mental healthcare services and the primary care provider (Newcomer & Hennekens, 2007). Collaboration among healthcare providers and other members of the treatment team is a best practice; such professional collaboration can offer an additional layer of com- munity support for people with mental healthcare needs. Collaborative mental health- care services involve primary care providers, mental health specialists, and case managers who coordinate services and also provide assistive services such as patient education, follow-ups of outcomes, adjustments, and evaluations (Katon, Unützer, Wells, & Jones, 2010; Njeru et al., 2016; Thota et al., 2012). Due to issues related to confidentiality, it is important for mental health service providers to speak with clients about the importance of opening lines of communication among different providers to ensure optimal service delivery. In many cases, a mental health service provider can work with the client to sign a consent form allowing the provider to speak with other members of the treatment Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. team. Multidisciplinary Collaborative Teams Multidisciplinary, collaborative health service approaches aim to improve access to healthcare, provide continuity of care, and thereby produce better outcomes. Multidisci- plinary, collaborative health services extract knowledge from various disciplines (Choi & Pak, 2006). Treatment team members contribute expertise according to their disciplines, often using discipline-oriented terms and practices. Members may focus on specific aspects of client needs that apply to their discipline, and expect other team members to address other aspects of treatment that relate to their specific discipline. A multi- disciplinary, collaborative approach is premised on the belief that each treatment team member addresses his or her area of expertise to the presenting health problem or issue in order to achieve holistic or comprehensive treatment. However, multidisciplinary treatment team members may or may not be invested in crossing expertise boundaries to advantage the client. For example, a treatment team López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  130 Section III Practice Issues comprising medical doctors, psychologists, clinical mental health counselors, nurses, social workers, and case managers, working with a person with mental health needs who lives in the community, may each seek to address discipline-specific issues as fol- lows. The medical doctor may prescribe medication and address concerns related to the individual’s physical health primarily and mental health needs only secondarily, unless treating a mental health disorder. Mental health specialists (e.g., psychologists and clin- ical mental health counselors) typically provide mental health counseling (Thota et al., 2012), and may not ask questions concerning physical health conditions that bear upon the presenting psychiatric symptoms. Nurse practitioners may assist with promotional programs for people with mental health disorders (Grundberg, Hansson, Hillerås, & Religa, 2016), independent of social workers and case managers who are involved in the treatment decision-making to ensure that the client has access to different aspects of the prescribed course of action (Ambrose-Miller & Ashcroft, 2016). These oversights by multidisciplinary team members, if unchecked, raise ethical issues about them doing harm to the client through omission rather than commission. Interdisciplinary Collaborative Teams An interdisciplinary team in a single location provides care for people with mental health needs, allowing for comprehensive assessment and treatment of both physical and mental health needs (Pomerantz, Kearney, Wray, Post, & McCarthy, 2014). The inter- disciplinary team members have regular meetings during which they share information important for comprehensive treatment planning according to their collective expertise (Collins, Hewson, Munger, & Wade, 2010; Reynolds, Chesney, & Capobianco, 2006). In contrast to multidisciplinary teams, interdisciplinary treatment teams focus on lever- aging treatment team expertise within a specific discipline to allow for cross-learning, so that the person receiving services experiences maximum benefit from several indi- viduals within the treatment setting. For instance, a medical doctor who is considering treatment options for a person with mental health needs who has been able to remain Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. within the community might consider mood disorder management to increase social engagement (Castien, Hanssen, & Fett, 2017) and improve the patient’s ability to carry out activities of daily living (Kim & Choi, 2015). An occupational therapist at the same practice might assist the same individual to manage his or her personal activities and livelihood issues (Seberg & Eriksson, 2018). A psychologist at the same practice might work with allied healthcare providers (e.g., nurses, occupational therapists, and social workers) to address personal and environmental factors influencing the person’s activ- ities of daily living, family support with home living issues, and engagement in signifi- cant life roles (e.g., vocational and employment counseling). Interdisciplinary care teams are less likely to commit treatment omissions by not knowing what other team members are contributing to the care support effort as might happen with multidisciplinary teams. Collaborative mental healthcare services in a community context also must address the interface among care programs working with the person with mental health condi- tions (Pollard et al., 2014). Doherty, McDaniel, and Baird (1996) proposed three core López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  Chapter 6 Community-Based Mental Health Counseling, Recovery Models 131 parts of collaboration, including the following: (a) locations (different locations vs. a single location), (b) services (unintegrated services vs. integrated services), and (c) com- munications among healthcare professionals (little communication vs. close communi- cation). For example, minimal collaboration (i.e., healthcare providers work at individual locations with scattered services and little communication) could be harmful to people who are receiving community-based treatment. A close collaboration, in which health- care providers are working in an integrated system and providing unified services by sharing organizational culture and decision-making across healthcare teams, provides people who are receiving community-based treatment with superior care. Communication among health service providers about diagnoses, treatment plans, and medical instructions for patients and families reduces the risk of medical errors, duplication of services, and conflicting management recommendations (Pollard et al., 2014). In such cases, the diagnoses of patients’ health conditions will be shared by other care providers, including sharing of treatment plans, prescriptions, and follow-up rec- ommendations. Therefore, communication among all care providers is essential, because the collaboration will be successful only when information related to diagnoses, medical recommendations, and treatment plans transfer efficiently and effectively from part to part. However, communication among core parts of the treatment team is not always easy; without a qualified communication coordinator or case manager, obstructed, frag- mented, or incomplete communication may lead to ambiguous and likely negative out- comes (Mitchell & Patience, 2008). CASE ILLUSTRATION 6.3 EDDIE: COMBINING MEDICATION AND MENTAL HEALTH COUNSELING TO TREAT BIPOLAR DISORDER Eddie is a 45-year-old man who was diagnosed with bipolar disorder. Eddie experienced a Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. great deal of distress from his mental health issues. On one hand, he reported experiencing very “extreme lows” that he attributed to depression, but on the other hand he reported ex- periencing “extreme highs” during which he felt grandiose. At times, during these highs, he engaged in risky sexual encounters and heavy substance use. Eddie sought treatment from his primary care physician, who referred him to a psychiatrist for medication. Eddie report- ed that he did not like taking his medications. At times he would take them inconsistently, or stop taking them altogether, only to find himself with worsening symptoms. He reported that the medications made him feel “flat,” neither high nor low. He reported that before medication, “the lows were bad, I hated feeling depressed, but at least I knew that it would not last forever, I could look forward to the highs!” For many individuals with bipolar disorder, treatment adherence to mediation manage- ment can be a major issue. In this case, it would benefit Eddie to seek mental health coun- seling (to address dysfunctional thoughts that might be contributing to negative feelings, to López, Levers, Lisa, and Debra Hyatt-Burkhart. Clinical Mental Health Counseling : Practicing in Integrated Systems of Care, Springer Publishing Company, Incorporated, 2019. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/tcsesl/detail.action?docID=5892553. Created from tcsesl on 2024-06-01 03:16:22.  132 Section III Practice Issues develop problem-solving skills, to increase social skills and structure while providing psy- choeducation on the disorder), in addition to taking medications. Signing a consent form for open communication among practitioners might help him to increase communication among service providers. This would allow his mental health practitioner to assist Eddie in developing skills to communicate with medical providers, and potentially to adjust the type or dose of medication that he is receiving. It also would allow the mental health practitioner to build a strong therapeutic relationship with Eddie to discuss, nonjudgmentally, the rea- sons why he might stop taking his medications while introducing psychoeducation related to bipolar disorder and the importance of mediation relative to holistic recovery. COMMUNITY-BASED INTERDISCIPLINARY MODELS FOR PEOPLE WITH MENTAL HEALTH CONDITIONS In this section, we provide a brief overview of the following interdisciplinary models in community mental healthcare: shelter-based collaborative mental healthcare, the cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness (the CRANIUM model; Mangurian, Niu, Schillinger, Newcomer, & Gilmer, 2017), the ElderLynk community outreach model (McGovern, Lee, Johnson, & Morton, 2008), The National Council for Community Behavioral Healthcare model (2009), and community mental health teams (CMHTs; Bháird et al., 2016; Rao, 2014; Woody, Baxter, Harris, Siskind, & Whiteford, 2018). Shelter-based collaborative mental healthcare is an integrated multidisciplinary col- laborative care (IMCC) that benefits people who are experiencing homelessness and who subsequently have a higher risk of mental illness and substance use disorders (Fazel, Khosla, Doll, & Geddes, 2008). In this Canadian community-based and shelter-based model of collaboration for mental healthcare, shelter employees work closely with pri- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. mary care providers from local communities in a collaborative team whose medical rec- ords are stored and shared electronically. Shelter staff also take on the responsibilities of consultant, educational support, and indirect patient discussion. This model facilitates referrals and interdisciplinary care, enhances the communication among care providers, harmonizes care plans, and therefore provides more integrated and comprehensive care for people who are experiencing homelessness. The CRANIUM model (Mangurian et al., 2017) is an example of an integrative inter- disciplinary care model that consists of four components including (a) a patient-cen- tered team (patients, healthcare providers, and coordinators), (b) population-based care (patient enrollment), (c) screening protocols (stepped care approach), and (d) treatment