Finding Help Guide: Adult Mental Health

What Is Mental Health?

Mental health has to do with our everyday life. It means the way we get along – in our families, at work, at school, at play, with our friends, and in our neighborhoods. It means how well we deal with the stresses in our life. When we speak of happiness, peace of mind, enjoyment or satisfaction, we are talking about mental health. Mentally healthy people enjoy life and they often:

  • feel good about themselves
  • feel comfortable with other people
  • are able to meet the demands of life

We all want to be mentally healthy. But no one feels good all of the time, and no line neatly divides everyday ups and downs from serious problems that need treatment. There are many degrees of mental health.

What Are Mental Health Problems and Who Has Them?

From time to time, we all feel:

  • anxious, worried or scared
  • sad, lonely, or depressed
  • unconfident
  • that we dislike ourselves
  • unsure about what to do, unable to make a decision, confused
  • regretful about something we did
  • guilty
  • ashamed
  • embarrassed
  • like a failure
  • lost

Sometimes these feelings last longer than we’re comfortable with and may begin to interfere with being able to carry out our daily life. This may mean it’s a good time to get help by seeing a mental health counselor or getting medication. Sometimes these feelings become very severe and overwhelming, and significantly prevent us from living our lives going to work or school, being in social situations, taking care of children, treating our family members appropriately.

Then it becomes more urgent that we get help such as counseling or talk therapy and medication, so that we don’t do serious harm to our life or loved ones. This is when mental health problems have become mental illnesses – which are treatable.

What Are Mental Illnesses?

Mental illnesses, mental disorders, or emotional problems are broad terms for over 200 different conditions which have signs and symptoms – mental, psychological, and physical – and effective treatments. This is important: mental illnesses are extremely treatable.

Mental illnesses cause mild to severe disturbances in thought and/or behavior, resulting in a person's inability to cope with life's ordinary demands and routines. They can be triggered by too much stress.

Mental illnesses also have a genetic component they run in families, so that if one or more relatives have had mental illnesses, your chance of having a mental illness is increased.

Seeking help is a sign of strength, not weakness.

Stress

Stress is the feeling of strain, worry, or tension inside our bodies that comes from difficulties we are experiencing. How we handle stress depends on what kind of stress it is and what kind of coping abilities we have learned. Some stress can make your life interesting and help you grow, but too much stress can be harmful. If you live with constant pressure, you may get nervous, exhausted, or frantic.

Stress can cause emotional and behavioral problems in the short run: fatigue, anger, irritability, depression, inactivity, substance abuse, or a breakdown in relationships, as well as physical effects such as headaches, nausea, heart palpitations, and dizziness.

In the long term, stress can contribute to further disintegration of your mental and physical health, leading to chronic or severe problems with anxiety, depression, sleep problems, loss of relationships or jobs, and even thoughts of suicide.


Some Things You Can Do When You Feel Stress Is Becoming A Problem:

  • Talk it out.
  • Work it off.
  • Accept the things about your life or yourself that you cannot change.
  • Do not depend on drugs or alcohol.
  • Do not try to be perfect.
  • Watch what you eat.
  • Take a break.
  • Get plenty of rest.
  • Do something for others.
  • Make a change.
  • Try to figure out how to solve the problems you are facing.
  • Get help.


Warning Signs of Mental Health Problems

Look over the following list of warning signs of mental health problems. If you (or someone you know) experiences one or more of the following for more than two weeks, you (or she/he) may need help. Do you:

  • Stay mostly alone; withdraw from others; have few or no friends.
  • Feel anxious or panicky
  • Worry a lot and do not know why
  • Have fast mood or behavior changes
  • Have unusual personality changes or emotional outbursts
  • Abuse alcohol or other drugs
  • Feel depressed: feel worthless, hopeless, despairing, desperate, and like a failure; cry easily and often
  • Have slowed or confused thinking
  • Abuse your spouse, children, or parents
  • Have lost interest in sex, or have problems with sexual relationships
  • Lack interest in home, school, work, or recreation activities you usually enjoy
  • Neglect your personal appearance
  • Have strange, unrealistic ideas or delusions
  • Have hallucinations – see or hear things that other people can’t see or hear
  • Think, plot, or talk about suicide.
  • Have big changes in your eating habits – gain or lose weight
  • Have changes in your sleep – unable to fall sleep, wake up very early, or sleep too much
  • Seem to be unable to get over the loss of someone important to you
  • Eat, drink, smoke, or spend money more than usual or excessively
  • Have outbursts of rage or violence
  • Have frequent flashbacks of a traumatic experience
  • Are unable to concentrate because of overwhelming feelings or thoughts

Sometimes your family, friends, or co-workers may see changes in your personality or behavior that you do not notice. Hopefully, they will talk with you about their concerns. Even if you think they are mistaken – or are interfering in your life – listen to what they say. They are sincerely trying to help you, and there are times when we all can use help.

What Are the Different Types of Mental Illnesses?

Anxiety Disorders are the most common group of mental illnesses, affecting over 10 percent of us (over 120,000 people in Hawai`i1). Anxiety disorders include:

  • Panic disorder – sudden, intense fee-lings of paralyzing terror with symptoms that may resemble a heart attack.

1 Hawai`i Department of Health, Adult Mental Health Division, “Prevalence of Mental Illness in Hawai`i: Year 2000 Census Estimate by State and Island;” Gundaya, Wylie, Crisanti, Tsunemoto, & Gottschalk. Adult Mental Health Services Research & Evaluation Center, UH

  • Phobias – overwhelming fear of partic-ular objects or fear of situations.
  • Obsessive-compulsive disorder – fearful thoughts and behaviors (obsess-sions) that a person tries to cope with by repeating words or phrases or doing repetitive, ritualistic behaviors (compulsions), such as constant hand washing.
  • Post-traumatic stress disorder (PTSD) – an often-recurrent reaction to a terrifying, life-threatening traumatic event. Symptoms include reliving the event, coldness to others, sleeplessness, memory problems, poor concentration, and little interest in outside activities.

Depressive Disorders are also known as mood, or affective, disorders. These illnesses affect 6 percent to 10 percent of us each year, and in Hawai`i, 42,000 people age 18-54 report having an episode of major depression each year.2 With appropriate treatment, usually both counseling and medication, more than 80% of people with depressive disorders improve substantially. Depressive disorders include:

  • Major depression – an extreme or prolonged episode of sadness and despair in which a person has difficulty thinking, concentrating, and enjoying the pleasures of life, and finds it difficult to function.
  • Bipolar disorder (also called manic-depression) – episodes of extreme mania ("highs") alternating with severe depression ("lows").
  • Dysthymia – continuous low-grade symptoms of depression and anxiety feeling unhappy all the time.

Schizophrenia affects about one percent of the population (over 12,000 people in Hawai`i) each year. Symptoms of this complex and severely disabling mental illness usually appear during adolescence or early adulthood (ages 15-25), but sometimes begin later in life, too. While some who experience a schizo-phrenic episode will recover fully, for most people schizophrenia is a chronic, long-lasting, severely disabling illness. However, medication can significantly reduce the impairment. Symptoms may include:

  • delusions
  • hallucinations (hearing voices or seeing things that are not present)
  • fragmented thoughts
  • disconnected or incoherent speech
  • withdrawal from the outside world
  • extremely inappropriate feelings
  • unusual physical movements

Dementing illnesses are a group of brain disorders, such as Alzheimer's disease, in which brain cells die and are not replaced, leading to impaired memory, thinking, and behavior. In Hawai`i, 20,700 people over 653 have Alzheimer's disease.

How Can Mental Health Problems Be Treated?

Mental illnesses are extremely treatable, and not treating them can be very damaging to the person who is ill and to their family/friends. An untreated illness can hurt an individual's personal, social and work life and – in some cases – may lead to suicide. Treatment by a mental health or other professional can include:

  • Evaluating the person's abilities and strengths, assessing the seriousness of their problems, and making a diagnosis and a plan for treatment
  • Providing counseling or talk therapy (psychotherapy) individually, in the family, and/or in a group to help a person control and recover from his/her problems
  • Prescribing and adjusting medication when appropriate, educating about side
  • effects, and monitoring
  • Preparing and updating a shortand/or long-range treatment care plan.
  • Helping a person find and use other support services in his/her community.

Knowing that you need help is the first step. That’s often the hardest part. Why?

  • You may not want to admit you’re having problems
  • You may feel ashamed
  • You may think the problems you’re having are your fault
  • You may be afraid that others will judge you, or think less of you, if you tell them about how you’re feeling or what you’re experiencing
  • You may believe that whatever you’re feeling or thinking is true, and that you’re not ill

Knowing where to find help is next. And that’s not always easy either. There are many ways and places to find help, but sometimes it’s confusing to figure out how to find the right place and the right kind of treatment that will be best for you – and that you can afford.

To find help:

  • Call Mental Health America of Hawai`i, 808-521-1846 and describe your situation; our staff and volunteers can help you find the help you need Monday through Friday, 9AM to 4:30PM.
  • Go to Mental Health America’s website, www.mentalhealth-hi.org and consult the Finding Help Guide phone list of over 500 agencies and programs in Hawai`i.
  • Talk to your doctor, nurse practitioner, or health clinic. They can check to see whether you have a physical condition or are taking medication that may be causing your emotional disturbances. If they do not find any physical or medication-related cause, they can refer you to appropriate mental health profess-ionals.
  • If you have health insurance, call them to find out what mental health treatment and which providers they will cover.
  • If you believe that you are experiencing a severe mental illness, and you have no health insurance or you’re on MedQUEST, call the State of Hawaii’s Access Crisis and Suicide line – 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands) and they will link you up.

You also might consider doing any of the following:

  • Make changes in your life situation to help solve problems that make you feel confused or unhappy.
  • Read self-help books from the public library or bookstore.
  • Change your lifestyle – eat healthier, exercise more, avoid alcohol and other substances, try to get the right amount of sleep.
  • Take training classes such as about relaxation, parenting, marriage enrichment, stress management, anger ma-nagement, etc.
  • Join a self-help or support group for the problems you are trying to deal with.
  • Join church, temple, or synagogue activities that may help you deal with problems and help you to feel less alone.
  • Use your employee assistance program through your job it may provide counseling or support.

Warning! A suicide threat is a cry for help – get help immediately! When someone threatens suicide or indicates that they are seriously considering killing themselves , expresses fear of losing control over their behavior, or says that they are “going over the edge,” you should always take them seriously, because the worst often does happen. Call 911, or Hawaii’s ACCESS Crisis and Suicide phone line, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands).

If you or someone you know is having one or more of the following symptoms, you or they need immediate help:

  • They say they are thinking about committing suicide.
  • They hear or see things others do not.
  • They appear very excited, confused, have bizarre behavior, or are very depressed.
  • They say they have an urge to, or actually do, act violently towards themselves or other people.
  • They are being abused, or are abusing someone else.
  • They have a strong reaction to a medicine they are taking.

Suicide Prevention QPR: Question, Persuade, Refer

QPR (Question, Persuade, Refer) uses three basic lifesaving skills: Q – Question the person about suicide. “Are you having thoughts of suicide?” “Are you having feelings about suicide?” “Do you have a plan?” Do not be afraid to ask. P – Persuade the person to get help. Listen carefully. Then say, "Let me help," or, "Come with me to find help." R – Refer the person for help. If the person is a child/adolescent, contact the parent or another adult, teacher, coach, or counselor. If the person is an adult, call a family member, your minister/rabbi, therapist or physician. Or call 911.

Ask a question...save a life!

  • Realize someone might be suicidal.
  • Reach out. Asking the suicide question DOES NOT increase their risk. Many people thinking about suicide feel relieved if they are asked about it.
  • Listen. Talking things out can be life saving.
  • Do not try to do everything yourself.
  • Get others involved.
  • Do not promise secrecy. Getting others to help the suicidal person is not being disloyal.
  • If persuasion fails, call 911 or the ACCESS Crisis and Suicide line, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands).

Finding Help in a Crisis

If you, or the person with the mental health emergency, are already being helped by a case manager/care coordinator, therapist, health clinic, or Community Mental Health Center, call them first. Ask them for suggestions on what you can do, how they can help, whether you should go to an emergency room, or where else you can find help. Otherwise, call 911 or the ACCESS Crisis and Suicide line, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands).

Crisis Response Services

Mental health crisis response services include:

  • 24-hour telephone hotlines.
  • Walk-in crisis evaluation and treatment centers.
  • Mobile outreach services to help people in their homes or wherever their crisis occurs.
  • Community crisis shelters for temporary help outside a person's home.
  • Special hospital services for emergencies not covered elsewhere.

Many people who need immediate help will agree to use the emergency services that are offered to them. However, as with other health services, sometimes people who seem to need help, refuse it. They may refuse it because they do not understand why they need help or what kind of help they will get, or fear that they will be rejected by their friends and family or forced to accept treatments or medicines they may not want In these situations, you as family or friends need to explain why you think help is needed, urge them to learn about and use the kinds of services that mental health experts recommend for them, reassure them that they won't be abandoned, and convince them to seek help.

A person may still refuse help. Medical evaluation and court hearing procedures – called involuntary commitment – can be used to decide legally whether a person can be forced to go to specific mental health facilities and receive treatment.

Hospitalization

Years ago, many people with serious mental health problems spent long periods (or even their entire lives) in hospitals. Today, most people, with treatment, do not have to be hospitalized and can live relatively "normal" lives. Modern mental health medications (called “psychotropic drugs”), which were first used in the 1960's, have helped make this possible. However, some people need to be hospitalized for short periods of time when their mental health problems worsen, and, occasionally, some people whose illnesses are very severe and do not improve with treatment, need to be hospitalized for long periods of time.

Hawai`i has one public mental hospital, Hawai`i State Hospital, located in Kaneohe on Oahu, as well as one private psychiatric hospital, Kahi Mohala, located in Ewa Beach. There are inpatient psychiatric units at Queens and Castle Hospitals on Oahu, at Maui Memorial Hospital on Maui, and in Kona Hospital on the Big Island.

Medication

How do mental health medications work? Just as aspirin can reduce fever without curing what causes the fever, mental health medications can help control symptoms but may not "cure" the mental illness. And just as no one knows how aspirin works to reduce fever or pain, we don’t know exactly how mental health medications work. These medications should always be started at the smallest dosage needed, and work best when taken along with psychotherapy, counseling, and any other needed community and support services. It is important to take them regularly, consistently, and at the prescribed dosage. It is important to work with your doctor to find the best medications at the best dosages to relieve your symptoms and enable you to feel better, and to take your medication without stopping. This can be difficult, because some medications take many weeks to take effect – and when you’re feeling terrible it can be extremely tough to wait. Also, some medications have disagreeable side effects. These may include, for example, excessive drowsiness, weight gain, or agitation. Be sure to ask what the possible side effects are and if side effects

occur, immediately tell your practitioner what is happening, so that dosages can be adjusted and, if necessary, medication can be changed. Sometimes these side effects wear off over time and you may be advised to wait them out. For many people, medications are a big help. Using mental health medications may be the only way for some people to recover from a frightening, disoriented mental state and feel in control enough to function in their lives. However, psychiatric drugs don’t work for everyone, and make some people feel less in control, or "spaced out" to the point where they cannot do as much as they would like. Usually, though, if you and your doctor are patient and try a variety of different medications, you can often find the one(s) that works for you.

Anyone considering treatment with a psychotherapeutic medication should give a complete medical history, including all other medications they are taking. Each person's response to a medication is affected by age, sex, body size, body chemistry, diet, other medications, and living habits. The right dosage varies from person to person.

Deciding About Medications

To decide for yourself, get answers to the questions listed below. Learn about the benefits and the risks of medication. Learn what medication can do, and what it cannot do. Questions you should ask about mental health medications are much like questions you should ask about any medicine:

  • Why are you recommending that I take this medication?
  • Can I get better without it?
  • Should I get counseling or therapy while I am taking the medication?
  • Are you starting me at the lowest dose? If not, why not?
  • How soon will I notice its effect?
  • Before I begin taking this medicine, can I get a second opinion?
  • What are possible side effects? If I have side effects, what should I do? Do they sometimes go away?
  • Will this medicine affect other medical problems I have?
  • Is it safe to take this medication along with other medications I am taking?
  • Is it safe to drink alcohol while taking this medication?
  • Can I use the generic drug rather than the more expensive brand name?
  • How much should I take? How many times a day? Before, or after meals?
  • How long will I need to take it?
  • How will this medicine affect my sexual feelings?
  • What will happen if I stop taking this medicine?
  • Where can I get written information about this medicine?
  • Is there anything else I should know about this medicine?

Questions for women in childbearing years:

  • Will this affect my menstrual periods?
  • May I take birth control pills along with this medication?
  • If I get pregnant, could the medicine affect my baby?
  • Can I take this medicine if I am nursing a baby?

Can I Be Forced To Take Medication?

Only in emergencies – or when ordered by the court – can you be forced to take any medicine without your informed consent. This occurs when professionals feel you are a danger to yourself or others, or that your mental illness is preventing you from making the best decision about medication.

If others want to decide for you, make sure they do so within the limits of the law. Call your local consumer4 advocacy agencies if you want help (see Finding HELP Phone List).

The term “consumer” in this booklet refers to someone who utilizes, or “consumes,” mental health services. This may mean being in the care of a psychiatrist, psychologist, social worker, care coordinator; or a residential treatment program, etc.

Specific Types of Medications for Mental Health Problems

Medications for mental illnesses can be divided into four major groups:

Anti-Anxiety Medications

Anti-anxiety medications are the most prescribed class of medication in the U.S. There are non-addictive medicines (e.g., Buspar, Celexa, Paxil, Prozac, and Zoloft) as well as potentially addictive medicines (e.g., Ativan, Valium, and Xanax) that are designed to make a person less anxious, nervous, or panicky.

They are often prescribed in combination with other medications because many people suffer from a combination of mental health problems.

Anti-anxiety medicines are usually only for short-term use. Continued use can lead to medication abuse, dependence, or addiction and withdrawal. Alcohol taken with these drugs can cause drowsiness or other severe reactions. Overdoses produce intoxication, unsteady walking, slurred speech, memory trouble and sleepiness.

Anti-Depressant Medications

Medicines including Celexa, Effexor, Pamelor, Paxil, Prozac, Serzone, Tofranil,

Cymbalta, and Zoloft reduce symptoms of depression such as sleep problems, despair, and low energy. It may take up to six weeks of taking prescribed dosages of these medications before you feel better. Taking more than the prescribed dosage may make you sick. Any change in your prescribed dosage must be discussed with your doctor. Drinking alcohol while taking antidepressant drugs can be dangerous. Also, stopping antidepressants suddenly can make your depression worse and bring on unwanted side effects. Older people must be especially careful when they use these medications.

Possible side effects of most antidepressants – which can start with the first dosage – may include blurred vision, dizziness, drowsiness, dry mouth, faster heartbeat, decreased sexual feelings, or weight gain. Less common but serious side effects include fainting, worsening glaucoma and decreased white blood cells leading to infections. Sometimes, negative side effects wear off over time as the antidepressant effect takes hold.

Bi-Polar/Mood Stabilizing Medications

Medicines such as Depakote, Lithium and Tegretol help treat certain mood disorders, especially bipolar disorder (manic-depressive illness).

With regular monitoring, mood stabilizers help many people lead healthy lives who otherwise would suffer from disabling mood swings. Taking more than the dosage prescribed can be poisonous. Regular blood tests are needed to adjust the amount of medication that works best. Signs of lithium toxicity may include nausea and vomiting, diarrhea, poor balance, confusion, slurred speech, shaky hands, sleepiness, thirst and frequent urination. If you experience any of these side effects, talk to your doctor about them.

Anti-Psychotic Medications

These are medications that are used to help control such symptoms as confused or racing thoughts, hearing voices or seeing things. Taken by pill or injection, they are usually not addictive. They control symptoms, but are not a cure, just like the other medications.

Anti-psychotic medicines include the newer ones such as Clozaril, Geodon, Risperdal, Seroquel, and Zyprexa, and the older medications like Haldol and Thorazine. Weight gain is a common side effect of some of these medications. Tardive dyskinesia – involuntary facial or body movements – is also a possible and sometimes permanent side effect of long-term treatment with the older anti-psychotic medications. To reduce possible side effects, other medicines are often prescribed along with the older anti-psychotic medications.

Sleep Medications

Sleep medications may be used for a short period to help with sleep problems, such as Trazodone (Desyrel), Zolpidem (Ambien), and Diphenhydramine (Benadryl).

Different Types of Mental Health Professionals

The people who provide the services in the private and public mental health system are called mental health professionals. If you have health insurance coverage or other financial resources, you can go directly to almost any private health clinic, counselor or therapist, agency, or program for your mental health services. Ask about the training and work experiences of a mental health professional before you use their services. Being licensed means they meet state requirements and have passed an examination by a licensing board; or they have been certified by having met the standards of a professional organization, state or national agency; or they may have completed training in a specialized area. The titles of “counselor,” “therapist,” “psychotherapist” and “psychoanalyst,” used by mental health professionals, can legally be used by anyone, and don’t automatically mean that they have had a specific amount or type of training or degrees. It never hurts to ask. Professionals who commonly treat mental health problems include:

  • Psychiatrists are physicians who specialize in treating mental illnesses, screen for physical problems, prescribe medicine (when needed), and provide psychotherapy. Education: Doctor of Medicine degree (M.D.) and three years of residency in psychiatry. Professional organization: Hawai`i Psychiatric Medical Association, 263-3070.
  • Psychologists evaluate, diagnose, counsel, provide psychotherapy, and educate individuals, families and groups of children or adults with menta illnesses. Education: Doctorate degree in psychology (Ph.D., Psy.D., Ed.D.). Professional organization: Hawai`i Psychological Association, 521-8995.
  • Social Workers help individuals and their families deal with emotional, social and economic problems through direct counseling or as case/care managers. Education: Bachelor's, Master's, or Doctorate degree in social work (B.S.W., M.S.W., D.S.W.). Licenses: Licensed Clinical Social worker (LCSW), Academy of Certified Social Workers (ACSW), or Qualified Clinical Social Worker (QCSW). Professional organiz-ation: National Association of Social Workers – Hawai`i Chapter, 521-1787.
  • Marriage & Family Therapists diagnose and treat individuals, couples, and families who are experiencing mental and emotional disorders along with other health and behavioral problems. Education: Masters Degree in Marriage and Family Therapy. Professional organization: Hawai`i Association of Marriage & Family Therapy, 291-5321.
  • Psychiatric Nurses administer and help monitor medications, provide other treatments, and monitor their clients' progress. Education: Registered nurse degree, Baccalaureate, Master's or Doctorate degree in psychiatric nursing (R.N., B.S.N., M.S.N., Ph.D.). Specialty License: Advanced Practice (APRN) may prescribe medications. Professional Organization: Hawai`i Nurses Association, 531-1628.
  • Case Managers/Care Coordinators help their clients find, organize and coordinate the mental health and living-support services they need. They generally work at a Community Mental Health Center or a nonprofit mental health provider agency.
  • Pastoral Counselors are religious ministers with special training in individual, family, and marital counseling who combine insights from psychology and wisdom from religious traditions.
  • Certified Peer Specialists are persons with mental illness who have been trained to help clients served by the Adult Mental Health Division to identify and achieve specific life goals. The State of Hawai`i has many Certified Peer

Specialists employed at agencies throughout the state.

  • Rehabilitation Therapists help people learn essential living skills and make realistic plans for their lives as they recover from their emotional problems or mental disorder. They may also provide Play, Art, Music, Dance, or Occupational therapy.
  • Vocational Therapists provide career and educational counseling by evaluating a person’s abilities, interests, talents, and personality characteristics in order to develop realistic academic and career goals

Caution!

If, at any time during your counseling/therapy, the therapist asks, or suggests, that you have sex with him/her, or do anything else you think is improper, leave quickly and report what happened by calling the counselor/therapist’s professional organization, the State’s Regulated Industries Complaints Office, 587-3222, or the Hawai`i Disability Rights Center, 949-2922 (Oahu) / 800-882-1057 (Neighbor Islands).

Culturally Appropriate Services

People from many different cultural backgrounds live in Hawai`i. It is natural for each of us to expect that health professionals understand and build on our language, customs and traditions when we need help with our health problems – including mental health problems.

Most mental health service providers try to be sensitive to their clients’ languages and cultures. They may use the skills of multi-cultural staff or a translator, so they can communicate in their client’s language to provide effective services. Their goal is to provide services that are based on specific cultural approaches to helping and problem solving.

However, a service provider may not always do a good job of communicating with every culture. If you find that you are not getting the kind of help you need, ask the persons working with you how and where you can find help that is more sensitive to your cultural background.

Can I Get Money or Help with Food and Medical Care?

Having enough money to live and pay for food and health care may be problems for people who are living with, or recovering from, severe long-term, disabling mental illnesses. If you cannot work – or can only work a little – financial, food, and medical aid programs are available from our state and federal government to help you.

If you have a case manager or care coordinator, he/she can help you find the aid you need. If you are in a hospital, your discharge plan should include ways to help you arrange for this kind of aid so your move back to your community will be easier. As part of your discharge plan, you may apply for some financial aid and have it arranged before you leave the hospital.

To arrange for help with your money needs, call the Access line, Military or Veterans’ Mental Health Services, or dial 211, Aloha United Way’s information line, to find out where to call.

Federal Assistance Programs

The Social Security Administration of the federal government has financial and medical support programs for disabled people: Supplemental Security Income (SSI), Medicare, and Social Security Disability Insurance (SSDI). Applying for government aid can be confusing, intimidating, and frustrating. It is usually quicker to use mental health case managers to arrange for government-funded services, but you can also call toll-free from anywhere in Hawai`i – 800-772-1213 – for help with applying for Social Security benefits. Social Security Insurance (SSI) is based on a person’s needs, not on work history, for disabled children and adults with limited incomes and few other resources. The rules allow people to do some work without suddenly losing their monthly payments. Families of children and adolescents also may apply for SSI. SSDI is for workers who become disabled and who have worked a certain amount of time and paid enough into the Disability Trust Fund to get financial benefits.

State Assistance Programs

The State’s Department of Human Services (DHS), provides limited amounts of financial aid to eligible persons through general assistance, food stamps, Hawai`i QUEST, and Medicaid. Hawai`i MedQUEST and Medicaid are medical assistance programs; they provide insurance coverage for both mental health care and medical services. To apply for these programs, call Hawai`i QUEST, 587-3521 or the State Department of Human Services, MedQUEST information line, 586-5390.

If you have a serious mental illness and need help finding emergency shelter, a residential treatment program, transitional or permanent housing, or a group home, call the Access Crisis and Suicide line, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands). The State's goal is to have enough permanent, affordable, acceptable housing for all mental health service consumers. As much as possible, each person should be allowed to choose and control his or her own living environment.

Homeless Shelters

Shelters for people who are homeless provide free food and lodging and try to help homeless people arrange to use the regular housing, health, financial aid, and other services in their community. Tragically, Hawaii’s homeless shelters are overcrowded with people who need temporary housing, many of whom are mentally ill.

Housing Residences That Have Staff

Some people who are living with serious mental health problems do not have a place to live, cannot live on their own or with their families, cannot find or afford good housing, or do not know what kind of place would be best for them. They may need a special residence that offers treatment and has a trained staff to help them become more self-sufficient where they can learn or strengthen their daily and community living skills. Or, they may be interested in living in a community care home where several individuals live together in a family home which is licensed by the State to provide room and board. If you have a disabling mental illness and do not feel like you can find a house or apartment to rent on your own, you can call the number listed in the “Residential Treatment, Supportive Housing, Group Homes” category on the Finding HELP Phone List for information about different types of housing options. If you are already have a case manager or care coordinator, they may be able to help you.

Below are descriptions of living situations that have staff available to help people with mental illnesses, some of whom may also have substance abuse problems:

  • 8-16 hour group home Provides on-site staff 8-16 hours per day, 7 days a week.
  • 24 hour group home: Provides on-site staff 24-hours daily.
  • Supported Housing/Bridge Subsidy Program: Rentals for persons who are stabilized and can live in the community with appropriate supports.
  • Shelter Plus Care for the Homeless: Rentals for homeless persons with severe and persistent mental illness.
  • Semi-Independent: Group living with property management staff on site 8 hours per day, some weekend coverage.
  • 24-hour Specialized Residential Treatment: for persons with severe and persistent mental illness; also for people with co-morbid medical conditions, including physical disabilities, and those who have suffered the effects of long-term institutionalization in psychiatric hospitals.
  • 24-hour Specialized Residential Treatment Licensed (Substance Abuse Treatment): Non-acute care in residential treatment facility.
  • Interim Housing: Licensed, structured setting, integrated treatment, uses Wellness Recovery Action Planning (WRAP) to assist in improving behavior. Designed to serve individuals at risk for losing their conditional release; those diverted from jail; and individuals being released from prisons or jails.
  • Crisis Residential: Licensed, residential setting for individuals experiencing a mental health crisis.

These residences offer the following of options regarding substance use:

Wet (Consumer-Choice) Housing: Resi-dents can use substances as they choose (though recommended otherwise), unless that use causes behavior which interferes with living in a residence. Damp (Abstinence-Encouraged) Housing: For individuals who recognize their need to limit their substance use and are willing to live in supported setting where uncontrolled use by themselves and others is actively discouraged; however, they are not ready or willing to be abstinent.

Dry (Abstinence-Expected) Housing: For individuals with mental illness and substance abuse who choose abstinence and who want to live in a sober group setting to support their abstinence. Any substance use is a program violation, but consequences are usually focused and temporary, rather than “one strike and you’re out.”

Community Care or Group Homes

There are many family homes which are licensed to take in up to five disabled (mentally ill) individuals. They provide room and board – three meals a day. Persons on Medicaid or MedQUEST are covered for this type of residence.

Many of these are wonderfully run by caring people, but there are some that, despite laws and regulations, do not provide excellent care. If you feel that you are being mistreated in a group home or other living situation, or not receiving appropriate services, call your local Hawai`i Disability Rights Center office or other consumer advocacy agency for help (see Finding HELP Phone List).

Public Housing

If you are looking for a place to rent and have a limited income, public housing programs may be helpful. The State and counties own and manage public housing units, but they usually have long waiting lists. The State will help pay the rent for any eligible person or family. For eligibility requirements and application information on housing assistance programs, call 211 to find out where to call. You can also call Hawai`i Centers for Independent Living (see Finding HELP Phone List) for housing information.

Types of Mental Health Services

A range of services and programs that help people with their basic living needs – food, money, housing, jobs, recreation, family and friendship – is the goal of an effective

mental health service. They also include medical aid; education and training classes; mutual self-help groups for individuals and families; outreach; crisis response; mental health treatment such as psychotherapy, counseling, and medication; and hospitali-zation.

All of these services are available to you and anyone else who may require them, and can be found through your health care provider or the Access Crisis and Suicide line, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands).

Community Health Centers and Community Mental Health Centers

Community Health Centers

If you do not have health insurance, you are not a veteran, your health insurance policy does not pay for all the health and mental health services you need, or you have Med-QUEST or Medicaid coverage, you can ask for help at the Community Health Center nearest you (see Finding HELP Phone List). These Centers provide a variety of high quality health care services – primary medical care, women’s, pediatric, and elder care, specialized care such as for AIDS/HIV and diabetes, counseling, and sometimes dental care. They give special attention to Native Hawaiians, immigrants, Pacific Islanders, homeless individuals, the elderly, and people in rural areas throughout Hawai`i. These centers know how to help people apply for and receive benefits to cover their health and human service needs.

Community Mental Health Centers

These are health centers operated by the State that specialize in mental health care and are designed for those who have no health insurance, inadequate health insurance, or Med-QUEST. There are five Community Mental Health Centers (CMHCs) on Oahu and nine on the Neighbor Islands. They provide individual, group, and family counseling; medication management; case management/care coordination; and psychosocial activities. CMHCs have a variety of professionals on staff – physicians, nurses, social workers, psychiatrists, and psychologists.

To find out if you are eligible for services at your local CMHC, call the Acess line and they can arrange an assessment, 808-832-3100 (Oahu) / 800-753-6879 (Neighbor Islands). If you go to a private therapist but you do not get the other living-support services you need, and you still meet the CMHC eligibility criteria, you can ask your CMHC for someone (a case manager) to help you find these other services you need. If you are eligible for CHMC services, you may want to ask some or all of these questions:

  • How can your Center help me, my family member, or my friend?
  • How much will it cost?
  • Will I get a written plan of what services I will receive?
  • What else does your Center do besides counseling, therapy and medication?
  • Can you help me with the other living-support services I need?
  • Can you help me obtain the benefits I am entitled to?
  • Can you put me in touch with self-help or support groups?

What Is “Case Management” Or “Care Coordination?”

Adults with serious mental illnesses work with a case manager or care coordinator at the CMHCs who will help you find, organize and coordinate the mental health and living-support services you need. Without a case manager/care coordinator, you may spend a lot of time arranging for services. What may take you hours can usually be done faster by a case manager/care coordinator.

Your case manager/care coordinator is your ally in the system – he/she can help you arrange for or find the financial, health and legal services you may need, will assist you in crisis situations, and is available to talk with you as often as you need – daily, weekly, or monthly. He/she will also re-evaluate your ongoing treatment plan regularly (for example, every six months).

Your treatment may be provided at the CMHC or other community-based agencies such as Helping Hands Hawai`i, CARE Hawai`i, or Mental Health Kokua. No matter where you go for services – even to a hospital, if your situation makes that necessary – your case manager/care coordinator is responsible for making sure that you get the services you need in a coordinated way.

What Will My Health Insurance Pay For?

Most people in Hawai`i are covered by health insurance through their employer, and many of these also provide drug coverage. Every private insurance plan is slightly different, but all must cover some mental health services.

Those who do not have employer-funded health insurance may be covered by Medicaid, Medicare, or Med-QUEST. Medicare offers drug coverage in addition to Part A (hospital) and Part B (outpatient) medical coverage.

Parity

Hawai`i law requires parity for mental health services for those covered by any employer-funded health insurance plan as well as those covered by Med-QUEST; i.e., these health insurance plans’ coverage for the following conditions must have the same charges and limits as for other illnesses like diabetes, asthma, and arthritis:

  • Major depression
  • Delusional disorder
  • Obsessive compulsive disorder
  • Dissociative disorder
  • Schizophrenia
  • Schizo-affective disorder
  • Bi-polar disorder

For other mental health conditions, such as anxiety disorders, insurance plans will pay at least the following benefits per year:

  • Not less than twenty-four (24) outpatient visits.
  • A combination of not less than 60 day of day treatment, or 60 days of residential treatment, or 60 days of partial hospitalization, or 30 days of hospitalization.
  • Not less than 30 physician or psychologist visits per year in these facilities.

If your health insurance does not provide these mental health benefits, call your insurance company and ask why. If you are not satisfied with their answer, call the Insurance Division of the State Department of Commerce and Consumer Affairs, 586-2790. Tell them about your dissatisfaction, and ask them what they can do to help you.

What Are My Rights?

Some rights are general – such as the human and constitutional rights we all share. Other rights are very specific. Both Federal and State laws include rights that protect persons with physical and mental disabilities from discrimination in housing, employment, education, transpor-tation and access to services.

Information explaining your rights as a mental health service client should be given to you by the professional or agency providing your mental health services. Your nearest Hawai`i Disability Rights Center office also has information on mental health consumer rights.

Briefly, You Have The Right:

  • To have your rights explained to you.
  • To privacy, respect and personal dignity.
  • To appropriate treatment and support services.
  • To have your own written treatment and discharge plan.
  • To receive quality services, regardless of your ability to pay.
  • To have uncensored written, telephone and spoken communication.
  • To refuse treatment and medication, and not be restrained or secluded, except in emergency situations.
  • To read and copy your clinical records.
  • To discuss your treatment and any dissatisfaction you may have.

Speak Up For Yourself!

These rights are YOUR rights. More and more mental health consumers are speaking out and acting on their own behalf – as their own advocates. It is important for you to stand up for yourself, your family member, or your friends. In addition, do not give up if you do not get what you need the first time. Sometimes service providers seem to discourage people, rather than help them, so you must be assertive.

Advance Psychiatric Directive

This is a legal document that contains a person’s preference regarding their care and treatment if and when they become hospitalized. It is made in “advance” of an acute mental health crisis, and it “directs” what care and treatment the person prefers.

It is comparable to having a living will for mental, as opposed to physical, health care. You can use an Advance Psychiatric Directive to explain to a doctor, institution, or judge what types of confinement, medication, or treatment you do or do not want. Through this Directive, you also may appoint a friend or family member as your "agent" to make mental health care decisions for you if you are incapable of making them yourself. It can improve communication between you and your physician, can prevent clashes with professionals over treatment, can prevent forced treatment, and may shorten your hospital stay.

For information on how to prepare an Advance Psychiatric Directive, call the Hawai`i Disability Rights Center (1-800-882-1057).

How To Advocate For Yourself

Here are some hints:

  • Try to take someone with you to appointments, to help you ask your questions and get the information you need.
  • Write everything down – the date, who you talked to, and what was said.
  • Ask questions, and be polite but
  • assertive.
  • Ask for written information on services, procedures, rules, regulations, laws, etc.
  • Keep calling or going back for services that you need.
  • Read, respond to, and save everything.
  • Use your right to appeal.

Consumer Advocates And Legal Services

Finding, getting, and keeping the services and government benefits you are entitled to can be a full-time job. If you cannot find the services you need, do not like your services, or feel you have been treated unfairly, you do not have to just accept what you have been told or accept the services you do not like. You may find it useful to ask for help from a consumer advocacy or legal services agency.

Consumer advocates, disability rights, and Legal Aid services are your allies; they work to protect people's rights and make sure mental health consumers get the services and benefits they are entitled to, and also help consumers become better advocates for themselves. For help, you can call Consumer Advocacy Agencies in the Finding HELP Phone List.

Court-Ordered Care

Most people voluntarily agree to use the mental health services they need. But sometimes people who seem to need help refuse to use services that are available. When this happens, there are special laws that allow a judge to order a person to receive mental health services, either in the hospital or as an “outpatient,” in the community.

These laws are called Involuntary Commitment. They try to balance each person's right to decide what is best for themselves and the State's duty to help people too disturbed or ill to understand they need help. Court-ordered care does not necessarily guarantee the most effective care is provided, but that is the intention of all parties involved in getting the court order.

Criteria For Court-Ordered Care

After other service possibilities have been explored and exhausted, the involuntary commitment process can be pursued through the Family Court. The court (following Hawaii's involuntary commitment laws) can order a person age 15 or older to live at, or regularly report to, a mental health treatment facility or program if the court finds all the following conditions are met:

  • The person is mentally ill or suffering from substance abuse.
  • The person is imminently dangerous to self or others, is gravely disabled, or is obviously ill.
  • The person is in need of care or treatment, or both.

Before anyone can be committed involuntarily, he/she has the right to have a lawyer or another legal representative make sure the law is being followed. If the individual cannot afford a lawyer, the court must assign one. Before pursuing court-ordered treatment for anyone, ask:

  • Who will be responsible for coordi-nating care?
  • How will the court-ordered services be paid for?
  • Who will develop and coordinate the follow-up treatment plan and services?

How Long Can Commitments Last?

To protect against the inappropriate use of involuntary commitments, Hawai`i laws give a schedule of when the consumer's situation must be reviewed and reevaluated:

  • For Emergency Hospitalization, a person can be taken to a hospital and held for evaluation up to 48 hours (two working days, excluding Saturday, Sunday and holidays), unless their situation meets the three commitment criteria listed above and the involuntary commitment proceeding has been started.
  • For Involuntary Hospitalization, a person can be taken to a hospital and held for evaluation up to 5 days while a formal commitment proceeding for them is carried out. They can be involuntarily committed to a hospital for up to 90 days if the court finds their situation meets the three commitment criteria listed above. They can be discharged from the hospital when they no longer meet commitment criteria.
  • A person's commitment must be reviewed and reevaluated every 90 calendar days for the first 180 days, and every 180 days thereafter. At any time after admission to a psychiatric facility, a patient or anyone on his or her behalf may ask the court to determine whether involuntary commitment is still needed.
  • For Involuntary Outpatient Commitments, the person can be ordered to get outpatient treatment for a period of up to 180 calendar days. At the end of 180 days, they are automatically discharged from Involuntary Outpatient commitment unless the Family Court orders an additional 180-day outpatient commitment.

What Are Clubhouses?

Some people living with mental illness want a place they can go to be with other people who understand and accept them and be involved in structured activities. A Clubhouse is a psychiatric rehabilitation program which provides mental health services to adults with serious mental illnesses. It is a voluntary program whose participants are called “members,” not patients or clients: each member’s strengths and needs are emphasized, rather than their mental illness, symptoms or psychiatric history.

Everyone is wanted and valued at the Clubhouse, which relies on the talents and skills of all its members in order to function members work daily in the Clubhouse food service, communications/reception area, and snack and thrift shop. Members are also provided opportunities to work in the community in paying jobs, and members are employed with such reputable employers as the Marriott hotels, Big Save, Subway, various restaurants, and even a cookie company. Each member is also encouraged to participate in community activities such as walk-a-thons and beach and park clean-ups, and to plan events including sports, picnics, bowling, camping, boat rides, and movies. Clubhouses have been instrumental in advocating for reducing stigma by speaking at agency meetings, Rotary and Lion’s club functions, and participating in health events. In addition, they have successfully lobbied the state legislature for better dental health care and increased personal needs allowances for their members and others.

There are 10 Clubhouses – 5 on Oahu, and 5 on the Neighbor Islands. To learn how you or someone you know can be a part of a Clubhouse program, contact Kathleen Rhoads Merriam, Statewide Clubhouse Coordinator, (808) 832-5775.

Are There Jobs for People with Mental Illnesses?

Having a job, besides providing income, helps each of us feel good about ourselves. Getting trained, finding, and keeping a job can play a big part in helping a person recover from a mental illness. But this can be hard for people with persistent, long-term mental illnesses who may lack training and skills and may be afraid about being able to do a job. They may also face unfair discrimination by employers, or be afraid that working could cause their government financial aid to be cut off.

Discrimination in the workplace is slowly decreasing. Employers and co-workers are learning that employees who use mental health services, like employees who use other kinds of health services, can use their own talents, experience, and motivation to work successfully.

State and Federal laws prohibit discrimination against persons with mental disabilities who are willing and able to work, or who need a reasonable accommodation to do a job. Some Medicaid and Social Security rules let disabled persons work and still receive public assistance.

Is There Help for Families of Mentally Ill Adults?

Respite services give families (natural, adoptive or extended) temporary relief from caring for a person with a mental health problem who is receiving mental health services from a provider. Typical respite is for a few days, but it may be for only a few hours or up to two weeks.

For families of adult consumers, Mental Health Kokua offers respite excursions, recreation activities, and camp-outs for consumers to give family members some relief.

There is also an organization, NAMI (National Alliance on Mental Illness) which provides support groups for family members of adults with mental illnesses. You can find the phone numbers for these agencies on the Finding Help phone list.

Topics Include

  • What Is Mental Health?
  • What Are Mental Health Problems and Who Has Them?
  • What Are Mental Illnesses?
  • Stress
  • Some Things You Can Do When You Feel Stress Is Becoming A Problem:
  • Warning Signs of Mental Health Problems
  • What Are the Different Types of Mental Illnesses?
  • How Can Mental Health Problems Be Treated?
  • Signs of Suicide/Crisis and Actions for Prevention
  • Suicide Prevention -- QPR: Question, Persuade, Refer
  • Finding Help in a Crisis
  • Crisis Response Services
  • Hospitalization
  • Medication
  • Deciding About Medications
  • Can I Be Forced To Take Medication?
  • Specific Types of Medications for Mental Health Problems
  • Anti-Anxiety Medications
  • Anti-Depressant Medications
  • Bi-Polar/Mood Stabilizing Medications
  • Anti-Psychotic Medications
  • Sleep Medications
  • Different Types of Mental Health Professionals
  • Culturally Appropriate Services
  • Can I Get Money or Help with Food and Medical Care?
  • Federal Assistance Programs
  • State Assistance Programs
  • How Can I Find A Place To Live?
  • Homeless Shelters
  • Housing Residences That Have Staff
  • Community Care or Group Homes
  • Public Housing
  • Types of Mental Health Services
  • Community Health Centers and Community Mental Health Centers
  • Community Health Centers
  • Community Mental Health Centers
  • What Is “Case Management” Or “Care Coordination?”
  • What Will My Health Insurance Pay For?
  • Parity
  • What Are My Rights?
© Mental Health America of Hawaii
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