Understanding Mental Health and Substance Abuse

1. Understanding Mental Healthand Substance Abuse Chris Yarnold, MA, CAP Seamus Allman, LMHC BayCare Behavioral Health (727) 462-7930 Christopher.Yarnold@baycare.org

2. Topics • Trends & Figures • Major Depressive Disorders • Bipolar Disorders • Substance Use Disorders • Treatment Options in the Greater Tampa Bay Area

3. National Trends • 20% of US adults experienced mental illness in 2011 • 9% of the US population are current illicit drug users • Integration of care, information, and payment is a trending concept in behavioral health • Co-existing behavioral health diagnosis increases the costs of chronic medical conditions • Community based behavioral health resources • Adults with behavioral health needs & health care reform Sources: TrendWatch, Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs & Outcomes, AHA, January 2012 Where is Behavioral Health Headed?, 2012 Summary Report: National Association of Psychiatric Health Systems

4. Quick Facts • One in five adults experience a mental health disorder in a given year. • Five to seven percent have a serious mental illness such as schizophrenia, a bipolar disorder, major depression, a personality disorder, and other conditions. • About one in ten children live with a serious mental or emotional disorder. • More than a million Floridians live with mental illness; many more have substance use disorders – often occurring in conjunction with a mental illness. Mental health disorders are the leading cause of disability in the U.S. • Florida ranks 49th among the 50 states and the District of Columbia in state mental health per capita spending ($39 per person per year). Only Idaho and Texas spend less on mental health than Florida. (Kaiser Health Foundation, accessed 1/13) • Mental health per capita funding in Florida (adjusted for inflation) is less than it was in the 1950s. (Florida Council for Community Mental Health, 2013)

5. Quick Facts – Florida Ranking (2010) • 13th in percentage of adults reporting poor mental health (37%) • 44th in health system performance (i.e., access, prevention and treatment, avoidable hospitalizations and costs, equity, and health lives) • 35th in child well being • 7th in men’s incarceration per 100,000 • 3rd in number of homeless • 3rd in number of children in juvenile detention facilities • 7th in number of child abuse victims • 4th in number of children in foster care

6. Local Trends - Florida • Suicide is the 3rd leading cause of death for persons ages 15-24 and the 2nd leading cause of death for ages 25-34. • It is the 9th leading cause of death for Floridians (Florida Vital Statistics, 2010). • Of the 67 counties, Pinellas ranked 4th in the State for suicides followed by Hillsborough (5th.) Pasco County ranked 11th (Florida Vital Statistics, 2010.) • Of the 24 medical examiner districts in the state, the Pasco - Pinellas district had the most deaths caused by oxycodone with 197. Hillsborough County was fourth with 128 deaths.

7. Involuntary Exams (Baker Acts)

8. Some Basic Facts • Demographics • Average age of examinee: 37 • 16% of exams for those 17 and younger • 7% for those 65 and older • 52% male/48% female • 5.9% of examinees are homeless • ½ of all homeless examinees in 10 Baker Act facilities

9. What is Mental Illness? • A diagnosable illness that affects a person’s thinking, emotional state, and behavior; and • Disrupts the person’s ability to • Work • Carry out daily activities • Engage in satisfying relationships

10. Who Develops Mental Illness? A famous English mathematician, responsible for many scientific discoveries, including centrifugal force. Wealthy and well educated, had access to the best knowledge of his day. Classified as bipolar due to his nervous breakdowns and fits of rage towards those who disagreed with him. The first scientist to be knighted for his great scientific contributions. Sir Isaac Newton

11. Who Develops Mental Illness? Six time Grammy Award Winner. The sixth best-selling recording artist in the US. Has battled many years with depression and attempted suicide by drinking furniture polish. Has had continued substance abuse and in 2005 was admitted to the Betty Ford Center for treatment. Billy Joel

12. Who Develops Mental Illness? One of the most respected figures in American broadcast journalism for more than thirty years with a television career that spanned morning, daytime and primetime. She has been an NBC news broadcaster since the age of 25. Suffers from depression and bipolar disorder. A graduate of Indiana University, who has been married for 28 years. Jane Pauley

13. Churchhill's Black Dog? A Metaphor for Depression • Churchill's Black Dog Sir Winston Churchill

14. Major Depressive Disorder: Signs & Symptoms • Behavioral: • Crying spells • Withdrawal from others • Neglect of responsibilities • Loss of interest in personal appearance • Loss of motivation • Slow movement • Use of drugs and alcohol

15. Major Depressive Disorder • Treatment Options • Pharmacology • Most common medications include Zoloft, Cymbalta, Prozac, Celexa • Psychotherapy • Cognitive Behavioral Therapy • Interpersonal Therapy • Treatment of mild to moderate depression • Electroconclusive Therapy (ECT) • Treatment of severe episodes not responsive to medication and psychotherapy • Transcranial Magnetic Stimulation (TMS) • Outpatient office procedure, alternative to ECT

16. Major Depressive Disorder & Suicide • Each year approximately 2 million adolescents attempt suicide • 3rd leading cause of death for young people 15-24 years of age • Approximately 38,000 people in the U.S. die from suicide each year • 8 out of 10 people who kill themselves gave definite clues and warnings regarding their plans • Almost four times as many males as females die by suicide • Most suicides occur 3 months after “feeling better”

17. Warning Signs of Suicide • Threatening to hurt or kill oneself • Seeking access to means • Talking or writing about death, dying, or suicide • Feeling hopeless • Feeling worthless or a lack of purpose • Acting recklessly or engaging in risky activities • Feeling trapped • Increasing alcohol or drug use • Withdrawing from family, friends, or society • Demonstrating rage and anger or seeking revenge

18. Bipolar Disorder • Definition • Characterized by alternating periods of depression, euphoria (mania), and normalcy. A person may or may not experience psychotic symptoms.

19. Bipolar Disorder • A balancing act- Depression v/s Mania • 5.7 million American Adults affected • Men : Women • Socioeconomic status • Marital status

20. Bipolar Disorder - Depression • Signs and Symptoms • Depressive states • Mood shifts • Triggers • (NAMI, 2011 and helpguide.org)

21. Bipolar Disorder - Mania • Signs and Symptoms • Ambitious plans • Risk taking • Impulsive activities • Decreased sleep minus fatigue

22. Substance Use Disorders (SUD) • Definition • DSM-V characterizes SUD as maladaptive patterns of substance use manifested by recurrent and significant adverse consequences related to repeated use of the substance.

23. SUD Signs & Symptoms • Physical dependence • Psychological dependence

24. The ABCs of SUD • Classes of Psychoactive Substances

25. Causes of Substance Use • Genetics • Biochemical • Developmental influences • Personality factors • Social learning & conditioning • Cultural & ethnic influences

26. BayCare Behavioral HealthServices • Adult Treatment services: • Psychiatric Medical Services (Evaluation and Medication Management) • Integrated Primary Care and Behavioral Health Services • Detox Program • Adult Residential for Co-Occurring Patients • Treatment and Resource Center for Veterans and Families • HIV Aids Services. • Inpatient Psychiatric Care • Outpatient for Mental Health and Addictions • Case Management for Mental Health and Addictions • Integrated Stabilization Unit • Specialty Programs: FACT, Housing, Supportive Living, Urgent Family Care, Veterans

27. Questions? For questions regarding services, please call the Registration Center at 866-762-1743