When someone you know or love has a mental illness many questions come to mind. We have requested answers from some of the experts in the field to answer the questions many of you may share.

To find answers to other frequently asked questions visit the following sites:

National Mental Health Association

Alegent Health Ask the Expert

Kids Health – For Parents, Kids, and Teens

NAMI National Information Helpline

MayoClinic.com – Ask a Mental Health Specialist

Please e-mail us if you have additional questions.

What does it mean to have a mental illness?
What causes mental illness?
Can mental illness be prevented?
How common Is mental illness?
What are some of the warning signs of mental illness?
What is the difference in mental health professionals?
How can I find a mental health professional right for my child or myself?
What are the treatment options available?
If my child or myself become involved in treatment, what do we need to know?
What do I need to know about medications?
If medication is prescribed for a mental illness but my child feel’s much better now, is it OK for them to stop taking the medication?
What does “level of care” refer to?
What is normal and what is not?
Where can I go for help?

What does it mean to have a mental illness?
Here are some important facts to remember about mental illness and recovery:

• Mental illnesses are biologically based brain disorders. They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.
• Mental disorders fall along a continuum of severity. The most serious and disabling conditions affect five to ten million adults (2.6 – 5.4%) and three to five million children ages five to seventeen (5 – 9%) in the United States.
• Mental illnesses strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.
• The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.
• Without treatment, the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives. The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.
• Early identification and treatment is of vital importance. By getting people the treatment they need early, recovery is accelerated and the brain is protected from further harm related to the course of illness.
• Stigma erodes confidence that mental disorders are real, treatable health conditions. We have allowed stigma and a now unwarranted sense of hopelessness to erect attitudinal, structural and financial barriers to effective treatment and recovery. It is time to take these barriers down.
  
  To find out more about specific mental illnesses, visit the "By Illness" page of WebMD.

What causes mental illness?
Although the exact cause of most mental illnesses is not known, it is becoming clear through research that many of these conditions are caused by a combination of genetic, biological, psychological and environmental factors. One thing is for sure -- mental illness is not the result of personal weakness, a character defect or poor upbringing, and recovery from a mental illness is not simply a matter of will and self-discipline.

Heredity (genetics): Many mental illnesses run in families, suggesting that the illnesses may be passed on from parents to children through genes. Genes contain instructions for the function of each cell in the body and are responsible for how we look, act, and think.

But, just because your mother or father may have a mental illness doesn't mean you will have one. Hereditary just means that you are more likely to get the condition than if you didn't have an affected family member.

Experts believe that many mental conditions are linked to problems in multiple genes -- not just one, as with many diseases -- which is why a person inherits a susceptibility to a mental disorder, but doesn't always develop the condition. The disorder itself occurs from the interaction of these genes and other factors -- such as psychological trauma and environmental stressors -- which can influence, or trigger, the illness in a person who has inherited a susceptibility to it.

Biology: Some mental illnesses have been linked to an abnormal balance of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or are not working properly, messages may not make it through the brain correctly, leading to symptoms of mental illness. In addition, defects in or injury to certain areas of the brain also have been linked to some mental conditions.

Psychological trauma: Some mental illnesses may be triggered by psychological trauma suffered as a child, such as severe emotional, physical or sexual abuse; a significant early loss, such as the loss of a parent; and neglect.

Environmental stressors: Certain stressors -- such as a death or divorce, a dysfunctional family life, changing jobs or schools, and substance abuse -- can trigger a disorder in a person who may be at risk for developing a mental illness.

Can mental illness Be prevented?
Unfortunately, most mental illnesses are caused by a combination of factors and cannot be prevented.

How common is mental illness?
Mental illnesses are very common; in fact, they are more common than cancer, diabetes or heart disease. According to the U.S. Surgeon General, an estimated 23% of American adults (those ages 18 and older) -- about 44 million people -- and about 20% of American children suffer from a mental disorder during a given year. Further, more than 7 million American adults, and more than 5 million children and adolescents suffer from a serious mental condition (one that significantly interferes with functioning).

Major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder are among the top 10 leading causes of disability in the U.S.. Mental illness does not discriminate. It can affect people of any age, income or education level, or cultural background. Although mental illnesses can affect anyone, certain conditions -- such as eating disorders -- tend to occur more often in females, and other disorders -- such as attention deficit/hyperactivity disorder -- more commonly occur in children.

What are some of the warning signs of mental illness?
Symptoms of mental disorders vary depending on the type and severity of the condition. Some general symptoms that may suggest a mental disorder include:

In adults
• Confused thinking
• Long-lasting sadness or irritability
• Extreme highs and lows in mood
• Excessive fear, worrying or anxiety
• Social withdrawal
• Dramatic changes in eating or sleeping habits
• Strong feelings of anger
• Delusions or hallucinations (seeing or hearing things that are not really there)
• Increasing inability to cope with daily problems and activities
• Thoughts of suicide
• Denial of obvious problems
• Many unexplained physical problems
• Abuse of drugs and/or alcohol

In older children and pre-teens
• Abuse of drugs and/or alcohol
• Inability to cope with daily problems and activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical problems
• Defying authority, skipping school, stealing or damaging property
• Intense fear of gaining weight
• Long-lasting negative mood, often along with poor appetite and thoughts of death
• Frequent outbursts of anger

In younger children
• Changes in school performance
• Poor grades despite strong efforts
• Excessive worrying or anxiety
• Hyperactivity
• Persistent nightmares
• Persistent disobedience and/or aggressive behavior
• Frequent temper tantrums

What is the difference in mental health professionals?
There are many types of mental health professionals. The variety of providers and their services may be confusing. Each have various levels of education, training, and may have different areas of expertise. Finding the professional who best fits your needs may require some research. Often it is a good idea to first describe the symptoms and/or problems to your family physician or clergy. He or she can suggest the type of mental health professional you should call.

Types of Mental Health Professionals

• Psychiatrist – A Psychiatrist is a medical doctor with special training in the diagnosis and treatment of mental and emotional illnesses. They provide psychiatric evaluations and a full range of treatment interventions for emotional and behavioral problems and psychiatric disorders. Like other doctors, psychiatrists are qualified to prescribe medication. Some psychiatrists may have additional training in working specifically with children and adolescents.
  
  Qualifications: should have a state license and be board eligible or certified by the American Board of Psychiatry and Neurology.
  
  
• Psychologist – A Psychologist has an advanced degree from an accredited graduate program in psychology, and 2 or more years of supervised work experience. Psychologists are trained to provide psychological evaluations and treatment for emotional and behavioral problems and disorders, provide psychological testing and assessments, make diagnoses, and provide individual and group therapy.
  
  Qualifications: a state license.
  
  
• Social Worker – Social Workers are identified by many different titles. They may be Clinical Social Workers, Licensed Professional Counselors, or Mental Health Counselors. Each provide most forms of psychotherapy and are trained to make diagnoses and provide individual and group counseling. Some Social Workers may obtain specific clinical training and thus identify themselves as Certified Alcohol and Drug Abuse Counselors or Marriage and Family Therapists. They must obtain a masters degree in social work from an accredited graduate program.
  
  Qualifications: state license; in addition individuals may be members of the Academy of Certified Social Workers or may have certification by the National Academy of Certified Clinical Mental Health Counselors.
  
  
• Nurse Psychotherapist - A Registered Nurse who is trained in the practice of psychiatric and mental health nursing. Like social workers, nurse psychotherapists are trained to diagnose and provide individual and group counseling.
  
  Qualifications: certification, state license.

How can I find a mental health professional right for my child or myself?
Feeling comfortable with the professional you or your child is working with is critical to the success of treatment. Finding the professional who best fits your needs may require some research. Begin by talking with him or her on the telephone. You may want to ask about their training and education, the approach used in working with patients, their philosophy, or whether or not they have a specialty or concentration. Other questions may include:

• What are the treatment options for me or my child?
• How will I be involved with my child’s treatment?
• How will we know if treatment is working?
• How long should it take before I see improvement?
• If medication is needed, what are the expected side effects?
• What should I do if my child’s problems get worse or do not improve?
• How can I reach you after office hours or in an emergency?
• Who covers for you when you are away from your office, out-of-town, or on vacation?
• Do you have an emergency contact number or an answering service?
• What insurance providers do you work with?
• If you feel comfortable talking to the counselor or doctor, the next step is to make an appointment. Finding a mental health professional that is right for you will assist both you and your child in achieving the best results possible for recovery.

What are the treatment options available?
Just as there are different types of medications for physical illness, different treatment options are available for those with mental illness. Treatment works differently for different people. It is important to find what works best for you or your child. Without early identification and treatment, the results can be tragic.

Types Of Treatment
Psychotherapy is a method of talking face-to-face with a therapist. Psychotherapy can take on many different forms. The following are a few of the types of available:

• Behavior Therapy - Includes stress management, biofeedback, and relaxation training to change thinking patterns and behavior.
• Psychoanalysis - Long-term therapy meant to "uncover" unconscious motivations and early patterns to resolve issues and to become aware of how those motivations influence present actions and feelings.
• Cognitive Therapy - Seeks to identify and correct thinking patterns that can lead to troublesome feelings and behavior.
• Family Therapy - Includes discussion and problem-solving sessions with every member of the family.
• Movement/Art/Music Therapy - These methods include the use of movement, art or music to express emotions. Effective for persons who cannot otherwise express feelings.
• Group Therapy - Includes a small group of people who, with the guidance of a trained therapist, discuss individual issues and help each other with problems.
• Drug Therapy - Involves the use of medication as part of the comprehensive treatment plan. Drugs can be beneficial to some persons with mental or emotional disorders, however, it is important to ask about risk, possible side effects and interaction with certain foods, alcohol,and other medications. Medication should be taken in the prescribed dosage and at prescribed intervals and should be monitored daily.
• Electric Convulsive Treatment (ECT) is used to treat some cases of major depression, delusions, and hallucinations, or life-threatening sleep and eating disorders that can not be effectively treated with drugs and/or psychotherapy. Discuss with your physician about the risks and side effects of ECT.

If my child or myself become involved in treatment, what do we need to know?
Beginning treatment is a big step for individuals and families and can be very overwhelming. It is important to continue involvement in the treatment process as much as possible. Some questions you will need to have answered include:

• What is known about the cause of this particular illness?
• Are there other diagnoses where these symptoms are common?
• Do you normally include a physical or neurological examination?
• Are there any additional tests or exams that you would recommend at this point?
• Would you advise an independent opinion from another psychiatrist at this point?
• What program of treatment is the most helpful with this diagnosis?
• Will this program involve services by other specialists? If so, who will be responsible for coordinating these services?
• What do you see as the family’s role in this program of treatment?
• How much access will the family have to the individuals who are providing the treatment?
• What medications are generally used with this diagnosis? What is the biological effect of this medication, and what do you expect it to accomplish? What are the risks associated with the medication? How soon will we be able to tell if the medication is effective, and how will we know?
• How much experience do you have in treating individuals with this illness?
• What can I do to help you in the treatment?

What do I need to know about medications?

The best source of information regarding medications is the physician prescribing them. He or she should be able to answer questions such as:

• What is the medication supposed to do and when should it begin to take effect?
• How is the medication taken and for how long?
• What food, drinks, other medicines, and activities should be avoided while taking this medication?
• What are the side effects and what should be done if they occur?
• What do I do if a dose is missed?
• Is there any written information available about this medication?
• Are there other medications that might be appropriate? If so, why do you prefer the one you have chosen?How do you monitor medications and what symptoms indicate that they should be raised, lowered, or changed?

All medications should be taken as directed. Most medications for mental illnesses do not work when taken irregularly, and extra doses can cause severe, sometimes dangerous side effects. Many psychiatric medications begin to have a beneficial effect only after they have been taken for several weeks.

Click here for additional information involving specific medications or to as a psychiatric pharmacist specific questions.

If medication is prescribed for a mental illness but my child feel’s much better now, is it OK for them to stop taking the medication?
It is not uncommon for people to stop taking their medication when they feel their symptoms have become controlled. Others may choose to stop their medication because of side effects. A person may not realize that most side effects can be effectively managed. While it may seem reasonable to stop taking the medication, the problem is that at least 50% of the time the symptoms come back. If you or your child are taking medication, it is very important that you work together with your doctor before making decisions about any changes in your treatment.

Another problem with stopping medication, especially if you stop it abruptly, is that you may develop withdrawal symptoms that can be very unpleasant. If you and your doctor feel a trial off your medicine is a good idea, it is necessary to slowly decrease the dosage of medications so that these symptoms don’t occur.

It is important that your doctor and pharmacist work together to make sure your medications are working safely and effectively. You should talk with them about how you are doing and whenever there are side effects that might make you want to stop your treatment.

What does “level of care” refer to?
You may hear mental health providers refer to the term “level of care”. The level of care refers to the degree to which insurance companies have approved for you or your child’s treatment. Facilities across the state of Nebraska are working to improve the continuum of care available to better serve those with mental illness. Some such levels of care include:

• Customer Assistance Program (CAP) Managed Care Only Service - The Customer Assistance Program provides short-term, solution-focused therapy aimed at assisting those who have personal problems that interfere with their daily living and well being. CAP is an early intervention approach to dealing with those problems before they become unmanageable. CAP is intended to provide assistance to individuals who do not have a DSM IV diagnosis or who will not need ongoing assistance. CAP services require registration, but not pre-certification.
• Outpatient Mental Health and Substance Abuse Services - Outpatient Mental Health and Substance Abuse services are behavioral health services rendered in an office/clinic environment, a member’s home, or other locations appropriate to the provision of service for psychotherapy or medication management. Services focus on the restoration, enhancement, and/or maintenance of a member’s level of functioning and the alleviation of symptoms, which interfere with functioning in at least one major life area (e.g. familial, social, educational, employment). The goals, frequency, and length of treatment will vary according to the needs of the individual or family being served and the response to treatment. Outpatient services may be provided in an individual, family, or group format.
• Intensive Outpatient (Managed Care Only Service) - Intensive outpatient is a level of care between day treatment and traditional outpatient. Service may be delivered in a group format within a facility or as an individualized format within a member’s own home. This level of care is intended to prevent admissions to higher levels of care or to serve as aftercare for members who are transitioning from higher levels. Intensive outpatient can be 6 -12 hours of individual, family, and group therapy per week.
• Community Treatment Aide (CTA) - Community Treatment Aide services are supportive, directive, and teaching services provided in the home, school, or other community location to assist the member in improving their capacity for living in the least restrictive environment. These services are typically delivered by a para-professional. They are to be prescribed and supervised by the supervising practitioner and included as part of the master treatment plan.
• Day Treatment - Day treatment provides a coordinated set of individualized therapeutic services to persons who may be able to function in a normal school, work, and/or home environment, but are in need of therapeutic supports. Day Treatment is a community-based level of care. It is a comprehensive, multidisciplinary approach to treatment for members who do not require or meet the guidelines for higher levels of care, but require more intensive and comprehensive services than can be provided at the outpatient level.
• Partial Hospitalization (Managed Care Only Service) - Partial hospitalization is a nonresidential treatment program that may or may not be hospital-based. The program provides diagnostic and treatment services on a level of intensity similar to an inpatient program, but on less than a 24-hour basis. These services include therapeutic milieu, nursing, psychiatric evaluation, medication management, group, individual and family therapy. The environment at this level of treatment is highly structured and there should be a staff-to-patient ratio sufficient to ensure necessary therapeutic services, professional monitoring, control, and protection. Partial hospital treatment may be appropriate when a member does not require the more restrictive and intensive environment of a 24-hour inpatient or residential setting, but does need up to eight hours of clinical services each day. Partial hospitalization can be used both as a transitional level of care (i.e., step-down from inpatient or residential treatment) as well as a stand-alone level of care to stabilize a deteriorating condition and avert hospitalization or residential treatment. This level of care is not appropriate for youth living in sub-acute levels of care.
• Treatment Foster Care - Treatment Foster Care is a level of care provided to children and adolescents who require a higher level of care than is found in traditional foster care. The member is placed in the safe, secure, and nurturing environment of a private home with licensed foster parents who have received specialized training in the care of children and adolescents with emotional or substance abuse disorders. Treatment foster parents provide care for one child and perform behavioral interventions and life skills training in addition to assuring that the child receives needed mental health and substance abuse services, medical care and education. This level of care is transitional, and typically considered for children and adolescents who have been recently discharged, or who are being diverted from higher levels of care. Family therapy is included in the per diem to prepare for reunification or alternative placement.
• Treatment Group Home - Treatment Group Homes provide 24-hour mental health and/or substance abuse services in a licensed, non-secure facility. They are designed for children and/or adolescents with significant functional impairment, but some capability to engage in community-based activities. Treatment group homes offer a less restrictive treatment environment that residential treatment, but are more restrictive that treatment foster care. Typically, treatment services include 24 hours per week of individual, group and family counseling, vocational training, recreational therapy and skill building. Members may also be involved in community-based activities such as school, work or recreation.
• Enhanced Treatment Group Home (Managed Care Only Service) - Enhanced Treatment Group Homes proved 24-hour mental health and/or substance abuse services in a licensed non-secure facility. Enhanced treatment group homes are designed for youth who are eligible for Medicaid manage care mental health/substance abuse services. Youth have significant functional impairments but some capacity to engage in community-based activities. Youth typically have impairments due to emotional disorders and primary or co-morbid clinically significant impairments from one of the disruptive behavior disorders of childhood and adolescence. Enhanced treatment group homes offer a less restrictive treatment environment then residential treatment and provides an enhanced array of treatment interventions and treatment modalities. Typically, treatment services include 21 hours per week of individual group and family counseling, intensive cognitive behavioral interventions, vocational training, recreational therapy, and skill building. Members need to be involved in community-based activities such as school, training or work experience, and recreation.
• Residential Treatment - This level of care provides 24-hour behavioral treatment in a licensed, highly structured residential program for child/adolescents who do not require an inpatient setting and will benefit from a short-term, structured residential setting. This supervised short-term treatment model serves as an alternative to inpatient hospitalization. In this facility-based program, children/adolescents receive services in a safe, structure setting, with continuous 24-hour observation and supervision. The program addresses the identified problem through 42 hours per week of crisis stabilization, initial and continuing bio-psychosocial assessment, care management, medication management, therapy, and mobilization of family support and community resources in the context of a comprehensive multidisciplinary treatment plan.
• 23-Hour Crisis Observation, Evaluation, Holding and Stabilization - This level of care provides up to 23 hours of care in a secure and protected environment. The program is medically staffed, psychiatrically supervised, and includes continuous nursing services. The primary objective of this level of care is for prompt evaluation and/or stabilization of individuals with acute symptoms or distress. Before or at admission, a comprehensive assessment is conducted and a treatment plan developed. The treatment plan should place emphasis on crisis intervention services necessary to stabilize and restore the individual to a level of functioning that does not require hospitalization. Duration of services at this level of care may not exceed 23 hours and 59 minutes, by which time stabilization and/or a determination of the appropriate level of care will be made, and facilitation of appropriate treatment and support linkages will be coordinated by the treatment team.
• Acute Inpatient - Acute inpatient treatment represents the most intensive level of care. Multidisciplinary assessments and multi-modal interventions are provided in a 24-hour secure and protected setting which is a medically staffed and psychiatrically supervised treatment environment. Twenty-four hour skilled nursing care, daily medical care, and a structured treatment milieu are required. The goal of acute inpatient is to stabilize acute psychiatric and substance abuse conditions.

What is normal and what is not?
Many parents, caregivers, and people in general find themselves questioning the definition of normal. The line between what is normal and abnormal is often blurred. The Mayo Clinic has addressed such concerns and the impact of “normal” on mental illness. To access the article click here

Where can I go for help?
Where you go for help will depend on the nature of the problem and/or symptoms and what best fits you. Often, the best place to start is by talking with someone you trust about your concerns. Ask for referrals and recommendations. These may come through friends, family, clergy, health care providers, or other professionals whom you know and trust. There are people and places all over the state of Nebraska available to talk, to listen, and to help. For additional information and resources please visit our finding help or resources/information .