Small but Effective Fixes for Desperate Situations

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Gaps

August 16, 2015; News & Observer (Raleigh, NC)

The dysfunctions of the mental health system are no secret: NPQ has reported on the effects of mental health cutbacks, and stories of desperate psychiatric patients play out every day around the world. Although the debate surrounding overmedication in psychiatry continues to rage, medication and ongoing follow-up—for many people—are the only real solution to debilitating psychosis and depression.

Over a decade ago, I worked as an admin assistant for a clinical psychopharmacology unit while studying translation at McGill University. While many of my phone conversations with patients were benign ones about secret NASA codes and covert spy operations, I also spoke to very desperate family members at the end of their ropes.

I remember one father who pleaded with me for an appointment with a specialist for his daughter, who was in the grips of bipolar disorder. But she didn’t have a family doctor, and I couldn’t schedule a consult without the name of one. The man broke down and cried the tears of a desperate father. All I could give was a sympathetic ear.

This story exemplifies not only the lack of access to specialists but also the heavy support that people living with a mental illness need from health care systems that don’t always know how to respond. While the lack of doctors and hospital beds are part of the problem, the lack of proper medical follow-up in general also fails patients, particularly when it comes to managing psychiatric medication.

One county in North Carolina had such a high average number of mental health patients on medication that something had to be done. Healthcare provider Daymark Recovery Services and the N.C. Hospital Association, therefore, tried a new tack to help people with a mental illness who live in remote areas to manage their medication.

Launched in early April, the Mobile Medication Program ensures that people at risk of psychiatric hospitalizations understand and stay on track with their drug regimens. Technicians and peer support counselors make home visits to help people remember what medication to take and when, with the goal of getting them independent within three months. The program also sends technicians instead of certified nurses on home visits to keep costs down.

While mobile medication follow-ups may seem like a small fix, the impact can be great, as medication noncompliance in psychiatry is related to greater hospitalization and greater risks of suicide.

“Without their medications, people experiencing mental illness can become unstable. That often leads to a hospital or jail,” says Allen Smart, vice president of programs for the Kate B. Reynolds Charitable Trust, which gave out grants worth $1.2 million to the mobile programs in Vance and Nash County. “Mobile Medication’s model is exciting,” he says, “because it cheaply addresses a missing link in healthcare. Providers don’t typically provide support to keep people on their medications.”

“The fact that most mental illnesses coincide with some other medical diagnosis further complicates the situation, […] leaving people to struggle with multiple prescriptions and complicated drug interactions,” states Julia Wacker, the Mobile Medication program manager. Imagine having to sort through a full box of different sizes and colors of pills a few times a day, all while experiencing mood swings or hearing voices, and it becomes clear why psychiatric patients don’t always take their medication and why medical follow-up is essential.

Much like the case of access to rural health care in Kansas that NPQ reported on, the Mobile Medication program also fills a pressing need by adding mental health services to an underserved area and treating people with not just psychiatric conditions but also chronic diseases, such as diabetes and COPD.

Overall, Mobile Medication’s goal is to peel back the layers that complicate mental illness, such as substance abuse and poverty, to address actual needs. This is a logical response to “a gap in the system” and a sensible way to address such an overwhelming problem that leaves so many in desperate straits.—Amy Butcher