Mental Health

Occasional anxiety is an expected part of life. People may feel anxious when faced with a problem at work, before taking a test, or making an important decision. However, anxiety disorders involve more than just a temporary worry of fear. For a person with an anxiety disorder, the anxiety does not go away and can even get worse over time. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and various phobia-related disorders.

Generalized Anxiety Disorder (GAD):

People with GAD tend to experience anxiety or worry much more than the average person. On most days, they will feel anxiety and/or worry about a number of things like personal health, work, social interactions, and everyday routine life circumstances. To receive a GAD diagnosis, a person must be experiencing these feelings for at least 6 months. The fear and anxiety can cause large problems in areas of their life, such as social interactions, school, and work. GAD symptoms include:

• • Feeling restless or on-edge
  • Being easily fatigued (ex. Feeling very tired or worn out)
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep

Panic Disorder:

People with panic disorder have repeated, unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and can reach their peak within minutes. This means that when a person feels a panic attack beginning, it may only take minutes or even seconds for the panic attack to become very serious and scary. Attacks can occur randomly, or can be caused by a trigger, such as bad news, a major life event, or a big change. Some people who experience panic attacks may express that they “feel like they’re dying”.

During a panic attack, people may experience:

• A pounding heartbeat or a very fast heartrate
• Sweating
• Trembling or shaking
• Shortness of breath, or feeling like they’re choking
• Feelings of doom
• Feeling that they are out of control of the body

People with panic disorder often worry about when the next attack will happen and try to prevent future attacks by avoiding certain places, situations, or behaviors that they associate with panic attacks. Worrying about having a panic attack, and the effort spent trying to avoid attacks, can cause serious problems in other areas of a person’s life.

Phobia-Related Disorders:

A phobia is an intense fear of specific objects or to certain situations. Although it can be realistic to be anxious in some circumstances, the fear that people with phobias feel is out of proportion to the actual danger caused by a situation or object.

People with a phobia:

• May have an irrational or excessive worry about encountering the feared object or situation
• Take active steps to avoid the feared object or situation
• Experience immediate intense anxiety upon encountering the feared object or situation
• Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

• Specific Phobias – People who have a specific phobia have an intense fear of, or feel intense anxiety about, specific types of objects or situations. Some examples of specific phobias include the fear of flying, heights, animals, blood, or receiving shots and/or vaccines.
• Social Anxiety Disorder – People with social anxiety disorder have a general intense fear of, or worry toward, social situations. They worry that actions or behaviors associated with their anxiety will be negatively seen by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations in general, to avoid feeling these unwanted feelings. Social anxiety disorder can show up in a range of situations, including the workplace, the school environment or even a gathering with friends.
• Agoraphobia – People with agoraphobia have an intense fear of using public transportation, being in open spaces, being in enclosed spaces, standing in line or being in a crowd, and being outside of the home alone. People with this disorder often avoid these situations because they think being able to leave might be difficult or impossible in the event they have a panic-like reaction or other embarrassing symptom. In the most severe cases, an individual may choose to not ever leave their house.
• Separation Anxiety Disorder – People often think that separation anxiety is something that only children deal with. However, adults can be diagnosed with it too. People who have separation anxiety disorders have fears about being away from people they are attached to. They often worry that something bad or unexpected will happen to the person they are attached to while they are not together. This fear leads them to avoid being apart from the person they are attached to, and they also avoid being alone. People with separation anxiety may have nightmares about being away from the person they are attached to or may experience physical symptoms before or when separation occurs

ADHD is a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.

It is normal to have some inattention, unfocused activity, and impulsivity, but for people with ADHD, these behaviors are more severe, occur more often, and interfere with or reduce the quality of how they function socially, at school, or in a job.

People with symptoms of inattention may often:

• Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
• Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
• Not seem to listen when spoken to directly
• Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
• Have problems organizing tasks and activities, such as what to do in a particular order, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
• Avoid or dislike tasks that require a lot of mental effort, such as schoolwork or homework, preparing reports, completing forms, or reviewing lengthy papers
• Lose things necessary for tasks or activities such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
• Be easily distracted by unrelated thoughts or things
• Be forgetful in daily activities such as chores, errands, returning calls, and keeping appointments

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm in their seats
• Leave their seats in situations when staying seated is expected, such as in the classroom or the office
• Often feel restless
• Be unable to engage in hobbies quietly
• Be constantly in motion or “on the go”
• Talk nonstop
• Blurt out an answer before a question has been completed, finish other people’s sentences, or speak without waiting for a turn in a conversation
• Have trouble waiting for their turn
• Interrupt or intrude on others in conversations, games, or activities

ADHD symptoms can appear as early as 3 and 6 years old and can continue through adolescence and adulthood. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult/failed relationships. ADHD symptoms can change over the life span.

Inattention means a person wanders off task, lacks persistence, has difficulty focusing, and is disorganized.

Hyperactivity means a person seems to move about constantly, including in situations where it is not appropriate, or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.

Impulsivity means a person makes quick actions that happen in the moment without thinking about them first that may have a high chance of harm, or a desire for instant rewards. An impulsive person may be socially intrusive and constantly interrupts people or makes important decisions without considering the long-term consequences.

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. It is typically diagnosed during late teen years or early adulthood. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely up (happy, irritable, or energized behavior) to very down (sad, indifferent, or hopeless periods).

Bipolar I Disorder:

Bipolar I Disorder is defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe- a person needs immediate hospital care. Usually depressive episodes happen as well, typically lasting at least 2 weeks. Sometimes people have depressive and manic symptoms at the same time.

Bipolar II Disorder:

Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic (less severe manic periods) episodes, but not the full-blown manic episodes that are typical of Bipolar I Disorder.

Cyclothymic Disorder (Cyclothymia):

Cyclothymia is defined by periods of less severe manic episodes as well as periods or depressive symptoms lasting for at least 2 years. However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories, which is referred to as “other specified and unspecified bipolar and related disorders.”

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviors – often without recognizing their harmful or undesirable effects. These distinct periods are called mood episodes. Mood episodes are very different from the moods and behaviors that are typical for that person. During an episode, the symptoms last every day for most of the day. Episodes may last for longer periods, such as several days or weeks.

People having a manic episode may:

• Feel very up, high, happy, irritable, or touchy
• Feely jumpy or weird
• Have a decreased need for sleep
• Have a loss of appetite
• Talk very fast about a lot of different things
• Feel like their thoughts are racing
• Think they can do a lot of things at once
• Do risky things that show poor judgement, such as eat and drink excessively, spend or give away a lot of money, or have reckless intimate relations
• Feel like they are unusually important, talented, or powerful

People having a depressive episode may:

• Feel very sad, down, empty, worried, or hopeless
• Feel slowed or restless
• Have trouble falling asleep, wake up too early, or sleep too much
• Experience increased appetite and weight gain
• Talk very slowly, feel like they have nothing to say, or forget a lot
• Have trouble concentrating or making decisions
• Feel unable to even do simple things
• Have little interest in almost all activities, a decreased or absent sex drive, or an inability to experience pleasure
• Feel hopeless or worthless or think about death or suicide

Borderline personality disorder is marked by an ongoing pattern of varying moods, self-image, and behavior. These symptoms often result in impulsive actions and problems in relationships. People with borderline personality disorder may experience intense episodes of anger, depression, and anxiety that can last from a few hours to days.

People with borderline personality disorder tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly. A person who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships.

Other signs and symptoms of borderline personality disorder may include:

• Efforts to avoid real or imagined abandonment (being left alone), such as quickly starting intimate relationships or cutting off communication with someone in anticipation of being abandoned
• A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love to extreme dislike or anger
• Distorted and unstable self-image or sense of self
• Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance use, reckless driving, and binge eating
• Self-harming behavior, such as cutting
• Recurring thoughts of suicidal behaviors or threats
• Intense and highly changeable moods, with each episode lasting from a few hours to a few days
• Chronic feelings of emptiness
• Inappropriate, intense anger or problems controlling anger
• Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions
• Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of not being in reality

Not everyone with borderline personality disorder experiences every symptom. Some people experience only a few, while others have many. Symptoms can be triggered by everyday events, such as minor separations from people they feel close to while traveling for business. The severity and frequency of symptoms and how long they last vary for each individual.

Depression (major depressive disorder or clinical depression) is a common but very serious mood disorder. If causes serious symptoms that affect how people feel, think, and handle daily activities such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks. Some forms of depression are slightly different, or they develop under unique circumstances.

Persistent Depressive Disorder (Dysthymia):

Dysthymia is a depressed mood that lasts for at least two years. A person diagnosed with this disorder may have episodes of major depression along with periods of less serious symptoms, but the symptoms must last for two years to be considered persistent depressive disorder.

Postpartum Depression:

Postpartum depression is much more serious than the “baby blues” that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery. The feelings of extreme sadness, anxiety, and depression may make it difficult for these new mothers to complete their daily care activities for themselves and/or for their babies.

Psychotic Depression:

Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having delusions or hallucinations. The psychotic symptoms typically have a depressive theme, such as delusions of guilt, poverty, or illness.

Seasonal Affective Disorder:

Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally stops during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression and help is available:

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness of negativity
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed will feel every symptom. Some people experience only a few symptoms while others may experience many. Several of these persistent symptoms in addition to low mood are required for a diagnosis of major depression. Symptoms may also vary depending on the stage of the illness.

There is a common misconception that eating disorders are a lifestyle choice. Eating disorders are actually very serious and often fatal illnesses that are associated with serious issues in people’s eating behaviors and thoughts and emotions related to eating. Preoccupation with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia Nervosa:

People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. They typically weigh themselves repeatedly, severely restrict the amount of food they eat, exercise an unnecessary amount, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest death rate of any mental disorder. While many people with this disorder die from complications that come with starvation, others die of suicide.

Symptoms include:

• Extremely restricted eating
• Extreme thinness
• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight
• Intense fear of gaining weight
• Distorted body image, a self-esteem that is heavily influenced by perceptions of body weight and shape, or a denial of the seriousness of low body weight

Other symptoms may develop over time, including:

• Thinning of bones (osteopenia or osteoporosis)
• Mild anemia and muscle wasting and weakness
• Brittle hairs and nails
• Dry and yellowish skin
• Growth of fine hair all over the body
• Severe constipation
• Low blood pressure, slow breathing, and pulse
• Damage to the structure and function of the heart
• Brain damage
• Multiple-organ failure
• Drop in the internal body temperature, causing a person to feel cold all the time
• Sluggishness or feeling tired all the time
• Infertility

Bulimia Nervosa:

People with bulimia nervosa have recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes. This binge-eating is followed by behavior that makes up for the overeating such as forced vomiting, excessive exercise, use of laxatives, fasting (going a period without eating), or a combination of these behaviors. People with bulimia nervosa may be slightly underweight, normal weight, or even overweight.

Symptoms include:

• Chronically inflamed and sore throat
• Swollen salivary glands in the neck and jaw area
• Worn tooth enamel and increasingly sensitive and decaying teeth because of exposure to stomach acid
• Acid reflux disorder and other gastrointestinal problems
• Intestinal distress and irritation from laxative abuse
• Severe dehydration from vomiting fluids
• Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

Binge-Eating Disorder:

People with binge-eating disorder lose control over their eating. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting. As a result, people with binge-eating disorder often are overweight or obese. Binge-eating disorder is the most common eating disorder in the United States.

Symptoms include:

• Eating unusually large amounts of food in a certain amount of time, such as a 2-hour period
• Eating when you’re full or not hungry
• Eating fast during binge episodes
• Eating until you’re uncomfortably full
• Eating alone or in secret to avoid embarrassment
• Feeling distressed, ashamed, or guilty about your eating
• Frequently dieting, possibly without weight loss

OCD is a common, chronic, and long-lasting disorder that causes people to have uncontrollable, reoccurring obsessions and/or compulsions that they feel the urge to repeat over and over. Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include a fear of germs or contamination, unwanted forbidden or taboo thoughts involving sex, religion or harm, aggressive thoughts towards others or self, and having things symmetrical or in a perfect order. Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. Common compulsions are excessive cleaning and/or handwashing, ordering and arranging things in a particular way, repeatedly checking on things (i.e., checking to see if the door is locked repeatedly), and compulsive counting.

Not all rituals or habits are compulsions. Everyone double checks things sometimes! But a person with OCD generally:

• Can’t control their thoughts or behaviors, even when they realize that their thoughts or behaviors are recognized as excessive
• Spends at least 1 hour a day on these thoughts or behaviors
• Doesn’t get pleasure when preforming the behaviors or rituals, but instead may feel brief relief from the anxiety the thoughts cause
• Experiences significant problems in their daily life due to these thoughts or behaviors

Some people with OCD have a tic disorder. A motor tic is a sudden, brief, repetitive movement, such as eye blinking and other eye movements, facial movements, shoulder shrugging, and head or shoulder jerking. Common vocal tics include repetitive throat clearing, sniffing, or grunting sounds.

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a traumatic situation. Fear causes many changes in the body that help defend against danger or to avoid it. This fight-or-flight response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, but most people recover from those symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People with PTSD may feel stressed or frightened, even when they are not in real danger.

Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden death of a loved one, can also cause PTSD. Symptoms usually begin early, within three months of the incident, but sometimes they begin years later. Symptoms must last more than a month and be serious enough to interfere with relationships or work to be considered PTSD. The course of the disorder also varies. Some people recover within six months, while others have symptoms that last much longer, and the condition becomes chronic.

To be diagnosed with PTSD, and adult must have all the following for at least one month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms.

Re-experiencing symptoms:

• Flashbacks – reliving the trauma over and over, including physical symptoms like a racing heart of sweating
• Bad dreams
• Frightening thoughts

Avoidance symptoms:

• Staying away from places, events, or objects that are reminders of the traumatic experience
• Avoiding thoughts or feelings to the traumatic event

Arousal and reactivity symptoms:

• Being easily startled
• Feeling tense or on edge
• Having difficulty sleeping
• Having angry outbursts

Cognition and mood symptoms:

• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Distorted feelings like guilt or blame
• Loss of interest in enjoyable activities

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change their personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

Arousal symptoms are usually constant instead of being triggered by things that remind one of the traumatic events. These symptoms can make a person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

Cognitive and mood symptoms can begin to worsen after the traumatic event but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family members.

Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the person, their family members, and friends. If left untreated, the symptoms can be persistent and disabling. However, effective treatments are available!

Schizophrenia is usually diagnosed in the late teen years to the early thirties and tends to be noticed earlier in males than females. A diagnosis of schizophrenia often follows the first episode of psychosis, when people show symptoms of schizophrenia. Gradual changes in thinking, mood, and social functioning often begin before the first episode of psychosis, usually starting in mid-adolescence.

The symptoms of schizophrenia usually fall into three categories:

Psychotic symptoms

These symptoms include changes in vision, hearing, smell, touch, taste, abnormal thinking, and odd behaviors. People with psychotic symptoms may lose a sense of reality and experience themselves and the world in a distorted way. People typically experience:

• Hallucinations, such as hearing voices or seeing things that are not there
• Delusions, which are firmly held beliefs not supported by facts (e.g., paranoia – irrational fears that others are out to get you or believing that the television, radio, or internet are broadcasting special messages that require some response)
• Thought disorder, which includes unusual thinking or disorganized speech

Negative symptoms

Negative symptoms include a loss of motivation, disinterest, or lack of enjoyment in daily activities, social withdrawal, difficulty showing emotions, and difficulty functioning normally. Individuals typically have:

• Reduced motivation and difficulty planning, beginning, and sustaining activities
• Diminished feelings of pleasure in everyday life
• “Flat affect” or reduced expression of emotions via facial expression or voice tone
• Reduced speaking

Cognitive symptoms

Cognitive symptoms include problems in attention, concentration, and memory. For some people, the cognitive symptoms of schizophrenia are subtle but for others, they are more prominent and interfere with activities like following conversations, learning new things, or remembering appointments. People usually experience:

• Difficulty processing information to make decisions
• Problems using information immediately after learning it
• Trouble focusing or paying attention

Schizophrenia sometimes runs in families, but it is important to know that just because someone in a family has schizophrenia, it does not mean that other members of the family will have it as well. Genetic studies strongly suggest that many different genes increase the risk of developing schizophrenia, but that no single gene causes the disorder itself.

A substance use disorder (SUD) is a mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe, with addiction being the most severe form of SUDs.

Researchers have found that about half of the people who experience a SUD during their lives will also experience co-occurring mental disorders. Co-occurring disorders can include anxiety disorders, depression, ADHD, bipolar disorder, personality disorders, and schizophrenia, among others.

For more information on substance use disorders, visit the Substance Use section of the app and website.

Mental illnesses do not usually happen out of the blue. In most cases, family members, friends, or teachers start to see small changes in a person, or the person with the mental illness notices a change in their thoughts or feelings and recognize their behavior is not “normal.” Like any condition, treating a mental health disorder early is important for the best results. Unfortunately, mental health disorders are not always easy to detect and sometimes appear slowly over time.

Each mental health disorder has its own symptoms, but if you or a loved one experiences one or more of the following, it may be an early warning sign of a mental health problem:

• Excessive worrying or fear
• Feeling excessively sad or low
• Confused thinking or problems concentrating and learning
• Extreme mood changes
• Strong feelings of irritability or anger
• Avoiding friends and social activities
• Hard time understanding or relating to other people
• Changes in sleeping habits or feeling tired and low energy
• Changes in eating habits such as increased hunger or lack of appetite
• Changes in sex drive
• Having delusions or hallucinations, which make a person sense things that don’t really exist
• Inability to notice changes in your own feelings, behavior, or personality
• Overuse of substances like alcohol or drugs
• Headaches, stomach aches, and ongoing “aches and pains”
• Unable to carry out daily activities or handle daily problems and stress
• Thinking about suicide
• An intense fear of weight gain or concern with appearance

Being able to recognize early warning signs and symptoms can help yourself or others with mental health problems take action to get help. Finding treatment early can help reduce the severity and may delay or prevent a major mental health disorder. Don’t be afraid to reach out if you or someone you know needs help. Learning all you can about mental health is an important first step.

Medications can be used to help treat the symptoms of mental illness – they do not cure mental health disorders. Medications are often used in combination with therapy and are offered in both inpatient and outpatient settings. Common medications used for mental health treatment include antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotics. These medications are prescribed by psychiatrists, psychiatric nurse practitioners, or primary care providers based on patients’ disorders, symptoms, and severity. It is important to only take mental health medications prescribed to you by your doctor. 

Psychiatric hospitalization happens when a person is admitted to a private psychiatric hospital, a medical hospital with a psychiatric floor, or a state psychiatric hospital. Psychiatric hospitalizations typically consist of stabilization, close monitoring, medication, administration of fluids and nutrition, and other necessary emergency care. Most people with mental health conditions will not need to spend time in a psychiatric hospital.

There are many misconceptions about psychiatric hospitalization. People can be voluntarily or involuntarily hospitalized. Voluntary admission happens when a mental health provider and patient agree that the patient would benefit from hospitalization or meets the criteria for hospitalization. The patient is usually required to sign a consent form that documents their rights and describes the hospitalization experience. By signing the form, the patient agrees to being hospitalized. If the patient later requests to leave, they can be discharged if a mental health professional determines they are safe. If it is believed that a patient is a risk to themselves or others, a mental health professional may request a hold. Involuntary commitment happens when a patient does not agree to psychiatric hospitalization, but a mental health professional believes the person is a risk to themselves or others. The person must have clear and present danger to themselves or others in the past 30 days. Involuntary commitment is used as a last resort! State hospitals in Alabama that only admit involuntary commitments include:

• Bryce State Hospital: serves adults ages 19 and older
• Taylor Hardin State Hospital: serves adults ages 19 and older who are criminally committed
• Mary Starke Harper Geriatric Psychiatric State Hospital: serves adults ages 65 and older

A person is a candidate for psychiatric hospitalization when they have severe mental health symptoms, hallucinations or delusions, suicidal thoughts, has not slept or eaten for days, and cannot care for themselves. There are several psychiatric hospitals in Alabama. For more information on where these centers are, please visit the Hospitals Archive – Alabama Hospital Association (alaha.org). 

Inpatient treatment, also referred to as residential mental health treatment, takes place in a live-in facility on a 24/7 basis. This level of care is best for people with mental illness who need constant medical and/or psychological supervision or have severe, long-term symptoms. The inpatient environment is very structured and helps patients work on rebuilding life skills without being exposed to negative influences. Often, people who have tried outpatient programs but relapsed back into drug or alcohol use, or continue to struggle with symptoms of mental health, find success in an inpatient program. Treatment for mental disorders in an inpatient facility usually consists of individual psychotherapy/counseling, group therapy, medication, medical supervision, recreational therapies, and complementary therapies (e.g., yoga or meditation).

There are several options for residential mental health treatment in Alabama:

Adult Residential

Specialized Medical Residential

Specialized Behavior Residential

Supervised Apartment 

Outpatient mental health treatment does not require people to live at the treatment center. Instead, people will visit the treatment center or therapist’s office on certain days of the week. Outpatient services are best suited for people with mild to moderate mental health symptoms, a solid support system, and have the ability to function outside of an inpatient or residential environment. There are many different types of outpatient options such as individual therapy, group therapy, family therapy, support groups, intensive outpatient care, and medicine management. Alabama specific outpatient treatment options include:

Assertive Community Treatment (ACT): A treatment model where health care providers work together to help people with mental illness holistically (medication, therapy, social support, employment, housing). When mental health care providers work together, research has shown treatment is more effective. Most often, ACT is used for people who have just left a residential setting who need a similar level of care, but wish to live independently.

Program for Assertive Community Team (PACT): An interdisciplinary team that works together to address the specific needs of individuals with a serious mental illness. The team makes an individual treatment plan for each person and then provides all the services within the team. The team consists of at least 1 full-time master’s level clinician, at least 1 half-time registered or practical nurse, and one full-time case manager. PACT and ACT are extremely important for divesting adults who are at high risk for readmission to a state psychiatric facility.

Supported Employment Team Intervention: Focuses on helping people with serious mental illness and those with co-occurring substance use disorders get and keep competitive jobs based on their interests. Supported employment team intervention also provides support to individuals throughout the entire process from looking for employment and services continue even after employment is obtained.

Jail Diversion (Stepping Up): Aims to reduce the amount of people with mental health conditions in jail. In Alabama, the state mental health department has extended the Stepping Up initiatives to help jails, emergency rooms, and courts- all settings that often do not have resources to help people with mental health conditions.

Other outpatient services in Alabama include:

• Adult in-home intervention
• Adult care management/coordination
• Adult partial hospitalization programs
• Adult outpatient therapy
• First episode psychosis team intervention

Peer support refers to activities and interactions among people who have had similar experiences of being diagnosed with mental health conditions. A peer support professional helps build stronger connections and inspire hope. Peer support also offers greater acceptance, understanding, and support compared to relationships with people who have not had the same struggles. Peer programs in Alabama include:

Certified Peer Specialist for Parents (CPS-P)

This type of peer support must be provided by a parent or caregiver who uses their lived experience to empower other parents of a child or youth with a serious emotional disturbance (SED). CPS-P assists parents with navigating through multiple agencies and human service systems (e.g., basic needs, health, mental health, education, social services, etc.). CPS-P also helps parents develop effective communication, self-help, and self-advocacy skills, in addition to developing healthy social networks.

Certified Peer Specialist for Adults

Certified peer specialists for adults must be in recovery from a diagnosed mental illness. They provide effective communication skills, recovery for mental health conditions, and serve as a role model to others with similar challenges.

Finding the best mental health treatment is a very important step in recovery. To find more information on mental health treatment options in your county, visit the Treatment Locator.

People with mental health disorders are at greater risk of considering, attempting or dying by suicide. Research has shown that when mental health disorders are not treated, the risk of dying by suicide is greater. Suicide is when someone purposefully causes their own death. A suicide attempt refers to someone hurting themselves in hopes of ending their life, but the attempt did not work, and they stay alive. There is no single cause of suicide. It is important to know the risk factors and warning signs of suicide to prevent it from happening.

RISK FACTORS:

• Mental health disorders
• Alcohol and other substance use disorders
• Hopelessness
• Impulsive/aggressive tendencies
• History of trauma/abuse
• Serious physical illness
• Previous suicide attempt(s)
• Family history of suicide
• A recent loss of a family member, job, finances, etc.

WARNING SIGNS:

• Talking about wanting to die or kill themselves
• Looking for a way to kill themselves
• Talking about feeling hopelessness or having no reason to live
• Talking about feeling trapped or being in unbearable pain
• Talking about being a burden to others
• Giving away their belongings
• Increasing the use of alcohol/drugs
• Acting anxious, agitated, or recklessly

• Actually, mental health problems are very common. In fact, mental health problems are the most common health conditions in the US.
• >50% of people will be diagnosed with a mental health problem or disorder at some point in their life
• 1 in 5 Americans will experience a mental health problem.
• 1 in 5 children either currently or have had a mental health disorder
• 1 in 25 Americans currently live with a serious mental health problem such as schizophrenia, bipolar and major depression disorders.

• Children, even when they are really young, can show early signs of mental health concerns.
• ½ of all mental health disorders show first signs around 14 years old.
• ¾ of mental health disorders begin before age 24.

• Majority of people with mental health problems are not violent and only 3-5% of all violent acts are committed by people with a severe mental illness
• Actually, people with severe mental illness are over 10x more likely to be the victims of violent crime compared to the general population.
• It is very likely that you know someone with a mental illness, and you may not even know.

People with mental health problems can be just as productive as other employees!

Mental health problems have nothing to do with being lazy or weak and many need help to get better

Research shows that people with mental health problems do get better, and many will recover completely

Treatment really depends on what the person needs. But when a person is prescribed a drug, they are often urged to go to counseling for the best results!

Friends and loved ones make a huge difference.

Involuntary commitment is only used as a last resort. There must be clear evidence before a person is involuntarily hospitalized. You cannot drop off a loved one at a psychiatric hospital because of your opinion of their mental health.

Alabama requires all public psychiatric facilities and hospitals to accept patients not matter their financial situation.

• Realize their full potential
• Cope with the stresses of life
• Work productively
• Make meaningful contributions to their communities

• Recognizing mental health problems and getting professional help when needed
• Connecting with others
• Staying positive
• Getting physically active
• Healthy diet
• Helping others
• Getting enough sleep
• Developing coping skills
• Mental exercises like playing games or solving puzzles