Our Resource Guide
Table of Contents
Table of Contents 1
What is NAMI? 2
Components of Palm Beach County 2
Programs and Services
Severe Mental Illness and Substance Use Disorders 6
Symptoms of Mental Illness 7
Diagnosis of Mental Illness 8
Types of Mental Illness 8
Substance Use Disorders 12
Co-Occurring Disorders 13
Serious Disorders of Children & Adolescents 14
Seeking Treatment 19
Medication Patient Assistant Programs 24
Resources for Care 23
Coping with a Relative Who Has a Mental Illness 26
Support and Advocacy Groups 30
Voluntary and Involuntary Hospitalization (The Baker Act) 29
Marchman Act 31
Seeking Treatment for Substance Use Disorders 32
Family Interaction with Law Enforcement 34
Crisis Intervention Teams 35
Jail Diversion Programs 37
Florida Assertive Community Treatment (FACT) 38
Rehabilitation Services 41
Cultural Diversity 42
Legal Considerations – Advance Directives & Guardianships 44
Financial Considerations – Federal and State Programs 45
Working within the System 50
Services for Veterans 51
Guide to Services 52
Appendix A 71
Appendix B 72
Appendix C 73
Invest in NAMI Palm Beach County 74
NAMI Palm Beach County Membership Form 75
WHAT IS NAMI?
The National Alliance on Mental Illness (NAMI), which is located in Arlington, VA, originated over thirty years ago as a national grassroots organization dedicated to brain disorders. NAMI is the nation’s voice on mental illness. Mental Illness affects one in every four families. These families go to NAMI—National Alliance on Mental Illness—to help them cope with the challenges they face. NAMI helps individuals with mental illness and their loved ones by focusing our efforts in three primary areas that offer awareness, hope, reform, and health to our community – education, support and advocacy.
Since 1983, the Palm Beach County NAMI affiliate (NAMI/PBC) which is associated with NAMI Florida, has responded to community needs by providing quality “education, support, and advocacy, thereby empowering people with mental illness and their families…” The NAMI/PBC office changes the perception of mental illness through raising awareness, education, and advocating for legislative improvements at the local, state, and national levels. We have a history of working to eradicate the stigma associated with brain disorders and a goal to improve the quality of life of individuals living with brain disorders and their families. There is always hope for recovery from mental illness through appropriate treatment. NAMI PBC can be used as a tool to strengthen the partnerships between families and peers and while serving as a bridge for them to access appropriate mental health services within their community. With the assistance of NAMI/PBC, people who are living with a mental illness and their families are able to establish a plan of care that best meets the needs of the person affected by the mental illness. We have support groups tailored for people who are living with a mental illness, family members and caretakers of a loved one who is living with a mental illness, and adolescents who are living with a mental illness. The foundation of our education and support efforts is the peer teaching peer component. All of our educators and support group facilitators are people who are living in recovery of a mental illness or are family members of a loved one who is living with a mental illness.
MISSION and VISION of NAMI PBC
NAMI PBC is an organization dedicated to providing advocacy, support, and education with the goal to empower persons with mental illness and their families. NAMI PBC’s vision is to be recognized as the leading organization for improving the quality of life and protecting the rights and interests of those affected by mental illness in Palm Beach County. Elimination of the stigma attached to mental illness is essential to achieve the goals of empowerment, social inclusion, and recovery.
COMPONENTS of NAMI PALM BEACH COUNTY
Ø NAMI Family Support Group – meets monthly
Ø NAMI Connection Consumer Support Group – meets weekly
Ø NAMI Young Adults Support Group – meets weekly
Ø NAMI Adolescent Support Group — meets weekly
Ø NAMI Help Line  588-3477 or email firstname.lastname@example.org
Ø Volunteer & Staff office – open 9 am – 5pm, Monday – Friday, to assist with information and referral
Ø NAMI Public Affairs Committee provides a collective voice for persons living with mental illness and their families regarding legislative issues, services, treatment and funding.
Ø It is through the awareness, education, and support that NAMI is able to work toward the improvement of the lives of those with mental illness and their families, while working to remove the negative stigma communities and societies have regularly associated with mental illness.
CIT (Crisis Intervention Team):
Ø 40-hour program for law enforcement officers on how to calm, assess, and facilitate crisis situations, reducing the use of force while enhancing officer safety. Over 3,000 Palm Beach County law enforcement personnel have been trained.
Ø Education Meetings: Speakers discuss mental health issues – held monthly for the general public.
Ø Speakers Bureau: Presentations by individuals in recovery and family members to share their stories and provide information on NAMI services.
Ø NAMI PBC website: www.namipbc.org
Ø NAMI National website: www.nami.org
Ø NAMI PBC newsletters: The Voice (monthly) and the NAMI PBC Peer Council’s White Picket Fence (quarterly)
Ø Family Guide on mental Illness – definitions/explanations/resources/information about mental illness.
PROGRAMS AND SERVICES
NAMI is the nation’s largest grass-roots organization of individuals with mental illness, their families, and friends who are dedicated to improving the quality of life of those affected by mental illness.
INFORMATION AND REFERRAL SERVICES
The NAMI/PBC office receives hundreds of calls each year from individuals, family members, friends, and healthcare professionals. Many of those who call report that this is the first contact they have made to try to discover what they should do and where they can go for help and information. Others call in frustration when they are unable to find assistance or get help from any other source.
FAMILY-TO-FAMILY EDUCATION COURSE
This is a free, 12 session course for families and friends of individuals with serious mental illnesses. Taught by trained NAMI family members, the participants receive updated information about illnesses of the brain and treatment options, coping skills, and the power of advocacy. Those who take the NAMI course are better equipped to work with their family member or friend and the mental health system in seeking and obtaining help.
PEER-TO-PEER EDUCATION COURSE
This is a 10 session education course on recovery for any person with a serious mental illness. Like Family-to-Family, the course is free and is taught by a team of two trained peer mentors who are experienced at living with their own mental illnesses. Participants learn about serious mental illnesses, coping skills, empowerment, and advocacy.
PROVIDER EDUCATION COURSE
This is a 5-week course that provides a subjective view of family and peer experiences with serious mental illness to staff at public agencies who work directly with people who are living with severe and persistent mental illnesses. The Provider Education course helps providers realize the hardships that people who are living with a mental illness and their families face. This course also helps providers appreciate the courage and persistence it takes to live with and recover from mental illness. The curriculum of this course is delivered by a teaching team comprised of two family members, two individuals who are living with a mental illness, and a mental health professional who is also either a family member or a person living with a mental illness.
PARENTS AND TEACHERS AS ALLIES
This is a two-hour in-service program designed for teachers, administrators, school health professionals, parents, and others in the school community. Parents and Teachers as Allies focuses on helping school professionals and families within the school community better understand the early warning signs of mental illnesses in children and adolescents and how best to intervene so that youth with mental health treatment needs are linked with services. It also covers the lived experience of mental illnesses and how schools can best communicate with families about mental health related concerns.
NAMI FAMILY SUPPORT GROUP
This NAMI support group is facilitated by family members for other families and loved ones to give them support and feedback on their daily challenges and special issues they face. Groups are confidential gatherings of caregivers who need a haven of understanding based on lived experience with mental illnesses among their family and friends.
NAMI CONNECTION SUPPORT GROUP
Individuals who have mental illnesses need support regularly to be able to share information confidentially about their personal roads to recovery, as well as the special challenges they face while coping with their illnesses. This group is led by specially trained persons who are in a unique position to offer support and empathy from people who know what it’s like and who have “been there.”
At monthly Education Meetings, experts from the community speak on a wide-range of mental health, legal, caregiving, and life management topics.
Individuals with mental illness and family members present to other family members, friends, professionals, individuals, and lay audiences about their personal journey and their issues, challenges, treatment, and coping strategies. Their goal is to enrich each audience’s understanding of how people affected by serious brain disorders cope with the reality of their mental illness and illustrate that recovery is possible.
ADVOCACY AND CONSULTATION
NAMI is directly involved in advocacy for the needs of those with a mental illness and their families. Volunteers serve on local committees and coalitions and participate extensively with agencies that address mental health and substance abuse issues. Members are trained on how to provide information to their local, state, and federal elected officials.
CRIMINAL AND JUVENILE JUSTICE ISSUES
The state’s jails and prisons often become the default housing for individuals with a mental illness who have experienced a public mental health crisis that results in incarceration. Statistics indicate that a majority of the people in jails and prisons who have a severe mental illness may be better served in another setting. NAMI PBC encourages and participates in training and programs to assist law enforcement throughout the county to identify and properly refer these individuals. Law enforcement officers are often the first responders to come in contact with a public mental health crisis event; thus, NAMI PBC strongly supports Crisis Intervention Team (CIT) training, an education program that provides 40 hours of specialized training for law enforcement officers, teaching them how to respond to calls concerning persons experiencing a mental health crisis. In this course, officers are exposed to basic dynamics of common types of mental illnesses and to the viewpoints and feelings of individuals affected by mental illness first hand. CIT officers become skilled in de-escalating potentially volatile situations, gathering relevant information, and evaluating the individual’s social support system for the purpose of appropriate placement for assistance.
NAMI/PBC volunteers are advocates who work to reduce stigma and discrimination. The NAMI/PBC volunteers are an extremely valuable source of help and support. They lead all of the NAMI signature best practice education courses, support groups, and dedicate hundreds of hours a year to enrich the lives of Palm Beach County residents who are affected by mental illness.
For more information about NAMI PBC programs and services, please contact us directly:
NAMI PBC office: 561-588-3477
SEVERE MENTAL ILLNESS AND SUBSTANCE ABUSE
SYMPTOMS OF MENTAL ILLNESSES
Mental illness refers to a group of brain disorders that can profoundly disrupt a person’s ability to think, feel, and relate to others and their environment. Often this results in an inability to cope with the ordinary demands of life. Symptoms vary and every individual is unique. All persons with mental illness typically have some of the characteristics summarized below. While a single symptom or isolated event is not necessarily a sign of mental illness, professional help should be sought if symptoms persist or worsen.
A variety of symptoms characterize some of the ways mental illness can affect a person’s behavior:
- Hyperactivity, or inactivity, or alternating between the two
- Deterioration in personal hygiene
- Noticeable and rapid weight loss
- Drug or alcohol abuse
- Forgetfulness and loss of valuable possessions
- Attempts to escape through geographic change, frequent moves or hitchhiking trips
- Bizarre behavior (staring, strange posturing)
- Unusual sensitivity to noise, light, and clothing
- Social withdrawal
- Change in personality
Often the symptoms of mental illness are cyclical, varying in severity from time to time. The duration of an episode also varies. Some persons are affected for others; the illness may last many years or a lifetime. There is no reliable way to predict the course of the illness.
Thought disorders are characterized by the inability to concentrate or cope with minor problems, irrational statements, peculiar use of words or language structure, excessive fears, or suspiciousness.
Expressions of Feelings
The way persons with mental illness express their feelings can be characterized by changes such as hostility from someone who formerly was passive and compliant, indifference (even in highly important situations), inability to cry or excessive crying, inability to express joy, and inappropriate laughter.
The following characteristics typically are included in a description of depression:
- sudden onset of sadness unrelated to events or circumstances
- loss of interest in once pleasurable activities
- expressions of hopelessness
- excessive fatigue and sleepiness or an inability to sleep
- feelings of worthlessness or guilt
- frequent tearfulness
- perceiving the world as dead
- thinking or talking about suicide
DIAGNOSIS OF MENTAL ILLNESSES
Accurate diagnosis may take time. The initial diagnosis is often modified later, perhaps several times, because it takes some time to evaluate response to treatment. It also can be difficult to pinpoint the problem because the individual has more than one disorder; for example, schizophrenia with an affective disorder, or an anxiety disorder such as obsessive-compulsive disorder with schizophrenia, or a personality disorder. It is important for the psychiatrist to reevaluate the diagnosis periodically in order to work out the best treatment approach. In some cases of apparent mental illness, alcohol, or drug abuse, an underlying medical condition such as hypothyroidism, multiple sclerosis or a brain tumor is found to be the problem. A thorough physical examination should be the first step when mental illness is suspected.
TYPES OF MENTAL ILLNESS
The word schizophrenia originates from a Greek term that means “splitting of the mind.” People with schizophrenia do not, however, have a “split personality.” They have a disorder that affects their thinking and judgment, sensory perceptions, and their ability to interpret and respond to situations or stimuli appropriately. There are usually drastic changes in behavior and personality. Anosognosia–lack of insight–about the illness is one of the most difficult symptoms to treat, and it may persist even when other symptoms (such as hallucinations and delusions) respond to treatment.
Schizophrenia will affect about 1% to 2% of the U.S. population at some time during their lifetime. It is usually first diagnosed between the ages of 17 and 25. There may be several psychotic episodes before a definitive diagnosis is reached. When this illness first appears, the person could feel tense and have difficulty concentrating. He/she might start to withdraw; school or work performance may begin to deteriorate; general appearance and personal hygiene could deteriorate; friends often drift away. Parents often misinterpret these symptoms as typical rebellious adolescent behavior, and even doctors may be uncertain about a diagnosis in the early stages.
Signs & Symptoms of Schizophrenia
Alteration of the senses: The senses (sight, hearing, touch, and/or smell) may be intensified especially early in the disease.
Inability to process information and respond appropriately (also known as “thought disorder”): Because the individual has difficulty processing external sights and sounds, and because he/she experiences internal stimuli that others are not aware of, his/her response is often illogical or inappropriate. Thought patterns are characterized by faulty logic, disorganized or incoherent speech, blocking, and sometimes neologisms (made-up words). He/she may relate experiences and concepts in a way that seems illogical to others, but hold great meaning and significance to himself/herself.
Delusions: These are false ideas that the person believe to be true. The individual adheres to these ideas in the face of reason. Some persons develop excessive religious preoccupation; however, unusual beliefs may be the product of a person’s culture and can only be evaluated in this context. There are common kinds of delusions, such as paranoid delusions, which are characterized by the belief that one is being watched, controlled, or persecuted. Individuals also experience grandiose delusions, which are centered on the belief that one has vast wealth, special powers or is a famous person, such as a politician or religious leader.
Hallucinations: Hallucinations are sensory perceptions with no external stimuli. The most common hallucinations are auditory, hearing “voices,” which the person may be unable to distinguish from the voices of real people. Delusions and hallucinations are the result of over-acuteness of the senses and an inability to synthesize and respond appropriately to stimuli. To the person experiencing them, however, they are real. Medications can be very helpful in controlling hallucinations.
Change in emotions: Early in the illness, the person may feel widely varying, rapidly fluctuating emotions and exaggerated feelings, particularly guilt and fear. Emotions are often inappropriate to the situation. Later there may be apathy, lack of drive, loss of interest, and an inability to enjoy activities.
Changes in behavior: slowness of movement, inactivity, and withdrawing from social situations are common changes that can occur in a person’s behavior. Motor abnormalities such as grimacing, posturing, odd mannerisms, or ritualistic behavior are sometimes present. There could also be pacing, rocking, or apathetic immobility.
There is no cure for Schizophrenia, but there are many medications available which can reduce the symptoms. Finding the right medication therapy is a very complex process that demands a working relationship with a psychiatrist that is based on trust. The outcome is very successful when the individual is treated appropriately with medications, has access to rehabilitation services, and has a supportive living environment.
Mood disorders or affective disorders include Major Depression and Bipolar Disorder and are some of the most common psychiatric diagnoses. The terms ‘mood’ and ‘affective’ refer to the state of one’s emotions. A mood disorder is marked by periods of extreme sadness or excitement, or both. If untreated, these episodes tend to recur or persist throughout life. Even when treated, there could be many repeat episodes.
Depression in some degree will effect between 10% and 20% of the population at some time during their lives, some as often as once or twice per year, with episodes that may last longer than six months each.
Beyond a persistent sad mood, the symptoms of depression include:
- loss of interest in daily activities, loss of energy and excessive tiredness
- poor appetite and weight loss, or the opposite, increased appetite and weight gain
- poor concentration
- sleep disturbance – sleeping too little or sleeping too much in an irregular pattern
- feelings of worthlessness or guilt that can reach unreasonable proportions
- feelings of hopelessness about the future
- recurrent thoughts of death or self-harm, wishing to be dead or attempting suicide.
People with the most severe depression find that they cannot work or participate in daily activities, and often feel that death would be preferable to a life of such pain. Probably more than with any other illness, people with depression are blamed for their problems and told to “snap out of it,” “pull themselves together,” etc. Often, others will say a person “has no right” to be depressed. It is critical for family and friends to understand that depression is a serious illness. The person with this illness cannot ‘snap out it’ any more than a person with diabetes or cancer can will away their condition. Depression is a very treatable illness. Approximately 75% of people properly diagnosed respond to treatment.
Bipolar disorder is characterized by extreme shifts in mood, energy, and functioning. These shifts fluctuate between periods of depression and an extremely elevated state known as mania.
Symptoms of hypomania or the more severe state of mania include:
- euphoric, expansive mood
- boundless energy, enthusiasm, and activity
- decreased need for sleep
- rapid, loud, disorganized speech
- short temper, argumentative, or irritable mood
- delusional thinking
- activities that have painful consequences such as spending sprees, reckless driving, or increased sexual behavior
Bipolar may appear in childhood or adolescence, although the majority of cases appear in young adulthood. Many believe there is a genetic component to the illness, since Bipolar Disorder and Major Depression often run in families.
Ironically, some of the symptoms of mania lead affected people to believe they are not experiencing manic symptoms and have never felt better.
The euphoric mood may continue even in the face of sad or tragic situations. Even when the person continues to feel swept up in the mood of excitement, family and friends may notice serious problems. For example, people with mania often go on spending sprees, become promiscuous, or abuse drugs and alcohol while being unaware of the serious consequences of their behavior.
Fortunately, Bipolar Disorder is one of the most treatable illnesses, generally with some of the newer atypical medications. In addition to medications, many people with Bipolar Disorder find individual behavior modification therapy and peer support groups helpful. Many of the symptoms of mania also can occur in Schizophrenia, which could complicate a diagnosis.
Both Major Depression and Bipolar Disorder are highly correlated with suicide and suicide attempts.
This illness is a combination of psychotic symptoms such as hallucinations or delusions and significant mood symptoms, either depression or mania or both. The psychotic symptoms persist when the mood symptoms resolve.
Anxiety Disordersinclude Generalized Anxiety Disorder, phobias, Panic Disorder, Obsessive-Compulsive Disorder (OCD), and Post-Traumatic Stress Disorder (PTSD). Symptoms can be so severe that they can become disabling, but these illnesses seldom involve psychosis.
Panic Disorder: Panic attacks come “out of the blue” when there is no reason to be afraid. Symptoms may include sweating, shortness of breath, heart palpitations, choking, or faintness.
Obsessive-Compulsive Disorder:OCD can cause the individual to have only obsessions or only compulsions, but most people have both. Obsessions are repeated, intrusive, unwanted thoughts that cause extreme anxiety. Compulsions are excessive, ritualistic behaviors that a person uses to diminish anxiety. Some examples of this are hand washing, counting, repeated checking, and repeating a word or action(s). Treatment includes both medication and therapy.
Post-Traumatic Stress Disorder (PTSD): according to the DSM-IV-TR, PTSD is the development of characteristic symptoms following exposure to an extreme traumatic stressor which caused intense fear, helplessness, or horror. Stressors can include combat, abuse, assault, or severe accidents. Symptoms can include repeatedly experiencing the event, as well as persistently avoiding stimuli that reminds the person of the event. Hallucinations and paranoia can occur in some severe cases. PTSD is associated with increased rates of depression, Substance Use Disorders, and Panic Disorder.
Substance Use Disorders
Substance Use Disorders include abuse and dependence on mind altering substances.
Substance Abuse is defined as repeated use of substances despite adverse social consequences, such as failure to meet family, school, or work responsibilities; interpersonal conflicts; legal problems; or using substances in potentially dangerous situations.
Substance Dependence, commonly known as addiction, is characterized by the presence of several physical and behavioral symptoms. One of these symptoms is the need for increased amounts of substances to achieve the desired effects, which is known as tolerance. Individuals also can experience withdrawal symptoms when they stop using.
These individuals typically devote increasing amounts of time and resources obtaining and using drugs or alcohol, and tend to give up other interests and responsibilities. People who are addicted might try unsuccessfully to control their use, take more of a substance, or use it more often than they plan to. Many also continue to use despite knowledge of related health problems.
Substance dependence can appear without previous substance abuse, while some people meet criteria for substance abuse without ever becoming dependent. However, studies tend to indicate a better-than-average change that substance abusers will become addicted.
In the past, many thought Substance Use Disorders were caused by moral failings or a lack of willpower. However, research indicates that there are identifiable genetic, psychological, and social risk factors that make some people more vulnerable to abuse or dependence. Over time, substance dependence appears to lead to changes in the brain that create a continued risk of relapse despite a person’s sincere desire for sobriety. Substance dependence is now generally considered to be a chronic condition. A relapse is not a sign of failure but rather, a possibility.
Each person should develop a plan in advance for returning to recovery as quickly as possible. Relapse prevention can provide the individual, his/her family, concerned friends, and professionals with useful information to help strengthen the individual’s recovery support system.
It is estimated that about a third of adults with mental health diagnoses have a co-occurring Substance Use Disorder, while more than half of adults with Substance Use Disorders have co-occurring mental health disorders. Symptoms of mental health and Substance Use Disorders often interact to precipitate, mimic, mask, or worsen each other. Co-occurring disorders tend to interact in ways that negatively impact a person’s ability to care for himself/herself and successfully function.
Accurate assessment and treatment designed to address co-occurring disorders offers the best opportunity for recovery. According to the SAMHSA National Survey on Drug Use and Health (2010), 9.2 million adults had both serious psychological distress and a Substance Use Disorder; and of that number, 55.6% received no treatment. Of the 44.4% who did get treatment, 33.6% received only mental health care, and 3.1% only substance abuse services. Only 7.7% received specific co-occurring treatment.
Without an integrated system of care, people with co-occurring disorders may receive “parallel” or “sequential” treatment, moving between mental health and substance abuse treatment providers depending on which disorder is more acute at the time. Professionals, as well as concerned family members or friends, may not get a complete understanding of the person’s individual needs.
People with co-occurring disorders benefit most from treatment methods that have the flexibility to address both disorders. Continuity of care and a full range of services including psychiatric, social, recreational, vocational, and cultural needs are important components of treatment. It also is important that treatment includes specialized counseling to address life skills, relapse prevention, and any trauma or abuse issues. Recovery support groups such as “Double Trouble” that welcome persons with co-occurring disorders are also helpful.
Suicide may be a manifestation of mental illness, but not all persons who commit suicide are mentally ill.
Signs of depression and warning signals of suicidal thoughts can include:
- Change in personality: Usually sad, withdrawn, irritable, anxious, tired, indecisive, apathetic, or moody
- Change in behavior: Difficulty concentrating on school, work or routine tasks; change in eating habits such as loss of appetite and/or weight, or conversely, overeating and/or weight gain, excessive tearfulness or crying.
- Change in sleep patterns: Oversleeping or conversely insomnia, sometimes with early waking
- Loss of interest: Reduced interest in friends, sex, hobbies, or other activities previously enjoyed
- Fear of losing control: Fear of “going crazy” or harming oneself or others
- Worries about money or illness:Either real or imagined
- Feelings of helplessness and worthlessness, overwhelming guilt, shame or self-hatred.
- Sense of hopelessness about the future
- Drug or alcohol abuse: It should be noted that drug and alcohol abuse lowers inhibitors and that people tend to do things when they are drunk or high that they would not normally do if they were sober.
- Recent loss:Loss through death, divorce, separation or a broken relationship, even the loss of a job, money, or status, may trigger suicidal thoughts
- Loss of religious faith
- Agitation, hypertension, and restlessnessmay indicate masked depression
- Giving away possessions
Do not be afraid to ask the person showing such symptoms if he or she is thinking about suicide. Just about everyone has contemplated suicide, however fleetingly, at one time or another. Raising the question of suicide shows you are taking the person seriously and responding to the potential of his or her distress.
If the answer is “Yes, I do think of suicide,” you must take it seriously. Ask questions like: Have you thought about how you would do it? Do you have the means? Have you decided when you will do it? Have you ever tried suicide before? What happened then?
Depending on their response, do not hesitate to contact your local 24-hour mental health crisis service, or your emergency 9-1-1 telephone service for help.
OTHER RESOURCES FOR THOSE CONCERNED ABOUT SUICIDE
NAMI refers you to the following websites for more in depth information on this topic:
SERIOUS DISORDERS OF CHILDREN & ADOLESCENTS
Some psychiatric disorders, such as Autism, typically start in childhood, while others such as mood disorders may first be diagnosed during adolescence or adulthood. Although there is still much to learn about childhood disorders, it is generally accepted that many, if not most, of the disorders listed below are primarily biological in nature, that is, based on structural and/or chemical abnormalities in the brain. They are sometimes referred to as neurological disorders.
Autism and other pervasive developmental disorders, Schizophrenia, and Schizoaffective Disorder are biologically based, resulting from a malfunction of the brain. Other disorders including Attention Deficit Hyperactivity Disorder (ADHD), Anxiety Disorder, and mood disorders can also be primarily biologically based and generally respond to drug therapy. For neurobiological disorders, appropriate medical diagnosis and treatment are essential. If a child cannot process information or is not in control of his emotions, psychosocial and educational strategies alone are not likely to be effective.
Many professionals continue to be reluctant to “label” children with a mental illness diagnosis given the uncertainties about behavior that may be due to developmental problems, the impact of illegal drugs or alcohol, and the ordinary emotional turmoil that accompanies the passage from adolescence to adulthood. However, families need to know what is wrong with their child. A diagnosis is essential to the task of designating an effective treatment and educational approach.
The child fails to relate normally to parents and other people and has play which is rigid, repetitive, and lacks variety. Seventy-five percent of children with Autistic Disorder also have an Intellectual Disability. Once present, Autism typically affects the person for life, although about one-third of affected individuals will be able to attain some degree of independence.
Anxiety may or may not be associated with a specific situation. Anxiety and worry may be far out of proportion to the actual likelihood or impact of a featured event. Anxiety Disorders include panic attacks, social phobia, Obsessive-Compulsive Disorder, and Post-Traumatic Stress Disorder.
Bipolar Disorder & Depression
In children, aggressive or hostile behaviors may mask underlying depression. Parents should consider the possibility of depression when there are unexplained physical complaints, a drop in school performance, social withdrawal, apathy, increased irritability, tearfulness, sleep problems, appetite changes, and suicidal behavior or symptoms. Children with Bipolar Disorder may present with mood swings, unpredictable angry outbursts, increased activity or irritability.
Schizophrenia usually starts in the late teens or 20’s, and seldom occurs before adolescence, but some cases at age five or six have been reported. There is evidence, however, that certain structural changes in the brain are present at birth in individuals who later develop Schizophrenia. The essential features are the same for children and adults; however, it may be difficult to diagnose them.
Tourette’s Disorder often begins when a child, age five to seven, begins to have tics such as eye blinking, grimacing, or shoulder jerks. Sudden vocalizations (barks, clicks, yelps) may appear later, and still later the person may involuntarily say words or phrases. Uttering obscene words out of context occurs in less than 10% of patients.
ADHD—Attention Deficit Hyperactivity Disorder
One of the many prevalent and serious disorders affecting children and adolescents is Attention Deficit Hyperactivity Disorder. ADHD has serious impact on the lives of many children and adolescents, and is frequently misunderstood.
ADHD is generally categorized into four sub-groups. The first two-groups reflect the major characteristics associated with ADHD: inattention, high activity level, and impulsivity. The first group is where the primary characteristics are inattentiveness and disorganization. This is called ADHD, predominantly inattentive type. The second condition is where hyperactivity and impulsivity are the striking features. This is called ADHD, predominately hyperactive-impulsive type. The third condition is a combination of the first two and the fourth condition is considered ADHD, Not Otherwise Specified.
The U.S. Department of Education uses the term ADD (Attention Deficit Disorder) for the type of ADHD characterized by inattentiveness and disorganization and reserves the term ADHD for the type in which hyperactivity and impulsivity is predominately featured.
ADHD is a complex neurobiological disorder and researchers believe that chemicals in the brain that are not working properly cause the symptoms of ADHD. More specifically, it is believed that the neurotransmitters, the chemical messengers of the brain, do not work properly in individuals with ADHD. As a result, many children with ADHD have difficulties in several spheres of functioning that may cause significant problems at home, at school, and in the community. Although children may be inattentive and impulsive at times, youngsters with ADHD behave this way more frequently and are more likely to cause problems at home and at school.
For the diagnosis of ADHD to be given, the symptoms need to have been present before the age of seven, and there must be impairment in two or more settings (such as home and school). It is often the case that a diagnosis is first made after children start school, and begin to underachieve academically. While ADHD is typically thought of as a disorder of young children, in fact, it frequently continues into adolescence and often into adulthood. Researchers have estimated that ADHD affects three to five percent of all children. ADHD is anywhere from three to six times more common in boys than girls.
ADHD often occurs with other conditions. According to information from a major study at the National Institute of Mental Health, two-thirds of children with ADHD have at least one other coexisting condition. Some of the most common co-occurring conditions are Oppositional Defiant Disorder, Anxiety Disorder, learning disabilities, and Depression.
Common Features of Children & Adolescents with ADHD: One of the primary complaints from parents and teachers is that children and adolescents with ADHD have difficulty following rules and instructions. The two core characteristics of ADHD, inattention and impulsivity, are largely to blame. Parents often complain that their child does not complete his/her chores. He/she may start a job but somehow never gets it finished.
Impulsivity is the second primary characteristic of ADHD. Specific examples include: responds quickly without waiting for instructions, makes careless errors, does not consider consequences, takes risks, carelessly damages possessions, has difficulty delaying gratification, and takes short-cuts in work.
Both inattention and impulsivity contribute to disorganization, difficulty getting started, and failure to complete homework. As a result, children with ADHD may have lower self-esteem as early as first or second grade. Many children with ADHD are less mature and may be developmentally behind their peers by as much as three or four years.
One way of characterizing the deficiencies of many children with ADHD is to indicate that they have “executive functioning” difficulties. Deficits in key executive function skills that interfere with the ability to do well academically include such things as: holding facts in your head and manipulating them, getting started on tasks, staying alert, and finishing work.
The challenges facing teenagers and ADHD are more complex. The risk of school failure, school suspension or expulsion, dropping out of school, substance abuse, pregnancy, speeding tickets, car wrecks, and suicide are greater for them.
Parents have observed that teenagers with ADHD are more difficult to discipline. On a more positive note, teenagers with ADHD can be very engaging, enthusiastic, and certainly energetic.
Parents who think their child may be exhibiting behavior reflective of ADHD should seek the opinion of a mental health professional or pediatrician who specializes in ADHD. Parents should gather information from the school about the child’s behavior. A diagnosis should be based upon a comprehensive evaluation, including interviews, tests, questionnaires, and direct observation. Interventions typically include psychosocial and behavioral components as well as medication.
Parents with children with ADHD can find support groups to be an invaluable aid. In addition to parent organizations that deal with a variety of mental disorders, such as the National Alliance on Mental Illness and the Federation of Families for Children’s Mental Health, parents can contact CHADD (Children and Adults with Attention Deficit Disorder).
It is important to keep in mind that ADHD is not just a passing phase for children. It is a long-term, sometimes lifelong condition. Many children receive effective intervention and family support, make great progress, and learn how to put their attributes to best use, especially in their adult years. Without effective intervention and family support, however, ADHD can significantly impair functioning for many years and help bring on other serious emotional and behavioral conditions.
Summarized from an article by Dan Casseday and Bob Friedman, University of South Florida.
Substance Use Disorders in Adolescents
According to the 2011 Monitoring the Future study, half of all adolescents have used illicit drugs by 12th grade, and 70% have tried alcohol. While national trends show an overall decline in adolescent substance use, the rates of new users of prescription opiates, which are perceived by most teens as less harmful and are readily available, are now comparable to the rates of new users of marijuana. The national Survey on Drug Use and Health reports that ages 14-17, the high school years, are still the highest risk time for starting the use of alcohol and drugs. The most commonly abused substances for teens are alcohol and marijuana, but in recent years, more youths initiated non-medical use of prescription drugs than started using marijuana.
Most adolescents engage in either experimental or social use; that is, using substances out of curiosity, or to be part of the crowd. However, research indicates that by age 18, about one in four adolescents will meet criteria for substance abuse, and one in 5 for substance dependence (see page 10 for a more detailed description of the differences between substance abuse and dependence).
Sometimes parents may minimize the behavior, particularly with alcohol or marijuana, or may rationalize that “All kids try it, so did I.” However, recent research suggests that alcohol has a significantly greater impact on learning and memory in adolescents than adults, but that adolescents experience less sedation and motor coordination effects so they may not accurately perceive their levels of impairment. The common adolescent pattern of binge drinking followed by withdrawal seems to carry a higher risk of long-term impairment on memory, cognitive functioning, and attention, which are essential for successful development to adulthood.
It can be difficult for parents to distinguish between experimental use and abuse. The best indicator is observing how much the substance use is affecting the teen’s life, including academic achievement, physical health, social activities, and choice of friends. A substance abuse evaluation, including drug testing, can help determine whether or not treatment is necessary. Many adolescents do not see their substance use as a problem; most teens enter treatment because of juvenile justice mandates.
Family therapy appears to be an important component of successful treatment for teens. However, in some cases families are not willing to participate, or family members may use substances themselves, and adolescents rarely have the options adults do to leave environments that put their recovery at risk. Teens also may feel uncomfortable at traditional 12-step programs due to age differences or difficulty speaking up in groups.
Youth who are in the process of discovering their identity may resist what they see as pressure to label themselves as alcoholics or addicts.
Co-Occurring Disorders in Adolescents
Data from the Substance Abuse and Mental Health Services Administration and the U.S. Department of Health and Human Services indicates that almost half of youths with a mental health diagnosis have a co-occurring Substance Use Disorder, while about 21% of youths admitted to substance abuse treatment have a co-occurring mental health disorder. The most common diagnosis is Conduct Disorder, followed by mood disorders. Research also supports an association between Post-Traumatic Stress and Substance Use Disorders, especially for girls.
“Internalizing” mental health disorders such as Anxiety or Depression seem somewhat more likely to precede substance abuse, while “externalizing” disorders, i.e., Conduct Disorder or Oppositional Defiant Disorder, may start simultaneously with substance use. Co-occurring disorders also seem to correlate with a higher risk of relapse within the first six months after treatment.
Just as with adults, adolescents may experience parallel or sequential rather than integrated treatment, shifting between the substance abuse and mental health service systems depending on which disorder is most acute at any given time.
Another challenge adolescents face in seeking appropriate help for co-occurring disorders stems from the limited research about appropriate psychiatric medications for adolescents and teens. Parents and adolescents must also find medications and treatment options that are tailored to meet the adolescent’s developmental needs. These adolescents often are involved with many other systems and need case management to reduce conflicts and promote effective cooperation.
It is important to know that the most expensive care is not necessarily the best. Private care is not necessarily better than the care offered through your local community health service program. In fact, care through the public sector may be necessary before certain community services are accessible.
Suggestions for seeking treatment:
- It is most important to understand it is neither your fault nor the fault of the person in crisis.
- Be informed as to what resources are available: Contact your local community mental health services program or NAMI Palm Beach County for referral information.
- Evaluate the situation:If you think there is danger to any person, call 9-1-1 or law enforcement. If a crisis occurs, but there appears to be no immediate risk, take the individual to a psychiatric emergency service or call the crisis intervention office, if available.
- If the need is not urgent;take time to talk with your relative. Do not make a diagnosis but stress that you care and are concerned and offer your help. Ask them how they feel about talking with a doctor or therapist. Be honest and direct. Use terms that you believe are most acceptable to them (e.g., unhappy, nervous, mixed up, worried). Respect their right to choose. Understand that they may need to deny what is happening at first, but by discussing it with them you have “opened the door,” and they may later be ready to talk and/or seek help.
- Understand their fears: Be patient and supportive. Accept that they may be more willing to talk with a trusted friend, doctor, clergy, or another family member.
- Always be honest:It is very important that trust exists if you are able to help your friend or relative. It will not help them to argue or deny that what they are seeing, hearing, and feeling is real. Assure them that you love them and understand that what they are experiencing is real to them and that you want to help. Do not hide your concern. Do not whisper.
- Share your concerns: You should always share your concerns with family members and try to get their cooperation. However, if their condition deteriorates, if you have serious concerns about their wellbeing, and you believe a crisis is imminent, you may need to pursue an involuntary order for treatment, also known in Florida as The Baker Act.
Keep in mind as you read this section that new and better medications are being tested and released every day. It is in both families’ and consumers’ best interest to keep up-to-date in this area. Read, explore, listen, and discuss with the appropriate physician. One of the best sources of information on medications, as well as other areas of treatment, is the national NAMI website, www.nami.org.
Psychotropic medications are often very useful in helping the person with mental illness to think more clearly and to gain control of his or her own thoughts, actions, and emotions. Medications also can dramatically decrease the need for hospitalization and increase the person’s ability to benefit from rehabilitation programs and to function independently. Any licensed physician, not just a psychiatrist, may prescribe medications. A psychiatrist, however, is more knowledgeable about these medications and should supervise ongoing drug therapy.
It is important to know the names of the prescription medications, their dosage, therapeutic benefits, and any side effects observed, and risks or precautions. Medications produce both beneficial effects and side effects.
People are highly variable in regard to how much benefit they will get from a drug and the type and severity of the side effects they will experience. While side effects may be evident soon after starting to take the medication, the desired effect may not be seen for several weeks. In fact, it may take months of continuous use before the maximum benefit is evident. Some side effects, especially those that appear early, are temporary and may go away or become less severe after a few weeks.
Resistance to taking prescribed medications is often due to unpleasant side effects. It is important that the prescribing physician discusses this with the patient and seeks the most effective and acceptable plan for treatment. The individual will be given an explanation and written summary of the most common side effects of medications which have been prescribed.
There are four main groups of drugs used to treat the symptoms of mental illness: mood stabilizers, antidepressants, anti-anxiety drugs and anti-psychotics.
- Mood Stabilizers:There are several medications used to reduce wide mood swings of persons, especially with Bipolar Disorder. Some of these medications require monitoring, so that symptoms can be controlled with the fewest side effects.
- Antidepressants:This group of medications is used to treat severe depression. Some common examples include:
- Anti-Anxiety Agents:A number of medications can be used to reduce anxiety, relax muscles, and calm the individual. They should generally be used only for short periods of time. Some are addictive and may produce severe reactions if used with alcohol.
- Anti-psychotics:These medications are most commonly used for treatment of the symptoms of psychosis, which include unusual or bizarre behavior, hallucinations, delusions, agitation, and disturbed thought processes. Some anti-psychotics are now used as mood stabilizers to lessen the mood swings that occur with Bipolar Disorder. They are sometimes used to calm the severely hyperactive behavior seen in the manic phase of Bipolar Disorder. They also can help prevent relapse and/or hospitalization.
Some of the more common anti-psychotic medications include:
- Mellaril (thioridazine)
- Moban (molindone)
- Navane (thiothixene)
- Prolixin (fluphenazine)
- Risperdal (risperidone)
- Serentil (mesoridazine)
- Seroquel (quetiapine)
- Stelazine (trifluoperazine)
- Thorazine (chlorpromazine)
- Trilafon (perphenazine)
- Zyprexa (olanzapine)
Some significant side effects of this group of drugs:
- Allergic Reactions
- Autonomic Reactions: dizziness, dry mouth, blurred vision, and difficulty with urinating and constipation
- Drowsiness, Extrapyramidal Reactions:movement problems, tremors
- Tardive Dyskinesia:involuntary movements
CAUTION: Optimal use of medications for the treatment of severe mental illnesses restores a quality of life to the individuals affected, as those medications are used in combination with support and behavior modification therapies.
The advice of a physician, particularly a psychiatrist, is advised so that optimal dosage can be achieved as quickly as possible as some of these medications may be addictive if used inappropriately. Please note that oral medications may produce serious reactions if used with alcohol.
It also is important to know that medications should be taken as prescribed by the doctor. Abruptly discontinuing certain medications can result in serious symptoms that can range from mild to life threatening.
In addition, the use of certain medications requires a doctor to order periodic lab work to measure the medication level in the bloodstream. Overall, communication with the physician should be a priority.
For a wealth of information on medications used to treat mental disorders, including a comprehensive list of medications, go to the National Institute of Mental Health website on medications: www.nimh.nih.gov/health/publications/mental-health-medications/complete-index
Medication PAPAs – Patient Assistance Programs
Pharmaceutical companies may offer free medications for needy patients. Pharmaceutical Research and Manufacturers of America (PhRMA) often provides free medications to physicians whose patients might not otherwise have access to the needed drug. PhRMA may be reached through its website, www.phrma.org or contact the Partnership for Prescription Assistance at 888-477-2669 or on-line at www.pparx.org/intro/php
RESOURCES FOR CARE
MENTAL HEALTH PROFESSIONALS
Any of the following may be involved in assessment and planning for treatment and care. Each has a specific task but also is part of the treatment team. Duties and responsibilities will vary.
Psychiatrists are physicians (MD or DO) with specific expertise in psychiatry. Psychiatrists typically have received four years of medical training, and then another four years of specialty training in psychiatry. They asses, make the diagnosis, and prescribe medications and possibly provide other treatment. They work with the treatment team to plan for care in the hospital after discharge. They may provide individual or group psychotherapy.
Clinical psychologists can be involved in administering diagnostic tests and formulating the diagnosis, and could have other responsibilities similar to those described for psychiatric nurses and social workers.
Advanced Registered Nurse Practitioners (ARNP) – ARNPs are nurses who have completed graduate study in psychiatric nursing. Under Florida law, ARNPs can make diagnoses and prescribe all medications (expect controlled substances) under the supervision of a licensed physician.
Psychiatric nurses have specific training in psychiatry. They generally have major responsibility for direct care in the hospital, day treatment programs or community mental health centers. They also can conduct individual or group counseling.
Social Workers, Counselors, and Therapists are licensed as Clinical Social Workers, Mental Health Counselors, and Marriage and Family Therapists. They work with the consumer, family, and the community in the context of the person’s total life situation.
Case Managers coordinate care and services in the community for the individual living with mental illness. They assist in obtaining housing, and linking the person to rehabilitation services and income programs such as SSI and SSDI. They generally work for community and mental health centers or an agency under contract with community mental health programs. The term ‘case manager’ sometimes is used interchangeably with social worker; although, education, experience, responsibilities and regulatory licensing are different.
COMMUNITY MENTAL HEALTH CENTERS (CMHCs)
Because serious mental illness is likely to require treatment over a long period of time, or an entire lifetime, most persons with such disorders will use the services of their local community mental health center. CMHCs may be involved in the initial assessment. The entry point for services may be by appointment with an intake worker, through crisis or psychiatric emergency services, through the commitment process, or by referral from a jail or homeless shelter.
Once a person is determined to be eligible for services, a case manager may be assigned to assist with linking the individual to such services as crisis intervention, income support, rehabilitation services, counseling services, and/or outreach. CMHCs also can offer residential and vocational services to eligible individuals. In addition, there may be a family education program to provide support and information to family members.
Payment for CMHCs is based on ability to pay. Most CMHCs are Medicaid providers. Many also are funded by the Florida Department of Children and Families through the managing entity—Southeast Florida Behavioral Health Network.
Inpatient Psychiatric Services
Individuals can receive inpatient treatment at either Crisis Stabilization Units (CSU) or at hospitals that have psychiatric units. A “receiving facility” means a facility, either private or public, has been designated by the Florida Department of Children and Families to receive individuals under emergency mental health conditions. The receiving facility renders psychiatric examinations and short-term psychiatric treatment and stabilization.
Crisis Stabilization Unit:A CSU is a publicly-supported mental health facility that provides brief intensive services for individuals experiencing an acute mental health crisis. The purpose of a CSU is to examine, stabilize, and redirect individuals to the most appropriate and least-restrictive treatment setting consistent with their needs.
Private Hospitals:Many private hospitals have psychiatric units and are also receiving facilities. Funding sources are different for public and private facilities. Some may take different forms of insurance, while others are able to serve individuals who do not have insurance.
Inpatient treatment is appropriate when someone is in a mental health crisis, specifically when that individual is dangerous to him/herself or others. If the individual is in crisis and it is an emergency situation, the family member should seek help. The facilities will assist in making sure the individual receives appropriate treatment from the appropriate facility.
The family can be a vital part of the treatment team if the individual wishes for them to be involved. For families who are able to maintain contact with their relative, the following are questions to consider and discuss with staff both during and after hospitalization:
- What is the diagnosis, and what does it mean? Has this been discussed with the individual?
- What are the symptoms associated with the diagnosis?
- What specific symptoms could be the most problematic? What do they indicate?
- How can these symptoms be monitored?
- What medications have been prescribed?
- What side effect(s) should be expected? Which, if any, warrant concern/caution?
- What is the treatment plan?
- Has the patient been educated individually or in a class setting about his/her illness, management of symptoms and the medications prescribed? Do you think the patient understood the explanation?
- How often will the patient be able to interact with the treatment team?
- What steps can be taken to assist the individual with following the plan for services after being discharged?
- What appropriate housing and services are available after discharge?
- What should be done if an emergency occurs after discharge?
Serious mental illness is usually a long-term condition; families should plan ahead even if they are fortunate enough to have to deal with only a few episodes. Families who have lived with mental illness for a long time often describe how carried away they were at the time of the first episode and how they sometimes imprudently committed themselves to expensive treatments in expectation of a cure.
Most individuals need an early medical diagnosis and effective treatment, a safe stable place to live, and a chance to develop or relearn social and vocational skills. Some of the best places to look for support and services, over a long period of time, are through the local and state NAMI organizations, local community health centers, and behavioral health clinics and centers. If services do not seem to be available, you may need to speak up. Contact advocacy groups, your local and state elected representatives, or even seek legal advice.
The ability of the person with a mental illness to learn about their diagnosis is important in progressing toward a productive and meaningful life. It also is valuable for the person and his/her family to take responsibility for identifying and managing the symptoms of the illness. An understanding of the mental illness, symptoms and treatment, social skills training, and problem solving should be a part of both inpatient and outpatient care. Programs like the NAMI Peer-to-Peer Education course, NAMI Connection Recovery Support Group, and drop-in centers can play an important role in recovery by providing a network of peer education and support.
COPING WITH A RELATIVE WHO HAS A MENTAL ILLNESS
Reactions of Families and Friends
When mental illness strikes, family members are often overwhelmed by feelings of bewilderment, guilt, and denial. Exhaustion from being on call 24 hours a day may be coupled with frustration and anger. This can be especially true when professionals are unable to accomplish what the family sees as basic assistance to help their relative regain a productive life.
It is “unloving” to feel resentment in response to the behavior of the relative with a mental illness. Realizing the person is ill does not always overcome the hurt, dismay and anger felt by those trying to help. He/she may rebuff attempts to help, and may be fearful or accusatory toward those trying to help. Understandably, families, friends, and coworkers have problems with these symptoms, yet a hostile reaction will almost certainly intensify or lengthen an episode.
It is natural and necessary to grieve for the person your loved one used to be, but strength and determination are needed to meet the coming challenges. Caring, supportive family members can play a vital role in helping their relative to regain the confidence and skills needed for rehabilitation.
Please keep in mind the following:
- Avoid placing blame and guilt. The family did not cause the illness. Self-blame and blame leveled by others are destructive. Focus instead on the future and on what can be done to develop supportive living arrangements that will enhance the possibility of rehabilitation and recovery for your family member or friend.
- Remember that other family members (siblings, grandparents) are affected too, and they probably are experiencing depression, denial, and guilt similar to your own feelings. Keep communication open by talking with them about their feelings and reactions.
- Both you and your relative/friend should learn all you can about the illness. Find out about benefits and support systems when things are going well; do not wait for a crisis.
- It is also important to address physical health problems as these exacerbate or become a considerable part of the mental health problem. The approach to care should be holistic.
Some suggestions for coping with problem behavior:
- Plan ahead for situations when acute symptoms may recur. Discuss this with the primary therapist or treatment team.
- Learn to recognize signs of relapse, such as withdrawal or changes in sleeping and eating habits. The individual may be able to identify early signs of relapse (and should be encouraged to do so). He/she may also be able to tell you what method has worked in the past to relieve stress and gain control of symptoms. A visit to a psychiatrist or other therapist could help prevent a full-blown relapse, particularly when the person needs an adjustment of medications.
- Anticipate troublesome situations. If a certain family member is having trouble coping with a relationship, consider not inviting him/her if the ill family member will be present.
- Do not agree with stopping medications because the condition is “cured” or because the medication “makes me feel sick.” Refer these decisions to the doctor who prescribed the medication.
- Set reasonable rules and limits and stick to them. It can help to ask the doctor or a counselor to help you do this.
- Do not suggest that a person in crisis “pull themselves together.” If possible, he/she would. Not being able to do this is part of the illness. Remember, the suffering and distress of the person with mental illness is even greater than your own.
- Do not expect and insist that all disturbing habits be corrected at once. Focus on what is being accomplished, not what is going wrong.
- At times, people with mental illness suffer from memory loss or inability to concentrate; just repeat the information in a nonjudgmental way.
- Do not support or be critical of delusional thinking. The person with mental illness needs to be able to depend on a person who is objective, aware of what is really happening and able to kindly work with the truth.
- Your family member could hallucinate—seeing, feelings, hearing, or otherwise perceiving things not perceived by others. Be honest. Accept his/her perceptions as his/her own. If asked, point out that you are not experiencing the hallucinations. A discussion of how to respond to hallucinations and to other symptoms is an important part of the family support and education sessions that are offered by NAMI Palm Beach County and at some community mental health agencies and other health settings.
Support & Advocacy Groups
NAMI Palm Beach County provides support programs for families and friends as well as for individuals who are living with a mental illness. Providing this assistance is part of the primary mission of NAMI PBC. It is important to share information about mental illness with others and to understand that serious long-term mental illness is not caused by something the individual has done. “We thought it was our fault,” is said too many times. Family members and friends, because of their lack of information, may not be able to provide the support that is needed.
Unless they have lived with a family member or friend who is mentally ill, it is difficult for most people, sometimes even physicians, to understand the everyday trials and concerns of the rest of the family. It is comforting to know that other people deal with almost exactly the same issues and understand. Sometimes they have suggestions and answers; at other times they can only say “Yes, I know,” and they do.
In support groups, information is shared about housing, sleeping, and eating problems, available social services, medications, missed expectations, the ill individual’s lack of friends and loneliness, grief and loss, and fear of taking vacations.
Many people drop in at support group meetings for a few months, get answers and support for the hard times, and then move on. Other people may move from support groups into committee work. Often people make lifelong friends. Many people say, “I want to help. I don’t want other people to go through what I went through.” Some work at making real changes by becoming advocates for better services and care. Our affiliate assists in all these ways.
THE BAKER ACT VOLUNTARY & INVOLUNTARY HOSPITALIZATIONS
Statutes governing the treatment of mental illness in Florida date back to 1874. In 1971, the Legislature enacted the Florida Mental Health Act, better known as the Baker Act, named for a State Representative from Miami. The Act has been amended many times since it was implemented, with extensive revisions made in 1996.
Some key definitions used in Baker Act hospitalization include:
Voluntary Admission:An adult can apply for voluntary admission if he/she is found to show evidence of mental illness, is competent to provide express and informed consent, and is suitable for treatment. A child must not only be willing to be admitted, but also must have his/her parent/guardian apply for the admission.
Mental Illness: Mental illness is defined as an impairment of the emotional processes that exercise conscious control of one’s actions or of the ability to perceive or understand reality. This impairment must substantially interfere with a person’s ability to meet the ordinary demands of living, regardless of etiology.
Express and Inform Consent:Consent that is voluntarily given in writing, by a competent person, after full disclosure to enable the person to make a knowing and willful decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion.
Incompetent to Consent to Treatment: A person whose judgment is so affected by the illness that he/she lacks the capacity to make a well-reasoned, willful, and knowing decision concerning medical or mental health treatment. A physician must evaluate any person admitted voluntarily within 24 hours after arrival at a receiving facility to confirm the person’s competence to provide express and informed consent for admission. If that individual is not competent, the person must either be discharged or involuntary placement must be initiated.
Persons on voluntary status who request discharge or who refuse or revoke consent to treatment must be discharged from the facility within 24 hours, unless the facility administrator files a petition with the circuit court for the patient’s involuntary placement.
INVOLUNTARY EXAMINATION AND TREATMENT
A person may be taken to a receiving facility for involuntary examination if there is a reason to believe that he/she is mentally ill and because of his/her mental illness:
- The person has refused voluntary examination or is unable to determine whether examination is necessary;
- Without care or treatment, the person is likely to suffer from neglect resulting in real and present threat of substantial harm that cannot be avoided through the help of others; and
- There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to self or others in the near future as evidenced by recent behavior.
An involuntary examination may be initiated by any one of the following means:
- A court may enter an order, based upon sworn testimony.
- A law enforcement officer, who has reason to believe the criteria is met.
- A physician, clinical psychologist, psychiatric nurse (ARNP), or clinical social worker, based on their examination of the person within the preceding 48 hours.
Regardless of the way the involuntary examination is initiated, law enforcement must take the person to the nearest receiving facility (or a centralized intake site) and the facility must accept (not necessarily admit) the person. If appropriate under state and federal law, the person may later be transferred to another facility.
Upon arrival at a receiving facility, a physician or clinical psychologist must examine a patient. The patient cannot be released by the receiving facility without the documented approval of a psychiatrist or clinical psychologist.
A person can be held in a receiving facility for involuntary examination for no longer than 72 hours. Within the 72 hour examination period, one of the following must take place:
- The individual must be released unless charged with a crime.
- The individual must be asked to give express and informed consent to voluntary placement.
- A petition for involuntary placement must be filed with the court by the facility administrator.
If a petition for involuntary placement is filed, a public defender will be appointed by the court to represent the person and a hearing will be scheduled within a few days. If the court finds that the person meets the criteria, he/she can be involuntarily hospitalized for a period of up to six months. However, facilities are required to discharge persons at any time they no longer meet the criteria for involuntary placement, unless the person has transferred to voluntary status.
INVOLUNTARY OUTPATIENT PLACEMENT
The 2004 Florida Legislature revised the Baker Act to add provisions for involuntary outpatient placement effective January 1, 2005. This allows court-ordered outpatient treatment for selected adults who have serious mental illness and meet the criteria established by the law.
A petition for involuntary outpatient placement can only be filed by administrators of community-based receiving facilities or state hospitals and only if the services proposed are currently available and funded for the person. The criteria that must be met by “clear and convincing evidence” include that the individual:
- Has a history of non-compliance with treatment and is unlikely to survive safely in the community without supervision, based on clinical determination;
- Has either at least twice within 36 months been involuntarily admitted to a receiving or treatment facility or received mental health services in a forensic or correctional facility; or engaged in one or more acts of serious violent behavior toward self or others, or attempted serious bodily harm, within the preceding 36 months;
- Is unlikely to voluntarily participate in the recommended treatment plan and has either refused voluntary placement or is unable to determine whether placement is necessary;
- In view of the person’s treatment history and current behavior, the individual is in need of involuntary outpatient placement in order to prevent a relapse or deterioration that would be likely to result in serious harm to self or others;
- Is likely the individual will benefit from involuntary outpatient placement; and
- All available less-restrictive alternatives that would offer an opportunity for improvement of his or her condition have been judged to be inappropriate or unavailable.
The person must meet all criteria and a service provider must agree to provide the services before the court can order the treatment. Court-ordered treatment can be for a period of up to six months, but the court can consider periods of continued treatment if all the criteria listed above are still met.
The Marchman Act provides individuals in need of substance abuse services with emergency services and temporary detention for substance abuse evaluation and treatment when required.
Marchman Act petitions that may be filed in Probate Court Records:
- An Ex Parte Petition for Involuntary Assessment and Stabilization or
- An Ex Parte Petition for Involuntary Treatment
A Petition for Involuntary Assessment and Stabilization may be filed:
When there is reason to believe that a person is substance abuse impaired and:
- Because of the impairment, he or she has lost the power of self-control with respect to substance use.
- The person’s judgment is impaired because of substance abuse and he/she is incapable of appreciating the need for, and is unable to make a rational decision in regards to, substance abuse services.
- He/she has either inflicted, attempted or threatened to inflict, or unless admitted, is likely to inflict, physical harm on himself/herself or another.
- The petition may only be filed by: The person’s spouse or guardian, any relative of the person, a director of a licensed service provider, a private practitioner, or any three adults who have personal knowledge of the person’s substance abuse impairment. In the case of a minor, only the parents, legal guardian/custodian or licensed service provider can file a petition.
Unlike the Baker Act, there is a filing fee required. Refer to the Schedule of Service Charges for current fees. The petitioner must also make arrangements for an available bed in a designated facility prior to submitting the petition for filing.
What happens after the petition is filed:
If the Court finds that the criteria have been met, an Order for Involuntary Assessment and Stabilization will be issued by the Court. The Court may set the case for a hearing, or the Sheriff may be ordered to transport the person to the designated facility.
The facility then has 5 days to do an assessment. After the assessment has been completed at the facility, the petitioner may file a Petition for Involuntary Treatment of Substance Abuse for the patient.
A hearing date is set for the determination of the need for treatment. The assessment results are subpoenaed as evidence for the hearing, and a summons to appear at the hearing is issued and served on the patient. At the hearing the court will hear all the evidence and determine if the Order for Involuntary Treatment for Substance Abuse is warranted.
SEEKING TREATMENT FOR SUBSTANCE USE DISORDERS
No single treatment is appropriate for all individuals. Types of treatment, as well as treatment goals, may vary from one person to another, and may even vary for the same person, depending on their stage of recovery. Substance abuse treatment programs generally incorporate the following goals (Schuckit, 1994; American Psychiatric Association, 1995):
- Reducing substance abuse and its effects or achieving a substance-free life
- Maximizing multiple aspects of life functioning
- Preventing or reducing the frequency and severity of relapse
People who have both Substance Use Disorders and mental illness should receive treatment that addresses both issues. These individuals are said to have a co-occurring disorder, and treatment of their Substance Use Disorder and mental illness should be carried out in an integrated way.
For many people, the primary goal of treatment is attainment and maintenance of sobriety, but this could take numerous attempts and individuals often experience relapses before achieving a long-term substance-free life. Treatment programs usually try to minimize the effects of continuing use and abuse through education, counseling, and self-help groups.
These programs stress reducing risky behavior through building new relationships with drug-free friends, changing recreational activities and lifestyle patterns, and reducing the amount and frequency of consumption (American Psychiatric Association, 1995).
The initial stage of treatment is often detoxification. This process involves an evaluation, stabilization, and a fostering of readiness for the person to participate in a substance abuse treatment program. Detoxification in a medical setting with 24-hour supervision is recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA) for people addicted to alcohol, sedatives, or hypnotics, and opiates. Withdrawal from these substances can often create medical complications for the individual that would require this type of monitoring.
Becoming alcohol or drug free, however, is only a beginning. Most people in substance abuse treatment have multiple, complex problems in many aspects of living. These may include medical and mental illnesses, disrupted relationships, underdeveloped or deteriorated social and vocational skills, impaired performance at work or in school, and legal or financial troubles. These conditions may have contributed to the initial development of a substance use problem or could have resulted from the disorder.
Efforts should be made by treatment programs to assist individuals in mending these problems so that they can achieve more responsibility in society and a greater satisfaction with life. This entails maximizing physical health, treating psychiatric disorders, improving psychological functioning, addressing marital or other family and relationship issues, resolving financial and legal problems, and improving or developing necessary educational and vocational skills. Many programs also help participants explore spiritual issues and find appropriate recreational activities.
Increasingly, treatment programs also are preparing persons for the possibility of relapse and helping them understand and avoid dangerous “triggers” that can lead to drinking or drug use. Persons are taught how to recognize cues, how to handle cravings, how to develop contingency plans for handling stressful situations, and what to do if there is a “slip.”
FAMILY INTERACTION WITH LAW ENFORCEMENT
Calling 9-1-1 is an extremely stressful decision. It is by definition an emergency. Not only do you have concern for the person about whom you are making the call, but you also want to make sure that law enforcement has enough information so that they will be able to respond effectively and safely.
Try to control the volume of your voice. When you shout over the phone, it is difficult for the 9-1-1 operator to understand what you are saying. Certainly this is a very emotionally charged time, but if the operator can only hear shouting, the information is not efficiently received. As calmly and clearly as possible, tell the operator the following if the information is available:
- Your name
- Your address
- The name of the person in crisis
- Your relationship to the person
- That the person has a mental illness
- Name of the diagnosis (Schizophrenia, Depression, etc.)
- Any medication being used
- Has medication use stopped? If so, for how long?
- Describe what the person is doing now
- Do you feel threatened?
- Is there a history of violent acting out?
- Does the person hear voices?
- Does the person fear someone?
- Are there any weapons in the house? If so, try to safely remove them before calling 9-1-1
- Where the person is within the house
- Request a CIT deputy/officer
WHEN LAW ENFORCEMENT ARRIVES
Have all the lights in the house turned on, so that all occupants can be clearly visible to the arriving officers. You can assist the officer who responds to the emergency call to establish his/her own ‘comfort zone’ by providing as much information as possible. This will allow the officer to know that you are not a threat, and also to know who the person in crisis is and whether or not the person in crisis is currently in an agitated state.
As calmly as possible, identify yourself and tell the officer as much information as you can including:
- Who you are
- Who you have called about
- What your relationship is to the person
- That the person has a mental illness
- What kind of mental illness it is
- What medication is being taken
- Has medication use stopped? If so, for how long?
- Whether or not the person is violent or delusional (paranoid)
- Any history of suicide attempt
- An attending psychiatrist’s and/or case manager’s names and telephone numbers
Officers responding to a 9-1-1 emergency call are very focusedwhen they arrive on the scene. First, they will make the scene safe for you, the person, and themselves. The more informed and at ease the officers are, the less likely someone will get injured or the situation will worsen.
Spend the time that is necessary answering all of the officer’s questions. Answer directly and concisely. Do not ramble, but offer any advice you deem helpful. After this is done, they officers will usually be better equipped to deal with the situation. Although it is difficult in times of crisis, being patient is essential.
If the individual with mental illness is in danger of physical injury, if his/her behavior is out of control, or if other persons are in danger, it is important to know what steps to take. Plan ahead by locating available sources for help and be sure to gather the following phone numbers to have handy in the event of a crisis: the local police or sheriff’s department (always request a CIT officer), name of a mental health professional, community mental health center mobile crisis units, friends or neighbors who may be of help, the NAMI Palm Beach County Help Line telephone number, and 2-1-1.
If you sense deterioration in your relative or friend’s mental condition, try to find out what is going on. Everyone occasionally has a bad day. However, there are usually early warning signs that signal problems, such as changes in sleep or social activities or increased hostility or suspiciousness. Encourage the individual to see a psychiatrist or social worker. The goal is to avert a crisis!
If you should have to call for help in a crisis, have information available about the family member or friend’s diagnosis, medications, previous hospitalization(s), and a description of the specific behavior that precipitated the crisis. It may be useful to have several copies of such information to give to the police and to mental health professionals.
However, if the individual needs crisis intervention, you might need to contact a CIT officer. The Crisis Intervention Team (CIT) Program is composed of specially trained uniform patrol officers who respond to calls related to a person having a mental health crisis. Officers can face challenges from or about persons attempting suicide, threatening harm to others, or displaying other dangerous symptoms or behavior.
Throughout the state, thousands of law enforcement officers have been trained in the nationally acclaimed 40-hour CIT course. The faculty, who are all professionals, family members, or consumers from the local mental health community, volunteer their time and talents to provide the most up-to-date information to law enforcement officers regarding mental illnesses, medications, de-escalation techniques, Baker Act authority, and unusual behaviors such as suicide, homicide, and aggressiveness. The course includes several hours spent in discussion with persons with mental illness who share their past interactions with the law.
CIT was originated by the Memphis, Tennessee, Police Department. CIT trained officers are capable and willing to routinely and repetitively handle this type of non-criminal call for service in addition to their normal patrol duties. Repeated opportunities to develop techniques and gain knowledge of the mental health system are of paramount importance for successful and safe interventions.
Dispatching CIT trained officers on calls involving persons having a crisis due to a mental disorder demonstrates CIT’s value to the community through the saving of lives, time, and money.
The Memphis model CIT programs now are in place in cities across America, as well as in other countries. To continue program development, an International CIT organization, CITI, was created. Its primary purpose is to facilitate understanding, development and implementation of Crisis Intervention Team (CIT) programs throughout the United States and other nations worldwide. CITI promotes and supports collaborative efforts to create and sustain more effective interactions among law enforcement, mental health care providers, individuals with mental illness, and their families and communities; CITI also works diligently to reduce the stigma of mental illness.
CIT International works to accomplish this purpose by raising public and stakeholder awareness through education and outreach, establishing and disseminating recommended standards for developing, implanting and sustaining crisis intervention programs, providing assistance to communities interested in developing CIT programs, supporting research, improving public health and safety, evaluation of CIT programs and partnering with CIT programs in various localities to hold annual International CIT Conferences.
Jail and Jail Diversion
According to the Surgeon General, the criminalization of mental illness is the silent epidemic of our times. One attorney stated that our jail and prison system is perhaps the greatest danger facing persons with mental illness today.
The number of inmates with a mental illness in Florida prisons and the number of individuals with a mental illness incarcerated in county jails has grown at an alarming rate since the mid 1980’s. Placing individuals who have had a public crisis with a mental illness in jail, or sending them to a prison, creates a vicious cycle as they are generally not able to receive all of the care and support they need to manage their mental illnesses. When released, they tend to recycle back into the jail/prison system.
Early treatment, early diagnosis and early intervention when symptoms escalate, may well succeed in avoiding incarceration. When this is not possible, NAMI members have worked with state and local law enforcement agencies and community health centers to make it possible to treat rather than punish persons who are mentally ill, by diverting them from jails and courts into residential treatment programs. This is true for both adults and adolescents who find themselves in the juvenile justice system.
Individuals living with mental illness who are facing legal problems should seek legal assistance. If they cannot afford a private attorney, Florida Legal Aid Service or the local State of Florida Public Defenders Office, mental health advocates, and others should be able to help.
The attorney representing the individual should look into releasing the person on bond as quickly as possible to allow him/her to get into treatment before the situation worsens. In cases where this may not be possible, the attorney should make an appropriate motion to ensure that proper psychiatric treatment and support are available while either release or trial is pending.
It is also helpful to find an attorney who has some understanding of brain disorders, the legal defenses available, and their impact on the individual who is charged. If the offense is of a minor nature, a skilled attorney may be able to arrange for a transfer to a psychiatric facility for treatment in exchange for delaying the criminal case with ultimate dismissal of the charges. Compliance with the recommended treatment may be ordered by the court as a condition of probation or even an alternative to trial or a substitute for serving time in jail.
It is not unusual that contact with the criminal justice system may provide the first opportunity to identify mental illness and connect the individual with community mental health centers. While it may not always be possible to avoid the original incident and incarceration, it should be the goal of the family, the person with mental illness, and the mental health system to eliminate future incidents.
FLORIDA ASSERTIVE COMMUNTIY TREATMENT (FACT)
FACT is a program supported by public funding that reduces hospitalization, homelessness, and criminal incarceration. Services are delivered to help those with the most chronic and persistent mental illnesses (Schizophrenia, Bipolar Disorder, and other illnesses that cause pronounced disability) to live in the community. The program is an official, funded program in Florida and was approved by the 1999 Florida Legislature.
FACT is an effective, evidence-based, outreach oriented, service-delivery model for people with severe and persistent mental illnesses. Using a 24-hour-a-day, seven-day-a-week, team approach, FACT delivers comprehensive community treatment, rehabilitation and support services to its clients in their homes, at work, or in the community. FACT teams are coordinated combinations of psychiatrists, nurses, social workers, substance abuse treatment specialists, vocational rehabilitation counselors, and peer counselors. The majority of FACT services are delivered where clients live, work, and spend their leisure time—not in the program office.
The team uses a positive, persistent, practical approach offering: (1) direct provision of psychiatric care and assistance with general health care; (2) help on managing symptoms of the illness; (3) immediate crisis response; (4) the most effective and appropriate anti-psychotic and anti-depressant medications; and (5) supportive therapy. FACT team members provide practical on-site support in coping with life’s day-to-day demands including: help obtaining financial supports and housing, assistance with housing tasks so a person can live in regular housing alone or with a roommate, help with socializing, treatment for clients with co-existing Substance Use Disorder, supportive employment services and job placement, assistance with legal issues, and support, education, and skill-teaching for families.
FACT – Comprehensive Care
Unlike traditional community services, FACT teams: (1) have one staff member for every ten clients (a team consisting of 10 can serve up to 100 clients) plus at least 16 hours a week of a psychiatrist’s time for every 50 clients; (2) treat both psychiatric and Substance Use Disorders at the same time; (3) take services to the clients rather than requiring clients to come to the office; (4) provide team case management and include the individual as a member of the team, which aids in continuity of care in case a staff member leaves; (5) help clients who have children to strengthen their parenting skills; (6) coordinate provisions of psychiatric care with general medical care and dental care; (7) continue to see a client who is in a hospital or jail, which often facilitates an earlier return to the community; (8) employ a psychiatrist who is a full team member, who is not a consultant to the team, who is able to participate and teach staff how to carry out treatment; and (9) lessen the family’s burden of providing and coordinating care so a FACT client and his/her family can relate more easily as family members.
FACT is Rehabilitation & Recovery Oriented
FACT helps clients regain control of their lives and move ahead with their plans. The FACT approach helps people live in regular housing, socialize in their community, and return to school or work. FACT’s attention to basic needs (housing, medical care, income) enables persons with mental illness – even those with severe disabilities – to regain stability, asses their goals, and take steps toward recovery. The relatively low cost of FACT care is an added benefit of the program. In many communities, the cost is less than the cost for inappropriately placing a person with mental illness in jail or for confinement in a state hospital.
The FACT program successfully treats and rehabilitates people who do not keep office appointments, people who have co-occurring psychiatric and Substance Use Disorder, people with severe and persistent mental illness, people with socially disruptive behavior who are at high risk for arrest and incarceration, people who are high users of emergency and inpatient hospital services, people who cannot meet their own basic needs and are living in substandard housing situations or who are homeless, and people who are at risk of placement in state hospitals.
Obtaining independent housing with access to services within the community is the primary goal and a fundamental value shared by people with mental illnesses. Having one’s own home – whether it is an apartment, a furnished room or a house – is the cornerstone of independence for people. With stable, permanent housing, people with mental illnesses are able to achieve other important life goals including improved health, education, job training, and employment. However, access to affordable housing that also is convenient to services for people with mental illnesses is becoming increasingly difficult.
Public mental health agencies and the mental health community in general may be able to assist in gaining access to housing that may include the following:
Residential Treatment Facilities: These homes are generally associated with the Community Health Centers in some way and offer group activities as well as rehabilitative services. They are generally considered transitional and are often reserved for individuals being discharged from state hospitals or community hospitals that are under contract with the Florida Department of Children and Families.
Assisted Living Facility (ALF): These homes are licensed by the Agency for Health Care Administration (AHCA) to provide 24-hour care and supervision of residents. Activities and rehabilitation services are limited in these housing settings.
Support Housing/Supported Living: These services assist persons with substance abuse and psychiatric disabilities develop the skills needed to transition into independent living.
Independent Living Alone/With Family: This arrangement works for persons who are fairly self-sufficient. Local agencies can be helpful with housing arrangements or in securing the assistance needed for independent living.
Nursing Homes: These facilities are designed for people who need continuous care 24 hours a day. Generally, there are other medical problems in addition to the mental illness in order to qualify, or the diagnosis is a form of dementia.
Adult Foster Care Homes and Caregivers: Caregivers in the foster care homes are responsible for the care, support, and well-being of the clients who live in the home. Adults placed in these homes are encouraged to feel like a member of the family, participating in family activities and responsibilities.
The Alternative Family Program (AFP): a residential program that provides care within licensed and certified homes for adults and seniors with severe and persistent mental illness. AFP Homes are licensed as Adult Foster Care Homes.
Other transitional, temporary, and permanent housing options could become available when funding is identified to support additional options.
Psychological rehabilitation should include the following: recreational activities, social skills training, employment related training and assistance, and assistance toward independent living. Limited rehabilitation services are available through some community mental health centers as well as private facilities. Assistance with education, training, and employment also is available through the State of Florida Department of Labor & Employment Security, Division of Vocational Rehabilitation.
The Americans with Disabilities Act (ADA) passed by Congress in 1990, is an important federal law which prohibits discrimination against any person with a disability. It also covers individuals who have a history of disability or who are regarded by others as impaired, even if they are not. This would include, for example, people who have had psychiatric treatment in the past but who are now fully recovered.
The ADA covers employment, public (government) services, and public accommodations. Employers cannot discriminate against an individual with a disability, including mental illness, if the person is otherwise qualified, by skills and background for the job. The employer also must provide “reasonable accommodations” that will allow an otherwise qualified person to perform the essential duties of the job. For more information on the ADA, contact:
US Department of Justice
950 Pennsylvania Avenue, NW
Civil Rights Division
Disability Rights Section – NYA
Washington, D.C. 20530
(From the Surgeon General’s Report for Mental Health)
Overview of Cultural Diversity & Mental Health Services
Racial and ethnic minority groups are generally considered to be under-served by the mental health service system. A constellation of barriers deters ethnic and racial minority group members from seeking treatment, and if the individual members of groups succeed in accessing services, their treatment could fail to meet their needs.
Research documents that many members of minority groups fear, or feel ill at ease with, the mental health system. Research and clinical practices have propelled advocates and mental health professionals to press for “linguistically and culturally competent services” to improve utilization and effectiveness of treatment for different cultures.
Introduction to Cultural Diversity and Demographics
Racial and ethnic populations differ from one another as well as from the collective societywith respect to culture. The term “culture” is used loosely to denote a common heritage and set of beliefs, norms, and values.
The historical experiences of ethnic and minority groups in the United States are reflected in differences in economic, social, and political status. The most measurable difference relates to income. Many racial and ethnic minority groups have limited financial resources. In 1994, families from these groups were at least three times as likely as white families to have incomes placing them below the federally established poverty line.
Cultural identity imparts distinct patterns of belief and practices that have implications for the willingness to seek, and the ability to respond to mental health services. These include coping styles and ties to family and community.
Cultural differences can be reflected in preferred styles of coping with day-to-day problems. Consistent with a cultural emphasis on restraint, Asian American groups encourage a tendency not to dwell on morbid or upsetting thought. They have little willingness to behave in a fashion that might disrupt social harmony. Their emphasis on willpower is similar to tendency documented among African Americans to minimize the significance of stress and to try to prevail in the face of adversity through increased striving.
Culturally rooted traditions of religious beliefs and practices carry important significance for willingness to seek professional mental health services. African Americans and a number of other ethnic groups, when faced with personal difficulties, have been shown to seek guidance from religious figures.
Many people of all racial and ethnic backgrounds believe that religion and spirituality favorably impact their lives and that well-being, good health, and religious commitment or faith are integrally intertwined.
Culture also impacts mental health by influencing whether and how individuals experience discomfort associated with mental illness. When conveyed by tradition and sanctioned by cultural norms, characteristic modes of expressing suffering are sometimes called “idioms of distress.” Idioms of distress often reflect values and themes found in the societies in which they originate.
One of the most common idioms of distress is somatization, the expression of mental distress in terms of physical suffering. Somatization is prevalent among persons from a number of ethnic minority backgrounds. Epidemiological studies have confirmed that there are relatively high rates of somatization among African Americans.
A culture-bound syndrome found among some Latino psychiatric patients is ‘ataque de envious,’ a syndrome of “uncontrollable shouting, crying, trembling, and aggressions” typically triggered by a stressful event involving family. A Japanese culture-bound syndrome, ‘Taihin kyofusho,’ is an intense fear that one’s body or bodily functions give offense to others. Culture-bound syndromes sometimes reflect comprehensive systems of belief, typically emphasizing a need for balance between opposing forces or the power of supernatural forces. Belief in indigenous disorders and adherence to culturally rooted coping practices are more common among older adults and among persons who are less acculturated.
Family & Community as Resources
Ties to family and community, especially strong in African, Latino, Asian, and Native American communities, are forged by cultural tradition and by the current and historical need to assist arriving immigrants, to provide a sanctuary against discrimination practiced by the larger society, and to provide a sense of belonging and affirming a central help-culture or ethnic identity. Family solidarity has been invoked to explain relatively low rates among minority groups of placing older people in nursing homes. Families play an important role in providing support to individuals with mental health problems. A strong sense of family loyalty means that, despite feelings of stigma and shame, families are an early and important source of assistance in efforts to cope, and that minority families may expect to continue to be involved in the treatment of a mentally ill member. Investigators have demonstrated an association between family warmth and a reduced likelihood of relapse.
BARRIERS TO THE RECEIPT OF TREATMENT
The under-representation in outpatient treatment of racial and ethnic minority groups appears to be the result of cultural differences as well as financial organizational and diagnostic factors. The service system has not been designed to respond to the cultural and linguistic needs presented by many racial and ethnic minorities.
Among adults, the evidence is considerable that persons from minority backgrounds are less likely than whites to seek outpatient treatment in the specialty mental health sector. This is not the case for emergency department care, from which African Americans are more likely than whites to seek care for mental health problems. Language, like economic and accessibility differences, can play an important role in why people from other cultures do not seek treatment.
All individuals, those with or without any type of mental or physical illness, are advised to prepare Advance Directives for care and decision making should they become unable to make decisions for themselves at some point. There are many components to Advanced Directives. One of which is the appointment of a healthcare surrogate, which is a person who can make healthcare decisions if an individual is unconscious or otherwise deemed incapable of making healthcare decisions.
Once a physician or the courts decide that a person cannot make well-reasoned and knowledgeable decisions the healthcare surrogate named in the Advance Directive is immediately notified to make treatment decisions the person would make if competent. The surrogate can access the person’s clinical record, release information, and apply for public benefits.
There are other legal and personal ramifications to the development of effective Advance Directives, and families and individuals are advised to contact their legal resource or Legal Aid Services for more information. It is also important to know that Advance Directives and the designation of a healthcare surrogate can be rescinded at any time. They are not permanent decisions.
If there is a concern that an individual with mental illness may become too incapacitated to make reasonable decisions concerning medical treatment, finances, and their care in general, the individual’s support person should consider requesting that the individual sign a health care surrogate form.
Guardianship also could be appropriate in some cases. This is a court-appointed responsibility that is awarded to an individual after the person with a mental illness becomes incompetent. The court would then assign responsibility to a family member or a professional guardian.
The courts have significant powers in the case of a person with mental illness becoming incapacitated which includes the authority to withdraw the rights to vote, marry, travel, contract, determine residence, have a driver’s license, sue and defend lawsuits, seek or retain employment, consent to medical treatment, personally apply for government benefits, make decisions about social environment or social aspects of life, and/or manage property and income or make any gift or disposition of property. The Guardian must file an annual accounting of finances.
Durable Power of Attorney
An attorney can draw up a Durable Power of Attorney, which may include the right of the designated agent to handle financial matters, give medical consent, or provide other assistance in the event of incapacity. It is important to recognize that while the agent is legally responsible for judiciously handling matters, there is no required accounting of funds or manner of care.
FEDERAL AND STATE PROGRAMS SSI, SSDI, MEDICAID, MEDICARE
Often a family will support an adult child who is mentally ill for a long period of time. Sometimes this requires the use of precious savings, which may not be necessary. Many do not realize that mental illness qualifies as a disability and that the disabled individual may be eligible for income and healthcare assistance.
There are two federal disability programs: SSI (Supplemental Security Income) and SSDI (Social Security Disability Income). The SSDI program is designated for people living with a disability. An application can be made at any local Social Security office. For information or an appointment at the local Social Security office, call 1-800-772-1213. Information you may need when contacting the Social Security office might be on the individual’s birth certificate or other proof of age, citizenship, information about the home where he or she lives, work history, any sources of financial support, and dates of any military service. You may also need the names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions where treatment has been received (with dates of treatment). Requirements of the department change and some information may no longer be needed.
The amount paid under SSI and SSDI varies, and some individuals are eligible for both sources of funding. Those who live independently may receive a larger amount than those who are supported at a relative’s home. To be eligible for SSI based on disability, a person must have a physical or mental impairment. In the case of a child, the impairment must prevent the child from performing normal activities of daily living. In the case of an adult, the disability would prevent the adult from doing any substantial gainful work. The disability of either a child or adult is expected to last at least a year or to result in death. In both cases of the adult or child, the individual or family has little or no income or resources. To be eligible for SSDI the person must have worked and paid Social Security, or be an unmarried son or daughter (with rare exception) who became disabled before age 22, who has a parent eligible for retirement/disability/death benefits. The disabled child does not have to be dependent or financially supported by the parent. The recipient also must have a physical or mental impairment that prevents the person from doing any substantial gainful work that has lasted or is expected to last for at least one year.
APPLICATION FOR SSI AND SSI FUNDING
Benefits are retroactive only to the date of application, so it is important to apply as early as possible and plan a persistent follow up. The application process can be expedited if medical records are obtained in advance. This includes records from hospitalizations, physicians, case managers, and other providers. An individual can be assisted in this process if he/she signs a release to allow a family member or authorized representative to assist. Applications should include a listing of all physical and mental conditions that may be considered as disabilities. The Social Security Administration has to consider multiple disabilities when assessing eligibility for benefits.
If benefits are denied, the ruling may be appealed by requesting: (1) reconsideration, (2) a hearing before an administrative law judge, (3) a review of the decision by the appeals councils, or (4) civil action in a federal district court. There is a 60-day appeal time period between each of these steps. The National Organization of Social Security Claimants helps individuals find representatives to handle SSA Appeals at 1-800-431-2804. The Departments of Legal Aid around the state handle SSA appeals and waiver requests usually without cost, when the case is ready to go for the third appeal in front of an administrative law judge.
Many consumers and their families find it a difficult task to obtain the required papers and information and work their way through the application and review process. There are attorneys who specifically handle these types of cases. While waiting on a decision on eligibility for SSI or SSDI, a disabled person may qualify for State Disability Assistance (SDA), food stamps, or assistance with emergency food and shelter through the Department of Social Services (DSS).
Importantly, when an individual applies for SSI or SSDI, he/she can request that SSA assess them for Presumptive Disability (PD). This will give an individual the opportunity to receive SSI and Medicaid for three months while Social Security is processing their claim for benefits. PD should be requested in writing and usually can be considered if it is obvious that an individual is too disabled to work for longer than a year. If an individual is not found eligible, repayment is not required. The Disability Determinations staff is required to make an eligibility decision usually within 90-days.
It may be desirable to have a representative designated to receive payments if the individual with mental illness is unable to manage his or her funds. This representative may be a relative or an agency or some other designated individual. Family should consider designating someone outside of the family to handle funds so that they can concentrate on support and care.
There is provision for SSI and SSDI payments to continue for a limited time while the individual is in a hospital or institution. This is designed to help the person maintain existing housing arrangements during a short period of hospitalization. Applications for this benefit must be made to the Social Security office. Under many circumstances, Medicaid is available for those who qualify for SSI. In Florida, Medicaid application can be made at any district office of the Department of Children and Family Services.
Conservatorship is the designation by the Probate Court of a person to manage substantial income or property for another person. However, if the only income is from SSI or SSDI, conservatorship is not necessary. In this case, a parent or other person can be appointed representative payee by the Social Security office to handle financial matters.
WILLS, TRUSTS, AND ESTATE PLANNING
If an individual with mental illness qualifies for SSI benefits, it is very important for the family to plan ahead so that SSI payment and Medicaid will not be lost through inadequate estate planning. By inheriting property or money, the individual may be disqualified for the entitlements, which cover the cost of residential services and medical care. Some families have drawn up a will, which disqualifies the relative who is mentally ill. Others have set up a Special Needs Trust with another relative as trustee, or with a financial institution and another relative as co-trustee. The Special Needs Trust must be restricted so that it cannot be used for basic living costs; a lawyer who specializes in this work should be consulted.
Supplemental Needs Trust – Many parents are not aware that special planning tools are available to protect assets for disabled family members. A Supplemental Needs Trust is a special trust designed to provide funds for a disabled individual’s needs without putting public benefits at risk. Parents or other family members can establish these trusts during life or through various estate plans.
Supplemental Needs Trusts are used to shelter funds for the benefit of the disabled person. These funds are typically the result of an inheritance or personal injury award. Funds are available for anything not provided by public benefits. Within a properly drafted trust, the funds are not considered in determining eligibility for public benefits.
Proper estate planning includes not only planning for others after a caregiver’s death, but also planning for the caregiver during his or her lifetime. The family must plan for the possibility that the caregiver(s) could become disabled as they age. There are many ways to make certain that the estate is preserved for the disabled child while still meeting the needs of the caregiver during their lifetime. Consult an attorney who specializes in these issues as laws can change.
Medicare is operated as a joint venture between federal and state governments. Medicare has three parts: Part A – Hospital Insurance, which helps pay for inpatient care in a hospital and skilled nursing facilities, home health care and hospice care; Part B – Medical Insurance, which helps pay for doctor’s services, out-patient hospital care and many other medical services and supplies; Part D, which pays for drugs. Medicare covers a number of health care needs, some of which require co-pays. For a detailed explanation of Medicare services available and on how to apply, go to Medicare’s website at www.medicare.gov or the Centers for Medicare and Medicaid Services (CMS) at www.cms.hhs.gov. You may also call 1-800-Medicare (800-663-4237).
There is a monthly premium for Medicare services and other out-of-pocket costs. When services are delivered, a deductible or co-pay may apply. If someone cannot afford to pay the Medicare premiums and other costs, he or she may also get help from the state through an assistance program. Assistance programs are for people who are entitled to Medicare and who have very low income.
Medicaid, a program funded with federal and state dollars, helps people who cannot afford medical care, such as people who have a low income and have limited savings accounts and other assets. It is for people of any age. It usually covers the full cost of health care in some cases; however, some patients may have to share a part of the cost. If someone qualifies for Medicare, he or she also could be qualified for Medicaid, depending upon income and other related factors. The federal government sets general guidelines for Medicaid; but each state legislature decides the following:
- Who qualifies for Medicaid
- What services will be covered
- How much to pay for the services
- How to run the Medicaid program
In Florida, eligibility is determined by the Florida Department of Children and Families and the Medicaid program is run by the Agency for Healthcare Administration (AHCA).
The Future of Florida’s Medicaid program is unclear. For up-to-date information contact The Centers for Medicare and Medicaid Services at ww.cms.gov. The following is a short list of services that may be covered differently in different parts of Florida depending on the Medicaid program operating in the area
- Community mental health services
- Prescription drugs
- Vision exams and glasses
- Hearing exams and hearing aids
- Dental service
- Home and community based services including AIDS services and assisted living for the elderly and disabled
- Health screenings for adults 21 and older
- Hospice services
- Care in intermediate care facilities for people with developmental disabilities
- Durable medical equipment and supplies including ambulatory equipment (canes, crutches, walkers, etc.)
- Physical, occupational, respiratory, and speech therapy
- Ambulance and other transportation services
- Special child health services
- Under Medicaid Reform, the state has also authorized other services at the Managed Care Organization’s discretion
There are several options available to individuals who are living with a disability and are able to and desire to work. Assistance with education, training, and employment may be found by contacting Florida’s Division of Vocational Rehabilitation at 866-515-3692. Other programs available include the following:
Ticket to Work – Persons who are current beneficiaries of Social Security could be eligible to participate in the Social Security Administration’s Ticket to Work program. The “Ticket” is a voucher that can be used to obtain employment-related supports and services from approved service providers known as Employment Networks. Tickets also can be placed with the Division of Vocational Rehabilitation. Participation in the Ticket program is voluntary for both the Social Security beneficiary and the Employment Network.
PASS Program – The Plan to Achieve Self Support (PASS) is an SSI program to help individuals with disabilities return to work. PASS lets disabled individuals set aside money and/or assets he/she owns to pay for items or services needed to achieve a specific work goal.
This could be a number of things and can include items such as supplies to start a business, school expenses, transportation, uniform requests, and training. In order to participate in the PASS program, an individual needs to contact the local SSA office and obtain a PASS form (SSA-545-BK). Additional information can be obtained by contacting the Social Security office – 800-772-1213 or visiting their website at www.socialsecurity.gov.
Other Employment Assistance – As time goes on, there could be other resources available to assist individuals with mental illness in obtaining employment. Organizations such as Clubhouses, Abilities, Inc., and college/university placement offices, as well as many employers at local companies, now offer to assist persons with disabilities in finding meaningful work.
WORKING WITHIN THE SYSTEM
TIPS ON GETTING THE HELP YOU NEED
Individuals living with a mental illness, their family members, and friends need to know how to be effective in getting help when someone is seriously mentally ill. The following suggestions will help:
- Keep your records updated and current. List names, addresses, phone numbers, dates of crisis events, admissions and discharge dates of hospitalization(s). Make notes of conversations and conferences. Make copies of everything that is mailed. Keep all notices and letters and keep all of these items in an easily accessible file folder.
- If acting on behalf of an individual with a mental illness, keep that person informed about everything you plan to do and obtain approval when appropriate.
- Be patient, polite, and keep conversations to the point.
- Do not accept any attempts to be intimidated and do not intimidate the professionals and caregivers.
- Do not accept vague answers or statements that seem confusing. For example, if a clinician says, “We are observing your daughter carefully,” realize that this statement provides no information of substance.
- Write letters of appreciation when warranted. Write letters of constructive criticism only when necessary. Address communications to the decision maker in an organization and consider sending copies to your legislators or other State officials.
- Learn communication techniques in getting information. For example, instead of saying “Who should I call now?” say “If this was your son, what would you do next?” General questions can always be asked, such as “What is the average length of stay for this type of condition?” or “How have you helped others in this type of situation?” The vast majority of professionals want to help, but are limited on being able to specifically give detailed advice.
- Do not be afraid or ashamed to acknowledge that you are the relative of a person who has a mental illness.
- Finally, be assertive! You are paying either directly or with your taxes for mental health services. You are entitled to information, respect, and courtesy and are not asking for favors. You are simply helping to get the job done.
SERVICES FOR VETERANS
Since 2001, the United States has deployed more than 1.5 million soldiers to fight the war. Upon returning home, 25% of these combat veterans have sought help for mental illness and have been diagnosed with Post-Traumatic Stress Disorder (PTSD). Half of these men and women had two or more distinct mental health diagnoses. The youngest group of these veterans (ages 18-24 years old) were at greatest risk for receiving mental health or PTSD diagnoses compared to veterans 40 years or older.
Traumatic Brain Injury (TBI) and depression, as well as other mental illnesses, are major concerns in the veteran population. When husbands, wives, mothers, and fathers now living with mental disorders come home, many families are left wondering what to do. NAMI believes it is our duty to honor and help these service men, women, and their families.
An initiative between NAMI and the Veterans Health Program and the Veterans Health Administration (VHA) to include NAMI’s Family-to-Family program and VHA facilities has already yielded impressive results. After taking the course, family members have reported they had an improved understanding of mental health issues and realized they were not alone! One mother said she has become less judgmental toward herself and is more confident that she can explain what goes on in her son’s mind. NAMI is a pioneer in peer education, giving families of individuals living with mental illness a place to turn to find a strong network of support and tools derived from the lived experience of other family members. The VA has realized that if you want to help the veteran, you have to help the people around the veteran as well.
In this handbook, we have offered you some general information of what is known about brain disorders. We have explained services available to you and have offered suggestions for coping. Mental illness is a difficult problem with no easy solutions; we hope this handbook is of some help to you.
GUIDE TO SERVICES
HOSPITALS AND MENTAL HEALTH CENTERS
Fair Oaks Hospital Pavilion
5352 Linton Boulevard, Delray Beach, FL 33484
P: 561-495-3737 F: 561-495-3710 Website: www.delraymedicalctr.com
Fair Oaks Pavilion provides comprehensive, progressive and caring inpatient psychiatric and medical detoxification services. We also provide inpatient and outpatient electroconvulsive therapy (ECT). Fair Oaks Pavilion is also a Baker Act receiving facility specializing in short term stabilization of acute psychiatric emergencies. It is a private facility that accepts most major insurances.
Jerome Golden Center
1041 45th Street, West Palm Beach, FL 33407
561-383-5753 (for services) or 561-383-5725 (for information)
Mobile Crisis Team: 561-383-5777
The mission of the Jerome Golden Center is to help clients build resiliency, facilitate recovery, and achieve reintegration into the community by designing and delivering behavioral healthcare services that meet their needs and expectations.
South County Mental Health Center
16158 South Military Trail, Delray Beach, FL 33484
P: 561-495-0522; Fax: 561-637-1410
South County Mental Health Center is a private, non-profit corporation chartered by the State of Florida in 1974. Since its creation, South County has provided quality mental health services to our community in a manner which enhances and preserves human dignity. The Center has been able to achieve its primary purpose of assisting those with a mental illness to attain their recovery goals.
St. Mary’s Institute for Mental Health
901 45th Street, West Palm Beach, FL 33407
Website: www.stmarysmc.com (search for mental health)
Provides inpatient hospitalization for adults 18 and over and has a special geropsychiatric unit as well as alcohol and drug detoxification. Intake is available 24-hours a day and psychiatric emergency response is available. The institute is a private Baker Act receiving facility and accepts involuntary patients for evaluation. Referrals from physicians, psychologists, mental health clinicians, law enforcement agencies, and community organizations are welcome.
West Palm Hospital Behavioral Health Services
2201 45th Street, West Palm Beach, FL 33407
P: 561-881-2601; F: 561-881-4364
West Palm Hospital is an 88-bed acute care Baker Act receiving facility licensed by the state of Florida to treat children, adolescents, and adults, and seniors. In addition to our outpatient services, West Palm Hospital also provides outpatient services for adults and seniors including a Partial Hospitalization Program (PHP) and an evening Intensive Outpatient Program (IOP) for co-occurring disorders.
West Palm Beach VA Medical Center
7305 N. Military Trail, West Palm Beach, FL 33410
P: 561-422-8262 or 1800-972-8262
Provides comprehensive primary and long-term care in areas such as neurology, oncology, pharmacy, dentistry, physical medicine, psychiatry, rehabilitation, surgery, and extended care for Veterans. The West Palm Beach VA Medical Center also operates a Blind Rehabilitation Center which is the referral center for Veterans who are blind and/or visually impaired throughout the state of Florida.
GEO/South Florida State Hospital (ASH/SFSH)
800 E. Cypress Drive, Pembroke Pines, FL 33025
ASH/SFSH is the state owned, privately managed, psychiatric hospital for the Department of Children and Families, Districts 8, 9, 10, 11, 14, and 15. There are 325 beds for severely and persistently mentally ill people who cannot be successfully treated in a less restrictive setting in the community.
COMMUNITY HEALTH CENTERS
Palm Beach County Health Department Centers Website: www.pbchd.com
Low cost health care and/or dental care provided at the clinics listed below.
Belle Glade Office
38754 State Road 80, Belle Glade, FL 33430; 561-996-1600
Delray Beach Office
225 South Congress Ave.,
Delray Beach, FL 33444
Lantana/Lake Worth Office
1250 Southwind Drive, Lantana, FL 33463; 561-547-6800
Riviera Beach Office
851 Avenue “P,” Riviera Beach, FL 33404; 561-803-7362
1839 East Main St.
Pahokee, FL 33476
West Palm Beach Office
1150 45th St., West Palm Beach, FL 33407; 561-514-5300
Affordable Health Centers
Found Care Healthcare Center
2330 South Congress Avenue
Palm Springs, FL 33406
Medical: Adults and Pediatrics
Office hours: Monday – Wednesday and Friday: 8:00am – 5:00pm
Thursday: 11:00am – 7:00pm; Saturday and Sunday: Closed
JFK Internal Medicine Faculty & Resident Practice
180 JFK Drive, Suite 210,
Atlantis, FL 33462
561-548-1450, option 3
Adults only; Medical only
Monday – Thursday: 8:00am – 9:00pm; Saturday: 9:00am – 2:00pm; Sunday: Closed
Genesis Community Health Center
564 East Woolbright Road
Boynton Beach, FL 33435
Medical: Adults and Pediatrics Office Hours: Monday – Friday: 8:00am – 6:00pm; Saturday: 8:00am – 3:00pm; Sunday: Closed
Provide on-site free and/or low cost health care and/or dental care.
6405 West Indiantown Road, B
Jupiter, FL 33458
By Appointment Only, Adults only
FAU Community Health Center 561-809-8880
1650 Osceola Drive, West Palm Beach, FL 33409
Adults and Pediatrics Primary Care, Mental Health & Diabetic Education
Office Hours: Monday – Friday: 8:30am – 5:00pm; Alternate Saturdays: 9:00am – 1:00pm
The Community Health Center of West Palm Beach 561-840-8681
2100 West 45th Street, Suite A-8
West Palm Beach, FL 33407
Medical and Dental
Office Hours: Monday – Thursday: 8:00am – 12:00pm (Medical only);
Tuesday & Thursday: 4:00pm – 7:00pm; Friday: By Appointment Only; Saturday and Sunday: Closed
Caridad Healthcare Center
8645 West Boynton Beach Blvd., Boynton Beach, FL 33437
General Information: 561-737-6336; Medical Appointments: 561-853-1634;
Dental Appointments: 561-853-1637
Office Hours: Monday: Closed; Tuesday – Friday: 8:30am – 4:30pm; Saturday: 8:00am – 1:00pm; Sunday: Closed
Medical Mission Center
9600 West Atlantic Avenue, Delray Beach, FL 33446; 561-637-2757
Office Hours: Monday: 8:30am – 5:00pm; Tuesday: 9:00am – 6:00pm; Wednesday: 8:30am – 2:00pm; Thursday: 9:00am – 6:00pm; Friday: Closed; Saturday: 7:30am – 2:00pm; Sunday: Closed
COUNTY PROVIDER RESOURCES
2-1-1 Palm Beach/Treasure Coast
P.O. Box 3588 Lantana, FL 33465
Adopt-A-Family of the Palm Beaches, Inc.
1712 Second Ave., N., Lake Worth, FL 33460
Adopt-A-Family is a not-for-profit, charitable organization established in 1983, dedicated to restoring families in crisis to stability and self-sufficiency by providing access to all-encompassing services to families and their children.
Center for Family Services of Palm Beach County, Inc.
4101 Parker Avenue, West Palm Beach, FL 33405
P: 561-616-1222 F: 561-616-1230
The Center for Family Services provides mental health, substance abuse, and psychiatric services. We accept various insurance plans, and offer a sliding fee scale as well as grants to provide counseling to clients experiencing trauma, mental health and/or substance abuse issues.
Department of Children and Families
Substance Abuse and Mental Health Program Office
111 South Sapodilla Avenue, West Palm Beach, FL 33401
P: 561-650-6860 Website: www.dcf.state.fl.us/mentalhealth
The Substance Abuse and Mental Health Program Office is an administrative office within the Department of Children and Families (DCF) that contracts for and monitors state-funded substance abuse and mental health services throughout Palm Beach County. Funding is allocated to contract providers to serve the following populations: Severe and Persistent Mentally Ill, Adults and Children with Substance Use Disorder, Serious Emotionally Disturbed Children, Adults and Children in need of Crisis Intervention, and individuals involved in the forensic system who are incompetent to proceed due to mental illness. In addition, the SAMH program office is collaborating with community groups and organizations to develop a co-occurring capable system of care in Palm Beach County.
Florida Assertive Community Treatment (F.A.C.T.) Team
Henderson Mental Health Center F.A.C.T. Team
3155 Lake Worth Road, Ste. 2, Lake Worth, FL 33461
P: 561-649-6500 F: 561-676-6501
The Florida Assertive Community Treatment (F.A.C.T.) Team is a service-delivery model for providing comprehensive community-based treatment to persons with severe and persistent mental illnesses. Services include: 1) Treatment Services (assessment, education, management, monitoring); 2) Rehabilitation Services (basic living skills, vocational and social); 3) Case Management Services; 4) Crisis Intervention; 5) Support Services (family and peer support).
Health Care District
This group provides health benefits for low income families. These programs are Coordinated Care 1 & 2. C.L. Brumback Primary Care Clinics are located at the Florida Department Health Centers.
Mental Health Association
909 Fern Street, West Palm Beach, FL 33401
MHA works to improve understanding about issues related to mental health through advocacy, education, research, and outreach. MHA programs include: Listen to Children Mentors, Beacon Centers, and Peer Place Drop-In center.
CIT is a community partnership between law enforcement agencies, the local mental and substance abuse treatment systems, mental health advocacy groups, consumers of mental health services, and their families. CIT establishes teams of trained officers within each law enforcement agency to respond effectively to people who are experiencing a mental health crisis, including those with co-occurring Substance Use Disorder. One should dial 9-1-1 and ask for a CIT Officer to respond to their mental health crisis, possibly diverting the person to a treatment facility rather than jail.
Mobile Crisis Unit
A great resource for emergency intervention, de-escalation, screening, and assessment for individuals in emotional distress. Services are available 24 hours a day, 7 days a week.
Jerome Golden Center Mobile Crisis Unit (Northern County):
561-383-5777 or 877-435-4740 (toll free)
Jerome Golden Center Mobile Crisis Unit (Glades Area):
South County Mental Health Center Mobile Crisis Unit (Southern County): 561-637-2101 or 877-858-7474 (toll free)
National Suicide Prevention Lifeline
The Alliance for Eating Disorders Awareness
1649 Forum Place, Suite 2, West Palm Beach, FL 33401
P: 561-841-0900; F: 561-653-0043
We offer educational presentations, support groups for those struggling and for their family and friends, advocacy for mental health legislation, a toll-free national phone help line, as well as referrals, training, support, and mentoring services, all free of charge.
Alzheimer’s Community Care, Inc.
800 Northpoint Parkway, Suite 101B, West Palm Beach, FL 33407
P: 561-683-2700 Website: www.alzcare.org
A Florida-based not-for-profit organization that provides specialized care to patients with Alzheimer’s and related disorders, and their caregivers. ACC is an innovative model of care that provides affordable services and resources to patients and their families, while preserving their dignity. ACC offers specialized adult day care, family nurse consultants, support groups, 24-hour crisis line, and dementia-specific education and training.
Alpert Jewish Family and Children’s Services
5841 Corporate Way, Suite 200, West Palm Beach, FL 33407
P: 561-684-1991; F: 561-684-5366
AJFCS is a nationally-accredited, non-sectarian agency serving individuals and families of all ages. With over two dozen focused programs, we have created a seamless network for helping families cope with life’s challenges.
9995 Military Trail, Palm Beach Gardens, FL 33410
P: 561-775-9650 Administrative Offices
Counseling Services: 561-775-9567 Website: www.diocesepb.org/charities
Catholic Charities of the Diocese of Palm Beach is a comprehensive non-profit family service organization with offices located in Okeechobee, Martin, Palm Beach, Indian River, and St. Lucie Counties. All services are available on a non-discriminatory basis to eligible clients regardless of religious affiliation or ethnic origin. It offers counseling services on a sliding scale fee. Spanish speaking counselors are available at some locations.
Center for Trauma Counseling, Inc.
6801 Lake Worth Road Suite 101, Lake Worth, FL 33467
P: 561-444-3914 Website: www.palmbeachmentalhealth.org
Center for Trauma Counseling is a 501(c)(3) non-profit organization serving Palm Beach County residents who suffer from symptoms and disorders associated with trauma-related events and experiences. We provide prompt, effective, and cost-affordable mental health services for children, adolescents, adults, elderly families, and groups.
Chrysalis Center, Inc.
230 S. Dixie Hwy., Lake Worth, FL 33460
P: 561-533-6640 F: 561-533-9106
Provides mental health and substance abuse counseling and targeted case management to children, adolescents and adults. Services include individual, family, and group therapy, day programs, psychiatric evaluations, medication management, psychological testing, and psychosexual evaluations.
Coalition for Independent Living Options, Inc. (CILO, Inc.)
6800 Forest Hill Blvd., West Palm Beach, FL 33413
P: 561-966-4288 ext. 119 F: 561-966-0441
CILO’s mission is to promote independence for people with disabilities. CILO offers advocacy, information and referral, independent living skills, mental health counseling, peer support and group counseling as well as victim’s advocacy, after school and summer programs.
Depression and Bipolar Support Alliance
A consumer-based organization dedicated to improving the quality of life for those affected with Depression and Bipolar Disorder and their families. Strives to promote public awareness to the community at large.
3175 S. Congress Ave., Ste. 310, Palm Springs, FL 33461
Faith*Hope*Love*Charity/Stand Down assists Veterans who are struggling, homeless, or have addictions. For enrollment, contact the West Palm Beach VAMC Health Care for Homeless Veterans Program at 561-422-8223 or 800-972-8262.
FAU Center for Autism & Related Disabilities (CARD)
Boca: 777 Glades Road, Boca Raton, FL 33431
Jupiter: 5353 Parkside Drive, Jupiter FL 33458
P: 561-297-2055 F: 561-297-2507
Website: www.autism.fau.eduEmail: email@example.com
The FAU Center for Autism and Related Disabilities (CARD) provides expert counseling, training, and support, at no charge, for people with autism and related disabilities, their families, and the professionals serving them.
Faulk Center for Counseling
(formerly known as the Center for Group Counseling)
22455 Boca Rio Road, Boca Raton, FL 33433
P: 561-483-5300; F: 561-483-5325
Since 1973, the Faulk Center for Counseling has provided free and low cost quality mental health services in the South Palm Beach community.
Kelly Pierce Pineda
1045 E. Atlantic Ave., Ste. 205, Delray Beach, FL 33483
Licensed Marriage and Family Therapist and Infant Mental Health Specialist. Provides individual, couples, and family therapy services with a special focus on relationships impacted by maternal depression, caregiver/child attachment concerns, and life transitions, such as the birth of a baby.
Multilingual Psychotherapy Centers, Inc.
1639 Forum Place, Ste. 7, West Palm Beach, FL 33401
Multilingual Psychotherapy Centers is a comprehensive mental health center that has been serving residents of Palm Beach County for over 10 year. Our staff speaks more than 10 languages, including Spanish, French, Creole, and Italian. We offer medical/psychiatric services, psychological testing, individual/family/group therapy in the office, home, and school settings, as well as support and case management services.
Palm Beach Behavioral Health and Wellness
345 Jupiter Lakes Blvd., Ste. 302A, FL 33458
P: 561-429-2397; F: 561-429-2398
Palm Beach Behavioral Health and Wellness is a comprehensive behavioral health practice servicing children, adolescents, adults, families, and couples. We provide therapeutic services, developmental, psychological, and psychoeducational testing.
Psychological Wellness Center
12008 South Shore Blvd., Suite 207, Wellington, FL 33414
P: 561-207-7625; F: 561-828-8075
Skilled psychologists conduct individual, couples, and family therapy in a nurturing, comfortable environment. Additional services include group therapy, comprehensive evaluations (psychoeducational, diagnostic, gifted), biofeedback and relaxation training, postpartum support and new parent groups, and community education and outreach.
Ruth & Norman Rales Jewish Family Services
21300 Ruth & Baron Coleman Blvd., Boca Raton, FL 33428
P: 561-852-3333, F: 561-852-3332
Provides a comprehensive range of out-patient counseling and support services for bereavement, families of individuals living with mental illness, and caregivers. Accepts insurance and offers sliding scale fees.
Amigos Adult Drop-In Center
Jeff Industries, 115 East Coast Avenue, Hypoluxo, FL 33432
561-582-0650 ext. 1224
Amigos offers recreational, community integration, adult basic education, support groups, and referral services to adults with mental illness.
Peer Place Drop-In Center
2100 45th Street, Suite B12, West Palm Beach, FL 33407
Our mission is to encourage individuals to take charge of their own recovery from mental illness by offering them the opportunity to achieve their personal potential and continued growth through recreation, support, and education.
Welcome Home Drop-In Center
The Shirley and Barton Weisman Delray Community Center
7091 West Atlantic Ave., Delray Beach, FL 33446
The Welcome Home Drop-In Center is for individuals living with chronic mental illness. The center provides an empowerment program designed to help participants make decisions, access resources and achieve personal objectives. Vocational and life skills training is an important part of the program.
SUBSTANCE ABUSE/TREATMENT CENTERS
Comprehensive Alcoholism Rehabilitation Programs, Inc. (CARP, Inc)
5410 East Avenue, West Palm Beach, FL 33407
561-844-6400 ext. 101; F: 561-844-7575
CARP, Inc. is one of the largest, most comprehensive substance abuse programs operating under a single administration in South Florida. The agency provides prevention, education and treatment services, to individuals and families, affected by alcoholism and drug dependency to achieve an abstinence-based recovery. The continuum of care offers detoxification, assessments, residential, outpatient, aftercare, and case management services for adults and adolescents in Palm Beach County and the Treasure Coast.
Counseling Services of Lake Worth
416 N. Dixie Hwy., Lake Worth, FL 33460
P: 561-547-0303 Website: ww.cslkw.org Email: firstname.lastname@example.org
Offers Drug Court Program, Anger Management, Batterer’s Intervention Program, Substance Abuse Evaluation & Treatment, DUI Program, Co-Occurring Treatment, EAP, Relationship Counseling, Mental Health Assessments & Treatment, Individual Therapy, and Urinalysis Drug Screen Testing, contracted Laboratory Drug Testing. Most services are offered in English and Spanish. Accessible via Palm Tran.
Drug Abuse Foundation of Palm Beach County, Inc.
400 S. Swinton Ave., Delray Beach, FL 33444
P: 561-278-0000 Website: www.dafpbc.org
Our purpose is to encourage and support the process of recovery and to promote drug-free living.
1700 North Dixie Highway, West Palm Beach, FL 33407
P: 561-833-6826 F: 561-832-4087
Gratitude House offers long-term residential day and out-patient services to women with substance abuse and co-occurring mental health issues. We have programs for pregnant women, mothers and infants, women with HIV and women 18 years and older. We offer support services such as case management and job counseling.
Partners in Treatment, Inc.
1489 Military Trail, Suite 216, West Palm Beach, FL 33409
P: 561-693-529; F: 561-615-0045
Partners in Treatment, Inc. facilitates an effective continuum of services for those who are seeking a happy, healthy, drug free lifestyle free from addiction and mental health issues. Our clients are counseled by Master’s level professionals and a CAP. Some case management is available.
Professional Training Association @ Care Florida
321 North Lake Blvd., Ste. 102, North Palm Beach, FL 33408
P: 866 494-0866 Website: www.careflorida.com
Provides day and night substance abuse treatment with community housing, intensive outpatient treatment specializing in dual diagnosis, gambling, eating disorders, addictive disorders, and other process addictions.
8800 Sunset Dr., Palm Beach Gardens, FL 33410
An extended-care residential treatment facility for men 18 and over who have a desire to develop and maintain their recovery from alcohol and/or drug abuse in a safe, structured environment. Clients may have completed inpatient residential treatment, may have experienced a recent relapse, or may not have reached the point of needing inpatient treatment.
328 N.E. Sixth Avenue, Delray Beach, FL 33483
561-278-0055 Website: www.waysidehouse.net
The mission of Wayside House is to provide women with addictions the support, programs, and services they need to recover mentally, physically, and emotionally in order to return to their families and communities ready to live a fulfilling life.
2200 North Florida Mango, Ste. 201 West Palm Beach, FL 33409
P: 877-413-6640 Website: http://www.wellingtonretreat.com
Offers comprehensive treatment for people living with Substance Use Disorder and mental illness. Wellington Retreat believes in treating people for each disorder simultaneously to ensure complete recovery.
American Association for Caregiving Youth (AACY)
1515 North Federal Highway, Suite 218, Boca Raton, FL 33432
P: 561-391-7401 F: 561-416-7213 Website: www.aacy.org
AACY promotes and supports children, teens, and their families who are caregiving for a loved one. AACY provides home visits and in-home help, school and outside activities, tutoring, referrals for physicians, and prescription discounts.
Boys Town South Florida
3111 South Dixie Highway, #200, West Palm Beach, FL 33405
P; 561-366-9400; F: 561-366-1133
Boys Town South Florida identifies children and families in the community who need and can benefit from our help; connects families to the best care available, and provides care and assistance through a wide variety of community based and in-home programs and services.
Center for Child Counseling
7731 North Military Trail, Suite 4, Palm Beach Gardens, FL 33410
P: 561-244-9499 F: 561-345-3800
The Center for Child Counseling strives to strengthen and empower children and families through prevention, early intervention, and treatment services that support their social-emotional wellness and growth. The Center provides an array of Individual, Group, and Family Therapy to support children, teens, and families experiencing mental health concerns.
Community Partners/Parent-Child Center
2001 Blue Heron Boulevard, Riviera Beach, FL 33404
P: 561-841-3500/561-841/3555 Website: www.cp-cto.org
As a COA accredited and Non-profits First certified agency, Parent-Child Center has 12 distinct programs designed to treat children, adolescents, and their families who are experiencing mental health disorders and specific risks associated with emotional health difficulties.
Family Preservation Services of Florida, Inc.
2051 Martin Luther King Blvd., Ste. 101 Riviera Beach, FL 33404
121 North 2nd Street, Suite 301, Fort Pierce, FL 34950
P: 772-595-3773 F: 772-464-0087
The mission of FPSFL is to maintain children in their own homes, strengthen families, and assist children and adults in becoming healthy, contributing members of their communities
11301 SE Tequesta Terrace, Tequesta, FL 33469
P: 561-744-0211; F: 561-743-8501
Sandy Pines is a residential treatment center for children and adolescents ages 5-17. We offer mental and behavioral health treatment in a safe and secure therapeutic environment. Sandy Pines has a fully bilingual (Spanish) program.
The Seal Therapeutic Corporation (The Seal Academy)
2290 NW 2nd Ave., Ste. 9 & 10, Boca Raton, FL 33431
P: 561-706-1004 or 561-715-5910 Website: www.nikkiwoller.com
First private academic therapeutic day school in Palm Beach County. The environment is geared toward educating and empowering children who are living with medical, emotional, and/or learning differences, specializing in Anxiety, OCD, Asperger’s Syndrome, ADHD, Bipolar Disorder, and learning disabilities.
Addiction Recovery Legal Services (ARLS), LLC
888 South Andrews Avenue, Suite 203, Ft. Lauderdale, FL 33316
P: 877-352-2873; F: 954-522-2584
A private Florida law firm that specializes in helping families with any and all litigation involving the Marchman Act. Consultations are 30 minutes for $75.00.
Legal Aid Society of Palm Beach County, Inc.
423 Fern Street, Suite 200, West Palm Beach, FL 33401
P: 561-655-8944 F: 561-655-5269 Website: www.legalaidpbc.org
The Legal Aid Society of Palm Beach County provides high quality civil legal advice, representation and education free of charge to disadvantaged children, families, and individuals in Palm Beach County so as to protect their personal safety, enhance their opportunities and living conditions and promote self-sufficiency.
Prescription Drug Assistance: P: 888-477-2669 Website: http://www.pparx.org
The Pharmaceutical Research and Manufacturers of America (PhRMA) launched a new interactive website that provides a comprehensive one-step link to more than 140 industry and 185 government and privately sponsored patient assistance programs for which they may be qualified. PhRMA also assists callers with basic eligibility requirements and provides contact persons.
Disability Rights Florida
2728 Centerview Dr., Ste. 102, Tallahassee, FL 32301
P: 800-342-0823 Website: www.disabilityrightsflorida.org
Disability Rights Florida is the official, Governor-designated protection and advocacy system for the State of Florida and has authority and responsibility under eight federal programs. It is a statewide, not-for-profit corporation.
Adult Protective Services Program – Department of Children & Families
Abuse Hotline: 800-962-2873 Southeast Region: 1400 W. Commercial Blvd., 2nd FL., Ft. Lauderdale, FL 33309 P: 954-818-5672
Protects vulnerable adults in need of services, or who have disabilities, from abuse, neglect, or exploitation.
Gulfstream Goodwill Industries, Inc.
1715 Tiffany Drive, East, West Palm Beach, FL 33407
P: 561-848-7200; F: 561-848-0346
Gulfstream Goodwill provides vocational assessments, employment services, benefits, planning assistance, day programs for individuals with developmental disabilities and brain injuries, juvenile and adult justice services, a charter school for 16-22 year olds with disabilities, residential services, and VITA.
Jeff Industries, Inc.
115 East Coast Avenue, Hypoluxo, FL 33462
Claudia Roberts, Executive Director
Fiscal/Administrative Offices: 561-547-9258 F: 561-547-9682
Program Offices: 561-582-0650 F: 561-582-0692
Office Hours: Monday – Friday, 8am – 4:30pm
We provide employment opportunities and job placement services for at-risk youth and adults with mental illnesses. We facilitate social, leisure, educational, and networking activities. We offer supportive and affordable housing.
2001 West Blue Heron Blvd., Riviera Beach, FL 33404
P: 561-841-3500 Fax: 561-841-3555
Housing Partnership has developed an array of innovative ad economically sustainable paths to affordable housing and community living for low to moderate income families, as well as for those with special needs. Our dedicated staff of professionals operates onsite in communities throughout the county and is headquartered in Riviera Beach, Florida.
Jeff Industries-Palm Haven House
Located on Sixth Avenue North at North Federal Highway in Lake Worth, Palm Haven House is home to ten consumers. The two houses were built primarily by a team of emotionally disturbed and mentally ill teenagers from the Ed Venture Charter School. Only the plumbing and electricity were installed by professionals. All the carpentry and cabinet work were done by teams of students supervised by a series of students.
Levine Jewish Residential & Family Service
5841 Corporate Way, Suite 200, West Palm Beach, FL 33407
P: 561-684-1991; F: 561-684-5366
LJRFS provides a continuum of structures and supports for adults with special needs, including sever and persistent mental illness. Our two group homes and world class supported independent living program offer 24/7 support and programs designed to maximize individual’s levels of functioning.
Palm Beach County Housing Authority
3432 W. 45th Street, West Palm Beach, FL 33407
Provides housing assistance for low-to-moderate income families, senior citizens, and handicapped persons. Applicants must provide verification of income.
Senator Philip D. Lewis Center
1000 45th Street, West Palm Beach, FL 33407
Palm Beach County’s central point of entrance for homeless individuals to receive services. The center offers intake, assessment, medical services, shelter beds, vocational placement, and life skills training.
The Homeless Coalition of Palm Beach County, Inc.
2100 Palm Beach Lakes Blvd., West Palm Beach, FL 33409
P: 561-478-5351 F: 561-478-5356
Attempts to identify, prevent, and alleviate the conditions that cause individuals and families to become homeless in Palm Beach County by advocating for and promoting a level of assistance that will result in the self-sufficiency of those affected. Provides referrals for clients when necessary and an information network for agencies.
The Lord’s Place
2808 Australian Ave., West Palm Beach, FL 33407
P: 561-494-0125 Website: www.thelordsplace.org
The Lord’s Place is dedicated to breaking the cycle of homelessness. We assist homeless families and individuals through a variety of programs and services, including interim housing, permanent housing, intensive case management, job training, and numerous support services.
- Belle Glade: 1079 S. Main St., Belle Glade FL 33430; P: 561-992-1316
- Palm Beach Gardens: 3970 RCA Blvd., Ste. 7009, Palm Beach Gardens, FL 33410; P: 561-624-6957
- West Palm Beach: 3111 S. Dixie Hwy., Ste. 100, West Palm Beach, FL 33405 P: 561-650-6804; 651-659-6814 TDD
- Boca Raton: Corporate Congress Plaza, 902 Clint Moore Rd., Ste. 118, Boca Raton, FL 33487; P: 561-544-4657
Assists individuals with disabilities who require vocational rehabilitation services to prepare for, enter, engage in, or retain employment. Services provided are done through Individualized Written Rehabilitation Programs based on individuals’ skills, abilities, and priorities. Services may include vocational assessment, training, placement, and many others as required to assist individuals into employment.
Telephone Reference Guide – National and Florida Agencies
Florida AIDS Hotline: 800-352-2437
Depression and Bipolar Support Alliance – PBC: 561-572-0503
Florida Child and Adult Abuse Hotline: 800-962-2873
Florida Advocacy Center for Persons with Disabilities: 800-342-0823
Florida Drug Assistance Helpline (Florida Legal Services): 800-436-6001
Florida Medicaid: 800-226-5082
Substance Abuse Hotline: 800-662-4357
Florida Suicide Prevention Coalition: 800-273-8255
National Alliance on Mental Illness (NAMI): 800-950-6264
National Alliance on Mental Illness-Florida: 850-671-4445
National Association for the Dually Diagnosed: 800-331-5362
National Institute of Mental Health: 866-615-6464
Southeast Florida Behavioral Health Network: 561-203-2485
Social Security Administration: 800-772-1213
State of Florida Information Center: 866-693-6748
Treatment Advocacy Center: 703-294-6010
Veteran’s Assistance: 800-827-1000
NAMI PBC – www.namipbc.org
American Psychiatric Association – www.psych.org
American Psychological Association – www.apa.org
National Association of Anorexia Nervosa and Associated Disorders – www.anad.org
Association of Black Psychologists – www.abpsi.org
Depression & Bipolar Support Alliance – www.ndmda.org
Depression & Bipolar Support Alliance – FL – www.geocities.com/dbsaflorida.html
Disabled People International – www.dpi.org
Florida Psychiatric Society – www.floridapsych.org
Florida Suicide Prevention – www.floridasuicideprevention.org
Institute of Psychiatry – www.iop.kcl.ac.uk
Medicaid – www.fdhc.state.fl.us/Medicaid
Medicare – www.medicare.gov
Mental Health America – www.nmha.org
Mental Health Consumers Survivors – www.lynx.org/csp
Mental Health Research Association – www.narsad.org
National Alliance on Mental Illness – www.nami.org
National Institute of Mental Health – www.nimh.nih.gov
Social Security – www.ssa.gov
Substance Abuse & Mental Health Services Administration – www.samhsa.gov
The Advocacy Center for Persons with Disabilities (Florida) – www.advocacycenter.org
The Center for Substance Abuse Prevention – hhtp://prevention.samhsa.gov
Treatment Advocacy Center (nationwide) – www.psychlaws.org
YOUR RIGHTS IN A FLORIDA MENTAL HEALTH FACILITY
An individual experiencing a mental health crisis can be admitted to a mental health facility. At the point of admission, the patient should be informed of his or her rights and should be able to ask questions and receive answers about those rights. Under federal law and Florida’s Mental Health Act, your rights are protected as follows:
RIGHT TO INDIVIDUAL DIGNITY:
You are to be treated with dignity and respect at all times.
RIGHT TO COMMUNICATE:
You may talk with people you choose by local telephone or in person, unless determined to be harmful to self or others.
RIGHT TO QUALIFIED TREATMENT:
You are to receive treatment and services based upon your needs; and you are expected to participate in your treatment plan.
RIGHT TO BE SAFE:
You are to be free of restraint, seclusion, isolation, or emergency treatment orders. Laws prohibit neglect or abuse of persons in a facility; however, certain rights can be restricted by your doctor for safety reasons.
RIGHT TO POSSESS CLOTHING & PERSONAL EFFECTS
RIGHT TO RELEASE OR DISCHARGE:
You may request at any time, if you are on voluntary status. You will be released within 24-hours from community-based receiving facilities (or three days from state facilities), unless a petition is filed with the court to hold you for an involuntary placement hearing.
RIGHT TO EXPRESS AND INFORMED CONSENT:
You must be given the following information before you are asked to give consent to treatment: the reason for your admission, your proposed treatment and its purpose, common side-effects of your treatment, alternatives, and the approximate length of care.
RIGHT TO AN ATTORNEY & REPRESENTATIVE:
You will have attorney appointed to represent you if you are placed at a facility on involuntary basis. Most often this is a Public Defender.
RIGHT TO PRIVACY & CONFIDENTIALITY:
You will have privacy when talking with your doctor, team members, and visitors whenever possible. Your treatment record is kept private except from your guardian, your attorney, certain state agencies, your parent or next-of-kin (limited information), because of a court order, or if you threaten to harm someone.
RIGHT TO VOTE
COMPLAINTS AND GRIEVANCES:
You can make a verbal or written complaint if you feel you or others are not treated fairly.
Invest in NAMI Palm Beach County
If you found the information in the NAMI PBC Resource Guide to Mental Health Services in Palm Beach County helpful, please consider investing in NAMI Palm Beach County today. Through our mission of support, education, and advocacy, our goal is to continue to provide all NAMI PBC programs and services at no charge to those who are affected by mental illness.
NAMI Palm Beach County distributes the Resource Guide free of charge at all community events, health fairs, education programs, support groups, and civic presentations.
NAMI PBC is a charitable organization organized under 501(c)(3) of the Federal code, which gives the organization its non-profit status. The organization is supported by generous donations from individuals, businesses, and community health providers. NAMI PBC’s programs and services are offered locally to those with a mental illness and their families free of charge so that cost does not become a barrier to obtaining help.
BECOME A MEMBER OF NAMI TODAY!
Street Address: Apt./Unit#:
Please check this box if you would like to give NAMI PBC permission to send you notices via email of events, programs, education courses, support groups, and other activities. Please note: NAMI Palm Beach County WILL NOT share this email address with others.
Membership Levels: NAMI/PBC Membership Regular – $35 Open Door – $3
NAMI/PBC Sponsorship Levels *Include Membership Family – $55 Professional – $65 Corporate – $250 Members are essential to NAMI PBC; your joining helps NAMI PBC continue to extend free outreach, support, and education to those in need. In bringing mental health issues to wider attention, we advocate for better treatment…As our membership base grows, our voice becomes stronger… Please make checks payable to NAMI Palm Beach County Mail to: 5205 Greenwood Avenue, Suite 110, West Palm Beach, Florida 33407 NAMI PBC is a 501(c)(3) non-profit, charitable organization – contributions are tax deductible to the fullest extent allowed by law. Together, we can continue to advocate for all those affect by mental illness. Thank you! Florida Solicitation Registration Number:CH6498 “A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling (800)-435-7352 toll-free within the state. Registration does not imply endorsement, approval, or recommendation by the state.”
Respect, Compassion & Hope … NAMI Works!
5205 Greenwood Avenue, Suite 110
West Palm Beach, Florida 33407
561-588-3477 * Email: email@example.com