Untreated behavioral health problems can undermine anyone’s well-being. Mental and emotional problems often make a person’s medical condition worse. Anxiety or depression make them less able to function, to be engaged in their own care and healing, or to follow medical advice or instructions.
Mental anguish can also make the physical pain from an illness or injury feel even worse than it might otherwise. Unsurprisingly, behavioral health problems often contribute to an emergency room visit or hospitalization that could have been avoided with timely, appropriate intervention.
Finding a mental health provider can be a special challenge to someone with a disability. Many places offering mental health care are inaccessible to people who have limited mobility. Many also have long waiting lists and cannot respond to crisis situations. In addition, many therapists and psychiatrists lack knowledge about the relationship between disability and behavioral health, not to mention how drugs that are commonly used to treat conditions like anxiety and depression may affect someone with a particular disability.
That’s a huge problem because adults with physical disabilities have higher rates of depression, anxiety, and stress than the general population. Those living with multiple sclerosis are at particular risk, as depression is one of the most common conditions accompanying the disease. In fact, someone with MS is up to three times more likely to be depressed than someone in the general population.
Having an in-house behavioral health program gives ICS the ability to intervene quickly when symptoms of mental or emotional health problems appear. It has also allowed us to develop our care managers’ skill in recognizing and addressing behavioral health problems.
The fears of one ICS member with multiple sclerosis were preventing her from accepting desperately-needed help and, as a result, she was hospitalized repeatedly. Lisa – not her real name – insisted on living on the floor of her apartment and getting around by dragging herself across the floor using an old mattress. She refused home care and assistive equipment that she needed, believing that accepting help would rob her of her independence.
Like many people with advanced MS, Lisa is incontinent and has a catheter. Because of the way she lived, her catheter was constantly in contact with the floor and, as a result, she frequently got dangerous urinary tract infections (UTIs). She also had pressure wounds on her hips from living on the floor.
When she became an ICS member, our goals for Lisa were to convince her to stop living on the floor in order to improve her health, and to free her of UTIs and pressure wounds, but the only way forward was to navigate the thicket of her fears. We did this by respecting her mental anguish and patiently building a relationship of trust. The hope was that she would come to feel safe enough to accept the services she needed.
Lisa remained on the floor for a long time. During this period her wounds and UTIs were treated and an ICS nurse instructed her how to keep her catheter and drainage bag clean to reduce the chance of infection.
Eventually, Lisa agreed to have a physical therapist evaluate her and teach her muscle strengthening exercises. She accepted a hospital bed with a specialty mattress to prevent further deterioration and additional pressure ulcers, and a Hoyer lift to get her in and out of bed. Finally, with a great deal of encouragement, she began using this equipment.
We were able to address Lisa’s medical needs by navigating her psychological problems. Because of this, she was able to avoid admission to a nursing home, where she would have refused to remain. She has been able to accept the equipment and treatment she needs to maintain her health while living at home.
Care management that integrates behavioral health
ICS uses a social work care management approach that allows us to take advantage of the strong relationships our care managers build with our members. As Lisa’s story illustrates, care managers address a member’s mental health issues as part of their overall effort to help the member remain as healthy and independent as possible.
When a care manager sees a member with complex behavioral health issues, an ICS behavioral specialist works with the care manager and the member as a team. Depending on the situation, this work may include addressing symptoms, diffusing conflict, engaging the member in creating a plan that prioritizes urgent matters, or all of these things.
This strategy of collaboration may result in the use of mobile crisis services, putting a plan in place to stabilize a volatile home care situation, referring the member for mental health counseling to an appropriate provider at an accessible facility in their community, or arranging for a clinical social worker to provide counseling in the home. In addition, any family caregiver-related issues that are contributing to the member’s distress are addressed.
The ICS behavioral health program is led by Rosemary Salopek, pictured above, a licensed master social worker with 20 years of experience. To learn more about Rosemary and how behavioral health affects people with disabilities, listen to her recent interview on Independence Radio here.