3) Collaborative Care

My uncle has bipolar disorder as well as diabetes. Several doctors and nurses that we have seen with him have said that we should be collaborating to best meet my uncle’s needs. What does this mean and how do we do this?

Collaborative care means working together to improve a person’s health and quality of life. This is best done in a coordinated health care system. Evidence does show that collaborative care is beneficial and it even seems to work with people who have co-occurring conditions such as your uncle (both bipolar disorder and diabetes). It can improve the medical or physical well-being of people as well as the management of bipolar disorder. It is difficult to implement because of the way health care systems operate, often with separate entities for costs, benefits, mental health and medical care. The problem often seen is how to get everyone to work together. Family plays a big part in advocating for partnerships and this may become an important role for you to play.

We have met a number of professionals since my uncle found out he has bipolar disorder. Who are all of these people and what do they do?

What a great question! Often, the process of working within the mental health care system can be confusing and it is difficult to remember who you have met and what their role was described as! From your first question, it sounds like the professionals that you have been working with are working within a team setting. This is great! It is important that the team consists of yourself and your loved one as well as the various professionals, who will have differing backgrounds and training.

Some of the professionals that you will likely work with include:

• Psychiatrists

A psychiatrist is a medical doctor who specializes in psychiatry. Psychiatrists can evaluate and diagnose all types of mental illness, carry out various treatments and therapies, prescribe medications, and work with psychological problems associated with medical disorders.

• Psychologists

Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical psychologists, counseling psychologists, or school psychologists. They work in many settings--for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. Psychologists are not medical doctors and cannot prescribe medications. Psychologists usually work in a consulting role.

• Psychiatric Nurses

Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental health-related problems. They conduct individual, family, and group therapy. Psychiatric nurses may be called “therapists” in certain settings, especially in community mental health.

• Social Workers

Social workers have degrees in social work, have completed a field supervision program, and are licensed/certified. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources. Social workers may be called “therapists” in certain settings just as psychiatric nurses.

Numerous other professional work with people who have a serious mental illness, such as bipolar disorder as part of a multidisciplinary team. They usually have at least two years of college-level training. These allied healthcare professionals may include:

• Occupational Therapists (OT)

• Recreational Therapists (RT)

• Registered Nurses (RN)

With many illnesses a doctor will oversee the overall course of treatment. This may not be the case with someone with bipolar disorder. A case manager may be utilized in order to offer ongoing assistance. A case manager may be from any of the above disciplines and have expertise in coordinating services for your loved one such as obtaining information on services or locating a healthcare professional. Case managers provide a critical function to monitor a person's needs and assure that appropriate agencies get involved. In many instances they also act as advocates for the client. Case managers can be nurses, social workers, or mental health workers and can be associated with mental health centers, psychosocial rehabilitation programs, or other agencies. Outreach workers may also be part of the team of professionals that work with you and your family. Often, outreach workers work closely with a case manager and may assist with social, recreational, vocational, educational and other community-oriented needs.

I want to be able to work effectively with the members of my uncle’s treatment team. How do I ensure that I have a good relationship with the team?

It is important to recognize that no matter who you are dealing with in the mental health care system, all people working in mental health are there to help others and to ultimately advance mental health of those that they encounter. People from all kinds of backgrounds with all types of experiences assist in increasing the understanding of mental health problems.

A nice list of simple ways to enhance your relationships with the mental health professionals you are dealing with is provided in a great book, “When someone you love has a mental illness”. They include these suggestions:

• Be courteous. Courtesy is to your advantage as a consumer and as an advocate for your loved one.
• Provide information.
• Be respectful of their time.
• Ask how you can be involved in a supportive way.
• Request meetings, with or without your loved one present, when you feel the need.
• Expect to be treated respectfully and with consideration.
• Keep in mind the frustrations and constraints professionals face, such as: their inability to help people who will not accept treatment; the stigma, prejudice, and ignorance regarding mental illness that they and their clients face; the desire of families for unrealistic results (cures); clients who do not improve because of our limited knowledge regarding the treatment of people with mental illness; the lack of adequate funding for programs, staff and clients’ essential needs.

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