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Vulnerable Population

Integrating the Interventions of Drug Abuse and Depression to Reduce Cost and Time of Treatment

Mental disorders are seen as the psychological disarrays that result in a pattern of anomaly in human behavior. There are various causes of mental disorders, and the extent usually varies among people. Mental disorder occurs in people differently. For some, it appears as a mild distress while it can be a serious disability for others.  People have had misconceptions about mental disorders for a long period of time (Aday, 2001). This led to the failure of people in seeking timely medical care and returning to normal life.

The definitions of mental illness also vary among different people. Some people take it lightly while others suffer from self-denial of experiencing symptoms. Others take it only as a mental distress even when has already been severe and made them enable to live normally. Contrary to people’s classical understanding, mental illness should be some condition that distorts or skews a person ability to discern, be in a good mood, feel as well as other aspect present in a person’s normal functioning. These mental conditions interfere or distort the person’s ability to endure or respond to basic difficulties of life (Lamb, 2005).

Mental illnesses are very diverse. Additionally, they can affect everyone regardless of age, body size, and skin color among other differences that humans have. They are also not affected by personal power or upbringing. Early diagnosis and treatment is an effective control, which restores people to their previous abilities in the majority of cases.

In the New York City (NYC), mental illnesses affect people and expose them to human and economic costs. Human costs are caused by personal suffering such as the inability to control oneself effectively or relate with people among others. One of the many mental illnesses that affect the quality of life of NYC residents is depression. Depression is also common in America, where an estimated 55 million Americans suffer from it every year. A survey was conducted by the Department of Health and Mental Hygiene. This survey, which was carried out for health and nutrition examination, found out that 7.5 % of the residents of NYC had suffered a severe depression during the previous year. This is a large number of people as it explored about 4500000 of people. This survey also found out that about half of the above figure had suffered from generalized anxiety in the same period.

This is a large proportion of the population as it amounts more than ten percent of the whole NYC population. This is of great significance due to the great potential that depression and anxiety combine to disrupt normal life and economic productivity. In the following year, NY community conducted health survey jointly with the New York City Department of Health and Mental Hygiene (DOHMH), where 6.3% of people equivalent to 378000 in the NYC had suffered a psychological stress due to unspecified reasons. This caused psychotic disorders sometimes, which were among the other challenges faced by the NY City dwellers, especially teenagers and young adults (Charness, 2005).

In the NYC, DOHMH and other health agencies make surveys and researches that are aimed at providing crucial information for the control and promotion of mental health and hygiene. Mental illnesses in the NYC can affect everybody as they do in other cities of America. In 2005, a survey dubbed Youth risk behavior was conducted by DOHMH. Among the respondents, who were contacted, 9.6% revealed that they had attempted suicide in the past year. Depression was the main cause of all these suicide attempts among the youth. 67% of young people tried to commit suicide, and the rest (33%) was caused by all other combined factors.

The prevalence of depression and anxiety among people under 30 years is 50 % higher than among those above this age. However, experts are skeptical sometimes about children’s experience as the real depression. Therefore, the number of depression is actually higher that the given percentage as some young people lost their lives in a suicide and, hence, could not be sampled.

DOHMH has tried to reduce the recurrence of such instances in the future for a long time. It achieves this by encouraging people to seek medical advice as early as possible, once symptoms of any mental disorder appear. It also carries out massive campaigns in order to encourage and assure people that the treatment really works. This is contrary to the understanding of the majority of people, who believe that mental illnesses are fatal. DOHMH encourages procedures such as early detection through screening the right and timely medication. Specialized psychoanalysis and counseling have great potential to reverse the condition, and they are also utilized. Many people changed their lives completely due to the above intervention.

However, the recovery from mental disorders, especially depression among the youth, is not easy. It requires the patients’ self-will and responsibility. The patient has to exercise respect to instructions and utilize the offered peer support, as well. Additionally, this strategy is dependent on the patient as treatment is mostly offered through outpatient care. The patient must possess a great zeal and motivation to recover his or her health.

DOHMH understands the advantages of having a mentally healthy young generation. It also seeks the synergistic effect of partnering with various stakeholders such as families, private healthcare providers and target group in order to assist them in high quality and specialized care.  The other objectives of DOHMH are increased public awareness, reduced stigma and ensured equity in all services related to the treatment.

DOHMH also helps various support organizations with information and training in addition to treatment.  It also has a good relationship with other organizations from other states in order to improve the service delivery and also share the current trends in mental illnesses. One example of such organizations is the New York affiliate of the National Alliance on Mental Illness. Hundreds of agencies signed contracts with DOHMH in order to help people of all ages and races in different regions. Many mental illnesses are less severe when detected early and can be fully cured through outpatient care. However, this is not always the case. Though, inpatient care can also be delivered, especially when the patient is at an advanced stage. There are many tailor-made programs to cater all of these age groups (Heymann, 2000).

The Target

This paper will evaluate the effects of substance abuse on management of depression and anxiety. The main aim is to integrate and synchronize substance abuse support in the treatment of depression in the NYC for reducing both time and cost of the treatment.  Substance abuse occurs either as the cause or the effect of depression. According to the survey carried out by DOHMH in the year 2005, about 30 % of youth, who had shown symptoms of depression in the previous year, began to abuse drugs. On the other hand, research has shown that about 5% of youth in New York get depressed after discovering that they are getting hooked up to substances. Furthermore, the life of a drug addict is full of depressing episodes. This paper will also analyze the effect of incorporating the control of substance abuse in the fight against depression.

In some people, the treatment of depression and anxiety can take a short period of time of about a week. Some people get better or totally healed taking antidepressants for few weeks. On the other hand, it may take up to nine weeks of treatment for others. At this point, the problem occurs for drug addicts. Their reasoning is severely impaired, and some have problems sticking to a routine for 9 weeks. Others lack the will power on the treatment and quit altogether. In the end, a certain group views the rate of recovery as unsatisfactory. In connection with this stress, they end up abusing drugs heavily. They are left grappling with heavy addiction, which will attract depression.

Talk therapy is also severely impaired by drugs. This is a significant limitation given that it is a crucial treatment tool for depression and anxiety. Even alcohol abuse through depression has a huge potential to deter any meaningful communication between therapist and patient. In addition, it is more difficult to contact with people, who take hard drugs, during talk therapy. Drug abuse also makes some patients unable to follow up the therapy conversation.

Life of drug and alcohol abuse is miserable by itself.  There are many episodes that are brought about by drug abuse are particularly dehumanizing. For instance, an alcoholic has to deal with the attacks of hangover and retching every day. Moreover, he wakes up wondering what happened the previous night, which can be torturing. Through these and other reasons, they are unable to fulfill their daily responsibilities, which lead to dissatisfied friends and relatives. This causes recriminations of various people, who only double stress and anxiety. Drug addicts face the above facts but at a higher intensity. If drug abuse is addressed carefully and incorporated in the management of depression and anxiety among the youth, about 20% of young people can be assisted to lead a normal productive life. Substance abuse needs to be approached either as a cause or a result of depression.

Suggesting a Model for Intervention

A model, which will be recommended to help restore the mental health of many young adults and teenagers, involves the diagnosis and help for drug abuse along with depression. DOHMH in the program dubbed Take Care New York responds to depression by screening the patient using PHQ-9. PHQ-9 refers to a small questionnaire, which has nine simple questions that are administered to a person in order to determine if the person is depressed. It concludes whether the patient needs help or not. Among teens, 70% get drunk for the first time before graduating out of high school. Additionally, around 31% of them have already abused marijuana. Drugs are a major cause of depression among teens and young adults. Furthermore, it complicates the treatment of depression and anxiety to a great extent. 40% of teenagers and young adults fail to complete their treatment and or therapy of depression due to drug abuse or/and peer pressure.

Around 35% of depression in youth is directly or indirectly related to drug abuse. DOHMH has to add PHQ-9. The questionnaire, which determines whether one takes drugs, should be followed by medical assistance. This can be accompanied by diagnosis of depression, help and intervention in depression respectively. This can lead to the increased response to treatment of more than 35%.

Although DOHMH has been at the frontline promoting the use of buprenorphine to treat heroin addicts, many things need to be done for people, who are hooked to other drugs. DOHMH has led to the use of buprenorphine, in which up to 1300 people used it at the beginning of 2007. This is the great increase as there was no one using it in January, 2003 in the NYC. However, dome treats drug addiction and depression cases differently. There is a need to integrate and streamline these two services in order to create a larger synergistic effect.

Cost Analysis

Depression cost the US economy a total of $83 billion in 2003 (Greenberg, et al., 2003). These were the cumulative costs of depressed individuals, which are occasioned by the cost of treatment as well as the ability of depressed people to be engaged creatively or, otherwise, in economic production. This is a very considerable cost for the county per year. This was the estimate in the year 2003. With increasing stress factors and population, this number has increased since that time. This also excludes the human cost occasioned by factors such as the inability to relate well with other people and the loss of personal happiness. This is alarming as the statistics show that 19 % of Americans get depressed at one time or another.

The individual cost of treatment per month may be fare, but it is still very high. The cost of medication ranges from $10-70 for each person per month. For the person taking medication for 9 weeks, this may be from around 22 to 150 dollars for the whole period. This refers to the person, who is disciplined enough to take medication consistently and avoid all depressors. Drug addicts have this treatment extended or repeated as some of them never finish their medication. They usually restart the medication again and again, spending up this amount to five or ten times ($1500). This cost can also increase if they are taking another independent medical procedure to relieve drug addiction.

Synchronization of these two procedures is that, what is required now. People will have to be screened and advised on drug abuse. The necessary medication can also be given together with the medication that is offered to quit depression and anxiety. In addition, synchronization of these two procedures will reduce the instances, when depressed people abuse substances due to frustration (Hoerster et al., 2011). This will occur due to counseling and peer support for drug addicts as this process will help them identify substance abuse as the main cause of depression instead of relief.

The most important factor is that it will make depressed youth treated only one time without future repetition of the same procedure, which can help one person save up to $1350. This will also reduce the human cost paid by depressed people. Such people will have more time to engage in social and economic production, as well, and this can save a large sum of dollars for the US economy.

Source of Funding

One of the organizations that would be willing to fund and participate in the project is the Fund for Public Health in New York (FPHNY). This is a fund, which is responsible for funding most of the health programs and organizations in the New York City. Its mandate ensures that no project or program is aimed at improving of public health stalls due to lack of finance. This fund also strives to use the most sustainable means of achieving the desired results. It does this to ensure that the taxpayer will receive the best value for their money in terms of the received services. It also have a large number of projects for funding, and that is the reason why saving an extra dollar is very crucial in keeping one more program running.

FPHNY is willing to provide funds due to the great potential for savings of the above program. For years, this fund has worked in close association with the New York Health Department among other organized health groups. It is a kind of alternative for innovative health programs, which has great potential to transform public health at a reduced cost. If the above program is presented by an organized group or taken into consideration by DOHMH, FPHNY proves that it will be really sustainable and cheaper than existing alternatives.

Department of Social Development is another potential source of funding. This department works to reduce disparity in the US population. It is located in every state, as well as in the NYC. It finances the social, economic and medical programs, particularly those relating to vulnerable groups and minorities.

This project is obviously about the minority of young people. Additionally, people with mental illness and especially depressed people become vulnerable in society. This is the role of such a government department to fund any program that would alleviate their suffering in a sustainable way. Reducing the time, over which depressed people recover, will increase the amount of time they dedicate to productive activities. Moreover, the human costs that these people pay because of their condition will also be recovered.

The other reason why the Department of Social Development may be willing to fund this program is because of the nature of the program. This program will be a summary and combination of the two processes, which were conducted separately. This was very expensive, and the results were erratic. Synchronization and integration of these two processes will lead to time and money saving (up to $1350) per person. This program with such a huge potential cannot escape the notice of the Department of Social Development, which is always looking for programs that can improve the life of society.

The thesis of this paper is synchronization of substance abuse treatment and treatment of depression in the NYC. The described program is aimed at integrating the above two procedures due to their inherent, intimate relationships.  They can be viewed as an inseparable part in modern society; however, they were taken separately. This has only served to increase their cost and reduce efficacy.

The integration of these procedures on a personal level has not been possible. Hence, coordination by a health agency in-charge can help achieve this. Throughout this paper, the process of integration has been discussed. The points of overlapping mandates and repetition of similar procedures have also been identified. Thus, organization and coordination has to be centralized for the whole procedure. This also makes it very easy for patients as they will be able to acquire all the necessary services for the restoration of their minds to healthy functioning at one stop.

The cost analysis has also been done, as well as the possible sources of finance have been identified. These sources have been funding many health programs in the past and are very reliable, as a result. The person or organization conducting or supervising this program has to follow only the right channels to fund it.

In fact, it is possible to minimize these lengthy mental health procedures (including treatment of drug abuse and independent treatment of depression and anxiety) in one short procedure that is easy to manage and delivers even better results.

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