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Ch11 outline
- 1. Community Mental Health Chapter 11
- 2. Introduction • Mental illness is the leading cause of disability in North America and Europe • ~26% of American adults have diagnosable mental or addictive disorders during a given year • 6% of adults in U.S. have serious mental illness • Needs of people with mental illnesses diverse • ~ ½ of people with mental illness have more than one disorder
- 3. Causes of Disability for All Ages, U.S.
- 4. Definitions • Mental health • Emotional and social well-being; psychological resources for dealing with day-to-day problems of life • Mental illness • all diagnosable mental disorders • Mental disorders • Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning
- 5. Good Mental Health • Adults with good mental health are able to: • Function under adversity • Change or adapt to changes around them • Maintain control over their tension and anxiety • Find more satisfaction in giving than receiving • Show consideration for others • Curb hate and guilt • Love others
- 6. Classification of Mental Disorders • Classification of mental disorders arbitrary because based on descriptions of behavioral signs and symptoms rather than clinical measurements • Diagnostic and Statistical Manual of Mental Disorders, 4th edition, by the American Psychiatric Association • Most influential book in mental health
- 7. Causes of Mental Disorders • Symptoms can arise from various causes: • Poor prenatal care, postnatal environment, genetics, environmental factors, brain function impairment, substance abuse, maladaptive family functioning • PTSD • Major Depression
- 8. Mental Illness in America • Mental illness one of most pervasive health problems in U.S. • Homicide and suicide #2 and #3 causes of death in 15-24 age group; associated with mood disorders • High rates of alcohol, tobacco, and other drugs use for coping with life’s problems another social indicator of mental illness
- 9. Stress • General Adaptation Syndrome (GAS)
- 10. Stress • Fight or flight reaction • Diseases of adaptation • Psychophysiologic disorders • Avoiding stressful situations preferable to managing stress • Stress management • Community support
- 11. History of Mental Health Care in America • Collective response to mental illness has been cyclic in the U.S. • Periods of enthusiastic reform and periods of national ambivalence
- 12. Mental Health Care before World War II • Colonial America mentally ill were cared for by families or private caretakers • Institutionalization first appeared in 18 th century • Population growth led to institution growth • Harsh treatments and unpleasant conditions
- 13. The Moral Treatment Era • Began in 1792 • Belief that environmental changes can affect the mind and alter behavior • Move people from settings causing life stressors into rural, peaceful setting • Appeared to have success and became widely acceptable
- 14. The State Hospitals • Dorothea Dix advocated for public hospitals providing decent care for indigents with mental illness • State hospitals built, but deterioration of services occurred as chronic nature of mental illness was discovered; long term or lifetime stays were the norm • Capacities quickly reached; personalized care lost; restraints became more practical; staff turnover high
- 15. The State Hospitals • 1940, population in state mental institutions was nearly a half million; many elderly • Electroconvulsive Therapy (ECT) introduced in 1939; still used today • Lobotomies practiced
- 16. Mental Health Care after World War II • NIMH established • Deinstitutionalization from state hospitals propelled by economics, idealism, legal considerations, and antipsychotic drugs • Community mental health centers - fully staffed centers originally funded by the federal government providing comprehensive mental health services to local populations
- 17. Mental Health Care Concerns Today • Experiences of people with serious mental illness has improved significantly in past 50 years • Challenges remain: • How to provide services to the homeless • Resolving problems of those with mental illness who are incarcerated
- 18. Homelessness • 2.1 million adults experience homelessness over the course of a year • 80% temporarily homeless, 10% episodically homeless, 10% chronically homeless • About half of all homeless adults have substance use disorders • Many have major depression and other co- occurring mental illness
- 19. Jails and Prisons • People with serious mental illness perpetrate more violence than others • 35% of people with mental illness are victimized by violence • More than half of all prison and jail inmates have mental health problems • Once released back into community, more likely to commit crime if untreated
- 21. Prevention • Prevention in community mental health considered more cost-effective than treatment • Primary • Secondary • Tertiary • Preventive community mental health care services • Primary • Secondary • Tertiary
- 22. Treatment • Treatment approaches • Goals to reduce symptoms, improve personal and social functioning, develop and strengthen coping skills, promote behaviors that make a person’s life better • Psychotherapy • Psychopharmacology • Psychiatric rehabilitation • Self-help groups
- 23. Federal Initiatives for Mental Health Care • Most federal support has been for research, surveillance, and goal setting; less support for prevention, early intervention, and treatment • Achieving the Promise: Transforming Mental Health Care in America • Medicaid spending and mental health concerns
- 24. Community Mental Health and Managed Care • Focused on reducing costs of care and making sure outcomes are effective • Behavioral health care services • Parity
- 25. Discussion Questions • How can community mental health centers work to reach 100% of their territory in need? • What role can schools play in supporting mental health in children and adolescents?