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90110 pp tx_ch11



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  • 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. 12 month prevalence of Mental disorders 18-25 years
  • 5. 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
  • 6. 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
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. Prevalence of serious emotional disturbance in 9- to 17-year-olds
  • 11. Stress• General Adaptation Syndrome (GAS)
  • 12. Stress• Fight or flight reaction• Diseases of adaptation• Psychophysiologic disorders• Avoiding stressful situations preferable to managing stress• Stress management• Community support
  • 13. 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
  • 14. 18 and 19th century treatments
  • 15. Shock treatment
  • 16. Mental Health Care before World War II• Colonial America mentally ill were cared for by families or private caretakers• Institutionalization first appeared in 18th century• Population growth led to institution growth • Harsh treatments and unpleasant conditions
  • 17. 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
  • 18. 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
  • 19. 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
  • 20. 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
  • 21. 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
  • 22. Resident patients in mental facilities state /county
  • 23. 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
  • 24. 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
  • 25. Prevention• Prevention in community mental health considered more cost-effective than treatment • Primary • Secondary • Tertiary• Preventive community mental health care services • Primary • Secondary • Tertiary
  • 26. 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
  • 27. 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
  • 28. Community Mental Health and Managed Care• Focused on reducing costs of care and making sure outcomes are effective• Behavioral health care services• Parity
  • 29. 1966 to 1989 community mental health facilities
  • 30. 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?