Chapter 21 Community Mental HealthCopyright © 2020 Wo

Chapter 21: Community
Mental Health
Copyright © 2020 Wolters Kluwer · All Rights Reserved
Chapter Highlights
Epidemiology of mental illness from a public health perspective
Early intervention in the treatment of schizophrenia
Strategies to enhance treatment adherence
Public health implications for children with behavioral
disorders
Evolution of community mental health
Policy development and legislation for mental health services
Role and responsibilities of the community mental health
practitioner
Question #1
Is the following statement true or false?
Genetic, biologic, and environmental risk factors all influence
the incidence of mental illness.
Answer to Question #1
True

Rationale: Genetic, biologic, and environmental risk factors all
influence the incidence of mental illness. Early intervention can
minimize the morbidity associated with mental illness.
Cultural Context of Mental Illness
Genetic, biologic, and environmental risk factors all influence
the incidence of mental illness.
Mental health and, conversely, mental illness are concepts
bound by culture.
Understanding of what connotes mental health is shaped by
social norms that evolve from generation to generation.
Definitions of Mental Health
No universally accepted definition of mental health; for
practical purposes, widely accepted parameters for what
behaviors connote psychopathology must be used to measure
Incidence
Morbidity
Mortality
Scope of Mental Illness
There is no difference in lifetime prevalence rates of major
mental illness between developed and developing countries.
The projected lifetime risk of developing a major mental illness

is highest in countries where the population is subject to
sustained violence.
Psychiatric disorders are the leading cause of disability
worldwide.
Question #2
Rationale: Adherence to psychopharmacology and
psychotherapy does not enhance recovery from mental illness.
False
Rationale: Adherence to psychopharmacology and
psychotherapy enhances recovery from mental illness.
Schizophrenia
Epidemiology
Early intervention programs for first‐ episode psychosis
Primary prevention programs
Enhancing treatment adherence in schizophrenia
Role of community mental health teams in treatment of
schizophrenia

Epidemiology of Schizophrenia
About 1% of the world’s population suffers from schizophrenia.
Symptoms of schizophrenia typically first appear in late
adolescence or young adulthood and persist throughout a
person’s life, causing significant impairment in all aspects of a
person’s psychosocial functioning.
Early Intervention Programs for First‐ Episode Psychosis
Early intervention programs—specialized teams of professionals
whose primary goal is to maintain the individual’s current level
of educational and vocational functioning through early
treatment
Enhancing Treatment Adherence in Schizophrenia
Nonadherence to medication is the most common factor
associated with relapse and recurrence of psychotic symptoms
Nursing interventions to enhance medication adherence
applicable to those with chronic mental illness
High‐ Risk Populations
The unemployed, the poor, and the homeless all report higher

levels of depression, anxiety, schizophrenia, and substance
abuse than do the general population.
The number of mentally ill clients who are homeless has
steadily increased in the United States as state governments
embarked on a systematic plan to “deinstitutionalize” the
mentally ill.
Role of Community Mental Health Teams in Treatment of
Schizophrenia
Respite services, day treatment facilities, and sheltered
workshops are a few of the outpatient services that help
alleviate the daily burden of care for families.
To address these shortcomings in the delivery of care,
community mental health teams coordinate both the
psychosocial and the psychopharmacological needs.
Mood and Anxiety Disorders
Epidemiology
Social factors
Biologic theories of depression and anxiety
Nursing interventions
Attention‐ Deficit/Hyperactivity Disorders and Emotional

Disorders in Children
The main characteristics that help healthcare practitioners,
including school nurses, differentiate ADHD from bipolar
disorder are the pervasiveness of the symptoms and the
predominant symptoms.
The Precipitous Rise in Autism—A Public Health Crisis
Long‐ term outcomes of children with autism are improved with
early identification and treatment.
Screening tools for autism have been developed, but most are
for use in toddlers and not in infants.
Screening for prodromal symptoms in infancy; some of the more
debilitating features of the disorder might be mitigated with
early intervention and treatment.
Question #3
Public health initiatives to educate communities about mental
health can be effective in lowering the incidence of high‐ risk
behaviors such as alcoholism.
False
Rationale: Public health initiatives to educate communities

about mental health can be effective in lowering the incidence
of high‐ risk behaviors such as suicide.
Evolution of Community Mental Health #1
Community‐ based treatment of the mentally ill gained
momentum as World War II veterans returned home exhibiting
the symptoms of posttraumatic stress disorder.
Aided by advances in the development of pharmacologic
treatment of the mentally ill, the numbers of patients treated in
state mental hospitals precipitously declined.
The continuum of care for the chronically mentally ill includes
community services, such as supportive housing and
employment.
Evolution of Community Mental Health #2
Since deinstitutionalization began, there has been an outcry of
frustration from nurses in the community about the lack of
supportive services to meet the needs of people with chronic
mental illness.
Public health initiatives to educate communities about mental
health can be effective in lowering the incidence of high‐ risk
behaviors such as suicide.
Question #4

The continuum of care for the chronically mentally ill includes
community services, such as supportive housing and
employment.
True
Rationale: The continuum of care for the chronically mentally
ill includes community services, such as supportive housing and
employment.
Legislation for Parity in Mental Health Insurance Benefits
All health insurance coverage, including deductibles, copays,
coinsurance, and out‐ of‐ pocket expenses, as well as all
treatment limitations, including frequency of treatment, number
of visits, days of coverage, or other similar limits, will be the
same regardless of health need or diagnosis.
Role and Responsibilities of the Community Mental Health
Practitioner
Teacher
Clinician
Advocate

Psychological First Aid
Populations traumatized by disasters
Populations at risk for psychological trauma
Psychological first aid is recommended to help support
survivors and first responders to natural and intentional
disasters.

Chapter 21 Community Mental HealthCopyright © 2020 Wo

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