These slides contain the lecture content for Week 12.

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Week 12 Lecture
Instructor: Gina Crosley-Corcoran, MPH
PBH 715 – Introduction to Social &
Behavioral Sciences

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SPECIAL TOPICS:
MENTAL HEALTH AND ILLNESS

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Introduction
 This week, we begin our discussions of special topics,
beginning with mental health and illness.
 It is estimated that one-quarter of all Americans have
one of four types of mental illness at any given time.
 Serious mental illness affects approximately 6% of the
US population
 These statistics make it very evident that mental
health is a significant public health issue.
 We want to explore the issue from the perspective of
the various levels of factors which influence it.

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Definitions
Mental
health
According to the World Health Organization (2007, as
quote in Coreil, 2010), “a state of well-being in which
every individual realizes his or her own potential, can
cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a
contribution to her or his community.”
Mental
illness
Refers to any cognitive, emotional, or behavioral
disorder defined in the DSM-IV § Includes depressive
disorders, anxiety disorders, learning disorders,
psychotic disorders

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Mental Health & Illness
 Multi-factorial problem
 Each factor explains only a small percentage of
mental illness.
 Not only is the presence of mental illness
multifactorial, the ability and/or decision to seek
treatment is as well.
 Factors at one level may/do influence factors present
at other levels – the levels are not “isolated” in their
influence.

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Intrapersonal-Level Factors
 Factors influencing mental illness
 Age, gender, genetics, biology, congenital conditions, and
behavior
 Factors influencing care seeking for mental illness as
well as compliance with treatment regimens
 Embarrassment
 Feelings that seeking help is a sign of weakness
 Mistrust of mental health professionals
 Early treatment and good compliance increase
likelihood of successful treatment.

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Intrapersonal-Level Factors
Universal prevention
• Most costly and
least cost-effective
as it is aimed at the
entire population
• May help to reduce
stigma and thereby
decrease illness
Selective prevention
• Focuses on those
who have a risk
factor for mental
illness but have not
yet had a problem
• Programs that
provide coping
skills for those who
have a mentally ill
family member
Indicated prevention
• Designed to
prevent mental
illness in those who
have some
symptoms of but
have not yet
developed mental
illness
• Targets high risk
populations
The Institute of Medicine has suggested three categories of primary
prevention for mental illness:

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Intrapersonal-Level Factors
Secondary
prevention
Pharmacotherapy
Psychotherapy
Tertiary
prevention
Reduction of disability,
impairment, or
handicap > improved
quality of life
Exercise programs for
those with a diagnosis
of mental illness

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Interpersonal-Level Factors
 Social networks and social support
 Large social networks and high rates of perceived
social support can help prevent mental health
problems
 Care-seeking and compliance are also affected by
social networks, support, integration, as well as the
relationship with the treatment provider

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Interpersonal-Level Factors
Secondary
prevention
Focuses on building
relationships and
ensuring a good
support structure
ROSE Program
(post-partum
depression)
Tertiary
prevention
Group therapy
Couples or family
therapy
Multi-systemic
therapy (anti-social
behavior in youth)

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Organizational-Level and
Institutional-Level Factors
•Job-related stress and job strain
•Provision (or not) of healthcare coverage, EAP, sick leave
•Stress reduction or management programs
Workplace
•About half of youth who receive mental health care enter through school system
•In part, because some disorders (ODD, ADHD) can cause great disruption in the
classroom
Schools
•Availability and cost of psychiatric medications
Pharmaceutical industry (societal-level as well)
•Medical system (societal-level as well) § Lack of training for PCPs in identifying mental
illness
Direct marketing of drugs to consumers (i.e. commercials, ads)

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Neighborhood-Level and
Community-Level Factors
Physical characteristics of
neighborhoods may lead to
poorer mental health
• May be result of exposures
like lead
• Physical environment may
lead to feelings of low self-
worth, lack of hope for the
future
Social aspects of
neighborhoods
• Social isolation
• Social norms around mental
health care
• Stigma
• Linkages between faith-based
organizations and mental
health services
• Difficulty in entering the
mental health services system

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Societal-Level Factors
 Policy
 National Institute of Mental Health was created in 1946
 Community Mental Health Centers Act in 1963
 Medicare and Medicaid in 1965
 Full mental health parity (equality in coverage) has still not
been achieved
 Medical care system
 Pharmaceutical industry

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Week 12 Assignment
Discussion Board
Extra Credit Due in Week 13
Read Mud Creek Medicine for
Week 14 Live Discussion