90110 pp tx_ch11
DESCRIPTION
TRANSCRIPT
![Page 1: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/1.jpg)
Community Mental Health
Chapter 11
![Page 2: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/2.jpg)
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
![Page 3: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/3.jpg)
![Page 4: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/4.jpg)
Causes of Disability for All Ages, U.S.
![Page 5: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/5.jpg)
12 month prevalence of Mental disorders18-25 years
![Page 6: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/6.jpg)
![Page 7: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/7.jpg)
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
![Page 8: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/8.jpg)
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
![Page 9: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/9.jpg)
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
![Page 10: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/10.jpg)
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
![Page 11: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/11.jpg)
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
![Page 12: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/12.jpg)
Prevalence of serious emotional disturbance in 9- to 17-year-olds
![Page 13: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/13.jpg)
![Page 14: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/14.jpg)
Stress
• General Adaptation Syndrome (GAS)
![Page 15: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/15.jpg)
![Page 16: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/16.jpg)
Stress
• Fight or flight reaction
• Diseases of adaptation
• Psychophysiologic disorders
• Avoiding stressful situations preferable to managing stress
• Stress management
• Community support
![Page 17: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/17.jpg)
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
![Page 18: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/18.jpg)
18 and 19th century treatments
![Page 19: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/19.jpg)
Shock treatment
![Page 20: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/20.jpg)
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
![Page 21: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/21.jpg)
![Page 22: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/22.jpg)
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
![Page 23: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/23.jpg)
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
![Page 24: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/24.jpg)
![Page 25: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/25.jpg)
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
![Page 26: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/26.jpg)
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
![Page 27: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/27.jpg)
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
![Page 28: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/28.jpg)
Resident patients in mental facilities state /county
![Page 29: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/29.jpg)
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
![Page 30: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/30.jpg)
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
![Page 31: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/31.jpg)
![Page 32: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/32.jpg)
Prevention
• Prevention in community mental health considered more cost-effective than treatment
• Primary
• Secondary
• Tertiary
• Preventive community mental health care services• Primary
• Secondary
• Tertiary
![Page 33: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/33.jpg)
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
![Page 34: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/34.jpg)
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
![Page 35: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/35.jpg)
Community Mental Health and Managed Care
• Focused on reducing costs of care and making sure outcomes are effective
• Behavioral health care services
• Parity
![Page 36: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/36.jpg)
1966 to 1989 community mental health facilities
![Page 37: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/37.jpg)
![Page 38: 90110 pp tx_ch11](https://reader033.vdocuments.us/reader033/viewer/2022051513/545c8892af7959b4098b47f1/html5/thumbnails/38.jpg)
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?