MENTAL HEALTH CARE POLICY

Liz Wolf & Brian Kelly

Legal Definition

: Current definition of mental disability according to Social Security: “For all individuals applying for disability benefits under title II, and for adults

applying under title XVI, the definition of disability is the same. The law defines disability

as the inability to engage in any substantial gainful activity (SGA) by reason of any medically

determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12

months” (Disability).

Statistics of Mental illness in America and Internationally 26.2 percent of Americans ages 18 and

older ,about one in four adults — suffer from a diagnosable mental disorder in a given year.

In the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people.

But the main burden of illness is concentrated in a much smaller proportion, about 6 percent, 1 in 17 that suffer from a serious mental illness

Prevalence of Mental illness Mental disorders are the leading

cause of disability in the U.S. Numerous people suffer from more than one mental disorder at a given time in their life. Nearly half ,45 percent, people with any mental disorder meet the criteria for 2 or more disorders. The severity is strongly connected to the simultaneous appearance of two or more psychiatric or physical illnesse.

Who and What age do Mental Illnesses affect people

Mood Disorders: The average age of onset is 30 years

Major Depressive Disorder: Major depressive disorder can cultivate at any age, the average age at onset is 32. More women than in men are diagnosed with this disorder.

Dysthymic Disorder: The average age of onset is 31.

Bipolar Disorders: average age of onset for is 25 years.

Suicide: About90 percent of people who kill themselves have a diagnosable mental disorder. It is most common in depressive disorder or substance abuse disorder. The main suicide rates in the U.S. are in white men over age 85. More men as opposed to women die by suicide; but, more women attempt suicide.

Schizophrenia: Affects men and women with equal number of occurrence's. Usually first emerges in men in their late teens or early twenties, and in women their twenties or early thirties.

Anxiety Disorders: Generally co-occur with depressive disorders and/or substance abuse. People usually have their first occurrence around 21.

Eating Disorders: Women are more likely than males to cultivate an eating disorder

ADHD: Mainly a common mental disorders in children and adolescent. The average age of onset is seven years, even though the disorder can continue into adolescence and sometimes into adulthood.

Autism/ Spectrum Disorders (Pervasive Developmental Disorders): Range in severity, autism is the most devastating. Often occurs at age 8, and affects about 1 in 110. Is more common in boys than girls, but girls with autism have a tendency to to have more severe symptoms and larger cognitive impairment. Children are usually diagnosed by 3.

Personality Disorders: "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” (Mental Illness in America). These disorders affect day-to-day life in destructive ways., onset is usually around 18 and over.

Ways People with Mental Illnesses are affected in their Daily Lives

Each type of mental disorder has different symptoms, which affect each individual differently, but what they do have in common is each one needs treatment to maintain the symptoms.

Treatments include: * Medication management- which requires monthly or twice

monthly visits. * Therapy- requires once or more visits weeklyProblems people with mental disorders encounter:* Getting good insurance or getting health insurance at all. If the person was diagnosed before they acquire new health insurance, pre-existing conditions; which makes them, what health insurance companies call high-risk individuals. Therefore the health insurance companies will deny you insurance. * Paying for everything is very expensive that most individuals cannot afford to keep up treatment and their disorder becomes disabling to them.

Mental Illness and how it Impacts on Society Media coverage on mental illnesses has an influential role

on how it impacts society, it can either be negative or beneficial. *Negative influence: creates generalizations, images,

ideas, assumptions, stigma, stereotypes (such as the association of mental illness and violence), can make the public distant themselves from people that suffer from mental disorders, and it defines the publics definition of what an mental illness is.

* Beneficial influence: instead of ignoring mental illnesses people can become more aware and informed about them, instead of isolating people with mental illnesses. It can give the public factual information.

* Mental illness is still portrayed as stigmatizing and shameful.

Mental Health Stigma

The stigma of mental health is a prevalent problem.

Some people believe that people with mental illnesses will not recover and are to blame for there problems.

In 1999 the US Surgeon General stated, “ Powerful and pervasive, stigma prevents people from acknowledging their own mental problems, much less disclosing them to others” (mental disorders).

People with mental disorders are victimized by not being able to get employment.

The clergy frequently deny or dismiss the actuality of mental illness.

Stigma

The public have been found to have a stereotypical and dangerous attitude towards mental illness and causes the public to distance themselves from people with mental illnesses, people find that people with mental illnesses will do something violent when the opposite is the case, people with mental illness are often the victims of violence.

Stigma and discrimination Have led to many social movement

and campaigns for change.

Leading events to mental health policy Ancient civilizations: described and treated

a variety of mental illness. The Greeks came up with the terms; melancholy, hysteria, and phobia. Also developed the Humorism Theory.

The Medieval Islamic world (8th century): were the first to develop psychiatric hospitals.

The Middle Ages/ Christian Europe: The origin of madness came about. People with mental disorders were victims of witch hunts, and were admitted to local workhouses, jails, and private madhouses.

Leading events continued Eighteenth century: Madness was seen as

organic and physical occurrence and had no connection to the soul or moral accountability. People with mental illnesses were put in asylums and were treated severe and like they were wild animals. By the end of the 18th century there was a moral treatment of the mentally ill movement.

Nineteenth century: There was a enormous growth of size and number of asylums.

Leading events continued Twentieth century: There was a swift in

names; asylums inmates were now called patient's and the asylums were now called hospitals. There was also a mental hygiene movement that designed at preventing mental illnesses from occurring. moral treatment” “Re-socialize” the patients

* World War II: There was the development of the a psychiatric manual for classifying mental disorders; the DSM and the ICD were developed.

Leading events continued In the 1900’s the emergence of Freudian psychiatry and

psychoanalysis Recognition of the influence of the social environment

on behavior Recognition of somatic (organic) origins of mental illness 1930s – electric shock and lobotomy Growing population of mentally ill in hospitals (by 1950,

every other bed) 1950s – introduction of psychotropic drugs that relieved

anxiety and psychiatric symptoms Success of new drugs in treating the chronically

mentally ill Convergence of physiological and psychosocial theories

of mental illness Media coverage and expose of mental hospitals

Mental Health Policies

1946: Hospital Survey and Construction Act (Hill-Burton Act) Provided funds for building hospitals aimed at increasing

availability of health services Mental Health Act of 1946

Created funding for research, training, and development of pilot project community clinics

Establishment of NIMH and National Advisory Mental Health Council

Employer-subsidized health insurance became popular during WWII due to policies excluding them from taxes

1963 – Community Mental Health Centers Act Created grants to states for constructing CMHCs and set a

goal of reducing the number of patients in custodial care by 50% in the next decade

Enlightened public opinion Civil rights movement De-stigmatization of mental illness mentally ill

Mental Health Policies Continued

1963 – Community Mental Health Centers Act Created grants to states for constructing CMHCs and set a goal

of reducing the number of patients in custodial care by 50% in the next decade

Enlightened public opinion Civil rights movement De-stigmatization of mental illness

Baker Act (1971): A person may be taken to a receiving facility for involuntary

examination if there is reason to believe that he or she is mentally ill and because of his or her mental illness: (a)1.  The person has refused voluntary

examination after conscientious explanation and disclosure of the purpose of the examination; or

2.  The person is unable to determine for himself or herself whether examination is necessary; and

Mental Health Policies continued

(b)1.  Without care or treatment, the person is likely to suffer from neglect or refuse to care for himself or herself; such neglect or refusal poses a real and present threat of substantial harm to his or her well-being; and it is not apparent that such harm may be avoided through the help of willing family members or friends or the provision of other services; or

2.  There is a substantial likelihood that without care or treatment the person will cause serious bodily harm to himself or herself or others in the near future, as evidenced by recent behavior.

A patient shall be examined by a physician or clinical psychologist within 72 hours.

  A petition for involuntary placement shall be filed in the appropriate court by the facility administrator when treatment is deemed necessary; in which case, the least restrictive treatment consistent with the optimum improvement of the patient's condition shall be made available.

Mental Health Policies continued

1975, amendments added services for children & elderly, transitional and follow-up care for those

discharged from hospitals, Drug and alcohol abuse services

ADAMH block grants (1981) Gave states lump sum monies to be

used for alcohol, drug abuse, and mental health services

1980s – coordination, case management, and multidisciplinary teams

Mental Health Policies contiued

Compulsory admission to mental health faciilities ( involuntary commitment/ sectioning): 2 views on this law/ policy:

1.) It takes away the persons personal liberty and right to choose

2.) It can theoretically prevent harm to self and others.

Grounds for involuntary commitment: immediate or imminent danger to self or others.

Mental Health Policy Continued

Proxy Consent (substituted decision making): Patients may be given a private representative, usually a family member or legal guardian to make the decision on how the patient will be treated.

Protection of persons with mental illness and Improvement of mental health care: 1991, the United Nations implemented this act. This improves the rights and opportunities of people with disabilities/ psychosocial disabilities.

Mental Health Parity: The passage of mental health parity is a tremendous victory for millions of Americans who have been unable to gain mental health care because of insurance discrimination.

Deinstitutionalization

In the 1960’s there was a progressive movement to move the mentally ill from institutions to community health services offered in the community.

YouTube on History of Asylums http://www.youtube.com/watch?v=z26aOVbb3QE

Currently Defined As

Mental disorders/ illness is a psychological and/ or behavioral model that causes the individual distress or disability, that is not apart of normal culture.

The causes of mental disorders use the diathesis- stress model or the biopsychosocial model.

Mental health providers believe that it is a genetic and environmental cause today.

Treatment options

Medications Psychotherapy

1.) Cognitive Behavioral Therapy 2.) Psychoanalysis 3.) Systemic therapy/ family therapyMost Mental Health Professionals use an integrative approach to treating their patients. The approach they use is dependent on the severity and the patient’s history.

Rights of Mental Patients Mental patients have the right to considerate

and respectful care, right to know hospital rules and regulations relating to patient conduct

right to know the identity of the physician in charge of care

sufficient information to enable patients to make informed decisions with respect to their treatment, the right to obtain information concerning diagnosis and treatment as well as prognosis if medically advisable

the right not to be a subject of experiment, the confidentiality of clinical records, and the right to receive an explanation of the hospital bill

References

Social Security. (2010). Retrieved September 20, 2010 from Disability: http://www.socialsecurity.gov/ disability/ professionals/ bluebook/ ge neral-info.htm.

Wikipedia. (2010). Retrieved September 20, 2010 from Mental Health Care Policy: http://en.wikipedia.org/ wiki/

mental_disorder#laws_and_policies. Statistics. (2009). Retrieved September 25, 2010 from

International Institute of Mental Health: http://www.nimh.nih.gov/ health/ topics/ statistics/ index.shtml.

Mental Disorders in America. (2009). Retrieved September 25, 2010 from National Institute of Mental Health http://www.nimh.nih.gov/ health/ publications/ the-numbers-count-mental-disorders-in-america/ index.shtml.

Patients Rights. (2006). Retrieved September 27, 2010 from Patients Rights: http://www.answers.com/ topic/ patients- rights-1.

Mental Illness In America. (2009). Retrieved September 28, 2010 from Mental Health Parity Act: http://www.healthieryou.com/ amer.html.