Community Mental Health

Chapter 11

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

Causes of Disability for All Ages, U.S.

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

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

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

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

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

Stress

• General Adaptation Syndrome (GAS)

Stress

• Fight or flight reaction

• Diseases of adaptation

• Psychophysiologic disorders

• Avoiding stressful situations preferable to managing stress

• Stress management

• Community support

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

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

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

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

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

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

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

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

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

Prevention

• Prevention in community mental health considered more cost-effective than treatment

• Primary

• Secondary

• Tertiary

• Preventive community mental health care services• Primary

• Secondary

• Tertiary

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

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

Community Mental Health and Managed Care

• Focused on reducing costs of care and making sure outcomes are effective

• Behavioral health care services

• Parity

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?