1. COMMUNITY MENTAL HEALTH

2. What is Mental Health?
The emotional and social well-being of an individual, including one’s psychological resources for dealing with the day-to-day problems of life.

3. Good Mental Health is the Ability to:
Function under adversity
Change or adapt to changes
Maintain control over one’s tension and anxiety
Find more satisfaction in giving than receiving
Show consideration for others
Curb hate and guild
Love others

4. Classification of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders, fourth addition
Anxiety Disorders
Childhood Disorders
Eating Disorders
Mood Disorders
Personality Disorders
Psychotic Disorders
Substance-Related Disorders
Other Disorders

5. Causes of Mental Disorders
Birth Defects
Inherited mental deficiency
Biologically caused mental retardation
Physical Impairment
Neurotransmitter failures related to psychotic episodes at puberty
Brain trauma due to accident
Psychological Causes
Being reared in economically deprived conditions
Parental abuse

6. Mental Illness in America
Four to five million adults have serious mental illness (SMI)
15.4% of the U.S. population 18 and older have had one incident of mental illness in the past 30 days
18.2 adults per 1,000 had experienced an episode of SMI in the past year

7. Social Indicators of Mental Illness
There are approximate 30,000 suicides in the U.S. yearly
In 1991 the number 2 and number 3 leading cause of death among year olds was homicide
In 1990 the divorce rate (4.7/1,000) was nearly half the marriage rate (9.8/1,000)
4.5 million women of childbearing age were current users of illegal substances
1,383 children died from abuse or neglect in 1991

8. Stress: A Contemporary Mental Health Problem
Stress is one’s psychological and physiological response to stressors
General Adaptation Syndrome (GAS) A three stage response to stressors
Alarm reaction
Resistance
Exhaustion
Fight or Flight

9. Mental Health in America Before World War I
Care provided by families or private caretakers
Those not cared for in the home were sent to the poor houses or almshouses
In the late 19th century as the number of people increased in the poor houses and almshouses attempts were made to separate people by type of disability
In 1851 Dr. Thomas Bond visited the famous Bedlam Hospital in England and founded Pennsylvania Hospital the first institution in America for the care of the mentally ill.
Blood letting
Blistering
Emetics
Warm and cold baths

10. The Moral Treatment Era for the Well-To-Do
William Tuke, and English Quaker, established moral treatment
Mental illness was caused by:
Infidelity
Being overworked
Envy
Gluttony
Drinking
Sexual excesses
Treated in an asylum with:
Rest
Light food
Exercise
Fresh air
Amusements

11. The State Hospitals
Institutions became a place for those society did not want to have around
Prisoners
Orphans
Wayward youths
The mentally ill
The rationalization was that with small numbers of patients proper care could be provided
The numbers of patients grew very rapidly
In time the institutions became human warehouses

12. The Mental Hygiene Movement
Occurred during the first few decades of the twentieth century
Believed that early detection treatment was key to curing mental illness
Wanted to address the problem at a community level
Established local mental hospitals (Bellevue in NY)
This movement did nothing to address the State Hospital problem
By the 1940s state mental institutions had grown to nearly a half-million

13. Mental Health Care After World War II
Psychiatrists came out of the war with new techniques called crisis management
In 1946 the National Institute of Mental Health was formed
Fostered research
Supported training
Improved clinical services

14. Deinstitutionalization
Discharging of patients from state hospitals and the relocating them in less crowded community settings
In ,922 resident patients
In ,619 resident patients
In ,000 resident patients
In ,000 resident patients

15. Deinstitutionalization Forces
Economics
States needed money for roads, education and welfare
There was a new profit motive to provide services for the mentally ill
Idealism: Keep people out of institutions
Legal considerations
Federal Legislation: Aid to the Permanently and Totally Disabled (APTD)
Welfare money could now be paid to discharged mental patients
Antipsychotic drugs
Chlorpromazine
Thorazine

16. Community Mental Health Centers
A Presidential commission recommended replacing all mental hospitals with community based mental health centers (1961)
Seen as secondary and tertiary prevention
The federal government became partially responsible for mental health care in the U.S.
Reduced budgets during the Regan years left community mental health centers understaffed and under utilized