1. Mental Health

2. Brainstorm… What comes to mind when you think of mental disorders? How might you encounter clients with mental disorders in the setting you plan to work in?

3. Clarifying terms Mental Disorders Mental Health Problems/Issues Mental Illness Developmental Disability Serious and Persistent Mental Illness Others?

4. A Model for understanding etiology- BioPsychoSocial Biological factors: –neurochemical imbalances –brain injury –genetic predisposition –substance-induced, etc.

5. Psychological factors –thinking patterns –learned helplessness –defense mechanisms –trauma

6. Social factors: –Racism –Urban living –Social definitions of “normal” –etc.

7. Influences on Mental Healthcare System Decade of the Brain Managed Care Health and Mental Health Parity –1996 Federal law removing caps for mental health benefits. –2005 state law requiring full mental health parity law, for group policies of 50+ employees. Phased in 2006- 2010 –2008 - Mental Health Parity and Addiction Act (fed) Group Plans 50+ employees Equality in out of pocket costs, limits, rules/practices

8. Deinstitutionalization Introduction of psychiatric medications in the 1950s & ’60s Movement toward community –based care, Community Mental Health Act of 1963 Ability to shift cost from state to federal gov’t Civil Rights movement

9. Balancing Rights Individual rights –Right to treatment –Right to refuse treatment Protection of vulnerable people –Involuntary commitment to inpatient –Involuntary outpatient treatment –Mental Health Court Protection of community

10. Small Groups Start with a go-round: each person in the group comment on the most important point from the reading. 1. Describe two of the challenges these families are facing in trying to get the mental health needs of their family member met. 2. Discuss the emotional and interpersonal difficulties these families are struggling with. 3. What lessons can we learn about how to effectively help families dealing with mental illness, based on these cases? 4. What questions do you have about the publicly funded mental health system?

11. Issues identified in the reading Inadequate treatment funding Inadequate prevention funding System steps in only after severe deterioration in functioning –Tx is more difficult and less effective Lack of community resources

12. Mental Health Treatment Private system Publicly funded system through King County Mental Health and Chemical Dependency Services Division Nonprofit or for profit providing “pro bono” or sliding scale services

13. Agencies –Central Area Youth and Family Services –Community Psychiatric Clinic –Asian Counseling and Referral –Consejo –Sound Mental Health –NAVOS/Highline West Seattle Mental Health

14. Mental Health Court-Involuntary Commitment 72 hour hold because of: –Danger to self –Danger to others due to mental disorder –Grave disability No crime has been committed Right to a hearing

15. Mental Health Court- Misdemeanor Crimes Goals of the program: –faster case processing time –improved access to public mental health treatment services –improved well-being –reduced recidivism –Increased public safety

16. MHC, Cont. Who is served? –Misdemeanants –Serious mental illness –Voluntary participants What is involved? –Designated court team: prosecutor, defender, judge, court liaison –Court-ordered treatment –Probation with an MHC probation officer. –Range of services in community.

17. Types of treatment Biological: –medication (pharmacotherapy) –electroconvulsive shock therapy

18. Treatment, cont. Psychological: –cognitive-behavioral strategies, –psychotherapy –solution focused therapy, family therapy –group counseling

19. Treatment, cont. Psychosocial-helping cx. live a productive life with their illness: –case management –assistance with daily living skills –job coaching –supportive housing –skills training.

20. Policy Development Consider the situation of Mark Browning. Discuss the following questions and develop criteria for involuntary commitment that protects the rights of the individual, takes care of people with mental illness in need, and protects family/community.

21. 1.What behaviors, emotions or thoughts indicate that Mark is ill enough that he should be required to get treatment? 2.How much of his history should influence this decision? 3.Who should have input into this decision? Who should have the final say? 4.Write a set of guidelines for this decision making process.

22. Consider the situation of Johanna Pratt. Discuss the following questions and come up with a plan for helping her move into supportive housing.

23. 1.What are Johanna’s needs? What services will need to be provided in her new home? 2.What skills do staff in the home need to work effectively with Johanna? 3.What behaviors would suggest that supportive housing was not appropriate, that she needs more restrictive care? 4.What steps might human services staff take to systemically address the issues in this situation?