COMMUNITY MENTAL HEALTH

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.

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

Classification of Mental Disorders Diagnostic and Statistical Manual of Mental Disorders, fourth addition http://www.psychologynet.org/dsm.html Anxiety Disorders Childhood Disorders Eating Disorders Mood Disorders Personality Disorders Psychotic Disorders Substance-Related Disorders Other Disorders

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

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

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 15-24 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

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

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

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

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

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

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

Deinstitutionalization Discharging of patients from state hospitals and the relocating them in less crowded community settings In 1955 558,922 resident patients In 1970 337,619 resident patients In 1980 150,000 resident patients In 1990 110,000 resident patients

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

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