1. Chapter 11 Community Mental Health

2. Introduction
Mental illness – leading cause of disability in North America and Europe
~20% of American adults have diagnosable mental disorders during a given year
Only 38% receive treatment
Needs of people with mental illnesses diverse
Services required to meet needs include therapeutic and social services

3. Causes of Disability for All Ages

4. Definitions Mental health Mental illness Mental disorders
all diagnosable mental disorders
Mental disorders
Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning

5. 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

6. Classification of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
Published by American Psychiatric Association
Most influential book in mental health
Classifies disorders based on behavioral signs and symptoms rather than definitive tests or measurements of brain or another body system
Challenges to diagnosis include comorbidity and lack of cultural competence

7. 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, stress
PTSD

8. Stress: A Contemporary Mental Health Problem
Stress – one’s psychological and physiological response to stressors
Stressors
General adaptation syndrome
Fight or flight reaction
Diseases of adaptation
Experts recommend combination of physical, social, environmental, and psychological approaches to managing stress

9. General Adaptation Syndrome

10. Mental Illness in the United States
One of nation’s most pervasive health problems
Indicators of mental illness problem in U.S.
More people die of suicides than car accidents
High rates of alcohol, tobacco, and other drug use

11. History of Mental Health Care in the United States
Response to mental illness characterized by periods of enthusiastic reform followed by periods of widespread ambivalence

12. Mental Health Care before World War II
Colonial America – people with mental illness cared for by families or private caretakers
Institutionalization first appeared in 18th century
Population growth led to institution growth
Harsh treatments and unpleasant conditions

13. 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

14. The State Hospitals
Supposed to provide therapeutic environment, based on close personal relationships between patients and well-trained staff
Deterioration of services occurred as chronic nature of mental illness was discovered; long term or lifetime stays were the norm
Maximum capacities quickly reached; personalized care lost; restraints became more practical; staff turnover high

15. The State Hospitals
1940, population in state mental institutions was nearly a half million
Staff case loads so large, only subsistence care possible
Electroconvulsive Therapy (ECT) introduced in response
Lobotomies practiced
Appearance of new medications in 1950s made widespread use unnecessary

16. Mental Health Care after World War II
National Institute of Mental Health (NIMH) established
To foster and aid research related to cause, diagnosis, and treatment of neuropsychiatric disorders
To provide training and award fellowships and grants for work in mental health
To aid states in the prevention, diagnosis, and treatment of neuropsychiatric disorders

17. Deinstitutionalization
Deinstitutionalization – discharging of thousands of patients from state mental hospitals
Propelled by economics, idealism, legal considerations, and antipsychotic drugs

18. Community Mental Health Centers
Mental Retardation Facilities and Community Mental Health Centers Act
Community mental health centers – fully staffed centers originally funded by the federal government providing comprehensive mental health services to local populations
Five core services
Problem of transinstitutionalization
Community Support Program

19. Mental Health Care Concerns in the United States Today
Experiences of people with serious mental illness has improved significantly in past 50 years
Challenges remain:
How to provide services to the homeless
Changing perception that mental illness is linked to extreme violence
Resolving problems of those with mental illness who are incarcerated

20. 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, major depression and other co-occurring mental illness
Successful interventions include provision of housing and services they need

21. Mental Illness and Violence
Extreme violence relatively rare in people with mental disorders
Much of risk attributable to comorbid factors
What should be done to prevent violence is unclear
Constitutional issues related to individual freedoms, privacy and other rights

22. Mental Health Care in Jails and Prisons
More than half of all prison and jail inmates have mental health problems
Correctional facilities designed to confine and punish, not to treat disease
Lack space, adequate number of qualified treatment personnel, and timely access to services
Once released back into community, more likely to commit crime if untreated

23. Prevention
Primary, secondary, and tertiary prevention applicable to mental disorders
Primary – reduces incidence of mental illness and related problems
Secondary – reduces prevalence by shortening duration of episodes
Tertiary – treatment and rehabilitation

24. Treatment Approaches Goals of treatment of mental disorders
To reduce symptoms
To improve personal and social functioning
To develop and strengthen coping skills
To promote behaviors that make a person’s life better

25. Psychopharmacology
Psychopharmacological therapy – treatment with medications
Conditions for which medications exist include: schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and obsessive-compulsive disorder
Other biomedical therapy – ECT

26. Psychotherapy Psychotherapy – treatment through verbal communication
Numerous approaches
Cognitive-behavioral therapy
More likely to be successful in less severe cases or when used in conjunction with other approaches

27. Technology
Use of technology in treatment via telephone, video conferencing, internet, , computer software
Benefits
Delivers flexible help directly to clients’ living environments
Lowers cost to patient
Increases privacy of patient
May reduce feelings of coerciveness

28. Psychiatric Rehabilitation
Primary objective is most often recovery rather than cure
Psychiatric Rehabilitation – current recovery-oriented services
Service include medication, therapy, adaptive skills, changing environment through accommodations at work or school
Practices must be evidence-based

29. Self-Help Groups
Self-help groups –concerned members of the community who are united by a shared interest, concern, or deficit not shared by other members of the community
National Alliance on Mental Illness (NAMI)

30. Challenges Facing Mental Health Care in the United States
Multiple services needed
Staff turnover relatively high
System is decentralized and fragmented
Lack of licensed providers in rural and low-income counties
Lack of cultural competence among providers

31. Government Policies and Mental Health Care
Following deinstitutionalization, government’s role in funding and policy became substantial
Medicaid
Mental Health Parity and Addiction Act of 2008
Parity – concept of equality in health care coverage for people with mental illness and those with other medical issues or injuries

32. The Affordable Care Act of 2010
Medicaid coverage for individuals with mental disorders grew
Individuals with mental disorders disproportionately benefit from coverage expansions
They tend to have lower incomes and less like to be insured
Communities may lack infrastructure to adequately meet needs of newly insured

33. 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?