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.

12 month prevalence of Mental disorders18-25 years

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

Prevalence of serious emotional disturbance in 9- to 17-year-olds

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

18 and 19th century treatments

Shock treatment

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

Resident patients in mental facilities state /county

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

1966 to 1989 community mental health facilities

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?