Community Health Ch. 11

What were the forces that propelled the building up of deinstitutionalization for half a century: (4)

1.) Economics 2.) Idealism 3.) Legal considerations 4.) The development and marketing of anti-psychotic drugs

What are some challenges (3) that CMHC face when attempting to improve the lives/treatment of those with mental illness?

1.) How to provide services to homeless people with serious mental illness and/or co-occuring substance use disorders. 2.) What to do about the perception that mental illness is linked to extreme violence 3.) resolving the problem of the more than one million people with mental illness incarcerated in American jails and prisons.

What were the 5 core services that were to be provided by the CMHC?

1.) Inpatient care 2.) Outpatient services 3.) 24-hour-a-day emergency care 4.) Day treatment or other partial hospitalization services 5.) Consultation and education

Treatment goals for mental disorders (4)

1.) Reduce symptoms 2.) Improve personal and social functioning 3.) Develop and strengthen coping skills 4.) Promote behaviors that make a person's life better

What are the 3 purposes of NIMH?

1.) To foster and aid research related to the cause, diagnosis, and treatment of neuropsychiatric disorders 2.) To provide training and award fellowships and grants for work in mental health 3.) To aid the states in the prevention, diagnosis, and treatment of neuropsychiatric disorders.

What portion of lobotomy patients showed stable improvement? What portion became worse off?

1/3 showed stable improvement 1/3 were worse off.

What percent of Manhattan residents living near the World Trade Center during 9/11 suffer from PTSD?

20%

What percentage of Americans have diagnosable mental disorders?

20%

What percentage of the diagnosed receive treatment?

38%

Mental Illness

A collective term for all diagnosable mental disorders.

Legal Leverage

A court-ordered mandate to force a patient to accept treatment, which may involve service providers taking control of the patient's disability income and/ or suspending the patient's eligibility for subsidizing housing.

Chemical straitjacket

A drug that subdues a mental patient's behavior

Community Mental Health Center (CMHC)

A fully staffed center originally funded by the federal government that provides comprehensive mental health services to local populations.

Affordable Care Act

A law passed in 2010 requiring individuals whose income is less than 133% of the federal poverty line be eligible for Medicaid, with all plans covering mental and substance use disorders at a parity with medical-surgical benefits.

Mental Retardation Facilities and Community Mental Health Centers Act

A law that made the federal government responsible for assisting in the funding of mental health facilities and services.

Moral Treatment

A nineteenth century in which people with mental illness stressors of their home environments and given "asylum" in a rural setting, including rest, exercise, fresh air, and amusements.

Psychotherapy

A treatment that involves verbal communication between the patient and a trained clinician.

Major depression

An effective disorder characterized by a dysphoric mood, usually depression, or loss of interest or pleasure in almost all usual activities or pastimes.

Bipolar disorder

An effective disorder characterized by distinct periods of elevated mood alternating with periods of depression.

ECT

Another from of biomedical therapy. Alternating electric current passes through the brain to produce unconsciousness and a convulsive seizure. Used to sever depression, selected cases of schizophrenia or overwhelming suicide ideation.

Why is preventing suicide difficult?

Because rate of complete suicide is only 11.3 per 100,000 people.

What are some of the acute side effects of chemical straitjackets?

Blurred vision, weight gain, and constipation

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 (AA, NA)

What are correctional facilities fundamentally designed to do?

Confine and punish, not to treat disease.

What is the single most influential book in mental health?

Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) - Published by the American Psychiatric Association.

What is one challenge in using a categorical system to diagnose mental disorders?

Differentiating normal reactions to life (severe grief following death) from a diagnosable disorder.

Secondary Prevention

Doesn't reduce the incidence of mental illness, but reduces its prevalence by shortening the duration of episodes through prompt intervention. Ex: Soldiers exposed to combat are less likely to experience PTSD if they receive intensive cognitive skills training within a few days of returning home.

Both legal leverage and mental health courts are more likely to be successful when:

Effective treatment services are available and the goals of intervention include meaningful recovery from mental illness or addiction and not just fewer days in jail.

T/F: Men are diagnosed with mood disorders more often than women.

False. Women are diagnosed more often than men, although this difference is smaller in countries that have less traditional gender-role differences in employment opportunities, educational attainment, and control of fertility.

What was Dorothea Dix responsible for?

Founding of 32 public mental health hospitals when asylum patients ended up in poor houses.

Mental Disorders

Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and /or impaired function.

What people are more exposed to environmental stresses and threats?

Homeless people. ; About half of all adults who are homeless have substance use disorders, major depression, and other co-occuring mental illness.

When did institutionalization begin?

In the 18th century when people with mental disorders were placed in undifferentiated poorhouses or almshouses along people with mental retardation, physical disabilities, and the otherwise deviant.

Is recovery from disorders like schizophrenia better in (with longer remissions and fewer relapses) in the developing world (Africa, India, and Indonesia) or in Developed countries such as the United States.

In the developing world

What happened to moral treatment when asylums became overcrowded?

Indigent patients again ended up in poor houses.

Psychiatric Rehabilitation

Intensive, individualized services encompassing treatment, rehabilitation, and support, delivered by a team of providers over an indefinite period to individuals with severe mental disorder to help them maintain stable lives in the community.

What are the different approaches to psychotherapy?

Interpersonal, couple, group, and family formats.

Tardive Dyskinesia

Irreversible, involuntary, and abnormal movements of the tongue, mouth, arms, and legs, which can result from long-term use of certain antipsychotic drugs (such as chlorpromazine)

What is the DSM-5?

Like preceding editions, DSM-5 places disorders in the discrete categories on the basis of behavioral signs and symptoms rather than definitive tests or measurements of the brain or another body system.

Contemporary ECT methods use:

Low doses of electric shock to the brain and general anesthetics to reduce the unpleasant side effects.

What is one of the best-known and most successful models of psychiatric rehabilitation is the

Madison (Wisconsin) Model, also Assertive Community Treatment (ACT). ACT delivers intensive, individualized services encompassing treatment, rehabilitation, and support over an indefinite period.

Psychiatric rehabilitation services include:

Medication, therapy, and adaptive skills (helping a pt learn to use an internet dating site).

What is the leading cause of disability in North America and Europe?

Mental Illness

Electroconvulsive Therapy (ECT)

Method of treatment for mental disorders involving the administration of electric current to induce a coma or convulsions.

The federal Medicaid program now pays:

More than half of publicly-funded mental health are, and its policies and regulations, which vary from state to state, impact what services are covered.

National Alliance on Mental Illness (NAMI)

National self-help group that supports the belief that major mental disorders are brain diseases that are of genetic origin and biological in nature and are diagnosable and treatable with medications.

Was deinstitutionalization a preplanned policy?

No.

Do people with severe mental illnesses seek treatment voluntarily?

No. Even the ones who do may not be fully engaged or cooperative.

What type of recovery process do Non-westernized countries use?

Non-Westernized cultures use less stigmatizing explanations for mental illnesses and prescribe a recovery process that includes collaborative roles for everyone - a patient; family, and community.

Prevalence rates of mental health problems were especially high among veterans of

Operation Iraqi Freedom (19%) and those deployed to Afghanistan (11%). 25% of veterans returning from Iraq accessed mental health services int he year after returning home.

Recovery

Outcome sought by most people with mental illness; includes increased independence, effective coping, supportive relationships, community participation, and sometimes gainful employment.

Neuroleptic drug

Pharmaceuticals that reduce nervous activity; another term for antipsychotic drugs

Community Support Program

Program created by the federal government which was the first program to to recognize that the problems of people with chronic mental illness are - first and foremost- social welfare problems.

Primary Prevention

Reduces the incidence of mental illness and related problems.

One Healthy People 2020 objective?

Reducing the suicide rate

Conditions for which medications exist are:

Schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and obsessive-compulsive disorder.

Cultural Competence

Service-provider's degree of compatibility with the specific culture of the population served , for example, proficiency in languages other than English, familiarity with cultural idioms of distress or body language.

Legally, authorities can act to prevent potential violence only when:

Someone voluntarily seeks assistance or has made frank threats

Mental Health

State of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. -------- Emotional and social well-being, including one's psychological resources for dealing with day-to-day problems of life.

What were the state mental hospitals designed to do?

Supply an environment in which therapeutic care was based on close personal relationships between patients and well-trained staff members, as prescribed in the methods of moral treatment.

Lobotomy

Surgical severance of nerve fibers of the brain by incision.

Parity

The Concept of equality in health care coverage for people with mental illness and those with other medical illnesses or injuries.

Early and cumulative adversity and maltreatment are believed to harm:

The development of the brain and affect later depression, post traumatic stress disorder, suicide attempts, drug and alcohol misuse, and criminal behavior.

Chlorpromazine (Thorazine)

The first and most famous antipsychotic drug, introduced in 1954 under the brand name Thorazine.

National Institute of mental Health (NIMH)

The nation's leading mental health research agency, housed in the National Institute of Health

What is a social indicator of mental illness?

The prevalence of alcohol, tobacco, and other drug abuse in this country.

Deinstitutionalization

The process of discharging, on a large scale, patients from state mental hospitals to less restrictive community settings.

One objective of Healthy People 2020:

To increase the proportion of adults with mental disorders who are receiving treatment.

What may medicaid pay for?

Traditional services like inpatient hospitalization, nut now newer approaches such as psychiatric rehabilitation.

Transinstitutionalization

Transferring patients from one type of public institution to another, usually as a result of policy change.

Tertiary Prevention

Treatment and rehabilitation ameliorate the symptoms of illness and prevent further problems for the individual and the community.

Cognitive-behavioral therapy

Treatment based on learning theory in which a patient learns adaptive skills through rewards and satisfaction.

Psychopharmacological Therapy

Treatment for mental illness that involves medications.

T/F: Many people with mental illness can be treated with medications and other forms of help, and are thus able to adapt successfully to community life.

True

T/F: Military services and combat zones increase one's risk of experiencing PTSD, major depression, or other mental health problems.

True

T/F: More people die of suicide than car accidents.

True

T/F: Most people with chronic mental illness prefer life in the community over life in an institution.

True

T/F: Once released back into the community, people with serious mental illness who do not receive treatment are more likely to commit another offense than are inmates without mental disorders, leading to practices such as "Legal leverage" to compel treatment in courts.

True

T/F: People with psychiatric disorders are more likely to abuse substances and be poor, unemployed, uneducated, victimized, single or divorced, and have parents who themselves have arrest records.

True

Mental Health Courts

Use judges who have special training and can use non adversarial procedures to mandate treatment and rehabilitation if the individual is found guilty rather than incarceration.

Evidence-based practices

Ways of delivering services to people using scientific evidence that shows that the services actually are effective.

When/Who put moral treatment into practice?

William Tuke put moral treatment into practice beginning in 1792

Are mental illnesses one of our nation's most pervasive public health problems?

Yes

The brain is very sensitive to stress and other environmental influences as it develops during childhood adolescence. Child adversity includes:

poverty, abuse, loss, neglect, trauma, and parental psychiatric disorder.