Foundations of Behavioral Health Policy and Social Work Final Exam

There is an opposite idea that there is an "objective reality"...

, which would mean that there is an external reality out there that we can touch

Which of the following is NOT true about mental illness today?

The number of people with mental illness has declined significantly over the last couple of decades thanks to scientific breakthroughs

What is the scope of the prescription drug abuse problem?

•0ver 2 million people over 12 years of age abuse tranquilizers, stimulants, sedatives •Overdose death rates have increased enormously since the 1980s •Deaths from opiate pain killers now exceed the number of deaths from heroin and cocaine combined

In 2017, the past year prevalence of mental illness determined by epidemiology studies ranges from 12 to 30 percent of adults, depending on how it is measured.

True

When Dr. Allen Frances refers to the DSM-V as having created "diagnostic inflation," he is referring to how the newest edition of the DSM has expanded psychiatric diagnoses into areas that used to be considered normal behavior, such as adult ADHD.

True

Disparities can exist in the diagnosis, progression, and treatment of mental health disorders: Asian Americans

Most young Asian Americans tend to seek out support from personal networks such as close friends, family members, and religious community members rather than seek professional help from general healthcare providers and mental health professionals for their mental health concerns.

What is medicaid?

-A "means-tested" program care funded by both the federal government and the state, but administered by the states •Provides payment for health care to poor children and their mothers, disabled people, and poor Medicare beneficiaries •Allowed them to receive care for mental health services in general hospital, community mental health centers and from individual providers who accepted Medicaid payments •Allowed them to receive care for mental health services in general hospital, community mental health centers and from individual providers who accepted Medicaid payments •Allowed them to receive care for mental health services in general hospital, community mental health centers and from individual providers who accepted Medicaid payments

What are some early beliefs and remedies for mental illness?

-Chinese medicine from 2700 B.C.; Yin and Yang -Mesopotamian and Egyptian papyri from 1900 BC; Wandering uterus -Classical antiquity; Demonic possession

What is HRSA's Definition of Core Mental Health Professions?

-Clinical Social Workers. -Marriage and Family Counselors -Psychiatric Nurse Practitioners -Psychiatrists -Clinical Psychologists

What are medicalziation drivers?

-Consumers -Pharm companies -Health insurance companies -Health care providers

What were the failures of deinstitutionalization?

-Created a new public health crisis as thousands of severely mentally ill were pushed into environments without sufficient treatment resources, resulting in homelessness and imprisonment of many mentally ill. -Closing beds in mental hospitals resulted in less opportunity for inpatient treatment for those who needed it periodically.

Criticisms of DSM-5

-DSM-5 work was secretive despite a petition from 50 professional organizations for open and independent review -Only psychiatrists were on the DSM-5 committee -DSM-5 lowered diagnostic thresholds so blurring the boundaries between pathology and normal behavior (exacerbates medicalization of normal behavior)

Deinstitutionalization has two parts:

1) the moving of the severely mentally ill out of the state institutions 2) the closing of part or all of those institutions. The former affects people who are already mentally ill.

What are the two central psychological dimensions of mental illness?

-Feelings: refers to levels of psychic distress and pain (as opposed to joy and contentment) being experienced. -Functionality: refers to the capacity (or lack thereof) to coordinate the flow of resources in a desired or adaptive way

Why was deinstitutionalized movement a failure? (Sutherland)

-Inadequate follow up care, shifting burdens of care, and high costs to sustain treatments were all consequences of the closure of mental institutions. -Did not succeed in creating a community- based care approach; rather, it simply shifted the burden of care from hospitals and institutions onto the community and families of the patients.

What were some of the techniques used on the mentally ill?

-Insulin-induced comas -Lobotomies -Malarial infections -Electroshock therapy

What is epigentic research & how it relates to better understanding of mental illnesses?

-It examines the ways in which environmental factors change the way genes express themselves. -The emerging area of epigenetics, meanwhile, could help provide a link between the biological and other causes of mental illness

ADHD Adults

-Most individuals diagnosed with adult ADHD did not have childhood ADHD symptoms -The treatment for Adult ADHD are stimulants - which are recreational drugs and thus the diagnosis allows for some to acquire the drug of their choice -The diagnosis redefines everyday difficulties into a sickness in need of treatment -Prescriptions for stimulants in the U.S. doubled between 2000 and 2005 -Prescription stimulants increases the non-medical use of stimulants

What are the biological theories of mental illness?

-Organic brain disease -Genetic -Neurochemical

What is medicare?

-Provides health care coverage to all persons over 65 and some disabled people •Medicare Part A pays for hospitalization •Medicare Part B requires a monthly premium but pays for outpatient care; Medicare Part D pays for prescription medications •Medicare Part B requires a monthly premium but pays for outpatient care; Medicare Part D pays for prescription medications In the 1990s psychiatrists and social workers were added as Medicare covered providers

What are the broad frameworks on mental illness?

-Spiritual or Supernatural -Somatogenic -Moral character -Biological and neurophysiological -Psychogenic / Learning and developmental -Sociological

What is Erikson's Life Cycle Theory?

-Theorized that ego development persists throughout one's life. -That psychosocial events drive change, leading to a developmental crisis. -Individuals pass through a series of life cycle stages.

Drivers of Adult ADHD Diagnosing-Pharma

-Therapeutic market was $3655 million in 2010, forecast to reach $7144 million by 2018 -Pharm companies are trying to globalize the diagnosis through new marketing -Pharm companies are targeting teachers and school nurses who participate in ADHD assessments -Pharm companies have developed screening devices or checklists in different languages to increase seld-diagnosing

What are examples of medicalization?

-as an attempt by higher governing powers to further intervene in the lives of average citizens. -as tool of an oppressive capitalist society bent on furthering social and economic inequality -Pharmaceutical companies engage in the medicalization process by marketing pills to solve never-ending group of "new" medical problems.

What percentage of deaths among working adults are attributed to alcohol misuse?

1 in 10

What makes LGBTQ individuals particularly vulnerable to mental health disorders?

1) Prejudice & stigma: directed toward LGBT individuals brings about unique stressors that may predispose one to mental illness. This stress may come from their fear of coming out and not being accepted by family, friends, teachers, co-workers, their religious community, and the community overall. A fear of being discriminated against for sexual orientation and gender identities. May come from being alienated or being afraid of being alienated from social structures, norms, or institutions; being bullied or not being able to achieve certain things because of bias. This is called "minority stress." These events may occur in social situations, employment, housing, healthcare, school settings, and many other areas. These events may involve verbal or physical or sexual violence or abuse. And may lead to internal and external conflicts. This stress may manifest itself and influence the LGBT individuals in different ways: a) External factors, such as discrimination or victimization; Physically or verbally attacked; Rejection and discrimination in education, employment, and housing b) Internal factors: such as concealing one's sexual identity and orientation, and maybe internalize homophobia, self-devaluation, anticipation of adverse events which likely result in risk-taking behaviors.- this is a unique stressor to sexual minority individuals and can lead to depression, PTSD, thoughts of suicide and substance abuse. 2) Disconnection/ lack of support Identifying as LGBT not only is a sexual orientation, but also has a group of involved individuals that share and enjoy this lifestyle. Generally, this group has a supportive and cohesive connection because of similar interests/ experiences/ challenges/ stresses (may also be united by their similar oppressive histories. Many LGBT individuals faced comparable challenges when, or if, they came out to family and friends, and endured the stress of being part of a minority group in a heteronormative society). However, while there is connection in the LGBT community among like members, there may be a disconnection with those who have mental health problems, primarily due to the societal stigma towards mental illnesses. Society has stigmatized the mentally ill and often excludes them from opportunities in housing, employment, education and community engagement. There is a public view of people with mental illness that they are violent or dangerous. Because of their mental health status and societal stigma associated with that, LGBT individuals with mental illnesses may not be accepted or have difficulty being accepted, or may be stigmatized within the LGBT community, just as they are in the community at large. Thus, LGBTQ people with mental illnesses must confront stigma and prejudice based on their sexual orientation or gender identity while also dealing with the societal bias against mental health conditions. This results in an increased risk for this group because of the double stigma and double stress, and that they do not fit into either LGBTQ or the mental health community, and may be excluded by both sides. This leads to even more isolation of these individuals and to hiding either of these factors as part of everyday life in order to gain acceptance. And research found that anticipating and/or internalizing stigma and concealing one's stigmatized identity was a strong predictor of psychological distress. Lack of social support, relationship, and community belonging, meanwhile having the sense of loneliness and shame, is correlated to worse health and mental health in LGBT individuals.

What are barriers to care?

Limited availability of mental health professionals: Limited options Long waits Limited affordability: Insufficient insurance coverage High cost Lack of knowledge of: Mental illness Mental health service system Stigma

What was the purpose of the Mental Retardation and Community Mental Health Centers Construction Act?

This act made federal grants available to states for establishing local community mental health centers, was intended to provide diagnosis, care, and treatment in the community in anticipation of the release of patients from state hospitals.

The circumstances of people with mental illness have changed dramatically over time.

True

Is Violence more common among mentally ill?

1. Epidemiologic studies show that the large majority of people with mental illness are never violent 2. Persons with mental illness are more likely to be victims of violence than perpetrators of violence 3. Mental illness IS strongly associated with suicide, which accounts for over half of US firearms-related mortality 4. Substance abuse is a risk factor for violence in mentally ill persons, and is a risk factor for repeat offenses of violence in persons with psychiatric diagnoses 5. These facts point to the importance of providing mentally ill individuals with treatment for drug and alcohol abuse

There are persistent findings that rates of mental illness are highest among the lowest SES groups in the U.S

True

What are the individual and provider barriers to mental health services for older adults?

1. Older adults are less likely to use specialty mental health treatment, and often instead receive mental health treatment from their primary care physicians. Why? 1) Older adults may view a psychological problem as a medical condition; 2) Stigma around mental illness & behavioral health treatment; 3) Many older adults have physical health conditions that require ongoing treatment; 4) May feel more comfortable talking to their PCP about mental health concerns as they have received medical treatment from them - built relationship and trust. Drawbacks: 1) Don't have enough time to discuss behavioral health concerns during a standard appointment; 2) Don't have sufficient knowledge and training in diagnosing mental disorders. For example, depression are oftentimes under-recognized or underdiagnosed. PCP are prone to misdiagnose depression as dementia in their older patients. Depression is both underdiagnosed and undertreated in primary care settings. Symptoms are often overlooked and untreated because they co-occur with other problems encountered by older adults. Limited knowledge may result in the low rate of depression screenings for older adults by PCP (2%-4%), even though highly recommended. 3) Not aware of other behavioral health providers and services in the community, limiting referrals to specialists. In fact, over half of older adults receiving mental health care are only treated by their primary physician. This can actually result in a barrier to proper mental health care due to physician under detection of mental health problems and low referral rates for psychotherapy. Lack of information: Research found that older adults have less knowledge about mental health and available mental health services than any other population, and thus, may not perceive that they are in need of behavioral health services, or may be clueless about available services. Many people, including older adults, have stereotypes that portray gradual mental health decline as a normal part of aging; however, this is contrary to the realities of normal aging, which includes stable cognition, ability to handle changes, and productive involvement with life. For example, under-recognition of depression is related to: a) Symptoms attributed to chronic medical conditions due to somatic presentations. b) Often do not complain of depressed mood or other symptoms such as crying spells, or irritability. c) Social isolation and withdrawal. d) Symptoms not prominent every day. e) Psychosocial and physical losses divert attention from consideration of depression diagnosis. -> Depression seen as "normal" and inevitable part of aging. Many older adults present somatic symptoms when their problem actually originates from a mental health issue, which probably stems from a lack of education about mental health and may result in a misdiagnosis. Lack of proper education about mental health can also result in denial of a mental health problem by older adults and a fear of being stigmatized. 3. Stigma • A pervasive barrier that hinders older adults with a mental health disorder from seeking out treatment. • May experience external stigma from the public (i.e. culturally constructed negative beliefs toward mental health conditions by the general population- schizophrenia being related to violent; onset of mental disorder is evil or sinful). • Internal stigma (i.e. shame about mental health disorder by oneself). Older adults with higher level of stigma are less likely to use behavioral health care. Research found that 1/3 of community-dwelling older adults are afraid if their friends discovered that they were receiving mental health services. 4. Geriatric Workforce Shortage • Limited availability of geriatric specialists in health and behavioral health settings. - PCPs lack of training in behavioral health or geriatrics; - Providers who specialize in treating mental health are rarely trained in geriatrics, and vice versa. It may be resulted by ageism, stigma against mental illness, few opportunities for specialization and training, difficulty recruiting from diverse racial and ethnic backgrounds, and low pay in geriatrics and substance use treatment. - Behavioral health services are typically provided by clinical social workers, psychologists, psychiatrists, and psychiatric nurses. - Only a minority of students in these fields receive extensive geriatric training (few programs, low enrollment). - Only a minority of these professionals regularlywork with older adults, thereby limiting their ability to gain practice expertise

Though relatively slightly, prevalence of depression and anxiety among children have increased over time:

Ever having been diagnosed with either anxiety or depression" among children aged 6- 17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011-2012. Rates of mental disorders change with age: Diagnoses of depression and anxiety are more common with increased age. Behavior problems are more common among children aged 6-11 years than children younger or older.

What are the five approaches to mental health policy analysis?

1.Analyzing the politics of policy making 2.Implementation analysis 3.Policy analysis by normative criteria 4.Policy analysis by patient case study 5.Formal policy analysis

The size of the population with mental illness as a proportion of the full population has remained relatively constant over U.S. history

True; many studies have proved that the prevalence of mental illness has remains relatively stable over U.S. history, especially over the past 5 decades.

What does lifetime prevalence of mental illness represent?

Probability that an individual will have a particular mental health disorder sometime in their lifetime.

What is the case of Joyce Brown (aka Billie Boggs)?

A celebrated case that dramatized the rights of the mentally ill In 1987 New York mayor Ed Koch was trying to clear the streets of homeless people Joyce lived on a sidewalk , defecated on herself, burned paper money, ran into traffic, shouted obscenities, dressed inadequately for the cold She was brought to Bellevue Hospital where psychiatrists diagnosed her as schizophrenic. Civil liberties Union psychiatrists disputed this. She was institutionalized for eleven weeks before her court decision...

What percentage of homeless single adults have a serious mental illness (SMI)?

30%

Why disparities matter? [Increasingly diverse population]

Another critical reason why disparity matters is the increasingly diverse population. As the population becomes more diverse and heterogeneous, it is increasingly important to address 2 health disparities. In 2016, people of color account for 40% of the entire population. It is projected that people of color will account for over half (54%) of the population by 2050

Why is mental illness treatment sometimes referred to as a "halfway technology?"

Because there are no cures in mental illness.

What were the psychogenic treatments in the newly established asylums that were part of Tuke's York Retreat?

Compassionate care and physical labor

Which edition of DSM was the first to feature detailed definitions of mental disorders?

DSM lll

What is the DSM 5 controversially known for? [Frances&Jones]

DSM-5 is frightening in its overinclusiveness, with lowered diagnostic thresholds and the addition of new ''subthreshold'' disorders. The boundary between pathology and normal behavior is blurred in a way that is likely to result in increased prevalence rates of mental disorders and new false epidemics.

What are the stages of addiction?

Each of these stages are connected to activation of specific circuits in the brain: 1.Binge drinking and intoxication 2.Withdrawal and negative affect 3.Preoccupation and craving

What was the purpose of the confinement laws in the mid-16th and 17th centuries?

Focused on protecting the public from the mentally ill, governments became responsible for housing and feeding undesirables in exchange for their personal liberty.

What are some questions that one can ask when analyzing benefits and services from a strengths perspective?

Is the benefit or service designed to remove societal barriers that prevent people from meeting their needs? Or does the benefit or service focus primarily on correcting what is perceived as problematic behavior of the target population? How much consumer choice is allowed? Cash benefits usually provide the most choice; however, if a service is unavailable, cash does not help. For example, if children with disabilities need therapeutic preschools and none are available, then the service must be developed to address the need

The number of mentally ill in jails and prisons

Is the reason that the criminal justice system is called the "de facto" mental health system,

Construction of Psychiatric Dx the Case of Adult ADHD. [Moncrieff study]

Like schizophrenia, depression and bipolar disorder, adult ADHD is presented in the dominant psychiatric literatures as a neurodevelopmental or neurobiological disorder that responds in a specific way to a particular type of chemical treatment. Because that treatment is a recreational (and presently illicit) drug, adult ADHD not only has the potential to transform the way we think about various everyday experiences, like forgetfulness, but also to simultaneously normalise and mystify the use of psychoactive substances. -adult ADHD is better understood (pace Rose), as one of a number of recent constructs, devised to market a particular class of pharmaceuticals that has started to shape the way in which people think and talk about themselves and their experiences -The pharmaceutical industry appears to have been instrumental in the rise of adult ADHD and associated prescribing. -Many studies report higher rates of adult ADHD in women than men, in contrast to the situation in children where boys outnumber girls by a factor of 4 (BUPA, 10 A.D.) !e growth in stimulant prescriptions has also been far larger in women (Castle et al., 2007) and educational and promotional material aimed at women is burgeoning. -All lists of proposed symptoms of adult ADHD contain multiple experiences and behaviours that are nigh on human universals, including forgetfulness, lack of organisation, a tendency to delay important tasks, to be distracted by noise, difficulty waiting to take a turn, irritability and so on -Moreover, it is unclear how adult ADHD relates to the childhood condition, since there appears to be a consensus that people with adult ADHD have a different spectrum of symptoms from children supposedly afflicted with the same disorder. -The well-documented rates of 'co-morbidity' in people diagnosed with adult ADHD con#rm the difficulty of viewing adult ADHD as a discrete disorder. -The strongest claim that adult ADHD has to validity as a neurobiologically-based brain disease is the contention that it responds specifically to stimulant medication -The analysis presented here suggests that the validity of the diagnosis of Adult ADHD is questionable, and that the drug treatments that are meant to improve its symptoms have not clearly demonstrated efficacy. The concept does not fulfill any conventionally accepted medical criteria of a disorder or a disease, in that it is not easily distinguishable from 'normality', there is a large overlap with other conditions, outcome is heterogeneous and there is little evidence that drug treatment is specific or effective. Moreover, there is such a discrepancy between childhood and Adult ADHD, with a mismatch in symptoms, and a different gender profile, that makes it difficult to conclude that there is any relation - other than in nomenclature - between the childhood 'condition', and the proposed condition of adults. -Asherson et al's suggestion that the manifestations of adult ADHD may be more 'trait-like,' indicates the overlap with concepts such as personality disorder, and indeed, many people who receive a diagnosis of adult ADHD may previously have been given a diagnosis of personality disorder, or be said to have abnormal 'personality traits'. -Although proponents present adult ADHD within a much #rmer disease framework, moral judgements are as intrinsic to its conception as they are to that of personality disorder. !e criteria for ADHD concern the failure to achieve an implicitly desirable level of social functioning, and occasionally make reference to the sorts of positively bad or foolish behaviour that suffers may exhibit -!e link with drug treatment reinforces the notion that we are 'neurochemical selves' in need of pharmaceutical rectification (Rose, 2004).

What are the most widely cited estimates of the prevalence of mental illness?

One-year prevalence and lifetime prevalence

Which of the following statement is correct?

Overall, men and women experience comparable prevalence of mental illnesses.

What are the pros and cons of block grants?

Pros: less restrictive, "devolution"= states more control, regional has a better idea Cons: money can be used ineffectively, fed. gov. not held accountable for failures

What are the implications for policy, practice, and research?

Promote the formulation and implementation of health policies that address women's needs and concerns from childhood to old age. 1) To reduce gender disparities in mental health involves looking beyond mental illness as a disease of the brain. This is not to deny that distress and disorder exist and require compassionate and scientifically based treatment nor that the stigma associated with all forms of mental illness must be eradicated. However, clinicians, researchers and policy makers also need to socially contextualize the mental disorders affecting individuals and the risk factors associated with them. 2) The focus is to encourage the development and implementation of policies to protect and promote women's mental health. The first stage for reorienting government departments and systems to make them more sensitive to women's mental health issues- is to increase awareness among influential people in all government sectors of the importance of addressing these issues for the community and total population. The second stage is to encourage the adoption of policies and procedures to achieve well defined goals. 3) If legislation exists but is not effective, strategies to determine the barriers to its implementation need to be explored and addressed. In some cases, policies and legislation may need to be revised; in other cases, it may be necessary to increase community awareness of them. For example, in relation to violent crimes against women it is not sufficient simply to have legislation or a policy - the criminal justice system, health care workers and the community at large need to be aware of the policy and what it entails. 4) This requires a multi-level, intersectoral approach, gendered mental health policy with a public health focus and gender-specific risk factor reduction strategies, as well as gender sensitive services and equitable access to them. 5) Gender based barriers to mental health care, especially cost and access, bias and discrimination must be removed. Intersectoral collaboration across government departments and gender sensitive policy making in education, housing, transport and employment are required to ensure that the multiple structural determinants of mental health are facilitated to work in positive synergy, maintain social capital and support social networks. 6) Social safety nets and income security are especially important for women and their mental health. • Enhance the competence of primary health care providers to recognize and treat mental health consequences of domestic violence, sexual abuse, and acute and chronic stress in women. 1) Currently, the rates of detection, treatment and appropriate referral of psychological disorders in primary health care settings are unacceptably low. The high rates of depression in women and alcohol dependence in men strongly indicate a large unmet need for improved access, at a community level, to low or preferably no cost gender sensitive counselling services. Psychologists and social workers working in communitybased health services that are responsive to the psychosocial issues of those they serve, are well placed to provide cost effective mental health services. All health care providers need to be better trained so that they are able to recognize and treat not just single disorders such as depression and alcohol dependence, but also their co-occurrence. Clinicians need to be equipped to assess and respond to gender specific, structurally 9 determined risk factors and to become proficient in providing much needed advocacy for their patients with other sectors of the health and social welfare system. 2) A public health approach necessarily broadens the notion of effective treatment. The most obvious way of reducing violence related mental health problems is to reduce women's exposure to violence. Women who have been but are no longer being battered show significant reductions in their level of depressive symptoms, while those who continue to experience violence do not. Providing access to refuges and alternative forms of safe housing is thus a powerful mental health treatment. At the same time, 'zero tolerance' health education and promotion campaigns to reduce violence against women and children need to be designed using culturally appropriate formats in order to counter traditional beliefs and attitudes that condone and perpetuate violence. • Build evidence on the prevalence and causes of mental health problems in women as well as on the mediating and protective factors.

Which of the following are included in Abraham Flexner's criteria for a "profession?"

Techniques that can be taught, motivated by altruism, based on knowledge not just routine activities

Which of the following is the best reason why we find published prevalence rates for mental illness differ over time and from study to study?

The definitions of mental illness change over time and there are various ways of measuring prevalence.

What is policy analysis?

The examination of government decisions in order to determine their impacts and their advantages and disadvantages in relation to possible alternatives

What is the purpose of policy analysis?

To demystify the actions of government and improve allocation of resources by taking into account facts, social values and the possibilities and limitations of public problem solving

Behavioral health encompasses chronic illness care, physical symptoms associated with stress, and substance abuse treatment.

True

Which of the following statement about access to care is correct?

Uninsured or underinsured is one of the major barriers to mental health services.

Deinstitutionalization is..

Was primarily enabled by the introduction of thorazine in the 1950s

Barriers to Care for children

a) Uncoordinated systems: The current health care system provides fragmented care to children and adolescents in numerous uncoordinated systems, rending inefficient delivery of needed services. Children's mental health resources are lacking in comparison with the adult services in terms of collaboration with other professionals, sometimes resulting in practitioners not being aware of services that may be available to their patients b) Shortage of Services. Similar to adult mental health care, there has been a workforce shortage for children and adolescent behavioral health specialists in the U.S. it's estimated that there are 8,300 child psychiatrists in the U.S., compared to 15 million youth who have mental health conditions (2013). Certain communities hurt the most because of the shortage. 80% of U.S. counties were designated as mental health professional shortage areas, and it was found that 1/3 of the counties did not have outpatient mental health facilities that accept Medicaid. For children cover under Medicaid, 60% couldn't get a specialist appointment (v.s. 11% for non-Medicaid children); and the length of waiting time for appointments for specialist was more than double for Medicaidchildren. c) Insurance coverage/ affordability issues: Children from low-income families & in the child welfare system usually covered under Medicaid, versus other families have private insurance or no insurance. It's found that children who are covered under Medicaid utilized more mental health services. Age, gender, race/ethnicity, history of physical abuse, public insurance, and borderline/clinical cutoff scores were associated with higher proportions of medication use. Socioeconomic statusmost children with unmet mental health needs fell in the lowest SES category. d) Lack of training, knowledge, or skill PCP, general health practitioner as gate keepers, yet may not have sufficient knowledge, training, or skills in identifying/ diagnosing mental health disorders. - underdiagnosed, even if properly diagnosed, may not receive effective treatment or follow-up. Absence of a 'gold standard' for dealing with children's mental health problems, specifically pinpointing 'unhelpful' guidelines from the National Institute for Health and Care Excellence e) Family issues Difficult family circumstances often lead to a lack of appointment uptake. Stigma and negative consequences of labelling. Parents, teachers and others may fear that, once identified, a mental health diagnosis will influence the way a child is treated. Parents may also fear that they will be blamed for their child's mental disability. As a result, families may not seek services. Parents doubt/ confidence in recommendations, friend/family disapproval, mother's education, and past negative experience/ attitude were also found as potential barriers. f) Logistic barriers, such as appointment times, inconvenience, child care, limited availability, location/distance, number of children, time, and transportation

Deinstitutionalization began in 1955 with the widespread introduction of..

chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication

Define addiction

A term used to indicate the most severe, chronic stage of substance-use disorder, in which there is a substantial loss of self-control, as indicted by compulsive drug taking despite the desire to stop taking the drug. In the DSM—5, the term addiction is synonymous with substance-use disorder.

What is the social constructionist approach?

A theory that concerned with the ways we think about and use categories to structure our experience and analysis of the world.

Example of Disparities existing in the diagnosis, progression, and treatment of mental health disorders.

Take African American community as an example: Due to the relatively low prevalence of mental health disorders in the African American community, mental health symptoms in African 5 Americans may go unrecognized and untreated or misdiagnosed and treated inappropriately by mental health professionals. African American consumers are over-diagnosed with schizophrenia and other psychotic disorders compared to non-Latinx Whites. Compared to other racial and ethnic groups, African Americans are more likely to present to their primary care physicians with symptoms of depression. Moreover, African Americans experience more chronic, severe, and disabling episodes of major depressive disorder than do Whites, which may be attributed to delayed access to behavioral health services.

What are the core values of social work?

Dignity and worth of the individual • Integrity • Service • Social Justice • Importance of human relationships • Competence • Client's Right to Self-determination • Respect

Advocacy in the US

Our democracy includes some important guarantees that we are able to make our voices heard on issues of importance to our lives . Our constitution guarantees (among other things): §The right to petition your government §The right to assemble peacefully §Freedom of speech §Freedom of the press

What is policy development?

Public Problem solving

What are benefits and services?

o Opportunities (i.e. civil rights or extra chance) o Services (i.e. counseling, case management, job training) o Goods (food, clothing, housing) o Vouchers and/or tax credits (food stamps, education vouchers, tax credit for day care expenses) o Cash (TANF, social insurance) o Power (reps of poor on agency boards, "home rule")

Modern treatments of mental illness are most associated...

with the establishment of hospitals and asylums beginning in the 16th century.

What is a policy goal?

A statement of the desired human condition or social environment the implementation of a policy is expected to accomplish. For example, a goal of the legislation that established the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is to safeguard the health of low-income women, infants, and children up to age 5 who are at risk of poor nutrition. Measures of the health of these populations, then, can be used as benchmarks by which to evaluate the efficacy of WIC as a policy. Policy goals are generally general and abstract.

What are some UN recommendations for substance abuse policy?

"Policies meant to prohibit or greatly suppress drugs present a paradox. They are portrayed and defended vigorously by many policy-makers as necessary to preserve public health and safety, and yet the evidence suggests they have contributed directly and indirectly to lethal violence, communicable disease transmission, discrimination, forced displacement, unnecessary physical pain, and the undermining of people's right to health." •Decriminalization of minor, non-violent drug offenses •Reduce violence and discrimination in policing •Ensure access to controlled medicines •Increase access to care for people who use drugs (PWUD) •Gender responsive policies

Which of the following gives the best explanation of the brain model of addiction?

Addictive drugs activate dopamine release, and over time this response desensitizes the reward circuits, creating increased cravings and lessening the person's ability to self-regulate

What are the consequences of anxiety disorders for older adults and society?

- Estimated past-year prevalence of 11.6% among older adults in the U.S. - Include a variety of conditions that involve either acute panic reactions (i.e. PTSD, panic disorder) or chronic anxiety (generalized anxiety disorder) - Highly comorbid with depressive disorders and medical conditions. And there's a reciprocal relationship between anxiety disorders and illness. - Has negative impacts on quality of life, subjective distress, disability among older adults. May be more disabling in older than in younger population. - Recent studies also established its linkage to later cognitive decline & impairment, falls, potential decreased physical activity, disability, and increased mortality

What were the promises of deinstutionalization?

1) Give mentally ill treated in less restrictive environments where they can experience autonomy and dignity. 2) Providing medications and community outpatient treatment would help mentally ill live successfully outside asylums.

What occurred during the time people had a belief in how the supernatural was related to mental illnesse(s).

11-15th century- Superstit ion, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement. -13th century- Beginning of witch hunts, persecuted women believed to be possessed.

What is the mental health financing policy timeline?

1963: CMHC Act 1965: Medicare and Medicaid 1972: SSI ans SSDI 1981: OBRA 1982: SSI Reviews 1990s: Emergence of managed care 1996: Mental Health Parity Act 2010: Affordable Care Act

What is the timeline of expansion of programs supporting community care for the mentally ill?

1965: •The 1965 enactment of Medicare and Medicaid during the presidency of Lyndon Baines Johnson had profound effects on expanding mental health care access and delivery for community-dwelling persons with mental disorders. 1970s: The 1970s enactment of SSI and SSDI provided income support to enable those disabled by mental illness to survive in the community. 1980s: Housing programs in the 1980s enabled the mentally impaired to afford stable housing which improves their chances of staying well

According to Reuter's article in 2013

?

Who thinks so and why do they believe that?

? We need to examine how the policymakers, the public, stakeholders- how they understand the social problem, at the time the policy was developed? At the same time, we also need to consider whether there are alternative ways of understanding those needs that may lead to opposition of the policy or even opposition to addressing the issue, or alternative views that may lead to more effective policy-making, particularly where social problems are still largely neglected. For example, again, discrimination against people of color or women in employment. If people perceive discrimination in employment as a social condition, simply "the way things are." When a woman or a person of color could not get a job that paid a living wage. They would think that was just their personal problem, and there's no social problem that in need for a policy to address. However, if the public recognize that this is not a normal situation, instead, is a social problem that negatively and systematically influences a large group of people, they would think that it deserves a public intervention.

What is the significance of the issue? [Disparities in Behavioral Health Care for Older Adult]

Among which, the oldest old population, which are those ages 85 or older, is also rapidly growing. Between 2000 and 2010, the oldest old population grew by approximately 30% percent, increasing from 3.9 million to 5.1 million. In 2010, about 13.6% of older adults were ages 85 or older, and it's estimated that by 2050, the percentage of oldest old will reach over 21% in this age group; approximately 4.3% in the total US population. It should be noted that the oldest old, are at a much higher risk for neurocognitive disorders and h

SSRIs are:

An example of a practice advance

Parent report on ADHD diagnosis in 2016:

Approximately 9.4% of children 2-17 years of age (6.1 million) had ever been diagnosed with ADHD, including: Ages 2-5: Approximately 388,000 children o Ages 6-11: Approximately 2.4 million children o Ages 12-17: Approximately 3.3 million children

How did Hippocrates define mental illness?

Blood, yellow bile, black bile, and phlegm—was responsible for physical and mental illness. Hippocrates classified mental illness into one of four categories —epilepsy, mania, melancholia, and brain fever

What U.S. policy has improved access to treatment for substance abuse?

Controlled Substances Act

What is a profession?

Criteria includes: -Professional activity is based on intellectual action along with personal responsibility. -The practice of a profession is based on knowledge, not routine activities. -There is practical application rather than just theorizing. -There are techniques that can be taught. -A profession is organized internally. -A profession is motivated by altruism with members working in some sense for the good of society

Why are there disparities in behavioral health services?

Culture and access to care: Availability of insurance coverage and affordability of care: Language barriers: Lack of service providers:

What is the Involuntary Commitment in Florida: The Baker Act?

Florida Mental Health Act of 1971 (Florida Statute 394.451-394.47891 (2009 rev.) The Baker Act allows for involuntary examination. It can be initiated by: judges & law enforcement officials Physicians mental health professionals. There must be evidence that the person: possibly has a mental illness (as defined in the Baker Act). is a harm to self, harm to others, or self neglectful (as defined in the Baker Act). Examinations may last up to 72 hours after a person is deemed medically stable Examinations occur in over 100 Florida Department of Children and Families-designated receiving facilities statewide

Treatment Rates Vary among States for children

Graph on page 10 of slide maps out the prevalence of children with mental health disorders but did not receive care. North Carolina had the highest prevalence of nontreatment at 72.2% and Washington, D.C., had the lowest rate at 29.5%. Note that the prevalence of at least one mental health disorder was highest in Maine (27.2%) and lowest in Hawaii (7.6%). Four states - Alabama, Mississippi, Oklahoma, and Utah - were in the top quartile for both mental health disorder prevalence and prevalence of children with a disorder who did not receive treatment.

There are several pathways to mental health policy. Match the pathway with the description.

Legislation: Laws passed in the state and federal legislatures Court decisions: Interpretations of federal and state laws Presidential executive orders: The issuance of an order by the US President that directs and manages how the federal government operates Federal agency regulations: Determine how laws will be carried out by the relevant federal agency

What is IOP- Involuntary Outpatient Placement?

On June 30, 2004, Governor Bush signed into law "Baker Act Reform" which authorized judges to order Involuntary Outpatient Placement (IOP), also known as court-ordered outpatient treatment, for people with severe mental illnesses who meet certain standards. IOP has been demonstrated to reduce: inpatient hospitalization days, Arrests and incarceration days, costs of hospitalizations Risk of suicide Ultimately, IOP works only if there are accessible, quality mental health services

Both SSI and the Social Security Disability Insurance (SSDI) program provided...

The financial resources for patients with SMI, discharged from state institutions, to return and live in the community.

What is the court decision on Joyce Brown?

The judge hearing the case concluded: "Freedom, constitutionally guaranteed, is the right of all, no less of those who are mentally ill. Whether Joyce Brown is or is not mental ill, it is my finding, after careful assessment of all the evidence, that she is not unable to care for her essential needs. I am aware her mode of existence does not conform to conventional standards, that it is an offense to aesthetic senses. It is my hope that the plight show represents will also offend moral conscience and rouse it to action. There must be some civilized alternatives other than involuntary hospitalization of the street." (Robert D. Lippmann, Matter of Boggs, 136 Misc.2d1082, Supreme

The "social causality" theory of mental illness posits that:

The stresses of poverty result in persons being at higher risk for mental illness.

Which of the following is NOT a criticism of the DSM-5 mentioned in the article by psychiatrist Allen Frances, M.D. ?

There were very few changes between the DSM-IV and the DSM-5.

Prior to the Harrison Act in 1914, alcohol and addictive substances were not regulated in the U.S.

True

SBIRT is an intervention that is designed as a way to intervene early with persons at risk for substance abuse.

True

When we make our voices heard, we are doing what is called

advocacy.

The initiation of the Medicaid program...

changed the way that public mental health care was delivered. It improved access to care, paid for a range of inpatient and outpatient services, provided reimbursement for care in alternative settings, such as nursing homes, and paid for acute mental health treatment in community general hospitals. In addition, it also created an incentive for states to close the facilities (state hospitals) they funded on their own, and move patients into community hospitals and nursing homes partially paid for by Medicaid and the federal government.

We come to agreement about what something means at any given time..

for example, "citizen" is something that we understand because we agree on what that is and how it is defined

The deinstitutionalization effort was fueled in the year 1965 because of the...

introduction of the Medicare & Medicaid.

What are the possible outcomes of individuals who are "Baker Acted"?

release of the individual to the community (or other community placement), a petition for involuntary inpatient placement (what some call civil commitment), involuntary outpatient placement (what some call outpatient commitment or assisted treatment orders), voluntary treatment (if the person is competent to consent to voluntary treatment and consents to voluntary treatment).

The medicare program..

resulted in a shift of inpatient mental health funding responsibility from the state (in state-run facilities/hospitals) to the federal government in nursing homes. With this, it encouraged the construction of nursing-home beds.

Gender is a known...

social determinant of health

"Nothing About Us Without Us"

§Social justice advocacy groups grew in the 1970s: §Mad Pride §Network Against Psychiatric Assault §On our Own §The Insane Liberation Front §The National Association for Rights and Protection and Advocacy §They wanted to be considered experts in what was best for them for recovery §They wanted to be considered persons, not symptoms. They were anti-psychiatry §They wanted to be included in policy making and systems reforms §Consumer operated services have become an integral part of the mental health system, focused on wellness-based management rather than illness-based management

N.A.M.INational Alliance of the Mentally Ill

§Started in 1978 by a group of families of mentally ill §It is now the nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness §There are NAMI affiliate groups in most communities providing education, mutual support and advocacy

What are the ways we can approach getting our voice heard, including (but not limited to)

§Technology and social media §Use of the media §Protests, marches, sit-ins §Letter writing and emails §Phone calls and in-person visits §Testimony §Public statements §Helping to spread information to stakeholders §Education

Access to and Utilization of Care for children

• The U.S. has a fragmented system of how it provides care for its citizen. • Gaps exist in the ways mental health disorders are identified, how children and families can initiate the diagnostic and t

What is the community mental health centers act (1963)?

•Championed by President John F. Kennedy •Idea was that community services were better than warehousing •Designed to expand access to mental health care to local populations (called "Catchment Areas") •Primarily financed the construction of outpatient mental health centers and several years of operating funds •In 1968 Congress ruled to expand CMHCs mission to serve children, older people and substance abusers •The CMHCs' limited budgets and responsibility for the needs of a local population drove them to allocate their budgets to less-impaired, lower cost patients rather than higher cost, more severely impaired people

What is the problem? [Disparities in behavioral health services]

• Underreported implicit biases in diagnosis assessment and treatment of people of color. For example, tendency for service providers to misdiagnose African American and Latino children with conduct disorders, due to stereotypes. Research found that even after controlling for socio-demographic factors, Latino children are more likely than White children are to be diagnosed with conduct disorders, based on the stereotypical assessment that these children are more likely to be violent and thus require placement in more restrictive settings. • Challenges (such as financial barriers, stigma, and discrimination) experienced by people of color with mental illness disproportionately delay the receipt of needed behavioral health services. • This is compounded by the shortage of workforce. The lack of either mental health providers or prescribers of psychotropic medications.

What is mental health treatment: "halfway technologies"

•Unlike other types of medical treatment, there have been no "cures" in mental health treatment and few advances in mental illness prevention •There have been great advances in symptom management •New treatments have been discovered and some old treatments have been stopped •Exnovation - when a treatment is found to be ineffective or harmful and is used less frequently or discontinued •Innovations •Efficacy advances - A new treatment is an improvement over older treatments because it is more effective in reducing symptoms •Practice advances - A new treatment is no more effective than an older one but is used because it is safer or more tolerable or easier to prescribe or use (i.e. SSRI)

What are historical aspects of committment?

•Up until the 1800s institutionalization was informally administered •1845 Chief Justice Lemuel Shaw of the Massachusetts Supreme Court established precedent that individuals could be restrained only if following two principles: •ONLY if they are dangerous to themselves or others and •ONLY if restraint would help to restore their problematic behavior •Although these principles became the foundation for most state statutes, involuntary institutionalization and involuntary treatment (medication) became a vehicle to deprive patients with psychiatric disorders of their civil liberties

What to consider for implementation analysis?

•What is the progress of the policy once it is put into action? •How is the policy executed? •Does the execution of the policy reflect competing political battles?

Parent report on ADHD diagnosis in previous years:

The percent of children 4-17 years of age ever diagnosed with ADHD had previously increased, from 7.8% in 2003 to 9.5% in 2007 and to 11.0% in 2011-12. The number of young children (ages 2-5) who had ADHD at the time of the survey increased by more than 50% from the 2007-2008 survey to the 2011-12 survey.

What are the consequences of dementia for older adults and society?

- Dementia is a medical term for a set of symptoms. Whatever the cause of the dementia, symptoms may include: memory loss; loss of understanding or judgment; decreased ability to make decisions; changes in how the person expresses their emotions; changes in personality; problems coping with daily living; problems with speech and understanding language; and problems socializing. - The most common type is Alzheimer's disease (50-75%). In 2016, it's estimated that approximately 700k people ages 65 and older died as a result of complications of AD (i.e. inadequate nutrition, inability to perform self-care tasks, personal safety challenges driving, cooking, walking alone, or falling). - Becomes more prevalent with advancing age. Think about: Is dementia a normal part of aging? Dementia is not a normal part of aging. It is an abnormal degeneration of the brain that leads to changes in a person's ability to think, speak, socialize and take part in normal daily activities. What's your thought? - Far-reaching impacts on individuals, families and society. Persons with dementia suffer as their level of functioning and quality of life decline as the disease progresses, and their families are faced with the immense burden of caring for a loved one over many years. Weekly caregiving hours are found to be 8.5 hours for individuals with mild dementia and 41.5 hours for individuals with severe dementia. The estimated total cost of dementia in 2010, including nursing home care, community care, informal care, and lost income was between 157 and 215 billion in the U.S.

What are ambiguous views of mental illness affect what policies are developed?

-"Social problems whose causality is debatable tend to be disadvantaged in the competition for scarce public resources." 1.Stigmatization of mental illness - mentally ill are considered suspicious, frightening, and rank low in "deservingness". ● 2.Advocacy for the mentally ill - belief in individual rights, consumer empowerment, parity in health care

McLellan & Woodworth ACA and Substance Abuse treatment

-.Based on these early concepts the US designed and financed a separate treatment system for this "condition" that was purposely independent from the rest of mainstream healthcare. In short, the system and the patients treated within it were stigmatized, segregated and marginalized. -The recent legislative changes in healthcare organization and financing through the Affordable Care Act and the Parity Act have been specifically designed to end the separate and unequal treatment of substance use disorders -Many may doubt that true integration will ever happen. This is a bad bet. At least four powerful forces will push for full integration: -First, the failure to identify and address harmful substance use within general medicine now accounts for over $120 billion in wasted medical care, rapid re-hospitalizations, poor adherence to treatment plans and drug-drug interactions requiring emergent care (Obama, 2011). -Second, integration of previously segregated illnesses into mainstream healthcare has happened before - many times -Third, the re-organization of care under the chronic care management model has created new, larger and more coordinated care teams and new recognition of the importance of behavioral health in comprehensive treatment. -The final and perhaps most important force for integration is the creation of new and very powerful market forces. -. Again, these unprecedented markets provide important incentives for greater access, innovation and quality - all proven drivers of consumer demand.

Florida Legislature should reform Baker Act [Editorial, article]

-Authorities need new legal tools, training and funding to ensure that juvenile Baker Act commitments are appropriate and effective. -The Legislature should change the Baker Act to give public defenders access to juveniles and medical records upon any involuntary admission. Patient privacy should remain paramount in most medical settings, but not when the power of the state forces people into care. -Intensive training in crisis intervention can reduce the need for both arrests and psychiatric commitments by coaching administrators, teachers and law enforcement officers on defusing difficult encounters with students before they escalate. -Children need ongoing counseling and outpatient mental health treatment, not a few days in a locked-down ward.

How did social work emerge as a mental health profession?

-Charities and corrections movement in the 1890s. -DorotheaDix, social work reformer was instrumental in the building of psychiatric state hospitals in the late 19th century. -In 1920 Mary Richmond, wrote "Social Diagnosis" which was a systematic approach to social casework and the importance of finding some approach to treating mental illness. -Jessie Taft, one of the first psychiatric social workers, wrote in 1920 about the use of psychiatric knowledge in dealing with children in placement -he Freudian psychoanalytic paradigm, the "talking cure" dominated through the 1940s; but psychiatrists remained the dominant profession. The psychiatrist Menninger (1948) said about psychiatric social workers. -The Smith College course was the first formal training program for social workers to become trained as "psychiatric social workers," specializing in social psychiatry."

Who are stakeholders?

-Groups or organizations who have an interest in particular issues -They define the issues. For example. those who believe that women should have equal rights will likely consider the following as social problem: not getting equal pay, not getting equal opportunity for promotion, etc. -They generate most of what is publicly known. For example, stakeholders work hard to gain widespread acceptance of the statement that women should have equal rights. They have generated large quantities of research and theory (i.e. feminism, intersectionality) designed to support equal rights for women. Such social movements can do a great deal to shape the definition of a problem and to document the problem in ways that reflect their values and ideologies, and bring this problem to the public's attention -There are always at least 2 sets of stakeholders (otherwise there would be no public debate). And in fact, by examining who wins or loses when a problem is defined in a specific way and the size of the gain or loss, you can often gain insight into which group was able to dominate the problem-definition process. For instance, again the homeless shelter case. If one set of stakeholders define the problem as homeless people discouraging shoppers and needing shelter and they dominate the problem-definition process, then establishing a policy to fund a homeless shelter away from the business hub is an obvious solution. In contrast, if we view the homeless population as people with strengths who face barriers to resources, we may decide to prioritize helping them quickly find a permanent home well-positioned in proximity to essential supports in order to create a base where they can recover from the economic crises that have resulted in them being homeless. -Occasionally they are governmental entities, but not always -Individuals may be on the scene, but they almost always speak for a larger group, otherwise no one would care much what one voice says in a nation of millions -And what's the end product they want? Are they: defending the status quo? Seeking change? Seeking an ideal?

Context/history in analysis

-How did the problem emerge? (i.e. Deinstitutionalization movement started from the 1950s. What are the circumstances that promoted change?) • When did the problem emerge? (In analyzing the policy, you want to find out if there were executive orders or other legislative events?) • What were the key events? • Are there important dates or people that helped shape how something unfolded? • Were there trends? (access to equal opportunity or mental health services increased or decreased over time; rates got higher or lower as time went on)

ADHD Conrad 2014

-The pharmaceutical industry certainly plays a significant part in this. In the past two decades, several major drug companies have heavily marketed ADHD and its pharmaceutical treatment in the U.S. (Schwarz, 2013) -While several of the countries we examined have their own"origin stories"about ADHD, the expanding influence of American psychiatry, especially biological psychiatry, is of great significance -Another major vehicle for the globalization of ADHD has beenthe growth in the adoption of the DSM criteria for ADHD. Until the1990s many countries used the ICD criteria for diagnosis of"hy-perkinetic syndrome", which was seen as similar to ADHD. The ICD diagnostic criteria, however, are much more restrictive with a higher threshold for diagnosis than the DSM. -First, there is an almost endless amount of information available on various sites about ADHD, its symptoms and its treatment. This information exists from numerous sources and in many languages. Various pharmaceutical and professional websites exist, in ad -Many of these sites are advocacy and support groups, some directly connected to U.S. support groups, spreading ideas about ADHD to anyone who seeks it. We have been particularly struck by the ADHD "checklist", simple screening devices usually based on DSM criteria, that allow Internet users to "measure" how many behaviors an individual exhibits that could lead to a possible ADHD diagnosis. These checklists are ADHD made simple, easily usable by professionals, consumers, and putative patients. Virtually all of these checklists are versions of U.S.-based checklists, and may contribute to the migration of DSM-based ADHD diagnosis..

What nine conjectures derived from the ''DSM-5 Wars'' and related scholarly literature.? [Lacasse 2013 After DSM5]

-These are simply propositions that I believe face academic and clinical social work in the modern era, especially in the wake of DSM-5 -The DSM-5 Definition of Mental Disorder Is Inadequate -DSM-5's Claim That All Mental Disorders Are Medical Diseases Is Unsupported -Conjecture Three: The DSM-5 Is More Political and Less Transparent Than Previous Editions -Conjecture Four: The DSM-5 Is Unreliable -Conjecture Five: The Ramifications of Unreliable Diagnoses Are Significant -Conjecture Six: The Accuracy of Knowledge Dissemination Regarding Psychiatric Diagnosis Is Poor -Conjecture Seven: The Primary Utility of the DSM Continues to be Financial, Not Scientific -Conjecture Eight: Applying DSM-5 Diagnoses to Clients Can Cause Harm -Conjecture Nine: There Are Viable Alternatives to Conventional Diagnosis

Stigma, Discrimination, Treatment Effectiveness and Policy Support: Comparing Public Views about Drug Addiction with Mental Illness [study]

-This study compares current public attitudes about drug addiction with attitudes about mental illness. -While the behavioral health field is increasingly emphasizing integration, our results suggest that it may be necessary for advocates to adopt differing approaches for advancing stigma reduction and policy goals given underlying differences in beliefs and attitudes about drug addiction and mental illness among the public. One approach to stigma-reduction holds promise. Research on HIV5,6 supports the notion that increasing public recognition about treatability can reduce stigma and discrimination toward those affected. It would be worthwhile to better understand how portrayal of addiction as treatable might lower stigma among a general public who has grown accustom to seeing media portrayals of untreated individuals with mental illness or drug addiction as disheveled, often homeless and potentially dangerous.

What is the Utilization of behavioral health services amongst older adults?

-Utilization rate is low among older adults. • Approximately one-third of older adults with mental disorders report past-year use of mental health services, compared to more than half of younger adults. • Less than half of older adults with depressive symptoms ever receive a mental health service during their lifetime. • Ethnic and racial minorities are less likely than Caucasian elderly to seek specialty mental health care.

Barlett and Manderscheid What Does Mental Health Parity Mean study

-the civil rights movement in the United States has evolved from "separate but equal" to "fully integrated." -, parity is a very important milepost on the way to another destination, which is the achievement of recovery and a meaningful life in the community for all individuals living with behavioral issues, including the SMI population -we must view the current progress under the ACA, imperfect as it may be, in implementing parity for all as yet another step forward, with perhaps many more to come. -perhaps "separate but equal" for behavioral health benefits is not the final goal for which we should be striving, but rather the achievement of full integration, both financial and clinical.

What are the consequences of the social problems among the LGBT population?

1) Increased risk in depression, anxiety, and suicidality As compared to people that identify as straight, LGBT individuals are: 3-times more likely to experience a mental health condition, such as major depression or generalized anxiety disorder. 2.5-times more likely to experience depression, anxiety, and substance misuse. 38-65% of transgender individuals experience suicidal ideation. LGBT youth are 4 times more likely to attempt suicide, experience suicidal thoughts, and engage in self-harm, as compared to youths that are straight. Overall, rates of mental health conditions are particularly high in bisexual and questioning individuals and those who fear or choose not to reveal their sexual orientation or gender identity. Though not all people will face mental health challenges, discrimination or violence, many people report less mental well-being. 2) Higher incidence of risk-taking behaviors An estimated 20-30% of LGBT individuals abuse substances, compared to about 9% of the general population. 25% of LGBT individuals abuse alcohol, compared to 5-10% of the general population. Sexual minority adults were more likely than sexual majority adults to have SUDs in the past year. In 2015, an estimated 15.1 percent of sexual minority adults had an alcohol or illicit drug use disorder in the past year compared with 7.8 percent of sexual majority adults. Research found that some LGBT individuals using substances as a comping mechanism, due to shame, internalized homophobia and other negative feelings, and sometimes because alcohol and substance use is often a large part of their social life. 3) Decreased satisfaction and quality of life Finding peers, building relationships, receiving support, is important in attaining satisfaction with life. Which may be particularly true when one self-identifies as a member of minority or stigmatized group, it's important for them to find others with similarities with them and establish relationship with them, and get acceptance within the community. However, as discussed, it could be hard for LGBTQ with mental illness, which is resulted by the double stigma. 4) Worse physical health, including higher rates of obesity, cardiac conditions, smoking and substance/ alcohol use LGBT individuals living in communities with high levels of prejudice die an average of 12 years sooner than those living in more accepting communities.

LGBTQ disparities in older adults

1) LGBT older adults are at an increased risk of mental health disorders than are other older adults. Specifically, LGB older adults are more likely to have mental health problems than their heterosexual counterparts, resulting from experiences of discrimination (Fredriksen-Goldsen et al., 2012). 2) Transgender older adults have higher levels of depressive symptoms than do nontransgender LGB older adults (Fredriksen-Goldsen et al., 2014). 3) LGB older adults face challenges accessing and receiving quality behavioral health care. Because many services are heteronormative or discriminatory (McParland & Camic, 2016). 4) LGB older adults are more likely to receive counseling and psychiatric medications than heterosexual older adults because LGB older adults seek out behavioral health care as a way to cope with being part of a stigmatized group (Stanley & Duong, 2015).

What is delivery in Chapin's Framework for Policy Analysis?

A critical dimension of policy analysis is examination of the system by which services are actually delivered to those who want and need them. The delivery system may take many forms. i.e. Public or private agencies can deliver services, and private institutions can provide publicly funded services under public supervision. For example, we know that Medicaid program is publicly funded by federal-state partnership. Medicaid pays for long-term health care services, which are often provided by private church-affiliated nursing facilities. It also funds acute health care which is often provided by private hospitals that are regulated by public agencies. Services can be delivered in a variety of ways—for example, by social workers in a hospital, nursing facility, or family service center or by case managers working in a senior center. Clients can be trained to provide support to their peers. Many community mental health systems train clients to support their peers. Online. Also, certain benefits, such as Social Security payments, are routinely delivered through direct bank deposit. Service delivery systems should be staffed by workers who reflect the ethnic diversity found within the target population. And services should be physically accessible and culturally responsive to people of all ethnic backgrounds. i.e. locating a program in an all-white neighborhood that does not have public transportation limits access to that service for low-income people of color who do not have private transportation. Similarly, providing services in only one language can restrict access, even if services are located close to the target community.

Prevalence rates of mental illness among African American

According to the US HHS Office of Minority Health: African American adults are 20% more likely to report serious psychological distress than adult whites. African American adults living below poverty are three times more likely to report serious psychological distress than those living above poverty. African American adults are more likely to have feelings of sadness, hopelessness, and worthlessness than are adult whites. And while African American adults are less likely than white people to die from suicide as teenagers, African Americans teenagers are more likely to attempt suicide than are white teenagers (8.3 percent vs. 6.2 percent). African American adults of all ages are more likely to be victims of serious violent crime than are non-Hispanic whites, making them more likely to meet the diagnostic criteria for posttraumatic stress disorder (PTSD). African Americans are also twice as likely as non-Hispanic whites to be diagnosed with schizophrenia.

Historical Advocacy Movements

Advocacy movements happen when a group is marginalized or oppressed, or when rights of citizenship are abridged. Advocacy can be about groups in the larger population (as you saw in the last few slides), or about particular issues, like abortion, or school choice- these are usually values issues. Issue specific advocacy has been very visible in recent years, for a range of causes, such as, for example: §March for Science §Anti-abortion protests §Women's March for equity and the passage of the Equal Rights Amendment (which still has not been ratified by enough states to become law of the land). §Advocacy related to the so-called "bathroom bills" and transgender protections and rights §Immigration rights, particularly legal rights and the travel ban that has been imposed

What is the prevalence of mental disorders among older adults?

An estimated 20% of older adults have a mental disorder, including depression, anxiety, and neurocognitive disorder. The current estimate of older adults with mental health conditions range from 5.6 - 8 million. With the fast growth of population, this number will double by 2030, reflecting a sharp increase of 10 to 14 million older adults. Next, let's look at the major mental health conditions that affect older adults: Depressive disorders, anxiety disorders, neurocognitive disorders, and substance use disorders. Of course, these disorders are not comprehensive for the entire 65+ population, but they affect a significant proportion of older adults.

Behavioral health service disparities in the LGBTQ population

Another significant negative consequence is that the double or dual stigma can be particularly harmful, when someone seeks treatment. 1) As a community, LGBTQ individuals do not often talk about mental health and may lack awareness about mental health conditions. This sometimes prevents people from seeking the treatment and support that they need to get better. 2) Cost: LGBT people and same-sex couples are more likely to live in poverty than their counterparts in the general population, possibly because of employment discrimination, and research found that many of the LGBTQ individuals had very low incomes. In addition, many do not have health insurance because their plans do not provide for coverage of same-sex partners. Researchers found in a recent study that 1/3 LGBT people were uninsured, including 34% of gay men, 31% of lesbians and 29% of bisexual people. Of these, two-thirds had been without coverage for more than two years. 3) Evidence suggests that implicit preferences for heterosexual people versus lesbian and gay people are pervasive among heterosexual health care providers. 4) In mental health care, stigma, lack of cultural sensitivity, and unconscious and conscious reluctance to address sexuality may hamper effectiveness of care. The attitudes of nurses and other health professionals have a large impact on LGBT parents seeking health care for their children. When services are accessed, providers may not be equipped to adequately treat mental health issues in the LGBT community, and their lack of knowledge may be seen as offensive for those in need of care. When care is delivered in an insensitive way, there is reluctance to seek it when necessary. This results in care only being sought when a condition becomes extreme and may hinder preventative care. 5) LGBT individuals that keep their sexuality hidden are at an increased risk of psychological distress. Some people report having to hide their sexual orientation from those in the mental health system for fear of being ridiculed or rejected. Some hide their mental health conditions from their LGBTQ friends. This also prevents them from accessing group-based coping resources that buffer against the negative effects of stigma.

Treatment of Children with Mental Illness

As we all know, early diagnosis and appropriate services for children and their families can make a big difference in the lives of children with mental disorders. According to statistics, more than 16% of American children have a mental health disorder. It was previously estimated that 1 in 5 children in the U.S. has a mental health issues that is left untreated. A more recent national survey, 2016 NSCH, however, reported that almost half of those children having a mental health disorder did not receive treatment from a mental health professional. Specifically, among the estimated 7.7 million children with a treatable mental illness, 49.4% did not receive needed treatment from a psychiatrist, psychologist, psychiatric nurse, or clinical social worker in the previous 12 months.

What are the consequences of depressive disorders for older adults and society?

Associated with a decrease in quality-adjusted life years (QALY). FYI- QALY is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. If an individual's health is below this maximum, QALYs are accrued at a rate of less than 1 per year. To be dead is associated with 0 QALYs. - Associated with increased healthcare costs. Older patients with symptoms of depression have roughly 50% higher healthcare costs than non-depressed seniors. - Reciprocal relationship between depression and disability. Depression is the leading cause of overall disability in the U.S. Reciprocally, becoming disabled may increase risk of depressive disorder, and depressive symptoms may exacerbate functional limitations. People with severe clinical depression find it hard to take care of themselves and to work a steady job. - A precursor to a variety of conditions, such as dementia, falls, and non-suicidal mortality. - Suicidal mortality is a significant and tragic consequence of depression among older adults. Depression is a significant predictor of suicide in elderly Americans. Comprising only 15% of the U.S. population, individuals aged 65 and older account for over 25% of all suicide deaths, with white males being particularly vulnerable. In particular, suicide among white males aged 85 and older (65.3 deaths per 100,000 persons) is nearly six times the suicide rate (10.8 per 100,000) in the U.S. - Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome. - Older people with depressive symptoms have poorer functioning compared to those with chronic medical conditions such as lung disease, hypertension or diabetes. Depression 3 also increases the perception of poor health, the utilization of health care services and costs.

What recommendations would you make to address this issue?

Because early detection and intervention is important in addressing mental health problems in children, education campaigns are needed and should focus on screening for mental disorders. . Due to lack of follow-up with the family or the stigma associated to the diagnosis, many children and adolescents fall through the cracks, as it is primarily the family's responsibility to contact the specialist. One way to better facilitate the transition of referral is to have an integrated care team, in which a behavioral health professional is embedded in the PCP's office. Another way is through community resources such as the juvenile justice system and the school system. Better screening of adolescents in the pre-trial services stage may lead more appropriate sentencing and better access to community resources. Systems of care and other community-based mental health care programs should be expanded to provide children and families with a broad range of effective services tailored to their individual needs. Mental health programs and outreach efforts should be tailored to address the needs of minority populations. Cultural competency training is needed in all mental health programs and education.

The Media Missed the Story Civil Rights and the Helping Families in Mental Health Crisis Act [article]

By focusing on mental illness as the cause of violence, the media has missed not only the rollback in civil rights that Rep. Murphy's Helping Families in Mental Health Crisis would entail, but also as the connection between drugs and violence. As Saleen Fazel notes in his studies of violence in persons diagnosed with schizophrenia and bipolar disorder, substance abuse, not mental illness, appears to be the mediator of violence. A 1994 report by the Bureau of Justice Statistics notes that in 64.4% of homicides, the perpetrators had been drinking alcohol. A separate 2011 study found that "57% of the homicides would be attributable to alcohol" in the United States. Additionally, there is some evidence that prescription drugs commonly prescribed to treat mental illness may spur violence. A 2010 study by Thomas Moore, Joseph Glenmullen, and Curt Furberg concluded: "Acts of violence towards others are a genuine and serious adverse drug event associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine, and antidepressants with serotonergic effects were the most strongly and consistently implicated drugs." Not knowing this connection led the media to cover Newtown shooter Adam Lanza's autism rather than his celexa prescription. Likewise, coverage of Tuscon shooter Jared Loughner focused on his diagnosis as a paranoid schizophrenic rather than the drug use that got him rejected from the army. And in the case of Elliot Rodger, the Santa Barbara shooter, the story was possible mental illness, ignoring his risperdone prescription and possible Xanax dependency. If the Helping Families in Mental Health Crisis bill passes, boosted by editorial support in the media, millions of Americans will potentially face the forced medication of outpatient commitment, which could potentially spark a new wave of violence across the country. But one thing is certain. If we are going to have a sensible discussion about mental health in the United 5/6 States, the media needs to stop equating mental illness with violence and start considering the civil rights issue of forced treatment. Only then will we be able to have a real conversation about the underlying causes of mass violence in America.

What is the prevalence of depression among older adults?

Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression have been experiencing episodes of the illness during much of their lives. Others may experience a first onset in late life—even in their 80s and 90s. 2 - Major depression is the most common depressive disorder, with a past-year prevalence of ~ 4%. - Symptoms: Low mood, anhedonia, sleep problems, poor appetite, hopelessness, and suicidal ideation. - Can be triggered by other chronic illnesses common in later life, such as Alzheimer's disease, Parkinson's disease, heart disease, cancer and arthritis. - Depression in older persons is closely associated with dependency and disability and causes great distress for the individual and the family.

What are gender specific risk factors?

Depression, anxiety, somatic symptoms and high rates of comorbidity are significantly related to interconnected and co-occurrent risk factors such as gender-based roles, stressors and negative life experiences and events. Gender acquired risks are multiple and interconnected. Many arise from women's greater exposure to poverty, discrimination and socioeconomic disadvantage. The social gradient in health is heavily gendered, as women constitute around 70% of the world's poor and carry the triple burden of productive, reproductive and caring work. Even in developed countries, lone mothers with children are the largest group of people living in poverty and are at especially high risk for poor physical and mental health. Gender specific risk factors for common mental disorders that disproportionately affect women include socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank, and unremitting responsibility for the care of others, and gender-based violence. Low rank, for example, is a powerful predictor of depression. Women's subordinate social status is reinforced in the workplace as they are more likely to occupy insecure, low status jobs with no decision-making authority. Those in such jobs experience higher levels of negative life events, insecure housing tenure, more chronic stressors and reduced social support. Traditional gender roles further increase susceptibility by stressing passivity, submission and dependence and impose a duty to take on the unremitting care of others and unpaid domestic labor. The high prevalence of sexual violence to which women are exposed and the correspondingly high rate of PTSD following such violence, renders women the largest single group of people affected by this disorder. Women have significantly higher rates of PTSD than men. General population surveys have reported that around 1 in every 12 adults experiences PTSD at some time in their lives and women's risk of developing PTSD following exposure to trauma is approximately twofold higher than men's. Gender-based violence is also a significant predictor of suicidality in women, with more than 20% of women who have experienced violence attempting suicide. Thus, while 5 completed suicide rates are higher in men, a nine-country study reported that women had consistently higher rates for suicide attempts.

Why disparities matter?

Disparities in health and health care not only affect the groups facing disparities. Addressing disparities in health and health care is not only important from a social justice standpoint, but also critical for improving the health of all Americans. Disparities in health and health care limit continued improvement in overall quality of care and population health. Moreover, health disparities are costly. Mental disorders led the list of the five most costly conditions overall in 2006, and that cost will continue to grow as marginalized populations increase in numbers. 30% of national health care expenditure is related to preventable healthcare need related to disparities in health or care. In addition to the added health care costs, other direct and indirect costs associated with health disparities are lost work productivity and premature death.

How is policy involved in mental health promotion?

Economic policy and women's health: • The implementation of the Affordable Care Act (ACA): Expanded health insurance coverage to a significant number of individuals Required mental health and substance use benefits be offered as Essential Health Benefits. The few policies protecting the rights of women to have access to comprehensive health care are constantly under scrutiny and at risk of defunding. In 2017, there has been a large effort to repeal and replace the ACA with a more conservative plan. • In May 2017, the House of Representatives passed the American Health Care Act (AHCA). • Implications of AHCA: Has the ability to deny coverage for pre-existing conditions Would eliminate the essential benefit clause, which is particularly important for women (i.e. maternity and newborn care- services that are very expensive and can be a determining factor for family planning; post-partum counseling services- esp. for post-partum depression which influence 10% of new moms every year; and standard public health practices after the trauma of sexual assault- such as testing and treatment of STI may not be covered with the repeal of this essential benefit clause).

What is the gender bias and stigma?

Employment plays an important role in determining women's and men's relative wealth, power, and prestige, which generates gender inequalities in the distribution of resources, benefits, and responsibilities, and consequently impacts health and mental health. Some examples include: Women and men are likely to perform different tasks and work in different sectors. In developing countries, women are more likely to work in the informal economy sector, and perform specific types of informal work, such as domestic work. In developed countries, similar situations exist. Women are more likely than men to spend more time in the house and are primarily responsible for the taking care of their family. Women in paid work receive lower wages than their male counterparts. Relative income inequality penalizing women and favoring men. Women used to earn around two thirds of the average male wage, and this disparity has been reducing. Yet, according to the 2017 data, women's median earnings is around 80% of that of men's, and this again, varies across races and ethnicities. In addition, women undertaking the nonstandard forms of employment, such as part-time work, or short-term contract, lower status, more casual, lower rates of pay jobs, suffer more from growing competitive pressures and cost-saving strategies. Consequences associated with it including: Lack of security, limited training and promotion opportunities, persistent negative stress, negative impact to social security coverage, health insurance, pensions, and so forth. Women are exposed to discrimination when entering a male-dominated workforce, such as STEM. i.e. women's mental health may be directly affected because they may feel forced to take risks to prove that they are able to do the job. And a study found that, in interviewing for an IT job, women dressing in a more feminine way are more likely to be judged as unqualified for the job, comparing with women dressing in a more genderneutral way. The workplace itself is another area where rank is predictive of depression and linked to gender. Additionally, research consistently found the highest levels of well-being and the least depression in the highest employment grade- which features with decision-making authority; the reverse is true for those in the lowest grades who have a higher prevalence of depression, and lower levels of well-being. Women are more likely to occupy lower status jobs with little decision-making discretion, which contributes in part to their high prevalence of depression. Women are more reluctant to argue for full protection for their health, especially where the health problems concerned imply gender differences. In general, women are exposed to some psychosocial risk factors at work more often than men are, while having less control over their work environment. Mental health problems are more common among women than among men.

How to reduce racial & ethnic mental health disparities?

Enforce CLAS guidelines; 1) Culturally and linguistically appropriate services (CLAS) are ways to improve the quality of services provided to all individuals, which will ultimately help reduce health disparities and achieve health equity. 2) CLAS is about respect and responsiveness: Respect the whole individual and Respond to the individual's health needs and preferences. Enforce the Community Benefits Clause of ACA; Another policy with implications for mental health disparities are the community benefit requirements for nonprofit hospitals under the Affordable Care Act, which they must comply with to maintain their tax-exempt status. As a part of the expected community benefit that these hospitals provide to the community, they are required to conduct community needs assessments of the communities they serve with widespread public input and design strategies to address needs uncovered in the assessment, such as financial and other barriers to care; In addition, these institutions are required to have a financial assistance policy that clearly spells out financial assistance guidelines, which is particularly relevant for people of color who are disproportionately poor and face income inequality. Examine societal attitudes towards people with mental illness and how that translates into discrimination; Examine the structural racial bias in mental health assessment and treatment among people of color, in particular youths; A structural racial bias in mental health assessment and treatment among youth of color that may result in them either not being diagnosed at all and ending up in the juvenile justice system or misdiagnosed and placed in a treatment cascade that results in incarceration. With regards to the misdiagnosis process, they indicated that African American children were more likely to be reported as having schizophrenia or a psychotic disorder for exhibiting similar "acting out" behavior as White children. This resulted in medication and institutionalization as a treatment modality as opposed to utilizing mental health counseling as an option. The end result of this treatment option is that African American children are more likely to revolve in and out of the mental health system without needed care, increasing the risk of later incarceration. Understand the differences (i.e. different prevalence of developing depressions; differences in expressing symptoms, etc) occur within ethnic subpopulations.

In summary regarding prevalence rates of mental illness among each racial/ethnic minority group.

Ethnic/racial minorities often bear a disproportionately high burden of disability resulting from mental disorders. • Although rates of depression are lower in African Americans (24.6%) and Hispanics (19.6%) than in whites (34.7%), depression in African Americans and Hispanics is likely to be more persistent. Why? Probable correlates: Lower rates of behavioral health service use. i.e. Research found that in 2015, among adults with any mental illness, 48% of whites received mental health services, compared with 31% of African Americans and Hispanics, and 22% of Asians. Compared with non-Hispanic whites, African Americans with any mental illness have lower rates of any mental health service use, including prescription medications and outpatient services, but higher use of inpatient services at hospitals. • American Indians/Alaskan Natives report higher rates of posttraumatic stress disorder and alcohol dependence than any other ethic/ racial group. • Most racial/ethnic minority groups overall have similar—or in some cases, fewer— mental disorders than whites. However, the consequences of mental illness in minorities may be long lasting

Early developments in psychiatry & psychology

Experimental-Wilhelm Wundt founded a laboratory specifically dedicated to original research in experimental psychology doing experiments on perception. Soon, experimental psychology laboratories sprung up in major universities in the U.S. Psychoanalysis- Freud; hypnosis, free association, and dream interpretation. Psychoanalysis is particularly notable for the emphasis it places on the course of an individual's sexual development in pathogenesis. Focus on the social environment-John Dewey and George Herbert Mead started the Chicago School of Psychology focusing on the social environment and on the activity of mind and behavior. Behaviorism- John B. Watson started Behaviorism in the early 1920s. It views all behavior as the product of environment and experience, and that all learning takes place through a process of association or "conditioning," Behaviorism dominated Psychology in the US for decades. Cognitive- 1950's Noam Chomsky argued that people's thoughts and language were more complex than could be explained by the processes of association or conditioning. Cognitive psychology became the dominant model, viewing people as having dynamic information processing capabilities. Neuro- n the 1970s, Neuropsychology and cognitive neuroscience emerged with technologies available to study brain function and links to the nervous system and are now the most active areas of psychological research.

Historically, there are no differences in how men and women with mental illness have been treated.

False

Individuals with serious mental illness have always been involved in their care.

False

People suffering from schizophrenia tend to be extremely violent.

False

SMI affects about 25% of the population at any time.

False

What is involuntary hospitalization?

Four goals of involuntary commitment: 1.Protecting society from persons with mental illness who are deemed dangerous 2.Protecting the mentally ill from harming themselves 3.Providing health care for mentally ill who are not likely to understand the severity of their illness 4.Relieving families and communities from persons who disrupt everyday life Involuntary care of mentally ill has been a source of debate and litigation for years Need for social control - viewing the state as parent, vs. Need for mentally ill to maintain their individual liberties

How has the U.S. LGBT population has grown substantially?

From then on, the society generally are more acceptable of the sexual and gender minorities. According to a recent nationwide study among over 340,000 adult respondents, over the short period of 6 years (2012-2017), the LGBT population in the U.S. has been increasing substantially. The size of the population has increased from 8.3 to over 11 million people who identify as LGBT in the U.S. The percentage jumped a full percentage point, from 3.5% in 2012 to 4.1% in 2016 and then to 4.5% in 2017.

U.S. self-identifying LGBT population by Gender & Race/Ethnicity

Gender Gap in LGBT Identification Expands. Women continue to be more likely to identify as LGBT than men, and this gender gap expanded last year. Overall, 5.1% of women in 2017 2 identified as LGBT, compared with 3.9% of men. The change among men over time has been minimal, with the LGBT percentage edging up from 3.4% in 2012 to 3.7% both last year and this year. On the other hand, the percentage of women identifying as LGBT has risen from 3.5% in 2012 to 5.1% today, with the largest jump occurring between 2016 and 2017. The LGBT percentage has risen among all race and ethnic groups since 2012, although not on an equal basis. Hispanics and Asians have seen the greatest increase, thus contributing the most on a relative basis to the uptick in LGBT identification nationwide (reduction in societal stigma, enabling those with fewer financial psychological resources to sustain challenges associated with the LGBT identity). Whites and blacks have seen the least change.

Gender bias and stereotyping in the treatment of female patients and the diagnosis of psychological disorders has been reported since the 1970's.

Gender bias occurs in the treatment of psychological disorders. Women are more likely to be diagnosed with depression compared with men, even when they have similar scores on standardized measures of depression or present with identical symptoms. • Female gender is a significant predictor of being prescribed mood altering psychotropic drugs. It has also been reported that women are 48% more likely than men to use any psychotropic medication after statistically controlling for demographics, health status, economic status and diagnosis. • Gender differences exist in patterns of help seeking for psychological disorder. Women are more likely to seek help from and disclose mental health problems to their primary health care physician while men are more likely to seek specialist mental health care and are the principal users of inpatient care. Men are also more likely than women to disclose problems with alcohol use to their health care provider. • Gender stereotypes regarding proneness to emotional problems in women and alcohol problems in men, appear to reinforce social stigma and constrain help seeking along stereotypical lines (i.e. a reluctance in men to disclose symptoms of depression). • Despite these differences, most women and men experiencing emotional distress and /or psychological disorder are neither identified nor treated by their doctor. An additional problem is that many people with psychological disorders do not go to their doctors. In a recent US study, almost three fifths of those with severe mental illness received no 7 specialty care over a 12-month period. If help is not sought in the year of onset of a disorder, delays in help seeking of more than 10 years are common in many countries . • Violence related mental health problems are also poorly identified. Women are reluctant to disclose a history of violent victimization unless physicians ask about it directly. Violence- physical, sexual and psychological- is related to high rates of depression and comorbid psychopathology, including PTSD, phobias and substance use, suicidality, as well as somatization, altered health behaviors, changed patterns of health care utilization and health problems affecting many body systems. • Where women lack autonomy, decision making power and access to income, many other aspects of their lives and health will necessarily be outside their control. • The complexity of violence related health outcomes increases when victimization is undetected and results in high and costly rates of utilization of the health and mental health care system. Violent victimization increases women's risk for unemployment, reduced income and divorce. Gender based violence is a particularly important cause of poor mental health because it further weakens women's social position by operating on the structural determinants of health at the same time as it increases vulnerability to depression and other psychological disorders

What is the problem with gender disparities?

Gender disparities exist in mental health and mental health outcomes. • Women are disproportionately affected by mental illness compared to men. Despite instances of comparable prevalence rates, research found that the impact of poor mental health has far worse outcomes for women than men. Much of the gender disparities can be mediated by equitable access to resources and services. • Women report worse health than men do and more acute problems, chronic conditions, and disability. Women experience higher stress, more chronic disease, more depression, more anxiety and are more likely to be victims of violence. Women earn less than men, and in many countries they don't have the same human rights as men. Yet women tend to live longer than men. This is the case without a single exception, in all countries. As of 2015 in the U.S., the life expectancy at birth is 81.2 years for females, and 76.3 for males- a 4.9-year disparity between males and females. 78.8 years for total population. ("morbidity paradox"). • Resulted by the combined impact of social and behavioral factors: Behaviorally, men are more likely to engage in health-damaging behaviors (i.e. smoke, alcohol consumption). However, men also exercise more frequently than do women. Socially, men and women navigate distinct types of social locations that mediate their exposure to health risks (unsafe living condition, greater stressful life events, chronic stressors in daily life), and health-damaging behaviors. Gender differentially affects the power and control men and women have over these socioeconomic determinants, their status, roles, options and treatment in society, as well as their access to health-promoting resources, goods, and services.

Discuss the difference between manifest and latent goals

Goals can be both manifest and latent. Manifest goals typically are publicly stated, whereas latent goals are not. Latent goals may reflect some policymakers' intentions, but they are often goals on which it would be difficult to achieve consensus or that would not be considered socially acceptable. Consequently, it is easier not to state them explicitly. For example, a manifest goal of the homeless assistance legislation we have been discussing is to fund services for homeless people; a latent goal may be social control of homeless people so that they do not interfere with shoppers.

Consequences of Mental Disorders Left Untreated for children

If left untreated, mental health issues can lead to behavioral outbursts that create unintended societal outcomes, such as: a) Truancy (which is associated with poor academic performance, high school dropout rate, face lifelong economic consequences, and can be a gateway to the school-to-prison pipeline). b) Increased substance abuse: Substance abuse is also linked to untreated mental illness - 43% of children who use mental health services also have a substance abuse disorder. c) Engagement with the criminal justice system - which is not only impactful to the children and young people and their families, but also a tremendous loss of economic potential, counting in billions to trillion of dollars a year, and is at the expense of taxpayers. In addition, it disproportionately affects youth of color, as statistics show that the majority of adolescents who encounter the criminal justice system are of color. The criminal justice system becomes a de facto mental health system for poor and minority youth who are unable to access care through the formal mental health system. d) Lack of employment. e) Other direct and indirect costs at the family, community, society levels. One important fact is that children with mental disorders, particularly depression, are at a higher risk for suicide. An estimated 90% of children who commit suicide have a mental disorder.

What us the Lanterman-Pateris-Short Act?

In 1967 in California the Lanterman-Petris-Short Act tightened the criteria for involuntary commitment: Designed to discourage commitment and reduce the length of confinement Established a series of criteria requiring evidence of impairtment or danger to Required continuing review of commitment decisions

What is the Lessard Decision?

In 1972 Lessard Decision in Wisconsin supported rights of persons with mental illness: Right to timely notice of the charges Right to a jury trial Aid of counsel Assurance that the claim of dangerousness is made beyond a reasonable doubt

What is the "Thank You Theory" of Civil Commitment?

In 1975 Alan Stone suggested a five step procedure of assessment of appropriateness for civil commitment which he called the "thank you theory," implying that patients looking back on the circumstance would be grateful for state intervention. The Thank You Theory Five Steps: 1.Reliable diagnosis of a severe mental illness 2.Assessment of whether the patient's immediate prognosis involves major distress 3.Availability of treatment 4.The possibility that the illness has impaired the person's ability to make a decision as to whether he or she was willing to accept treatment 5.Assessment as to whether a reasonable person would accept or reject such treatment

Disparities can exist in the diagnosis, progression, and treatment of mental health disorders: Latinos

In 2005, the American Psychological Association noted that while one in five Americans identifies as Hispanic, only 1% of psychologists identified themselves as Hispanic. APA went on to note that while 70% of non-Hispanic whites return for a second appointment after an initial visit to a psychologist, on 50% of Hispanics do. 36 percent of Hispanics with depression received care, versus 60 percent of whites. Bilingual patients are evaluated differently when evaluated in English versus Spanish, and Hispanics are more frequently undertreated than are whites.

Percentage of children with ADHD and another disorder or conditions:

In 2016, among U.S. children ages 2-17 years: Nearly 2 of 3 (64%) children with current ADHD had at least one other mental, emotional, or behavioral disorder. About 1 out of 2 (52%) children with ADHD had a behavior or conduct problem. About 1 out of 3 (33%) children with ADHD had anxiety. Other conditions affecting children with ADHD include: depression, autism spectrum disorder, and Tourette Syndrome.

Prevalence rates of mental illness among Asian Americans/Pacific Islanders

In general, Asian Americans report fewer mental health concerns than do whites. However: 18.9 percent of Asian American high school students report considering suicide, versus 15.5 percent of whites. 10.8 percent of Asian American high school students report having attempted suicide, versus 6.2 percent of whites. Asian American high school females are twice as likely (15 percent) to have attempted suicide than males (7 percent). Suicide death rates are 30 percent higher for 15-24 year old Asian American females than they are for white females (5.3 versus 4.0). Suicide death rates for 65+ year old Asian American females are higher than they are for white females (4.8 to 4.5).

How does gender interact with other social determinants?

In some developing countries, when families face economic difficulties, they are most likely to sacrifice the daughters' opportunities for receiving education, instead of the sons'. In the long run, gender, together with lack of education, also interact with other determinants, such as socioeconomic status, income and employment, to affect one's health opportunity and outcome.

Why was DSM III revised in 1987?

It was revised because the criteria(s) that were listed in the previous edition, it was more subjective than objective.

What was the purpose of the Omnibus Budget Reconciliation Act (OBRA) of 1981?

It was to remove the direct part of the federal government when it came to mental health.

U.S. self-identifying LGBT population by Income & Education

LGBT identification is more common among those with lower incomes, as has been the case consistently since 2012. The income gap is larger this year than it has been, with 6.2% of those making less than $36,000 a year in household income identifying as LGBT, compared with 3.9% of those making $90,000 or more. There are no major differences in LGBT identification by educational attainment, although the percentage of postgraduates who self-reported as LGBT is slightly lower than those with less formal education

What is Heteronormativity and the gender binary system?

LGBTQ have long been ostracized and stigmatized by society because of their "nontraditional" sexual orientation. Society has deemed heterosexuality the norm. Before the 1970s, having an attraction to a same-sex partner, or being gender nonconforming, was behavior that was unacceptable and needed to be discontinued or cured. The third edition of DSM (DSM-III) marks the start when homosexuality no longer considered as a mental disorder

Prevalence rates of mental illness among Lastino/Hispanic Americans

Lifetime prevalence rates among Latino Americans born in the U.S. are lower than those for non-Latino whites, vary among ethnic groups. And the lifetime rates are higher among U.S.-born Latinos comparing with their foreign-born counterparts. Despite these generally lower rates, according to CDC data reported in 2012: Latino high school males are just as likely to report suicidal thinking as non-Latino whites (10.7 percent versus 10.5 percent), and more likely to attempt suicide (6.9 percent versus 4.6 percent). Latino high school females are more likely to report suicidal thinking than non-Latino white females (20.2 percent to 16.1 percent) , and more like to attempt suicide as well (13.5 percent to 7.9 percent). As the CDC data suggest, young Latino fema

Why We Need to End the War On Drugs? [TED talk]

Look at the murder and mayhem in Mexico, Central America, so many other parts of the planet, the global black market estimated at 300 billion dollars a year, prisons packed in the United States and elsewhere, police and military drawn into an unwinnable war that violates basic rights, and ordinary citizens just hope they don't get caught in the crossfire, and meanwhile, more people using more drugs than ever -. And what we really need to do is to bring the underground drug markets as much as possible aboveground and regulate them as intelligently as we can to minimize both the harms of drugs and the harms of prohibitionist policies. -So the challenges we face today are twofold. The first is the policy challenge of designing and implementing alternatives to ineffective prohibitionist policies, even as we need to get better at regulating and living with the drugs that are now legal. But the second challenge is tougher, because it's about us. The obstacles to reform lie not just out there in the power of the prison industrial complex or other vested interests that want to keep things the way they are, but within each and every one of us. It's our fears and our lack of knowledge and imagination that stands in the way of real reform. And ultimately, I think that boils down to the kids, and to every parent's desire to put our baby in a bubble, and the fear that somehow drugs will pierce that bubble and put our young ones at risk. In fact, sometimes it seems like the entire War on Drugs gets justified as one great big child protection act, which any young person can tell you it's not.

Measures and outcomes

Macro- how does this matter to the nation/group/stakeholders? • Define success • Define how the stakeholders will know success- how do they measure the outcome to determine if the policy/program is a success. • Cost estimates- obtain an estimate of how much it would cost to implement the policy • Cost-benefit comparisons • Metrics (i.e. If there's a policy for preschoolers to receive early childhood education, that will prepare them to graduate from elementary school with a decent GPA. We would want to measure the metrics, in terms of how many students enroll in this program? Are their test scores improved? If so, how much do they improve? And so forth)

What are the different patterns of mental illnesses in gender differences?

Men and women experience comparable rates of mental health problems; however, the type of health problems either experience is distinct. • Women experience higher rates of the affective mental health disorders, such as depression and anxiety. Rates of depression vary markedly among countries (suggesting the importance of macrosocial factors). However, depression is almost always reported to be twice as common in women compared with men across diverse societies and social contexts. • The prevalence of major depressive disorder among women is nearly double than that of men. Despite its high prevalence, less than half the patients with depression disorder are likely to be identified by their doctors in primary care settings. Gender differences in patterns of help seeking and gender stereotyping in diagnosis compound difficulties with identification and treatment. Female gender predicts being prescribed psychotropic drugs. Even when presenting with identical symptoms, women are more likely to be diagnosed as depressed than men and less likely to be diagnosed as having problems with alcohol. • Men are more likely to be diagnosed with antisocial personality disorders and substance abuse. Men predominate in diagnoses of alcohol dependence with lifetime prevalence rates of 20% compared with 8% for women, reported in population-based studies in established economies. • Comorbidity is associated with mental illness of increased severity, higher levels of disability and higher utilization of services. Women have higher prevalence rates than men of both lifetime and 12-month comorbidity involving three or more disorders. Depression and anxiety are the most common comorbid disorders but concurrent disorders include many of 4 those in which women predominate such as agoraphobia, panic disorder, somatoform disorders and PTSD. • No gender-significant differences in lifetime prevalence rates of severe mental disorders such as schizophrenia and bipolar disorder. • Differences in rates of disorder are only one dimension of the role played by gender in mental health and illness. Beyond rates, gender is related to differences in risk and susceptibility, the timing of onset and course of disorders, diagnosis, treatment and adjustment to mental disorder. There are several gender specific mental health conditions that used to and/or still are attributed exclusively to women, you can find more examples on pages 7-8 in the lecture slides and in the textbook.

President Carter established the President's Commission on Mental Health (PCMH), which called for a new national priority for adults and children with serious mental disorders and recommended an orderly phase-down of state hospitals through performance contracts that would integrate federal and state funding which thus led Congress to enact the..

Mental Health Systems Act, with numerous changes to the federal CMHC program, including, importantly, a shift in emphasis to increase the priority of this population and to expand services beyond clinical care alone.

What are Childhood Mental Disorders?

Mental health in childhood means reaching developmental and emotional milestones, and learning healthy social skills and how to cope when there are problems. Mentally healthy children have a positive quality of life and can function well at home, in school, and in their communities. On the other hand, mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day. Below are some data derived from the National Survey of Children's Health (NSCH) conducted by CDC that may help you understand some commonly diagnosed mental disorders in childhood. Overall, ADHD, behavior problems, anxiety, and depression are the most commonly diagnosed mental disorders in children 9.4% of children aged 2-17 years (approximately 6.1 million) have received an ADHD diagnosis. 7.4% of children aged 3-17 years (approximately 4.5 million) have a diagnosed behavior problem. 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety. 3.2% of children aged 3-17 years (approximately 1.9 million) have diagnosed depression

What are mental disorders in the community?

Mentally ill can create significant difficulty for their families and their communities Some will violate norms of acceptable behavior and disrupt social activities and often the police must intervene Some may be so disoriented or neglectful of themselves that their own lives are in danger Suicide is a concern for patients with serious and persistent mental disorders

Prevalence rates of mental illness among Native Americans/Alaskan Natives

Native Americans experience serious psychological distress 1.5 times more than the general population. • Native Americans experience PTSD more than twice as often as the general population. • Although overall suicide rates are similar to those of whites, there are significant differences among certain age groups. Suicide is the second leading cause of death among 10-34 year olds; whereas, the suicide rate among Native Americans that are more than 75 years old is only one-third of the general population. • Native Americans use and abuse alcohol and other drugs at younger ages, and at higher rates, than all other ethnic groups.

Treatment Rates Vary among Different Mental Disorders for children

Nearly 8 in 10 children (78.1%) aged 3-17 years with depression received treatment. 6 in 10 of children (59.3%) aged 3-17 years with anxiety received treatment. More than 5 in 10 children (53.5%) aged 3-17 years with behavior disorders received treatment.

What is the data on people with AMI and receiving services? [Disparities in behavioral health services]

People from racial/ethnic minority groups are less likely to receive mental health care. For example, in 2015, among adults with any mental illness, 48% of whites received mental health services, compared with 31% of African Americans and Hispanics, and 22% of Asians. As compared to the White people, African Americans, Latinxs, Asian Americans, and Native Americans • Less likely to use behavioral health services; There are differences in the types of services (outpatient, prescription, inpatient) used more frequently by people of different ethnic/racial groups. Adults identifying as two or more races, and American Indian/Alaska Natives were more likely to receive outpatient mental health services and more likely to use prescription psychiatric medication than other racial/ethnic groups. Inpatient mental health services were used more frequently by African Americans adults and those reporting two or more races. Asians are less likely to use any types of mental health services than any other race/ ethnic group. • When used behavioral health services, they had a poorer quality of care; • Had a higher burden of unmet mental health need; • Were disproportionally represented among the homeless with mental health conditions and among those with mental health conditions who were incarcerated.

What is Chapin's Framework for Policy Analysis

Policy goals Benefits and services Eligibility rules Service delivery systems Financing

How does that affect deinstitutionalization and people with mental illness?

Pooled financing block grants can promote flexibility and the optimum continuum of services for patients. Braided funds can lead to uniform benefits for insured and uninsured populations, and can also reduce the clinical and administrative barriers between programs in some state behavioral health service systems

Andersen's Behavioral Model of Health Service Use [examples of factors]?

Predisposing factors: Gender, age, employment, education Enabling factors: Household income, insurance coverage, English proficiency Needs factors: Subjective needs, objective needs

What are the causes of change in the following models?

Psychological: Intra-individual and developmental Sociological: External environmental Biological: Structural, genetic, and neurochemical Psychosocial/biological: Environment (e.g. stress) affects neurochemistry

What are structural determinants?

Refer to the factors that lead to social stratification and social class divisions and thus, people's socioeconomic and political position in the society. These differentiated socioeconomic and political positions generate hierarchies of power and prestige, and affect access to resources and opportunities. For instance, distribution of power and money, education and employment opportunities, social class, gender, and race/ethnicity, are the common structural determinants of health The context and structural determinants together constitute the upstream social determinants of health, and operate through the downstream determinants - intermediate and proximal determinants of health. Rooted on the underlying context and structural social settings, differences in the intermediate and proximal factors lead to group or individual differences in vulnerability and its resulting health outcomes. Intermediate determinants of health include the material circumstances (i.e. community infrastructure and working conditions) and psychological circumstances (i.e. stressful living environment). Proximal determinants of health include the biological factors and individual health behaviors.

What are the social problems among LGBQT population?

Since the removal of homosexuality as a diagnostic category in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), society has begun to reduce the stigma of having a lesbian, gay, bisexual, or transgender (LGBT) identity. However, health, mental health and religious establishments often consider this a lifestyle outside of the norm, creating challenges in health and mental health.

What are social determinants of health?

Social determinants of health are widely recognized as the social and economic conditions in which people are "born, grow up, live, work, and age" that influence the prevention and treatment of illnesses, as well as people's abilities to reach the full health potential. Some examples: a) Social gradients, represented by shorter life expectancy and higher prevalence of diseases for people in the lower end of social ladders, can be considered as one type of social determinants of health; b) social exclusion and discrimination that may lead to psycho-emotional stress and burden; c) social support and social networks; d) employment and workplace stress; and e) accessibility to healthy life style, such as availability of healthy food, exercise and/or transportation. Shaped by the economic and political forces across a multitude levels, these socioeconomic conditions distribute unevenly among populations, and consequently, result in individual and group differences in health care access and outcomes.

Facts about Mental Disorders in U.S. Children

Some of these conditions commonly occur together: Having another disorder is most common in children with depression: about 3 in 4 children aged 3-17 years with depression also have anxiety (73.8%) and almost 1 in 2 have behavior problems (47.2%). For children aged 3-17 years with anxiety, more than 1 in 3 also have behavior problems (37.9%) and about 1 in 3 also have depression (32.3%). For children aged 3-17 years with behavior problems, more than 1 in 3 also have anxiety (36.6%) and about 1 in 5 also have depression (20.3%).

W ht are edibility rules in Chapin's Framework for Policy Analysis?

Some rules require that people may receive benefits only if they have made prior contributions recognized by the entity providing the benefit. Ex: Social Security retirement benefits are available only to workers who have been employed in a qualifying job and have paid into the system for the required amount of time, although spouses and children of qualified workers are also eligible for certain benefits. The eligibility rules for many of the services and benefits your clients receive are based on a means test. For example, many policies provide financial aid only to people whose income and assets fall below a certain level. In addition, some policies require that recipients can demonstrate functional as well as financial need. For instance, older adults can receive Medicaid funding for nursing facility care only if they have exhausted their financial resources and are also severely functionally impaired. Since they hinge on an assessment of impoverishment, means tests can be stigmatizing and can discourage people in need from applying for services. Asset tests, in particular, can force individuals in need to deplete even a small financial cushion, resulting, in the long run, in greater economic insecurity and dependence on public assistance. Processing eligibility determinations based on means tests can be expensive, too; programs available only to select populations usually have higher administrative costs than those that are more universally available. On the other hand, benefits with less stringent eligibility rules may lead to overwhelming cost, as a larger number of prospective beneficiaries qualify for assistance. Eligibility rules may be based on judicial decisions. For example, a judge may rule that a family should receive services designed to prevent further child abuse.

What is a policy objective?

Specific statements that operationalize desired results. i.e. one objective for WIC is to increase the birth weight of infants in low-income families. Another objective is to increase breastfeeding among mothers enrolled in the program. In the latter case, if the objective specifies a desired percentage of increase, then it provides a specific statement of expected outcome by which to evaluate the program's effectiveness.

What are the barriers to services?

Stigma:For example, people may consciously or unconsciously avoid saying "I am depressed", but "I am sick and tired of being sick and tired". They themselves would not appreciate the fact that they have mental disorders, because it's tied to frailty, which is not acceptable. Discrimination: (i.e. Racism, bias, and discrimination in treatment settings). Research found that African-Americans are less likely to be offered either evidence-based medication therapy or psychotherapy. Compared with Whites with the same symptoms, African-Americans are more frequently diagnosed with schizophrenia and less frequently diagnosed with mood disorders, probably because of differences in how African Americans express symptoms of emotional distress. Client's mistrust of the treatment process (Not being sensitive to culture can lead to misdiagnosis, and that happens. And that easily leads to a legacy of distrust. The belief that mental health treatment "doesn't work"). Client-provider relationship Study found that physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with AfricanAmerican patients than with White patients. A mental health system weighted heavily towards non-minority values and culture norms. Transpotation ssues, difficulty finding childcare/taking time off work. • Lack of awareness of the resources and services that are available Lack of awareness of the resources and services that are available.

What is access?

The ability of an individual to receive behavioral health services, including: §Capacity to receive services due to cost, insurance status, program eligibility requirements (often based on diagnosis, income, location, and other demographic factors) §Physical proximity of service providers in relation to those in need (waiting time, transportation and travel time, workforce) §Availability of quality care

Disparities can exist in the diagnosis, progression, and treatment of mental health disorders: Native Americans/Alaskan Natives

The concept of mental illness and beliefs about why and how it develops have many different meanings and interpretations among Native Americans. Physical complaints and psychological concerns are not distinguished and Native Americans may express emotional distress in ways that are not consistent with standard diagnostic categories. Native Americans appear to use alternative therapies at rates equal to or greater than whites. In fact, research has found that Native American men and women who meet the criteria for depression, anxiety, or substance abuse disorders are significantly more likely to seek help from a spiritual healer than from specialty or other medical sources

U.S. self-identifying LGBT population by birth cohort

The expansion in the number of Americans who identify as LGBT is driven primarily by the cohort of millennials. The percentage of millennials who identify as LGBT expanded from 5.8% in 2012 to 7.3% in 2016 to 8.1% in 2017. LGBT identification is lower among older generations: a) The percentage of individuals with LGBT identification is lower among the older. Generally, there is a negative association between age and percentage of LGBT identification. b) The LGBT percentage in Generation X was up only marginally (.2%) from 2016 to 2017. There was almost no change/slightly decrease in LGBT percentage since 2012 among baby boomers and traditionalists. Fact: The self-identifying LGBT population skews younger. Why? Some argue that younger people are more likely to actually live as LGBT and to identify that way because they are growing up in a time when it's more acceptable to acknowledge those feelings and to act on them. A

What is a disparity?

There are two types of disparities that matter to this discussion: 1. "A 'health disparity' refers to a higher burden of illness, injury, disability, or mortality experienced by one population group relative to another." 2. "A 'health care disparity' typically refers to differences between groups in health insurance coverage, access to and use of care, and quality of care." Research has shown that health outcomes are tied to variance in social and economic statuses, and to the environment in which one lives. These differences have been shown to create large gaps between groups of people in terms of burden and incidence of disease, and mortality rates. A complex and interrelated set of individual, provider, health system, societal, and environmental factors contribute to disparities in health and health care. Individual factors include a variety of health behaviors from maintaining a healthy weight to following medical advice. Provider factors encompass issues such as provider bias and cultural and linguistic barriers to patient-provider communication. How health care is organized, financed, and delivered also shapes disparities as do social and environmental factors, such as poverty, education, proximity to care, and neighborhood safety.

Why does the problem need to be addressed?

There can be a variety of reasons why the issues are in need to be addressed. For example, people with mental illnesses cannot receive mental health benefits to receive appropriate treatment. Think about: What are some of the reasons that call for public policy to address the problem? (i.e. social justice, human rights, dignity of the persons, expenditures associated with treating severe symptoms- ER visits, hospitalization, arrest, incarceration, loss productivity of our workforce, etc)

What is social rank?

There is a strong social gradient in health. Adverse mental health outcomes are 2 to 2 ½ times higher amongst those experiencing greatest social disadvantage compared with those experiencing least disadvantage. • Environmental stressors, including increased numbers of negative life events, experiences and chronic difficulties, are highly significant in accounting for the lower social class predominance of non-psychotic psychiatric disorders like depression and anxiety. • Less control over decision making, the structural determinants of health and less access to supportive social networks correlate with higher levels of morbidity and mortality. • These are the material indicators of inequality and social disadvantage. However, research found that social gradient in mental health also operates on a subjective level. Social position carries with it an awareness of social rank and a clear understanding of where one stands in the scale of things. (i.e. MacArthur Scale of Subjective Social Status- it presents a "social ladder" and asks individuals to place an "X" on the rung on which they feel they stand relative to other people in the society). Depression, for example, is strongly related to several interrelated factors: a) Perceptions of the self as inferior or in an unwanted subordinate position, with low self-confidence; b) Behaving in submissive or in non-assertive ways; c) Experiencing a sense of defeat in relation to important battles, and wanting to escape but being trapped. • Men and women occupy different social-structural locations that mediate their exposure to risks that are harmful to health, their participation in health-damaging behaviors, and their access to goods and resources that promote well-being.

What are risk factors for mental health problems among older adults?

There may be multiple risk factors for mental health problems at any point in life. Older people may experience life stressors common to all people, but also stressors that are more common in later life, like a significant ongoing loss in capacities and a decline in functional ability. For example, older adults may experience reduced mobility, chronic pain, frailty or other health problems, for which they require some form of long-term care. In addition, older people are more likely to experience events such as bereavement, or a drop in socioeconomic status with retirement. All of these stressors can result in isolation, loneliness or psychological distress in older people, for which they may require long-term care. Mental health has an impact on physical health and vice versa. For example, older adults with physical health conditions such as heart disease have higher rates of depression than those who are healthy. Additionally, untreated depression in an older person with heart disease can negatively affect its outcome. Older adults are also vulnerable to elder abuse - including physical, verbal, psychological, financial and sexual abuse; abandonment; neglect; and serious losses of dignity and respect. Current evidence suggests that 1 in 6 older people experience elder abuse. Elder abuse can lead not only to physical injuries, but also to serious, sometimes long-lasting psychological consequences, including depression and anxiety.

The social determinants of health theory emphasizes on what?

They are on a complex interplay of variables on multiple levels. Generally, in terms of its reach, the social determinants of health can be categorized into four levels: a) context, b) structural determinants, c) intermediate determinants, and d) proximal determinants. Specifically, the context can be understood as the determinant of social determinants of health, or in other words, the causes of health inequalities. It refers to the socioeconomic-, historic-, and political contexts. These broad contexts are formed by the structural, cultural and functional factors of a society. These factors' impact to individuals is hard to be quantitatively measured, yet is powerful in dynamically formulating social stratification and consequently, influencing people's health opportunities and outcomes. Though varies in countries, in general, the context determinant consists of six factors: governance, discrimination, macroeconomic policy, social and public policies, cultural and societal values, and epidemiological conditions

Why Has US Drug Policy Changed So Little Over 30 Years-1.pdf [Study]

Though almost universally criticized as overly punitive, expensive, racially disparate in impact, and ineffective, American drug policy remained largely unchanged from 1980 to 2010. Marijuana is an important exception: policy and law underwent many changes, with the strong likelihood of more, involving increased legal access to the drug, in the near future. For cocaine, heroin, and methamphetamine there has been an almost relentless increase in the numbers incarcerated for drug offenses, rising from about 50,000 in 1980 to 500,000 in 2010. The disparities in African American imprisonment rates are higher for drug offenses than for other types of crime; some of this disparity results from unjustifiably harsher sentences for crack than for powder cocaine offenses. The battles necessary to achieve even modest reductions in these disparities and other overly severe sentencing regimes at the state and federal levels demonstrate how difficult it is to achieve changes in drug policy. Recent reforms in health care at the federal level offer hope for increased access to treatment services, but otherwise only drug policy rhetoric has changed much. -the policies are expensive, divisive, and intrusive, to return to the starting point of this essay, and the problem is declining for reasons other than policy. Excessive punishment is itself offensive to Western sensibilities. These have not been persuasive arguments. The problem has declined, if you accept my argument about the distinct nature of the prescription drug misuse problem, and that may be enough to protect the status quo.

Magnitude and intensity of the problem and of the outcomes proposed

What are some measures of what might happen if no action is taken? • What are some measures of what should happen if options are chosen? • Quantitative estimates (how many dollars lost? How many families housed in temporary housing? How many students sent to school? How many lives affected now or in the future?) • In this class, you are not required to produce a quantitative analysis, but you should be aware that these are usually a part of this process, and *some* numbers (like stats) are expected, as you demonstrate the magnitude of the problem

What is financing in Chapin's Framework for Policy Analysis/?

When you analyze a social policy or program, consider how it is funded. Funding that is not assured from year to year can result in chaos for staff and clients. Because private funding depends on voluntary giving, its stability and adequacy fluctuate depending on the givers. Entitlements have the most year-to-year stability. However, even publicly funded entitlements can meet the fate of the AFDC program, which was eliminated in 1996 and replaced with a less secure—and largely inadequate—block grant. Though public funding is generally more stable and adequate than funding from other sources, federal crises around the debt ceiling and the sequester, as well as severe budget shortfalls in many states, illustrate the potential volatility of even these public funds.

DSM 3 began a..

a multiaxial classification system that took into account the entire individual rather than just the specific problem behavior

Strategies for improvement for clinical social workers when helping out individuals from the LGBTQ population?

a) Be open to hearing their experiences and respond in a nonjudgmental way to their concerns. If one encounters bias or oppression when seeking help, the likelihood is that the person will not return to the provider and/or not follow up with appropriate treatment. b) It is important for those seeking help to be met in an affirming setting that welcomes the inclusion of LGBT clients. Small things can have a great impact on the initial contact: a rainbow picture in the waiting room or in one's office will speak volumes. Addressing a client by their preferred name or pronoun goes a long way in engaging a person in treatment. c) The use of inclusive language and open-ended questions is essential: asking "do you have a significant other" is very different than asking a male client "do you have a wife or girlfriend" or a female client "do you have a husband or boyfriend". Asking a gender-inclusive question opens the door for honesty and disclosure without fear of rejection. d) The use of mindfulness has been shown to be effective as an adjunct to mental health counseling or therapy. Mindfulness helps one to be more aware of being in the present and accepting of experiences. Researchers found there was a correlation between gay men who were able to use mindfulness and having less distress related to discrimination based on age and sexuality. There was also a positive impact on self-esteem using this technique.

Deinstitutionalization efforts have reflected a largely international movement to reform the "asylum-based" mental health care system and move toward community-oriented care...

based on the belief that psychiatric patients would have a higher quality of life if treated in their communities, being closer to family support, rather than in "large, undifferentiated, and isolated mental hospitals".

Social constructionism says that all of our values, perspectives, and beliefs are structured by

how we each individually perceive and interpret the world- through each of our "lenses," rather than being something external and objective.

Behavioral health disorders result from..

maladaptive behaviors that negatively impact your physical or mental condition. And some of the examples include: Substance abuse; Gambling; Eating disorders, and etc.

Example of social constructionism

once again, discrimination in the workplace, women and people of color to receive less pay or less opportunity for promotion. The issue is out there, external and objective. That's the reality. But, how we view and interpret it depends on the values and beliefs that were constructed and agreed upon socially at the given time. Back several decades ago, it's socially constructed as a normal situation, just the way it is. Thus, seeing through this lens, the public accepted this and didn't think this is a social problem, instead, they attributed it to individual flaws, individual failure of not being able to get jobs or get higher pay. On the contrary, as we can see now, discrimination in employment is socially constructed and perceived in a different way. Our personal beliefs and group consensus agree that this is discrimination, structural barrier exist to preventing women and people of color in the workplace, harming social justice and equality. And therefore, we need to create a policy to address it. Such consensus shapes what a group of people, or even the entire society, considers to be "real" at a given time. This is an example of how consensus change over time, and how such changed consensus shapes society's responses to those issues.

Using Social Constructionist Approach means..

that the explanations of all human interactions, including social problems, are based on socially and personally constructed views of reality.

What is the status quo?

§17.3% (over 7.5 million) of adults with any mental illness (AMI) are uninsured. §56.4% of adults (over 24 million) with AMI received no treatment. §11.8 million adults with AMI feel they have unmet needs. §19% of adults with a substance use disorder are uninsured. §22.5 million adults & adolescents that require substance use treatment do not receive any services. §61.5% of youth with major depression do not receive any mental health treatment. §21.62% of adults with a disability were not able to see a doctor due to costs. An estimated 47% of adults are not receiving treatment because of costs.

History of the Mental Health Consumer Movement Fountain House

§1868: Elizabeth Packard, a former mental asylum patient, started the Anti-Insane Asylum Society §1908: Clifford Beers, former mental asylum patient, founded the National Committee on Mental Hygiene §1940s: A group of former patients founded WANA (We Are Not Alone), focused on helping patients transition from hospitals to communities. This led to the opening of Fountain House in New York City, a model mutual support and rehabilitation setting. It is still operating and focused on housing, employment, education and health and wellness initiatives

What are the Changing Roles of Persons with Mental Illness?

§Early American history: Inmates §Early - mid 1900s:: Hospital patients §1960s - 1970s: Clients §1980s onward: Consumers

Why is access important?

§Individuals: •Poor quality of life, medical problems, low-quality medical and behavioral health care •Low educational attainment, low workforce productivity, poverty •Abuse, trauma experiences •Involvement in the criminal justice system and incarceration •Family discord, social stigma, and discrimination §Families: §Financial burdens §Emotional strain §Communities and the entire society: §Direct costs §Indirect costs Far-reaching and profound impacts

What is the Anderson's behavioral model of health service use?

§Originally developed to study the determining factors of health service use for the non-Hispanic White population in the 1960s. §Has been adapted and frequently applied to studies on mental health service use and attitudes among diverse racial and ethnic groups.

What is the Anderson's behavioral model of health service use? [factors]

§Predisposing factors: Factors that are independent of personal circumstances and experiences that may cause the need for service use. §Enabling factors: Differences in the resources available to the individual in using health services. §Need factors: Mental health problems that are in need of mental health services

Are there themes that cut across all of these groups and issues? What is it about the activities that they undertake that brings about movement in policy?

§Public awareness and "being seen" §Public debate about issues and aspects, including providing language to the public for previously unfamiliar issues §Pressure on politicians, including a refusal to allow them to do their job without scrutiny and public transparency §Education of policy makers of the reasons for a movement, including how particular orientations towards an issue impact on "the public good" (economically, morally, cohesiveness, etc.)

What is access to care: state ranking?

§The Access Ranking indicates how much access to mental health care exists within a state. §The access measures include access to insurance, access to treatment, quality and cost of insurance, access to special education, and workforce availability. §A high Access Ranking indicates that a state provides relatively more access to insurance and mental health treatment.

The Consumer Movement

§The Civil Rights movement of the 1960s first addressed issues of race, and then expanded to include issues of ethnicity, sexual discrimination, and disability rights §The mental health consumer movement was a civil rights movement for persons who had been oppressed by the mental health system, incarcerated, treated without consent §The movement was focused on the rights of the mentally ill to humane treatment, the theory that recovery was possible §It generated peer support and self-help aimed at recovery

What is the timeline of U.S. Drug Control Policy?

•1914 - The Harrison Act •1920-1933 Prohibition (The Volstead Act) •1937 - Marihauna Tax Act •1952- The Boggs Act •1956 - The Narcotics Control Act •1970s - The Controlled Substances Act •1971 - Nixon's "War On Drugs" •1971- 1975 - Creation of a federally subsidized drug treatment program •1982 - Reagan's Organized Crime Drug Enforcement Taskforce •1980's - Nancy Reagan's "Just Say No" program •1986 - Anti-Drug Abuse Act •1988 - Office of National Drug Control Policy (ONDCP)

Define substance use disorder

•A diagnostic term in the DSM-5 referring to recurrent use of alcohol or other drugs that causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home. Depending on the level of severity the disorder is classified as mild, moderate or severe

What is the history of u.s. drug treatment approaches and programs?

•Abstinence •12 Step Programs started by Alcoholics Anonymous •Methadone •Suboxone •SBIRT •Marijuana legalization •Affordable Care Act Michael Botticelli Ted Talk Addiction is a Disease •Law enforcement acting as treatment advocates

What is prescription drug abuse like in the U.S?

•Abuse of prescription drugs has become more prevalent than use of any illegal drug except marijuana, so that is now consider an epidemic •The most abused prescription drugs include drugs prescribed for pain (oxycontin & opioids), methadone (for treatment of heroin abuse), buproprion (for treatment of depressive disorder and tobacco addiction), stimulants (e.g. Adderall for ADHD) •Most abusers of prescription drugs do not get them from dealers, but from friends, family, theft or by doctor shopping •Regulatory policies are complex since these are these are still legal drugs. Some states have initiated online systems for detecting doctor shopping. •This is primarily a U.S. problem: 80% of opioids and 99% of hydrocodone used in the world are used by people in the U.S.

What are the critiques of the Brain Model of Addiction?

•Addiction starts from voluntary behaviors. The brain model challenges the notion of self-determination and personal responsibility for your actions •So, this model seems to excuse personal irresponsibility and criminal acts related to addiction •It does not explain why some people become addicted and others don't. So far genetic or brain abnormalities associated with addiction have not been found

What is the concept of neurobiological roots of addiction?

•All addictive drugs activate circuits in the brain releasing dopamine. •Dopamine release is a reward signal that triggers conditioning - repeated experiences of the reward become associated with the stimuli that preceded them •Addictive substances desensitize the reward circuits of the brain •This lessens a person's ability to feel pleasure and motivation to pursue everyday activities •This results in an increasing craving for more alcohol or drugs and negative emotions when these cravings are not fulfilled •Disrupted biologic processes in the brain can lessen voluntary behavioral control - weakening of the executive function regions of the brain which lessens abilities of decision making, control of inhibitions, and self-regulation, which explains why people with addictions can be sincere in their desire to stop but unable to do so.

What are the managed care components?

•Capitation: •A fixed, predetermined payment per person for a specific range of services over a fixed period of time •The capitation amount received by the provider organization is the same regardless of how many services an enrollee uses or how much they cost •Provides an incentive to providers for conservative use of services and less costly services in order to maximize their earnings •Gatekeeping: •Limits use of specialists, hospitals and procedures. All etra care requires a referral through a primary care physician •Utilization management •Includes pre-certification, concurrent review and case management procedures for high-cost patients. Provider has to obtain certifications from managed care company

What are the analytic perspectives on mental health policy?

•Process: focus on the dynamics of policy formulation with regard to sociopolitical and technical variables. •Product: focus on policy choices. •Performance: focus on the description and evaluation of program outcomes.

What are innovations in treating schizophrenia?

•Chlorpromazine (Thorazine) was the main thrust behind deinstitutionalization •Thorazine's discovery and diffusion was the beginning of the modern era of psychopharmacology •Discovered by Henri Laborit, a Parisian surgeon, who used it originally for anesthesia, and discovered by chance it alleviated hallucinations and delusions in psychiatric patients •It was released in 1954 in the U.S. by Smith, Kline & French pharmaceutical company •It was not considered the first order treatment for schizophrenia (psychotherapy was) until the late 1960s. •Thorazine has serious side effects: •EPS - Extrapyramidal Syndrome (rigidity, tremors, motor inertia) •Anti-Parkisonian medications were discovered to reduce EPS symptoms •New-Generation antipsychotics have less side-effects •Including clozapine, olanzapine, risperidone •Lower rates of side effects improve patients' adherence to medication

What is analysis by normative criteria?

•Comparing the policy to alternative policies or service systems •Starts with specifying "normative criteria" or "benchmarks" for gauging the new policy's performance •Normative criteria may include: •Effectiveness •Efficiency •Equity •Cost control •Any other criteria that indicate success given the context

What is supporting life in the community: income and housing supports?

•De-institutionalization created a problem of how to support mentally ill people in the community when they couldn't work and support themselves •Federal legislation that provided cash support and housing to disabled people, including the psychiatrically disabled, provided minimal supports •Since the 1980s SSI and SSDI enrollment grew rapidly among the mentally ill •In 1996 Congress eliminated eligibility for persons with a primary diagnosis of drug abuse or alcohol addiction

What are exnovations in treating depression?

•Electroconvulsive therapy (ECT) •Psychodynamic therapies •Opium •Monoamine oxidase inhibitors (MAOIs)

What are innovations in treating depression?

•Electroconvulsive therapy (ECT) with anesthesia and smaller doses •Cognitive behavioral therapy (CBT) •Interpersonal therapy •Tricyclic antidepressants (TCAs) •Selective serotonin reuptake inhibitors (SSRIs)

What are the consequences of these the mental health changes?

•Exchanging the failures of big bureaucracy and tight centralized budgets that took care primarily of the severely mentally ill in institutions •Replacing with a complicated system of care that provides services to a broader range of mental disorders providing consumers with more choices in care, but also fails to care well for people with serious mental illness

What are the factors which increase susceptibility to addiction?

•Family history - through heritability and child-rearing practices, permissive normative attitudes toward drug use •Early exposure to drug use especially in adolescence when the brain is still developing, more sensitive to drugs and when the brain circuits involved in executive functioning are underdeveloped •Exposure to high risk environments - where there is easy access to drugs and poor familial and social supports •Certain mental illnesses including mood disorders, ADHD, psychoses

What is analysis by patient case study?

•Focuses intensively on the experience of a single patient and the response of the system of care to meeting their needs •Like a "grand round" in medicine, it is designed to pinpoint the flaws in the execution of a mental health policy

What mental health services have transformed?

•From a state-run, centralized, planned activity •To a decentralized, specialty market-driven system of mental health care

What is Reagan's OBRA?

•In 1981 the Omnibus Budget Reconciliation Act cut overall mental health funding and created "block grants" to states, a lump sum of federal money provided to states with few strings attached, so that states could finance and design their own mental health programs

What occurred in the emergence of managed care?

•In principle, managed care is means to provide care in the most cost-effective way •It was designed to overcome problems of the traditional fee-for-service approach to health care services: •Where patients often receive inappropriate services •Patients were in treatment for long periods of time in inpatient and outpatient •Clinicians didn't operate with clear treatment plans or focused objectives •Services were fragmented and uncoordinated (e.g. inpatient and outpatient mental health care) •Managed care began to dominate mental health care services in the mid 1990s bringing serious regulation to the mental health industry through: •Capitation payments to providers •Utilization review and management •Rationing of services to patients •Administration through managed care behavioral health care organizations (MBHOs)

What are recommendations from a public health model?

•Leaving legal drinking age at 21 - since the adolescent brain is most susceptible to addiction •Provide supports for early identification of and response to substance abuse problems in the primary care system •With coverage of substance abuse care provided through the Mental Health and Addiction Parity Act •With integration of behavioral health specialists in primary care clinics to improve the management of substance abuse problems before they get severe

What is insanity?

•Mainly a legal concept, •not a medical or psychiatric concept •Thomas Szasz (Myth Of Mental Illness, 1961)argued against psychiatric diagnosing, coercive treatments, involuntary confinement, and the use of psychiatric diagnoses in the courts, calling both practices unscientific and unethical.

What are the five claims about drug use according to Reuter?

•Marijuana must be treated separately from other substances •For other illicit drugs, the only major legal changes in policy have been increases in the severity of sentencing, and significant racial disparities in sentencing for drug offenses •Harm reduction policies and programs have increased in most of the Western world (e.g. needle exchange programs) but only methadone maintenance has been accepted in the U.S. •Prohibition policies have not worked. Legalization of more drugs (e.g. cocaine and heroin) might lead to lower crime and less transmission of blood borne diseases), but are still not popular in the U.S. •Prevalence of drug use is not a good target for drug policy. Policy should be oriented toward reducing violence, dysfunction and disease related to drug use and to reducing incarceration and racial disparities in incarceration.

What were the 1970's Housing Support Programs- Section 8?

•People with persistent mental illness who have stable housing have better clinical outcomes and use fewer health and mental health services than persons without stable housing •Income support through SSI and SSDI is not enough to pay for stable housing for the mentally ill •Starting in 1970 the federal government started the Section 8 program - subsidizing rental housing for low-income persons including disabled persons •In 1987 the McKinney Act provided block grants to states and local governments to develop supportive housing for persons at risk of homelessness

What are problem statements?

•Policy creation is always about a problem or a conflict. •What is the problem that the policy is trying to address? •Why? •Who thinks so and why do they believe that?

What is the historical overview of mental health policy changes? [Circumstances that promoted change]

•Postwar economy was booming with more funds for domestic programs •New generation of drugs - psychotropic medication •Studies indicated community based care was preferred to institutional care •President Kennedy supported programs to improve mental health care

What is the primary driver of mental health system Change: Changes in Financing

•Prior to 1950s state governments paid for most of mental health care •Mental health care spending grew dramatically between the 1950s and 1970s, due to: •Medicaid was established in 1965 which provided states with a federal/state share of costs for mental health services; thus, the states' role in financing mental health care dropped •In 1955 77% of mental health care was in inpatient (state-run) hospitals •By 1975 only 28% of mental health care was in inpatient facilities Outpatient care rates exploded from 379,000 in 1955 to 2 million in 1978

What are some exnovations in treatment of schizphrenia?

•Psychosurgery (trephination, lobotomies) •Hydrotherapy •Insulin shock therapy •Psychoanalysis for schizophrenia

What is the Affordable Care Act?

•Requires group health plans and insurers that offer mental health and substance use disorder benefits Requires provider to provide coverage that is comparable to coverage for general medical and surgical care •The law says that you can't discriminate against a person because of a pre-existing condition. This means that more people will get the care they need and have it covered by their insurance plan. It also means an insurance plan can't cancel your coverage for a pre-existing condition •Supports services focused on preventative care, integrated and coordinated care where behavioral health services for mental health care and substance abuse are imbedded in primary care service organizations.

What were the 1970's public cash support programs (SSDI)?

•SSDI (Social Security Disability Insurance) became a major support for the mentally ill. First enacted for persons over 50, it was expanded to any person with 10 years of work history who became disabled. •It is a federal program, so the states do NOT determine eligibility or levels of support •Level of benefits determined by past earnings; so the more you earned before you were disabled, the more you get after becoming disabled •People on SSDI can get Medicare after two years •Like SSI, it caused a surge in the number of people with SSDI through the 1970s •Like SSI, the growth of SSDI resulted in Congress requiring a "disability review" every three years, and in 1982 Congress required disability reviews to be conducted in person in SSA offices •As much as one-fourth of persons dropped from SSDI in the first year of reviews were mentally impaired persons

What were the 1970's public cash support programs (SSI)?

•SSI (Supplemental Security Income) was a means-tested program that: •gave monthly income to poor disabled adults and children regardless of their work history. •SSI payment levels were set nationally, but states could supplement them •SSI recipients were also eligible for food stamps and Medicaid •In 1990 ADHD and other children's mental health disorders were qualified for SSI which doubled the number of children with SSI •In 1996 in order to reduce the federal budget deficit, Congress required re-assessment of eligibility of ADHD recipients and many were dropped

What is the opioid crisis?

•The Harrison Narcotics Act of 1914, as interpreted, prohibited doctors from prescribing narcotics to narcotics addicts "to maintain their addictions." In the 1970s, methadone treatment was authorized but limited to clinics where the drug was dispensed,

When people argue for and against policies, they make claims about many things:

•The policy itself and what it contains, •The situation that it is supposed to address, •The people who are meant to be impacted, •The environment that the policy fits into, •And even whether the policy is socially just, fair, or equitable.

What is the Mental Health Parity Act?

•The private insurance market has never covered mental health care at the levels of general health benefits - typically private insurance had limits on yearly mental health spending, number of visits, and required higher co-payments •"Adverse selection," is when private insurers restrict eligibility to people with serious mental illness so that they don't lose a lot of money on costly patients - "bad risks" •In 1996 Congress passed the Mental Health Parity Act, which eliminated yearly and lifetime caps on mental health coverage, and in principal was supposed to have mental health access and services on par with other health conditions 2008: Mental Health Parity and Addiction Equity Act (MHPAEA) included the treatment of substance abuse and removed the limits on mental health treatment, cost sharing, and in- and out-of-network coverage

What is formal policy evaluation?

•Treats policy as an experiment that needs to be tracked over time •Involves the use of rigorously defined input and output measures and formal research design •Often involves calculating the costs and the benefits of the mental health policy •Often looks at whether desired effects are realized for an intended population

What to look for when analyzing the politics of policy making?

•What is the social problem that prompted the process? •In what way did it come to light? •How were proposals for remedying the situation formulated? •What was the outcome? A new law, ruling, regulatory procedure, administrative change or budgetary shift? •Which set of interests emerged victorious and why? •Were the goals of those who advocated for the issue satisfied?

What are three major twentieth-century psychodynamic schools:

-Drive psychology: Posits that infants have sexual (and other) drives. -Ego psychology:. Under this theory, the id is the compartment of the mind containing the drives and instincts. The superego contains the sense of right and wrong, largely derived from parental and societal morality. The ego is responsible for adaptation to the environment and for the resolution of conflict. -Object relations theory:departs from drive theory in that the relationship to an object is motivated by the primacy of the relationship rather than the object being a means of satisfying a drive.

The many different classification systems that were developed over the past 2,000 years have differed in their relative emphasis on..

-Phenomenology: Involve close scrutiny of suffers' experiences in mental disorder. Example: Against a focus on these "exterior" symptoms, the phenomenologist would argue that such symptoms must not be confusedly thought to be the most central symptoms of the disease, purely because they are the easiest to observe. Instead they would urge us to consider, for instance, the viscous and burdening nature of depression that makes even the smallest task a great effort, and is felt almost as a physical weight on the body. -Etiology: Genetic, medical/physical conditions, & environmental factors All in all, environmental factors may affect the risks of developing and/or experiencing mental disorders: 1) the same type of environmental exposure increases the risk of many different mental disorders.2) many different types of environmental exposures contribute to the same disorder.3) no constellation of adverse environmental exposures will result in psychopathology among all the exposed individuals. -Course as defining features:A patient may be said to be at the beginning, the middle or the end, or at a particular stage of the course of a disease or a treatment. Further explanation: Because of their different emphasis on the defining features, these systems are very different also in terms of the disorders included.Moreover, the various systems for categorizing mental disorders have differed with respect to whether their principal objective was for use in clinical, research, or statistical settings.

What are the persisting criticisms of psychiatric diagnosing?

-Still relies on fallible subjective judgements rather than objective biological markers -Diagnostic inflation" -Pharmaceutical companies are complicit in creating new avenues for marketing drugs by renaming normal life processes as mental disorders (e.g., PMS), or supporting diagnostic fads.

What needs to be considered is the sociocultural context of justification?

-The sociocultural context the psychological processes are unfolding. -The evaluator's values and worldview

What are the four possible outcomes of an individual who is "Baker Acted"?

1) Liberating the individual and letting them be in the community or another community placement. 2) A petition may be needed for involuntary inpatient placement 3) Involuntary outpatient placement 4) Treatment that is voluntarily decided by the person if he/she is competent to consent.

Name three barriers to access to mental health care.

1) Not enough availability of mental health professionals 2) The level of affordability is restricted, with inadequate insurance coverage, and the cost to pay for services is high being some of the reasons. 3) The stigma that is attached to seeking/receiving care.

List the two types of health disparities and give an example of each.

1) One health disparity relates to how diagnosing and treatment of mental health disorders have been done amongst people of color Ex: African Americans have been over-diagnosed with schizophrenia and other types of psychotic disorders than individuals coming from the non-Latinx Whites population. 2) Another health disparity relates to how health outcomes are reported amongst women and males. Ex: It has been said that women report their health issues more, and report more serious and chronic issues as well, compared to men, although there is research that has shown that women live longer.

Based on the data in this graph, briefly describe three demographic trends in the prevalence of SMI in U.S. adults.

1. In regards to sex, the prevalence rate for women is the highest. 2. Adults in the age range 18-25 have the highest SMI prevalence rate. 3. In the race/ethnic category, the prevalence rate is the least for Asian adults.

Describe two (2) criticisms of psychiatric diagnosing.

1. It has been found that psychiatric diagnosing still depends on subjective decisions, instead of looking at biological markers. 2. Pharmaceutical companies partake in illegal activity with others when trying to make new ways to sell drugs by giving new names to standard life processes and making them look like mental disorders.

History of classification systems of mental disorder

1840: Idiocy/insanity" in the 1840 census defining categories of mental health disorders: : mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy. 1917: The American Medico-Psychological Association, together with the National Commission on Mental Hygiene, formulated a plan that was adopted by the Bureau of the Census for gathering uniform statistics across mental hospitals. The American Psychiatric Association subsequently collaborated with the New York Academy of Medicine to develop a nationally acceptable psychiatric classification that would be incorporated within the first edition of the American Medical Association's Standard Classified Nomenclature of Disease. This nomenclature was designed primarily for diagnosing inpatients with severe psychiatric and neurological disorders. 1950: Mental Disorders (DSM-I) in 1952. The use of the term "reaction" throughout DSMI reflected the influence of Adolf Meyer's psychobiological view that mental disorders represented reactions of the personality to psychological, social, and biological factors (etiologically-based). During the 1940s and 1960s, Psychiatry was dominated by psychoanalytic theory. It was marginalized from other medical specialties because of its failure to be able to classify and reliably differentiate mental disorders.DSM-II was largely similar to DSM-I but eliminated the term "reaction". 1974:DSM-III introduced a number of important methodological innovations, including 1) explicit diagnostic criteria, 2) a multiaxial system, and 3) a descriptive approach that attempted to be neutral with respect to theories of etiology.The major contributions of DSM-III include: 1) systematic application of operationalized criteria to psychiatric diagnosis; 2) forms a basis on empirical data rather than clinical opinion to optimize diagnostic criteria; and 3) emphasis on course and outcome as a critical defining feature of psychiatric illness. DSM-III greatly expands number of diagnoses 1994:DSM-IV, was published. Numerous changes were made to the classification (e.g., disorders were added, deleted, and reorganized), to the diagnostic criteria sets, and to the descriptive text based on a careful consideration of the available research about the various mental disorders.Most far-reaching change in DSM-IV was the systematic addition of "clinically significant distress or impairment" across the diagnostic criteria. 2013:DSM-5 reflects a fundamental change which is the removal of the multi-axial approach to diagnosis. The rationales of the fundamental change are based on unclear boundaries between medical and psychiatric diagnoses, inconsistent use of Axis 4 by clinicians and researchers, as well as poor psychometric and clinical validity of Axis 5.

What is the difference between a mental illness and a serious mental illness (SMI)?

A mental illness that result in serious functional impairment, which substantially interferes with or limits one or more major life activities.

What are the differences between policy goal and policy objective?

A policy goal is a general statement that describes a yearning of human condition or the social environment through carrying out a policy with the anticipated outcomes, while a policy objective describes clearly defined statements with anticipated outcomes that are operationalized.

The U.N. recommends the following in regards to substance abuse policy:

All of these Gender responsive policies Decriminalization of non-violent drug offenses Increasing access to treatment for people who use drugs Reducing discrimination in drug policing

What are some goals of involuntary commitment?

All of these Protecting the individuals with mental illness from hurting themselves Relieving families and communities from persons who disrupt daily life Protecting the society as mentally ill people are deemed dangerous

The typical measures epidemiologist use to define the rate of mental illness in the population include:

All of these Symptoms and signs of mental illness The level of difficulties a persons with a mental health condition has in filling their social roles Whether a person has sought treatment for mental illness

Which of the following is true about the evolution of DSM editions?

All of these The most recent edition is the DSM-V Asperger's Disorder was dropped as a diagnostic category in the latest edition. There are studies that show that there is a lot of inaccuracy in psychiatric diagnosing The original DSM classified homosexuality as a "sexual deviation disorder"

What is true about the mental health system today?

All of these. For the most part, the current first-line treatments for serious mental illness are not much more effective than the ones used previously. We have more effective treatments than we did 50 years ago. The main advances in the treatment of mental illnesses are due to treatments that are easier to diffuse to providers and patients.

What are some of the criticisms about the DSM-5?

All of these. The DSM-5 exacerbates the medicalization of normal behavior. It promotes the globalization of the diagnosis of adult ADHD. There are serious concerns about the reliability and validity of DSM-5 diagnoses. It has led to the increasing and excessive use of psychotropic medications

What is a co-occurring disorder?

An individual with a mental illness and substance addiction.

The sociodemographic characteristics of people with mental illness have changed substantially over time.

And overall conclusion is: age and mental illness have had a very stable relationship. So the overall rate of mental illness across the gender groups are largely similar. However, over time, no systematic trend in the relative prevalence by race is found. The prevalence of mental illness was uniformly highest among the lowest SES group over the past 5-6 decades.

Which of the following statement is not true?

Asian American high school males and females are at the similar rate of attempting suicide.

Moral treatment had to be abandoned in America in the second half of the 19th century...

Asylums became overcrowded and custodial in nature and could no longer provide the space nor attention necessary.

Both etiological theories coexist today in what the psychological discipline holds as the..

Biopsychosocial model

What is trepanation?

Examination of prehistoric skulls and cave art from as early as 6500 BC has identified surgical drilling of holes in skulls to treat head injuries and epilepsy

All children diagnosed with ADHD require medication.

False

Being wealthy guarantees you receive the best care.

False

The likelihood of becoming addicted to drugs or alcohol depends mainly on your family history of addiction.

False

The stigma Americans hold toward substance abusers and people with mental illness has been found to be equivalent

False

What lead to the changes in the lives of people with mental illness?

Financing changes: Public health and disability insurance programs; Medicaid & Medicare= SSI, Decentralizing=Individuals with a mental illness have flexible and more entitlements to a range of largely uncoordinated programs and resources, including medical care and income support. Supply changes: Funding growth and new regulatory changes, unprecedented increases in the number of mental health professionals, number of private psychiatric hospital beds also increased: Mental health care and services have been mainstreamed. Treatment changes:New treatment options, new providers of psychotherapy (social workers and counselors), and a range of private psychiatric inpatient providers.

What is the difference in training between a psychiatrist and an advanced practice psychiatric nurse?

For psychiatrists, there are 3 to 4 years of post-degree supervised clinical training, while advanced practice psychiatric nurses' post-graduate clinical training is not required.

What is CBT?

It involves the examination of cognitive distortions and the use of behavioral techniques to treat common disorders such as major depression.

What is NOT TRUE about prescription drug abuse in the U.S.?

It is most prevalent in the minority population.

Public policy that supported the reductions of numbers of inmates of state hospitals included several different policy developments which enabled psychiatric patients to live in the community. Match the policy/program with what it did.

Mental Retardation and Community Mental Health Centers Construction Act: Subsidies for construction of community mental health centers Medicare: Paid for health care for the disabled and elderly Medicaid: Paid for health care for persons with poverty-level income Social Security Disability Insurance: Provided income for disabled persons Omnibus Reconciliation Act: Provided block grants to states to pay for mental health & substance abuse programs

What is true about advances in psychotherapy?

None of these ECT is no longer used because of the extreme side effects Cognitive behavioral therapy is now considered to be less effective as medications for depression Probing into patients' unconscious factors is considered the first-line treatment for depression

Which of the following statement about disparity is incorrect?

None of these.: Health disparities result in direct and indirect costs, such as lost work productivity and premature death. Disparities in health and health care limit continued improvement in overall quality of care and population health. 30% of national health care expenditure is related to preventable healthcare needs related to disparities in health or care. As the population becomes more diverse and heterogeneous, it is increasingly important to address health disparities.

Andersens' behavioral model is one of the most influential and widely used model to understand the factors that may influence health service use. The model divide the influencing factors into three major categories. Connect the following terms with the correct matching definition.

Predisposing factors: Characteristics that are independent of personal circumstances and experiences Enabling factors: Resources available to the individuals in obtaining care Need factors: Actual and perceived need for services

What was the dominant psychogenic treatment for mental illness during the first half of the 20th century?

Psychoanalysis

Connect the following terms with the correct matching definition.

Psychoanalytic theory emphasizes unconscious motivations and early influences Cognitive theory Emphasizes subjective experience, beliefs and thoughts Behavioral theory Emphasizes the influence of learning

What are the focuses of changes in the following models: Psychological, sociological, biological, psychosocial/biological

Psychological: Personality Sociological: Society/circumstances environment Biological: Brain, genes, neurotransmitters Psychosocial/biological: Environment's affects on neurotransmitters

Which program was the first to formally train psychiatric social workers?

Smith College

The process by which a bill becomes a law occurs in what order?

Step 1 Big ideas emanate from individuals and are picked up by legislative sponsor Step 2 Bill is introduced to either house of congress by a sponsor, either a Senator or Representative Step 3 The bill goes to a committee in the legislature to change and/or vote or send it to a subcommittee Step 4 Members of the House or Senate debate the bill and propose amendments Step 5 The President either approves and passes the bill into law , vetoes the bill or chooses no action

Match the following U.S. drug policies with their descriptions.

The Volstead Act: Outlawed the manufacture and transportation and sale of liquor Nixon's War on Drugs: Initiated "stop-and-frisk" tactics Controlled Substances Act: Enabled the FDA to begin categorizing substances by their risk for abuse Office of National Drug Control Policy: Established the position of the "drug czar" Harrison Act: Taxed the production and distribution of opiates and coca products

If Angie, who is a new freshman at college and is having extreme anxiety and difficulty sleeping at night, is told by her therapist that her parents did not teach her strategies to cope with new situations, her therapist is using which explanatory system for mental illness?

The learning and developmental model

What does the one-year prevalence of mental illness represent?

The percentage of the population meeting criteria for a diagnosable illness over a 12-month period

What was the primary purpose of the Mental Health Parity Act passed by congress in 1996?

The primary purpose was to remove annual and lifetime limits on getting mental health coverage, hoping to mental health access and services which were as good as in terms of providing, with other types of medical issues.

Prevalence of mental illnesses among US adults (2017)

There were an estimated 46.6 million adults in the United States with AMI. This number represented 18.9% of all U.S. adults. That's approximately 1 in 5 of U.S. adults who have any type of mental illness. The prevalence of AMI was higher among women than men. Young adults aged 18-25 years had the highest prevalence of AMI, compared to adults aged 26- 49 years and aged 50 and older. The prevalence of AMI was highest among the adults reporting two or more races, the percentage is 28.6%. The second highest prevalence of AMI was found among the Whites. The prevalence of AMI was lowest among the Asian group.

The somatogenic theory of mental illness of the time—promoted especially by the father of America psychiatry, Benjamin Rush led to

Treatments such as blood-letting, gyrators, and tranquilizer chairs.

Dorothea Dix's advocacy for more humane treatment of the mentally ill is believed to have directly influenced the increasing numbers of psychiatric hospitals in the U.S.

True

Since there are no biological tests, markers, or well-controlled studies identifying biological lesions responsible for any mental disorders it can be argued it is erroneous to refer to any behaviors as medical problems or disease.

True

The social work profession has more people in the mental health workforce and is projected to have the highest level of workforce shortage by 2025 compared to psychiatrists, mental health counselors, and clinical and counseling psychologists.

True

With subsequent revisions of the diagnostic manual since DSM-III, however, increasing dissatisfaction with the validity of the criteria has become apparent with complaints that the criteria do not sufficiently differentiate disorders... [Suris]

leading to high rates of diagnostic comorbidity, diagnosis lack specificity for selection of treatment, genetics fail to distinguish psychiatric disorders, and many observed syndromes do not fit any diagnostic definition.