Policy Ch 7
20. Describe the significance of the 1975 O'Connor v. Donaldson decision by the Supreme Court.
"The State cannot confine a non-dangerous person who is capable of surviving safely... by himself or with the help of willing and responsible family or friends" Due process of rights of people with mental illness were established. Clarified the conditions under which a state might commit someone for psychiatric care. The state cannot confine a non dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members
Describe the National Committee for Mental Hygiene. When was it founded and what did it promote?
1909. Promised the prevention of mental disorders. Argued prevention is easier and less expensive then treatment. Treated mental illness as a problem of social and or personal adjustment its rationale was similar to the public health movement—felt that improvements in family life and social conditions would prevent the occurrence of minor mental disturbances that left untreated, could develop into incurable mental disorders National Committee for Mental Hygiene 1909- to foster the prevention of mental disorders arguing that prevention is easier and less expensive than treatment
According to the American Psychiatric Association, approximately what proportion of homeless Americans suffer from severe and persistent mental illness?
28% to 37%
Housing first
A mental health approach that places people who are homeless, usually also experiencing severe mental illness, substance abuse, or release from prison, into affordable housing.
According to The National Comorbidity Survey Replication in 2005 (NCSR), what is/are the most common psychiatric disorder(s) among Americans?
Anxiety Disorders followed by mood disorders , then impulse control and substance disorders
Who was Dorothea Dix, and what was her contribution to US mental health policy?
Apostle to the Insane" • Effective methodology - Visit prisons & almshouses - Reportedfindings - Provided access to policy elites and politicians - Advocatedforstructuralchanges • 31 asylums • Psychiatric social work • Focus: Protecting people with MI • Asylums viewed as a model for providing protective and therapeutic environment
What were the first public institutional settings for the mentally ill?
Asylum
DSM
Diagnostic and Statistical Manual of Mental Disorders initials of the American Psychiatric Association's book that lists diagnostic criteria for many psychological disorders
2. List and describe the various ways that mental illness has been viewed/constructed.
Eccentricity: Popular Culture: Mental illness often constructed as correlated with creativity Sin:Early 18th Century: Behaviors associated with mental illness constructed as consequences of sin and/or possession Disease:• Growing awareness of biological dimensions of MI • Mechanic(1962): - If maladaptive behaviors seen as counter-beneficial to self, then constructed as "sick" - If maladaptive behaviors seen as beneficial to self, then constructed as "bad" Disability:Severe and persistent MI can provide significant benefits
Mental hygiene
Is the science of preventing mental illness and preserving mental health through the use of psychology psychiatry and education it also focuses on promoting public awareness
Who was Robert Felix, and what was his contribution to US mental health policy?
Leader of the Mental hygiene movement near the end of world war 2. The leading force behind the National Mental Health Act.
Describe "carve-out strategy" as presented in the text. What are its effects on mental health services?
Mental health services are treated from medical services. Either the Managed care organization or the State Medicaid authority contracts with local providers for mental health and substances abuse treatment in an approach known as managed behavioral health care MBCH. Sometimes this shows cost reductions yet some states struggle with implantation
According to the text, how likely are individuals with severe mental illness to commit violent acts, as compared to the general public?
More likely
What effect did the passage of Medicaid have on patients in psychiatric institutions?
Patients with insurance coverage typically caters to short stays, with patients who are more likely to have affective disorders such as depression are treated in private psychiatric service hospitals...Public hospitals generally serve patients who need long term care.
In what sense is access to mental health services a social justice issue?
People of lower socioeconomic status have less access to services. First-mental illness might be a symptom or result of social or economic disadvantage. Second- access to treatment (as a benefit of group membership) is distributed on a basis of advantage
Describe the trend that some call "criminalization" of mental illness. To what does this refer?
People with mental illness are over represented in prison populations.
According to the text, how likely are people of color to receive mental health treatment as compared to members of the cultural majority?
Private insurance coverage owners are moe likely to receive treatment then those who do not. It is comparable.
Describe the mental hygiene movement. How did this movement change thinking about childhood? What sort policies did mental hygiene proponents endorse, and how do these relate to this construction of mental illness?
Problem of social and/or personal adjustment • Paralleled public health movement • Improvements in family life and social conditions would prevent the development of lesser symptoms of MI - If left untreated, these can grow into incurable mental disorders - Physicaldiseasemodel • Focus on childhood problems
Describe the role of social workers in the Mental Hygiene Movement and the impact of that role on the profession.
Roles of mental health professionals changed. The field of community psychiatry was born, bringing psychiatrists our of mental institutions and into schools, courts and even private homes. Social workers enjoyed higher status than they had been accorded in the rigid hierarchy of mental institutions
SPMI
Serious Persistent Mental Illness Adults with serious mental illness are persons aged 18 or older who currently have, or at any time during the past year have had a diagnosable mental, behavioral or emotional disorder of sufficient duration to meet diagnostic criteria specified within the DSM-IV-TR .
Discuss the tensions and controversies surrounding involuntary commitment of the mentally ill.
Some people in US with mental illness have been confined against their will in institutions The court ruled under the O'Connor vs Donaldson that Clarified the conditions under which a state might commit someone for psychiatric care. The state cannot confine a non dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members
Describe the expansion of asylums for the mentally ill through 1955. How many Americans were housed by then, and what sorts of interventions were provided? To what construction of mental illness do these interventions relate?
The expansion peaked at this time. More than half a million Americans diagnosed with mental illness were housed. Intervention The gap between the reality of life in an asylum and the promise of effective treatment widened because the populations in these institutions kept growing......populations continued to grow and this increased intractable cases. The asylums became a place of despair—a last resort for those with no other options
18. What has been the effect of Medicaid on people with severe and persistent mental illness? How does the text characterize the significance of this program for people with severe and persistent mental illness?
The mental health services financed vary from state to state. Increase in state level control of the program. There haas been expansion Mental health expenditures have increased at a rate that exceeds inflation Medicare and Medicaid cover and increased and growing proportion of Us mental health costs The share contribution by Medicaid increased from 17 to 28 percent from 1986 to 2005 Medicaid has been described as the "single largest and most important medical program affecting operons with severe and persistent mental illness"
5. Describe the process by which the Diagnostic and Statistical Manual (DSM) has been composed. How has the content of the DSM changed over time?
The most recent edition has been composed in a conference. Various things such as asbergers have been dropped overtime. Today there are three times the number of things listed then the first edition. reflects the ongoing effort to standardize psychiatric terminology that began during the 1920s. It defines mental illness in exquisite detail based on cognitive, emotional and behavioral indicators. DSM III in 1980 was a turning point in psychiatry. It rejectd psychodynamic interpretations (eliminating the term neurosis) and provided a scientifically based medical model of mental illness. New disorders including PTSD, ADD were now included, Later versions of DSM continued to build off the medical model and seldom talked about the cause of the mental illness, focus on treatment
What does Torrey see as the difference between "mental health" issues and "mental illness"? How does he believe interventions should differ in these cases?
The standards are too strict and it interferes with peoples ability to help with mental illness.
Describe the "de facto mental health system" as presented in the text. What four major components comprise this?
This is a system of services that has evolved without a central plan or policy to govern its development. It has 4 main components 1. Specialty mental health sector (outpatient services, psychiatrist, social workers and psychiatric nurses) 2. General medical/primary care sector( general medical practitioners for some it's the only way for help or the initial contact point-primary care Doc) 3. Human services Sector (social services, rehabilitation, school based counseling) 4. Voluntary support network sector ( self-help groups, peer counselors)
4. Provide information about the nation's first public hospital designed exclusively for the insane. What was its name, where was it located,and what was significant about its development?
Virginia Eastern Asylum (Williamsburg). It was provided because there was a need for early intervention and recognition of the external effects of madness.
Describe the National Alliance for the Mentally Ill, and its advocacy functions and foci.
a nationwide grassroots advocacy group, representing families and people affected by mental disorders in the United States. Emerged in 1979 to advocate for patients' rights and reduce the stigma associated with mental illness
Who was Elizabeth Packard, and what was her contribution to US mental health policy?
an advocate for the rights of women and people accused of insanity. A trial took place that declared her not mentally ill. rgued against Dix argued that involuntary commitment of mental patients was incarceration without due process was 19year old who had "brain fever" she was put into an institution for being "insane" by her husband when in fact she was sane
Discuss how the Housing First model differs from traditional approaches to housing the mentally ill and the premise behind both approaches to housing the mentally ill.
an approach that offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections to the community-based supports people need to keep their housing and avoid returning to homelessness.
Describe the significance of the 1976 Tarasoff v. Regents of the University of California decision with regard to mental health programs.
case in which the Supreme Court of California held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient. DUTY TO WARN-mental health practitioners whose patients present a significant threat of violence are require to take reasonable steps to protect the intended victims. Duty to warn to protect life of potential victims
3. During the early 18th century, to what was mental illness was often attributed to?
constructed as consequences of sin and/or possession but shifted to personal and environmental influences.
Traitement moral
links between emotions, social conditions and insanity.
Describe California's Short-Doyle Act. How did this policy affect services for persons who with mental illness?
seeks to encourage the treatment of a patient suffering from a psychiatric disorder in his home community, with the assistance of local medical resources. One corollary of this program is the closer working together of the psychiatrist and the rest of the medical profession. A second goal of the act is the application of the public health principles to mental illnesses and mental retardation. Educational and consultative services provide implementation of these principles. claim process system allows California's County. Mental Health Plans (MHPs) to obtain reimbursement of funds for medically necessary. specialty mental health services provided to Medi-Cal-eligible beneficiaries and also to.
Insurance parity
written in 1996; implemented in 199 providing equal coverage for mental and medical problems.