PHHE 295. Chapter 11. Community Mental Health

PHHE 295

Chapter 11: Community Mental Health

Chapter Objectives

1)      Define mental health and mental disorders.

2)      Explain what is meant by the DSM-IV-TR.

3)      Give an example of how cultural differences can affect psychiatric diagnosis.

4)      Identify the major causes of mental disorders.

5)      Explain why mental health is one of the major community health problems in the United States.

6)      Define stress, and explain its relationship to physical and mental health.

7)      Briefly trace the history of mental health care in the United States, highlighting the major changes both before and after World War II.

8)      Define the term deinstitutionalization and list and discuss the propelling forces that brought it about.

9)      Describe the movement toward community mental health centers.

10)  Identify the major mental and physical problems of people who are homeless.

11)  Describe mental health courts and the use of “legal leverage” to compel treatment.

12)  Define primary, secondary, and tertiary prevention as they relate to mental health care services and give an example of each.

13)  List and briefly describe the three basic approaches to treatment for mental disorders.

14)  Describe what “recovery” means for people with mental illness in the United States, and for those in less developed countries such as India or Tanzania.

15)  Explain what is meant by psychiatric rehabilitation, and list the kinds of services provided by effective programs.

Key Terms

·         Mental Health: Emotional and social well-being, including one’s psychological resources for dealing with day-to-day problems of life.

·         Mental Illness: A collective term for all diagnosable mental disorders.

·         Mental Disorders: Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning.

·         Cultural Competence: Service provider’s degree of compatibility with the specific culture of the population served, for example, proficiency in language(s) other than English, familiarity with cultural idioms of distress or body language, folk beliefs, and expectations regarding treatment procedures and likely outcomes.

·         Major Depression: An affective disorder characterized by a dysphoric mood, usually depression, or loss of interest or pleasure in almost all usual activities or pastimes.

·         General Adaptation Syndrome: The complex physiological responses resulting form exposure to stressors.

·         Fight or Flight Reaction: An alarm reaction that prepares one physiologically for sudden action.

·         Diseases of Adaptation: Diseases that result from chronic exposure to excess levels of stressors, which produce a General Adaptation Syndrome response.

·         Moral Treatment: Treatment for mental illness based on belief that mental illness was caused by moral decay.

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

·         Lobotomy: Surgical severance of nerve fibers of the brain by incision.

·         National Institute of Mental Health: The nation’s leading mental health research agency, housed in the National Institutes of Health.

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

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

·         Neuroleptic Drugs: Drugs that reduce nervous activity; another term for antipsychotic drugs.

·         Chemical Straightjacket: A drug that subdues a mental patient’s behavior.

·         Tardive Dyskinesia: Irreversible condition of involuntary and abnormal movements of the tongue, mouth, arms, and legs, which can result from long-term use of certain antipsychotic drugs.

·         Mental Retardation Facilities and Community Mental Health Centers Act: A law that made the federal government responsible for assisting in the funding of mental health facilities and services.

·         Community Mental Health Center: A fully staffed center originally funded by the federal government that provides comprehensive mental health services to local populations.

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

·         Bipolar Disorder: An affective disorder characterized by distinct periods of elevated mood alternating with periods of depression.

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

·         Cognitive-Behavioral Therapy: Treatment based on learning new thought patterns and adaptive skills, with regular practice between therapy sessions.

·         Psychopharmacological Therapy: Treatment for mental illness that involves medications.

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

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

·         Evidence-Based Practices: Ways of delivering services to people using scientific evidence that shows that the services actually work.

·         Self-Help Groups: Groups of concerned members of the community who are united by a shared interest, concern, or deficit not shared by other members of the community.

·         National Alliance on Mental Illness: A national self-help group that supports the belief that major mental disorders are brain diseases that are of genetic origin and biological in nature and are diagnosable and treatable with medications.

·         Behavioral Health Care Services: The managed care term for mental health and substance abuse/dependence care services.

Chapter Summary

·         Mental illness constitutes a major community health concern because of its prevalence and chronicity and because of the social, cultural, and economic attention and resources it demand from all of us.

·         Americans are afflicted with a variety of mental disorders, caused by genetic factors, environmental factors, or a combination of both. These disorders, which can range from mild to severe, are often chronic and may limit the ability of some of those afflicted to live independently.

·         Stress, resulting from social and environmental forces, can have a detrimental influence on both physical and mental health. Combat-zone military veterans and survivors of and responders to natural and human-made disasters are at especially high risk for developing mental disorders.

·         Over the years, society’s response to the needs of those with mental illness has been characterized by long periods of apathy interrupted by enthusiastic movements for new and enlightened approaches to care.

·         Deinstitutionalization, in which thousands of mental patients housed in state and county hospitals were discharged and returned to their communities, was the most prominent movement of the twentieth century. The origins of many of the current problems in community mental health care, such as a large number of homeless people and prison inmates with mental illnesses, can be traced to this movement.

·         The basic concepts of prevention in community health can be applied to the prevention and treatment of mental disorders.

·         Among the most common treatment approaches are psychotherapy, which is based on the use of medications. Self-help groups provide additional support to people at risk for relapse.

·         People with severe mental illnesses generally pursue recovery rather than cure. Recovery entails adaptive change, including increased independence, effective coping, supportive relationships, community participation, and sometimes gainful employment.

·         Psychiatric rehabilitation programs for those living in our communities with mental illness show promise that with community support, many individuals can achieve the level of recovery necessary for them to be integrated successfully into their communities.

·         Important issues face those concerned with providing services for people with mental disorders. One is finding ways to provide a variety of easily accessible preventative, intervention, and treatment services to people from culturally diverse backgrounds, with multiple problems and few resources, in a climate of cost containment under managed care.