COMMUNITY MENTAL HEALTH

1. COMMUNITY MENTAL HEALTH

2. What is Mental Health? • The emotional and social well-being of an individual, including one’s psychological resources for dealing with the day-to-day problems of life.

3. Good Mental Health is the Ability to: • Function under adversity • Change or adapt to changes • Maintain control over one’s tension and anxiety • Find more satisfaction in giving than receiving • Show consideration for others • Curb hate and guild • Love others

4. Classification of Mental Disorders • Diagnostic and Statistical Manual of Mental Disorders, fourth addition http://www.psychologynet.org/dsm.html • Anxiety Disorders • Childhood Disorders • Eating Disorders • Mood Disorders • Personality Disorders • Psychotic Disorders • Substance-Related Disorders • Other Disorders

5. Causes of Mental Disorders • Birth Defects • Inherited mental deficiency • Biologically caused mental retardation • Physical Impairment • Neurotransmitter failures related to psychotic episodes at puberty • Brain trauma due to accident • Psychological Causes • Being reared in economically deprived conditions • Parental abuse

6. Mental Illness in America • Four to five million adults have serious mental illness (SMI) • 15.4% of the U.S. population 18 and older have had one incident of mental illness in the past 30 days • 18.2 adults per 1,000 had experienced an episode of SMI in the past year

7. Social Indicators of Mental Illness • There are approximate 30,000 suicides in the U.S. yearly • In 1991 the number 2 and number 3 leading cause of death among 15-24 year olds was homicide • In 1990 the divorce rate (4.7/1,000) was nearly half the marriage rate (9.8/1,000) • 4.5 million women of childbearing age were current users of illegal substances • 1,383 children died from abuse or neglect in 1991

8. Stress: A Contemporary Mental Health Problem • Stress is one’s psychological and physiological response to stressors • General Adaptation Syndrome (GAS) A three stage response to stressors • Alarm reaction • Resistance • Exhaustion Fight or Flight

9. Mental Health in America Before World War I • Care provided by families or private caretakers • Those not cared for in the home were sent to the poor houses or almshouses • In the late 19th century as the number of people increased in the poor houses and almshouses attempts were made to separate people by type of disability • In 1851 Dr. Thomas Bond visited the famous Bedlam Hospital in England and founded Pennsylvania Hospital the first institution in America for the care of the mentally ill. • Blood letting • Blistering • Emetics • Warm and cold baths

10. The Moral Treatment Era for the Well-To-Do • William Tuke, and English Quaker, established moral treatment • Mental illness was caused by: • Infidelity • Being overworked • Envy • Gluttony • Drinking • Sexual excesses • Treated in an asylum with: • Rest • Light food • Exercise • Fresh air • Amusements

11. The State Hospitals • Institutions became a place for those society did not want to have around • Prisoners • Orphans • Wayward youths • The mentally ill • The rationalization was that with small numbers of patients proper care could be provided • The numbers of patients grew very rapidly • In time the institutions became human warehouses

12. The Mental Hygiene Movement • Occurred during the first few decades of the twentieth century • Believed that early detection treatment was key to curing mental illness • Wanted to address the problem at a community level • Established local mental hospitals (Bellevue in NY) • This movement did nothing to address the State Hospital problem • By the 1940s state mental institutions had grown to nearly a half-million

13. Mental Health Care After World War II • Psychiatrists came out of the war with new techniques called crisis management • In 1946 the National Institute of Mental Health was formed • Fostered research • Supported training • Improved clinical services

14. Deinstitutionalization • Discharging of patients from state hospitals and the relocating them in less crowded community settings • In 1955 558,922 resident patients • In 1970 337,619 resident patients • In 1980 150,000 resident patients • In 1990 110,000 resident patients

15. Deinstitutionalization Forces • Economics • States needed money for roads, education and welfare • There was a new profit motive to provide services for the mentally ill • Idealism: Keep people out of institutions • Legal considerations • Federal Legislation: Aid to the Permanently and Totally Disabled (APTD) • Welfare money could now be paid to discharged mental patients • Antipsychotic drugs • Chlorpromazine • Thorazine

16. Community Mental Health Centers • A Presidential commission recommended replacing all mental hospitals with community based mental health centers (1961) • Seen as secondary and tertiary prevention • The federal government became partially responsible for mental health care in the U.S. • Reduced budgets during the Regan years left community mental health centers understaffed and under utilized