38. Chronic Mental Illness

Question 1

define serious and persistent mental illness

Answer 1

psychiatric disorder that persists over many years, produces severe disability, and requires long term care and support.

Question 2

ppl with what illnesses often qualify as having serious and persistent mental illness?

Answer 2

schizophrenia, schizoaffective, severe bipolar

Question 3

mental health dollars have been transferred from what to what in the era of deinstitutionalization?

Answer 3

state mental health hosp to community programs.

Question 4

why was deinstitutionalization considered a failure in most states?

Answer 4

community programs not created: health money used for hospital based care systems and other things

Question 5

in the US what % of people with severe and persistent mental illness receive NO care?

Answer 5

half

Question 6

what is the goal of community care?

Answer 6

help people whose lives are affected by severe mental illness to achieve life goals (housing, employment, symptom management, freedom from addiction, good health, staying out of hosp)

Question 7

what are some of the evidence-based practices that support the health of pts with severe mental illness?

Answer 7

• appropriate med use
• supported employment
• dual diagnosis services
• outreach-oriented case management
• illness self-management strategies
• family psychoeducation

Question 8

what is the cornerstone of treating the severely mentally ill?

Answer 8

adequate housing. 33% of homeless have mental illness.

Question 9

most adults with severe mental illness live where?

Answer 9

w family (40%)

Question 10

in what ways is work helpful for people with severe mental illness?

Answer 10

direct improvements in activity level, social contact, money and also can help self-esteem, illness management, quality of life

Question 11

what is employment support?

Answer 11

helps pts find jobs, provides monitoring and support.

Question 12

what % of ppl with severe mental illness abuse alc/drugs?

Answer 12

50%.

Question 13

what does alc/drug abuse lead to in ppl with severe mental illness?

Answer 13

inc symptoms, more hospitalizations, homelessness, infectious diseases, victimization, poor response to treatment

Question 14

what is the role of families for ppl with mental illness?

Answer 14

providing psychoeducation to families improves the course of their relatives’ mental illness

Question 15

what is the role of the day to day environment for people with mental illness? what is ideal?

Answer 15

overstimulation leads to symptomatic relapse, understimulation leads to atrophy, lethargy. ideal is supportive, emotionally consistent.

Question 16

compared to the general popn, what is the average life expectancy of ppl with severe mental illness?

Answer 16

15-30 y less

Question 17

what contributes to the shortened lifespan of ppl with severel mental illness?

Answer 17

med side effects, low exercise, poor diet, high tobacco use, less access to general healthcare

Question 18

what is the rate of suicide in scz and bipolar?

Answer 18

10-15%

Question 19

what highly correlates with suicide?

Answer 19

hopelessness

Question 20

what type of therapy helps prevent suicide? what are the stages of that therapy?

Answer 20

supportive psychotherapy (rather than exploratory/psychodynamic)
stages: engagement, illness mastery, working through