Chapter 11: Community Mental Health

Question 1

what challenges remain in terms of mental health?

Answer 1

how to provide services to homeless, changing perception that mental illness is linked to extreme violence, resolving probs of those w/ mental illness who are incarcerated, general public still scared of people w/ mental health concerns

Question 2

what %age of people are homeless?

Answer 2

80% temporarily homeless, 10% episodically homeless, 10% chronically homeless

Question 3

how many homeless adults have substance use disorders, depression, other co-occurring mental illnesses?

Answer 3

1/2

Question 4

what do successful mental health interventions look like?

Answer 4

provision of housing and services they need

Question 5

what is the relationship btwn mental illness and violence?

Answer 5

• Extreme violence relatively rare in people w/ mental disorders
• Much of risk attributable to comorbid factors
• What should be done to prevent violence is unclear due to issues related to individual freedoms, privacy

Question 6

what is mental illness like in jails and prisons?

Answer 6

• More than ½ of all prison and jail inmates have mental health probs
• Correctional facilities designed to confine and punish not to treat disease
• Lack space, adequate number of qualified treatment personnel, and timely access to services
• Once released back into community, more likely to commit crime if untreated

Question 7

how can we apply primary, secondary, and tertiary prevention to mental disorders?

Answer 7

• Primary - reduces incidence of mental illness and related probs
• Secondary - reduces prevalence by shortening duration of episodes
• Tertiary - treatment and rehabilitation

Question 8

what is the goal of treatment of mental disorders?

Answer 8

• To reduce symptoms

- To improve personal and social functioning

Question 9

what is psychopharmacological therapy?

Answer 9

• treatment w/ medications
• Conditions for which medications exist include: schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and OCD
• Other biomedical therapy: ECT

Question 10

what is psychotherapy?

Answer 10

• treatment through verbal communication
• Numerous approaches
  Cognitive-behavioural therapy: teach the person who has mental illness adaptive skills in coping w/ their illness
• Most likely to be successful in less severe cases or when used in conjunction with other approaches

Question 11

what are the benefits of using technology to treat mental illness?

Answer 11

delivers flexible help directly to clients’ living environments, lowers cost to patient, increases privacy of patient, may reduce feelings of coerciveness

Question 12

what is psychiatric rehabilitation?

Answer 12

• Primary objective is most often recovery rather than cure
• Psychiatric rehab - current recovery-oriented services
• Services include: medication, therapy, adaptive skills, changing environment through accommodations @ work/school
• Practices must be evidence based

Question 13

what are self-help groups?

Answer 13

concerned members of the community who are united by a shared interest, concern, or deficit not shared by other members of the community

Question 14

what are some challenges facing mental health care?

Answer 14

• Multiple services needed
• Staff turnover relatively high
• System is decentralized and fragmented
• Lack of licensed providers in rural and low-income areas
• Lack of cultural competence among providers

Question 15

what was mental health care like befroe WWII?

Answer 15

• Colonial times - people w/ mental illness cared for by families or private caretakers
• Institutionalization first appeared in 18th century
• Institutionalization in terms of mental health: being committed to a mental institutions
• Population growth led to institution growth
• Harsh treatments and unpleasant conditions
• This is bc of so many people being put into mental institutions, so they became very crowded

Question 16

what was mental health care like in the moral treatment era?

Answer 16

• Began in 1972
• People believed that mental illness was based on moral decay
• Belief that environmental changes can affect the mind and alter behaviour
• Move people from settings causing life stressors into rural, peaceful setting
• Appeared to have success and became widely acceptable

Question 17

what are mental institutions?

Answer 17

• State hospitals = mental institutions
• Supposed to provide therapeutic environment, based on close personal relationships btwn patients and well-trained staff
• Deterioration of services occurred as chronic nature of mental illness was discovered, long term or lifetime stays were the norm
• Max capacities quickly reached, personalized care lost, restraints (cuffs) became more practical, staff turnover high
• Didn’t account for chronic nature of mental illness
• A lot of patients would never go home
  1940 - population in mental institutions was ½ million in north america

Question 18

what is electroconvulsive therapy (ECT)?

Answer 18

• electric shock treatment
• introduced as a response to large staff case load
• When you give someone ECT, you put leather restraints and electrodes on their head and the zap you w/ large dose of electrical current
• Used when patients are suicidal
• Used to control people who were becoming too hard to handle bc of overcrowding
• After 6 months, people would go back to normal

Question 19

what are lobotomies?

Answer 19

• separating 2 halves of the brain, can’t be undone
• Patients were a vegetable, not capable of complex emotions
• Very inhumane, not a good way to control people w/ mental illness
• Once they had a lobotomy they were easier to handle and wouldn’t cause any problems

Question 20

what helped to make releasing ppl back in to the community easier?

Answer 20

• new medications in the 1950s
• Chlorpromazine: first and most famous antipsychotic drug, introduced in 1954, brand name: thorazine
• Neuroleptic drugs: family of drugs that reduce nervous activity
• Chemical straight jacket: drug that controls a patients behaviour
• Subdues patients behaviour, most popular ways when people were coming out of mental institutions and released into society

Question 21

what is the national institute of mental health (NIMH)?

Answer 21

• Established in 1946 after WWII
• To foster and aid research related to cause, diagnosis, and treatment of neuropsychiatric disorders
• To provide training and award fellowships and grants for work in mental health
• To aid in the prevention, diagnosis, and treatment of neuropsychiatric disorders

Question 22

what is deinstitutionalization?

Answer 22

• discharging of thousands of patients from mental hospitals

- Began in the 50s

Question 23

deinstitutionalization was propelled by 4 factors:

Answer 23

1. Economics: it was expensive to keep everyone in the mental institutions
2. Idealism: keeping poor people live in the facilities isn’t the right thing to do
3. Legal considerations: is it within the bounds of the law for us to be holding these people against their will in these mental institutions?
4. Antipsychotic drugs: made deinstitutionalization more doable
   - Some drugs had bad side effects
   - Ex. tardive dyskinesia: is actually an irreversible condition, causes involuntary and abnormal movements of the following body parts: tongue, mouth, arms, and legs, resulted from long-term use

Question 24

what are the 5 core services of community mental health centres?

Answer 24

inpatient care, outpatient services, 24-hour-a-day emergency care, day treatment or other partial hospitalization services, consultation and education

Question 25

what is transinstitutionalization and what is the problem with it?

Answer 25

• transferring patients from one public health institution to another
• when people are in a mental institution for so long they were so old and put directly into an old folks home

Question 26

what are mensheds?

Answer 26

men come together to get social support from their peers which offsets depression

Question 27

what is mental health?

Answer 27

emotional and social wellbeing, including one’s psychological resources to deal with the day to day problems of life

Question 28

what is mental illness?

Answer 28

collective term for all diagnosable mental disorders

Question 29

what are mental disorders?

Answer 29

health conditions that are characterized by alterations in thinking, mood, or behaviour

Question 30

Adults w/ good mental health able to:

Answer 30

function under adversity, change or adapt to changes around them, maintain control over their tension and anxiety, find more satisfaction in giving than receiving show consideration for others, curb hate and guilt, love others

Question 31

what is the DSM?

Answer 31

• diagnostic and statistical manual of mental disorders
• Published by APA
• Most influential book in mental health
• Classifies disorders based on behavioural signs and symptoms rather than definitive tests or measurements of brain or another body system
• Challenges to diagnosis include comorbidity and lack of cultural competence

Question 32

what are some causes of mental disorders?

Answer 32

poor prenatal care, postnatal environment, genetics, environmental factors, brain function impairment, substance abuse, maladaptive family functioning, stress, PTSD

Question 33

what is stress?

Answer 33

one’s psychological and physiological response to stressors

Question 34

WHEN You respond to a stressor, you go through 3 stages (General Adaptation Syndrome):

Answer 34

1. Stage of alarm
2. Stage of resistance
3. Stage of exhaustion
   aka fight or flight

Question 35

Why was the Community Support Program considered a novel approach to helping people with mental
disorders?

Answer 35

• first recognition that probs of ppl w/ chronic mental illness are social welfare probs
• most ppl w/ chronic mental illness prefer life in a community than an institution

Question 36

What legal and practical concerns limit society’s options for dealing with the potential for serious violence among people who have mental illness?

Answer 36

• legally, authorities can act to prevent potential violence only when someone voluntarily seeks assistance or has made frank threats
• many times ppl w/ severe mental illness don’t seek treatment voluntary, are often marginalized unemployed, poor, abuse drugs/alcohol