Lecture 1

Question 1

How does the National Institute of Mental Health define Severe Mental Illness?

Answer 1

(a) a major diagnosis of non-organic psychosis or personality disorder
(b) duration of at least 2 years
(c) at least two of the five categories of functional disabilities

Diagnosis: a major affective, non-organic psychotic disorder or a disorder that may lead to a chronic disability such as BPD

Duration: Treatment history meets one or both of the following criteria:
1) has undergone psychiatric treatment more intensive than outpatient care more than once in a lifetime
2) has experienced an episode of continuous, supportive residential care, other than hospitalization, for a period long enough to have significantly disrupted the normal living situation

Disability: severe recurrent disability resulting from mental illness. The disability results in functional limitations in major life activities. Individuals must meet at least two of the following criteria on a continuing or intermittent basis:
1. Is unemployed, is employed in a sheltered setting or supportive work situation or has markedly limited skills and a poor work history
2. Requires public financial assistance from out-of-hospital maintenance and may be unable to procure such assistance without help
3. Has difficulty in establishing or maintaining a personal social support system
4. Requires help in basic livings skills such as hygiene, food preparation, or money management
5. Exhibits inappropriate social behavior which results in intervention by the mental and/or judicial system

Question 2

What are considered “difficult” to treat patients?

Answer 2

They’re not compliant
There is no or little progress

Contextual factors:
- poverty
- low social-economic status
- unemployment
- homelessness
- criminal/inappropriate social behavior

Dual diagnosis:
- in combination with substance abuse
- childhood trauma, childhood abuse, attachment problems
- depressive or anxiety symptoms

Question 3

What do we have to keep in mind when using the term “difficult patient”

Answer 3

Just by using the words difficult to treat as a professional, you are stigmatizing
What you think at the beginning of treatment will affect how you will treat the patient and how hopeful you will be
Approaching the client as if change is always possible

Question 4

optimal
distinctiveness theory

Answer 4

suggests that identification with a group simultaneously
meets the need for similarity (through within-group comparisons) and difference (through
between-group comparisons)