Week 1 Flashcards
Etiology
- The cause of something
- presumed or theorized cause
- Many disorders have many which can be different in each client even though they have the same disorder
Epidemiology
- the prevalence of a disorder
- how common
- distribution (racial, worldwide, etc)
- ex: 1 in 1000, common among men, etc
Key Treatment Conditons
- What are “they” saying about how we should go about treating this?
Treatment Strategies
- What are effective/ineffective?
Premorbid
- Condition that existed first
Comorbid
- coexisting condition
- what else does client have?
1484 Pope Innocent
What was treatment for people declared “strange?” (Possessed by the devil)
- admit possession and repent
- Be tortured until one admits
- Death to force the soul from devil
1520
What did Martin Luther declare?
- “Mad people are possessed by the devil.”
The Age of Enlightenment (After Middle Ages)
What was the thought on what to do with “the criminal, the demented, and the debtor?”
- Institutionize rather than kill them.
Moral Treatment of Mentally Ill
What is Millieu therapy?
- Reinforce good and decent behavior by changing environment
- recover, life moves on
- revival/ religious experience to set you on the road to proper living
Social Darwinism
What is Social Darwinism?
- “Survival of the fittest” MI are inferior and should be sterilized lest they contaminate the gene poool Misfits should be “locked up”
- 25 states passed sterilization laws by 1936
Settlement Movement
What was the Settlement Movement?
- Help unfortunate
- Child labor laws passed Compulsory education enacted
- WWI saw a conservative swing
- anti- immigrant sentiment flared “Jewish Peril”
Word War II
What is shell shock called now?
- PTSD
1950
What resulted in the breakthrough on Psychotropic medications?
- less physical restraints
- less labotomies
- people no longer had to be hospitalized if given medication
- managed difficult people
1948
What was the National Institute of Mental Health founded and funded for?
- Drive research
- policy
- dollars
The Age of Enlightenment (After Middle Ages)
What was the big change in the perception of the cause of mental illness?
- Considered NOT to be a result of witchcraft, etc
- NOT demonic
- Something wrong with the person
- ”You are the problem/it’s your fault”
1484 Pope Innocent
What were the results of Pope Innocent’s actions towards mentally ill?
- witch burning
- inquisiton
Advantages of the 1963 Act
What was made practical because of advances in psychotropic medications?
- halfway houses
- group homes
1975
For what did Congress begin requiring services?
- children
- aged
- alcohol and drug patients
- follow-up treatment for hospitalized patients
Advantages of the 1963 Act?
What did the substantial decrease in institution admissions mean?
- The fewer people in institutions means more people in the community
Problems with the 1963 Act
What were some of the problems with the CMHA?
- Areas to be served by mental health centers were too large
- Boundaries between rich/poor were confused
- Clnics wanted “best” areas which were in nice areas with less issues.
- Focus on Clinical services rather than prevention
- too much for the centers to handle with managed money
1963 Community Mental Health Act
Which of the aspects of the act couldn’t meet the demands of the people?
- Prevention
- JFK thought of this and only could get 5% of allocated dollars for the act
1963 Community Mental Health Act
For what did the established funding for community mental health centers provide?
Inpatient service
Outpatient Service
Partial hospitalization
24-hour emergency care
Consultations, education, prevention
1963 Community Mental Health Act
What serves as a foundation for the system we have today as well as the current delivery of treatment?
- The Community Mental Health Act
- The compromise bill that was finally passed.
1960 JFK
What was The Kennedy Plan?
- reintegrate mentally ill into community so therefore dollars and jobs were at stake
- able to do this because of medications
- prevention was a key idea
1960 JFK
What did the AMA think about JFK’s thoughts on prevention?
- They opposed JFK
- feared socialized medicine (health care) would follow which was kin to communism apparently
The Age of Enlightenment (After the Middle Ages)
Describe the conditions in the institutions?
- Deplorable
- People were chained and caged
The Reform Movement
What were the conditions like in institutions during the Reform Movment?
- Conditions were bad
Ancient Greece
What was the general thought on the mentally ill in Ancient Greece?
- Mentally ill are under influence of angry gods
- must be shunned
- deparate them by placing them on islands together
North Africa/Eastern Mediterranean Countries
What is Trephination?
- releases evil spirits
- 2 cm hole in the head
- we learned this from exacavations
- recent incidents of trephinaton in Cali
Emerging Medical Beliefs
What was the medical treatment proposed?
- In April, bleed the patient
- in may, purge the patient,
- in October, bleed the patient or give them an ice cold water dip (precursor to shock treatment)
- alternative to moral treatment
Scientific Psychology (1900)
Describe the theory?
- Psychological rather than organic factors dominant in mentally ill
- theories followed from friend to your theory of mentally ill (all theories)
North Africa/Eastern Mediterranean Countries
How were mentally ill people viewed?
- MI ppl are possessed by evil spirits stuck inside them
Colonial Times in the USA
What happened to the mentally ill during the colonial times?
- hanged
- imprisoned
- tortured as agents of satan
Moral Treatment of Mentally Ill
What was the assumption about the mentally ill that still exist in threads today?
- person’s own devious behavior caused them to be possessed
- Insane are normal and need moral environment to recover
- 80% recovery reported, not ill expected to recover sanity
- Moral treatment was essentially Millieu therapy
- disorder is a reflection of “moral weakness” (not same as moral values)
The Reform Movement
Dorthea Dix
- “Insane asylums are scandal and disgrace”
- worked worldwide for reform to clean up institutions
The Reform Movement
Benjamin Rush 1745-1813
- Father of American Psychiatry
- Encouraged more humane TX Treat the MI with respect and dignity,
- moral hospitals were deplorable
- first to suggest that addiction was public health issue
- on the Declaration of Independence (I think)
Emerging Medical Beliefs
What were some of the emerging medical beliefs?
- Insane suffer from brain lesions or oversupply of blood or yellow bile
1950 Scientific Psychiatry
What did the focus become?
- Classify disturbances
- Deal with problems of Moral Treatment
1850 Scientific Psychiatry
What was taking shape during this time?
- Medical Model takes shape
- DSM was starting to be developed
- something wrong with brains but it was unknown
- figuring out classifications of different issues
- advances in brain physiology, chemistry, medicine, etc,
- signaled hope
Scientific Psychology
Wht does the research say about Scientific Psychology?
- Research failed to reveal organic pathology in most Pts who were MI
- Psychological rather than organic factors dominate in MI
- Theories followed from Freud to your theory of MI
Scientific Psychology (1900)
What was the focus for scientific psychology?
- Observable data;
- experimental Psychology
- Testing significance
- Deduce from the way ppl answer questions what might be goin on in their head
- measuring IQ
USA late 19th century
What societal changes do we see during the late 19th century?
- Social shift from agrarian to urban Increase in immigration
USA Late 19th Century
What was the assumption about the immigrants that were coming in from all over the world, especially Europe?
- Generally inferior, lack moral fiber and desire to improve themselves
- immigrants, especially Catholic were undesirable
USA Late 19th Century
What were the mental health implications?
- Admissions to mental health hospitals doubled in US but for “foreigners” it increased six times Because they weren’t easily understood they were made to be mentally ill
Politics & Mental Healthcare
What do liberals believe about mental health?
- Environmental conditions drive mental disturbances
- poverty
- anxiety
- Would spend money on treatment
- create jobs
- more facilities
Politics & Mental Healthcare
What do conservatives typically believe about mental health?
- Environment is fine
- problem is the bad individual
- individual’s problem
- individual’s responsibility
Great Depression
Great Depression
- Institutions neglected again.
- Economic reform followed but not social reform
- Reforms that were instituted in 1929 were reversed a few years back
- Wall Street Crashed
1960 JFK
What does the “rise of liberal thinking” mean?
- Optimism
- Time of possiblity
- Our nation can solve everything
1960 JFK
What did the Joint Commisison Report claim about what drives the mentally ill?
- Lack of education
- Poverty
- Social/psychological connection
1980-2010
What was the result of the reemergence of conservative policies in Lansing and Washington?
- Deinstitutionalize even if there is no community placement possible
- mental health money went to jails and prisons
- mental illness has now become an issue for the judicial system
1980-2010
What happened to LaFayette clinic in Detroit?
- Closed in Detroit in the middle of the night and Pts removed
Clinton Health Reform Proposals
What were the Clinton Health Reform Proposals?
- Single payer system
- MI and Substance abuse Tx not carve out
- Portability of coverage
- No penalty for pre-existing conditions
- Defeated by conservative lobby
The Affordable Care Act (2010) Obama Care
What did the Affordable care act do?
- Eliminated meaningless and cheap healthcare insurance
- Requires basic coverage
- Be insured or fined Added 24 million or so covered individuals (helped marginal hospitals in Rural America survive
The Affordable Care Act (2010) Obama Care
What basic coverage is required?
- Children to 26,
- pre-existing conditions not excluded,
- mental health covered,
- substance abuse Tx covered,
- Women’s coverage without increased premium etc
USA Late 19th Century
What happened to the mental health system during the late 19th Century?
- System became overwhelmed
- moral treatment could not cope
- physicians concluded that “they are incurable, brain defects, nothing to be done.”
JFK 1960
What was the “War on Poverty?”
- Reduce poverty and you decrease mental illness
1850 Scientific Psychiatry
What was the thought on the mentally ill?
- Illness is based on organic brain pathology
- something must be wrong with the brain
What are the prevalent mental disorders for males?
- Alcohols and drug dependencies
- Anxiety disorders
- Dysthymia
- other mood disorders
- Antisocial personality disorders
What are the prevalent mental disorders in females?
- Anxiety disorder
- Major depressive disorder
- other mood disorder
- Alcohol dependancies
- Obsessive compulsive disorder (anxiety disorder)
Modern Healthcare
How do Diagnostic Systems impact counseling?
- Client must be diagnosed
- must meet criteria
What does the Preauthorization Process look like?
- biopyschosocial history first session
- diagnose and get authorization for more sessions
- diagnosis clinically significant
- treatment plan with goals and objectives
- gatekeeper decides how many sessions are needed
Modern Healthcare
How does Philosophy impact counseling?
- Should we treat everyone or reserve for treatable?
Modern Healthcare
How does fashion impact counseling?
- Cognitive behavior is 85% all therapy, it is a fad these days
- whats the next big thing in treatment
Historical Approach
What is the Development Model?
- Mechanistic view: behavioral
- organismic view: humanistic
- contextual view: cognitive behavioral
Historical Approach
What is the Remediation Model?
- Something wrong/ problem
- Medical view: seek to understand the biochemical drivers
Historical Approach
What is the takeaway from developmental model and remediation model?
- Both models co-exist today.
- combination of these models work together
Modern Healthcare (Delivery of Services to Mentally Ill)
How does Economics impact counseling?
- Who is paying?
- What does it cost?
- MUST be considered as part of the treatment plan
- some things are covered some are not
- whats the next thing?
- Dollars matter
Managed Care Model (operates today)
What does the Managed Care Model look like today?
- We’re not paying for it unless you show and tell what you’re doing,
- Can’t do it you don’t get paid
- Treatment planning, be able to translate into behavioral language different behavioral approaches
- We’re not paying for “talking”
- Controls coverage, sessions, everything “managed” by someone else
Gatekeepers
What is the role of the Gatekeepers?
- Take down insurance data
- Make sure it’s valid
- Set up an appointment
- Intake covered
- Biopsychosocial intake
- Clinician justifies disorder by talking language of DSM
- authorize who gets treatment and how much
