1. Community Mental
Health
Chapter 11

2. Introduction
• Mental illness is the leading cause of disability
in North America and Europe
• ~26% of American adults have diagnosable
mental or addictive disorders during a given
year
• 6% of adults in U.S. have serious mental illness
• Needs of people with mental illnesses diverse
• ~ ½ of people with mental illness have more
than one disorder

3. Causes of Disability for All Ages, U.S.

4. Definitions
• Mental health
• Emotional and social well-being; psychological
resources for dealing with day-to-day problems
of life
• Mental illness
• all diagnosable mental disorders
• Mental disorders
• Health conditions characterized by alterations in
thinking, mood, or behavior associated with
distress and/or impaired functioning

5. Good Mental Health
• Adults with good mental health are able to:
• 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

6. Classification of Mental Disorders
• Classification of mental disorders arbitrary
because based on descriptions of behavioral
signs and symptoms rather than clinical
measurements
• Diagnostic and Statistical Manual of Mental
Disorders, 4th edition, by the American
Psychiatric Association
• Most influential book in mental health

7. Causes of Mental Disorders
• Symptoms can arise from various causes:
• Poor prenatal care, postnatal environment,
genetics, environmental factors, brain function
impairment, substance abuse, maladaptive
family functioning
• PTSD
• Major Depression

8. Mental Illness in America
• Mental illness one of most pervasive health
problems in U.S.
• Homicide and suicide #2 and #3 causes of
death in 15-24 age group; associated with
mood disorders
• High rates of alcohol, tobacco, and other drugs
use for coping with life’s problems another
social indicator of mental illness

9. Stress
• General Adaptation Syndrome (GAS)

10. Stress
• Fight or flight reaction
• Diseases of adaptation
• Psychophysiologic disorders
• Avoiding stressful situations preferable to
managing stress
• Stress management
• Community support

11. History of Mental Health Care in America
• Collective response to mental illness has been
cyclic in the U.S.
• Periods of enthusiastic reform and periods of
national ambivalence

12. Mental Health Care before World War II
• Colonial America mentally ill were cared for
by families or private caretakers
• Institutionalization first appeared in 18 th
century
• Population growth led to institution growth
• Harsh treatments and unpleasant conditions

13. The Moral Treatment Era
• Began in 1792
• Belief that environmental changes can affect
the mind and alter behavior
• Move people from settings causing life
stressors into rural, peaceful setting
• Appeared to have success and became widely
acceptable

14. The State Hospitals
• Dorothea Dix advocated for public hospitals
providing decent care for indigents with
mental illness
• State hospitals built, but deterioration of
services occurred as chronic nature of mental
illness was discovered; long term or lifetime
stays were the norm
• Capacities quickly reached; personalized care
lost; restraints became more practical; staff
turnover high

15. The State Hospitals
• 1940, population in state mental institutions
was nearly a half million; many elderly
• Electroconvulsive Therapy (ECT) introduced
in 1939; still used today
• Lobotomies practiced

16. Mental Health Care after World War II
• NIMH established
• Deinstitutionalization from state hospitals
propelled by economics, idealism, legal
considerations, and antipsychotic drugs
• Community mental health centers - fully
staffed centers originally funded by the federal
government providing comprehensive mental
health services to local populations

17. Mental Health Care Concerns Today
• Experiences of people with serious mental
illness has improved significantly in past 50
years
• Challenges remain:
• How to provide services to the homeless
• Resolving problems of those with mental
illness who are incarcerated

18. Homelessness
• 2.1 million adults experience homelessness
over the course of a year
• 80% temporarily homeless, 10% episodically
homeless, 10% chronically homeless
• About half of all homeless adults have
substance use disorders
• Many have major depression and other co-
occurring mental illness

19. Jails and Prisons
• People with serious mental illness perpetrate
more violence than others
• 35% of people with mental illness are
victimized by violence
• More than half of all prison and jail inmates
have mental health problems
• Once released back into community, more
likely to commit crime if untreated

21. Prevention
• Prevention in community mental health
considered more cost-effective than treatment
• Primary
• Secondary
• Tertiary
• Preventive community mental health care
services
• Primary
• Secondary
• Tertiary

22. Treatment
• Treatment approaches
• Goals to reduce symptoms, improve personal
and social functioning, develop and strengthen
coping skills, promote behaviors that make a
person’s life better
• Psychotherapy
• Psychopharmacology
• Psychiatric rehabilitation
• Self-help groups

23. Federal Initiatives for Mental Health Care
• Most federal support has been for research,
surveillance, and goal setting; less support for
prevention, early intervention, and treatment
• Achieving the Promise: Transforming Mental
Health Care in America
• Medicaid spending and mental health concerns

24. Community Mental Health and Managed
Care
• Focused on reducing costs of care and making
sure outcomes are effective
• Behavioral health care services
• Parity

25. Discussion Questions
• How can community mental health centers
work to reach 100% of their territory in need?
• What role can schools play in supporting
mental health in children and adolescents?