COMMUNITY
MENTAL HEALTH
What is Mental Health?
The emotional and social well-being of
an individual, including one’s
psychological resources for dealing with
the day-to-day problems of life.
Good Mental Health is the Ability
to:
Function under adversity
Change or adapt to changes
Maintain control over one’s tension and
anxiety
Find more satisfaction in giving than receiving
Show consideration for others
Curb hate and guild
Love others
Classification of Mental
Disorders
Diagnostic and Statistical Manual of Mental
Disorders, fourth addition
http://www.psychologynet.org/dsm.html
Anxiety Disorders
Childhood Disorders
Eating Disorders
Mood Disorders
Personality Disorders
Psychotic Disorders
Substance-Related Disorders
Other Disorders
Causes of Mental Disorders
Birth Defects
Inherited mental deficiency
Biologically caused mental retardation
Physical Impairment
Neurotransmitter failures related to psychotic
episodes at puberty
Brain trauma due to accident
Psychological Causes
Being reared in economically deprived conditions
Parental abuse
Mental Illness in America
Four to five million adults have serious
mental illness (SMI)
15.4% of the U.S. population 18 and
older have had one incident of mental
illness in the past 30 days
18.2 adults per 1,000 had experienced
an episode of SMI in the past year
Social Indicators of Mental
Illness
There are approximate 30,000 suicides in the
U.S. yearly
In 1991 the number 2 and number 3 leading
cause of death among 15-24 year olds was
homicide
In 1990 the divorce rate (4.7/1,000) was
nearly half the marriage rate (9.8/1,000)
4.5 million women of childbearing age were
current users of illegal substances
1,383 children died from abuse or neglect in
1991
Stress: A Contemporary Mental
Health Problem
Stress is one’s psychological and
physiological response to stressors
General Adaptation Syndrome (GAS) A
three stage response to stressors
Alarm reaction
Resistance
Exhaustion
Fight or Flight
Mental Health in America Before World War I
Care provided by families or private caretakers
Those not cared for in the home were sent to the poor
houses or almshouses
In the late 19th century as the number of people
increased in the poor houses and almshouses attempts
were made to separate people by type of disability
In 1851 Dr. Thomas Bond visited the famous Bedlam
Hospital in England and founded Pennsylvania Hospital
the first institution in America for the care of the mentally
ill.
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Blood letting
Blistering
Emetics
Warm and cold baths
The Moral Treatment Era for the
Well-To-Do
William Tuke, and English Quaker, established
moral treatment
Mental illness was caused by:
Treated in an asylum with:
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Infidelity
Being overworked
Envy
Gluttony
Drinking
Sexual excesses
•Rest
•Light food
•Exercise
•Fresh air
•Amusements
The State Hospitals
Institutions became a place for those society did
not want to have around
Prisoners
Orphans
Wayward youths
The mentally ill
The rationalization was that with small numbers
of patients proper care could be provided
The numbers of patients grew very rapidly
In time the institutions became human
warehouses
The Mental Hygiene Movement
Occurred during the first few decades of the
twentieth century
Believed that early detection treatment was
key to curing mental illness
Wanted to address the problem at a
community level
Established local mental hospitals (Bellevue in
NY)
This movement did nothing to address the
State Hospital problem
By the 1940s state mental institutions had
grown to nearly a half-million
Mental Health Care After World
War II
Psychiatrists came out of the war with
new techniques called crisis
management
In 1946 the National Institute of Mental
Health was formed
Fostered research
Supported training
Improved clinical services
Deinstitutionalization
Discharging of patients from state
hospitals and the relocating them in less
crowded community settings
In
In
In
In
1955
1970
1980
1990
558,922 resident patients
337,619 resident patients
150,000 resident patients
110,000 resident patients
Deinstitutionalization Forces
Economics
States needed money for roads, education and
welfare
There was a new profit motive to provide services
for the mentally ill
Idealism: Keep people out of institutions
Legal considerations
Federal Legislation: Aid to the Permanently and
Totally Disabled (APTD)
Welfare money could now be paid to discharged
mental patients
Antipsychotic drugs
Chlorpromazine
Thorazine
Community Mental Health
Centers
A Presidential commission recommended
replacing all mental hospitals with community
based mental health centers (1961)
Seen as secondary and tertiary prevention
The federal government became partially
responsible for mental health care in the U.S.
Reduced budgets during the Regan years left
community mental health centers
understaffed and under utilized