© 2014 by Pearson Education, Inc. All rights reserved. Introduction to Human Services: Through the Eyes of Practice Settings, 3rd Edition Michelle E. Martin Chapter 8 Mental Health and Mental Illnesss © 2014 by Pearson Education, Inc. All rights reserved.

Early Explanations of Mental Illness Evil spirits trepanning. Hippocrates believed that mental illness came from an imbalance in the body’s four humors (blood, black bile, phlegm, yellow bile). Witchcraft Boston witch trials Ergot poisoning Menu

Hippocrates’ 4 Humors

Definitions of Abnormality Many definitions have been proposed, yet none are universally accepted Most definitions, however, share some common features… “The Four Ds” Deviance – Different, extreme, unusual Situational context - the social or environmental setting of a person’s behavior. Menu

Definitions of Abnormality Distress – Unpleasant and upsetting Danger – Poses risk of harm Dysfunction – Causes interference with life Maladaptive

The History of Mental Illness: Perceptions and Treatment Asylums – almshouses – work houses Dorothea Dix (1840s) The Deinstitutionalization of the Mentally Ill Mental Health Study Act Community Mental Health Centers The passage of the CMHC Act set the deinstitutionalization movement into motion Outpatient Prison System © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Diagnosis The controversy of diagnosis. Once a ____ always a _____ Self-fulfilling Prophesy Stereotypes Trouble with treatment © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

"On being sane in insane places" David Rosenhan, psychologist (Journal Science in 1973) Phase 1 - "pseudopatients" (three women and five men) briefly feigned auditory hallucinations gained admission to 12 different psychiatric hospitals in five different States All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release. The average time that the patients spent in the hospital was 19 days. Other patients knew they were faking. © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

"On being sane in insane places" Phase 2 - an offended hospital administration challenging Rosenhan to send pseudopatients to its facility, whom its staff would then detect. Rosenhan agreed and in the following weeks out of 193 new patients the staff identified 41 as potential pseudopatients, with 19 of these receiving suspicion from at least 1 psychiatrist and 1 other staff member. In fact Rosenhan had sent no one to the hospital. © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Diagnosis ICD-10 Codes For Mental Disorders Diagnostic and Statistical Manual, Version IV, Text Revision and now DSM V Includes definitions of disorders, their symptoms, and criteria. http://www.psyweb.com/ Differences between 4 and 5 © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Common Mental Illnesses and Clinical Issues The first two axes of the DSM-V are the ones most commonly used Clinical or mental disorders are diagnosed on Axis I © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

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Mental Health Practice Settings and Counseling Interventions Intervention Strategies The mental health community’s tendency to approach mental illness from a pathological perspective An alternative approach to viewing mental illness is to use a strengths perspective Positive Psychology Self-sufficiency & self-determination © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Mental Illness and Special Populations Mental Illness and the Prison Population: The Criminalization of the Mentally Ill Inadvertent shifting of chronically mentally ill patients from public hospitals to jails & prisons Women are particularly overrepresented in the prison population Mental Health Courts © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Current Legislation Affecting Access to Mental Health Services Other Federal Legislation Former president George W. Bush announced the establishment of New Freedom Initiative Equal integration of mentally ill into community Complaints of the commission’s report Slow recovery Slow application of new treatment methods © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.

Current Legislation Affecting Access to Mental Health Services Mental Health Parity Some mental illnesses take a lifetime to develop; others seem to hit out of nowhere Mental Health Parity Act was passed in 1996 The Mental Health Parity and Addiction Equity Act of 2008 Patient Protection and Affordable Care Act of 2010 Insurance companies are to treat mental illness like physical illness. © 2014, 2011, 2007 Pearson Education, Inc. All rights reserved.