Community Mental Health I. What is mental illness?

Criticisms of the Construct. Thomas Szasz (1961) Does mental illness exist or can these behaviors be better conceptualized as problems in living? Rosenhan (1973) Does mental illness largely reflect a set of expectancies derived from labeling? Benefits of labeling.

Models of Mental Illness. Deviation from the norm. Degree of functionality.

Community Mental Health II. What were the effects of the deinstitutionalization movement?

What caused this movement? The wide-spread availability of psychiatric medications. The philosophy of community psychiatry. The general time period in which deinstutitionalization occurred. Budget cuts?

What do critics believe was the negative fallout? Lack of available housing. Transinstutionalization of care. Where do the largest portion of SMI live? Alcohol and drug abuse. Epidemiological research indicates that persons with mental illness are more likely than the general population to experience with drug and alcohol. Sexual abuse. Some research suggests that people with mental illness may be at more risk for sexual victimization (e.g., Mowbray et al., 1997).

Do environmental factors affect the success of reintegration? Community attitudes towards persons with mental illness. Education is positively related to increased tolerance. Size of the community also appears to be a factor. Cities over 100,000 appear to be the least equip to provide services to the mentally ill. Cities between 10 and 100K are the most. Small towns falling somewhere in the middle.

Do environmental factors affect the success of reintgration? "Depersonalization of Care" A fancy word for job burnout. Causes of…

Community Mental Health III. Treatment options for CMI Populations

Intensive Case Mangement (ICM) Typically, but not always, a social worker. Links clients to needed services and gives instruction in basic living skills. Has been found to reduce rates of hospitalization.

Assertive Community Treatment (ACT). Mobile case management. Developed by Stein and Test in 1985 in Madison, Wisconsin. Other aspects of ACT is that takes a wholistic approach, attempts to capitalize on the client’s strengths, and attempts to work within the ecology of the client.

Characteristics of ACT Team Approach. In vivo services Small caseload and frequent contacts. Fixed point of responsibility. Flexible service delivery. 24/7 Crisis Availability ACT Addendum

Efficacy of ACT Programs Bond et al. (1990) compared ACT to drop-in community centers. Nelson et al. (2007) reviewed studies that compared ACT, ICM, or housing programs.

Staffing Pattern Per Team (ODMH Administrative Rules for ACT Certification) Team Leader Psychiatrist Nurse Therapist Community Support Specialist Employment Specialist Peer Specialist ACT Addendum