1. Behavioral Health KNR 365

2. Definitions Mental Health: A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life ◦The Free Dictionary Behavioral Health: Diagnosis and treatment of mental health and substance abuse disorders ◦www.unityhealth.com/Glossary/index.htm

3. Where? Acute inpatient hospital units in general medical hospitals ▫Separate youth & adults ▫Locked & unlocked Partial hospitalization Outpatient Day treatment More….

4. PSY 350

5. Incidence 57 million in US Leading cause of disability 15-44 years  Almost ½ have 2 or more disorders Behavior is culturally relative  Within norm of the culture Often stigmatized  Has a detrimental effect on seeking treatment, acceptance in community, detrimental effect on recovery ◦Carter & Van Andel, 2011

6. DSM The Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association Used in US & much of the world ▫Establish consistence criteria for mental disorders ▫Guide diagnosis of patients ▫Communicate with patients & other clinicians ▫Reimbursement from insurance companies

7. DSM-IV-TR The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000 Multiaxial classification system Rated on 5 axis

8. DSM-IV-TR Axis: I: Clinical disorders/Other conditions that may be a focus of clinical attention Axis II: Personality disorders/Mental retardation Axis III: General medical conditions Axis IV: Psychosocial and environmental problems Axis V: Global Assessment of Functioning

9. Axis V: Global Assessment of Functioning (GAF Scale) Current level of adaptive functioning in social relationships, occupational functioning, and use of leisure time Looks at overall functioning Continuum from psychiatric illness to health Looks at highest functioning in last year Scale 1 (sickest) to 100 (healthiest) ▫81-90/91-100 = positive mental health ▫31-70 most outpatients ▫1-40 most inpatients

10. DSM 5 (5/2013) www.psych.org/practice/dsm/dsm5 www.psych.org/practice/dsm/dsm5 Removed multiaxial classification system ▫Axis I, II, III in Section 2  Diagnostic criteria & codes ▫Replaced Axis IV with psychosocial & contextual factors  ICD-9-CM V codes  ICD-10-CM Z codes (10/24) ▫Dropped Axis V  Simple score from GAF not enough information  Variety of assessments, WHO

11. DSM 5 Neurodevelopmental Disorders ▫Intellectual Disabilities, Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder Schizophrenia Spectrum & Other Psychotic Disorders Bipolar & Related Disorders Depressive Disorders Anxiety Disorders ▫Social Anxiety Disorder

12. DSM 5 Obsessive-Compulsive & Related Disorders ▫Hoarding Disorder, Trichotillomania, Excoriation Trauma & Stress-Related Disorders Dissociative Disorder Somatic Symptoms & Related Disorders Feeding & Eating Disorders Elimination Disorders Breathing-Related Sleep Disorders Parasomnies

13. DSM 5 Sexual Dysfunction Gender Dysphoria Disruptive, Impulse-Control, & Conduct Disorders Substance-Related and Addictive Disorders ▫Cannabis-Related Disorders Neurocognitive Disorders Personality Disorders Paraphilic Disorders

14. DSM 5 Other Mental Disorders Medication-Induced Movement Disorders & Other Adverse Effects of Medication WHO International Classification of Diseases ▫ICD codes

15. Covered in Text Generalized anxiety disorder Major depressive disorder Schizophrenia Substance-related disorders Suicide & suicidal ideation Eating disorders (assignment)

16. Shock: Electroconvulsive Therapy

17. TED Talk Auditory Halucination

18. Cognitive Behavior Therapy

19. Control and change negative thoughts to change mood and behavior Change maladaptive thought Cognitive restructuring Relaxation training

20. Acceptance & Commitment Therapy

21. ACT differs from CBT in that instead of challenging distressing thoughts by looking for evidence and coming up with a more rational response (CBT), in ACT, the thought is accepted as a thought, e.g. “I’m having the thought that this boat is going to sink”, and then defused using a variety of techniques

22. Acceptance ACT is based on the idea that, generally, trying to rid ourselves of pain and distress only increases it, and turns it into something traumatic. The alternative is to accept it - but that doesn't mean being defeated or tolerating suffering. We learn to make room for painful feelings, thoughts, and sensations - allowing them to be there, coming and going without us struggling against them

23. Mindfulness & Values Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally Values clarification

24. See ICF text

25. Evidence-based Practice Active Leisure in the Emotional Experience of People with Schizophrenia ▫McCormick, Snethen, Smith, Lysaker, 2012, TRJ  Majority of activity was sedentary  Majority of leisure activity was sedentary  Physically active leisure was significantly associated with lower negative emotion  No association with activity and positive emotion  “There is reason to advocate for the inclusion of leisure-time physical activity in psychiatric rehabilitation for people with SSD.” (p. 179)

26. Evidence-based Practice SAMHSA's National Registry of Evidence-based Programs & Practices http://www.nrepp.samhsa.gov/ http://www.nrepp.samhsa.gov/ National Guideline Clearinghouse http://www.guideline.gov/ http://www.guideline.gov/

27. Recommended Resource K. Grote & S. Warner, 2013, Idyll Arbor, $45.00 K. Grote, M. Hasl, R. Krider, & D. Mortensen, 1995, Amazon

28. Recommend Resource Reproducible Care Plans Efficacy-based protocols for behavioral health settings Guideline on how to develop you own protocols and treatment plans Diagnostic protocols represent most common diagnostic groups & outline treatment & services routinely provided Program protocols include structure, process, & outcome criteria & treatment to offer Treatment plans cover many of the difficult behaviors of clients Bibliographies list outcome- oriented research

29. Recommended Resource Affective Domain ▫Flat Affect ▫Lability ▫Low Self-Esteem Cognitive Domain ▫Ruminating Thought ▫Delusions or Hallucinations ▫Poor Concentration ▫Loose Associations Physical Domain ▫Lethargy ▫Unsteady Gait Leisure Domain ▫Lack of Initiative ▫Few Leisure Interests ▫Multiple Stresses ▫Few Social Supports ▫Knowledge Deficit ▫Require Structure