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Mental Health Services. Chapter 9. Introduction . Should the mentally ill capable of harming themselves or others be involuntarily committed to a hospital is an important issue to be resolved in the mental health field.

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Introduction l.jpg

  • Should the mentally ill capable of harming themselves or others be involuntarily committed to a hospital is an important issue to be resolved in the mental health field.

  • National attention was focused on mental illness by three former presidents:

    • John F. Kennedy

    • Jimmy Carter

    • Ronald Reagan

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  • Almost all levels of government have become involved with the problem of mental illness.

  • Mental illness is on of the major health problems of America.

  • The private sector is virtually uninvolved in the struggle to combat the problems of mental illness.

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Beginnings in Mental Health

  • The first social workers to be allied with the mental health establishment worked in hospitals.

  • The percentage of Americans estimated to be suffering from at least one psychiatric disorder is 20 percent.

  • An estimated four to five thousand mental health facilities have been established, including such agencies as community mental health centers, state and county hospitals, private hospitals, V.A. psychiatric services, residential treatment centers for children, free-standing hospitals and clinics.

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Elements of the Mental Health Network

  • One of the most important elements of the mental health service network is the community mental health center (CMHC).

  • The mental health network includes both prevention and treatment.

  • In the past 30 years more than 700 of the centers have been put into operation, but 2,000 are needed.

  • Existing centers provide mental health care to millions of Americans.

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Elements of the Mental Health Network

  • Community mental health centers are designed to provide mental health services to people living in the community, close to home and family.

  • The services of the center:

    • Must be coordinated with the provision of services by other health and social service agencies

    • Must be available and accessible promptly

    • When medically necessary, must be available and accessible 24 hours a day, seven days a week.

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Essential Elements of Comprehensive Mental Health

  • Mental health services today can be classified as being pluralistic. They include:

    • 24 hour crisis services

    • Case management services

    • Day treatment services

    • Outpatient treatment

    • Residential treatment

    • Hospitalization (two types)

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Mental Hospitals

  • Mental hospitals are an important part of the mental health service network and generally fall into three categories:

    • State and county hospitals

    • Veterans Administration Hospitals

    • Private hospitals

      * Large state hospitals are believed to be negative in their effect on patients.

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Social Work in the Mental Hospital

  • The social worker is concerned with all aspects of the patient’s relationships within the hospital, as well as to their family and community.

  • Patients respond best to treatment when they understand and cooperate with it and trust the staff.

  • Rehabilitation can be achieved best when the patient’s interest in family, employment and the community is sustained while undergoing treatment.

  • The social worker assists the patient in using the family and community resources for protection and restoration to normal activities.

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Aftercare Facilities

  • Aftercare services are to assist in the re-socialization of patients.

  • One specialized aftercare facility is the halfway house providing living arrangements.

  • It provides opportunities for re-establishing work, family, and social relationships on a gradual basis under sheltered conditions.

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Therapeutic Clubs

  • Therapeutic clubs are one of the newer developments in aiding those who have been mentally ill.

  • Fountain House is the first such facility believing:

    • People with emotional disabilities have productive potential

    • Work is important for everyone

    • Everyone needs social relationships

    • People need adequate housing

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Outpatient Psychiatric Clinics

  • Outpatient clinics are widely used for the care of emotionally disturbed children.

  • Through interviews and testing, a diagnosis is made.

  • Treatment is planned that will alleviate the problems by modifying the child’s unacceptable behavior.

  • Difficulty in disciplining, temper tantrums, poor relationships with peers and siblings, and poor adaptation to school are the more frequently encountered problems.

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Residential Treatment Centers for Children (RTC)

  • It is estimated that there are as many as 2 million children under the age of eighteen who have emotional problems severe enough to warrant urgent attention.

  • There are 10 million to 15 million more who would benefit from psychiatric help of some kind.

  • Services to children have not been developed in a coordinated, effective fashion.

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Jails and Prisons

  • Two areas in desperate need of expanded mental health services.

  • 1.9 million men and women were incarcerated in 2000 and is expected to reach 2.3 million in 2005.

  • Most jails and prisons have inadequate mental health services especially those who suffer from alcohol and drug dependence.

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Special Problems and Issues in Mental Health

  • Homeless mentally ill:

    • The number of the mentally ill homeless that is frequently mentioned in the media is 3 million.

    • An increasing number of these are children and women.

    • Critical shortage of any kind of housing and employment opportunities.

    • “greyhound therapy” is utilized by giving these people one-way tickets to other parts of the country.

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Special Problems

  • Voluntary and Involuntary Commitment:

    • In most states long term commitment has been abolished.

    • Unless a person has demonstrated that they are a threat to themselves or others, no one can take away the right to freedom.

    • The fact that because of the nature of their illness many are unable to make rational decisions about their care is not considered by the courts.

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Special Problems

  • The Chronically Mentally Ill:

    • It is estimated by the National Institute of Mental Health that 2.4 million are chronically mentally ill.

    • NIMBY (not in my backyard) Communities refusing to accept this population.

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Special Problems

  • Teenage Suicide:

    • In the past 25 years suicide has increased 300 percent in the U.S. and is the leading cause of death in the fifteen to twenty-four age group.

    • Correlated with sociological, psychological and economic forces

    • Suicide high among those who experience repeated school failures and long-standing behavioral problems.

    • Not having family support correlates with high numbers of suicides/attempt rates.

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Special Problems

  • The Message of youth suicide is increasingly clear:

    • Employment opportunities for youth are imperative

    • Success experiences will almost certainly reduce the risk of suicides

    • All teaching-learning encounters need to emphasize the importance of good coping skills for youth

    • Learning to deal with stress situations needs to be a high priority educational objective for all youth

    • As a nation we need to reaffirm the value and worth of good family support systems and the use of the nation’s resources to strengthen the family.

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  • One of the most overlooked, under-funded and neglected components of mental health.

  • Two potentially fertile fields for prevention in mental illness are the public schools and the workplace.

  • There is much unused knowledge of human behavior that could be used to help youngsters before the drop out of school, take their own lives, abuse drugs, or turn to premature sex to relieve boredom.

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  • Continuing research is needed.

  • Mysteries of the human mind abound.

  • The mental health need of the elderly have been sorely neglected.

  • By the year 2010, approximately 20 percent of the American population will be 65 years or older.

  • Our nation needs a plan to address the growing mental health needs of our aging population.