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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