Download m1_mhs6095_intro_ppt_v8

Dr. Carol MacKinnon-Lewis
Introduction to Children’s
Mental Health
History – What is Mental Health/Mental Illness?
Mental
health
challenges
and other co-occurring
An
overall
theme
is the importance
of
disorders
will
provide
the
context
for
much
of this
understanding context.
course.
Context is not just culture. It could be changes
Many
of the
values
and
principles
associated
that
have
taken
place
over
time in the
concept of
with family-centered
care are not unique to the
mental
health.
mental health area.
We’ll see a similarity is perspectives, but
differences in the terminology used.
We’ll look at:Continually ask yourself
about the role of contexts.
• Mental health vs. Mental Illness
•
A number of perspectives
•
Mental disorder
•
Mental illnesses
It’s important to have an overall understanding of
the range of disorders.
World Health Organization Definition
FromWorld
The
a cross-cultural
Health Organization
perspective,
explains
it’s nearly
that
scholars from
impossible
to define
variousmental
cultures
health.
define mental health
differently.
It’s generally agreed that mental health is broader
Concepts
than
a lackofofmental
mentalhealth
disorders.
include:
•YouSubjective
may not have
well-being
a mental
– How
disorder,
do I feel?
but still may
not be mentally healthy either.
• Perceived self-efficacy – Do I feel in control of
There
mymay
life?be an absence of discrete, diagnosable
mental disorder.
• Inter-generational dependence
You may feel you’re not in control of your life.
• Self actualization of one’s intellectual and
emotional potential
Other Definitions
Mental health (Fallon House): the
successful performance of mental function.
The successful performance resulted in:
•
Productive activities
•
Fulfilling relationships with others
•
Ability to adapt to change and cope with
adversity
It’s not the absence of adversity, but the ability to
adapt to change and cope with it.
Mental health: a relatively enduring state of
being in which a person is reasonably
satisfied with self as a reflection of their
zest for living.
Elaboration of WFMH’s Definition
World Federation of Mental Health
Elements of mental health may be identifiable, but the term itself isn’t easily defined.
The definition is rooted in value judgments, which may vary across cultures.
Mental health shouldn’t be seen as the absence of illness.
For instance, when individuals feel they are:
•
Coping
•
Fairly in control of their lives
•
Able to face challenges
•
Taking care of responsibility
Mental Disorders
Mental disorders have been viewed
as diseases with underlying biological
and neurological causes and
impairments.
Contrary View
Mental disorders:
•
Social constructs
•
We look at behaviors
•
Labeled based on social and
culture perspectives
We now have improved technologies
for studying brain functioning.
We label overt, observable behaviors.
Two Very Divergent Views
Mental Disorders
What do you
think?
Is this
reasonable?
Diseases with underlying biological
and neurological causes
Social constructions / Our
interpretations of behaviors
Is there a
difference?
Can there be a
combination?
There are certain criteria that meet the conditions of being a disease with the underlying and neurological causes.
Others are viewed as judgments based on the behavior.
Importance of Context
Bio-psychological Model
BIOLOGICAL
01
CULTURAL
PSYCHOLOGICAL
04
02
SOCIAL
03
Viewing behavior without an understanding for the context in which the behavior occurs is dangerous.
Behaviors labeled as dysfunctional or pathological may be understandable when viewed in the proper context.
Movement to a Therapeutic State
Horwitz conducts research on depression.
There’s been a movement to classify depression as a
disease with biochemical roots and to treat it with
medication.
Horwitz believes that a therapeutic intervention is required
to treat this.
This is an example of a condition that at times meets the
definition of a disease, and at times doesn’t.
We have gray areas.
Dr. Allan V. Horwitz
There’s
a huge
cultural
There’s has
beenbeen
a huge
cultural
transformation
transformation in
in the
the
construction
of
mental
construction of mental illness
illness in
in
a
short
period
of
time.
a short period of time.
Behaviors
Behaviors that
that violate
violate rules
rules or
or
norms
are
interpreted
as
norms are interpreted as
symptoms
symptoms of
of mental
mental disorder.
disorder.
Why is this Background Important?
This isn’t a simple field.
Helping people / Intellectually challenging
The factors that play a role include:
•
Bio
•
Psychosocial
•
Cultural
•
Economic
•
Political
Seriousness of the Problem
Three Main Factors
1.
How do we determine the
seriousness
of this
Prevalence
or frequency
of problem?
the problem
2.
Magnitude
3.
Privacy
Stay away from using the word, “cause”, because
there’s different meanings connected to it.
Many factors may contribute to a problem, but a
problem that leads to lots of other negative
outcomes is more serious.
Prevalence of the Problem
It’s very
The
DSM
common
can be used
for a 14-year
to defineold
something
to report as
a case. symptoms than a parent.
different
Three Months
Six Months
One Year
Lifetime
The child
Some
people
mayhave
report
take
more
theinternalizing
created and
translated them into:
symptoms.
The
prevalence rate
will be much higher if we
• Measurement
instruments
say it’s a case.
• Instruction
We have to:
• Diagnostic interviews
• Identify sample
To determine prevalence in children’s mental
•health,
Solicit
weparticipation
use diagnostic interviews.
•If a Conduct
diagnosisdiagnostic
is present,interviews
we define somebody
as a case.
The best research comes from pulling
together the findings of separate studies in
different communities.
Community surveys: to identify random
probability samples in a community.
Research on Prevalence
Approximately ¼ of youth have
diagnosable mental disorders
within a six-month period.
Close to 20% meet the criteria for
having a serious emotional
disturbance.
Serious emotional disturbance: the
diagnosis of a condition that interferes
with the functioning of a child.
According to the criteria, our
priority should be on kids who
have a diagnosis that significantly
interferes with their functioning.
For information on the trends in prevalence in
disabilities from the CDC, click here.
Examples Common Diagnoses
Internalizing Problems
Externalizing Problems
•
Are not always manifested
•
Behaviors are observable
•
The emotions we feel
•
Often interfere with social relationships
•
More difficult to observe and measure
•
In frequent motion
One of the most common diagnoses is
anxiety disorder, including phobias and
depression.
Conduct disorders, anti-social behavior,
delinquent behavior, and physical
altercations are externalizing problems..
Comorbidity of Diagnoses
A high level of comorbidity means that
individuals have more than one diagnosis.
Comorbidity is not uncommon, and tends to
result in more severe impairment.
Psychiatric problems tend to co-occur with other
problems, like developmental disabilities.
Sometimes they lead to substance abuse and
poor interpersonal relationships.
Intervention must take this all into account,
also when establishing service systems.
A high degree of correlation with poor school
functioning, speaks to the importance of
close partnerships in treatment with schools.
Age of Onset, Magnitude, and Primacy
That
represents
a that
major
from a production
Research
suggest
theloss
age of
and
societal
standpoint.
onset
for mental
disorders continues
to decrease.
The suffering and stress caused to the
individuals and families have a major effect.
Adult disorder:
Suicide
is one of the highest causes of death in
young people, making the magnitude severe.
½ had an age of onset 14 or younger
Lee Schorr
¾ had an age of onset 24 or younger
• Coined the term rotten adolescent outcomes
The National Comorbidity Study:
•
Individuals 16 years and older
•
Asked for every disorder found
•
Asked when it first began
Kid disorders:
• The syndrome includes substance abuse and
failure
19%school
have a
serious emotional disturbance
25% are
at risk of not
becoming productive
From
a standpoint
of prevalence,
magnitude,
adults.
and primacy, these are all very significant
problems.
Ronald Kessler
Increased Focus on Effects of Trauma
We’ve become more aware of the large numbers
of people exposed to trauma.
We have adolescents who’ve moved in and out
of the worst foster homes, and ones who’ve
been abused.
The effects of trauma may be manifested in
different disorders.
Most of us are exposed to significant traumas.
However, some of us have the coping skills or
our environments have the resources to allow us
to better deal with it.
Exposure to Trauma
We’re becoming more aware of the impact of
trauma, due to natural disasters.
Study Conducted:
•
1,420 youngsters sampled
•
25% exposed to high-magnitude
traumatic event by age 16
•
6% exposed to one such event in
the last 3 months
Jane Costello
The most commonly referenced trauma-related
disorder is post-traumatic stress disorder (PTSD).
This interferes with people’s functioning.
Research by Fairbank reports that children
exposed to trauma have almost doubled the
rates of psychiatric disorder of those who
haven’t been exposed.
Effects of Psychological Trauma
If the trauma is a lower magnitude
event, it doesn’t have the same
impact.
The impact is a function of:
•
Their resilience to protect the
factors
•
The degree of support
•
The skills they have
The impact isn’t as great if you
have good coping skills, and
people who can help.
Resilience is a significant part of
this whole equation.
More Effects of Psychological Trauma
Adverse Childhood Experiences Study (ACES)
ACES was a study with a large sample that looked at adults in their 40s,
50s, 60s, and beyond.
They gathered data on their:
•
Physical health
•
Psychological functioning
•
Exposure to adverse childhood experiences
They found that there were long-lasting physical and emotional effects in
adults of significant impact exposure to trauma as youths.
We rarely ask about context before conducting intake interviewing.
We’ve had very little that was targeted to help individuals deal with
exposure to trauma.
Implications for Policy
There’s been a lack of a coherent policy to address
the seriousness of the problem.
The problems have been dismissed as being too
infrequent or just a stage that kids go through.
In the beginning of the 20th century, juvenile courts
death with these problems.
After WWII, many young adults weren’t qualified to
serve in the military because of mental health
problems.
There’s been a greater focus on mental health.
There’s been a lack of coherent policy, but there’s a
greater recognition now of the seriousness.
Involvement in Multiple Systems
Unclaimed
Children with
Children
Mental Health
Jane Knitzer wrote the book, Unclaimed
Children.
Education
She maintained that each of the systems passed
their responsibility on to other the systems.
Child Welfare
As a result, kids were left without the services
they needed.
Juvenile Justice
Substance Abuse
Developmental Service
These systems have to accept responsibility and work together in order to develop effective policies and services that’ll
lead to positive outcomes.
Progress
CASSP
There’s been progress made.
In 1984, The National Institute of
Mental Health initiated CASSP.
The policy’s focus was to shift
attention to children with serious
emotional disturbances.
It was also to develop services
based on a set of values.
In 1993, the Substance Abuse and Mental
Health Services Administration started a
children’s mental health initiative to further
support systems of care development.
Additional Progress
Significant changes have
occurred throughout the years.
Awareness of children’s mental
health problems
Co-occurrence with other
challenges
The role of families and youth
Movement towards more strengthbased care
Efforts to develop a culturally
competent system, that takes into
account context.
The expansion of evidence-based
interventions
Next Week
Next Week’s Topics
• Characteristics of effective
systems
• What it means to be an effective
system
• What does it look like?
You have reached the end of the presentation.