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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.