Term
| 2 ways of recognizing deviations from "normal" metal health |
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Definition
innappropriate recations bizarre/inappropriate behavior according to context *keep cultural context in mind |
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Term
| comment on why defining normal mental health is not a simple matter |
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Definition
dominant culture defines "normal" preceeding events can cause "unusual" reactions (such as in ptsd) is it normal for them? how was this person previously? |
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Term
| the range of mental health problems that are treated by professionals |
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Definition
range from adjustment d/o or bad day mid range substance experimentation etc high spmi |
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Term
| what does the term severe and persistent mental illness mean?provide examples. what percentage of americans are likely to have a spmi? |
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Definition
accute/chronic not eposidic mh issue clt has constant need for care schizophrenia, bipolar disorder 2.1-2.6% in the U.S. |
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Term
| Discuss the role of general practice physicians play in treating mental health problems. |
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Definition
| prescribing medications, 1st line of defense, more accessable |
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Term
| the four main professionals the deliver mental health services. Discuss their training, orientation, settings, and hierarchyin which the professionals generally practice. |
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Definition
psychiatrist- dr. meds psychologist- dr. brain functioning -therapy social worker- masters-person in enviro- therapy psych nurse- some meds, therapy |
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Term
| the role of NIMH inincreasing the pool of mh professionals. |
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Definition
| National Institute of Mental Health- provides grants |
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Term
| Overall those practicing in the mental health profession have increased. At what levels? |
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Definition
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Term
| It is projected that there is likely to be a stronger relationship between mental health social workers and managed care in the future. Discuss. |
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Definition
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Term
| The typical MH worker is likely to have less than a four year college degree. Discuss. |
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Definition
Psych techs, etc- more of them so that we can pay fewer professionals. mh pop has low status- social justice? |
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Term
| What is the most frequent reason given for seeing a mental health professional? What group is likely to be seen for this condition? |
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Definition
depression females societal standards |
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Term
| Prior to the mid 1950's where did severely mentally ill recieve treatment? How were they treated? How did this approach evolve? |
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Definition
Institutions/ assylums dorothy dix moral tx prison ospitals warehousing |
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Term
| identify some of the improovements in training for psychiatrists. Any concerns? |
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Definition
More scientific basis/research too scientific- tend to objectify clients |
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Term
| the largest expenditure on mental tx for medicade is psych drugs discuss |
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Definition
cheaper than therapy or treatment, the lower income the clt the highter risk for spmi medicade is the highest funder of mh tx |
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Term
| identify the the dominant psychotherapuetic approach to mental illness from the late 19th to mid-20th century and discuss it's relationship to mentalhealth services during that time |
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Definition
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Term
| identify the various institutions and the agencies and that provide contemporary mental health services, including the role of nursing homes? |
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Definition
state hops, comm hosp, dr office residential tx private hospital elderly and midaged (housed) |
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Term
while the numbers of admissions to public m h hopsitals hias increased over the years, the structure for the delivery of services has dramatically changed. discuss. |
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Definition
| community based programming, short stays inpt, revolving door! |
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Term
| mental illness substance abuse and homelessness among young persons |
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Definition
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Term
| Who are dorothea dix and philippee pinel? |
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Definition
moral treatment/ europe deinstitutionalization |
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Term
| Discuss the era between 1955 and 1975 as it relates to mental health tx in the us |
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Definition
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Term
| what is meant by "moral tx" who were its reciepients? |
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Definition
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Term
| lessons learned by worcester state hospital |
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Definition
too many clients= a housiung affect there were not enough resources the more clients you have the lower the quality of care they recieve |
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Term
| discuss the impact of wwii on mental health service |
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Definition
discovery of shell shock mental health scerrnings before deployment for the 1st time |
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Term
| what group of professionals is most and least likely to provide services for the spmi? why? |
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Definition
psychiatrists high contact although breif due to- meds psychologists low contact |
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Term
| reccomendations of the joint commission of mental illness and health in 1961 |
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Definition
this ACT was the foundation of the community mental health movement which coexisted with increased social justice movements |
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Term
| what is the relationship between the civilrights movement and mental health tx? |
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Definition
| civil rights= rights for all even mh increased awareness of warehousing |
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Term
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Definition
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Term
| nixon years and mh services |
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Definition
histile services and funding were reduced |
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Term
| presidents commission on mh under carter in 1977 and the mh systems act of 1980 |
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Definition
economy was low, there was a gas crisis the acts were not enforced |
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Term
| regan era and congressional response to mental health systems act of 1980 |
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Definition
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Term
| national alliance for the mentally ill NAMI |
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Definition
| advocacy group for spmi mainly composed of peopl with spmi |
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Term
| the relationship between deinstitutionalization and expansion of social welfare programs |
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Definition
| increased need socail welfare after persons are released into the community |
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Term
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Definition
| as people age the percentage of persons with mh issues increases, ex alzhimers, dementia |
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Term
| introduction of psychotrophic medications an tx for mental illness |
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Definition
| stabelized several types of spmi, reduced symptoms and allowed clts to move out of institutions |
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Term
| mental illness homelessness and substance abuse |
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Definition
self medication/low-no income increase of mh increased risk of homelessness mh= harder to get/maintain a job= money issues= hard to get tx= cyclicle |
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Term
| there have been some major improovements in the deliver of mh services. Identify some of these. There are also numerous challenges. Discuss. |
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Definition
independent living/ self determination cmhc- close to people, not on the outskirts of town wrap around services meds and housing costly programs restricting/ access to care can be difficult |
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Term
| Problem with identifying psychological problems in various communitites |
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Definition
intiviewer biases stigma/ based on self report scales/ are they valid? cultural validity |
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Term
| Incidence versus Prevelence of mental illness |
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Definition
Incidence- number of new cases Prevelence- number of total cases |
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Term
| Estimates of mental illness can vary greatly. Why? |
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Definition
lack of clear criteria to identify mental illness, and distinguish different dx people not wanting to "step forward" with mi stigma |
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Term
| discuss the epidemiology catchment area program (five cities), the nationa comoboridity studies (representative sample of US citizens)? what were some of the findings of intrest? |
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Definition
mh gender differences were discovered increased risk of comorbidity was found nonrepoondents had increased level of mental illness, 1/2 of repoondents have had mi, 30% have had mi over last 12 mos 5 cities- st luis, new haven, durhaven and ? |
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Term
| simply counting the number of ppl with mental health probles is not particularly helpfull, why? |
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Definition
| not all mh conditions are disabeling, it is not good to lump all types of mh issues togeather |
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Term
| most persons w/mh issues do not recieve tx, discuss |
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Definition
stigma $ access unaware of services available oblivious to the fact thet they have a mh issue dont want care bad experience in the past |
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Term
| what groups are at the greates risk for mh problems? why? |
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Definition
minorities low socieoeconomic status divorced persons females |
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Term
| discuss the potential link between schizophrenia and social class. |
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Definition
| schizo can lead to low class (hard to keep a job), also low social class increases stress levels which can trigger those predisposed to schizo who may have not shown any signs previously |
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Term
| ethnic disparities are common in mental health but difficult to interperet, discuss |
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Definition
| unable to capture diversity |
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Term
| discuss some of the anticedents of antisocial behavior in childhood and discuss the potential implications for later in life. |
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Definition
| stress and abuse lead to adaptive issues which leads to etoh use agression etc |
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Term
| discuss the sdversity hypothesis |
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Definition
the more sheltered a person the lower their coping skills the more adversity a person comes into the greater their coping skills |
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Term
| interestingly one of the goals that came form the joint comission on mental illness and health in 1961 has actually realized, discuss |
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Definition
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Term
| discuss home care versus institutional care for persons who suffer from schizophrenia |
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Definition
it is hard to keep these clts on meds home care is not highly effective for many, they need hospitilization and care |
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Term
| what are some of the family stressors/burdens associated with community care? |
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Definition
| stigma, housing, stress/care (meds, apts,$), appartments etc, community support, $ |
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Term
| how can mental illness of a parrent affect the children in the famiy? |
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Definition
| decrease in social skills possible nurture causing personality disorder, depends on the parent and the typ of mi |
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Term
| intorduction of neuroleptic (and psychotropic) drugs, socialwelfare system, and deinstitutionalization; from 560,000 to 57,000 residing in mh hospitals |
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Definition
| meds decreased symptomology, persons able to care for self independently and function well within society, a need is still present for therapy and groups etc for this pop access is a big issue |
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Term
| what is meant by the term "institutionalisim"? what are some of the characteristics? |
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Definition
| contributes to isolation, clts became dependent on the system, a slowing of affect |
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Term
| creative models of community care |
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Definition
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Term
| Program of assertiveness community treatment (PACT) and other family-oriented rehabilitation models and major barrier for implementation of these programs |
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Definition
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Term
| new medications for the mentally ill pluses and minuses |
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Definition
decrease in side effects (as opposed to old meds) although there are side effects ex insomnia and incontinence |
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Term
| employment challenges for the SPMI |
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Definition
| paying bills on time, supervision, maintaing work |
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Term
| major funding source for treatment of mi |
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Definition
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Term
| why are mh practicioners sometimes hesitant to refer clients to SSI or SSDI? |
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Definition
| labeling, lengthy process, past experiences, denial |
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Term
| 1980 ammendment to the socialsecurity act and its consiquences |
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Definition
| decrease in benifits, status reviews must occur every 3 years, the beginning of major homeless populations |
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Term
| extension of the vr act of 1986 |
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Definition
| continue funding, allows ppl to make $ |
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Term
| 1996 social security legislation and substance abuse |
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Definition
| you can not get ssd with a past of etoh or substance abuse |
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Term
| tghe impact of the deficit reduction act of 2005 |
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Definition
| states increased controll of medicaed proigrams (which caused inconsistencies) |
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Term
| the role of case management for working with SPMI. some of the related issues |
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Definition
| advocate, negotiate, broker, voactional services, difficult, differentiationin training of workers |
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Term
| fragmentation of the structure for administration of mental health services |
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Definition
| $ not used efficently, duplicate services, disconnection b2w service providers, no standardization of care |
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Term
| medicade and managed care model of mentla health services, pluses and minuses |
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Definition
| time and service limits, SPMI needs more services and expensive services |
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Term
| Historical differences in mh tx for those from various economic backgrounds |
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Definition
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Term
| the expansion and fluxuation of mental health services |
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Definition
| alms houses, stigma, prisons, mh movement, moral tx, hospitilization, warehousing, deinstitutionalization, civil rights, homelessness |
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Term
| differences on restrictions on care for health mh and substance abuse |
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Definition
mh and sh has fewer days covered in the hospital and more/higher out of pocket expenses, the parity act tried to reverse this but it did not work, insc cos founds ways around it |
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Term
| mh parity act of 1996, what were the intentions? what actually occured? Parity under clinton for federal employees health benifits prog |
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Definition
* attempt was to lessen disparities in mh and substance abuse services *companies found loopholes *same thing was attempted in fed emp plan |
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Term
| Managed care actually excercises a lot of influence over clinical in the decisions of delivery of mh services- how? |
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Definition
| compliance w/insc- caps on visits, alternatives to talk therapy being explored, greater affordability, the clinician should determine the clits needs # of visits not the insc co, must have dsm dx before care |
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Term
| discuss the emergence of psychiatriac DRG's |
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Definition
| 1983 Cost containment Diagnostic Regulation Groups who determine dx average costs, does not work well |
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Term
| rapid increases in MH units in general hospitals and private hospitals. implication for tx of children |
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Definition
| entrapranuers invested in psych clinics/hospitals (b/c of managed care) limits for mh are lax beds in hospitals opened up- children psych wards open up |
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Term
| who makes up the majority of public sector hospitap pts? why? |
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Definition
| most severe and chronic/ reoccurant illness- bc public hospitals can deny pts with medicare |
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Term
| utilization of mh services among various groups of ppl (edu, income, etc) |
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Definition
white ppl are 2xs as likely as aa the higher the edu level the more likely to use mh services |
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Term
| the role medicade plays in the delivery of mh services |
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Definition
| the number one provider of mh services, allows persons with spmi to get more care |
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Term
| patient cost sharing, carve outs and carve ins |
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Definition
*co-pay *hmo's etc network of docs seperate network of mh docs contracting *in house |
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Term
| there has been a large decline in the number of residents in public mental health hospitals yet some groups continue to resist this movement; who and why? |
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Definition
| hospital workers, unions, towns built around mh hospitals= $$ loss of jobs |
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Term
| medicade funding has inadvertently perpetuated barriers for improoved mental health services, why? |
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Definition
| they have an inpatient bias and a bias to allow more services for spmi |
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Term
| strengths and weaknesses of state flexability and the federal waiver program administering medicade |
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Definition
this created a way for states to create inovative programs to meet their populations needs, it caused inconsisticiencies/disparities |
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Term
| discuss the under tx of mh |
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Definition
| not everyone w/mh is identified, stigma, access, limit in sessions, over reliance/utilization of meds, cultural compotency |
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Term
| the role of primary medical care |
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Definition
| 40-60% of all mh visits occur @ the pcp office, prone to just give meds and not consider other options or refer out |
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Term
| what exactly is managed care? |
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Definition
| monitors tx inorder to reduce cost and unneeded procedures |
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Term
| capitation (in accordance to providers) |
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Definition
| a fixed amount providers will give out for the year determined per person |
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Term
| subcapitation (in accordance to providers) |
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Definition
| for specialized services such as dentistry psychologists etc |
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Term
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Definition
*when a pcp manages everyday care and refferal to specialits * witholding part of the pcp and returning based on referrals and bonuses (ie you get rewarded for not making referrals) |
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Term
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Definition
| a board decided weathor a clt is elligible for services/ or needs them- board may have ppl on it with no mh/h experience what so ever |
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Term
| the variability of managed care plans and some of the currnet models of managed care orginizations |
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Definition
group model (kaiser) staff model (physiscians) network (providers w/pre negotiated fees) |
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Term
| managed care and severe mental illness |
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Definition
| spmi high costs for care, hard to treat, causes physical medical issues, difficult to treat, doctors often misdiagnose they are not experts and often give the wrong medications |
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Term
| the use of carve outs for delivering mental health services |
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Definition
there is poor communication between the md/psych/ and insurance company as to the clts needs services are advanced |
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Term
| what about the stigma associated with spmi and tx implications |
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Definition
| clts are often not give appropriate priority |
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Term
| spmi involves more kinds of cost thanusual, explain |
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Definition
| cost to the clt, family, community, legal system due to recidivisim, self medicating, criminal justice issues |
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Term
| the under tx of substance dependency through managed care |
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Definition
| in pt care reduced, detox substituted for tx, out pt service contracts limited, clts have little or no money for in pt care |
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Term
| there are many variations of utilization reviews. what are some of them? |
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Definition
set of criteria that is subject to calculations, professional judgement, relationships, second opinions, appeals, etc w/clts and providers |
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Term
| the profit motive of managed care and public trust |
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Definition
| the balance must be watched |
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Term
| how much money does the US currently spend on health care? |
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Definition
| over two trillion dollars a year |
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Term
| how many americans currently have NO healthcare? |
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Definition
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