Learning Objectives

1. Identify themes and research advances in the field of mental health.
2. Discuss the origins of stigma and its impact.
3. Recognize the relationship between brain function and behavior.
4. Identify approaches to prevention and treatment of mental disorders.
5. Recognize the impact of the organization and financing of mental-health care.
6. Discuss the impact of consumer and family movements in the area of mental-health service delivery.
7. Utilize a lifespan approach to the consideration of mental health and mental illness.
8. Discuss mental health in a social and cultural context.
9. Discuss the impact of nature and nurture in the area of mental health.
10. Describe common psychiatric disorders and their prevalence throughout the lifespan.
11. Recognize preventative measures and effective clinical interventions for children, adults and older adults.
12. Identify barriers to accessing mental-health services for children, adults and older adults.
13. Describe the costs and financing mechanisms for mental-health services.
14. Recognize the benefits and limitations of confidentiality.
15. Discuss the recommendations of the Surgeon General's Report for the future of mental-health service delivery.

Course Contents

1. Introduction and Themes
    Overarching Themes
      Mental Health and Mental Illness: A Public Health Approach
      Mental Disorders are Disabling
      Mental Health and Mental Illness: Points on a Continuum
      Mind and Body are Inseparable
      The Roots of Stigma
        Separation of Treatment Systems
        Public Attitudes About Mental Illness: 1950s to 1990s
        Stigma and Seeking Help for Mental Disorders
        Stigma and Paying for Mental Disorder Treatment
        Reducing Stigma
    The Science Base of the Report
      Reliance on Scientific Evidence
        Research Methods
        Levels of Evidence
    Overview of the Report’s Chapters
    Chapter Conclusions
      Chapter 2: The Fundamentals of Mental Health and Mental Illness
      Chapter 3: Children and Mental Health
      Chapter 4: Adults and Mental Health
      Chapter 5: Older Adults and Mental Health
      Chapter 6: Organization and Financing of Mental Health Services
      Chapter 7: Confidentiality of Mental Health Information: Ethical, Legal, and Policy Issues
      Chapter 8: A Vision for the Future—Actions for Mental Health in the New Millennium
    Preparation of the Report
    References
2. The Fundamentals of Mental Health and Mental Illness
    The Neuroscience of Mental Health
      Complexity of the Brain I: Structural
      Complexity of the Brain II: Neurochemical
      Complexity of the Brain III: Plasticity
    Imaging the Brain
    Overview of Mental Illness
      Manifestations of Mental Illness
        Anxiety
        Psychosis
        Disturbance of mood
        Disturbance of Cognition
        Other Symptoms
      Diagnosis of Mental Illness
      Epidemiology of Mental Illness
        Adults
        Children and Adolescents
        Older Adults
      Future Directions for Epidemiology
      Costs of Mental Illness
    Overview of Etiology
      Biopsychosocial Model of Disease
      Understanding Correlation, Causation, and Consequences
      Biological Influences on Mental Health and Mental Illness
        The Genetics of Behavior and Mental Illness
        Infectious Influences
          PANDAS
      Psychosocial Influences on Mental Health and Mental Illness
        Psychodynamic Theories
        Behaviorism and Social Learning Theory
      The Integrative Science of Mental Illness and Health
    Overview of Development, Temperament, and Risk Factors
      Physical Development
      Theories of Psychological Development
        Paiget: Cognitive Development Theory
        Erik Erikson: Psychoanalytic Development Theory
        John Bowlby: Attachment Theory of Development
      Nature and Nurture: The Ultimate Synthesis
    Overview of Prevention
      Definitions of Prevention
      Risk Factors and Protective Factors
    Overview of Treatment
      Introduction to Range of Treatments
      Psychotherapy
        Psychodynamic Therapy
        Behavioral Therapy
        Humanistic Therapy
      Pharmacological Therapies
        Mechanisms of Action
        Complementary and Alternative Treatment
      Issues in Treatment
        Placebo Response
        Benefits and Risks
        Gap Between Efficacy and Effectiveness
        Barriers to Seeking Help
    Overview of Mental Health Services
      Overall Patterns of Use
      History of Mental Health Services
    Overview of Cultural Diversity and Mental Health Services
      Introduction to Cultural Diversity and Demographics
        Coping Styles
      Family and Community as Resources
        Epidemiology and Utilization of Services
        African Americans
        Asian/Pacific Islanders
        Hispanic Americans
        Native Americans
      Barriers to the Receipt of Treatment
        Help-Seeking Behavior
        Mistrust
        Stigma
        Cost
        Clinician Bias
      Improving Treatment for Minority Groups
        Ethnopsychopharmacology
        Minority-Oriented Services
        Cultural Competence
      Rural Mental Health Services
    Overview of Consumer and Family Movements
      Origins and Goals of Consumer Groups
        Self-Help Groups
      Accomplishments of Consumer Organizations
      Family Advocacy
    Overview of Recovery
      Introduction and Definitions
      Impact of the Recovery Concept
    Conclusions
      Mental Health and Mental Illness Across the Lifespan
    References
3. Children and Mental Health
    Normal Development
      Theories of Development
        Development Viewed as a Series of Stages
        Development Viewed as a Series of Stages
        Behavioral Development
      Social and Language Development
        Parent-Child Relationships
        Origins of Language
        Relationships With Other Children
      Temperament
      Developmental Psychopathology
        Current Developmental Theory Applied to Child Mental Health and Illness
    Overview of Risk Factors and Prevention
      Risk Factors
        Biological Influences on Mental Disorders     
         Psychosocial Risk Factors
        Family and Genetic Risk Factors
        Effects of Parental Depression
        Stressful Life Events
        Childhood Maltreatment
        Peer and Sibling Influences
        Correlations and Interactions Among Risk Factors
      Prevention
        Project Head Start
        Carolina Abecedarian Project
        Infant Health and Development Program
        Elmira Prenatal/Early Infancy Project
        Primary Mental Health Project
        Other Prevention Programs and Strategies
    Overview of Mental Disorders in Children
      General Categories of Mental Disorders of Children  
      Assessment and Diagnosis
      Evaluation Process
      Treatment Strategies
        Psychotherapy
        Psychopharmacology
    Attention-Deficit/Hyperactivity Disorder
        Prevalence
        Causes
      Treatment
        Pharmacological Treatment
          Psychostimulants
          Dosing
          Side Effects
          Other Medications
        Psychosocial Treatment
          Behavioral Approaches
          Cognitive-Behavioral Therapy
          Psychoeducation
        Multimodal Treatments
        Treatment Controversies
          Overprescription of Stimulants
          Safety of Long-Term Stimulant Use
    Depression and Suicide in Children and Adolescents
      Conditions Associated With Depression
      Prevalence
        Major Depression
        Dysthymic Disorder
        Suicide
      Course and Natural History
      Causes
        Family and Genetic Factors
        Gender Differences
        Biological Factors
        Cognitive Factors
        Risk Factors for Suicide and Suicidal Behavior
      Consequences
      Treatment
        Depression
          Psychosocial Interventions
          Pharmacological Treatment
        Bipolar Disorder
          Pharmacological Treatment
        Suicide
          Psychotherapeutic Treatments
          Psychopharmacological Treatments
          Intervention After a Suicidal Death of a Relative, Friend, or Acquaintance
          Community-Based Suicide Prevention
          Crisis Hotlines
          Method Restriction
          Media Counseling
          Indirect Case-Finding Through Education
          Direct Case-Finding
          Aggressive Treatment of Mood Disorders
          Air Force Suicide Prevention Program — A Community Approach
    Other Mental Disorders in Children and Adolescents
      Anxiety Disorders
        Separation Anxiety Disorder
        Generalized Anxiety Disorder
        Social Phobia
        Treatment of Anxiety
        Obsessive-Compulsive Disorder
      Autism
        Treatment
      Disruptive Disorders
        Treatment
      Substance Use Disorders in Adolescents 
      Eating Disorders
    Services Interventions
      Treatment Interventions
        Outpatient Treatment
        Partial Hospitalization/Day Treatment
        Residential Treatment Centers
        Inpatient Treatment
      Newer Community-Based Interventions
        Case Management
          Team Approaches to Case Management
        Home-Based Services
          Family Preservation Programs Under the Child Welfare System
          Multisystemic Therapy
        Therapeutic Foster Care
        Therapeutic Group Homes
      Crisis Services
    Service Delivery
      Service Utilization
        Utilization in Relation to Need
        Early Termination of Treatment
        Poverty and Utilization
        Culture and Utilization
      Service Systems and Financing
        Private Sector
        Public Sector
        Children Served by the Public Sector
        Managed Care in the Public Sector
      Culturally Appropriate Social Support Services
      Support and Assistance for Families
        New Roles for Families in Systems of Care
        Family Support
        Family Support Groups
        Practical Support
      Integrated System Model
      Effectiveness of Systems of Care
        The Fort Bragg Study
        The Stark County Study
      Summary: Effectiveness of Systems of Care
    Conclusions
    References
4. Adults and Mental Health
    Chapter Overview
      Mental Health in Adulthood
        Personality Traits
          Self-Esteem
          Neuroticism
          Avoidance
          Impulsivity
Sociopathy
      Stressful Life Events
        Past Trauma and Child Sexual Abuse
        Domestic Violence
        Interventions for Stressful Life Events
      Prevention of Mental Disorders
    Anxiety Disorders
      Types of Anxiety Disorders
        Panic Attacks and Panic Disorder
        Agoraphobia
        Specific Phobias
        Social Phobia
        Generalized Anxiety Disorder
        Obsessive-Compulsive Disorder
        Acute and Post-Traumatic Stress Disorders
      Etiology of Anxiety Disorders
        Acute Stress Response
        New Views About the Anatomical and Biochemical Basis of Anxiety
        Neurotransmitter Alterations
        Psychological Views of Anxiety
      Treatment of Anxiety Disorders
        Counseling and Psychotherapy
        Pharmacotherapy
          Benzodiazepines
          Antidepressants
          Buspirone
        Combinations of Psychotherapy and Pharmacotherapy
    Mood Disorders
      Complications and Comorbidities
        Clinical Depression Versus Normal Sadness
      Assessment: Diagnosis and Syndrome Severity
        Major Depressive Disorder
        Dysthymia
        Bipolar Disorder
        Cyclothymia
        Differential Diagnosis
      Etiology of Mood Disorders
        Biologic Factors in Depression Monoamine Hypothesis
        Evolving Views of Depression
        Anxiety and Depression
        Psychosocial and Genetic Factors in Depression
        Stressful Life Events
        Cognitive Factors
        Temperament and Personality
        Gender
        Genetic Factors in Depression and Bipolar Disorder
      Treatment of Mood Disorders
        Stages of Therapy
          Acute Phase Therapy
          Continuation Phase Therapy
          Maintenance Phase Therapies
      Specific Treatments for Episodes of Depression and Mania
        Treatment of Major Depressive Episodes
          Pharmacotherapies
          Alternate Pharmacotherapies
          Augmentation Strategies
          Psychotherapy and Counseling
          Bipolar Depression
          Pharmacotherapy, Psychosocial Therapy, and Multimodal Therapy
          Preventing Relapse of Major Depressive Episodes
        Treatment of Mania
          Acute Phase Efficacy
          Maintenance Treatment to Prevent Recurrences of Mania
        Service Delivery for Mood Disorders
    Schizophrenia
      Overview
        Cognitive Dysfunction
        Functional Impairment
        Cultural Variation
        Prevalence
          Prevalence of Comorbid Medical Illness
      Course and Recovery
        Gender and Age at Onset
      Etiology of Schizophrenia
      Interventions
        Pharmacotherapy
        Ethnopsychopharmacology
        Psychosocial Treatments
          Psychotherapy
          Family Interventions
          Psychosocial Rehabilitation and Skills Development
          Coping and Self-Monitoring
          Vocational Rehabilitation
    Service Delivery
      Case Management
      Assertive Community Treatment
      Psychosocial Rehabilitation Services
      Inpatient Hospitalization and Community Alternatives for Crisis Care
      Services for Substance Abuse and Severe Mental Illness
    Other Services And Supports
      Consumer Self-Help
      Consumer-Operated Programs
      Consumer Advocacy
      Family Self-Help
      Family Advocacy
      Human Services
        Housing
        Income, Education, and Employment
        Health Coverage
      Integrating Service Systems
    Conclusions
    References
5. Older Adults and Mental Health
    Chapter Overview
      Normal Life-Cycle Tasks
      Cognitive Capacity With Aging
      Change, Human Potential, and Creativity
      Coping With Loss and Bereavement
    Overview of Mental Disorders in Older Adults
      Assessment and Diagnosis
      Overview of Prevention
        Primary Prevention
        Prevention of Depression and Suicide
        Treatment-Related Prevention
        Prevention of Excess Disability
        Prevention of Premature Institutionalization
      Overview of Treatment
        Pharmacological Treatment
          Increased Risk of Side Effects
          Polypharmacy
        Treatment Compliance
        Psychosocial Interventions
        Gap Between Efficacy and Effectiveness
    Depression in Older Adults
      Diagnosis of Major and “Minor” Depression
        Late-Onset Depression
        Prevalence and Incidence
        Barriers to Diagnosis and Treatment
        Course
        Interactions With Somatic Illness
      Consequences of Depression
      Cost
      Etiology of Late-Onset Depression
      Treatment of Depression in Older Adults
        Pharmacological Treatment
          Tricyclic Antidepressants
          Selective Serotonin Reuptake Inhibitors and Other Newer Antidepressants
          Multimodal Therapy
          Course of Treatment
        Electroconvulsive Therapy
        Psychosocial Treatment of Depression
    Alzheimer’s Disease
      Assessment and Diagnosis of Alzheimer’s Disease
        Mild Cognitive Impairment
        Behavioral Symptoms
        Course
        Prevalence and Incidence
        Cost
      Etiology of Alzheimer’s Disease
        Biological Factors
      Protective Factors
        Histopathology
        Role of Acetylcholine
      Pharmacological Treatment of Alzheimer’s Disease
        Acetylcholinesterase Inhibitors
        Treatment of Behavioral Symptoms
      Psychosocial Treatment of Alzheimer’s Disease Patients and Caregivers
    Other Mental Disorders in Older Adults
      Anxiety Disorders
        Prevalence of Anxiety
        Treatment of Anxiety
      Schizophrenia in Late Life
        Prevalence and Cost
        Late-Onset Schizophrenia
        Course and Recovery
        Etiology of Late-Onset Schizophrenia
        Treatment of Schizophrenia in Late Life
      Alcohol and Substance Use Disorders in Older Adults
        Epidemiology
          Alcohol Abuse and Dependence
          Misuse of Prescription and Over-the-Counter Medications
          Illicit Drug Abuse and Dependence
        Course
        Treatment of Substance Abuse and Dependence
    Service Delivery
      Overview of Services
      Service Settings and the New Landscape for Aging
        Primary Care
        Adult Day Centers and Other Community Care Settings
        Nursing Homes
        Services for Persons With Severe and Persistent Mental Disorders
      Financing Services for Older Adults
        Increased Role of Managed Care
        Carved-In Mental Health Services for Older Adults
        Carved-Out Mental Health Services for Older Adults
        Outcomes Under Managed Care
    Other Services and Supports
      Support and Self-Help Groups
      Education and Health Promotion
      Families and Caregivers
      Communities and Social Services
    Conclusions
    References
6. Organizing and Financing Mental Health Services
    Overview of the Current Service System
      The Structure of the U.S. Mental Health Service System
      The Public and Private Sectors
      Patterns of Use
        Adults
        Children and Adolescents
    The Costs of Mental Illness
      Indirect Costs
      Direct Costs
      Mental Health Spending
      Spending by the Public and Private Sectors
      Trends in Spending
      Mental Health Compared With Total Health
    Financing and Managing Mental Health Care
      History of Financing and the Roots of Inequality
      Goals for Mental Health Insurance Coverage
      Patterns of Insurance Coverage for Mental Health Care
      Traditional Insurance and the Dynamics of Cost Containment
      Managed Care
        Major Types of Managed Care Plans
        The Ascent of Managed Care
      Dynamics of Cost Controls in Managed Care
      Managed Care Effects on Mental Health Services Access and Quality
      Impact on Access to Services
      Impact on Quality of Care
    Toward Parity in Coverage of Mental Health Care
      Benefit Restrictions and Parity
      Legislative Trends Affecting Parity in Mental Health Insurance Coverage
    Conclusions
    Appendix 6-A: Quality and Consumers’ Rights
    References
7. Confidentiality of Mental Health Information
    Chapter Overview
    Ethical Issues About Confidentiality
    Values Underlying Confidentiality
      Reducing Stigma
      Fostering Trust
      Protecting Privacy
    Research on Confidentiality and Mental Health Treatment
    Current State of Confidentiality Law
      Overview of State Confidentiality Laws
      Exceptions to Confidentiality
        Consent by the Person in Treatment
        Disclosure to the Client
        Disclosure to Other Providers
        Disclosure to Payers
        Disclosure of Information to Families
        Oversight and Public Health Reporting
        Research
        Disclosure to Law Enforcement Agencies
        Disclosure to Protect Third Parties
    Federal Confidentiality Laws
    Potential Problems With the Current Legal Framework
    Summary
    Conclusions
    References
8. A Vision for the Future
    Continue To Build the Science Base
    Overcome Stigma
    Improve Public Awareness of Effective Treatment
    Ensure the Supply of Mental Health Services and Providers
    Ensure Delivery of State-of-the-Art Treatments
    Tailor Treatment to Age, Gender, Race, and Culture
    Facilitate Entry Into Treatment
    Reduce Financial Barriers to Treatment
    Conclusion
    References
  Post Test