1
Q
Etiology
A
- The cause of something
- presumed or theorized cause
- Many disorders have many which can be different in each client even though they have the same disorder
2
Q
Epidemiology
A
- the prevalence of a disorder
- how common
- distribution (racial, worldwide, etc)
- ex: 1 in 1000, common among men, etc
3
Q
Key Treatment Conditons
A
- What are “they” saying about how we should go about treating this?
4
Q
Treatment Strategies
A
- What are effective/ineffective?
5
Q
Premorbid
A
- Condition that existed first
6
Q
Comorbid
A
- coexisting condition
- what else does client have?
7
Q
1484 Pope Innocent
What was treatment for people declared “strange?” (Possessed by the devil)
A
- admit possession and repent
- Be tortured until one admits
- Death to force the soul from devil
8
Q
1520
What did Martin Luther declare?
A
- “Mad people are possessed by the devil.”
9
Q
The Age of Enlightenment (After Middle Ages)
What was the thought on what to do with “the criminal, the demented, and the debtor?”
A
- Institutionize rather than kill them.
10
Q
Moral Treatment of Mentally Ill
What is Millieu therapy?
A
- Reinforce good and decent behavior by changing environment
- recover, life moves on
- revival/ religious experience to set you on the road to proper living
11
Q
Social Darwinism
What is Social Darwinism?
A
- “Survival of the fittest” MI are inferior and should be sterilized lest they contaminate the gene poool Misfits should be “locked up”
- 25 states passed sterilization laws by 1936
12
Q
Settlement Movement
What was the Settlement Movement?
A
- Help unfortunate
- Child labor laws passed Compulsory education enacted
- WWI saw a conservative swing
- anti- immigrant sentiment flared “Jewish Peril”
13
Q
Word War II
What is shell shock called now?
A
- PTSD
14
Q
1950
What resulted in the breakthrough on Psychotropic medications?
A
- less physical restraints
- less labotomies
- people no longer had to be hospitalized if given medication
- managed difficult people
15
Q
1948
What was the National Institute of Mental Health founded and funded for?
A
- Drive research
- policy
- dollars
16
Q
The Age of Enlightenment (After Middle Ages)
What was the big change in the perception of the cause of mental illness?
A
- Considered NOT to be a result of witchcraft, etc
- NOT demonic
- Something wrong with the person
- ”You are the problem/it’s your fault”
17
Q
1484 Pope Innocent
What were the results of Pope Innocent’s actions towards mentally ill?
A
- witch burning
- inquisiton
18
Q
Advantages of the 1963 Act
What was made practical because of advances in psychotropic medications?
A
- halfway houses
- group homes
19
Q
1975
For what did Congress begin requiring services?
A
- children
- aged
- alcohol and drug patients
- follow-up treatment for hospitalized patients
20
Q
Advantages of the 1963 Act?
What did the substantial decrease in institution admissions mean?
A
- The fewer people in institutions means more people in the community
21
Q
Problems with the 1963 Act
What were some of the problems with the CMHA?
A
- Areas to be served by mental health centers were too large
- Boundaries between rich/poor were confused
- Clnics wanted “best” areas which were in nice areas with less issues.
- Focus on Clinical services rather than prevention
- too much for the centers to handle with managed money
22
Q
1963 Community Mental Health Act
Which of the aspects of the act couldn’t meet the demands of the people?
A
- Prevention
- JFK thought of this and only could get 5% of allocated dollars for the act
23
Q
1963 Community Mental Health Act
For what did the established funding for community mental health centers provide?
A
Inpatient service
Outpatient Service
Partial hospitalization
24-hour emergency care
Consultations, education, prevention
24
Q
1963 Community Mental Health Act
What serves as a foundation for the system we have today as well as the current delivery of treatment?
A
- The Community Mental Health Act
- The compromise bill that was finally passed.
25
# 1960 JFK
What was **The Kennedy Plan?**
* reintegrate mentally ill into community so therefore dollars and jobs were at stake
* able to do this because of medications
* prevention was a key idea
26
# 1960 JFK
What did the AMA think about JFK’s thoughts on prevention?
* They opposed JFK
* feared socialized medicine (health care) would follow which was kin to communism apparently
27
# The Age of Enlightenment (After the Middle Ages)
Describe the conditions in the institutions?
* Deplorable
* People were chained and caged
28
# The Reform Movement
What were the conditions like in institutions during the **Reform Movment?**
* Conditions were bad
29
# Ancient Greece
What was the general thought on the mentally ill in Ancient Greece?
* Mentally ill are under influence of angry gods
* must be shunned
* deparate them by placing them on islands together
30
# North Africa/Eastern Mediterranean Countries
What is Trephination?
* releases evil spirits
* 2 cm hole in the head
* we learned this from exacavations
* recent incidents of trephinaton in Cali
31
# Emerging Medical Beliefs
What was the medical treatment proposed?
* In April, bleed the patient
* in may, purge the patient,
* in October, bleed the patient or give them an ice cold water dip (precursor to shock treatment)
* alternative to moral treatment
32
# Scientific Psychology (1900)
Describe the theory?
* Psychological rather than organic factors dominant in mentally ill
* theories followed from friend to your theory of mentally ill (all theories)
33
# North Africa/Eastern Mediterranean Countries
How were mentally ill people viewed?
* MI ppl are possessed by evil spirits stuck inside them
34
# Colonial Times in the USA
What happened to the mentally ill during the colonial times?
* hanged
* imprisoned
* tortured as agents of satan
35
# Moral Treatment of Mentally Ill
What was the assumption about the mentally ill that still exist in threads today?
* person’s own devious behavior caused them to be possessed
* Insane are normal and need moral environment to recover
* 80% recovery reported, not ill expected to recover sanity
* Moral treatment was essentially Millieu therapy
* disorder is a reflection of “moral weakness” (not same as moral values)
36
# The Reform Movement
Dorthea Dix
* “Insane asylums are scandal and disgrace”
* worked worldwide for reform to clean up institutions
37
# The Reform Movement
**Benjamin Rush 1745-1813**
* Father of American Psychiatry
* Encouraged more humane TX Treat the MI with respect and dignity,
* moral hospitals were deplorable
* first to suggest that addiction was public health issue
* on the Declaration of Independence (I think)
38
# Emerging Medical Beliefs
What were some of the emerging medical beliefs?
* Insane suffer from brain lesions or oversupply of blood or yellow bile
39
# 1950 Scientific Psychiatry
What did the focus become?
* Classify disturbances
* Deal with problems of Moral Treatment
40
# 1850 Scientific Psychiatry
What was taking shape during this time?
* Medical Model takes shape
* DSM was starting to be developed
* something wrong with brains but it was unknown
* figuring out classifications of different issues
* advances in brain physiology, chemistry, medicine, etc,
* signaled hope
41
# Scientific Psychology
Wht does the research say about Scientific Psychology?
* Research failed to reveal organic pathology in most Pts who were MI
* Psychological rather than organic factors dominate in MI
* Theories followed from Freud to your theory of MI
42
# Scientific Psychology (1900)
What was the focus for scientific psychology?
* Observable data;
* experimental Psychology
* Testing significance
* Deduce from the way ppl answer questions what might be goin on in their head
* measuring IQ
43
# USA late 19th century
What societal changes do we see during the late 19th century?
* Social shift from agrarian to urban Increase in immigration
44
# USA Late 19th Century
What was the assumption about the immigrants that were coming in from all over the world, especially Europe?
* Generally inferior, lack moral fiber and desire to improve themselves
* immigrants, especially Catholic were undesirable
45
# USA Late 19th Century
What were the mental health implications?
* Admissions to mental health hospitals doubled in US but for “foreigners” it increased six times Because they weren’t easily understood they were made to be mentally ill
46
# Politics & Mental Healthcare
What do liberals believe about mental health?
* Environmental conditions drive mental disturbances
* poverty
* anxiety
* Would spend money on treatment
* create jobs
* more facilities
47
# Politics & Mental Healthcare
What do conservatives typically believe about mental health?
* Environment is fine
* problem is the bad individual
* individual’s problem
* individual’s responsibility
48
# Great Depression
Great Depression
* Institutions neglected again.
* Economic reform followed but not social reform
* Reforms that were instituted in 1929 were reversed a few years back
* Wall Street Crashed
49
# 1960 JFK
What does the “rise of liberal thinking” mean?
* Optimism
* Time of possiblity
* Our nation can solve everything
50
# 1960 JFK
What did the Joint Commisison Report claim about what drives the mentally ill?
* Lack of education
* Poverty
* Social/psychological connection
51
# 1980-2010
What was the result of the reemergence of conservative policies in Lansing and Washington?
* Deinstitutionalize even if there is no community placement possible
* mental health money went to jails and prisons
* mental illness has now become an issue for the judicial system
52
# 1980-2010
What happened to LaFayette clinic in Detroit?
* Closed in Detroit in the middle of the night and Pts removed
53
# Clinton Health Reform Proposals
What were the Clinton Health Reform Proposals?
* Single payer system
* MI and Substance abuse Tx not carve out
* Portability of coverage
* No penalty for pre-existing conditions
* Defeated by conservative lobby
54
# The Affordable Care Act (2010) Obama Care
What did the Affordable care act do?
* Eliminated meaningless and cheap healthcare insurance
* Requires basic coverage
* Be insured or fined Added 24 million or so covered individuals (helped marginal hospitals in Rural America survive
55
# The Affordable Care Act (2010) Obama Care
What basic coverage is required?
* Children to 26,
* pre-existing conditions not excluded,
* mental health covered,
* substance abuse Tx covered,
* Women’s coverage without increased premium etc
56
# USA Late 19th Century
What happened to the mental health system during the late 19th Century?
* System became overwhelmed
* moral treatment could not cope
* physicians concluded that “they are incurable, brain defects, nothing to be done.”
57
# JFK 1960
What was the “War on Poverty?”
* Reduce poverty and you decrease mental illness
58
# 1850 Scientific Psychiatry
What was the thought on the mentally ill?
* Illness is based on organic brain pathology
* something must be wrong with the brain
59
What are the prevalent mental disorders for males?
* Alcohols and drug dependencies
* Anxiety disorders
* Dysthymia
* other mood disorders
* Antisocial personality disorders
60
What are the prevalent mental disorders in females?
* Anxiety disorder
* Major depressive disorder
* other mood disorder
* Alcohol dependancies
* Obsessive compulsive disorder (anxiety disorder)
61
# Modern Healthcare
How do Diagnostic Systems impact counseling?
* Client must be diagnosed
* must meet criteria
62
What does the **Preauthorization Process** look like?
* biopyschosocial history first session
* diagnose and get authorization for more sessions
* diagnosis clinically significant
* treatment plan with goals and objectives
* gatekeeper decides how many sessions are needed
63
# Modern Healthcare
How does **Philosophy** impact counseling?
* Should we treat everyone or reserve for treatable?
64
# Modern Healthcare
How does fashion impact counseling?
* Cognitive behavior is 85% all therapy, it is a fad these days
* whats the next big thing in treatment
65
# Historical Approach
What is the Development Model?
* Mechanistic view: behavioral
* organismic view: humanistic
* contextual view: cognitive behavioral
66
# Historical Approach
What is the Remediation Model?
* Something wrong/ problem
* Medical view: seek to understand the biochemical drivers
67
# Historical Approach
What is the takeaway from developmental model and remediation model?
* Both models co-exist today.
* combination of these models work together
68
# Modern Healthcare (Delivery of Services to Mentally Ill)
How does **Economics** impact counseling?
* Who is paying?
* What does it cost?
* MUST be considered as part of the treatment plan
* some things are covered some are not
* whats the next thing?
* Dollars matter
69
# Managed Care Model (operates today)
What does the Managed Care Model look like today?
* We’re not paying for it unless you show and tell what you’re doing,
* Can’t do it you don’t get paid
* Treatment planning, be able to translate into behavioral language different behavioral approaches
* We’re not paying for “talking”
* Controls coverage, sessions, everything “managed” by someone else
70
# Gatekeepers
What is the role of the Gatekeepers?
* Take down insurance data
* Make sure it’s valid
* Set up an appointment
* Intake covered
* Biopsychosocial intake
* Clinician justifies disorder by talking language of DSM
* authorize who gets treatment and how much
DSM
flashcards
Decks in class (7)
# Cards
