EXAM 1 MENTAL HEALTH
Exam 1
Chapter 1
Mental Health
Difficult to Define
No Single, universal definition
Many components influenced by factors
Dynamic, ever-changing state
– The culture of any society strongly influences its values and beliefs, and this, in turn, affects how that
society defines health and illness. What one society may view as acceptable appropriate, another society
may see as maladaptive and inappropriate.
– The World Health Organization defines health as state of complete physical, mental, and social wellness,
not merely the absence of disease or infirmity. No single universal definition of mental health exists. In
mot cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
Influencing Factors:
Individual- a person’s biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality,
ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation,
and coping or stress management abilities.
Interpersonal- include effective communication, ability to help others, intimacy, and a balance of separateness,
and connectedness.
Social/cultural- a sense of community, access to adequate resources, intolerance of violence, support of
diversity among people, mastery of the environment and a positive, yet realistic, view of one’s world
– The culture of any society strongly influences its values and beliefs, and this, in turn, affects how that
society defines health and illness. What one society may view as acceptable appropriate, another society
may see as maladaptive and inappropriate.
– The World Health Organization defines health as state of complete physical, mental, and social wellness,
not merely the absence of disease or infirmity. No single universal definition of mental health exists. In
most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
– More Information about individual/interpersonal/social cultural
– Individual- biologic makeup, intolerable or unrealistic worries or fears makeup, intolerable or unrealistic
worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of
disharmony in life, and a loss of meaning in one’ life.
– Interpersonal- ineffective communication, excessive dependency on or withdrawal from relationships, no
sense of belonging, inadequate social support, and loss of emotional control.
,– Social/cultural- lack of resources, violence, homelessness, poverty, an unwarranted negative view of the
world, and discrimination such as stigma, racism, classism, ageism, and sexism.
Disorders that affect:
Mood: Bipolar, depression
Behavior: Addictive disorders, OCD
Thinking: Schizophrenia, Anorexia
Mental disorders often cause significant distress, impaired functioning, or both. Individuals experience
dissatisfaction with self, relationships, and ineffective coping. Daily life can seem overwhelming or
unbearable. Individuals may believe that their situation is hopeless.
Criteria for Diagnosis:
– Dissatisfaction with characteristics, abilities, accomplishments
– Ineffective or unsatisfying relationships
– Dissatisfaction with one’s place in the world
– Ineffective coping with life events
– Lack of personal growth
Diagnostic and Statistical Manual of Mental Disorders
– DSM-5: Taxonomy published by the American Psychiatric Association
– Purposes:
o Standardize nomenclature, language (Referred as how the disorder is called)
o Identify defining characteristics or symptoms
o Assist in identifying underlying causes (Psychosocial factors)
– Allows the practitioner to identify all factors that relate to a patient’s condition:
– Major psychiatric disorders
– Medical conditions
– Psychosocial and environmental problems (Example Homelessness)
Access 1 or access 2 –This is how they identify conditions
The definition of mental health is standardized and universally accepted - FALSE
,Historical Perspectives
Ancient Times
• Ancient times
– Sickness as displeasure of gods; punishment for sins; viewed as demonic or divine
– Aristotle and imbalances of the four humors (blood, water, yellow and black bile); balance
restoration via bloodletting, starving, and purging
– Early Christians’ view as possession by demons
• When they failed they used more severe and brutal measures such as incarceration in
dungeons, flogging, and starving.
– Ancient times-Those with mental disorders were viewed as being either divine or demonic, depending
on their behavior.
– Renaissance- Those with mental illness were distinguished from criminals. Those considered harmless
were allowed to wander the countryside or live in rural communities. The more “dangerous” were
thrown in prison, chained, and starved.
“Bedlam”
Saint Mary of Bethlehem
A hospital was officially declared a hospital for the insane, the first of its kind. By 1775, visitors at the institution were
charged a fee for the privilege of viewing and ridiculing the inmates, who were seen as animals, less than human.
• Period of enlightenment (1790s)
– Creation of asylums; moral treatment
– Dorothea Dix
• Sigmund Freud: scientific study, treatment of mental illness
A safe refuge or haven offering protection at institutions where people had been whipped, beaten, and
starved just because they were mentally ill. With this movement began the moral treatment of mentally ill.
In the United States, Dorothea Dix (1802-1887) began a crusade to reform the treatment of mental illness
after a visit to Tuke’s institution in England. She was instrumental in opening 32 state hospitals that offered
asylum to the suffering. The period of enlightenment was short-lived. Within 100 years after
establishment of the first asylum, state hospitals were in trouble. Attendants were accused of abusing the
residents, the rural locations of hospitals were viewed as isolating patients from their families and homes,
and the phrase insane asylum took on a negative connotation.
• Psychopharmacology (1950s): development of psychotropic drugs
• Community mental health movement
– Deinstitutionalization
• 1963 Community Mental Health Centers Construction Act. Began a deliberate shift to
the community
– Legislation for disability income
, • Allowed people with with severe and persistent mental illness to be more independent
financially and to not rely on family for money.
– Changes in commitment laws
• Changes in the early 1970s made it more difficult to commit people for mental illness
against their will.
– In the 1950s, the development of certain medications changed the field of mental health.
These medications included antipsychotics (Chlorpromazine and haloperidol), antidepressants
(tricyclic), and antianxiety agents (benzodiazepines).
– Lithium’s were also created
Current state
• More than 18.6% of Americans aged 18 years and older have diagnosable mental disorder (NIMH,
2008), 20.7 million have a substance use disorder, and 8.4 million of this population have a dual
diagnosis.
• 15 million adults and 4 million children and adolescents with impaired daily activities
• Economic burden exceeds that of all types of cancer.
• Some believe that deinstitutionalization has had negative as well as positive effects. Although
deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to
those beds correspondingly increased by 90%.
• Such findings have lead to the term revolving door effect. The continuous flow of clients being
admitted and discharged quickly overwhelms general hospital psychiatric units. Patients are often
boarded or kept in the ED while waiting to see if the crisis de-escalates or till an inpatient bed can be
located or becomes available. (Patients keep coming back, discharged, and then they come back)
• Shorter, unplanned hospital stays further complicate frequent, repeated hospital admissions. People
with severe and persistent mental illness may show signs of improvement in a few days but are not
stabilized. Thus, they are discharged into the community without being able to cope with community
living.
• Issues and concerns:
– “Revolving-door” effect due to deinstitutionalization
• Often “boarded” in EDs while awaiting inpatient beds
– Shorter hospital stays, decompensation, rehospitalization, dual diagnoses
Homelessness is roughly a 42% have a serious mental illness associated with substance abuse
33% have a physical illness comorbidities
Objectives for the Future
Healthy People 2020 objectives:
o Increase the number of people identified, diagnosed, treated, helped to live healthier lives
o Decrease rates of suicide, homelessness
o Increase employment for those with serious mental illness
o Provide more services for incarcerated persons with mental health problems
Exam 1
Chapter 1
Mental Health
Difficult to Define
No Single, universal definition
Many components influenced by factors
Dynamic, ever-changing state
– The culture of any society strongly influences its values and beliefs, and this, in turn, affects how that
society defines health and illness. What one society may view as acceptable appropriate, another society
may see as maladaptive and inappropriate.
– The World Health Organization defines health as state of complete physical, mental, and social wellness,
not merely the absence of disease or infirmity. No single universal definition of mental health exists. In
mot cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
Influencing Factors:
Individual- a person’s biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality,
ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation,
and coping or stress management abilities.
Interpersonal- include effective communication, ability to help others, intimacy, and a balance of separateness,
and connectedness.
Social/cultural- a sense of community, access to adequate resources, intolerance of violence, support of
diversity among people, mastery of the environment and a positive, yet realistic, view of one’s world
– The culture of any society strongly influences its values and beliefs, and this, in turn, affects how that
society defines health and illness. What one society may view as acceptable appropriate, another society
may see as maladaptive and inappropriate.
– The World Health Organization defines health as state of complete physical, mental, and social wellness,
not merely the absence of disease or infirmity. No single universal definition of mental health exists. In
most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying
interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
– More Information about individual/interpersonal/social cultural
– Individual- biologic makeup, intolerable or unrealistic worries or fears makeup, intolerable or unrealistic
worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of
disharmony in life, and a loss of meaning in one’ life.
– Interpersonal- ineffective communication, excessive dependency on or withdrawal from relationships, no
sense of belonging, inadequate social support, and loss of emotional control.
,– Social/cultural- lack of resources, violence, homelessness, poverty, an unwarranted negative view of the
world, and discrimination such as stigma, racism, classism, ageism, and sexism.
Disorders that affect:
Mood: Bipolar, depression
Behavior: Addictive disorders, OCD
Thinking: Schizophrenia, Anorexia
Mental disorders often cause significant distress, impaired functioning, or both. Individuals experience
dissatisfaction with self, relationships, and ineffective coping. Daily life can seem overwhelming or
unbearable. Individuals may believe that their situation is hopeless.
Criteria for Diagnosis:
– Dissatisfaction with characteristics, abilities, accomplishments
– Ineffective or unsatisfying relationships
– Dissatisfaction with one’s place in the world
– Ineffective coping with life events
– Lack of personal growth
Diagnostic and Statistical Manual of Mental Disorders
– DSM-5: Taxonomy published by the American Psychiatric Association
– Purposes:
o Standardize nomenclature, language (Referred as how the disorder is called)
o Identify defining characteristics or symptoms
o Assist in identifying underlying causes (Psychosocial factors)
– Allows the practitioner to identify all factors that relate to a patient’s condition:
– Major psychiatric disorders
– Medical conditions
– Psychosocial and environmental problems (Example Homelessness)
Access 1 or access 2 –This is how they identify conditions
The definition of mental health is standardized and universally accepted - FALSE
,Historical Perspectives
Ancient Times
• Ancient times
– Sickness as displeasure of gods; punishment for sins; viewed as demonic or divine
– Aristotle and imbalances of the four humors (blood, water, yellow and black bile); balance
restoration via bloodletting, starving, and purging
– Early Christians’ view as possession by demons
• When they failed they used more severe and brutal measures such as incarceration in
dungeons, flogging, and starving.
– Ancient times-Those with mental disorders were viewed as being either divine or demonic, depending
on their behavior.
– Renaissance- Those with mental illness were distinguished from criminals. Those considered harmless
were allowed to wander the countryside or live in rural communities. The more “dangerous” were
thrown in prison, chained, and starved.
“Bedlam”
Saint Mary of Bethlehem
A hospital was officially declared a hospital for the insane, the first of its kind. By 1775, visitors at the institution were
charged a fee for the privilege of viewing and ridiculing the inmates, who were seen as animals, less than human.
• Period of enlightenment (1790s)
– Creation of asylums; moral treatment
– Dorothea Dix
• Sigmund Freud: scientific study, treatment of mental illness
A safe refuge or haven offering protection at institutions where people had been whipped, beaten, and
starved just because they were mentally ill. With this movement began the moral treatment of mentally ill.
In the United States, Dorothea Dix (1802-1887) began a crusade to reform the treatment of mental illness
after a visit to Tuke’s institution in England. She was instrumental in opening 32 state hospitals that offered
asylum to the suffering. The period of enlightenment was short-lived. Within 100 years after
establishment of the first asylum, state hospitals were in trouble. Attendants were accused of abusing the
residents, the rural locations of hospitals were viewed as isolating patients from their families and homes,
and the phrase insane asylum took on a negative connotation.
• Psychopharmacology (1950s): development of psychotropic drugs
• Community mental health movement
– Deinstitutionalization
• 1963 Community Mental Health Centers Construction Act. Began a deliberate shift to
the community
– Legislation for disability income
, • Allowed people with with severe and persistent mental illness to be more independent
financially and to not rely on family for money.
– Changes in commitment laws
• Changes in the early 1970s made it more difficult to commit people for mental illness
against their will.
– In the 1950s, the development of certain medications changed the field of mental health.
These medications included antipsychotics (Chlorpromazine and haloperidol), antidepressants
(tricyclic), and antianxiety agents (benzodiazepines).
– Lithium’s were also created
Current state
• More than 18.6% of Americans aged 18 years and older have diagnosable mental disorder (NIMH,
2008), 20.7 million have a substance use disorder, and 8.4 million of this population have a dual
diagnosis.
• 15 million adults and 4 million children and adolescents with impaired daily activities
• Economic burden exceeds that of all types of cancer.
• Some believe that deinstitutionalization has had negative as well as positive effects. Although
deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to
those beds correspondingly increased by 90%.
• Such findings have lead to the term revolving door effect. The continuous flow of clients being
admitted and discharged quickly overwhelms general hospital psychiatric units. Patients are often
boarded or kept in the ED while waiting to see if the crisis de-escalates or till an inpatient bed can be
located or becomes available. (Patients keep coming back, discharged, and then they come back)
• Shorter, unplanned hospital stays further complicate frequent, repeated hospital admissions. People
with severe and persistent mental illness may show signs of improvement in a few days but are not
stabilized. Thus, they are discharged into the community without being able to cope with community
living.
• Issues and concerns:
– “Revolving-door” effect due to deinstitutionalization
• Often “boarded” in EDs while awaiting inpatient beds
– Shorter hospital stays, decompensation, rehospitalization, dual diagnoses
Homelessness is roughly a 42% have a serious mental illness associated with substance abuse
33% have a physical illness comorbidities
Objectives for the Future
Healthy People 2020 objectives:
o Increase the number of people identified, diagnosed, treated, helped to live healthier lives
o Decrease rates of suicide, homelessness
o Increase employment for those with serious mental illness
o Provide more services for incarcerated persons with mental health problems
