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Lecture 2

PSYC*3690 Lecture Week 2.doc

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University of Guelph
PSYC 3690
Benjamin Gottlieb

Tuesday, Jan 15, 2013 PSYC*3690 Community Mental Health Lecture #3 - background of community mental health, where it came from, historic factors - 1950s and 1960s when the community mental health approach was developed - factors: 1) The availability and development of psychoactive medications - the medications allowed for deinstitutionalization - people were removed from mental hospitals and treated in the community on an outpa- tient basis - when people symptoms and strange behaviour/thoughts could be managed through medication, it meant that people were more amenable to talking therapy - made it easier to talk to people about their issues - also made it easier to bring people with serious mental disorders into the community - community-based treatment was possible because they weren’t so scary 2) Challenge to mental hospitals - there were a series of investigative reports about mental hospitals - some interesting pseudo-patient studies (journalists who feigned mental illness so they could get into the mental hospital and investigate it) - the hospitals were decided to be unhealthy places for people and the hospitals were iatrogenic (treatment that produces illness) - stories were of a snake-pit environment where no treatment was being administered - once the pseudo-patients got admitted, they couldn’t get out, the staff interpreted their protests that they were journalists as delusions and the journalists eventually started to feel crazy - the conclusion came that there was no active treatment - legal filings were made to say you can’t keep people in a mental hospital unless they are receiving treatment (Nescent Right To Treatment) - there were a variety of new approaches to hospital treatment that were introduced (To- ken economies, sheltered workshops in the mental hospital), tried to make the hospital a little more like the real world - gave people more contact to society - brought in volunteers - allows patients fur lows where they would go with a group and leave the hospital - movement to deinstitutionalize mental health care and set up a system of community- based treatment (decision made in 1950’s, more strongly in the 1960’s) - the patient’s after living in the mental hospital for 30-40 years were happy there - it was torture for them to be told that their home they had been in for so long was no longer their home - the key element is you need to have developed a comprehensive system of care/sup- port system for people with serious mental health problems in order for deinstitutional- ization to work and we didn’t - the ideology of deinstitutionalization far outreached the design of community-based programs - we deinstitutionalized people before we had developed a system of care for them - these people live in group homes - these people end up being victimized by more aggressive members of society (crimi- nals) - the phenomena got the name “Dumping” for the victims of deinstitutionalization - patients he knew were dumped in inner-city Detroit in a motel with 4 of them stuck in a room - they were in a worse place than they were in the hospital, there was no programming or system of comprehensive care - huge profits were going on by housing mental patients - could get activities in places like “Project Friendship” or mental wards in hospitals and medication but not talking therapy - deinstitutionalization has ushered in community-based treatment - revolving door phenomenon is very common 3) Study of help-seeking for mental health problems - huge commission on mental health and mental illness during Kennedy’s years - similar surveys done in Canada - in study, go to a large random sample of the population and ask them: When you have a stressful event/issues in parenting/marital problems/feeling down who do you go to for help? - best friends, mom (Kith and Kin = friends and family) - the first person that men turn to is the women they are in a relationship with - women talk to other women because they have a network of relationships - 1 of the reasons women live longer than men because when a man’s wife dies, 1 of 2 things will happen: he’ll find another partner right away or he’ll die - women when their husband dies, they have an insurance policy, they have the insur- ance of other female friends - the number one topic that men don’t want to talk about is the state of the relationship - studies of loneliness: when men feel lonely, being with other men does not reduce their feelings of loneliness but being with a woman or more than one women does reduce their loneliness - “in some dimensions women are the superior species” - first line of defense is partner, close friends, close family members - after that, the second line of defense people go to are people with no training in mental health or little training - community gate keepers/caregivers: members of the clergy, family doctors (carry the largest base of mental health patients), teachers, hair dressers (the way to get repeat clients in hairdressing is to listen to their story and give them di- rect advice), bartenders - Carl Rogers - if you go and become a hotline worker they teach you: active listening, empathy, repeating what they’re saying but never give advice - the third line of defense is counsellors, therapists and mental health specialists - the connection is that we want to teach the second line of defense how to provide mental health assistance to the people who they deal with, teach them to be responsive to people’s mental health problems by giving them help and referring them - the twist: it’s important because if we’ve learned that there’s a hierarchy of who people go to and we find out that the 2nd line are approached more, then that means we have a chance to do early intervention by working through these community gate-keepers - you can refer all you like, it doesn’t mean people will act on it - if the second line are so important and, we should concentrate on putting mental health specialists in primary care (doctors) or give doctors more training and tools - the key here is early intervention consultation with and training of community care- givers - e.g. recognizing and predicting suicide, bullying behaviour, violence - by learning how important this second line is we can hopefully extent their reach 4) The importation into the mental health system of nonprofessionals and para- professionals - out of a recognition that a lot can be accomplished by listening and supporting people that ordinary citizens have been recruited to provide mental health assistance - nonprofessional = ordinary citizens, paraprofessionals = 2 year college degree - nonprofessionals are helping at hotlines, crisis lines, crisis centers - along with that also the recognition that our society is diverse and we need to bring more nonprofessionals/paraprofessionals because they understand the cultures of peo- ple - a reliance on non-traditional manpower is a feature of community mental health Features of Community Mental Health 1. emphasis is largely on prevention 2. populations at risk - populations at risk = groups of individuals who are experiencing certain stressors, milestones and transitions that challenge their coping skills - we know there are people who are at turning points in their life who if we can extend some information to them and perhaps some skill training, we can take them off a mal- adaptive trajectory and put them on a good trajectory - if we can recognize they are being challenged and if we can intervene with the appro- priate technology - we do have an interest in the entire community - trellis is the main mental health service provider in guelph 3. emphasis on nontraditional manpower 4. emphasis on rapid and brief intervention 5. consultation with community caregivers 6. an emphasis on removing or diminishing environmental stressors (having 2 exams within 24 hours) January 16 Lecture Notes for PSYC 3690 (due to false notice of cancelled class) Topic: Historical Factors Leading to the Development of Community Mental Health Practice 1. Development of psychoactive medications for depression, anxiety, etc made it possible to treat people in the community with talking thera- pies because the medication tended to suppress the more frightening and bizarre behaviours often displayed by people with mental illness. It paved the way for deinstitutionalization by allowing people to be treat- ed on an outpatient basis or in the psychiatric wing of general hospi- tals. Although these medications are not without problems of their own, they nevertheless reduced patient suffering and stigma, and ush- ered in a new era of community-based treatment. 2. Journalistic inquiries and some research on life in mental hospitals re- vealed that little active treatment was occurring, meaning the hospi- tals were largely holding tanks in which people were expected to be- have and think in mentally ill terms. Journalists who feigned mental ill- ness so they could see what went on inside ended up feeling crazy themselves because they were sent that role by the staff, and the more they protested the more they were deemed delusional or para- noid. The word, ”iatrogenic” means treatment or advice that inadver- tently produces illness and greater complications, and that is what mental hospitals were seen to do. Legal suits were brought against these “total institutions”, the results of which were that the court decided that mentally ill inpatients had “the nascent right to treatment” and if such treatment were not provid- ed, then the residents needed to be discharged into the community. Al- though there were some attempts to r
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