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University of Guelph
PSYC 3690
Benjamin Gottlieb

Mental Health is…  Having the ability to deal constructively with reality  Having the capacity to adapt to change  Having an overall goal, the attainment of which once strives for daily  Having the ability to handle stress constructively  Having the capacity to relate to other people  Having the capacity to love one self and others  Something all of us want for ourselves, whether we know it by name or not. When we speak of happiness or peace of mind or enjoyment, or satisfaction, we are usually talking about mental health.  There is no line that neatly divides the mentally healthy from the unhealthy. There are many different degrees of mental health, no one characteristic by itself can be taken as evidence of good mental health, nor the lack of any one as evidence of mental illness and nobody has all the traits of good mental health all of the time  Physical and mental well being  Cognitive and emotional state that allows the individual to develop and use his/her abilities to pursue reasonable goals, meet needs and cope with life problems Principles of Community Mental Health Practise  Emphasis on fast service delivery o NO Waiting lists o As early as possible when they have a mental health problem o Brief intervention  Emphasis on using non-traditional man power o Reach out to more people and provide assistance  Emphasis on community based care o Proving comprehensive community based support system o Persistent mental health patients (revolving door patients)  In and out of mental health issues  Emphasis on populations or groups at risk o By virtue of their common exposure to stressors/adversities/coping challenges o Teen moms, family caregivers of people with dementia (creates depression), divorce o Lacking protective factors that other may have o Marketing programs and get the word out  Advocacy for policy changes that will make life less stressful for the population at large or subgroups o Policies that promote mental health and protect people o Universal health care  Strive for No favouritism in the system o Poverty places you at risk of everything bad ***  Poor people have worse health, poor quality of life  Trying to understand how that works  How does poverty lead to illness? - psychological question in need of answer  "Health Depends on Wealth" article  Poverty limits life longevity and happiness  Eliminate poverty  Reoccurring theme in health  Food programs, permanent housing o Being single is a huge risk factor for negative consequences  Compared to people who are happily partnered o ODSP - Ontario Disability Support Program  Income support policy is important o Look after most vulnerable citizens in our society Mental Health Facts in Canada  1 in 5 people will experience mental health issues in their lifetime  Remaining 4 will have a friend or family member who will  Mental illness affects thinking, mood or behaviour; impairment of functioning with symptoms from mild to severe  About 20% of people with mental health disorder have a co-occurring substance abuse problem  Schizophrenia affects 1%, major depression 8% (is higher than that), and anxiety disorder 12% of people  1 in 10 Canadian 15 years of age or older report symptoms of alcohol or illicit substance dependency  3.8% of adults in Ontario are classified as having moderate or sever gambling problems  70% onset is in adolescence or childhood  15-24 are more likely to report problems than older adults  25% of male drinkers are high-risk drinkers compared to 9% female drinkers  Women are 1.5 more likely to have anxiety or mood disorders 2010 stats  14.3 billion in public expenditures went towards mental health services  Drugs and hospitalization  7.2% of government funding goes to mental health  Rehabilitation studies o Companies will hire you to perform services that get people back to work History of Mental Health What is Community Mental Health as a Field of Practise? Where did it come from? Psychoactive Medical Development  1950's development of medication  1960's came on the scene and made it possible to alleviate the more bizarre and disturbing symptoms o Delusional, repetitive behaviours, beliefs in hopeless life o Very little medical knowledge about serotonin o Giving society and individual relief o Allowed individuals to receive talking therapy (arm chair therapy) o People became more involved in therapy  Risks and dangers of medication o Patients need to know of them o Medication can get in the wrong hands o Adverse side effects  Dry mouth, trembling (Tardif dyskinesia) o People complain about the medication prescribed to them  Trial and error  Sometimes medication just doesn’t work o A lot of people who just wont take the medication  You must face the reality that you have a disturbance  People do not want to accept this  stigma o Can save lives o May take a lot of time to take affect Deinstitutionalization  Ideology about the harmful effects of putting people into mental hospitals where they will be out of sight, out of mind  Investigations by people in the psychiatric field and my journalists o Evidence that nothing was going on in the institutions by way of active treatments o Warehouses for the mentally ill o Largely custodial environments not treatment environments o Kept behind locked doors o Conditions were appalling o Pseudo patient studies (journalists pretending to be a patient)  Environment is socially constructed in a way to say that these people are mentally ill and to behave in mentally ill ways  People expected them to behave mentally ill (role given to patients)  Felt like they were going crazy in this environment  Suing mental hospitals cause they were not providing active treatment Nascent (birth, human right) right to treatment (legal lever for effecting change)   Iatrogenic o Treatment that causes more illness o Induce and exaggerate illness  Wholesale movement from mental hospitals to the community o Shut down the hospitals o This ideology preceded the actual practice of community base treatment o Nothing was set up for these people, no community support system in place o Put at greater risk of victimization o Also reached to the correctional institutions o Were at greater risk in the community o Put into hotels  Treat people in the community and not in institutions o Symptoms were under greater control  General hospital  Still working on effective and responsive community help for people with sever mental disorders  Transitional housing is not a good life o Look at different type of housing structure Public's Help-seeking choices  In the 60's there were studies of the mental health of the US population  Where the public went for help with their emotional and personal problems  Hierarchy of Help-Seeking 1. Family member (men= spouse, women= female bff) 2. Close Friends 3. Family Doctor (psychosomatic) 4. Clergy (Pastoral Counselling) 5. Hair dressers, coaches, teachers 6. Chat/Internet 7. MASH and support groups  We need to get to these people and teach them  Early intervention is a prevention strategy  Distress Centers  Hotlines  Crisis lines Supply and Need Imbalance  Prevalence is the number of people with disorder at a specific time point (static concept)  Incidence (dynamic concept) the rate at which new cases of the disorder arise in the population  Economy is the leading effect on people's health  The poorer you are the more at risk you are of adverse outcomes Research on the imbalance between the number of people who have a clinic mental health disorder and the availability of mental health professionals  Looking at the true prevalence of mental disorders relative to the availability of mental health professionals  How do you establish the true prevalence of mental disorders o Contact places such as mental hospitals/psychiatrics etc..  Will not show the true prevalence  A lot of people do not seek help  Only look at the tip of the iceberg  Missing people who go to other sources of help  Family physicians, family, etc.. o Random sample of the population and survey them  Self-report tools  Face to face interviews  Combine methods in data collection  Selecting large representative sample for the survey  Randomly select smaller number of people for a more intensive diagnostic interviews  Requires intense training for interviewers o We need diagnostic tools that are short, acceptable to the public and which we know are valid  Do not use language that scares people  Do not use questions that require length responses  There are many more people with health problems than there are mental health professionals to meet the needs of the public o If you base need on prevalence o Not based on DEMAND for mental health service  Will they or do they want  People who go for mental health treatment is a small percentage of people who have mental health issues  Approx. 15-20% of people with mental health disorders saw a mental health professional (based on research in specific states) o Need is objective measures on whether people are mentally ill or not  Imported nonprofessional (paraprofessionals) to the field for help o Provide a lot of service for problems in living  Life transitions (divorce, retirements)  Stressful life events  Short term problem focus solving o Many of us go through problems with living  Marriage, parenting, transitions, jobs  Most of the mental health problems in the public o Non-traditional man power  Community care givers (family doctors, central figures in organizations in neighbourhoods, scout leaders, managers, worship leaders) are given training  Employers need to take action in the work place  Started with alcoholism in the work place  Can call a help-line for child's homework  Own assistance program  If business's cant afford this, they buy an EAP service  Bachelor degree plus on job training  Trained to diagnose who needs help and how to reach out to them o NOT serious mental health psychosis  Need professional help  Small fractions of problems Epidemiology of Mental Illness  Epidemiology o The study of the distribution and determinants of health and disease in human population groups with an emphasis on prevention o Try to understand the origins of illness, diseases and serious social problems o Infection disease is no longer a major research issue (we know where many of the diseases come from)  Specific causation for a specific disorder o In the mental health field we almost never can pin point any single cause of mental illness  Usually a number of factors that interact  Interact over time  Mental disorders don't happen over time, they take time  Feed on themselves and other environmental influences  There are risk factors and protective factors for mental illness  How do we go about searching these factors? o Public health agency of Canada (federal) o Centre for disease control (USA) o Taken on major social problems  Child abuse  Homicide  Environment and past  Child Injury (Guelph University)  Parental supervision  Cognitive development  Influence of peers o Distinguish between incidence and prevalence  Prevalence is important to research  Point prevalence  At any given moment of time  Planning services  Life-time prevalence  Ever having had an episode of a disorder Research Designs that Epidemiologist use to identify Risk ( and protective) Factors  Case-Control Design o Cross-sectional o Two groups of people  One group has the disorder you are interested in (case)  One group does not have the disorder (controls) o Try to make these groups equivalent to one another except for the main difference o Goal to identify factors that are present among the cases and absent among the controls  These factors are called risk factors  It may not be an all or none but the degree of the factors which will effect the cases vs. the controls o Always have some ideas of what we are looking for, candidate or possible risk factors  From clinic practises  Research literature o If we find that our hypothesis is correct than those become hypothesized and likely risk factors o Statistically significant presence or intensity and different in cases vs. control than there is a likely difference o Do not confuse this with "control groups" - but no body is manipulating anything  Nothing is introduced to the cases to see the effects it produces  Cohort Design o Prospective and longitudinal o 2 groups of people  Have the hypothesized risk factors  Don’t have risk factors o Want these people to be as much alike as possible o Both groups are well at the beginning of the study o Testing predictive strength of the risk factors o Goal is to determine whether and how strongly the risk factors predict the illness o Relative Risk Ratio  Statistic of how likely the group with the risk factor is of developing the illness disorder o More powerful design that other one because it is predicting the incidents of the disorder  Every prevention program ought to be trying to reduce risk factors and promote protective factors  Generally, protection arises through a process o Social support is about the relationship between people o A set of interactions and relationship qualities that develop overtime Prevention Frameworks Primary  Reduction of the incidents of disorders o Stop it before it happens  Health promotion o Positive notion of prevention o We want to lift people up to a higher level of functioning o foster optimal health o Exercise, diet  Have some symptoms and unease  Having trouble sleeping, lost appetite but you do not have the whole complex (not clinical case) Secondary  Early intervention to nip in bud as soon as the disorder becomes present  When it becomes clinical  Case finding  Outreach projects o Do not wait for people to look for help o active  Medical practise is to wait until the person is sick and looking for help o Passive waiting approach Tertiary  Harm reduction, relapse prevention  Reduce the additional adverse consequences of having a disorder  Except the fact that there are people who will have a disorder and we simply want to ensure that worse things do not happen to that person  INSIGHT o Where or not we should help people who are confirmed drug addicts o Work on cleaning these people up  Eat well, use clean needles, housing, clothing, minimum income  Compassionate thing to do is to limit the adverse consequences of their habit o By accepting drug needs we hope to limit violence  Cannot get rid of Schizophrenia o Help them to cope with it  In a single program you may see different levels of prevention  More accurate, precise and easier to use Universal  Prevention available to all member of the population or to certain subgroups Restrictions of alcohol  o Drinking and driving  Ride programs  Speed limits  Pap tests (subgroups) Selective  Programs for a subgroup of people known to be at risk AS A GROUP  Example is women with the BR gene for breast cancer o Children with a depressed parents  Have not individually screened them Indicated  Each person individually screened and positive for the risk factor  Example: a program for teen mothers who have come to the attention of children's aid on the basis of at least on prior episode of child abuse Depression and Suicide Do I study? Depression  Common mental disorder  How do you measure depression in the population at large  CES-D Scale o Epidemiological scale for depression  Underlying dimensions of the measure o Negative mood (depression is a mood disorder) o Psychomotor retardation  Now energy  Lethargy  "I can not get going" o Helplessness and hopelessness Attitudes   Negative attitudes about present and future  Giving up and giving in  Factor Analysis o Statistically analyse the items and how they cluster o 4 clusters  All the reversed scored items  The dimensions are the rest of the three  How to establish validities of the diagnostic tools 1. Professional Advice o 20 items instrument does get at depression o Get yourself a couple of mental health profession o 2 who independently determine whether people are depressed or not through clinical interview o Sample of individuals o Take the sample who are depressed and find that sure enough they have a high score on the 20 item CES-D o Take the individuals and administer this measure  Self report or through interview  Those who the professionals said are depressed should have elevated scored  Those who professionals said are NOT depressed should low scores 2. Administer measure to depressed people before and after they have been treated o Should see high score before and low score after o Discriminates between those who are not depressed, borderline depressed and those who are at case level depression 3. Correlating scores with scores obtained for other depression measures with known validities which are much longer o Premium on short measures that get us information that we want o Cheaper to use a shorter form o More acceptable to the public  No one wants to fill out a long form  High acceptability  Does not stigmatize  People do not shy away from it o Non-response rates and missing data rates are low with short measures  Reliability o Test-retest reliability or stability  Score a person gets at time one will be highly related at time two  Assumes no major issues that have come up (stressors)  General sample o Internal reliability  Do the items in you assessment tool all correlate with one another  If they are all apart of one underlying disorder  All items should correlate with the total score Who is more at risk of being depressed in Canada during previous year  o Women (15-24) are more likely, goes down with age  8.3 % of sample  Emerging adult hood o Age is a factor as well  Who is more at risk for being depressed in Canada during a lifetime o Women still are more likely at risk o 13.9 percent of sample (women 15-24) o Men are more likely to have anti-social behaviour (drugs and alcohol)  16-20% of Canadian population has a mental disorder o Not a diagnosed mental disorder  Need for mental health services o 16-20% that we can objectively diagnose o The amount of people who need  Demand o Do people seek mental health treatment o The amount of people who do seek o 12% seek or get treatment  WHY does this gap occur?! o Stigma o Access o Knowledge  Don’t know about the services until we NEED them  We need to help people know about these system o Social Network  Reaction to your symptoms  May go to network for help o Don't believe in therapy o Disrupts denial o Don’t define symptoms in mental health terms o Cultural definitions of health and disorder o Cost (160$ for 50 minutes) o Illness itself disables you from action  Psychomotor retardation  Helplessness and hopelessness o Past treatment didn’t work o People believe the illness is self-limiting o Self-help beliefs o Don’t know what to expect  The cause of stress o Uncertainty October 8, 2013 - There are drugs that can be taken to decrease the risk of depression - Some birth control pills are known to increase the risk of depression - Genetic factors can increase the risk of depression - Hypothyroidism and Hyperthyroidism and diabetes can increase the likelihood of depression - Medical risk factors for depression o Certain kinds of diagnoses (because of the threat associated with them) are more likely to lead to depression  People who receive a life threatening diagnosis (cancer) - Psychosocial Risk factors o Many boil down to experiences that have the meaning of loss to the individual  Loss of: self-esteem, of sense of control, of affection from an attachment figure, job, of status, control of surroundings  Experience of abuse, of neglect  Sexual assault (loss of control, loss of faith in others)  Anger turned inward  Helplessness and hopelessness (repeated experiences of loss)  Early childhood experiences that make people particularly sensitive to aspects of the environment, these life experiences are called predisposing factors (abuse, incest), those sensitivities don’t get expressed until precipitating events with  Poverty  Being single places you at greater risk of depression and aggression  No matter what they do they have no impact Secondary Prevention performed by telephone distress centers Discussion - 1.What is the advantage of hotlines? o Easy access o No eligibility criteria o No screening criteria o No cost to user, low cost for the service itself o Providing support unconditionally, unconditional positive regard, active listening, non-judgmental, don’t tell them what to do or give advice – just listen - 2.What are the goals of these programs? o To reach those se
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