Category:

Mental Health: A Report of the Surgeon General

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
      • Piaget: 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

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