Behavioral Health Chap 27, 28

  1. Key documents for Mental Health and Community:
    Health people 2020

    National Health Promotion and Disease Prevention Objectives

    Report of the Surgeon General on Mental Health- first SG report on Mental Illness

    • New Freedom Initiative -- 3 impediments to provision of quality mental health care
    • -Stigma
    • -Unfair treatment limitations and financial requirements
    • -Fragmented mental health service delivery system
  2. Incidence and Prevalence of Mental Health:
    Global problem

    Accounts for > 15% of mortality (suicide is 11th COD)

    Higher rates in poor, poorly educated, and unemployed

    Many are homeless and go untreated

    Age as an influencing pattern of mental illness in a community

    Gender differences in prevalence of certain mental disorders
  3. CHN needs on substance use/mental health:
    Needs basic understanding of issues related to specific substance; clear idea of desired outcomes related to treatment or prevention program

    -Trends of substance use across different populations and communities

    -Difference between legal and illegal substance use

    -Consequences of substance use on community

    -Substance use from environmental perspective
  4. Alcohol's highest incidence of use in:
    Young Adults (18-25)
  5. Prevalence of Tobacco Use:
    Decline over past decade but not consistent across age groups and genders
  6. Most frequently reported illicit drug
  7. Prevalence of Cocaine:
    Double in the last 25 years
  8. Prevalence of Opiates/Heroin
    Death rates for dependent users are 6-20x higher than for the general population
  9. Prevalence of Prescription Drug Abuse:
    Rise in college age students
  10. Theoretical Frameworks:
    Process Theory-- identify resources and structure needed to develop, implement, and evaluate

    Effect Theory-- provides rationale for why intervention will work

    Public Health Prevention Theory-- level of prevention for program focus, type of intervention to use, and target population
  11. Determinants of Mental Health

    Numerous factors such as genetics, environment, societal frame of reference and context

    Cultural beliefs

    Expectations, Standards, Legal Parameters

    Process of adaptation as a source of stress (individual's perception of stress; subsequent response)

    Nature vs. Nurture

    *Genetics playing major role in development of alcohol dependence

    Individual factors (AUDs)-- high antisocial behavior, high impulsivity, major depression, social anxiety problems, hx of childhood sexual abuse, hyperactivity, attention problems, seminal events

    Environmental factors-- influence of peers, lower socioeconomic status, partner use, substance use by family members
  12. Effect theory provides a rationale for why ___ will work
  13. Routine Screening for Mental Health
    • Brief Psychiatric Rating Scale (BPRS)
    • Beck Depression Scale
    • Montgomery-Ashberg Depression Rating Scale (MADRS)
  14. Screening for Depression:
    Center for Epidemiologic Studies Depression Scale (CES-D)
  15. 3 Levels of Screening for Substance Use:
    • Actual Consumption
    • At-Risk Drinking
    • SUDs

    (Level of Risk is based on level of consumption)
  16. Screening instruments for substance use:
    Self Report- Michigan Alcoholism Screening Test, CAGE questionnaire, Drug use screening inventory (DUSI)

    Biological screens- urine, blood, hair, saliva, breath, and meconium
  17. Types of Self-Report Screenings:
    MAST, Drug Abuse Screening Test, CAGE questionaire, Drug Use Screening Inventory (DUSI)
  18. Types of Biological Screening for Substance Use:
    Urine, Blood, Hair, Saliva, Breath, and Meconium
  19. Mental Health Community Interventions:
    • Integrative health assessment:
    • -treatment hx
    • -personal life stressors
    • -disturbances in sleep
    • -appetite
    • -energy level not attributable to rational explanation
    • -complaints of chronic pain
    • -hx of abuse, trauma, substance use, family hx of mental illness
  20. Community Level interventions for Mental Health Promotion:
    • Anticipated Outcomes
    • Risk-Protective Activities
    • Life-Sustaining Activities
    • Life-Enhancing Activities
  21. Multifaceted roles of the CHN
    Ability to access/use epidemiologic data

    Advocacy- increase client access to services, reduce stigma, and promote improved public understanding, and improve services in community mental health; political involvement


    Case management, Case-finding, Referral

  22. Lack of fixed, regular, adequate nighttime residence including supervised public or private shelters that provide temp accomodations, institutional settings providing temp shelter or public/private places that are not designed for or used as regular sleeping accomodation for human beings
  23. Demographics of HOMELESS

    78% > 18yrs

    More likely single male

    Variable Ethnicity

    ***FASTEST growing segment: families
  24. Fastest growing segment of homeless:
    Families with Children
  25. Contributing factors to homelessness:
    • Poverty
    • Lack of Affordable Health Care
    • Employment
    • Domestic Violence
    • Mental Illness
    • Addictions Disorders
    • Additional variables: personal or financial crisis, natural disasters, personal choice
  26. Homeless Subpopulations:
    Men (increased chance of being treated with disdain)


    Children (<18 without parent, foster, or institutional care)

    Families (mostly single mothers)



    Older Homeless

    Lesbian, Gay, Bisexual, Transgender
  27. Chronic Health problems of Homeless
    • TB
    • HIV/AIDS
    • Diabetes
    • HTN
    • Addictions
    • Mental Disorders
  28. Homeless are at increased risk for ____
    trauma and criminal victimization
  29. Homeless have severe ____ due to poverty, substance abuse, poor nutrition, coexisting illnesses
    Severe Oral Health Problems
  30. The prevalence of HIV is _____x > among homeless
    3 times greater
  31. Resources to Combat Homelessness
    • Public Sector
    • Private Sector
  32. Goals of the Resources to Combat Homelessness
    Impact homelessness on local, state, and national level

    Ensure coordinated, comprehensive and systematic approach to addressing problems of homelessness
  33. Public Sector Resources:
    • McKinney-Vento Homeless Assistance Act
    • Interagency Council on Homelessness
    • Center for Mental Health Services
    • Projects for Assistance in Transition from Homelessness (PATH)
    • National Resource Center on Homelessness and Mental Illness
    • Health Care for the Homeless (HCH)
    • US Department of Housing and Urban Development
    • White House Office of Faith-Based and Community Initiatives
  34. Expanded the def of homeless to include children sharing housing due to economics, abandoned in hospitals, waiting foster placement, or living in hotels and camp grounds
    McKinney-Vento Homeless Assistance Act
  35. Private Sector Resources
    • NCH (National Coalition for Homeless)
    • National Center on Family Homelessness
    • National Coalition for Homeless Veterans
    • National Alliance to End Homelessness
    • National Center for Homeless Education
    • Commission on Homelessness and Poverty, American Bar Association
    • Homes for the Homeless
    • National Law Income Housing Coalition
  36. The CHN must clarify/reevaluate personal beliefs and values regarding:
    • Poverty
    • Homelessness
    • Addiction
    • Mental Disorders
  37. Role of CHN for the homeless
    Providing care to marginalized (persons excluded from mainstream society) and disenfranchised (persons deprived of rights)
  38. Settings for the CHN to work in for Homeless
    Shelters, Clinics, Soup Kitchens, Churches, Community Centers, Social Service Agencies, Streets
  39. ___ and ___ are essential for the CHN working with Homeless
    • Trust
    • Self Clarification of beliefs/values

    **MUST have comprehensive and holistic approach
  40. Primary Prevention for Homeless:
    Advocating for affordable housing, employment, and better health care access

    Financial counseling; assistance in locating sources of legal/financial aid to prevent eviction; assistance in accessing social services, temp housing, or health care to avoid a housing, health or family crisis

    Health Education: positive parenting skills, violence prevention, anger management, coping skills, healthy eating, principles of basic hygiene, immunization programs
  41. Secondary Prevention for Homelessness:
    Assessment of Client Needs for Housing, Health Care, Education, Social Services, and Employment

    Screening for Communicable Diseases

    Assessment of Barriers to Accessing Services
  42. Tertiary Prevention for Homelessness:
    • Provide Rehab care
    • Support clients already homeless
    • Treating complications of advanced disease
  43. Seamless delivery of services as people transition from one level of care to another
    Case Management
  44. Development of innovative modes for response to homelessness...done at each level of prevention for positive change
Card Set
Behavioral Health Chap 27, 28
Behavioral Health Chap 27 28