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Unformatted text preview: Chapter 17
Contemporary Issues in Abnormal Psychology
Contemporary Issues in Abnormal Psychology I
1. Hospitalization 2. (next lecture)
3. Legal issues
4. Mental health efforts Perspectives on Prevention: Focus 5. Previously, most mental health focused on restorative efforts 0. Helping people after they have already developed problems 6. No effort on prevention until 10 years ago 1. Congress directed NIMH to focus on prevention Perspectives on Prevention: Types 7. Prevention efforts are classified into the following three subcategories: Perspectives on Prevention: Foci 8. Universal: influence the general population 9. Selective: focus on subgroups at risk
10.Indicated: identify high risk individuals but not yet diagnosed Prevention Strategies, Treatment, and Maintenance: Range
Perspectives on Prevention: Universal Tasks 11.Universal interventions are concerned with two key tasks 2. Altering the conditions that can cause or contribute to mental disorders
3. Establishing conditions that foster positive mental health
4. Use epidemiological studies to identify atrisk groups (recently divorced, disabled)
0. Tells what to look for and where to look Perspectives on Prevention: Universal – Types (I)
12.Universal interventions include:
13.1. Biological measures 5. Health psychology – exercise, diet 14.2. Psychosocial measures 6. Maintain optimal development & functioning
7. Learn physical, emotional & social competencies Perspectives on Prevention: Universal – Perspectives on Prevention: Universal Types (II)
15.Universal interventions include:
16.3. Sociocultural measures 8. Focus on making community safe and attractive
9. Social conditions that will foster healthy development and functioning individuals Perspectives on Prevention: Selective Focus 17.Selective interventions are aimed at a specific subgroup of the population considered at risk for developing mental health problems
10. E.g. adolescents, elderly, lower SES, military, children of mentally ill Perspectives on Prevention: Selective – Example (I)
18.Problem of teenage alcohol and drug abuse:
19.1. Education programs in middle school 11. Based on assumption that if children are made aware of dangers that they will choose to avoid 20.2. Intervention programs for high risk teens 12. Identify teens having problems and help before it becomes an issue Perspectives on Prevention: Selective – Example (II) 21.Problem of teenage alcohol and drug abuse:
22.3. Parental education and familybased intervention programs 13. Involve families, increase parent’s awareness 23.4. Peer group influence programs 14. Using peer influence not to use alcohol & drugs Perspectives on Prevention: Selective – Example (III)
24.Problem of teenage alcohol and drug abuse:
25.5. Programs to increase selfesteem
15. Develop confidence to resist peer pressure 26.6. Mass media and modeling programs 16. Commercials depicting negative consequences 27.7. Combined prevention programs 17. Involving school, community, peers This Is Your Brain On Drugs
Perspectives on Prevention: Indicated Focus 28.Indicated intervention emphasizes the early detection and prompt treatment of maladaptive behavior in a person’s family and community setting Perspectives on Prevention: Examples 29.Indicated intervention: Brief intervention to prevent long term behavioral consequences 18. PTSD as a result of military combat
19. Katrina, 9/11, VPI The Mental Hospital as a Therapeutic Community: Function 30.Hospitalization may occur when an individual is considered dangerous to self or to others or when symptoms are so severe that the person is unable to care for self in the community
31.Use therapy in hospital setting to create a ‘therapeutic community’ to treat individual The Mental Hospital as a Therapeutic Community: Milieu 32.Incorporating the ongoing activities of the hospital into a treatment program is a key aspect of milieu therapy
33.Staff expectations are communicated
34.Patients are encouraged to be involved
35.Group cohesiveness is created
36.Patients are given the freedom and responsibility for selfgovernment The Mental Hospital as a Therapeutic Community: Learning 37.Sociallearning treatment programs make use of techniques such as token economies 38.Use learning principles to shape socially 38.
39.Focus is on returning patient to community The Mental Hospital as a Therapeutic Community: Aftercare 40.Aftercare programs can help smooth the transition from institutional to community life 20. Provide livein facilities to serve as a ‘home base’ to smooth the transition back into the community
21. E.g. halfway house
22. Problems of relapse and of community response Deinstitutionalization: Change (I) 41.1963 Community Mental Health Act 23. Close hospitals, treat in communities 42.In the last 45 years, the # of state mental hospitals is down from 310 to under 150
43.The patient population has been reduced by over 75% Deinstitutionalization: Change (II) 44.The reduction from a high of onehalf million hospitalized mental health patients to under 100,000
45.Made possible by use of antipsychotic drugs and promised community services & support Deinstitutionalization: Controversy 46.There has been a great deal of controversy over 46.
deinstitutionalization & the failure to provide adequate followup of these patients in the community
24. Freeing of unprepared confined persons Deinstitutionalization: Result Homeless Mentally Ill 47.Services and support have not been available for patients or families
48.The result has been the homeless mentally ill – vagrants, ‘bag ladies’, street crime and high death rate PSYC 3230 49.Wednesday, April 27: Lecture on Contemporary Issues in Abnormal Psych.
25. Pop quiz #12 50.Friday, April 29: Hourly Exam #8 over chapters 16 & 17
51.Monday, May 2: Study day (no class)
52.Friday, May 6 @ 8:00AM Final Exam PSYC 3230 53.Wednesday, April 27 (Today): Lecture on Contemporary Issues in Abnormal Psych.
26. Pop quiz #12 54.Friday, April 29: Hourly Exam #8 over chapters 16 54.
55.Monday, May 2: Study day (no class)
56.Friday, May 6 @ 8:00AM Final Exam Contemporary Issues in Abnormal Psychology II
57.Legal issues 27. Patient Rights
29. Insanity Plea 58.Mental health efforts 30. Managed Care
31. Organized Efforts 59.Challenges for the future Legal Issues 60.Patient Rights
62.Insanity Plea Patient Rights and the Rights of Society: Actual vs Potential 63.Subject of forensic psychology: Rights of patient vs rights of society
64.Judicial system responds once a crime is committed
65.Potential dangerousness results in commitment to a mental hospital 32. Difference between voluntary and involuntary 32.
commitment Patient Rights and the Rights of Society: Rights of Patients
66.Prior to the 1970’s loss of civil rights
67.Patient rights and the 1970’s
40. Right to treatment (1975)
Freedom from confinement (1975)
Right to compensation for work (1973)
Right to live in a community (1974)
Right to less restrictive treatment (1975)
Right to legal counsel (1976)
Right to refuse treatment (1977)
Right to proof need of confinement (1979) Legal Issues and the Mentally Disordered: Commitment
68.To be committed, an individual must be 41. Dangerous to themselves or to others
42. Incapable of providing for their basic physical needs 43. Unable to make responsible decisions about hospitalization and
44. In need of treatment or care in a hospital Legal Issues and the Mentally Disordered: Dangerousness
69.Issue of dangerousness: 45. Schizophrenics, manic, personality disorder 70.Assessment of dangerousness: 46. to protect public; 46.
47. difficult to predict; 48. tendency to be conservative 71.Duty to warn (Tarasoff decision)
49. Breaking confidence Legal Issues and the Mentally Disordered: Commitment Process
72.Commitment begins with filing for commitment hearing 50. Person is then evaluated by mental health professional
51. If decision is to commit, then periodic reevaluations 52. If imminent danger, emergency hospitalization for 72 hours Legal Issues and the Mentally Disordered: Insanity Plea 73.The insanity plea for capital crimes is an important issue in forensic pathology
74.Many people have questioned the use of the “not guilty by reason of insanity” defense (NGRI)
53. Way to avoid consequences of behavior
54. (e.g. Primal Fear; John Hinkley) Legal Issues and the Mentally Disordered: NGRI 75.NGRI: not legally responsible for criminal behavior 55. Did not possess full mental faculties at time of crime 55.
(did not know what they were doing)
56. Issues: Does this extend to drugs?; Does this extend to DID (fault of alter personality)
57. Difference between incompetency and insanity A Time to Kill 76.(part 17, 5:05) Legal Issues and the Mentally Disordered: NGRI Precedents (I)
77.Precedents defining the insanity defense:
78.The M’Naghten Rule (1843)
79.The Irresistible Impulse Rule (1887) 58. Even if know wrong, couldn’t avoid doing act 80.The Durham Rule (1954) 59. Not responsible if product of mental defect Legal Issues and the Mentally Disordered: NGRI Precedents (II)
81.Precedents defining the insanity defense:
82.The American Law Institute Standard (1962) 60. Broadened Durham Rule defect not necessary 83.The Federal Insanity Defense Reform Act (1984) (burden of proof on defense) Legal Issues and the Mentally Disordered: Legal Issues and the Mentally Disordered:
McNaghten & ALIS 84.The M’Naghten Rule (1843) held that the accused must have been laboring under such a defect of reason as not to know
61. The nature and quality of the act
62. That the act was wrong 85.The American Law Institute Standard extended the possibility of insanity pleas
63. Person has the incapacity to appreciate the criminality of their conduct or to conform their conduct to the law Legal Issues and the Mentally Disordered: FIDRA (1984) 86.The successful use of the insanity defense (1981) by John Hinckley set off a storm of protest
87.Federal Insanity Defense Reform Act (1984)
64. One effect and widely adopted reform was to shift the burden of proof (of insanity) to the defense
65. Must prove insanity (opposite to guilt) Legal Issues and the Mentally Disordered: Successful NGRI
88.NGRI successful if:
89.Diagnosed mental illness
66. The Bobbit case 91.Violent crime, but not murder
67. John Hinkley 92.Prior mental hospitalizations Legal Issues and the Mentally Disordered: Current NGRI
93.Recently, guilty but mentally ill
94.Sentenced but placed in treatment facility
68. (e.g. Loraina Bobbit) Mental health efforts 95.Managed Care (HMO’s)
96.Organized Efforts Insurance and Mental Illness: HMO’s (I) 97.37 million in US effected every year by mental illness (extremely low estimate)
98.HMO’s provide insurance coverage for both physical and mental illnesses
99.HMO’s have become the ‘gate keeper’ for provision of insurance coverage 69. Problem: business takes precedence over need in decision making
70. Treatment is limited in duration and quality Insurance and Mental Illness: HMO’s (II)
100. The HMOs and mental health care 71. Designated services obtained from designated providers for a designated population at a designated cost 101. 72. Decisions based on finances not on quality of 72.
services (lowest bid)
75. Implications for mental health services Time limited therapy; outpatient, not inpatient
Focus on medication, not therapy
Even medications are limited Organized Efforts for Mental Health: Awareness 102.
In recent years, a growing public awareness of magnitude of mental health problem
Early awareness grew out of WW II due to number of rejected recruits and the effects of war (e.g. PTSD) Organized Efforts for Mental Health: Federal Agencies
76. Federal agencies devoted to promoting research, training, and service in the mental health community include:
77. The National Institute of Mental Health (1946 under NIH research and training)
78. The National Institute on Drug Abuse
79. The National Institute on Alcohol Abuse and Alcoholism
80. Both NIDA and NIDAA under NIMH Organized Efforts for Mental Health: OSHA 104.
National Institute for Occupational Safety and Health (recognizes mental health) 81. Works in cooperation with private industry to deal 81.
with job stress
82. Workload and space
83. Work schedule
84. Role stressors (responsibilities, autonomy)
85. Career security
86. Interpersonal relations
87. Job control (flexibility, routine) Organized Efforts for Mental Health: Federal vs State
While there is some federal support for research, training and service in mental health
There is very little local and state support for financing the needs of the mentally ill
88. Note: recent transfer to hospital services to private control
89. Note: further reductions in state support of local mental health services Organized Efforts for Mental Health: Professional Organizations 107.
Private organizations active in programs to promote mental health include 90. The American Psychological Association
91. The American Psychological Society
92. The American Psychiatric Association
93. The American Medical Association
94. The Association for the Advancement of Behavior Therapy 95. The American Association for Social Work
95. Organized Efforts for Mental Health: Private Organizations
108. Private organizations serve 96. To lobby federal agencies for support, research and service
97. To provide consultation regarding programs
98. To maintain high professional and ethical standards
99. To provide for accreditation of professionals, clinics, hospitals, etc. Organized Efforts for Mental Health: Corporate & Volunteer 109.
Many corporations and a number of volunteer associations are also active in programs to promote mental health
NMHA (National Mental Health Association) Organized Efforts for Mental Health: NMHA 111.
NMHA (National Mental Health Association) works to 100.
104. Improve services
Recruit and train volunteers
Create educational programs
Promote rights of mental patients Organized Efforts for Mental Health: International 112.
International efforts for mental health are 112.
being lead by:
105. The World Health Organization 1. Over 200 million world wide with mental illness
2. Due to effects of war, poverty, migration disease 106.
The World Federation for Mental Health
3. volunteer Challenges for the Future: Organized & Individual 113.
It seems imperative that more effective planning be done at community, national, and international levels if mental health problems are going to be reduced or eliminated
The history of abnormal psychology provides clear examples of individuals whose work efforts were instrumental in changing the way we think about problems (Dorthea Dix, Clifford Beers) Challenges for the Future: Opportunities for Involvement
115. There are many opportunities to be involved 107.
Working at local, national, international levels
Accepting responsibility in your family, your community and at work
This effects all of us both directly & indirectly End of Chapter 17
End of Chapter 17 ...
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