chapter 27 behavioral health in the community

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 27Behavioral Health in the Community


Mental Health in Transition: Key DocumentsMental Health in Transition: Key Documents

• Healthy People 2010 (see Table 27.1)

• National Health Promotion and Disease Prevention Objectives

• Report of the Surgeon General on Mental Health

• New Freedom Initiative – three impediments to provision of quality mental health care:

– Stigma

– Unfair treatment limitations and financial requirements

– Fragmented mental health service delivery system


Incidence and PrevalenceIncidence and Prevalence

• Global problem

• Mental illness accounts for >15% of mortality worldwide (WHO, 2007)

• Higher rates in poor, poorly educated, and unemployed

• Many are homeless and go untreated

• Age affects the pattern of mental illness in a community

• Gender differences in prevalence of certain mental disorders


Substance Use and the CHNSubstance Use and the CHN• Continuum including abstinence, low-risk use,

risk/hazardous use, harmful use and dependence (see Fig. 27.1)

• CHN 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

– Differences between legal and illegal substance use

– Consequences of substance use on community

– Substance use from environmental perspective


Prevalence of Substance Use and Use DisordersPrevalence of Substance Use and Use Disorders

• Alcohol: highest incidence of use in young adults (18-25 yrs)

• Tobacco: decline over past decade but not consistent across age groups and genders

• Marijuana: most frequently reported illicit drug

• Cocaine: majority are males 18 to 25 yrs of age

• Heroin: most >18 yrs and male

• Meth, Ecstasy, and PCP

• Prescription drugs: across all age groups; rise in college students


QuestionQuestion

Is the following statement true or false?

• The highest use of alcohol occurs in middle-aged adults.


AnswerAnswer

• False

– Young adults, ages 18 to 25 years, are the group with the highest use of alcohol.


Theoretical FrameworksTheoretical Frameworks• Process theory: identify resources and structure

needed to develop, implement, and evaluate

• Effect theory: provides rationale for why intervention will work

– Determinant theory

– Intervention theory

– Impact theory

– Outcome theory

• Public health prevention theory: level of prevention for program focus, type of intervention to use, and target population


Determinants of Mental HealthDeterminants of Mental Health

• Complex

• 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


Determinants of Substance Use DisordersDeterminants of Substance Use Disorders

• Nature vs. nurture

• Genetics plays a major role in development of alcohol dependence

• Individual factors (associated with AUDs): high antisocial behavior, high impulsivity, major depression, social anxiety problems, history of childhood sexual abuse, hyperactivity, attention problems, seminal events

• Environmental factors: influence of peers, lower socioeconomic status, partner use, substance use by family members


QuestionQuestion


• Effect theory attempts to explain the rationale for an intervention.


AnswerAnswer

• True

– Effect theory provides a rationale for why an intervention will work.


Screening and Brief Intervention Screening and Brief Intervention • Routine screening

– Brief Psychiatric Rating Scale (BPRS; see Fig. 27.7)

– Beck Depression Scale

– Montgomery Ashberg Depression Rating Scale (MADRS)

• Screening for depression: Center for Epidemiologic Studies Depression Scale (CESD; see Fig. 27.8) and shorter version, the CESD-10


Screening for Substance Use and SUDsScreening for Substance Use and SUDs

• Three levels: screening for actual consumption, screening for at-risk drinking, and screening for SUDs

• Level of risk: based on level of consumption

• Screening instruments

– Self-report: Michigan Alcoholism Screening Test (MAST); Drug Abuse Screening Test; CAGE questionnaire; Drug Use Screening Inventory (DUSI)

– Biological screens: urine, blood, hair, saliva, breath, and meconium

• Positive screen: possible brief intervention


Community-Level Interventions Community-Level Interventions • Community assessment and focus of intervention

• Level of prevention

• Mental health community interventions

– Integrative health assessment

– Factors include treatment history; personal life stressors; disturbances in sleep, appetite, or energy level without a rational explanation; complaints of chronic pain; history of abuse, trauma, substance use, and family history of mental illness


Community Level Interventions (cont.)Community Level Interventions (cont.)

• Mental health promotion

– Anticipated outcomes

– Risk-protective activities

– Life-sustaining activities

– Life-enhancing activities


QuestionQuestion


• The CAGE questionnaire is a valid self-report tool to screen for substance use.


AnswerAnswer

• True

– Self-report tools such as the CAGE questionnaire are reliable and valid tools that can be used to screen for substance use.


CHN & Community-Level Interventions CHN & Community-Level Interventions • Multifaceted role

– Ability to access and use epidemiologic data

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

– Education

– Case management, case-finding, referral

– Collaboration


Substance Use & Community-Level Interventions Substance Use & Community-Level Interventions

• Population-based screening programs

• Governmental agencies as resources

• Policy-based interventions

• Mental health policy

• Substance use policy


Internet ResourcesInternet Resources• Al-Anon Family Group Headquarters, Inc.:

http://www.al-anon.org/index.html

• Mothers Against Drunk Driving (MADD): http://www.madd.org/

• National Alcohol Screening Day: http://www.mentalhealthscreening.org/events/nasd/index.aspx

• National Institute on Alcohol Abuse and Alcoholism (NIAAA): http://www.niaaa.nih.gov/

• National Institute of Mental Health: http://www.nimh.nih.gov

• Substance Abuse and Mental Health Administration (SAMHSA): http://www.samhsa.gov/