community conversations about mental...
TRANSCRIPT
On January 16, 2013, President Barack Obama directed Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services and Secretary Arne Duncan of the U.S. Department of Education to launch a national conversation on mental health to reduce the shame and secrecy associated with mental illness, encourage people to seek help if they are struggling with mental health problems, and encourage individuals whose friends or family are struggling to connect them to help.
Mental health problems affect nearly every family. Yet as a nation, we have too often struggled to have an open and honest conversation about these issues. Misperceptions, fears of social consequences, discomfort associated with talking about these issues with others, and discrimination all tend to keep people silent. Meanwhile, if they get help, most people with mental illnesses can and do recover and lead happy, productive, and full lives.
This national dialogue will give Americans a chance to learn more, from research and from each other, about mental health issues. People across the nation are organizing community conversations to assess how mental health problems affect their communities and to discuss topics related to the mental health of young people. In so doing, they also will decide how they might take action to improve mental health in their families, schools, and communities. This could include a range of possible actions to establish or improve prevention of mental illnesses, promotion of mental health, public education and awareness, early identification, treatment, crisis response, and recovery supports available in their communities.
These community conversations will encourage innovation and creativity to meet the concerns of our nation and ensure that all perspectives are heard and respected. We all have a stake in the outcomes.
Mental health issues in our communities—particularly for our youth—are complex and challenging; but, by coming together and increasing our understanding and raising awareness, we can make a difference.
Pamela S. Hyde, J.D.AdministratorSAMHSA
Paolo del Vecchio, MSWDirectorCenter for Mental Health ServicesSAMHSA
Community Conversations About Mental Health
Goals and Objectives of the Community Conversations About Mental Health
This toolkit is designed to help participants in community conversations about mental health achieve three main goals:
• GetAmericanstalkingaboutmentalhealthtobreakdownmisperceptionsandpromoterecoveryandhealthycommunities;
• Findinnovativecommunity-basedsolutionstomentalhealthneeds,withafocusonhelpingyoungpeople;and
• Developclearactionstepsforcommunitiestomoveforwardinawaythatcomplementsexistinglocalactivities.
The Information Brief for Community Conversations About Mental Health
The Information Brief is designed to be used alongside the other elements of the Toolkit for Community Conversations About Mental Health and provides data and information to help community conversations participants consider key issues of importance to their com-munities. The Information Brief follows the format of the Discussion Guide section of the Toolkit for Community Conversations About Mental Health and has the following sections:
• Session1:StartingtheConversationOpening Question: What does mental health mean to me? What does it mean to our community?
• Session2:IdentifytheChallengesOpening Question: What are the challenges and factors we should consider?
• Session3:FocusingonYouthOpening Question: How can we best support the mental health of young people?
• Session4:CommunitySolutionsOpening Question: What steps do we want to take in our community?
Table of ContentsGoals and Objectives of the Community Conversations About Mental Health
The Information Brief for Community Conversations About Mental Health
Terms and Definitions .................................................... 1
Session 1: Starting the Conversation ....................3
Understanding the Basics ..........................................3
Attitudes and Beliefs About Mental Health .....................................................................6
Mental Health in the Community ...........................7
Research About the Mental Health of Young People ............................10
Session 2: Identify the Challenges .........................11
Session 3: Focusing on Youth ................................14
Session 4: Community Solutions ......................... 17
Appendix 1: Helpful Resources and Websites .................................................................... 19
Appendix 2: Acknowledgments ........................20
Reference List ................................................................. 21
Community Conversations About Mental Health
Information Brief
Community Conversat ions About Menta l Hea l th
Acknowledgments
ThisreportwaspreparedfortheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)byAbtAssociatesanditssubcontractorstheDeliberativeDemocracyConsortium,andEverydayDemocracyundercontractnumber[HHSS283200700008I/HHSS28342002T]withSAMHSA,U.S.DepartmentofHealthandHumanServices(HHS).L.WendieVelozandChrisMarshallservedastheGovernmentProjectOfficers.
Disclaimer
Theviews,opinions,andcontentofthispublicationarethoseoftheauthoranddonotnecessarilyreflecttheviews,opinions,orpoliciesofSAMHSAorHHS.Thelistingofanynon-Federalresourcesisnotall-inclusiveandinclusioninthispublicationdoesnotconstituteendorsementbySAMHSAorHHS.
Public Domain Notice
AllmaterialappearinginthisreportisinthepublicdomainandmaybereproducedorcopiedwithoutpermissionfromSAMHSA.Citationofthesourceisappreciated.However,thispublicationmaynotbereproducedordistributedforafeewithoutthespecific,writtenauthorizationoftheOfficeofCommunications,SAMHSA,HHS.
Electronic Access and Printed Copies
Thispublicationmaybedownloadedororderedathttp://store.samhsa.gov.OrcallSAMHSAat1-877-SAMHSA-7(1-877-726-4727)(EnglishandEspañol).
Recommended Citation
SubstanceAbuseandMentalHealthServicesAdministration,CommunityConversationsAboutMentalHealth:InformationBrief.HHSPublicationNo.SMA-13-4763.Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration,2013.
Originating Office
OfficeofCommunications,SubstanceAbuseandMentalhealthServicesAdministration,1ChokeCherryRoad,Rockville,MD20857.HHSPublicationNo.SMA-13-4763.PrintedJune2013.
SAMHSA Descriptor
TheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)istheagencywithintheU.S.DepartmentofHealthandHumanServicesthatleadspublichealtheffortstoadvancethebehavioralhealthofthenation.SAMHSA’smissionistoreducetheimpactsubstanceabuseandmentalillnessonAmerica’scommunities.
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Terms and DefinitionsBefore we start looking at these central questions, let’s define some terms that will be used heavily throughout this informational brief:
Mental Healthisastateofwell-beinginwhichanindividualrealizeshisorherownabilities,cancopewiththenormalstressesoflife,canworkproductively,andisabletomakeacontributiontohisorhercommunity.Inthispositivesense,mentalhealthisthefoundationforindividualwell-beingandtheeffectivefunctioningofacommunity.1
Mental Illness isdefinedas“collectivelyalldiagnosablementaldisorders”or“healthconditionsthatarecharacterizedbyalterationsinthinking,mood,orbehavior(orsomecombinationthereof)associatedwithdistressand/orimpairedfunctioning.”Underthesedefinitions,substanceusemightbeclassifiedaseitheramentalhealthproblemoramentalillness,dependingonitsintensity,duration,andeffects.2
Mental Health Promotionconsistsofinterventionstoenhancetheabilitytoachievedevelopmentallyappropriatetasksandapositivesenseofself-esteem,mastery,well-being,andsocialinclusionandtostrengthentheabilitytocopewithadversity.3Thisabilitytocopeisreferredtoasresilience.
Mental Health Treatment istheprovisionofspecificinterventiontechniquesbyaprofessionalforconditionsidentifiedinthemostrecenteditionoftheDiagnosticandStatisticalManualofMentalDisorders(DSM).Theseinterventionsshouldhaveproveneffectiveness,theabilitytoproducemeasurablechangesinbehaviorsandsymptoms,andshouldbeperson-andfamily-centeredandculturallyandlinguisticallyappropriate.4
Prevention isasteporsetofstepsalongacontinuumtopromoteindividual,family,andcommunityhealth;preventmentalandsubstanceusedisorders;supportresilienceandrecovery;andpreventrelapse.5
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Terms and Definitions Recoveryisaprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlife,andstrivetoreachtheirfullpotential.Peoplewithmentalillnessescananddorecoverfromtheseconditions,andhopeplaysanessentialpartinovercomingtheinternalandexternalchallenges,barriers,andobstacles.Controllingormanagingsymptomsispartofthisprocess.Reducingoreliminatingsubstanceuseiscriticalforrecoveryfromaddiction.6
Recovery Support Services includeafocusonprovidingforthehealth,housing,vocational,andsocialsupportneedsofpeoplewithmentalhealthproblems.Theseincludepeer-andfamily-operatedservices.7
Substance Abuseisdefinedastheuseofalcoholordrugsdespitenegativeconsequences.8
Substance Useisdefinedastheconsumptionofloworinfrequentdosesofalcoholandotherdrugs,sometimescalledexperimental,casual,orsocialuse.9
Traumaresultsfromanevent,seriesofevents,orsetofcircumstancesthatisexperiencedbyanindividualasphysicallyoremotionallyharmfulorthreateningandthathaslastingadverseeffectsontheindividual’sfunctioningandphysical,social,emotional,orspiritualwell-being.10
Young People/Youth aredefinedhereaspersonsuptoage25.
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Session 1: Starting the ConversationWhat Does Mental Health Mean to Me? What Does It Mean to Us?
There are many views and opinions about mental illnesses, their causes, and how we can best treat and respond to these conditions. The following information provides some basic facts about mental health and mental illness to help participants begin the conversation.
Understanding the Basics
Mentalhealthplaysanimportantroleinyouroverallwell-being.Anestimated19.6percentofAmericansages18andolder—aboutoneinfiveadults—willexperienceamentalhealthproblemthisyear.11Butstudiesshowthatmostpeoplewithmentalproblemsgetbetter,andmanyrecovercompletely.
Mentalhealthincludesouremotional,psychological,andsocialwell-being.Itaffectshowwethink,feel,andact.Italsohelpsdeterminehowwehandlestress,relatetoothers,andmakechoices.Mentalhealthisimportantateverystageoflife,fromchildhoodandadolescencethroughadulthood.
Overthecourseofyourlife,youmayexperiencementalhealthproblems.Yourthinking,mood,andbehaviorcouldbeaffected.12
Manyfactorscontributetomentalhealthproblems,including:
• Lifeexperiences,suchastraumaorahistoryofabuse• Biologicalfactors,suchasgenesorchemicalimbalancesinyourbrain• Familyhistoryofmentalhealthproblems
Takingcareofone’smentalhealthisjustasimportantastakingcareofone’sphysicalhealth.Overallhealthincludesawell-balancedandnutritiousdiet,regularexercise,stressmanagement,earlyandongoingmentalhealthserviceswhenneeded,andtakingtimetorelaxandenjoyfamilyandfriends.Findingagoodbalancebetweenworkandhomeisimportanttomentalandphysicalhealth.
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Types of Mental Health Problems
Peoplecanexperiencedifferenttypesofmentalhealthproblems.Somecanoccurforashorttime,andsomeoccuroveranon-goingtimeperiod.Justasotherhealthconditions,thesearerealanddiagnosablehealthconditionsthataffectandareaffectedbyfunctioningofthebrain,anorganofthebodyjustlikethekidney,liver,orheart.Mentalhealthproblemscanaffectyourthinking,mood,andbehavior.Commontypescaninclude:13
Anxiety DisordersPeoplewithanxietydisordersrespondtocertainobjectsorsituationswithfearanddread.Anxietydisorderscanincludeobsessive-compulsivedisorder,panicdisorders,phobias,andPost-TraumaticStressDisorder(PTSD).
Attention Deficit Hyperactivity DisorderAttentiondeficithyperactivitydisorder(ADHD)isoneofthemostcommonchildhooddisordersandcancontinuethroughadolescenceandadulthood.Symptomsincludedifficultystayingfocusedandpayingattention,difficultycontrollingbehavior,andhyperactivity(over-activity).
Eating DisordersEatingdisordersinvolveextremeemotions,attitudes,andbehaviorsinvolvingweightandfood.Eatingdisorderscanincludeanorexia,bulimia,andbingeeating.
Co-Occurring Mental and Substance Use DisordersMentalillnessesandsubstanceusedisordersoftenoccurtogether.Sometimesonedisordercanbeacontributingfactortoorcanexacerbatetheother.Sometimestheysimplyoccuratthesametime.
Mood DisordersThesedisordersinvolvepersistentfeelingsofsadnessorperiodsoffeelingoverlyhappy,orfluctuatingbetweenextremehappinessandextremesadness.Mooddisorderscanincludedepression,bipolardisorder,SeasonalAffectiveDisorder(SAD),andcompulsiontoself-harm.
Personality DisordersPeoplewithpersonalitydisordershaveextremeandinflexiblepersonalitytraitsthataredistressingtothepersonand/orcauseproblemsinwork,school,orsocialrelationships.Personalitydisorderscanincludeantisocialpersonalitydisorderandborderlinepersonalitydisorder.
Psychotic DisordersPeoplewithpsychoticdisordershear,see,andbelievethingsthataren’trealortrue.Anexampleofapsychoticdisorderisschizophrenia.
Substance Use DisordersSubstanceusedisordersinvolvethedependenceonorabuseofalcoholand/ordrugs,includingthenonmedicaluseofprescriptiondrugs.14
Suicidal BehaviorSuicideisaseriousproblemthatcausesimmeasurablepain,suffering,andlosstoindividuals,familiesandcommunitiesnationwide.Millionsofpeopleconsider,plan,orattemptsuicideeachyear;manydieasaresult.
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Promotion of Mental Health and Prevention of Mental Illnesses
Whenwepromotementalhealth,wehelppeopleimprovetheirhealthandwell-being,havepositiveself-esteem,andtobevaluedandcontributingmembersoftheircommunities.Mentalhealthpromotionalsohelpsbuildresiliencyinpeople,helpingthemcopebetterduringlife’schallenges.
Preventioninterventionshelptoreducethelikelihoodofdevelopingamentalillnessorasubstanceusedisorderandcanhelpdelaytheonsetorreducetheseverityofamentalillness.Preventionaddressesproblemsbeforetheyhappenbyaddressingthosethings–riskfactors–thatcanmakeitmorelikelyforapersontodevelopproblems.Thesecanincludeworkingtocreatehealthyenvironmentsthatreducetheeffectsofpovertyandtheriskofviolence,childmaltreatment,drug/alcoholmisuse,andbullyingandensurethatpeoplehaveaccesstothecarethattheyneedwhensymptomsjustbegintoappear.Preventioneffortsfocusoncommunitiesorlargepopulationsthroughuniversalstrategiesorinterventionstargetedathigh-riskindividualsandthosewhomaybeshowingsomeminimalsignsandsymptomsofdevelopingamentalillnessorasubstanceusedisorder.
Someimportantwaysthatwecanpromotementalhealthandpreventmentalillnessandsubstanceusedisordersistoincreaseprotectivefactorsandusepromisingstrategiesthataddresstheneedsofchildren,adults,andfamiliesinthecommunity.Protectivefactorsincludegoodcommunicationskills,reliablesupportanddisciplinefromparentsandcaregivers,supportforearlylearning,qualityhealthcare,healthypeergroups,socialconnectedness,andsucceedingschools.Promisingstrategiesemphasizepubliceducationandawarenessaboutissuesrelatedtomentalhealthandsubstanceuse-andincludeearlyidentificationofmentalhealthproblemsandaccesstoappropriateinterventions.
Treatment for Mental Health Problems
Mostpeoplewhoexperiencementalillnesseswillimproveiftheyreceiveappropriatesupports,services,andtreatment.Thefirststeptogettingtherighttreatmentistoseeahealthcareprofessionalandreviewyoursymptomsandlifecircumstances.Treatmentoptionsaretailoredtoeachspecificpersonandcondition;however,themostcommonformsoftreatmentinclude:
• Psychotherapy, or “talk therapy” (sometimes called counseling)—teachespeoplestrategiesandgivesthemtoolstodealwithstressanduncomfortablethoughtsandbehaviors.Psychotherapyhelpspeoplemanagetheirsymptomsbetterandfunctionattheirbestineverydaylife.15
• Cognitive behavioral therapy (CBT)—helpspeoplelearnhowtoidentifyunhelpfulthinkingpatterns,recognizeandchangeinaccuratebeliefs,relatetoothersinmorepositiveways,andchangebehaviorsaccordingly.CBTcanbeappliedandadaptedtotreatmanyspecificmentaldisorders.16
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• Medications—usedtotreatthesymptomsofmanymentaldisorderssuchasschizophrenia,depression,bipolardisorder(sometimescalledmanic-depressiveillness),anxietydisorders,andattentiondeficit-hyperactivitydisorder(ADHD).Medicationscanalsobeusedtomanagethecravingsandrelapseassociatedwithcertainkindsofaddictions.Sometimesmedicationsareusedwithothertreatmentssuchaspsychotherapyorcounseling.17
• Rehabilitative services—includerecovery-focusedactivitiesortreatment/therapeuticinterventionssuchasassistanceinimprovingorrestoringdailylivingskills,socialandleisureskills,groomingandpersonalhygieneskills,andmealpreparationskills;othersupportresources;and/ormedicationeducation.
Recovery from Mental Health Problems
Studiesshowthatmostpeoplewithmentalhealthproblemsgetbetter,andmanyrecovercompletely.Recoveryisdefinedasaprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlife,andstrivetoreachtheirfullpotential.Recoveryissupportedbymentalhealthtreatmentandsupportservicesinthecommunity.18
Recoveryisbuilton:
• Health—overcomingormanagingone’sdisease(s)orsymptoms–includingabstinenceifonehasanaddiction–andmakinginformed,healthychoicesthatsupportphysicalandemotionalwellbeing.
• Home—astableandsafeplacetolive.
• Purpose—meaningfuldailyactivities,suchasajob,school,volunteerism,familycaretaking,orcreativeendeavorsandtheindependence,income,andresourcestoparticipateinsociety.
• Community—relationshipsandsocialnetworksthatprovidesupport,friendship,love,andhope.
Attitudes and Beliefs About Mental HealthWeknowalotaboutwhatAmericansbelieveaboutmentalhealthandmentalillnessfromnationalsurveys.ThesesurveysrevealthatwhileAmericanshavelearnedagreatdealaboutcharacteristicsandcausesofmentalillnessesoverthelastseveraldecades,negativebeliefsaboutpeoplewithmentalillnessescontinuetogrow.19
Thesenegativeattitudesaboutpeoplewithmentalillnessesaremostlyinfluencedbythemisconceptionthatpeoplewithmentalillnessesaremoreviolentthanthegeneralpopulation.20Peoplewithmentalillnessesarenomoreviolentthanthegeneralpopulationunlesscertainotherriskfactorsareinvolved,includingalcoholabuseoruntreated,activepsychosisassociatedwithparanoiaandincludingspecifictypesofcommandhallucinations.21Infact,peoplewithmentalillnessesonlycommitthreetofivepercentofviolentactseveryyear.22Peoplewithmentalillnessesaremuchmorelikelytobevictimsofcrimethanperpetrators.23
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Impact of Attitudes and Beliefs
People’sattitudesandbeliefsaboutmentalillnesssetthestageforhowtheyinteractwithandsupportapersonwithmentalillness.
• Whenpeoplehavepositiveattitudesaboutmentalhealth,theymayengageinsupportiveandinclusivebehaviors(e.g.,willingnesstodateapersonwithmentalillnessortohireapersonwithmentalillness).24
• Whenattitudesandbeliefsareexpressednegatively,theymayresultinavoidance,exclusionfromdailyactivities,and,intheworstcase,exploitationanddiscrimination.25
Attitudesandbeliefsaboutmentalillnessareshapedbypersonalknowledgeaboutmentalillnessandknowingandinteractingwithsomeonelivingwithamentalillness.Attitudesandbeliefscanbeinfluencedbyculturalstereotypes,mediastories,andinstitutionalpractices.
Mental Health in the CommunityTherearemanyintertwinedfactorsthatinfluencethementalhealthofanindividualandtheresourcesavailableinacommunitytomeettheneedsofpeoplewithmentalhealthproblems.
Spirituality and Mental Health
Manyturntofaithcommunitiesforsupportindealingwithmentalhealthproblems.Faithcanprovideimportantelementsofsolaceandsupportforsuchindividuals.Faithcommunitiescanalsoplayakeyroleineducatingtheirmembersaboutmentalhealthproblems.26Supportiverelationships,suchasfamily,long-termfriendships,andmeaningfulonnectionsthroughfaithcanbeimportanttobuildingresilienceandwell-being.
Culture and Mental Health
Culturecanprovidealensforhowpeoplethinkaboutmentalhealth,whethertheyseekhelpformentalhealthproblems,andhowpeopleandmentalhealthprofessionalsinteractwithoneanother.27Peopletypicallythinkofcultureintermsofraceorethnicity,butculturealsoreferstoothersocialgroupsdefinedbycharacteristicssuchasage,gender,religion,incomelevel,education,geographicallocation,sexualorientation,disability,orprofession.28Ratesandtypesofmentalhealthproblemsandseekingtreatmentcanvaryaccordingtothepopulation.29Racialandethnicminoritiesbearagreaterburdenfromunmetmentalhealthneedsandsufferagreaterlosstotheiroverallhealthandproductivity.30
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Mental Health is a Public Health Issue
Providingforandsupportinggoodmentalhealthisapublichealthissuejustlikeassuringthequalityofdrinkingwaterorpreventingandmanaginginfectiousdiseases.Communitiesprosperwhenthementalhealthneedsofcommunitymembersaremet.Unaddressedmentalhealthissuescanhaveanegativeinfluenceonhomelessness,poverty,employment,safety,andthelocaleconomy.Foryoungpeople,mentalhealthisinfluencedbyawebofinteractionsamongtheyoungperson,thefamily,childservicesystems(school,health,fostercare),andtheneighborhoodsandcommunitiesinwhichtheylive.
• ApproximatelyoneinfiveAmericanswillhaveamentalhealthprobleminanygivenyear,yetonlyalittleoveroneinthreepeoplewithamentalhealthproblemwillreceivementalhealthservices.31
• Over38,000Americansdiedbysuicidein2010,makingthenumberofAmericanswhodiebysuicidemorethandoublethenumberwhodiedbyhomicide.32
• One-thirdofindividualswithseverementalillnesseswhoreceivecommunitymentalhealthservicesafterlengthystaysinastatehospitalachievefullrecoveryinpsychiatricstatusandsocialfunction,andanotherthirdimprovesignificantlyinbothareas.33
• Ofthemorethansixmillionpeopleservedbystatementalhealthauthoritiesacrossthenation,only21percentareemployed.34
• Supportedemploymentprogramsthathelppeoplewiththemostseriousmentalillnessesplacemorethan50percentoftheirclientsintopaidemployment.35
• Between2007-2009,theaverageexpenditureperadultages18-26forthetreatmentofmentalhealthdisorderswasabout$2,000.Ofthispopulation,averageexpenditurefortreatmentofmentalhealthproblemswashigherforyoungadultsages18-21estimatedat$2,300peryearthanforthoseages22–26estimatedat$1,800.36
• In2006,186,000youngadultsreceivedsocialsecuritydisabilitybenefitsbecausetheirmentalillnesswassoseverethattheywerefoundtobeunabletoengageinsubstantialgainfulactivity.37
• SeriousmentalillnessescosttheU.S.anestimated$193.2billioninlostearningsperyear.38Effectivenationwideschool-basedsubstanceabusepreventionprogrammingcanofferstatessavingswithin2yearsrangingfrom:39
o $36millionto$199millioninjuvenilejustice40
o $383millionto$2.1billionineducation41
o $68millionto$360millioninhealthservices42
Homelessness, Mental Health, and the Community
From the January 2010 HUD Point-in-Time (PIT) counts, Continuums of Care reported that:
• 26.2 percent of sheltered adults who were homeless had a severe mental illness, and
• 46 percent of sheltered adults on the night of the PIT count had a chronic substance abuse problem and/or a severe mental illness.
Prejudice and discrimination associated with mental and substance use disorders create enormous housing challenges for these individuals.43
Did You Know?
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Substance Abuse and Communities
SubstanceabusetakesatremendoustollonAmerica’scommunities.Mentalandsubstanceuseconditionsoftenco-occur.Inotherwords,individualswithsubstanceuseconditionsoftenhaveamentalhealthconditionatthesametime,andpersonswithmentalhealthproblemsoftenabusesubstancesorexperienceaddictionatthesametime.Thefollowingincludesstatisticsonsubstanceabuseandco-occurringmentalandsubstanceusedisorders:
• In2011,anestimated20.6millionpersons(8.0percentofthepopulationaged12orolder)wereclassifiedwithsubstancedependenceorabuseinthepastyear.44
• 19.3millionpersons(7.5percentofthepopulationaged12orolder)neededtreatmentforanillicitdrugoralcoholuseproblembutdidnotreceivetreatment.45
• Approximatelyeightmillionadultshaveco-occurringdisorders.46
• Only6.9percentofindividualsreceivetreatmentforbothconditionswhile56.6percentreceivenotreatmentatall.47
• Co-occurringmentalandsubstanceusedisorderratesarehighamongpeoplewhoexperiencehomelessness.48
• Onestudyreporteda23percentlifetimeprevalencerateofco-occurringdisordersforindividualswhoexperiencehomelessness,andthesepeoplemayfacecomplexphysical,social,andpsychologicalchallengestorecovery.49
• Withtreatment,emergencyroomvisits,hospitalstays,andperiodsofincarcerationaresignificantlyreduced.50Likewise,high-riskandharmfulsubstanceuseisdecreased.Stablehousingalongwithsupportiveservicesprovidesahigherquality,self-directed,andsatisfyinglifeinthecommunity.51
The Treatment Gap in AmericaAlmost two-thirds of the over 45 million adults with any mental illness and almost 90 percent of the over 21 million adults with substance use disorders go without treatment in our country every year.52
Did You Know?
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Research About the Mental Health of Young People
Theresearchsupportstheneedforpreventionandearlyinterventionstrategiestoaddressthemental,emotionalandbehavioralproblemsthatcanoccurthroughoutayoungperson’slife.
• MorethanhalfofadolescentsintheUnitedStateswhofailtocompletehighschoolhaveadiagnosablepsychiatricdisorder.53
• Individualswithmentalillnessesdieonaverage8.5yearsearlierthanthegeneralpopulation,duemostlytopreventablehealthconditionslikeheartdisease,diabetes,hypertension,andtobaccouse.54
• Bullyingcanhavesignificantmentalhealthconsequencesforbothvictimsandbullies.55
o Comparedtoindividualswhowerenotbullied,victimsofbullyingwerenearlythreetimesaslikelytohaveissueswithgeneralizedanxietyasthosewhowerenotbulliedand4.6timesaslikelytosufferfrompanicattacksoragoraphobia.
o Childrenwhoreportedbeingbothbulliesandvictimsshowedanearlyfivetimesgreaterriskofdepressionasyoungadultscomparedtothosewhohadonlyexperiencedbeingabullyoronlyexperiencedbeingavictim.
• Researchhasdemonstratedthatpreventioneffortscandelaythefirstuseoftobaccoandalcohol.56
• Bingedrinkingandheavyalcoholusepeaksbetweenthoseaged18-25,withnearly40percentofpeopleinthatagegroupreportingbingedrinkingand12percentreportingheavyalcoholuse.57
• Abuseofprescriptiondrugsishighestamongyoungadultsaged18to25,with5percentreportingnonmedicaluseinthepastmonth.58
• DatafromSAMHSA’sChildren’sMentalHealthInitiativeindicatedthatamongyouth12andolderwhoidentifiedsubstanceuseproblemsatintakeinChildren’sMentalHealthInitiative-fundedsystemsofcare,36percentinvolvedwiththechildwelfaresystemand32percentinvolvedwiththejuvenilejusticesystemreportednosubstanceuseproblemsafter6months.59
• Bypreventingachildfrombecomingdependentonalcohol,wecansaveapproximately$700,000overthecourseofthechild’slifetime.60
• Byhelpingachildgraduatefromhighschoolwhowouldotherwisehavedroppedout,wecansaveasmuchas$388,000overthecourseofthechild’slifetime.61
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Session 2: Identify the ChallengesWhat Are the Challenges and Factors We Should Consider?
To make progress on mental health issues, we need to think strategically about the challenges we are facing and the factors that have the greatest influence on mental health—particularly those that affect young people. This session will help you consider some of those challenges and factors and begin thinking about how to address them.
Challenges to Promoting Mental Health
Inthepast,thesciencedidnotexistabouthowtoeffectivelypromotementalhealthandpreventmentalillnesses.Now,wehavetheknow-howbutstillneedtoeducatecommunities,serviceproviders,andothersthatpreventionispossible.Promotionandpreventionwillhelpustoultimatelyreducedisabilityandhardshipbyreducingtheprevalenceofmentalhealthdisorders.62
Promotionandpreventioninvolvesanewapproachtomentalhealthissues.Thisapproachrequirespeopleandcommunitiestothinkandactdifferentlybyaddressingmentalhealthissuesbeforetheybecomementalillnesses.
Challenges for Youth Transitioning to Adulthood
Asyouthbecomeadults,alargenumberhavebehavioralhealthproblems,andveryfewactuallyreceivetreatment.
• YouthtransitioningtoadulthoodtypicallyhavedifficultiesaccessinghealthcareandthehighestuninsuredrateintheUnitedStates.64Additionally,theyoftenhavelowperceptionsofrisk65althoughthispopulationhasthehighestrateofhomicide,66andhighratesofhomelessness,67arrests,68mentalhealthproblems,69schooldropouts,70andsubstanceabuse.71
• Itisestimatedthat6-12percentoftransition-ageyouthandyoungadultsstrugglewithaseriousmentalhealthcondition(2.4-5millionindividuals).72
• AccordingtotheTreatmentEpisodeDataSetfor2009,amongsubstanceabusetreatmentadmissionsaged12to17,fewerthanoneineight(11.9percent)werereferredbyschools.73
• Treatmentadmissionsaged15to17mostfrequentlyreportedmarijuana(71.9percent)oralcohol(17.7percent)astheirprimarysubstanceofabuse.74
The Importance of Involving Families
Family-driven care means that families have a decision-making role in the care of their own children as well as the policies and procedures that shape care for children in their community, state, tribe, territory, and nation.63
Did You Know?
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Did You Know?
Economic Costs of Mental Health Problems
The annual cost of mental, emotional, and behavioral disorders among young people is estimated to be $247 billion – including the costs of treatment and lost productivity.79
Access to Support, Services, and Treatment
Attitudesandbeliefscanpreventapersonfromseekingtreatment,althoughresearchtellsusthattreatmentiseffectiveandpeopledorecover.
• Only38percentofadultswithdiagnosablementalhealthconditionsgettreatment.Ofthe45.9millionpeople18andolderwhohavebehavioralhealthconditions,just17.9millionreceivedtreatment.75
• Lessthanoneinfiveadolescentsgettreatmentfordiagnosablementalhealthconditions.76
• Aswithotherchronicillnesses,individualswhoseektreatmentandrecoverysupportservicesformentalhealthproblemslearnnewlifeskillsandgoontolivehealthy,empowered,andproductivelives.77
• Stablehousingisimportanttoindividualsseekingtreatmentandfordeliveringservicestothepersonintheirlivingenvironmentandcommunity.Throughresearchweknowthattreatmentiseffectiveandrecoveryispossiblebutnotwhenaperson’sbasicneedforsafetyandhousingarelacking.78
Paying for Mental Health Care
• Lackofabilitytoaffordcareisamongthetopreasonsthatpeoplewithunmetneedreportedfornotseekingtreatment.80
• Peoplewithmentalhealthandsubstanceabuseproblemshavehistoricallyhadhighratesofbeinguninsured.81
• Asaconsequence,mentalhealthandsubstanceabusetreatmentspendinghasdependedmoreonpublicpayersthanallhealthcare,withpublicpayers—suchasMedicaid—accountingforapproximately60percentofmentalhealthspending.82
• AsaresultoftheAffordableCareAct,manycurrentlyuninsuredAmericanswithmentalhealthandsubstanceabuseproblemswillbecomeeligibleforaffordablehealthinsurancecoverage.Beginningin2014underthelaw,allnewsmallgroupandindividualmarketplanswillberequiredtocovertenEssentialHealthBenefitcategories,includingmentalhealthandsubstanceusedisorderservices,andwillberequiredtocoverthematparitywithmedicalandsurgicalbenefits.TheMentalHealthParityandAddictionsEquityAct(MHPAEA)requiresgrouphealthplansandinsurersthatoffermentalhealthandsubstanceusedisorderbenefitstoprovidecoveragethatiscomparabletocoverageforgeneralmedicalandsurgicalcare.Asaresultofthesetwopiecesoflegislation,anestimated62millionAmericanswillhaveimprovedaccesstoservicesformentalandsubstanceusedisorders.83
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Perceptions of Violence and Mental Illness
Toooften,depictionsandperceptionsofviolenceandmentalillnesscanperpetuatenegativeattitudesandmythsaboutindividualslivingwithamentalillness.
• Peoplewithmentalillnessesonlycommitthreetofivepercentofviolentactsandaremuchmorelikelytobevictimsthanperpetratorsofviolence.84
• Researchhasdemonstratedthatindividualswhoreceivedtreatmentformentalillnessesinthecommunity(outpatient,day,andresidentialtreatment)were11timesmorelikelytohavebeenthevictimsofviolentcrimethanthegeneralpopulationinthepastyear.85
Criminal Justice Involvement
Nevertheless,therearehighratesofmentalillnessesandsubstanceabuseproblemsamongpeopleinthecriminaljusticesystem.
• Approximately70percentofjailinmateswithmentalillnessesareincarceratedfornon-violentoffenses.86
• In2005,individualswhoexperiencedmentalhealthproblemsaccountedfor56percentofstateprisoners,45percentoffederalprisoners,and64percentofjailinmates.87
• Sixty-seventoseventypercentofyouthinthejuvenilejusticesystemhaveadiagnosablementaldisorder.88
Sexual Orientation
Socialattitudesregardingsexualorientationcanalsoimpacthowweviewpeoplewithmentalhealthproblems:
• Therejectionoflesbian,gay,bisexual,andtransgender(LGBT)youthbytheirfamilies,orbytheirpeersandcommunity,canhaveprofoundandlong-termimpacts,includingdepression,useofillegaldrugs,andsuicidalbehavior.89
14 Community Conversat ions About Menta l Hea l th
Session 3: Focusing on YouthHow Can We Best Support the Mental Health of Young People?
Young people experience some of the highest prevalence rates of mental illness and yet have some of the lowest help seeking rates of any group. Additionally, childhood emotional and behavioral disorders are the most costly of all illnesses in children and youth.
Early Life Experiences
Earlylifeexperiencesareimportantinshapinganindividual’slifeintoadulthoodandcanimpacthowanindividuallearnsandrespondstostressfulevents.90
• Whenyoungchildrenareexposedtorepeatedtraumaticexperiences(e.g.,childabuse,witnessingviolence),theyareatincreasedriskofdevelopingmentalhealthproblems,substanceabuse,andchronichealthproblems(likeheartdiseaseanddiabetes).91
• Thenegativeimpactsoftheseearlyexperiences(sometimesreferredtoas“toxicstress”)canbepreventedorreversedwhenachildhasarelationshipwithasupportive,responsive,andcaringadultatanearlyage.92
• AdverseChildhoodExperiences,orACEs,isatermthatdescribesalltypesofabuse,neglect,andothertraumaticexperiencesthatoccurtoindividualsundertheageof18.Thesecanhaveaprofoundimpactonthatchild’sfuturehealth.Infact,apersonwhoexperiencesfourormoreACEswere7.4timesmorelikelytoconsiderthemselvesalcoholics,3.9timesmorelikelytohavechronicbronchitisoremphysema,4.6timesmorelikelytoreportbeingdepressed,and1.9timesmorelikelytodevelopcancer.93
Schools Play an Important Role
Schoolsplayacriticalroleinensuringthatbehavioralproblemsareidentifiedearlysothatyoungpeoplecangrowandthriveinahealthyenvironment.Schoolscanleadcoordinationeffortsinbringingyouth-servingagenciestogethertoguaranteethatchildren,youth,andfamiliescaneasilyaccessservicesthatarecommunitybased,childcentered,familyfocused,andculturallyandlinguisticallycompetent.
• Childrenwhohavenotdevelopedsocialandemotionalskillsbythetimetheyenterschoolareatadisadvantage.Forexample,childrenneedtobeabletopayattention,respondappropriatelytodirections,interactpositivelywithpeersandadults,andcontroltheiremotionsandbehaviorsinschoolinordertobesuccessful.95
Early Childhood Experiences Help Build Success Later in LifeChildren begin developing social and emotional skills at a very young age, and these skills form an important foundation for being able to succeed in school, in relationships, and in life.94
Did You Know?
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• Studentswithpoorsocialskillsaremorelikelyto:experiencedifficultiesininterpersonalrelationshipswithteachersandpeers;showsignsofdepression,aggression,oranxiety;demonstratepooracademicperformance;andhaveahigherincidenceofinvolvementinthecriminaljusticesystemasadults.96
• Withoutadequatetreatment,youngadultsincollegewithamentalillnessaremorelikelytoreceivelowerGPAs,dropoutofcollege,orbeunemployedthantheirpeerswhodonothaveamentalhealthchallenge.97Thirty-onepercentofcollegestudentshavefounditdifficulttofunctionduetodepressioninthepastyear,whilemorethan50percenthavefeltoverwhelminganxiety,makingithardtosucceedacademically.98
• Approximately50percentofstudentsage14andolderwithamentalillnessdropoutofhighschool.Thisisthehighestdropoutrateofanydisabilitygroup.99
Leftuntreated,childhoodmentalandemotionaldisorderscanleadtopooroutcomesinschool,limitedemploymentopportunities,andothernegativeeconomicimpactsinadulthood.
Early Onset of Mental and Substance Use Disorders
Mentalhealthproblemsoftenbeginatanearlyageandbecomemoresignificantduringadolescenceandyoungadulthood.
• Halfofadultmentalhealthproblemsbeginbeforeage14,andthree-quartersbeginbeforeage24.100
• In2007,8.2percentofadolescents,anestimated2.0millionyouthsaged12to17,experiencedatleastonemajordepressiveepisode.101
• Amongalladolescentswithmajordepressiveepisodesinthepastyear,nearlytwothirds(62.3percent)didnotreceivetreatmentfortheirdepression.8.4percentoffull-timecollegestudentsaged18to22experiencedmajordepressioninthepastyear.102
• Ofchildrenandyouthinneedofmentalhealthservices,75-80percentoftheseyouthdonotreceiveservices.103
Did you know? The importance of seeking
treatment earlyDelays in receiving treatment after the first onset of symptoms of schizophrenia or psychosis are found to be related to: poorer response to antipsychotic medications, presence of more severe symptoms, more frequent recurrences and hospitalizations, and higher suicide risk.104
Did You Know?
16 Community Conversat ions About Menta l Hea l th
Suicide Prevention is Key
Fartoomanyofournation’syouthtaketheirownlives:
• Suicideisthethirdleadingcauseofdeathamongyouthages15-24.105
• Onesurveyfoundthatina12-monthperiod,almost13.8percentofhighschoolstudentshadseriouslyconsideredsuicide,10.9percentofhighschoolstudentshadmadeasuicideplan,and6.3percentofhighschoolstudentsattemptedsuicideatleastonce.106
• Oneoutofevery53highschoolstudents(1.9percent)reporthavingmadeasuicideattemptthatwasseriousenoughtobetreatedbyadoctororanurse.107
• Thetollamongsomegroupsisevenhigher.Forexample,thesuicidedeathrateamong15–19-year-oldAmericanIndian/AlaskaNativemalesistwoandone-halftimeshigherthantheoverallrateformalesinthatagegroup.108
• Suicidetoucheseveryone,butthereishelpandhopewhenindividuals,communities,andprofessionalsjoinforcestopreventsuicide.SeeSAMHSA’sPreventingSuicide:AToolkitforHighSchools(http://store.samhsa.gov/shin/content/SMA12-4669/SMA12-4669.pdf)andSAMHSA’sSuicidePreventionResourceCenter’sRolesinPreventingSuicide(http://www.sprc.org/basics/roles-suicide-prevention).
• Ifyouorsomeoneyoucareaboutisfeelingalone,hopeless,orisincrisis,callorchatwithcaringcounselorsattheNationalSuicidePreventionLifelineat1-800-273-TALK(8255)or(http://suicidepreventionlifeline.org/GetHelp/LifelineChat2.aspx).
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Session 4: Community SolutionsWhat Steps Do We Want To Take In Our Community?
Whether you are part of a small group of concerned citizens or a community-wide planning process, you can start working on local ideas and can focus on identifying individual and community solutions.
Itisimportanttofirstidentifywhatmentalhealthresourcescurrentlyexistinthecommunityanddeterminewhatelseisneeded.Workwithcommunitymemberstomapoutwhatpreventionstrategies,treatment,andrecoverysupportservicescurrentlyexistandhowtheyaremeetingtheneedsofthoseserved.
Aperson’smentalhealthcanbeaffectedbymanyelementsofoursociety.Theplaceswhereindividualsandcommunitieschoosetofocustheireffortscanbemuchbroaderthanmanypeoplemightthink.Forcommunities,itisdifficulttoknowwheretostartsincethetopicinvolvesschools,humanservices,providernetworks,families,neighborhoods,faithcommunities,andmanyotherstakeholders.
Thefollowingarealistofcommunityfactorsthatcanimpactmentalhealth.109
• Culturalnorms–suchasalcoholuse,bullying• Discrimination• Employmentopportunity• Foodinsecurity–notknowingwhereyournextmealwillcomefrom• Housingquality• Incomeinequality• Neighborhoodconditions• Physicalisolation• Publicservices• Socialstatus• Accesstohealthservices
Getting the Facts About What Works
Toassistwithcommunityplanningandimplementation,thereareavarietyofresourcestoidentifyeffectiveapproachestomeetthementalhealthneedsofyoungpeople.Whenchoosingevidence-basedapproaches,itisimportanttoidentifyandprioritizetheneedsofyoungpeopleinthecommunitysothatyoucandeterminewhichtypeofintervention,strategy,orapproachwillbethemostappropriate.110Itisalsoimportanttoassessthecommunity’scapacity(e.g.,financialresources,organizationalcommitment,communitybuy-in)toimplementanintervention,strategy,orapproachwhilepreservingthecomponentsthatmadetheoriginalpracticeeffective.111Communitiescanworktogethertodecidewhatinterventions,strategiesandapproachesmatchtheneedsofyoungpeopleinthecommunityandcanbeimplementedwithinthecommunity’scapacity.
For more information on evidence-based practices, refer to Appendix 1, “Helpful Resources and Websites.”
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Additional Suggestions for Community Planning
Tailor your efforts to your community.Everycommunityisdifferentwhenitcomestodevelopingthenextstepsinsupportingourchildren,youth,andfamilies.
Celebrate what has been done in your community to strengthen mental health.Everycommunityisstartingfromauniquepointwithexistingassetsandresources.Itisimportanttocelebratethethingsthatarealreadytakingplaceinyourcommunity.
Highlight what work still needs to be done.Therewillalwaysbemoretodotosupportthehealthydevelopmentofyoungpeople.Taketimetorecognizehoweveryoneinthecommunitycanpitchinandsupportmentalhealth.
Describe what direction you plan to take as a community.Createavisionforhowyourcommunitywilladdressthementalhealthneedsofyouthandfamilies.
Keep working together.Effectiveeffortstoaddressmentalhealthrequiretheneedtoformandsustainpartnershipsfrommanydifferentpartsofthecommunity.Communityconversationmeetingsshouldbeconsideredjustthestartofanon-goingdialoguetoplan,implement,andevaluateefforts.
For more information you could use to host a conversation in your community, please go to www.CreatingCommunitySolutions.org and refer to Appendix 1, “Helpful Resources and Websites.”
(These materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organization’s programs or activities.)
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Appendix 1: Helpful Resources and Websites (Note: These organizations, materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organization’s programs or activities.)
••
••
•
•
•
•
•
••••
••
••
•
•
•
••
•
•
•
••••
Resources• InformationAboutMentalHealth • http://www.MentalHealth.gov• SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA) • http://www.SAMHSA.gov• NationalInstituteofMentalHealth(NIMH) • http://www.nimh.nih.gov• Additionalinformationyoucouldusetohostaconversationinyour
community• http://www.CreatingCommunitySolutions.org
Promoting Mental Health and Preventing Mental IllnessSuicidePreventionResourceCenter http://www.sprc.orgTheInstituteofMedicine’sPreventing Mental, Emotional and Behavioral Disorders Among Young People:ProgressandPossibilities
http://www.iom.edu/Reports/2009/Preventing-Mental-Emotional-and-Behavioral-Disorders-Among-Young-People-Progress-and-Possibilities.aspx
Addressingbullying http://www.stopbullying.govNationalCenterforMentalHealthPromotionandYouthViolencePrevention http://www.promoteprevent.org
FindYouthInfo http://www.findyouthinfo.gov
MillionHearts http://millionhearts.hhs.gov/index.html
Addressing Public AttitudesResourceCentertoPromoteAcceptance,Dignity,andSocialInclusion •
••
http://promoteacceptance.samhsa.gov
VoiceAwards http://www.samhsa.gov/voiceawardsChildren’sMentalHealthAwarenessDay http://www.samhsa.gov/children
Evidence-Based Practices for TreatmentNationalRegistryforEvidence-BasedProgramsandPractices http://www.nrepp.samhsa.gov
NationalCenterforTrauma-InformedCare http://www.samhsa.gov/nctic
Children’sMentalHealthInitiativeTechnicalAssistanceCenter http://www.cmhnetwork.org
Recovery Support ServicesNationalConsumerTechnicalAssistanceCenters http://ncstac.org/index.phpHomelessResourceCenter http://www.homeless.samhsa.govSharedDecisionMakinginMentalHealthTools http://162.99.3.211/shared.aspCollegeDrinking:ChangingtheCulture http://www.collegedrinkingprevention.gov
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Appendix 2: Acknowledgments NumerouspeoplecontributedtothedevelopmentoftheToolkitforCommunityConversationsonMentalHealth.WewouldliketoacknowledgetheSAMHSAstaff,workgroup,andinternswhocontributedtothecontentdevelopmentandeditofthistoolkit.
Wewouldliketothankthefederalagenciesthatassistedwiththecontentdevelopmentandreviewofthispublication:U.S.DepartmentofHealthandHumanServices(HHS),OfficeoftheSecretary;HHS,OfficeoftheAssistantSecretaryforPublicAffairs;theCentersforDiseaseControlandPrevention;theNationalInstituteofMentalHealth;theNationalInstituteonDrugAbuse;theNationalInstituteonAlcoholAbuseandAlcoholism;theHealthResourcesandServicesAdministration;theU.S.DepartmentofEducation;andtheU.S.DepartmentofJustice,OfficeofJuvenileJusticeandDelinquencyPrevention.
WealsoacknowledgetheNationalInstituteforCivilDiscourse,EverydayDemocracy,AmericaSpeaks,NationalIssuesForums,NationalCoalitionforDialogueandDeliberation,andtheDeliberativeDemocracyConsortiumfortheircontributionstothecontentofthispublication.
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Reference List 1. WorldHealthOrganization.(2001).StrengtheningMentalHealthPromotion(Factsheetno.220).
Geneva:WorldHealthOrganization.Retrievedfromhttps://apps.who.int/inf-fs/en/fact220.html
2. Ibid.
3. Ibid.
4. SubstanceAbuseandMentalHealthServicesAdministration.(2013).DefinitionsofTraumaandResilience.Retrievedfromhttp://www.samhsa.gov/children/trauma-resilience-definitions.asp
5. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA)12-4687).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.
6. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).SAMHSA’sWorkingDefinitionofRecovery(HHSPublicationNo.PEP12-RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF
7. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2009).GuidingPrinciplesandElementsofRecovery-OrientedSystemsofCare:WhatDoWeKnowFromtheResearch?(HHSPublicationNo.(SMA)09-4439).Rockville,MD:CenterforSubstanceAbuseTreatment.Retrievedfromhttp://partnersforrecovery.samhsa.gov/docs/Guiding_Principles_Whitepaper.pdf
8. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA)12-4687).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.
9. Ibid.
10. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Traumadefinition.Retrievedfromhttp://www.samhsa.gov/traumajustice/traumadefinition/definition.aspx
11. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm
12. U.S.DepartmentofHealthandHumanServices.(2013).WhatIsMentalHealth?Retrievedfromhttp://www.mentalhealth.gov/basics/what-is-mental-health/index.html
13. U.S.DepartmentofHealthandHumanServices.(2013).WhattoLookFor?Retrievedfromhttp://www.mentalhealth.gov/what-to-look-for/index.html
14. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2008).ResultsFromthe2007NationalSurveyonDrugUseandHealth:NationalFindings.(DHHSPublicationNo.(SMA)08-4343).Rockville,MD:OfficeofAppliedStudies,SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/data/nsduh/2k7nsduh/2k7results.pdf
15. NationalInstituteofMentalHealth.(2013).Psychotherapies.Bethesda,MD.Retrievedfromhttp://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml.
16. Ibid.
17. NationalInstituteofMentalHealth.(2013).MentalHealthMedications.Bethesda,MD.Retrievedfromhttp://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml.
18. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).SAMHSA’sWorkingDefinitionofRecovery(HHSPublicationNo.PEP12-RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF
19. Smith,T.W.,Marsden,P.,Hout,M.,&Kim,J.(2011).GeneralSocialSurvey,1972-2010[machine-readabledatafileandcodebook].Storrs,CT:TheRoperCenterforPublicOpinionResearch,UniversityofConnecticut/AnnArbor,MI:Inter-universityConsortiumforPoliticalandSocialResearch[distributors].Retrievedfromhttp://dx.doi.org/10.3886/ICPSR31521.v1.
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20. Pescosolido,B.,Martin,J.,Link,B.,Kikuzawa,S.,Burgos,G.,Swindle,R.,etal.(2000).Americans’ViewsofMentalHealthandIllnessatCentury’sEnd:ContinuityandChange.PublicreportontheMacArthurMentalHealthModule,1996GeneralSocialSurvey.Bloomington,Indiana:IndianaConsortiumforMentalHealthServicesResearchandJosephPMailmanSchoolofPublicHealth,ColumbiaUniversity.
21. Monahan,J.,Steadman,H.,Silver,E.,Appelbaum,P.,Robbins,P.,Mulvey,E.,etal.(2001).RethinkingRiskAssessment:TheMacArthurStudyofMentalDisorderandViolence.NewYork:OxfordUniversityPress.
22. Appelbaum,P.&Swanson,J.(2010).Law&Psychiatry:GunLawsandMentalIllness:HowSensibleAretheCurrentRestrictions?PsychiatricServices,61(7),652-654.
23. Teplin,L.,McClelland,G.,Abram,K.,&Weiner,D.(2005).Crimevictimizationinadultswithseverementalillness:ComparisonwiththeNationalCrimeVictimizationSurvey.ArchivesofGeneralPsychiatry,62(8),911-921.doi:10.1001/archpsyc.62.8.911.
24. CentersforDiseaseControlandPrevention,SubstanceAbuseandMentalHealthServicesAdministration,NationalAssociationofCountyBehavioralHealth&DevelopmentalDisabilityDirectors,NationalInstituteofMentalHealth,&TheCarterCenterMentalHealthProgram.(2012).AttitudesTowardMentalIllness:ResultsfromtheBehavioralRiskFactorSurveillanceSystem.Atlanta,GA:CentersforDiseaseControlandPrevention.
25. Ibid.
26. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2004).BuildingBridges:MentalHealthConsumersandMembersofFaith-BasedandCommunityOrganizationsinDialogue(DHHSPub.No.3868).Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.
27. U.S.DepartmentofHealthandHumanServices.(2001).MentalHealth:Culture,Race,andEthnicity—ASupplementtoMentalHealth:AReportoftheSurgeonGeneral.Rockville,MD:CenterforMentalHealthServices.
28. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2013).InfusingCulturalCompetencyintotheSPF.Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfrom:http://captus.samhsa.gov/prevention-practice/strategic-prevention-framework/cultural-competence/elements-culture
29. U.S.DepartmentofHealthandHumanServices.(2001).MentalHealth:Culture,Race,andEthnicity—ASupplementtoMentalHealth:AReportoftheSurgeonGeneral.Rockville,MD:CenterforMentalHealthServices.
30. Ibid.
31. Kessler,R.,McGonagle,K.,Zhao,S.,Nelson,C.,Hughes,M.,Eshleman,S.,etal.(1994).Lifetimeand12-monthPrevalenceofDSM-III-RPsychiatricDisordersintheUnitedStates:ResultsfromtheNationalComorbiditySurvey.ArchivesofGeneralPsychiatry,51(1),8-19.
32. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).TenLeadingCausesofInjuryDeathsbyAgeGroupHighlightingViolence-RelatedInjuryDeaths.Atlanta,GA:NationalCenterforInjuryPreventionandControl.Retrievedfromhttp://www.cdc.gov/injury/wisqars/pdf/10LCID_Violence_Related_Injury_Deaths_2010-a.pdf
33. Harding,C.,Brooks,G.,Ashikaga,T.,Strauss,J.S.,&Breier,A.(1987).TheVermontlongitudinalstudyofpersonswithseverementalillness.AmericanJournalofPsychiatry,144(6),727–735.
34. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2009).2009CMHSUniformReportingSystemoutputtables.Retrievedfromhttp://www.samhsa.gov/dataoutcomes/urs/urs2009.aspx
35. Cook,J.,Leff,H.,Blyler,C.,Gold,P.,Goldberg,R.,Mueser,K.,etal.(2005).Resultsofamultisiterandomizedtrialofsupportedemploymentinterventionsforindividualswithseverementalillness.ArchivesofGeneralPsychiatry,62(5),505–512.
36. Davis,K.(2012).StatisticalBrief#358:ExpendituresforTreatmentofMentalHealthDisordersamongYoungAdults,Ages18-26,2007-2009:EstimatesfortheU.S.CivilianNoninstitutionalizedPopulation.Rockville,MD:MedicalExpendituresPanelSurvey,AgencyforHealthcareResearchandQuality.
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37. UnitedStatesGovernmentAccountabilityOffice.(2008).YoungAdultswithSeriousMentalIllness:SomeStatesandFederalAgenciesAreTakingStepstoAddressTheirTransitionChallenges(ReporttoCongressionalRequestors,GAO-08-678).Retrievedfromhttp://www.gao.gov/new.items/d08678.pdf
38. Kessler,R.,Heeringa,S.,Lakoma,M.,Petukhova,M.,Rupp,A.,Schoenbaum,M.,etal.(2008).Theindividual-levelandsocietal-leveleffectsofmentaldisordersonearningsintheUnitedStates:ResultsfromtheNationalComorbiditySurveyReplication.AmericanJournalofPsychiatry,165(6),703-11.doi:10.1176/appi.ajp.2008.08010126.
39. Miller,T.&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-BenefitAnalysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.
40. Ibid.
41. Ibid.
42. Ibid.
43. U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessmentReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/documents/2010homelessassessmentreport.pdf;Folsom,D.,Hawthorne,W.,Lindamer,L.,et.al.(2005).Prevalenceandriskfactorsforhomelessnessandutilizationofmentalhealthservicesamong10,340patientswithseriousmentalillnessinalargepublicmentalhealthsystem.AmericanJournalofPsychiatry,162(2),370-376.
44. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:SummaryofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration
45. Ibid.
46. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings.(NSDUHSeriesH-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.
47. Ibid.
48. U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessmentReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/documents/2010homelessassessmentreport.pdf
49. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2005).SubstanceAbuseTreatmentforPersonsWithCo-OccurringDisorders.TreatmentImprovementProtocol(TIPSeries42,DHHSPublicationNo.(SMA)12-3992).Rockville,MD.Retrievedfromhttp://www.ncbi.nlm.nih.gov/books/NBK64197/pdf/TOC.pdf;PolcinD.&Henderson,D.M.(2008).Acleanandsoberplacetolive:philosophy,structure,andpurportedtherapeuticfactorsinsoberlivinghouses.JournalofPsychoactiveDrugs,40(2),153-159;Hannigan,T.,&Wagner,S.(2003).Developingthe“Support”inSupportiveHousing:AGuidetoProvidingServicesinHousing.RetrievedfromCorporationforSupportiveHousingwebsiteathttp://documents.csh.org/documents/pubs/DevelopingSupport-full.pdf;Larimer,M.E.,etal.(2009).Healthcareandpublicserviceuseandcostsbeforeandafterprovisionofhousingforchronicallyhomelesspersonswithseverealcoholproblems.JournaloftheAmericanMedicalAssociation,301(13),1349–1357.
50. Culhane,P.,Metraux,S.,&Hadley,T.(2002).Publicservicereductionassociatedwithplacementofhomelesspersonswithseverementalillnessinsupportivehousing.HousingPolicyDebate,13(1),107-163.
51. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).PermanentSupportiveHousing:BuildingYourProgram(HHSPub.No.SMA-10-4509).Rockville,MD:CenterforMentalHealthServices.
52. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm
53. U.S.DepartmentofEducation.(2001).Twenty-thirdannualreporttoCongressontheimplementationoftheIndividualswithDisabilitiesEducationAct.Washington,D.C.:U.S.DepartmentofEducation.
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54. Druss,B.(2011).UnderstandingExcessMortalityinPersonswithMentalIllness.MedicalCare,49(6),599-604.
55. Copeland,W.,Wolke,D.,Angold,A.,&Costello,E.(2013).AdultPsychiatricOutcomesofBullyingandBeingBulliedbyPeersinChildhoodandAdolescence.JAMAPsychiatry,70(4),419-426.
56. Miller,T.,&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-BenefitAnalysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMentalHealthServicesAdministration.
57. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:SummaryofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.
58. Ibid.
59. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).PromotingRecoveryandResilienceforChildrenandYouthInvolvedintheJuvenileJusticeandChildWelfareSystems.Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.
60. Ibid.
61. Ibid.
62. DepartmentofHealth.(2001).Makingithappen:aguidetodeliveringmentalhealthpromotion.London,UK.Retrievedfromhttp://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007907
63. NationalFederationofFamiliesforChildren’sMentalHealth.(2013).DefinitionofFamily-DrivenCare.Retrievedfromhttp://ffcmh.org/family-driven-definition
64. U.S.DepartmentofLabor,EmployeeBenefitsSecurityAdministration.(2010).YoungAdultsandtheAffordableCareAct:ProtectingYoungAdultsandEliminatingBurdensonFamiliesandBusinesses.Washington,DC.Retrievedfromhttp://www.dol.gov/ebsa/pdf/fsdependentcoverage.pdf;Lotstein,D.,Inkelas,M.,Hays,R.,Halfon,N.,Brook,R.(2008).AccesstoCareforYouthwithSpecialHealthCareNeedsintheTransitiontoAdulthood.JournalofAdolescentHealth,43(1),23-29.
65. Millstein,S.,&Halpern-Felsher,B.(2001).PerceptionsofRiskandVulnerability.InFischhoff,B.,Nightingale,E.,&Iannotta,J.(Eds.)AdolescentRiskandVulnerability:ConceptsandMeasurement.(pp.15-29).Retrievedfromhttp://www.nap.edu/openbook.php?record_id=10209&page=15
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72. Davis,M.,&VanderStoep,A.(1997).Thetransitiontoadulthoodforyouthwhohaveseriousemotionaldisturbance:DevelopmentalTransitionandyoungadultoutcomes.JournalofMentalHealthAdministration,24(4),400-426.
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74. Ibid.
75. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:MentalHealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm
76. Kataoka,S.,Zhang,L.,&Wells,K.(2002).UnmetNeedforMentalHealthCareAmongU.S.Children:Variationbyethnicityandinsurancestatus.AmericanJournalPsychiatry,159(9),1548-55.doi:10.1176/appi.ajp.159.9.1548.
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78. Culhane,P.,Metraux,S.,&Hadley,T.(2002).Publicservicereductionassociatedwithplacementofhomelesspersonswithseverementalillnessinsupportivehousing.HousingPolicyDebate,13(1);U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).PermanentSupportiveHousing:BuildingYourProgram(HHSPub.No.SMA-10-4509).Rockville,MD:CenterforMentalHealthServices,SubstanceAbuseandMentalHealthServicesAdministration.
79. Eisenberg,D.,&Neighbors,K.(2007).EconomicsofPreventingMentalDisordersandSubstanceAbuseAmongYoungPeople.PapercommissionedbytheCommitteeonPreventionofMentalDisordersandSubstanceAbuseAmongChildren,Youth,andYoungAdults.Washington,DC:ResearchAdvancesandPromisingInterventions,BoardonChildren,Youth,andFamilies,NationalResearchCouncilandInstituteofMedicine.
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81. Ibid.
82. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration.(2010).NationalExpendituresforMentalHealthServicesandSubstanceAbuseTreatment,1986-2005(DHHSPublicationNo.(SMA)10-4612).Rockville,MD:CenterforMentalHealthServicesandCenterforSubstanceAbuseTreatment,SubstanceAbuseandMentalHealthServicesAdministration.
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103. Kataoka,S.,Zhang,L.,&Wells,K.(2002).UnmetneedsformentalhealthcareamongU.S.children:Variationbyethnicityandinsurancestatus.AmericanJournalofPsychiatry,159(9),1548-1555.
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106. U.S.DepartmentofHealthandHumanServices,CentersforDiseaseControlandPrevention.(2010).Youthriskbehaviorsurveillance—UnitedStates,2009.SurveillanceSummaries.MMWR,59(SS-5).
107. Ibid.
108. Heron,M.(2007).Deaths:Leadingcausesfor2004.NationalVitalStatisticsReports(l56-5).Hyattsville,MD:NationalCenterforHealthStatistics.Retrievedfromhttp://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf
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110. Ibid.;AdministrationforChildrenandFamilies.(2013).ChildWelfareInformationGateway,FidelityinEvidence-BasedPractice.Retrievedfromhttps://www.childwelfare.gov/management/practice_improvement/evidence/fidelity.cfm
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