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Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies. For nearly two centuries Americans have grappled with the question of how to serve individuals with severe disorders. During the second half of the twentieth century, mental health policy advocates reacted against institutional care, claiming that community care and treatment would improve the lives of people with mental disorders. Once the exclusive province of state governments, the federal government moved into this policy arena after World War II. Policies ranged from those focused on mental disorders, to those that focused more broadly on health and social welfare. In this book, Gerald N. Grob and Howard H. Goldman trace how an ever-changing coalition of mental health experts, patients' rights activists, and politicians envisioned this community-based system of psychiatric services. The authors show how policies shifted emphasis from radical reform to incremental change. Many have benefited from this shift, but many are left without the care they require.
At least 5.6 million to 8 million-nearly one in five-older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation. For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas. Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.
Perhaps never before has an objective, evidence-based review of the intersection between gun violence and mental illness been more sorely needed or more timely. Gun Violence and Mental Illness, written by a multidisciplinary roster of authors who are leaders in the fields of mental health, public health, and public policy, is a practical guide to the issues surrounding the relation between firearms deaths and mental illness. Tragic mass shootings that capture headlines reinforce the mistaken beliefs that people with mental illness are violent and responsible for much of the gun violence in the United States. This misconception stigmatizes individuals with mental illness and distracts us from the awareness that approximately 65% of all firearm deaths each year are suicides. This book is an apolitical exploration of the misperceptions and realities that attend gun violence and mental illness. The authors frame both pressing social issues as public health problems subject to a variety of interventions on individual and collective levels, including utilization of a novel perspective: evidence-based interventions focusing on assessments and indicators of dangerousness, with or without indications of mental illness. Reader-friendly, well-structured, and accessible to professional and lay audiences, the book: * Reviews the epidemiology of gun violence and its relationship to mental illness, exploring what we know about those who perpetrate mass shootings and school shootings. * Examines the current legal provisions for prohibiting access to firearms for those with mental illness and whether these provisions and new mandated reporting interventions are effective or whether they reinforce negative stereotypes associated with mental illness. * Discusses the issues raised in accessing mental health treatment in regard to diminished treatment resources, barriers to access, and involuntary commitment.* Explores novel interventions for addressing these issues from a multilevel and multidisciplinary public health perspective that does not stigmatize people with mental illness. This includes reviews of suicide risk assessment; increasing treatment engagement; legal, social, and psychiatric means of restricting access to firearms when people are in crisis; and, when appropriate, restoration of firearm rights. Mental health clinicians and trainees will especially appreciate the risk assessment strategies presented here, and mental health, public health, and public policy researchers will find Gun Violence and Mental Illness a thoughtful and thought-provoking volume that eschews sensationalism and embraces serious scholarship.
Yale Textbook of Public Psychiatry is a comprehensive resource on treatment, rehabilitation, recovery, and public health of persons cared for in organized, publically funded systems of care. Edited and authored by experts in public psychiatry at the Yale Department of Psychiatry, this text provides up-to-date information on clinical work in the public sector. This book will be a useful reference for professionals and students of public psychiatry, administrators, and policy makers.
With chapters written by leading scholars and researchers, the third edition of A Handbook for the Study of Mental Health provides an updated, comprehensive review of the sociology of mental health. The volume presents an overview of the historical, social, and institutional frameworks for understanding mental health and illness. Part I examines the social factors that shape psychiatric diagnosis and the measurement of mental health and illness, the theories that explain the definition and treatment of mental disorders, and cultural variability in mental health. The section addresses the DSM-5 and its potential influence on diagnosis and research on mental health outcomes. Part II investigates the effects of social context on mental health and illness. Part III focuses on the organization, delivery, and social context of mental health treatment. The chapters in Part III address the likely impact of the Affordable Care Act on mental health care. This volume is a key resource for students, researchers, advocates, and policymakers seeking to understand mental health and mental health delivery systems.
Why write another book on ethics? As practitioners we are involved both in the design and delivery of services to people with mental health problems. In common with all other professionals, our work has led to the experience of ethical dilemmas: typically, these have involved major confrontations, either with our col leagues or our consciences. This book, however, is not limited to a discussion of such major themes. Rather, we have tried to use a broader canvas: ethics, in our view, is really about the judgement of right and wrong in ordinary, everyday life. Ethics are highly personal: we fashion our own personal code from our experi ence of others, and from the 'tests' which bring meaning to our lives. Such experiences shape our individual values. We bring these codes and values to our work. We are not always aware of their influence in our dealings with people. Although we may not always be aware of it, all our actions pose an ethical question. Given that our work involves us in helping others to live ordinary, satisfying lives, this challenge heightens the intensity of our ethical dilemmas. This is most evident where our personal code conflicts with the implicit code of the health setting.
"Examines the private nonprofit sector and the tax-exempt institutions that make up this sector providing important services and benefits to all Americans, with histories behind different institutions and the forces and developments that have buffeted them and what they have done to retain their resilience"--Provided by publisher.
Since the earliest medical, philosophical, and literary texts in ancient civilizations, madness has posed some basic issues: how to separate sanity from insanity, to distinguish mental and bodily illnesses, and to specify the variety of internal and external forces that lead people to become mentally ill. This book explores the answers to these questions that have emerged over time and concludes that current portrayals are not much improved compared to those that emerged thousands of years ago. The puzzles that madness presents are likely to remain unresolved for the foreseeable future and perhaps forever.
Before the 1940s, children in the United States with severe emotional difficulties would have had few options for care. The first option was usually a child guidance clinic within the community, but they might also have been placed in a state mental hospital or asylum, an institution for the so-called feebleminded, or a training school for delinquent children. Starting in the 1930s, however, more specialized institutions began to open all over the country. Staff members at these residential treatment centers shared a commitment to helping children who could not be managed at home. They adopted an integrated approach to treatment, employing talk therapy, schooling, and other activities in the context of a therapeutic environment. Emotionally Disturbed is the first work to examine not only the history of residential treatment but also the history of seriously mentally ill children in the United States. As residential treatment centers emerged as new spaces with a fresh therapeutic perspective, a new kind of person became visible—the emotionally disturbed child. Residential treatment centers and the people who worked there built physical and conceptual structures that identified a population of children who were alike in distinctive ways. Emotional disturbance became a diagnosis, a policy problem, and a statement about the troubled state of postwar society. But in the late twentieth century, Americans went from pouring private and public funds into the care of troubled children to abandoning them almost completely. Charting the decline of residential treatment centers in favor of domestic care–based models in the 1980s and 1990s, this history is a must-read for those wishing to understand how our current child mental health system came to be.
Critical illness is a fact of life. Even those of us who enjoy decades of good health are touched by it eventually, either in our own lives or in those of our loved ones. And when this happens, we grapple with serious and often confusing choices about how best to live with our afflictions. A Life Worth Living is a book for people facing these difficult decisions. Robert Martensen, a physician, historian, and ethicist, draws on decades of experience with patients and friends to explore the life cycle of serious illness, from diagnosis to end of life. He connects personal stories with reflections upon mortality, human agency, and the value of "cutting-edge" technology in caring for the critically ill. Timely questions emerge: To what extent should efforts to extend human life be made? What is the value of nontraditional medical treatment? How has the American health-care system affected treatment of the critically ill? And finally, what are our doctors' responsibilities to us as patients, and where do those responsibilities end? Using poignant case studies, Martensen demonstrates how we and our loved ones can maintain dignity and resilience in the face of life's most daunting circumstances.