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While many psychiatrists and psychologists tend to diagnose and treat a principle disorder, most psychiatric patients have more than one disorder. This book deals with treatment needs of psychiatric patients who meet diagnostic criteria for more than one disorder concurrently.
Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.
Bringing together treatment and referral advice from existing guidelines, this text aims to improve access to services and recognition of common mental health disorders in adults and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways.
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
This book explains in detail the diagnosis, management, and treatment of comorbid disorders in patients with autism spectrum disorders (ASD). Important insights are provided into the nature of the symptoms of psychiatric comorbidities in these patients, and particularly children and adolescents, with a view to assisting clinicians in reaching a correct diagnosis that will permit the implementation of appropriate treatment strategies, whether psychological or pharmacological. The full range of potential comorbidities is considered, including mood disorders, anxiety disorders, obsessive-compulsive disorder, schizophrenia spectrum and other psychotic disorders, eating disorders, disruptive behavioral disorders, Tourette’s disorder, and substance-related disorders. In each case guidance is provided on how to avoid incorrectly attributing symptoms to ASD and on treatment options. Psychiatric Comorbidities in Autism Spectrum Disorders will be of value to all practitioners who are confronted by patients with these complex co-occurring conditions.
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
While the efficacy of cognitive therapy for depression is well established, every clinician is likely to encounter patients who do not respond to "standard" protocols. In this highly practical volume, leading authorities provide a unified set of clinical guidelines for conceptualizing, assessing, and treating challenging presentations of depression. Presented are detailed, flexible strategies for addressing severe, chronic, partially remitted, or recurrent depression, as well as psychiatric comorbidities, medical conditions, and family problems that may complicate treatment. The book also offers essential knowledge and tools for delivering competent care to specific populations of depressed patients: ethnic minorities; lesbian, gay, and bisexual people; adolescents; and older adults.
In a world of information that tends toward randomness, therapists and clinicians often need guidance regarding how best to use new technologies and yet not allow the chaos of new media to undermine their practice. Here, a leading provider of online mental health information, Dr. Robert Hsiung, has gathered a group of distinguished contributors to discuss clinical, ethical, and legal issues pertaining to e-therapy. Full of case studies and examples of active programs that deliver mental health information and therapy via new media, E-Therapy offers first-hand accounts of the potential and risks of recent trends in 'distance therapy' and 'telepsychiatry.' Chapters include The Internet 'Expert': Ronald Pies An E-Patient's Story: Martha Ainsworth Chat Room Therapy: Gary S. Stofle Using E-mail to Support Outpatient Treatment: Joel Yager Community Telepsychiatry: Sara F. Gibson An Online Self-Help Group Hosted by a Mental Health Professional: Robert C Hsiung Principles of Professional Ethics: Robert C Hsiung Legal Ethics in On-line Mental Health: Nicholas P. Terry
Disorders of anxiety and substance use are, for some reason, rarely treated in an integrated fashion by professionals. This timely volume addresses this glaring omission with dispatches from the frontlines of research and treatment. Thirty-four international experts offer findings, theories, and intervention strategies for this common form of dual disorder, across a range of substances and of anxiety disorders, to give the reader comprehensive knowledge in a practical format.
Mental health and substance use disorders affect approximately 20 percent of Americans and are associated with significant morbidity and mortality. Although a wide range of evidence-based psychosocial interventions are currently in use, most consumers of mental health care find it difficult to know whether they are receiving high-quality care. Although the current evidence base for the effects of psychosocial interventions is sizable, subsequent steps in the process of bringing a psychosocial intervention into routine clinical care are less well defined. Psychosocial Interventions for Mental and Substance Use Disorders details the reasons for the gap between what is known to be effective and current practice and offers recommendations for how best to address this gap by applying a framework that can be used to establish standards for psychosocial interventions. The framework described in Psychosocial Interventions for Mental and Substance Use Disorders can be used to chart a path toward the ultimate goal of improving the outcomes. The framework highlights the need to (1) support research to strengthen the evidence base on the efficacy and effectiveness of psychosocial interventions; (2) based on this evidence, identify the key elements that drive an intervention's effect; (3) conduct systematic reviews to inform clinical guidelines that incorporate these key elements; (4) using the findings of these systematic reviews, develop quality measures - measures of the structure, process, and outcomes of interventions; and (5) establish methods for successfully implementing and sustaining these interventions in regular practice including the training of providers of these interventions. The recommendations offered in this report are intended to assist policy makers, health care organizations, and payers that are organizing and overseeing the provision of care for mental health and substance use disorders while navigating a new health care landscape. The recommendations also target providers, professional societies, funding agencies, consumers, and researchers, all of whom have a stake in ensuring that evidence-based, high-quality care is provided to individuals receiving mental health and substance use services.