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Mental Health and Mental Illness Fundamentals Part 2
Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counseling Education
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery

~ Review Prevention strategies for mental illness
~ Identify the fundamentals, benefits and drawbacks of the most common treatments: Psychodynamic, behavioral, humanistic, and pharmacological
~ Identify the factors that can enhance utilization of services including providing culturally responsive services addressing unique coping styles, the role of the family in treatment, ways to address cultural barriers including mistrust and stigma.
~ Explore the recovery concept and its impact on mental health and mental illness across the lifespan
~ Prevention has been conceptualized as
~ Primary: Stopping a problem behavior from ever occurring delaying the onset of a problem behavior
~ Secondary: Preventing recurrence or worsening
~ Tertiary: Reducing the impact of a problem behavior
~ Strengthening knowledge, attitudes, and behaviors that promote emotional and physical well-being
~ Promoting institutional, community, and government policies that further physical, social, and emotional well-being of the community

Prevention Premises
~ Theory and research based
~ Address the individual as well as the micro, macro and exosystem
~ Focus on strengths development
~ Enhancing protective factors
~ Reducing risk factors
~ Many mental health problems share some of the same risk factors for initial onset, so targeting those factors can result in positive outcomes in multiple areas
~ Abuse and neglect (direct or indirect)
~ Family discord (hostility, domestic violence divorce)
~ Low self-esteem
~ Lack of supportive family or peers
~ Lack of school or work success
~ Lack of involvement in prosocial activities
Protective Factors
~ Self regulation
~ Secure attachment
~ Effective communication skills
~ Effective interpersonal skills
~ Supportive family and peers
~ Consistent discipline and rules
~ Responsiveness of caregivers
~ Safe environment
~ Support for learning
~ School engagement
~ Positive parent and teacher expectations
~ Access to wrap around services
~ Good coping and problem solving skills
~ Opportunities for engagement in prosocial activities
~ High self-esteem and self-efficacy
~ Appropriate empathy
~ Future orientation

Risk Factors
~ Neurophysiological deficits (autism, epilepsy, cerebral palsy)
~ Difficult temperament
~ Chronic illness
~ Below-average intelligence or learning disability
~ Family dysfunction
~ Abuse or neglect
~ Social disadvantage
~ Overcrowding or large family size,
~ Family member with mental health or addictive disorder
~ Admission into foster care
~ Living in an area with a high rate of disorganization
~ Inadequate schools

Approaches to Treatment
~ Psychodynamic
~ The role of the past in shaping the present is emphasized
~ Belief in the unconscious, so that there is much from the past that influences our behavior of which we are not aware
~ Important part of psychodynamic psychotherapy is to make the unconscious conscious

Approaches to Treatment
~ Behavioral
~ Focuses on current behavior and observable actions
~ General principles of learning are applied to the learning of maladaptive as well as adaptive behaviors
~ The environment provides reinforcements and punishments that shape behavior (direct and vicarious)

Approaches to Treatment
~ Cognitive Behavioral
~ Explores how thoughts and environmental stimuli shape behavior and learning and how learning shapes thoughts
~ Cognitive-behavioral therapy strives to alter faulty cognitions and replace them with thoughts and self-statements that promote adaptive behavior

Approaches to Treatment
~ Humanistic
~ Central focus of humanistic therapy is the immediate experience of the client.
~ The emphasis is on the present and the potential for future development rather than on the past, and on immediate feelings rather than on thoughts or behaviors.
~ It is rooted in the everyday subjective experience of the person seeking assistance and is much less concerned with mental illness than it is with human growth
~ A critical aspect of humanistic treatment is the relationship between the therapist, who serves as a guide in an exploration of self-discovery

Approaches to Treatment
~ Pharmacological
~ Antidepressants (SSRI, SNRI, Tricyclics): Depression, anxiety, compulsive behavior
~ Anxiolytics (Anti-anxiety): Anxiety
~ Antipsychotics (Typical and Atypical): Schizophrenia
~ Stimulants: ADD AD/HD
~ Antimanic (Lithium); Anticonvulsants (Depakote): Mania

Approaches to Treatment
~ Ethnopsychopharmacology
~ Ethnic and cultural influences can alter an individual’s responses to medications
~ These differences are both genetic and psychosocial in nature.
~ They range from:
~ Genetic variations in drug metabolism due to genetic variations in drug-metabolizing enzymes
~ Cultural practices that affect diet
~ Medication adherence (Availability, blood level stability)
~ Simultaneous use of traditional and alternative healing methods

~ 1/3 of African Americans and Asian Americans are slow metabolizers of antipsychotic and antidepressant medications (easier to OD or experience serotonin syndrome)
~ Demographic factors (financial/cost, ethnicity, age)
~ Patient and cultural attitudes
~ Shame and stigma
~ Not having the time
~ Fear of being hospitalized/Mistrust
~ Thinking that they could handle it alone
~ Thinking that no one could help
~ Identifying mental health issues as “medical”

Fragmented System
~ Specialty mental health sector
~ General medical/primary care sector
~ Human services sector
~ Voluntary support network sector

Patterns of Use
~ Bearing in mind that 28-47 percent of the population have a diagnosable mental or substance abuse disorder, only about one-third receives treatment in 1 year

Cultural Factors
~ The term culture is used loosely to denote a common heritage and set of beliefs, norms, and value
~ People have multiple ethnic or cultural identities
~ Level of acculturation differs between individuals
~ Culture impacts
~ Identification of mental health issues
~ Meaning assigned to it
~ Coping skills
~ Appropriate treatment modalities

Family and Community as Resources
~ Ties to family and community, especially strong in African, Latino, Asian, and Native American communities, due to the need to
~ Assist arriving immigrants
~ Provide a sanctuary against discrimination
~ Provide a sense of belonging
~ Affirm a centrally held cultural or ethnic identity.
~ Families play an important role in providing support to individuals
~ A strong sense of family loyalty means that, despite feelings of stigma and shame, families are an early and important source of assistance in efforts to cope
~ Minority families may expect to continue to be involved in the treatment of a mentally ill member
Recovery Concept
~ Recovery is called a process, an outlook, a vision, a guiding principle.
~ Recovery does not refer to any specific services
~ A person with mental illness can recover even though the illness is not “cured” . . . . [Recovery] is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness (Anthony 1993)

Recovery Concept
~ Consumers’ have a more optimistic attitude and expectation which may improve the course of their illness
~ Most common factors associated with recovery
~ Medication
~ Community support/case management
~ Self-will/self-monitoring
~ Vocational activity (including school)
~ Spirituality (Sullivan, 1994)
~ Recovery Oriented System of Care (ROSC)
~ Multidisciplinary episodic system of care with no wrong door.
~ Emphasis is on achieving goals vs. removing defects.

~ Mental health issues are mediated by brain function
~ Mental disorders are defined by signs, symptoms, and functional impairments as opposed to causes
~ 20% of Americans experience a mental disorder in a given year.
~ A range of treatments including counseling and psychopharmacology exist for most disorders
~ The consumer movement has increased the involvement of individuals with mental disorders and their families in mutual support services, consumer-run services, and advocacy.
~ The Recovery Concept reflects renewed optimism about the outcomes of mental illness and the opportunities open to persons with mental illness to participate to the full extent of their interests in the community of their choice

~ We reviewed prevention strategies for mental illness
~ Identified the fundamentals, benefits and drawbacks of the most common treatments: Psychodynamic, behavioral, humanistic, and pharmacological
~ Identified the factors that can enhance utilization of services including providing culturally responsive services, addressing unique coping styles, engaging the family in treatment, addressing cultural barriers including mistrust and stigma.