Assessment and Treatment of Persons With Serious Mental Illness. The. International Journal of Psychosocial Rehabilitation.
Current Approaches to Assessment and Treatment of Persons. With Serious Mental Illness. Jeffrey R Bedell.
This article rejects the idea that the sociology of mental illness classification and organizational embeddedness shows that mental illness is a pure social construct. Mental Health and Mental Illness. According to the U.S. surgeon general (1999), mental health is the successful performance of mental function, resulting in. 'Clinical Neuropsychology: A Pocket Handbook for Assessment, Second Edition' is a practical reference source for neuropsychologists, interns, and trainees working in. Limbic resonance is the theory that the capacity for sharing deep emotional states arises from the limbic system of the brain. These states include the dopamine. The International Journal of Psychosocial Rehabilitation Current Approaches to Assessment and Treatment of Persons With Serious Mental Illness. Read Handbook of Minority Aging by Keith Whitfield PhD (9780826109637) and top BA - Psychology and health care books, journals & resources.
Mount Sinai School of Medicine. Richard H Hunter. Illinois Department of Mental Health and Developmental. Disabilities and Southern Illinois University. Patrick W Corrigan.
5. Reference Type: reference-list. Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., et al. (2007). Use of mental health-related. Philosophy of Mental Illness. The Philosophy of Mental Illness is an interdisciplinary field of study that combines views and methods from the philosophy of mind. Child & Youth Mental Health Service (CYMHS) Adult Mental Health; Aged Persons Mental Health Services (APMHS) Consultation-Liaison (CL) Psychiatry.
University of Chicago. Reprint from: Professional Psychology: Research and Practice.
June 1. 99. 7 Vol. No. 3, 2. 17- 2. 28. JEFFREY R. BEDELL received his Ph. D in clinical. psychology from the University of South Florida in 1. He is currently. an associate professor of psychiatry (psychology) at Mount Sinai School. Medicine and is the director of Community Options, a clinical research.
Elmhurst Hospital Center developing and evaluating clinical. RICHARD H. HUNTER received his Ph. D from Southern Illinois University. Carbondale in 1. 98.
He is chief psychologist for the Bureau of Clinical. Services, Illinois Department of Mental Health and Developmental Disabilities. Department of Psychiatry at.
Southern Illinois University's School of Medicine. He is working on programs. PATRICK W. CORRIGAN , Psy. D, is an associate professor.
University of Chicago, where he directs the Center. Psychiatric Rehabilitation, a clinical, research, and training program. He is also. the principal investigator and director of the Illinois Staff Training. Institute for Psychiatric Rehabilitation, related to the implementation. Correspondence may be addressed to Jeffrey R. Bedell. Mount Sinai Services of the Mount Sinai School of Medicine, Elmhurst Hospital.
Center, 7. 9- 0. 1 Broadway, Elmhurst, New York, 1. ABSTRACTPsychologists increasingly have the opportunity to work with persons. Managed care encourages services. Diagnostic practices needed to be effective in such. Psychological. treatments that have been demonstrated effective include cognitivebehavioral. These innovative assessment and treatment. In the past, many psychologists believed that they had little.
Psychology training generally includes little exposure to course work and. Millet &. Schwebel, 1. The mainstream. of psychology seems to focus on treatments for less severe psychological. Stewart, Horn. Becker, & Kline, 1. However, the treatment of persons with serious mental disorders is becoming.
There is. a small group of psychologists who have focused on this population. Wohlford, Myers, & Callan, 1. Geczy & Sultenfuss, 1. Hargrove &. Spaulding, 1.
There has been a significant change in psychology's. Harding, Zubin, & Strauss, 1.
Demonstrating the importance of. American Psychological. Association (APA) recently established in the Practice Directorate a Task. Force on Serious Mental Illness/Severe Emotional Disturbance that reports. Committee for the Advancement of Professional Practice (CAPP). This. Task Force focuses on issues of training, treatment, contact with consumers. The Task Force assists the CAPP in providing expertise.
Staton. 1. 99. 1 ; Sullivan, 1. It is increasingly important for psychologists to have assessment and. The goal of this. Because. of space limitations, we can neither present all treatment approaches nor. We do. however, provide detailed information on some of the most widely used and.
The New Practice Environment. What are the changes in the practice environment that are shaping clinical. Psychologists today are being asked to provide effective treatment. Patients increasingly have the characteristics outlined below. Serious and Chronic Disorders. Psychology, as a profession, has in the past focused on persons with.
We psychologists have increasingly had the. Of course, psychologists have provided. However. in the future, clients with these diagnoses may be increasingly prevalent. Clients treated in public mental. Staton. 1. 99. 1 ; Sullivan, 1. Acute Symptoms. Not only do clients currently treated in outpatient settings have more. This change is the.
Staton, 1. 99. 1. As a consequence, more intensive outpatient treatment programs are being. The psychologist. Psychologists. are valuable to the treatment process when they have treatment skills relevant. It is also important that the psychologist demonstrate leadership in establishing. Fewer Environmental Supports.
Clients with serious disorders are known to have relatively fewer environmental. Clients. who have been symptomatic over a long period of time strain their support. Families sometimes withdraw and place more reliance on the mental. Persons with serious disabilities are less well able.
Housing and income may be substandard or. The psychologist, to be effective, must know how to develop. Multiple Disabilities. It is increasingly shown that persons with serious disorders have multiple. Substance abuse is the most frequent problem compounding.
Mental retardation may co- occur with mental. In addition, persons with schizophrenia often experience.
Clients today offer more challenges to the practitioner. The following. make matters even more difficult. Practitioners are required to use less hospital care. In the past. persons with serious disorders who were symptomatic and had poor environmental.
Hospitalization provides protection. However, at a rate of $5. Practitioners are also required to provide briefer outpatient therapy. At the same time that inpatient treatment is being restricted for the sickest. Brief therapies that. Practitioners skilled in effective short- term therapies are. Advances in the Assessment of Persons With Severe Mental Illness.
Managed care is increasingly targeting mental health services to persons. For example, legislation has. Staton, 1. 99. 1). At the same time, treatment is to be focused on functional disabilities. For example, treatment of a person.
Global treatments or. Thus, it is essential that the practitioner be skilled in both. Categorical Diagnosis. Because treatment is increasingly focused on people with more serious. The Diagnostic. and Statistical Manual of Mental Disorders (4th ed.; DSMIV . American Psychiatric Association, 1. Medicare, and Medicaid.
Thus, skill in the use of the DSMIV is necessary. It is recommended.
Structured Clinical Interview for the DSMIV (SCIDIV. First, Spitzer, Gibbon, & Williams, 1. The empirical training.
Functional Diagnosis. Most managed care companies want the clinician to demonstrate how the. Focusing on functional disabilities is helpful in this. For example, a functional assessment of an individual with the. This skill deficit is important.
The functional skill. The development of the functional capacity (communication. Functional assessment focuses on the degree to which the individual's.
By comparing the functional skills and resources. Treatment is targeted at deficit areas.
Practitioners skilled at functional. Detailed examples of these types.
Farkas, O'Brien, Cohen, and Anthony. Yoman and Edelstein (1. Advances in the Treatment of Persons With Severe Mental Illness. The treatments described in this section illustrate a range of approaches. They do, however, share.
These commonalities. The treatments share a positive view of the patient. Much has been. written about the poor prognosis of persons with serious mental disorders. For example, in describing the syndrome of schizophrenia.
DSMIV states "Complete remission . American Psychiatric. Association, 1. 99. Such a view of these patients is overly pessimistic. Practitioners of the treatments. In addition to having clinical experiences, these practitioners are aware. Harding et al., 1.
Bedell, 1. 99. 4 ). Hopefulness is an essential.
These treatments also share a learning and skill training orientation. Most treatments that have been shown to be effective with persons who have.
This theory and tradition include a positive orientation. Procedures are structured, objective, and. They emphasize didactic education, demonstration. The treatments share an outcome orientation. The procedures described. Objective goals are preferred.
If a prescribed treatment process does not result in. These treatments also mobilize nonprofessional. We note that a common theme of many of the following treatments is the.
Nonprofessionals are recognized as being essential partners in. They often know more about the community and its. There are a number of innovative psychological treatments that use these.
Space does not permit a description of all effective treatments. Rather, a few approaches are presented to provide useful examples of the. The following section describes an overview model of treatment, referred. Also, we present.
Several innovative. TargetedIntermittent Long- Term Treatment.
How is it possible to provide brief, effective, and economical therapies. One answer is to use a model of treatment. With this type of therapy, treatment is provided very intensively (perhaps. The effort and cost of this targeted phase of treatment is. This intensive treatment is only provided intermittently because intensive.
As. the client gains functional stability, the frequency of treatment is reduced. As progress continues, direct treatment from the psychologist. The frequency of the.
During long periods of stable functioning, treatment may be shifted. This reduced contact is associated with lower. During. these periods of reduced direct contact, learning and rehabilitation continue. Of central importance is the idea that the therapist is readily available. In addition, the learning that occurs. Over a long period of time, these targetedintermittent. This model of treatment may be operationalized in many ways.
The types. of innovative assessment and treatment practices described in this article. CognitiveBehavioral Social Skills Training. Social skills training is the single most important innovation for. As. an empirically based approach to treatment, it has, during the last 2.
There are. now applications of social skills training to major depression, schizophrenia. Brady, 1. 98. 4 ; Hersen & Bellack, 1. Ladd & Mize, 1. Morrison. & Bellack, 1.
Robertson, Richardson, & Youngson, 1. Wallace. et al., 1.
Mental Illness, Philosophy of. The Philosophy of Mental Illness is an interdisciplinary field of study that combines views and methods from the philosophy of mind, psychology, neuroscience, and moral philosophy in order to analyze the nature of mental illness. Philosophers of mental illness are concerned with examining the ontological, epistemological, and normative issues arising from varying conceptions of mental illness. Central questions within the philosophy of mental illness include: whether the concept of a mental illness can be given a scientifically adequate, value- free, specification; whether mental illnesses should be understood as a form of distinctly mental dysfunction, and whether mental illnesses are best identified as discrete mental entities with clear inclusion/exclusion criteria or as points along a continuum between the normal and the ill. Philosophers critical of the concept of mental illness argue that it is not possible to give a value- neutral specification of mental illnesses. They argue that that our concept of mental illnesses is often used to disguise the ways in which mental illness categories enforce pre- existing norms and power relations.
Questions remain about the relationship between the role that values play within the concept of mental illness and how those values relate to concepts of illness more generally. Philosophers who consider themselves a part of the neurodiversity movement claim that our concept of mental illness should be revised to reflect the diverse forms of cognition that humans are capable of without stigmatizing individuals that are statistically non- normal. There are also epistemological issues concerning the relationship between mental illness and diagnosis. Historically, the central issue centers on how nosologies (or classification- schemas) of mental illness, especially the Diagnostic and Statistical Manual of Mental Disorders (the DSM), relate mental dysfunctions with observable symptoms. Mental dysfunction, on the DSM system, is identified via the presence or absence of a set of symptoms from a checklist. Those critical of the use of behavioral symptoms to diagnose mental disorders argue that symptoms are useless without a theoretically adequate conception of what it means for a mental mechanism to function poorly.
A minimal constraint on a diagnostic system is that it must be able to distinguish a person with a genuine mental illness from a person suffering from a problem with living. Critics argue that the DSM, as currently constituted, cannot do this. Lastly, there are a host of questions surrounding the relationship between mental illness and normativity. If mental illness undermines rational agency, then there are questions about the degree to which the mentally ill are capable of autonomous decision- making. This bears on questions regarding the degree of moral and legal responsibility that the mentally ill can be assigned. Further questions about agency arise over bioethical questions about the standing of the demands made on healthcare professionals by the mentally ill. For example, individuals with Body Integrity Identity Disorder (BIID) request that surgeons amputate their healthy limbs in order to restore a balance between their internal self- representation and their external body image.
Bioethicists are divided over whether the requests of patients with BIID are genuinely autonomous and deserving of assent. Table of Contents. Conceptions of Mental Illness. Alienism and Freud. DSM I â€“ IIThe Bio- psycho- social Model DSM III â€“ 5. Criticisms of the Bio- psycho- social Model.
Mental Illness as Dysfunction. Neurobiological Eliminitivism.
The Role of Value Szasz's Myth of Mental Illness. Neurodiversity Motivation Autism, Psychopathy. Responsibility and Autonomy Psychopathy Body Integrity Identity Disorder and Gender Dysphoria References and Further Reading. Conceptions of Mental Illnessa.
Alienism and Freud. Although there are many conceptions of madness found throughout the ancient world (demon possession, divine revelation or punishment, and so forth), the conception of a distinctly mental form of illness did not fully begin to crystallize, at least in the West, until the latter half of the nineteenth- century with the creation and rise of mental asylums. Individuals who were housed in asylums were thought to be psychotic or insane.
Psychotic inmates were seen as distinctly different from the non- psychotic population and this justified the creation of special purpose institutions for the containment of psychotic individuals. Psychotics were construed as suffering from distinct and localizable organic brain disorders and were treated by medical professionals known as Alienists (Elliott 2. Writing at the time, German psychiatrist Emil Kraepelinâ€™s nosology divided psychoses into one of two types: mood disorders and demtia praexcox (Kraepelin 1. All other forms of distress were though to fall outside of the province of the asylum and of medical treatment. Non- psychotic individuals who were unhappy with their lives, who felt intense anxiety, or who might vacillate between periods of high and low- motivation were not thought to have psychotic problem. These individuals were not treated or seen by alienists but instead sought help from their family, friends, or clergy (Horwitz 2.
Non- psychotic dysphoria (unhappiness) was, in this context, understood not as a distinctly medical problem but instead in a variety of other forms: a typically social problem with living, a character flaw, or simply as a different way of life. The solution for the unhappiness that many individuals suffered was not found within the asylum but instead from the family, god, or other social institutions. There was, at this time, a clear distinction between medical problems resulting in psychosis and social problems that caused suffering. Sigmund Freud grew up in the alienist tradition and received his medical degree in 1. Freud's theory of the mental and of mental illness would revolutionize western understanding of psychology and would become the dominant paradigm in the psychological sciences until the middle of the twentieth- century.
Where the alienists saw mental illnesses as manifestations of rather discrete brain dysfunctions, Freud would come to understand the distinction between normal persons and the mentally ill as arising from a conflict in psychological mechanisms that were a part of the normal human repertoire (Freud 1. Ghaemi 2. 00. 3, 4). Where the alienist understood non- psychotic unhappiness as a problem to be solved by individuals and their support networks, Freud understood problems in living as the domain of the psychotherapist. Paul Roazen famously quotes Freud as claiming that â€œ[t]he optimum conditions for (psychoanalysis) exist where it is not neededâ€”that is, among the healthyâ€ (Roazen 1.
Crucial to Freud's reorientation of mental disorder was his view of the relationship between observable behavioral symptoms and underlying psychological disorder. Unlike Kraepelin, who understood psychotic behavioral symptoms as closely tied to specific underlying brain dysfunction, Freud did not believe that behavioral symptoms could be tied to unique disorders.
The underlying source of human psychological suffering, as Freud understood it, stemmed from universal childhood experiences that if poorly resolved or understood, could manifest in adulthood as neurosis. Freud saw repression, for example, as a normal part of development from child to adult.
An individual could fail to properly apply repressive techniques. If this occurs then poorly repressed trauma can manifest itself in a myriad of ways from obsessive cleaning, chronic gambling, melancholia, and so forth. Freud 1. 91. 5/1. Horwitz 2. 00. 1, 4. Simply noting melancholia in a patient would not be enough for a psychoanalyst to understand the source of repressive dysfunction. Because a client troubled by chronic gambling and another client troubled by hysteria could, in principle, be suffering from the same underlying repressive dysfunction, any diagnostic manual based on Freud's conception of mental disorders would not hold symptoms as fundamentally important to the diagnostic process.
Instead, Freud claimed that the only way to truly understand a patient's underlying psychological dysfunction is to acquire detailed information about a person, including his or her dreams, in order to uncover repressed sexual urges (Freud 1. The first two editions of the DSM were largely based on Freud's underlying theory of repression and mental disorder. This nosology would dominate western thinking about the mentally ill until the 1.
DSM I â€“ IIWhen the Â first edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 1. Nearly 2/3 of the chairs of psychology departments in American universities were chaired by psychoanalysts and the emerging DSM strongly reflects their theoretical assumptions (Strand 2. By this point, psychiatry was seen as an extension of medical practice. This required the creation of a nosology, a catalogue of disorders for clinical practice (Graham 2. The first- edition of the DSM represented a revolutionary change in the conception and treatment of mental illness. Given the expansive notion of mental illness proposed by Freud and his students, the first two editions of the DSM conclude that many individuals that, prior to this point, Â were not Â seen as mentally ill, would benefit from therapy.
Because symptoms were only weakly correlated with underlying illness on the psychodynamic view, only repeated, and Â intensive, conversations with a qualified analyst could help a person get to the root cause of his problems (Horwitz 2. Grob 1. 99. 1, 4. The first- edition of the DSM devotes a significant proportion of its 1.
American Psychiatric Association 1. Unlike future editions of the manual, illnesses are not identified in terms of a series of symptoms but instead in terms of the underlying psychological conflict responsible.