Book: Depression, Anxiety, and Other Things We Don’t Want to Talk About

Book Title:

Depression, Anxiety, and Other Things We Don’t Want to Talk About.

Author(s): Ryan Casey Waller.

Year: 2021.

Edition: First (1ed).

Publisher: Nelson Books.

Type(s): Paperback, Audiobook, and Kindle.

Synopsis:

Mental illness loves to tell lies. One of those lies is that you really should be able to manage what you are struggling with. Pastor and psychotherapist Ryan Casey Waller says no. Mental health issues are not a symptom of a spiritual failing or insufficient faith; rather, suffering is the very thing our Saviour seeks to heal as he leads us toward restoration. And yet, as Waller has experienced personally, the battle can be lonely and discouraging. But it does not have to be.

Combining practical theology, clinical insights, and deep empathy, Waller offers a rare mix of companionship and truth, inviting us to:

  • Have shame-free conversations about mental health;
  • Discover why self-knowledge is so important to a deep relationship with God;
  • Understand the intersection of biology, psychology, and spirituality;
  • Explore varying avenues of healing in community, therapy, and medication; and
  • Be equipped to support loved ones while practicing self-care.

Waller bridges the gap between the spiritual and the psychological in this empathetic, imminently helpful guidebook, reminding us all that we are not alone. Hope starts now.

What is a Community Mental Health Service?

Introduction

Centre for Mental Health Services, also known as community mental health teams (CMHT) in the United Kingdom, support or treat people with mental disorders (mental illness or mental health difficulties) in a domiciliary setting, instead of a psychiatric hospital (asylum). The array of community mental health services vary depending on the country in which the services are provided. It refers to a system of care in which the patient’s community, not a specific facility such as a hospital, is the primary provider of care for people with a mental illness. The goal of community mental health services often includes much more than simply providing outpatient psychiatric treatment.

Community services include supported housing with full or partial supervision (including halfway houses), psychiatric wards of general hospitals (including partial hospitalisation), local primary care medical services, day centres or clubhouses, community mental health centres, and self-help groups for mental health.

The services may be provided by government organisations and mental health professionals, including specialised teams providing services across a geographical area, such as assertive community treatment and early psychosis teams. They may also be provided by private or charitable organisations. They may be based on peer support and the consumer/survivor/ex-patient movement.

The World Health Organisation (WHO) states that community mental health services are more accessible and effective, lessen social exclusion, and are likely to have fewer possibilities for the neglect and violations of human rights that were often encountered in mental hospitals. However, WHO notes that in many countries, the closing of mental hospitals has not been accompanied by the development of community services, leaving a service vacuum with far too many not receiving any care.

New legal powers have developed in some countries, such as the United States, to supervise and ensure compliance with treatment of individuals living in the community, known as outpatient commitment or assisted outpatient treatment or community treatment orders.

Brief History

Origins

Community mental health services began as an effort to contain those who were “mad” or considered “lunatics”. Understanding the history of mental disorders is crucial in understanding the development of community mental health services. As medical psychology developed as a science and shifted toward the treatment of the mentally ill, psychiatric institutions began to develop around the world, and laid the groundwork for modern day community mental health services.

Pre-Deinstitutionalisation

On 03 July 1946, US President Harry Truman signed the National Mental Health Act which, for the first time in the history of the United States, generated a large amount of federal funding for both psychiatric education and research. The passing of this Act eventually led to the founding of the National Institute of Mental Health (NIMH) in 1949. At the end of the 1940s and moving into the beginning of the 1950s, the governor of Minnesota Luther Youngdahl initiated the development of numerous community-based mental health services. He also advocated for the humane treatment of people in state institutions.

Deinstitutionalisation

Philippe Pinel played a large role in the ethical and humane treatment of patients and greatly influenced Dorothea Dix. Dix advocated the expansion of state psychiatric hospitals for patients who were at the time being housed in jails and poor houses. Despite her good intentions, rapid urbanisation and increased immigration led to a gross overwhelming of the state’s mental health systems and because of this, as the 19th century ended and the 20th century began, a shift in focus from treatment to custodial care was seen. As quality of care declined and psychotropic drugs were introduced, those with mental illnesses were reintroduced to the community, where community mental health services were designated as primary care providers.

Mental Health Movements

Reform MovementEraSettingFocus of Reform
Moral Treatment1800-1850AsylumHumane, restorative treatment
Mental Hygiene1890-1920Mental hospital or clinicPrevention, scientific orientation
Community Mental Health1955-1970Community mental health centreDeinstitutionalisation, social integration
Community Support1975-PresentCommunitiesMental illness as a social welfare problem (e.g. treatment housing, employment, etc.)

Post-Deinstitutionalisation

Following deinstitutionalisation, many of the mentally ill ended up in jails, nursing homes, and on the streets as homeless individuals. It was at this point in history that modern community mental health services started to grow and become influential. In 1955, following a major period of deinstitutionalisation, the Mental Health Study Act was passed. With the passing of this Act, the US Congress called for “an objective, thorough, nationwide analysis and re-evaluation of the human and economic problems of mental health.” Following Congress’ mandate, the Joint Commission on Mental Illness conducted numerous studies. For the next four years this Commission made recommendations to establish community mental health centres across the country. In 1963, the Community Mental Health Centres Act was passed, essentially kick-starting the community mental health revolution. This Act contributed further to deinstitutionalisation by moving mental patients into their “least restrictive” environments. The Community Mental Health Centres Act funded three main initiatives:

  • Professional training for those working in community mental health centres;
  • Improvement of research in the methodology utilised by community mental health centres; and
  • Improving the quality of care of existing programmes until newer community mental health centres could be developed.

That same year the Mental Retardation Facilities and Community Mental Health Centres Construction Act was passed. President John F. Kennedy ran part of his campaign on a platform strongly supporting community mental health in the United States. Kennedy’s ultimate goal was to reduce custodial care of mental health patients by 50% in ten to twenty years. In 1965, the Community Mental Health Act was amended to ensure a long list of provisions. First, construction and staffing grants were extended to include centres that served patients with substance abuse disorders. Secondly, grants were provided to bolster the initiation and progression of community mental health services in low-SES areas. Lastly, new grants were established to support mental health services aimed at helping children. As the 20th century progressed, even more political influence was exerted on community mental health. In 1965, with the passing of Medicare and Medicaid, there was an intense growth of skilled nursing homes and intermediate-care facilities that alleviated the burden felt by the large-scale public psychiatric hospitals.

20th Century

From 1965 to 1969, $260 million was authorised for community mental health centres. Compared to other government organisations and programmes, this number is strikingly low. The funding drops even further under Richard Nixon from 1970-1973 with a total of $50.3 million authorised. Even though the funding for community mental health centres was on a steady decline, deinstitutionalisation continued into the 1960s and 1970s. The number of state and county mental hospital resident patients in 1950 was 512,501 and by 1989 had decreased to 101,402. This continuing process of deinstitutionalisation without adequate alternative resources led the mentally ill into homelessness, jails, and self-medication through the use of drugs or alcohol. In 1975, Congress passed an Act requiring community mental health centres to provide aftercare services to all patients in the hopes of improving recovery rates. In 1980, just five years later, Congress passed the Mental Health Systems Act of 1980, which provided federal funding for ongoing support and development of community mental health programmes. This Act strengthened the connection between federal, state, and local governments with regards to funding for community mental health services. It was the final result of a long series of recommendations by Jimmy Carter’s Mental Health Commission. Despite this apparent progress, just a year after the Mental Health Systems Act was passed, the Omnibus Budget Reconciliation Act of 1981 was passed. The Omnibus Act was passed by the efforts of the Reagan administration as an effort to reduce domestic spending. The Act rescinded a large amount of the legislation just passed, and the legislation that was not rescinded was almost entirely revamped. It effectively ended federal funding of community treatment for the mentally ill, shifting the burden entirely to individual state governments. Federal funding was now replaced by granting smaller amounts of money to the individual states. In 1977, the National Institute of Mental Health (NIMH) initiated its Community Support Program (C.S.P.). The C.S.P.’s goal was to shift the focus from psychiatric institutions and the services they offer to networks of support for individual clients. The C.S.P. established the ten elements of a community support system listed below:

  • Responsible team.
  • Residential care.
  • Emergency care.
  • Medicare care.
  • Halfway house.
  • Supervised (supported) apartments.
  • Outpatient therapy.
  • Vocational training and opportunities.
  • Social and recreational opportunities.
  • Family and network attention.

This conceptualisation of what makes a good community programme has come to serve as a theoretical guideline for community mental health service development throughout the modern-day United States psychological community. In 1986, Congress passed the Mental Health Planning Act of 1986, which was a Federal law requiring that at the state government level, all states must have plans for establishing case management under Medicaid, improving mental health coverage of community mental health services, adding rehabilitative services, and expanding clinical services to the homeless population. More specifically, community mental health providers could now receive reimbursement for services from Medicare and Medicaid, which allowed for many of the centres to expand their range of treatment options and services. As the 1990s began, many positive changes occurred for people with mental illnesses through the development of larger networks of community-based providers and added innovations with regards to payment options from Medicare and Medicaid. Despite these advancements, there were many issues associated with the increasing cost of health care. Community mental health services moved toward a system more similar to managed care as the 1990s progressed. Managed care as a system focuses on limiting costs by one of two means: either keeping the total number of patients using services low or reducing the cost of the service itself. Despite the drive for community mental health, many physicians, mental health specialists, and even patients have come to question its effectiveness as a treatment. The underlying assumptions of community mental health require that patients who are treated within a community have a place to live, a caring family, or supportive social circle that does not inhibit their rehabilitation. These assumptions are in fact often wrong. Many people with mental illnesses, upon discharge, have no family to return to and end up homeless. While there is much to be said for the benefits that community mental health offers, many communities as a whole often harbour negative attitudes toward those with mental illnesses. Historically, people with mental illnesses have been portrayed as violent or criminal and because of this, “many American jails have become housing for persons with severe mental illnesses arrested for various crimes.” In 1999 the Supreme Court ruled on the case Olmstead v. L.C. The Court ruled that it was a violation of the Americans with Disabilities Act of 1990 to keep an individual in a more restrictive inpatient setting, such as a hospital, when a more appropriate and less restrictive community service was available to the individual.

21st Century and Modern Trends

In 2002, President George W. Bush increased funding for community health centres. The funding aided in the construction of additional centres and increased the number of services offered at these centres, which included healthcare benefits. In 2003, the New Freedom Commission on Mental Health, established by President Bush, issued a report. The report was in place to “conduct a comprehensive study of the United States mental health delivery system…” Its objectives included assessing the efficiency and quality of both public and private mental health providers and identifying possible new technologies that could aid in treatment. As the 20th century came to a close and the 21st century began, the number of patients diagnosed with a mental health or substance abuse disorder receiving services at community mental health centres grew from 210,000 to approximately 800,000. This nearly four-fold increase shows just how important community mental health centres are becoming to the general population’s wellbeing. Unfortunately, this drastic rise in the number of patients was not mirrored by a concomitant rise in the number of clinicians serving this population. The staggering new numbers of patients then are being forced to seek specialised treatment from their primary care providers or hospital emergency rooms. The unfortunate result of this trend is that when a patient is working with their primary care provider, they are more likely for a number of reasons to receive less care than with a specialised clinician. Politics and funding have always been and continue to be a topic of contention when it comes to funding of community health centres. Political views aside, it is clear that these community mental health centres exist largely to aid areas painfully under resourced with psychiatric care. In 2008, over 17 million people utilised community mental health centres with 35% being insured through Medicaid, and 38% being uninsured. As the 2000s continued, the rate of increase of patients receiving mental health treatment in community mental health centres stayed steady.

Purpose and Examples

Cultural knowledge and attitude is passed from generation to generation. For example, the stigma with therapy may be passed from mother to daughter. San Diego county has a diverse range of ethnicities. Thus, the population diversity in San Diego include many groups with historical trauma and trans-generational trauma within those populations. For example, witnesses of war can pass down certain actions and patterns of survival mechanism to generations. Refugee groups have trans-generational trauma around war and PTSD. Providing services and therapy to these communities is important because it affects their day-to-day lives, where their experiences lead to trauma or the experiences are traumatic themselves. Knowledge and access to mental health resources are limited in these multicultural communities. Government agencies fund community groups that provide services to these communities. Therefore, this creates a power hierarchy. If their missions do not align with each other, it will be hard to provide benefits for the community, even though the services are imperative to the wellbeing of its residents.

The combination of a mental illness as a clinical diagnosis, functional impairment with one or more major life activities, and distress is highest in ages 18-25 years old. Despite the research showing the necessity of therapy for this age group, only one fifth of emerging adults receive treatment. Psychosocial interventions that encourage self-exploration and self-awareness, such as acceptance and mindfulness-based therapies, is useful in preventing and treating mental health concerns. At the Centre for Community Counselling and Engagement, 39% of their clients are ages 1-25 years old and 40% are in ages 26-40 years old as well as historically underrepresented people of colour. The centre serves a wide range of ethnicities and socio-economic statuses in the City Heights community with counsellors who are graduate student therapists getting their Master’s in Marriage and Family Therapy or Community Counselling from San Diego State University, as well as post-graduate interns with their master’s degree, who are preparing to be licensed by the state of California. Counselling fees are based on household incomes, which 69% of the client’s annual income is $1-$25,000 essentially meeting the community’s needs. Taking into account of San Diego’s population, the clinic serves as an example of how resources can be helpful for multicultural communities that have a lot of trauma in their populations.

Future

On one hand, despite the field’s movement toward community mental health services, currently “insufficient empirical research exists regarding the effectiveness of community treatment programmes, and the evidence that does exist does not generalise to all types of community treatment.” In addition to the fact that community mental health’s overall success must be further evaluated, in the times when it has proved effective, very little research exists to help in understanding what exact aspects make it effective. Effective and insightful research will be crucial in not only evaluating, but also improving the techniques community mental health utilises. On the other hand, the demand for and necessity of community mental health is driving it into the future. With this seemingly unrelenting increase in the number of people experiencing mental health illnesses and the number of people reporting these problems, the question becomes what role community mental health services will play. In 2007, almost 5% of adults in the United States reported at least one unmet need for mental health care. Funding has historically been and continues to be an issue for both the organisations attempting to provide mental health services to a community and the citizens of the community who are so desperately in need of treatment. The community mental health system’s goal is an extremely difficult one and it continues to struggle against changing social priorities, funding deficits, and increasing need. Community mental health services would ideally provide quality care at a low cost to those who need it most. In the case of deinstitutionalisation, as the number of patients treated increased, the quality and availability of care went down. With the case of small, private treatment homes, as the quality of the care went up their ability to handle large numbers of patients decreased. This unending battle for the middle ground is a difficult one but there seems to be hope. For example, the 2009 Federal Stimulus Package and Health Reform Act have increased the funding for community health centres substantially. Undoubtedly as community mental health moves forward, there will continue to be a juggling act between clinical needs and standards, political agendas, and funding.

Book: Understanding Mental Illness 6th edition: Mental Health Awareness For Self Teaching

Book Title:

Understanding Mental Illness 6th edition: Mental Health Awareness For Self Teaching.

Author(s): Marianne Richards.

Year: 2015.

Edition: Sixth (6th).

Publisher: CreateSpace Independent Publishing Platform.

Type(s): Paperback and Kindle.

Synopsis:

Understanding Mental Illness is the 6th edition of this professionally acclaimed book. This is a comprehensive, jargon-free guide aimed at volunteers, patients, carers, new professionals and students of mental health, as well as the keen general reader.

The book contains a wealth of information, including a history of mental illness from primitive times to the 20th century, with the often-bizarre treatments meted out in earlier times.

There is a selection of case histories on common disorders, together with ‘pen portraits’ illustrating ‘a day in the life of’ medical and non-medical therapists. Illustrated throughout with a glossary, suggested reading and index. The keen student is sure to find topics of interest for further study in this fascinating field.

Book: Boys Don’t Cry

Book Title:

Boys Don’t Cry: Why I hid my depression and why men need to talk about their mental health.

Author(s): Tim Grayburn.

Year: 2018.

Edition: First (1st).

Publisher: Hodder & Stoughton.

Type(s): Hardcover, Paperback, Audiobook and Kindle.

Synopsis:

For nearly a decade Tim kept his depression secret. It made him feel so weak and shameful he thought it would destroy his whole life if anyone found out. But an unexpected discovery by a loved one forced him to confront his illness and realise there was strength to be found in sharing his story with others. When he finally opened up to the world about what he was going through he discovered he was not alone.

Boys Don’t Cry is a book that speaks against the stigma that makes men feel like they are less-than for struggling, making sense of depression and anxiety for people who might not recognise those feelings in themselves or others. It is a brutally honest, sometimes heart-breaking (and sometimes funny) tale about what it really takes to be a ‘real man’, written by one who decided that he wanted to change the status quo by no longer being silent.

Book: Breaking the Barriers

Book Title:

Breaking the Barriers: Early Intervention to Mental Health Issues.

Author(s): Lade Hephzibah Olugbemi.

Year: 2020.

Edition: First (1st).

Publisher: Independently Published.

Type(s): Paperback and Kindle.

Synopsis:

“If you don’t know what your barriers are, it’s impossible to figure out how to tear them down.” – John Manning, author of The Disciplined Leader.

This is true about mental health in the community. Barriers to information and understanding have affected people with mental health issues, as well as their friends, work colleagues and family members. This book seeks to shed light on the many factors that causes barriers to preventing mental health problems. It demystifies the various issues surrounding mental health, especially within the Black, Asian and Minority Ethnic (BAME) communities. It also explores the various factors that trigger mental illness, the role of the media, religion and culture in complicating the barriers.

By reading Breaking The Barriers, you will become more aware of the various issues around mental health, and better equipped to overcoming the barriers.

Book: Reasons to Stay Alive

Book Title:

Reasons to Stay Alive.

Author(s): Matt Haig.

Year: 2015.

Edition: First (1st).

Publisher: Canongate Books Ltd.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.

Synopsis:

Aged 24, Matt Haig’s world caved in. He could see no way to go on living. This is the true story of how he came through crisis, triumphed over an illness that almost destroyed him and learned to live again.

A moving, funny and joyous exploration of how to live better, love better and feel more alive, Reasons to Stay Alive is more than a memoir. It is a book about making the most of your time on earth.

“I wrote this book because the oldest clichés remain the truest. Time heals. The bottom of the valley never provides the clearest view. The tunnel does have light at the end of it, even if we haven’t been able to see it . . . Words, just sometimes, really can set you free.”

Psychiatrists have Started the Process of Mapping Genetic Architecture of Mental Disorders

Research Paper Title

Psychiatrists begin to map genetic architecture of mental disorders.

Background

Mental illness affects one in six US adults, but scientists’ sense of the underlying biology of most psychiatric disorders remains nebulous.

That is frustrating for physicians treating the diseases, who must make diagnoses based on symptoms that may only appear sporadically.

Now, a large-scale analysis of postmortem brains is revealing distinctive molecular traces in people with mental illness.

An international team of researchers reports that five major psychiatric disorders have often overlapping patterns of gene activity, which furthermore vary in disease-specific – and sometimes counterintuitive – ways.

The findings, they say, might someday lead to diagnostic tests, and one has already inspired a clinical trial of a new way to treat overactive brain cells in autism.

Reference

Dengler, R. (2020) Psychiatrists begin to map genetic architecture of mental disorders. Neuroscience. 359(6376), pp.619. DOI: 10.1126/science.359.6376.619

Book: Mental: Everything You Never Knew You Needed to Know about Mental Health

Book Title:

Mental: Everything You Never Knew You Needed to Know about Mental Health.

Author(s): Dr Steve Ellen and Catherine Deveny.

Year: 2018.

Edition: First (1st).

Publisher: Anima.

Type(s): Hardcover, Paperback, Audiobook, and Kindle.

Synopsis:

How do we define mental illness? What does a diagnosis mean? What should you ask your doctor before you begin treatment? Are there alternatives to medication? What does the research show actually works?

Practitioner and professor of psychiatry Dr Steve Ellen and popular comedian Catherine Deveny combine forces to demystify the world of mental health. Sharing their personal experiences of mental illness and an insider perspective on psychiatry, they unpack the current knowledge about conditions and treatments coveing everything from depression and anxiety to schizophrenia, personality disorders and substance abuse.

Whether you have a mental illness or support someone who does, Mental offers clear practical help, empowering you with an arsenal of tips and techniques to help build your resilience.

Book: Mental Health and Well-being in Primary Education

Book Title:

Mental Health and Well-being in Primary Education: A Practical Guide and Resource.

Author(s): Laura Meek, Jo Phillips, and Sarah Jordan.

Year: 2020.

Edition: First (1st).

Publisher: Luminate.

Type(s): Paperback and Kindle.

Synopsis:

Good mental health is much more than the absence of mental illness – it also means having self-belief and the resilience to cope with stress and change. In order to teach such skills, teachers and other education professionals must equip themselves and their workplaces with the procedures, understanding and confidence required to monitor mental health, share concepts effectively, identify warning signs and act appropriately if issues arise.

Written by an author team combining clinical and teaching expertise, Mental Health and Wellbeing in Primary Education puts all the information you need at your fingertips with detailed guidance on creating a culture of wellbeing, overviews of how a wide variety of common mental health problems including anxiety, anger and ADHD are typically diagnosed and managed, warning signs to look out for, and a range of ready-made forms, exercises and lesson plans.

A New Definition of Mental Health!

Research Paper Title

A proposed new definition of mental health.

Background

The authors propose a new approach to the definition of mental health, different than the definition proposed by the World Health Organisation, which is established around issues of person’s well-being and productivity.

It is supposed to reflect the complexity of human life experience.

Introduction

The definition of mental health proposed by the World Health Organization (WHO) is organised around a hedonic and eudaimonic perspective, in which a key role is assigned to person’s well-being and productivity. While regarding well-being as a desirable goal for many people, its inclusion in the definition of mental health raises concerns. According to Keyes, well-being includes emotional, psychological and social well-being, and involves positive feelings (e.g., happiness, satisfaction), positive attitudes towards own responsibilities and towards others, and positive functioning
(e.g., social integration, actualisation and coherence).

However, people in good mental health experience a wide range of emotions, such as sadness, anger or unhappiness; most adolescents are often unsatisfied, unhappy about present social organisation and may lack social coherence. Does this mean that they are not in good mental health? A person responsible for her/his family might feel desperate after being fired from his/her job, especially in a situation characterised by scarce occupational opportunities; should we question her/his mental health? Actually, raising the bar of mental health may create unrealistic expectations, encourage people
to mask most of their emotions while pretending constant happiness, and even favour their isolation when they feel sad, angry or worried.

Also the concept of positive functioning (“can work productively and fruitfully”), in line with the eudaimonic tradition, raises concerns, as it implies that a person at an age or in a physical or even political condition preventing her/him from working productively is not by definition in good mental health.

The definition of mental health is clearly influenced by the culture that defines it. However, as also advocated by Vaillant, an effort can be made to identify elements that have a universal importance for mental health, as for example, vitamins and the four basic food groups are universally given a key role in eating habits, in spite of cultural differences.

You can read the rest of the article here.

Reference

Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J. & Sartorius, N. (2020) A proposed new definition of mental health. Psychiatria Polska. 51(3), pp.407-411. doi: 10.12740/PP/74145. Epub 2017 Jun 18.