UBLIC & HOSPITAL PSYCHIATRY  Components:

PUBLIC ψ  Crisis intervention

Encompasses all mental health service systems that are  Public Education
primarily sponsored & funded by governments
1960’s TERTIARY
 community mental health service centers.  ↓ the prevalence of residual efffects & disabilities caused by
 Rather than isolating persons w/ mental d/o for long an illness or a d/o
periods, preferable to tx these persons in the  reach the highest feasible level of functioning
community & to hospitalize them only briefly & under
 Rehabilitation
certain restrictions
 Always addresses px suffering from most severe/debilitating
 Problem: understaffed, underbudgeted  illnesses (schizophrenia), most severe affective d/o, & most
disabling personality d/o
COMMUNITY MENTAL HEALTH  Most of w/c begin in late adolescens & young adulthood.
1963: JFK  Community Mental Health Centers Act  Has chronic relapsing nature
Five Basic Psychiatric Services:
DEINSTITUTIONALIZATION
 Inpatient care
1950’s
 Emergency services (24hr)
Large numbers of px are discharged from public psychiatric
 Community consultation hospitals back into the community to receive outpatient care
 Day care  partial hospitalization, halfway house,
aftercare services, outpatient New institutions: Halfway houses
 Research & Education Revolving door policy: readmitted

Basic Concepts in Community Mental Health TRANSINSTITUTIONALIZATION

Commitment Transfer of px to other facilities
 Responsibility for planning One set of problem has been exchanged for another w/o solving
 Identify all mental health needs the problems of persons who are chronically mentally ill. 
 Inventory resources available to meet these needs Prison inmates (Incarceration)
 Organize system of care
Services  Incarcerated, homeless, mentally ill persons  crime: survival
 Long Term Care strategies (trespassing for shelter) or psychosis induced
 Case Management behavior
 Community Participation
Homeless mentally ill persons
 Consultation
Street people
 Evaluation & Research
 Schizophrenia, substance dependence, etc
 Evaluation  process of obtaining information Episodically homeless
about a total community mental health program &  Personality d/o, substance abuse, mood d/o
it’s effects Situationally homeless
 Research  focus on key issues  Situational stress
 Least Restrictive Alternatives
 Mentally ill persons should be tx in setttings that Homeless women may be more likely than men to have intact
interfere least with their civil rights & freedom to social skills & social networks
participate in society Common: schizophrenia & schizoaffective d/o, alcohol &
substance abuse, medical problems (anemia, lice, deficiencies,
PREVENTION TB)
PRIMARY
 Prevent the onset of a dse or d/o Treatment
Outreach programs
 ↓ it’s incidence (new cases: population in a specific
period) PSYCHOGERIATRIC LONG TERM CARE
 Eliminate causative agents, ↓ risk factors, ↑ host Long term care usually falls on families (70%, unpaid caretakers)
resistance, interfere with dse transmission
OUTPATIENT COMMITMENT PROGRAM
 Examples: Patients report to the clinic for medication, individual/grp tx,
vocational training
 Mental health education programs
Conservatorship
Parent training in child dvlpt
 Alternative
Alcohol & drug educ prog
 Competence building  Conservators  usually not part of the tx system, often family
Outward bound members who are given responsibility for the px’s well being
Head start w/ varying amounts of authority over their life.
Day care programs for disadvantaged
children HOSPITAL ψ
Phases
 Social support systems (to ↓ stress to high risk px)
 Admission
Widow-to-widow programs
 Immediate evaluation & refinement
 Anticipatory guidance
 Clarification of tx goals & discharge criteria
Counseling peace corps volunteers
 Progress toward & achievement of goals
 Crisis intervention (after a stessful life event such
 Discharge
as bereavement, marital separation, divorce,
 Appropriate aftercare or follow-up
traumas, group disasters)
Prevention of post-traumatic stress d/o
Tx programs:
 Short-term crisis intervention (1-4 wks)
 Eradicate stressful agents & reduce stress
 Extended tx (>4wks)
 Pre/perinatal care  prevent mental retardation &  Partial hospitalization (open ended)
cognitive d/o in children
 OB services Indications for hospitalization (Gabbard)
 Dietary modifications  Severity of illness factors
 Modification of laws  provide healthy  Danger to self/others
environment for child dvlpt  Interference to work/ family
 STD education  ÓPD responsiveness
 Dual dx (Complication w/ substance abuse)
SECONDARY  Tx factors
 Early identification & prompt tx of an illness or d/o  Previous hospitalization (response)
 Environmental factors
 ↓ the prevalence (existing cases: population at risk at
 Family system
specific time) by shortening it’s duration
  Objective: To determine the effects of a demographic, social &
personal factors on mental health & illness by use of
structured interview conducted by non-psychiatrists
 Main objective: test the association between life stress &
psychological symptoms
 Mental d/o (not present, mild, moderate, marked)

L
 Incidence ↑ as age ↑
81% = 20-59 yo (mild-severely incapacitating)
23.4% = substancially impaired
 socioeconomic status was the single most significant
D’08
variable affecting mental illness
PIDEMIOLOGY low socioeconomic grp = 6x more s/s

NEW HAVEN study

Epidemiology  Hollingshead & Redlich
The study of the distribution, incidence, prevalence &  Neurosis  ↑ in high socioeconomic grp
duration of the dse
 Psychosis  ↑ in low socioeconomic grp
ψ: understanding of the causes, tx, prevention of mental
d/o

Most common mental d/o: anxiety d/o  Class Status:

Next most common: depressive & alcohol/subst abuse
15% of px for medical/ surgical problem have an associated
 I  business & professional leaders
emotional d/o Long established core grp of interrelated families
Sociodemographic: ↑ # of mental do <45 yo  inherit money
 M<F (depressive & anxiety) Values: emphasize tradition, stability & social
 M>F (substance abuse & antisocial) responsibility
 M=F (schizophrenia) Upwardly mobile grp of new ppl  self made,
Schizophrenia: better prognosis & outcome in third world highly educated & aggressive
countries Family relationships not cohesive & stable

Types of Studies  II  some educ beyond highschool

Tensions generally arise from striving for success
Observational  no intervention
Experimental  III  clerical work, small busines, economic security but
little opportunity for advancement; Less satisfaction &
 Cohort  grp chosen from a well-defined population & less optimism
studied over a long period of time
 Longitudinal studies
 IV  working class
 Provide direct estimates or risk associated w/a  V  not completed elementary school
suspected causal factor
 More time consuming & expensive STIRLING COUNTY Study
 Usually conduced when ample evidence from case-  Leighton
history studies indicate that a relation exists  Rural areas
between a risk factor & a d/o
 Chess & Thomas: temperamental characteristics of  57%  mental d/o
followed up infants  20% notable impairment

 Retrospective  based on past data/events  20% need ψ attention

 F>M
 Prospective  also longitudinal; based on observing
events as they occur (problem: lost to follow-up) NIMH Epidemiologic Catchment Area Survey (NIMH-ECA)
 Cross-Sectional Study  prevalence of dse in a  Reiger
representative study population at a particular point in  Identify % of population w/ mental d/o receiving tx
time  15% of the population (of the US) is affected by mental
disorders
 Case-History  retrospective, examines persons w/ a
 1/5 of w/c receive care from mental health specialists
particular dse.
 Diagnostic Interview Schedule (DIS)
 Case-Control  retrospective, examines persons w/o a  Assess the presence, duration & severity of symptom
particular dse  M<F (2x depression)
 Clinical Trial  RCT, determine effect of a given tx  M>F (alcohol)
 Double Blind Study  <30 yo (substance abuse)

 Crossover study  at one pnt, the tx & the control

change places! If the control improves, one can
conclude that the makeup was truly random

Major Epidemiological Studies

CHICAGO study
 Faris & Dunham
 Schizophrenia: ↑ at central areas of Chicago (lowest
socioeconomic grp)
 Drift Hypothesis: impaired persons slide down the social
scale because of their illness
 Segregation Hypothesis: schizophrenic persons actively
seek city areas where anonymity & isolation protect
them from the demands that more organized society
makes on them

 Social Causation theory: being a member of a low

socioeconomic gp is significant in causing illness
 Social Selection theory: having a mental d/o leads one
to become a member of the low socioeconomic grp as a
secondary phenomenon

MIDTOWN MANHATTAN study

 Rennie & Srole
 L D’08

Go Prev Med!

Ayoko nang i-summarize yung iba pang biostat. (False Positive,

distribution, ANOVA, etc…etc.) Di na kaya ng superpowers ko.
Yey me. 

“SANA HINDI MAKATULOG”