Mental Disability and Rehabilitation Sourcebook, 1st Ed.

By Omnigraphics

Provides an overview of the most common types of mental disability, behavioral-health therapies, co-occurring disorders, medications commonly used to treat mental disability, treatment options, culturally competent care, accessibility, rehabilitation, and the ways in which the Affordable Care Act provides parity protections for behavioral-health services, along with tips on finding a therapist, supporting a friend or family member through diagnosis and treatment, and information about the neurodiversity movement, along with information on how to find government and local disability programs and resources.

• Language: English
• Publisher: Omnigraphics
• Release date: Nov 1, 2019
• ISBN: 9780780817715

Book preview

Part 1 | Psychiatric Disability

Chapter 1 | Mental Health and Early Warning Signs

WHAT IS MENTAL HEALTH?

Mental health includes emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Over the course of your life, if you experience mental-health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental-health problems, including:

Biological factors, such as genes or brain chemistry

Life experiences, such as trauma or abuse

Family history of mental-health problems

Mental-health problems are common but help is available. People with mental-health problems can get better and many recover completely.

EARLY WARNING SIGNS

Not sure if you or someone you know is living with mental-health problems? Experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:

Eating or sleeping too much or too little

Pulling away from people and usual activities

Having low or no energy

Feeling numb or like nothing matters

Having unexplained aches and pains

Feeling helpless or hopeless

Smoking, drinking, or using drugs more than usual

Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared

Yelling or fighting with family and friends

Experiencing severe mood swings that cause problems in relationships

Having persistent thoughts and memories you cannot get out of your head

Hearing voices or believing things that are not true

Thinking of harming yourself or others

Inability to perform daily tasks like taking care of your kids or getting to work or school

MENTAL HEALTH AND WELLNESS

Positive mental health allows people to:

Realize their full potential

Cope with the stresses of life

Work productively

Make meaningful contributions to their communities

Ways to maintain positive mental health include:

Getting professional help if you need it

Connecting with others

Staying positive

Being physically active

Helping others

Getting enough sleep

Developing coping skills

WHY IS MENTAL HEALTH IMPORTANT?

Mental disorders are among the most common causes of disability. The resulting disease burden of mental illness is among the highest of all diseases. In any given year, an estimated 18.1 percent (43.6 million) of U.S. adults ages 18 years or older suffered from any mental illness and 4.2 percent (9.8 million) suffered from a seriously debilitating mental illness. Neuropsychiatric disorders are the leading cause of disability in the United States, accounting for 18.7 percent of all years of life lost to disability and premature mortality. Moreover, suicide is the tenth leading cause of death in the United States, accounting for the deaths of approximately 43,000 Americans in 2014.

Mental health and physical health are closely connected. Mental health plays a major role in people’s ability to maintain good physical health. Mental illnesses, such as depression and anxiety, affect people’s ability to participate in health-promoting behaviors. In turn, problems with physical health, such as chronic diseases, can have a serious impact on mental health and decrease a person’s ability to participate in treatment and recovery.

UNDERSTANDING MENTAL HEALTH AND MENTAL DISORDERS

The existing model for understanding mental health and mental disorders emphasizes the interaction of social, environmental, and genetic factors throughout the lifespan. In behavioral health, researchers identify:

Risk factors, which predispose individuals to mental illness

Protective factors, which protect them from developing mental disorders

Researchers now know that the prevention of mental, emotional, and behavioral (MEB) disorders is inherently interdisciplinary and draws on a variety of different strategies.

Over the past 20 years, research on the prevention of mental disorders has progressed. The understanding of how the brain functions under minimally stressed conditions and in response to stressors, combined with knowledge of how the brain develops over time, has been essential to that progress. The major areas of progress include evidence that:

MEB disorders are common and begin early in life

The greatest opportunity for prevention is among young people

There are multiyear effects of multiple preventive interventions on reducing substance abuse, conduct disorder, antisocial behavior, aggression, and child maltreatment

The incidence of depression among pregnant women and adolescents can be reduced

School-based violence prevention can reduce the base rate of aggressive behaviors in an average school by 25 to 33 percent

There are potential indicated preventive interventions for schizophrenia

Improving family functioning and positive parenting can have positive outcomes on mental health and can reduce poverty-related risk

School-based preventive interventions aimed at improving social and emotional outcomes can also improve academic outcomes

Interventions targeting families dealing with adversities, such as parental depression or divorce, can be effective in reducing the risk for depression among children and increasing effective parenting

Some preventive interventions have benefits that exceed costs, with the available evidence strongest for early childhood interventions

Implementation is complex, and it is important that interventions be relevant to the target audiences

The progress identified above has led to a stronger understanding of the importance of protective factors. A 2009 Institute of Medicine (IOM) report advocates for multidisciplinary prevention strategies at the community level that support the development of children in healthy social environments. In addition to advancements in the prevention of mental disorders, there continues to be steady progress in treating mental disorders as new drugs and stronger evidence-based outcomes become available.

EMERGING ISSUES IN MENTAL HEALTH AND MENTAL DISORDERS

New mental-health issues have emerged among some special populations, such as:

Veterans who have experienced physical and mental trauma

People in communities with large-scale psychological trauma caused by natural disasters

Older adults, as the understanding and treatment of dementia and mood disorders continues to improve

As the federal government begins to implement the health-reform legislation, it will give attention to providing services for individuals with mental illness and substance-use disorders (SUDs), including new opportunities for access to and coverage for treatment and prevention services.

This chapter contains text excerpted from the following sources: Text beginning with the heading What Is Mental Health? is excerpted from What Is Mental Health? MentalHealth.gov, U.S. Department of Health and Human Services (HHS), April 5, 2019; Text beginning with the heading Why Is Mental Health Important? is excerpted from Mental Health and Mental Disorders, Office of Disease Prevention and Health Promotion (ODPHP), U.S. Department of Health and Human Services (HHS), December 7, 2010. Reviewed October 2019.

Chapter 2 | Mental Disorders

WHAT ARE MENTAL DISORDERS?

Mental disorders (or mental illnesses) are conditions that affect your thinking, feeling, mood, and behavior. They may be occasional or long-lasting (chronic). They can affect your ability to relate to others and function each day.

WHAT ARE SOME TYPES OF MENTAL DISORDERS?

There are many different types of mental disorders. Some common ones include:

Anxiety disorders, including panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and phobias

Depression, bipolar disorder, and other mood disorders

Eating disorders

Personality disorders

Psychotic disorders, including schizophrenia

WHAT CAUSES MENTAL DISORDERS

There is no single cause for mental illness. A number of factors can contribute to risk for mental illness, such as:

Your genes and family history

Your life experiences, such as stress or a history of abuse, especially if they happen in childhood

Biological factors such as chemical imbalances in the brain

A traumatic brain injury

A mother’s exposure to viruses or toxic chemicals while pregnant

Use of alcohol or recreational drugs

Having a serious medical condition like cancer

Having few friends, and feeling lonely or isolated

Mental disorders are not caused by character flaws. They have nothing to do with being lazy or weak.

WHO IS AT RISK FOR MENTAL DISORDERS?

Mental disorders are common. More than half of all Americans will be diagnosed with a mental disorder at some time in their life.

HOW ARE MENTAL DISORDERS DIAGNOSED?

The steps to getting a diagnosis include the following:

A medical history

A physical exam and possibly lab tests, if your provider thinks that other medical conditions could be causing your symptoms

A psychological evaluation. You will answer questions about your thinking, feelings, and behaviors.

WHAT ARE THE TREATMENTS FOR MENTAL DISORDERS?

Treatment depends on which mental disorder you have and how serious it is. You and your provider will work on a treatment plan just for you. It usually involves some type of therapy. You may also take medicines. Some people also need social support and education on managing their condition.

In some cases, you may need more intensive treatment. You may need to go to a psychiatric hospital. This could be because your mental illness is severe. Or it could be because you are at risk of hurting yourself or someone else. In the hospital, you will get counseling, group discussions, and activities with mental-health professionals and other patients.

This chapter includes text excerpted from Mental Disorders, MedlinePlus, National Institutes of Health (NIH), September 15,2014. Reviewed October 2019.

Chapter 3 | Prevalence of Mental Illness

MENTAL ILLNESS: AN OVERVIEW

Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (46.6 million in 2017). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe. Two broad categories can be used to describe these conditions: any mental illness (AMI) and serious mental illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI.

Any Mental Illness

Any mental illness is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below).

Serious Mental Illness

Serious mental illness is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI.

PREVALENCE OF ANY MENTAL DISORDER AMONG ADULTS

How Common Is Any Mental Illness?

Figure 3.1 shows the past-year prevalence of AMI among U.S. adults.

Figure 3.1. Past Year Prevalence of Any Mental Illness among U.S. Adults (2017). (Source: Substance Abuse and Mental Health Services Administration (SAMHSA).)

*All other groups are non-Hispanic or Latinx. **NH/OPI = Native Hawaiian/Other Pacific Islander. ***AI/AN = American Indian/Alaskan Native

In 2017, there were an estimated 46.6 million adults aged 18 or older in the United States with AMI. This number represented 18.9 percent of all U.S. adults.

The prevalence of AMI was higher among women (22.3%) than men (15.1%).

Young adults aged 18 to 25 years had the highest prevalence of AMI (25.8%) compared to adults aged 26 to 49 years (22.2%) and aged 50 and older (13.8%).

The prevalence of AMI was highest among adults reporting two or more races (28.6%), followed by White adults (20.4%). The prevalence of AMI was lowest among Asian adults (14.5%).

Mental-Health Services: Any Mental Illness

Figure 3.2 presents data on mental-health services received within the past year by U.S. adults aged 18 or older with any AMI. The National Survey on Drug Use and Health (NSDUH) defines mental-health services as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.

In 2017, among the 46.6 million adults with AMI, 19.8 million (42.6%) received mental-health services in the past year.

More women with AMI (47.6%) received mental-health services than men with AMI (34.8%).

Figure 3.2. Mental-Health Services Received in Past Year among U.S. Adults with Any Mental Illness (2017). (Source: Substance Abuse and Mental Health Services Administration (SAMHSA).)

*All other groups are non-Hispanic or Latinx.

The percentage of young adults aged 18 to 25 years with AMI who received mental-health services (38.4%) was lower than adults with AMI aged 26 to 49 years (43.3%) and aged 50 and older (44.2%).

How Common Is Serious Mental Illness?

Figure 3.3 shows the past year prevalence of SMI among U.S. adults.

In 2017, there were an estimated 11.2 million adults aged 18 or older in the United States with SMI. This number represented 4.5 percent of all U.S. adults.

The prevalence of SMI was higher among women (5.7%) than men (3.3%).

Young adults aged 18 to 25 years had the highest prevalence of SMI (7.5%) compared to adults aged 26 to 49 years (5.6%) and aged 50 and older (2.7%).

The prevalence of SMI was highest among the adults reporting two or more races (8.1%), followed by White adults (5.2%). The prevalence of SMI was lowest among Asian adults (2.4%).

Figure 3.3. Past Year Prevalence of Serious Mental Illness among U.S. Adults (2017). (Source: Substance Abuse and Mental Health Services Administration (SAMHSA).)

*All other groups are non-Hispanic or Latinx. **NH/OPI = Native Hawaiian/Other Pacific Islander. ***AI/AN = American Indian/Alaskan Native

Mental-Health Services: Serious Mental Illness

Figure 3.4 presents data on mental-health services received within the past year by U.S. adults 18 or older with SMIs. The NSDUH defines mental-health services as having received inpatient treatment/counseling or outpatient treatment/counseling or having used prescription medication for problems with emotions, nerves, or mental health.

In 2017, among the 11.2 million adults with SMI, 7.5 million (66.7%) received mental-health treatment in the past year.

More women with SMI (71.5%) received mental-health treatment than men with SMI (57.7%).

The percentage of young adults aged 18 to 25 years with SMI who received mental-health treatment (57.4%) was lower than adults with SMI aged 26 to 49 years (66.2%) and aged 50 and older (75.6%).

PREVALENCE OF ANY MENTAL DISORDER AMONG ADOLESCENTS

Based on diagnostic interview data from the National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 3.5 shows the lifetime prevalence of any mental disorder among U.S. adolescents aged 13 to 18.

An estimated 49.5 percent of adolescents had any mental disorder.

Figure 3.4. Mental-Health Services Received in Past Year among U.S. Adults with Serious Mental Illness (2017). (Source: Substance Abuse and Mental Health Services Administration (SAMHSA).)

*All other groups are non-Hispanic or Latinx.

Figure 3.5. Lifetime Prevalence of Any Mental Disorder among Adolescents (2001–2004). (Source: National Comorbidity Survey Adolescent Supplement (NCS-A).)

Of adolescents with any mental disorder, an estimated 22.2 percent had severe impairment. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) based criteria were used to determine impairment level.

This chapter includes text excerpted from Mental Illness, National Institute of Mental Health (NIMH), February 2019.

Chapter 4 | What Are Co-Occurring Disorders?

CO-OCCURRING DISORDERS

When a person has mental-health and substance use disorder at the same time, they have co-occurring disorders. Compared to the general population, people with mental-health disorders are more likely to experience a substance-use disorder, repeatedly use alcohol and/or drugs to the point of impairment, and neglect major responsibilities at home, work, or school. Youth who have experienced a major depressive episode are twice as likely to start using alcohol or an illicit drug. A 2010 study found that more than 29 percent of youth who started using alcohol within the past year did so after a major depressive episode, compared to 14.5 percent of youth who had not experienced a major depressive episode. The same pattern also occurred with the use of illicit drugs.

Substance use shares many characteristics with mental illness. Prevention efforts and early treatment are beneficial for people who are at risk for both substance-use and mental-health disorders. A U.S. Surgeon General’s report highlights the scope of substance use (including alcohol) and its negative health impacts for individuals and the nation. Because mental-health and substance-use disorders are complicated and involve biological, psychological, and social elements, the Substance Abuse and Mental Health Services Administration (SAMHSA) supports an integrated treatment approach to co-occurring disorders. This approach allows practitioners to comprehensively address symptoms and underlying causes, which often lowers the cost of treatment and leads to better outcomes.

Substance use is not the only disorder that occurs at the same time as mental-health disorders. Different mental-health disorders can occur together (such as anxiety and depression) or mental-health disorders can overlap with physical health disorders (such as depression and diabetes). Symptoms of mental-health disorders can also be similar to other conditions. For example, autism spectrum disorder (ASD) is the name for a group of developmental disorders often characterized by impairments in the ability to communicate and interact with others. ASD includes a wide range of symptoms, skills, and levels of disability. These disorders occur in about 1.5 percent of children and often co-occur with disorders such as depression, anxiety, and sensory integration disorder.

WHICH CAME FIRST

It is often impossible to say which disorder came first. In one case, a person may experience anxiety from childhood trauma and turn to drugs to cope, developing an addiction. In another case, the person may use heroin and have negative experiences that could lead to posttraumatic stress disorder (PTSD). The important thing is to get help for both problems—substance-use problems and any other mental-health disorders.

Treating co-occurring disorders can be challenging because often the different specialists involved do not coordinate treatment for the different problems. Doctors, social workers, psychologists, and psychiatrists most often treat mental-health disorders, whereas a mix of healthcare professionals with various backgrounds may provide treatment for drug addiction.

TREATMENT MUST ADDRESS THE WHOLE PERSON

National Institute on Drug Abuse (NIDA) and other federal agencies are working to make sure people who have co-occurring disorders receive integrated treatment that addresses both substance use and other mental-health disorders. Some medications may ease symptoms of a mental-health disorder and also may help the person stay off a certain drug.

Other types of treatment also may be effective. For example, for teens with co-occurring disorders, cognitive-behavioral therapy (CBT) can help. This therapy helps the person change harmful beliefs and behaviors, and provides skills to handle stressful circumstances.

This chapter contains text excerpted from the following sources: Text under the heading Co-Occurring Disorders is excerpted from Common Mental Health Disorders in Adolescence, U.S. Department of Health and Human Services (HHS), May 1, 2019; Text beginning with the heading Which Came First? is excerpted from What Are Co-Occurring Disorders? National Institute on Drug Abuse (NIDA) for Teens, March 8, 2012. Reviewed October 2019.

Chapter 5 | The Connection between Mental Health and Chronic Disease

CHRONIC DISEASES

Chronic diseases are noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. They are the leading cause of death and disability in the United States. They cause 7 out of 10 deaths each year and are among the most preventable and treatable of all health problems. Chronic diseases include illnesses such as heart disease, diabetes, cancer, and arthritis.

Mental-health disorders are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. They are medical conditions that often result in a reduced ability to cope with the routine daily activities such as going to work or raising a family. Just like chronic diseases, mental-health disorders are treatable. Most people diagnosed with a serious mental-health disorder can receive relief from their symptoms by following a treatment plan specifically designed for them by a trained psychologist or psychiatrist. Mental-health disorders are not exclusive to those who exhibit a lack of personal strength, personality traits such as being shy, or have a certain socioeconomic status. Mental-health disorders include illnesses, such as major depression, bipolar disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).

One common finding is that people who suffer from chronic disease are more likely to also suffer from depression. Scientists have yet to determine if having a chronic disease increases the prevalence of depression or depression increases the risk of obtaining a