Questions and Topics We Can Help You To Answer:
Paper Instructions:
The case study for this module's writing assignment is "How Do We Handle a Girl Like Maria?,"
The paper should address the 5 discussion questions that appear in the case.
SCENARIO:
Maria Sanchez, her husband, and their three children
had lived in their apartment building for about 2
years when they noticed a new person moving in on
the floor below them. New families moved in from time
to time, but this person didn’t have a family and kept
to herself. After asking around, Maria learned from a
neighbor downstairs that the new person’s name was
Lynn and that she was not currently employed, but
hoped to find work soon, perhaps as a cashier or a
custodian. Maria is annoyed that Lynn keeps her tele-
vision on late into the night. She has been meaning
to say something about it, but so far Lynn keeps to
herself and Maria hasn’t found her very friendly—Lynn
tends to look away without saying anything when Maria
passes her in the hallway. Maria also learned that Lynn
was recovering from a recent bout of mental illness
and that she was anxious about the demands of living
independently once again. The neighbor added that
Lynn meets monthly with a probation officer from the
Department of Corrections.
Maria noticed that every few days a regular visitor
arrived at the building in a van from the mental health
center to spend an hour or so with Lynn in her apartment.
Maria worries that people who see the mental health
center van might think those in the van were visiting
Maria’s family. She knew that people with mental illness
needed to live somewhere, but why did it have to be in
her building? Would other recovering mental patients
rent the next vacant apartment in her building? Would
people begin loitering in front of the building or behaving
strangely? Would Maria’s children be safe? Would the reputation of their neighborhood begin to decline?
Introduction
Mental illness is one of the major health issues facing every community. It is the leading cause
of disability in North America and Europe, and costs the United States more than half a trillion
dollars per year in treatment and other expenses (see Figure 11.1).1
Mental disorders are associated with smoking, reduced activity, poor diet, obesity, and hypertension, and also contribute to
unintentional and intentional injury. Mental disorders reduce average life expectancy, in some
cases (involving substance use disorders, anorexia nervosa, schizophrenia, and bipolar mood
disorder) by the same amount as does smoking more than 20 cigarettes a day.2
Clearly, there is
“no health without mental health.”3
Approximately 20% of American adults (about 45 million people) have diagnosable mental
disorders during a given year, and about 5% of adults in the United States have serious mental
illness, that is, illness that interferes with some aspect of social functioning. Only 38% of those
diagnosed with a mental disorder receive treatment.4
Some of these people require only minimal counseling, followed by regular attendance of supportive self-help group meetings to remain
in recovery, while others suffer repeated episodes of disabling mental illness. These individuals
require more frequent medical treatment and more significant community support. Finally,
there are the most severely disturbed individuals, who require repeated hospitalization.
The tragic shootings at Virginia Tech and Northern Illinois Universities brought the issue
of mental disorder in college students to national attention. Almost half of college students
show a 12-month prevalence of some form of mental disorder (most often alcohol use disorder,
at 20.37%), and less than 25% receive treatment (see Table 11.1).5
In 2010, 2.9 million youths
(12.2% of those aged 12 to 17) received treatment or counseling for problems with emotions or
behavior in a specialty mental health setting (inpatient or outpatient care).6
Because the needs of people with mental illness are many and diverse, the services required
to meet these needs are likewise diverse and include not only therapeutic services but social
0% 4% 8% 12% 16% 20% 24%
All other causes of disability
Migraine
Diabetes
Cancer (malignant neoplasms)
Communicable diseases
Digestive diseases
Injuries (disabling)
Sense organ diseases
Cardiovascular diseases
Respiratory diseases
Musculoskeletal diseases
Alzheimer’s disease and dementias
Alcohol and drug use disorders
Mental illnesses
FIGURE 11.1 Causes of disability for all ages combined: United States, Canada, and Western
Europe, 2000.
Note: Measures of disability are based on the number of years of “healthy” life lost with less than full health (i.e., YLD: years lost due to
disability) for each incidence of disease, illness, or condition.
Data from: President’s New Freedom Commission on Mental Health (2003). Achieving the Promise: Transforming Mental Health Care in America.
Rockville, MD: Author, 20.
TABLE 11.1 12-Month Prevalence of Mental Disorders in College Students and
Non-College–Attending Peers, Ages 18–25
Diagnostic Characteristic In College Not in College
Any psychiatric diagnosis 45.79 47.74
Any alcohol use disorder* 20.37 16.98
Any drug disorder* 5.08 6.85
Major depression 7.04 6.67
Bipolar disorder 3.24 4.62
Any anxiety disorder 11.94 12.66
Pathological gambling 0.35 0.23
Any personality disorder* 17.68 21.55
* Difference is statistically significant (p <.05).
Source: Modified from Blanco, C., O. Mayumi, C. Wright, et al. (2008). “Mental Health of College Students and Their Non-College-
Attending Peers.” Archives of General Psychiatry, 65(12), 1429–1437.
Chapter 11 Community Mental Health 289
services requiring significant community resources. As we explain, mental disorders and mental
health care occur in a diverse social, cultural, and economic context that strongly influences
how people cope with adversity, manifest emotional distress, and seek help, and has important
ethical implications for proper diagnosis, treatment, and recovery.
Definitions
Mental health is the “state of successful performance of mental function, resulting in productive
activities, fulfilling relationships with other people, and the ability to adapt to change and to
cope with adversity.”7
Characteristics of people with good mental health include possessing a
good self-image, having positive feelings about other people, and being able to meet the demands
of everyday life.
Good mental health can be expressed as emotional maturity. In this regard, adults who
have good mental health are able to do the following:
1. Function under adversity.
2. Change or adapt to changes around them.
3. Manage their tension and anxiety.
4. Find more satisfaction in giving than receiving.
5. Show consideration for others.
6. Curb hate and guilt.
7. Love others.
“Mental illness is a term that refers collectively to all diagnosable mental disorders.
Mental disorders are health conditions that are characterized by alterations in thinking,
mood, or behavior (or some combination thereof) associated with distress and/or impaired
functioning.”7
People with mental illness have neurobiological disorders that prevent them
from functioning effectively and happily in society. Many people with mental illness can be
treated with medications and other forms of help, and are thus able to adapt successfully
to community life.
Classification of Mental Disorders
The single most influential book in mental health is probably the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric
Association.8
It identifies the various mental disorders, provides descriptive information and
diagnostic instructions for each, and has significant implications for who merits a diagnosis,
whether a treatment should be reimbursed by insurance, what school and social services a
person is entitled to, the top priorities for mental health research, and what kinds of new ther-
apeutic medications should be developed. (Furthermore, as a “living document” that can be
updated online much more frequently than in the past, this latest edition should probably be
regarded as DSM-5.0.) Disorders classified in DSM-5 are listed in Table 11.2.
Like preceding editions, DSM-5 places disorders in discrete categories on the basis of
behavioral signs and symptoms rather than definitive tests or measurements of the brain or
another body system. Not surprisingly, given the multiple purposes it serves, DSM-5 has met
with controversy. For example, one challenge in using a categorical system is to differentiate
normal reactions to life (e.g., severe grief following the death of a loved one) from diagnosable
disorder (e.g., major depression; see Box 11.1).9
In addition, progress in genetic research has
blurred both the boundaries between mental disorders and the boundaries between disorders
and normal variations in behavior.10 As a result, nearly half of people with mental illness (46.4%)
are diagnosed with more than one disorder,11 a problem known as comorbidity. Depression
and anxiety are separate categories in DSM-5, for example, yet are found together in many
individuals12 and have similar genetic risk factors.13
Mental health emotional and
social well-being, including one’s
psychological resources for dealing
with day-to-day problems of life
Mental illness a collective term
for all diagnosable mental disorders
Mental disorders health
conditions characterized by alter-
ations in thinking, mood, or behavior
(or some combination thereof)
associated with distress and/or
impaired functioning
Major depression an affective
disorder characterized by a dysphoric
mood, usually depression, and/or
loss of interest or pleasure in almost
all usual activities or pastimes
290 UNIT TWO The Nation’s Health
TABLE 11.2 Major Diagnostic Categories of Mental Disorders
Category Examples
Neurodevelopmental Disorders Autism Spectrum Disorder, Attention-Deficit/Hyper-
activity Disorder
Schizophrenia Spectrum and Other
Psychotic Disorders
Schizophrenia with Catatonia, Schizoaffective
Disorder
Bipolar and Related Disorders Bipolar Disorder, Cyclothymic Disorder
Depressive Disorders Major Depressive Disorder, Premenstrual Dysphoric
Disorder
Anxiety Disorders Specific Phobia, Panic Disorder, Agoraphobia
Obsessive-Compulsive and Related
Disorders
Obsessive-Compulsive Disorder, Body Dysmorphic
Disorder, Hoarding Disorder
Trauma- and Stressor-Related
Disorders
Posttraumatic Stress Disorder, Acute Stress Disorder
Dissociative Disorders Dissociative Identity Disorder, Dissociative Amnesia
Somatic Symptom and Related
Disorders
Somatic Symptom Disorder, Conversion Disorder
Feeding and Eating Disorders Anorexia Nervosa, Bulimia Nervosa, Binge-Eating
Disorder
Sexual Dysfunctions Erectile Disorder, Female Sexual Interest/Arousal
Disorder
Disruptive, Impulse-Control, and
Conduct Disorders
Conduct Disorder, Pyromania
Substance-Related and Addictive
Disorders
Alcohol Use Disorder, Cannabis Use Disorder, Gam-
bling Disorder
Neurocognitive Disorders Delirium, Alzheimer’s Disease
Personality Disorders Antisocial Personality Disorder, Paranoid Personality
Disorder, Borderline Personality Disorder
BOX 11.1 Criteria for Major Depressive Episode
A. Five (or more) of the following symptoms have been
present during the same 2-week period and represent
a change from previous functioning; at least one of the
symptoms is either (1) depressed mood or (2) loss of
interest or pleasure.
Note: Do not include symptoms that are clearly attribut-
able to another medical condition.
1. Depressed mood most of the day, nearly every day, as
indicated by either subjective report (e.g., feels sad,
empty, hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents,
can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every
day (as indicated by either subjective account or
observation).
3. Significant weight loss when not dieting or weight
gain (e.g., a change of more than 5% of body weight
in a month), or decrease or increase in appetite nearly
every day. (Note: In children, consider failure to make
expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feelings
of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappro-
priate guilt (which may be delusional) nearly every
day (not merely self-reproach or guilt about being
sick).
8. Diminished ability to think or concentrate, or inde-
cisiveness, nearly every day (either by subjective
account or as observed by others).
