Transcript Document

What are Behavioral Health Disorders?

When we use the term, we are referring to:
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
Mental disorders (or mental illnesses) + substance use
disorders = behavioral health disorders
However, the term “behavioral health” is not universally
agreed upon in the field
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
Historical context
Differences between mental health and substance use
treatment communities/systems
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What are Mental Disorders?
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A syndrome characterized by clinically significant disturbances
in a person’s thinking, emotional state, and/or behavior that
disrupt his/her ability to work or carry out other daily
activities, and engage in satisfying personal relationships
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The diagnosis of a mental disorder should have clinical utility:
it should help determine prognosis, plan
treatment, and potential outcomes.

Individuals whose symptoms do not meet
full criteria for a disorder may still need
treatment or care.
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The Key Dimensions of Mental
Disorders
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Anxiety
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Disturbances in perception and thinking
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Hallucinations, delusions
Disturbances of cognition
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Feelings of fear or dread, rapid heart rate, shortness of breath,
lightheadedness
Difficulty organizing, processing, and recalling information
Disturbances of mood
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Emotional highs or lows as prominent feature
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When Do Symptoms Cross a Threshold
to Become a Disorder?
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Mental illness and mental health exists on a continuum
that is based on the:
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Nature and severity of symptoms
Duration of symptoms
Extent to which symptoms cause “clinically significant distress
or impairment in social, occupational, or other important areas
of functioning.”
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How Are Disorders Determined and
Described?
Multiple sources of information
Recognizable pattern of
symptoms (Syndrome)
Meets explicit criteria as
described in the DSM-5
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How Are Mental Disorders Diagnosed?
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The Diagnostic and Statistical Manual Fifth Edition (DSM5) of the American Psychiatric Association provides a
common language and typology for mental disorders in
both children and adults.
• APA published first classification of
mental disorders in 1844 as
forerunner of DSM
• Four iterations post WW II with
DSM-IV-TR published in 2000
• The DSM-5 was released by the
American Psychiatric Association in
May 2013
• DSM 5 builds on its predecessors
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What Are Substance Use Disorders?
Addiction is a brain disease that affects multiple brain
circuits, including those involved in reward and motivation,
learning and memory, and inhibitory control over behavior.
National Institute on Drug Abuse: Drug Facts- Treatment Approaches for Drug Addiction:
http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
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The annual total estimated societal cost of substance abuse in
the United States is $510.8 billion
Source: Substance Abuse and Mental Health Services Administration, Leading Change: A Plan for SAMHSA’s Roles and Actions
2011-2014 Executive Summary and Introduction. HHS Publication No. (SMA) 11-4629 Summary. Rockville, MD: Substance Abuse and
Mental Health Services Administration,2011.
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Not all Mental Illnesses are Alike:
Mental Illness in the General Population
Diagnosable
mental
disorders 16%
Serious
mental
disorders
5%
Severe
mental
disorders
2.5%
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In a Given Year…

22% of the United States adult population will be
diagnosed with a behavioral disorder
16% Meet
criteria for
mental illness
9% Meet
criteria for
substance
use
disorders
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What Are Co-Occurring Disorders?

The term refers to co-occurring substance use
(abuse or dependence) and mental health
disorders.
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Clients said to have co-occurring disorders
when at least one disorder of each type can be
established independently of the other and is
not simply a cluster of symptoms resulting from
a single disorder.
COCE, 2007
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PARALLELS: MENTAL ILLNESSES AND ADDICTIONS
(Minkoff, 1996)
MAJOR MENTAL ILLNESS
ALCOHOLISM/ADDICTION
1.
A biological illness.
1.
A biological illness.
2.
Hereditary (in part).
2.
Hereditary (in part).
3.
Chronicity
3.
Chronicity
4.
Incurability
4.
Incurability
5.
Leads to lack of control of behavior and
emotions
5.
Leads to lack of control of behavior and
emotions
6.
Affects the whole family
6.
Affects the whole family
7.
Symptoms can be controlled with proper
treatment
7.
Symptoms can be controlled with proper
treatment
8.
Progression of the disease without treatment
8.
Progression of the disease without treatment
9.
Disease of denial
9.
Disease of denial
10.
Facing the disease can to lead to depression
and despair.
10.
Facing the disease can to lead to depression
and despair.
11.
Disease is often seen as a “moral issue,” due
to personal weakness rather than biological
causes
11.
Disease is often seen as a “moral issue,” due
to personal weakness rather than biological
causes
12.
Feelings of guilt and failure
12.
Feelings of guilt and failure
13.
Feelings of shame and stigma
13.
Feelings of shame and stigma
14.
Physical, mental, and spiritual disease
14.
Physical, mental, and spiritual disease
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What is the Relationship between Mental
Illnesses and Substance Use Disorders?
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Acute and chronic substance use can produce psychiatric
symptoms
Substance withdrawal can cause psychiatric symptoms
Substance use can mask psychiatric symptoms
Psychiatric disorders can mimic symptoms associated
with substance use
Acute and chronic substance use can exacerbate
psychiatric disorders
Acute and chronic psychiatric disorders can exacerbate
the recovery process from addictive disorders
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Consequences of Co-occurring Disorders
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Increased vulnerability to relapse and rehospitalization
More psychotic symptoms
Inability to manage finances
Housing instability and homelessness
Noncompliance with medications and treatment
Increased vulnerability to HIV infection and hepatitis
Increased contact with the criminal justice system
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Substance Abuse & Addiction in
Criminal Justice
60
54 %
47 %
Percent of Population
50
53 %
44 %
Alcohol use disorder
(Includes alcohol
abuse and
dependence)
40
30
Drug use disorder
(Includes drug abuse
and dependence)
20
8%
10
2%
0
Household
Jail
Source: Compton et al., Am J Psychiatry, 2010.
State Prison
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SMI and Co-Occurring Substance Use
Disorders (CODs)
Prevalence of SMI and CODs in Jail Populations
General Population
Jail Population
95%
5%
83%
28%
17%
72%
Serious Mental Illness
Serious Mental Illness
COD
No Serious Mental Illness
No Serious Mental Illness
No COD
Sources: Kessler RC, Chiu WT, Demler O, Walters EE. “Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the
National Comorbidity Survey Replication” (NCS-R). Archives of General Psychiatry, 2005 Jun; 62 (6): 617-27; Henry Steadman, Fred C.
Osher, Pamela C. Robbins, Brian Case, and Steven Samuels, “Prevalence of Serious Mental Illness Among Jail Inmates,” Psychiatric Services,
60 (2009): 761-65; Abram, K. M., Teplin, L. A. (1991). “Co-occurring disorders among mentally ill jail detainees,” American Psychologist, 46
(10), 1036–1045.
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What Are Co-Occurring Disorders?
(contd.)
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Among the jail population:
83%
28%
17%
72%
Serious Mental Illness
No Serious Mental Illness
Co-Occurring Substance Use
Disorder
No Co-Occurring Substance
Use Disorder
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The Problem: Overrepresentation of
Persons with Behavioral Disorders. Why?
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Arrested at disproportionately higher rates
 Co-occurrence of substance use disorders
 Homelessness
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Stay longer in jail and prison
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Limited access to health care
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Low utilization of EBPs
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High recidivism rates
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More criminogenic risk factors
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What Accounts for the Problem?
High Recidivism Rates on Reentry
Screened 2,934
probationers for
mental illness:
• 13% identified as
mentally ill
• Followed for average
of two years
No more likely to be arrested …
… but 1.38 times more likely to be revoked
Source: Vidal, Manchak, et al. (2009); see also: Eno Louden & Skeem (2009); Porporino & Motiuk (1995)
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What Accounts for the Problem?
Those with Mental Illnesses Have More “Central 8”
Dynamic Risk Factors
60
58
56
54
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50
48
46
44
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40
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Persons with mental illnesses
Persons without mental illnesses
LS/CMI Tot
….and these predict recidivism more strongly than mental
illness
Source: Skeem, Nicholson, & Kregg (2008)
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The Behavioral Health – Criminal
Justice Problem in Summary
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We arrest them more often . . .
We stress them while they’re incarcerated . . .
We keep them incarcerated longer . . .
They don’t get access to adequate mental health care . . .
They are more likely to “fail” community supervision.
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