Contemporary Issues in Contemporary Issues in Abnormal PsychologyAbnormal Psychology

Three Subcategories of PreventionThree Subcategories of Prevention

Universal InterventionsUniversal Interventions Efforts aimed at influencing the general Efforts aimed at influencing the general

populationpopulation

Selective InterventionsSelective Interventions Efforts aimed at a specific subgroup of the Efforts aimed at a specific subgroup of the

population that would be considered at risk for population that would be considered at risk for developing mental health problemsdeveloping mental health problems

Indicated InterventionsIndicated Interventions Efforts that are directed to high-risk individuals, Efforts that are directed to high-risk individuals,

who are identified as having minimal detectable who are identified as having minimal detectable symptoms of mental disorder but do not meet symptoms of mental disorder but do not meet criteria for diagnosis.criteria for diagnosis.

Perspectives on PreventionPerspectives on Prevention

Universal interventionsUniversal interventions Biological measuresBiological measures

Good Health Habits (Exercise and Diet)Good Health Habits (Exercise and Diet) Psychosocial measuresPsychosocial measures

Develop SkillsDevelop Skills

Acquire an accurate frame of referenceAcquire an accurate frame of reference

Becoming prepared for problems related to life cycleBecoming prepared for problems related to life cycle Sociocultural measuresSociocultural measures

Reciprocalism between the individual and societyReciprocalism between the individual and society

Improve social conditions (consider socioeconomic)Improve social conditions (consider socioeconomic)

Perspectives on PreventionPerspectives on Prevention

Perspectives on PreventionPerspectives on Prevention

Selective interventionsSelective interventions

Education programsEducation programs Intervention programs for high-risk teensIntervention programs for high-risk teens Parental education and family-based intervention Parental education and family-based intervention

programsprograms Peer group influence programs (pos. peer culture)Peer group influence programs (pos. peer culture) Programs to increase self-esteem (social skills)Programs to increase self-esteem (social skills) Mass media and modeling program (Mass media and modeling program ( Combined prevention programsCombined prevention programs

Perspectives on PreventionPerspectives on Prevention

Indicated interventionIndicated intervention

Crisis interventionCrisis intervention Short-term crisis interventionShort-term crisis intervention Telephone hot lineTelephone hot line Immediate crisis intervention Immediate crisis intervention

servicesservices Crisis telephone hot-line Crisis telephone hot-line

counseling servicescounseling services Postdisaster debriefing sessionsPostdisaster debriefing sessions

Mental Hospitals as Therapeutic Mental Hospitals as Therapeutic CommunitiesCommunities

Milieu therapy (environment)Milieu therapy (environment) Increase involvement, clear communication and Increase involvement, clear communication and

expectations.expectations.

A social-learning treatment programA social-learning treatment program Uses learning principles (token, levels, etc.)Uses learning principles (token, levels, etc.)

Traditional mental hospital treatmentsTraditional mental hospital treatments Pharmacotherapy, occupational therapy, Pharmacotherapy, occupational therapy,

recreational therapy, individual and group recreational therapy, individual and group therapy.therapy.

Aftercare programsAftercare programs Reintroduce or gradual return to environmentReintroduce or gradual return to environment

Controversial Legal Issues and Controversial Legal Issues and the Mental Disorderedthe Mental Disordered

The commitment processThe commitment process Dangerous to themselves, or to Dangerous to themselves, or to

othersothers Incapable of providing for their Incapable of providing for their

basic physical needsbasic physical needs Unable to make responsible Unable to make responsible

decisions about hospitalizationdecisions about hospitalization And/or in need of treatment or And/or in need of treatment or

care in a hospitalcare in a hospital

Controversial Legal IssuesControversial Legal IssuesForensic Psychology – Branch of Forensic Psychology – Branch of psychology dealing with legal problems psychology dealing with legal problems relating to mental disorders and the legal relating to mental disorders and the legal rights and protection of mental patients.rights and protection of mental patients. Centers on the rights of mental patients and Centers on the rights of mental patients and

the rights of members of society to be the rights of members of society to be protected from disturbed individuals and vice protected from disturbed individuals and vice versa. versa.

Examples include: right to refuse treatment, Examples include: right to refuse treatment, right to be treated in less restrictive right to be treated in less restrictive environment, right to treatment, etc…environment, right to treatment, etc…

The Commitment ProcessThe Commitment ProcessVoluntary CommitmentVoluntary Commitment

Involuntary CommitmentInvoluntary Commitment A person who is judged to be potentially A person who is judged to be potentially

dangerous due to their psychological state may be dangerous due to their psychological state may be confined in a mental institution. confined in a mental institution.

May or may not include legal chargesMay or may not include legal charges The individual must be judged as:The individual must be judged as:

Dangerous to themselves, or to others.Dangerous to themselves, or to others.

Incapable of providing for their basic physical needsIncapable of providing for their basic physical needs

Unable to make responsible decisions about Unable to make responsible decisions about hospitalizationhospitalization

And/or in need of treatment or care in a hospitalAnd/or in need of treatment or care in a hospital

The Commitment Process The Commitment Process (cont)(cont)

Petition for a commitment hearing is filedPetition for a commitment hearing is filed

Judge appoints two examinersJudge appoints two examiners

Hearing occurs within 14 to 30 daysHearing occurs within 14 to 30 days

Case is reviewed after 60 days of Case is reviewed after 60 days of hospitalizationhospitalization

The law allows emergency hospitalization The law allows emergency hospitalization without a formal commitment hearing if without a formal commitment hearing if “imminent danger” exists for up to 72 “imminent danger” exists for up to 72 hourshours

Assessment of Dangerousness IAssessment of Dangerousness I

Prediction is difficult Prediction is difficult Typically Err on Conservative Side Typically Err on Conservative Side Practitioners Overpredict ViolencePractitioners Overpredict Violence We aren’t as good at prediction as we We aren’t as good at prediction as we

would like to bewould like to be

Increased risk with Increased risk with Alcohol Use Alcohol Use Current Psychotic SymptomsCurrent Psychotic Symptoms Manic IndividualsManic Individuals Past History of ViolencePast History of Violence

Assessment of Dangerousness IIAssessment of Dangerousness II

Methods of AssessmentMethods of Assessment Predisposing Personality + Environ-Predisposing Personality + Environ-

mental Instigation = Dangerous Actmental Instigation = Dangerous Act Personality Assessed by Personality Tests Personality Assessed by Personality Tests

and Past Behavior/Historyand Past Behavior/History Environmental Instigation is Difficult to Environmental Instigation is Difficult to

PredictPredict Very Difficult to Assess Dangerousness in Very Difficult to Assess Dangerousness in

Overcontrolled IndividualsOvercontrolled Individuals

Assessment of Dangerousness IIIAssessment of Dangerousness III

Duty to Protect (Tarasoff Decision)Duty to Protect (Tarasoff Decision) Resulted from 1976 Court DecisionResulted from 1976 Court Decision Therapist has a duty to warn a prospective Therapist has a duty to warn a prospective

victim of any explicit threat made by a victim of any explicit threat made by a client in a therapy session.client in a therapy session.

Has been inconsistently applied. Has been inconsistently applied. Best guide is to make a reasonable effort Best guide is to make a reasonable effort

to assess and warn.to assess and warn.

Insanity Defense (NGRI) IInsanity Defense (NGRI) I

NGRI used in less than 2% of court NGRI used in less than 2% of court casescases The M’Naughten Rule (common)The M’Naughten Rule (common) The Irresistible Impulse RuleThe Irresistible Impulse Rule The Durham RuleThe Durham Rule American Law Institute Standard (common)American Law Institute Standard (common) Federal Insanity Defense Reforms ActFederal Insanity Defense Reforms Act

Insanity Defense (NGRI) IIInsanity Defense (NGRI) II

NGRI successful if:NGRI successful if: previous mental illness diagnosis existsprevious mental illness diagnosis exists the defendant is femalethe defendant is female the case does not involve murderthe case does not involve murder the individual was previously hospitalizedthe individual was previously hospitalized

Guilty But Not Mentally Ill (GBMI)Guilty But Not Mentally Ill (GBMI) Go to tx facility rather than prisonGo to tx facility rather than prison

Deinstitutionalization IDeinstitutionalization IDeinstitutionalization – movement to close Deinstitutionalization – movement to close mental hospitals and to treat people with mental hospitals and to treat people with severe mental disorders in the communitysevere mental disorders in the community

Reduced psychiatric population by 73% Reduced psychiatric population by 73% from 1970-1992.from 1970-1992.

Role of antipsychotic medicationsRole of antipsychotic medications

Many unforseen problems occurredMany unforseen problems occurred

Homeless (33% chronic mental disorder Homeless (33% chronic mental disorder and 84% abuse various substances)and 84% abuse various substances)

Deinstitutionalization IIDeinstitutionalization II

Research indicates that deinstitution-alization Research indicates that deinstitution-alization is unsuccessful if continuing care in the is unsuccessful if continuing care in the community is not available.community is not available.70% of all $ spent on mental health in US is 70% of all $ spent on mental health in US is on hospitalizationon hospitalizationEffects of Privatization of Mental Health are Effects of Privatization of Mental Health are Many Many Who is hospitalized?Who is hospitalized? More socioeconomically advantagedMore socioeconomically advantaged HMO membersHMO members Nursing homes are now most common setting for Nursing homes are now most common setting for

the chronically mentally illthe chronically mentally ill

Perspectives on PreventionPerspectives on PreventionPrevention ClassificationPrevention Classification Universal Interventions (define and Universal Interventions (define and

example)example) Selective Interventions (define and Selective Interventions (define and

example)example) Indicated Interventions (define and Indicated Interventions (define and

example)example)

Which if any of the approaches have Which if any of the approaches have been effective at decreasing drug been effective at decreasing drug abuse?abuse?

Challenges for the Future IChallenges for the Future I

The Crisis in Mental Health CareThe Crisis in Mental Health Care Rise in treatment costRise in treatment cost

Biggest future challenge will be getting services Biggest future challenge will be getting services to those who need themto those who need them

Free clinics and crisis centers have high staff Free clinics and crisis centers have high staff burnoutburnout

Less often reimbursed Less often reimbursed Less availableLess available

Challenges for the Future IChallenges for the Future I Managed health careManaged health care

Pharmacotherapy most common treatmentPharmacotherapy most common treatmentFocused, Brief, Intermittent TreatmentFocused, Brief, Intermittent TreatmentIndividual psychotherapy discouraged Individual psychotherapy discouraged Managed care gatekeepers are not clinicians and Managed care gatekeepers are not clinicians and conflicts arise in differences and lack of conflicts arise in differences and lack of understandingunderstandingClinicians have left the field or require cash payClinicians have left the field or require cash pay

The field of Psychotherapy is being most The field of Psychotherapy is being most dramatically altered by economic trends in the dramatically altered by economic trends in the health care industryhealth care industry