Chapter 8 Poverty, Income Assistance, and Homelessness

Chapter 8: Mental Health, Substance Abuse, and

Developmental Disabilities

Social Work: A Competency-Oriented Education

Council on Social Work Education (CSWE)

- Defines Educational Policy and Accreditation Standards (EPAs)

- Developed 10 “Core Competencies” and 41 Related “Practice Behaviors”

Every student should master the Practice Behaviors and Core Competencies before completing the program

Resources Aligned to EPAS 2008

The Textbook –

- “Helping Hands” icons call attention to content that relates to Practice Behaviors and Competencies

- “Competency Notes” at the end of the chapter help put the Practice Behaviors and Competencies in practical context

Resources Aligned to EPAS 2008 (cont’d)

The Practice Behaviors Workbook developed

with the text provides assignable exercises that assist in mastering the Practice Behavior and Competencies

Additional on-line resources can be found at: www.cengage.com/socialwork

Mental health needs of people• Mental disorders account for 4 of the 10 leading

causes of disability worldwide• 25% of U.S. population is affected by mental

disorders in any given year• Half of individuals with severe mental disorders are

also affected by substance abuse• Major depression is the leading cause of mental

disability in U.S.

EP 2.1.1a, 2.1.7a, 2.1.9b

Mental health needs of people• 37% of people who abuse alcohol and 53% of

individuals who abuse other drugs have at least one serious mental illness

EP2.1.1a, 2.1.7a, 2.1.9b

Mental health definitions• Societal labeling determines who is categorized

as mentally ill• Stigma of the label is as damaging as the illness• Definitions usually are based on visible

symptoms rather than severity

EP 2.1.3a

Categorizing mental illness• Medical model – severe emotional problems

caused by brain dysfunction or intrapsychic causes• DSM-IV-TR – multiaxial system that focuses on

psychological, biological, and social aspects• PIE system – focuses on social functioning and

environmental, mental health, and physical health

problems

EP 2.1.3b, 2.1.7a, 2.1.7b

Mental health: A matter of viewpointMental health is promoted by our competence in dealing with our environment and our confidence of being able, when necessary, to cause desired effects (Thomas Szasz)

EP 2.1.7a, 2.1.7b

Mental health: A matter of viewpoint (cont’d)Szasz’s classification of mental health problems:• Personal disabilities (e.g., depression)• Antisocial acts• Deterioration of the brain

EP 2.1.7a, 2.1.7b

The development of mental health problems• Heredity, biological, and genetic factors• Psychosocial developmental factors• Social learning• Social stress• Societal reactions and labeling• Collective mobilization• Systems/ecological perspective

EP 2.1.7a, 2.1.7b

Ecological/systems perspective

Allows focus on all factors within individual’s present and past environment:• Behaviors/symptoms and extent to which they

disrupt living• Tolerance of those exposed to symptoms• Cultural assumptions and understandings• Availability of resources and costs to individual and

family, including stigma

EP 2.1.7a

Types of mental health problems

• Depression• Bipolar disorder• Schizophrenia• Anxiety disorders• Suicide• Homelessness

EP 2.1.3a

Impact of mental health status • 5% of children in U.S. experience moderate or

severe emotional or behavioral problems• Women, persons of color, the elderly, those who

are poor, persons who are gay, lesbian, bisexual,

or transgender, and those living in rural areas are

at risk of experiencing mental health problems

EP 2.1.3b

Survivors of disaster and trauma

• Persons who experience or observe trauma are

likely to experience post-traumatic stress disorder

(PTSD) • Persons who work with individuals exposed to

trauma are also subject PTSD• As many as 30% of those who deploy to war zones

experience PTSD

EP 2.1.3b

Alcoholism and chemical dependence• Alcoholism – use of alcohol that interferes with

personal life• Addiction – physical and/or psychological

dependence on mood changing substances,

including but not limited to alcohol, drugs, food,

sex, or money

EP 2.1.7b

Commonly abused substances

• Alcohol• Other depressants• Narcotics, including morphine and heroin• Stimulants such as cocaine and

methamphetamine• Hallucinogens, including marijuana• Rohypnol

EP 2.1.3a

Cost of substance abuse• Deaths• Disability• Accidents• Crime• Property losses• Long-term impacts on children • An estimated $420 billion in 2009

EP2.1.9a

At-risk populations and substance abuse

• Adolescents• Elderly • Women• Children• People of color

EP 2.1.7b

Other factors • Genetics• Physiology• Self-medication • Experimentation• Desire to “fit it”• Learned behavior

EP 2.1.3a

Intervention Approaches• Alcoholics Anonymous/other self-help groups• Hospitalization• Day and out-patient treatment programs• Family systems model• Psycho educational approach• Dual diagnosis

EP 2.1.3a

Developmental disabilitySevere, chronic disability of a person:• Attributable to mental or physical impairment or

combination of both• Manifested before age 22• Likely to continue indefinitely• Results in substantial functional limitations • Results in need for special care/services

EP 2.1.7b

Americans with Disabilities Act (ADA)

• Enacted in 1990• Covers persons with AIDS, substance abusers,

and those with mental disorders • Includes physical disabilities such as cerebral

palsy, learning disabilities, and developmental

EP 2.1.7b

Factors associated with

developmental disability• Hereditary and fetal development • Prenatal • Perinatal • Postnatal

EP 2.1.7a

Changing views • From inhumane to moral treatment• Introduction of psychoanalysis• Shift to community mental health programs• Initial postwar developments• Deinstitutionalization• Community mental health programs• Neurobiology and related technologies

EP 2.1.1a, 2.1.8b, 2.1.9a

Intervention options

• Partial hospitalization• Day treatment programs• Halfway houses • Supervised living

EP 2.1.9b

Quality mental health programs

• Comprehensive services and supports• Integrated delivery system• Sufficient funding• Consumer and family-driven systems• Safe and respectful treatment environments• Information accessible to consumers and family

members

EP 2.1.9b

Quality mental health programs• Culturally competent• Emphasize health promotion and morality

reduction• Adequate mental health workforce

EP 2.1.9b

Intervention

• Self-help groups• Family systems model• Cognitive/behavioral approach• Few inpatient or residential programs exist for

women and children that also provide care for the

children

EP 2.1.3b, 2.1.8b

The Americans with Disabilities Act

• Comprehensive approach • Bans discrimination based on disabilities among

private employers with a work force of more than

15 persons• Provides for accommodations in public places,

services, transportation, and telecommunications

EP2,1,8a, 2.1.8b, 2.1.9b

The Americans with Disabilities Act (cont’d)

• Advocated for supported employment of individuals

with disabilities• Encouraged education and reduction of stigma

associated with having a disability

EP2,1,8a, 2.1.8b, 2.1.9b

Other legislation• The Rehabilitation Act• The Assistive Technology Act• Crime Victims with Disabilities Awareness Act• Hate Crimes Prevention Act• No Child Left Behind Act (NCLB)• Individuals with Disabilities Education Act (IDEA)• Deficit Reduction Act of 2005

EP2.1.8a, 2.1.9b

Other legislation (cont’d)• Wellstone and Domenici Mental Health Parity and

Addiction Act (2008)• Patient Protection and Affordable Care Act (2010)

EP2.1.8a, 2.1.9b

The struggle continues

• End discrimination in seeking housing • Guard against abuses that stem from Medicaid

managed care• Achieve full funding of each component of the

NCLB• Reauthorization of key legislation• Expand S-CHIP

EP2.1.8a, 2.1.9b

The struggle continues (cont’d)• Amend federal revenue and tax policy to enable

families of people with disabilities to stay together• Strengthen civil rights laws that affect people with

disabilities• Fund and regulate attendant services for persons

with disabilities

EP 2.1.8a, 2.1.9b

The struggle continues (cont’d)

• Protection of individuals with disabilities from:

- Criminalization or victimization based on

disability

- Use of genetic information to deny employment

or health insurance

- Use of physical and chemical restraints and

seclusion

EP 2.1.8a, 2.1.9b

Affordable Care Act

• Comprehensive health care reform legislation enacted on March 23, 2010

• Expected to expand insurance coverage to 32 million U.S. citizens and legal immigrants by 2019

• Monumental accomplishment for the Obama administration

• Fulfilled one of Obama’s major campaign promises

EP 2.1.1a, 2.1.8a

Affordable Care Act (cont’d)

• Parity for mental health and substance abuse services

• No discrimination based on preexisting conditions• No rate changes based on health status• Greater availability of insurance, at lower cost• Expansion of Medicaid

EP 2.1.1a, 2.1.8a

Career opportunities• Clinical social work• Crisis intervention and child and family services• School-based services and drug treatment • Case managers • Advocates• Policymakers• Outreach programs

EP 2.1.1a, 2.1.8b, 2.1.9b

Chapter 8 Poverty, Income Assistance, and Homelessness

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