Carson CH 18

Contemporary Issues in
Abnormal Psychology
Three Subcategories of Prevention
Universal Interventions
 Efforts aimed at influencing the general
population
Selective Interventions
 Efforts aimed at a specific subgroup of the
population that would be considered at risk for
developing mental health problems
Indicated Interventions
 Efforts that are directed to high-risk individuals,
who are identified as having minimal detectable
symptoms of mental disorder but do not meet
criteria for diagnosis.
Perspectives on Prevention
Universal interventions
 Biological measures
Good Health Habits (Exercise and Diet)
 Psychosocial measures
Develop Skills
Acquire an accurate frame of reference
Becoming prepared for problems related to life cycle
 Sociocultural measures
Reciprocalism between the individual and society
Improve social conditions (consider socioeconomic)
Selective interventions
 Education programs
 Intervention programs for high-risk teens
 Parental education and family-based intervention
programs
 Peer group influence programs (pos. peer culture)
 Programs to increase self-esteem (social skills)
 Mass media and modeling program (
 Combined prevention programs
Indicated intervention
Crisis intervention
 Short-term crisis intervention
 Telephone hot line
 Immediate crisis intervention
services
 Crisis telephone hot-line
counseling services
 Postdisaster debriefing sessions
Mental Hospitals as Therapeutic
Communities
Milieu therapy (environment)
 Increase involvement, clear communication and
expectations.
A social-learning treatment program
 Uses learning principles (token, levels, etc.)
Traditional mental hospital treatments
 Pharmacotherapy, occupational therapy,
recreational therapy, individual and group
therapy.
Aftercare programs
 Reintroduce or gradual return to environment
Controversial Legal Issues and
the Mental Disordered
The commitment process
 Dangerous to themselves, or to
others
 Incapable of providing for their
basic physical needs
 Unable to make responsible
decisions about hospitalization
 And/or in need of treatment or
care in a hospital
Controversial Legal Issues
Forensic Psychology – Branch of
psychology dealing with legal problems
relating to mental disorders and the legal
rights and protection of mental patients.
 Centers on the rights of mental patients and
the rights of members of society to be
protected from disturbed individuals and vice
versa.
 Examples include: right to refuse treatment,
right to be treated in less restrictive
environment, right to treatment, etc…
The Commitment Process
Voluntary Commitment
Involuntary Commitment
 A person who is judged to be potentially
dangerous due to their psychological state may be
confined in a mental institution.
May or may not include legal charges
 The individual must be judged as:
Dangerous to themselves, or to others.
Incapable of providing for their basic physical needs
Unable to make responsible decisions about
hospitalization
And/or in need of treatment or care in a hospital
The Commitment Process
(cont)
Petition for a commitment hearing is filed
Judge appoints two examiners
Hearing occurs within 14 to 30 days
Case is reviewed after 60 days of
hospitalization
The law allows emergency hospitalization
without a formal commitment hearing if
“imminent danger” exists for up to 72
hours
Assessment of Dangerousness I
Prediction is difficult
Typically Err on Conservative Side
 Practitioners Overpredict Violence
 We aren’t as good at prediction as we
would like to be
Increased risk with
 Alcohol Use
 Current Psychotic Symptoms
 Manic Individuals
 Past History of Violence
Assessment of Dangerousness II
Methods of Assessment
 Predisposing Personality + Environ-
mental Instigation = Dangerous Act
 Personality Assessed by Personality Tests
and Past Behavior/History
 Environmental Instigation is Difficult to
Predict
 Very Difficult to Assess Dangerousness in
Overcontrolled Individuals
Assessment of Dangerousness III
Duty to Protect (Tarasoff Decision)

 Resulted from 1976 Court Decision
 Therapist has a duty to warn a prospective
victim of any explicit threat made by a
client in a therapy session.
 Has been inconsistently applied.
 Best guide is to make a reasonable effort
to assess and warn.
Insanity Defense (NGRI) I
NGRI used in less than 2% of court
cases
 The M’Naughten Rule (common)
 The Irresistible Impulse Rule
 The Durham Rule
 American Law Institute Standard (common)
 Federal Insanity Defense Reforms Act
Insanity Defense (NGRI) II
NGRI successful if:
 previous mental illness diagnosis exists
 the defendant is female
 the case does not involve murder
 the individual was previously hospitalized
Guilty But Not Mentally Ill (GBMI)
 Go to tx facility rather than prison
Deinstitutionalization I
Deinstitutionalization – movement to close
mental hospitals and to treat people with
severe mental disorders in the community
Reduced psychiatric population by 73%
from 1970-1992.
Role of antipsychotic medications
Many unforseen problems occurred
Homeless (33% chronic mental disorder
and 84% abuse various substances)
Deinstitutionalization II
Research indicates that deinstitution-alization
is unsuccessful if continuing care in the
community is not available.
70% of all $ spent on mental health in US is
on hospitalization
Effects of Privatization of Mental Health are
Many
Who is hospitalized?
 More socioeconomically advantaged
 HMO members
 Nursing homes are now most common setting for
the chronically mentally ill
Prevention Classification
 Universal Interventions (define and
example)
 Selective Interventions (define and
example)
 Indicated Interventions (define and
example)
Which if any of the approaches have
been effective at decreasing drug
abuse?
Challenges for the Future I
The Crisis in Mental Health Care
 Rise in treatment cost
Biggest future challenge will be getting services
to those who need them
Free clinics and crisis centers have high staff
burnout
 Less often reimbursed
 Less available
Challenges for the Future I
 Managed health care
Pharmacotherapy most common treatment
Focused, Brief, Intermittent Treatment
Individual psychotherapy discouraged
Managed care gatekeepers are not clinicians and
conflicts arise in differences and lack of
understanding
Clinicians have left the field or require cash pay
 The field of Psychotherapy is being most

dramatically altered by economic trends in the
health care industry

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Contemporary Issues in

Duty to Protect (Tarasoff Decision)

 The field of Psychotherapy is being most

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