She campaigned for reform in 1854 to get federal help for care of mentally ill - failed.

Organized a corps of nurses in the Civil War - 1802-1887.

Provided five basic services in the community.

1. inpatient hospitalization

2. partial hospitalization

3. outpatient services

4. emergency services

5. Education and consultation

*In ID, all that remains is part of Adult MHS of IDHW.

Homelessness Huge numbers of the mentally ill in prison

(16% or 283,800 in local and state correctional facilities are mentally ill.)

(Dep't of Juv. Corrections estimates the figure of mentally disturbed youth at 30%)

*Late 1980s 50% of homeless in NYC were mentally ill *Mayor Koch authorized mental health workers to commit them to Bellevue Hospital.

*By 1999, 41 states had authorized the practice. *Provides for the commitment of individuals who d/n meet the standard for involuntary commitment but who are unable to seek treatment on their own.

The Substance Abuse and Mental Health Services Administration

*oversees all block grants to the states

*since 1990s funding has remained static

Agencies are awarded a predetermined amt of $ per client for whom they must provide services.

Intent is for agencies to provide preventative and primary care like HMOs. Growing practice.

In '04, epidemiologist discovered that children taking antidepressants were >2x more likely to be suicidal.

FDA refused to allow him to testify in cong. hrgs.

Later FDA backed down and put warning labels on meds

Still # of children on antidepressants increased 15% first 3 mo. of '04

Nat'l Alliance on Mental Illness

Founded in 90s by a group of patients & relatives to fight for mentall ill & prevent arbitrary cuts by gov't

Group is active in ID in working w/IDHW

Provided for req'd inclusion of MH services w/employee health benes

Results: Modest. Only applies to businesses w/50+ employees. Some employees altered employee benes so MH benes were more restrictive

Hope: This Act will mark the end of MH funding downsizing

Substance Abuse and Mental Health Administration

Fed. agency responsible for all the block grants to the states for services in substance abuse & MH & for determining nat'l policy

*18 million Americans are alcoholics

*200,000 alcoholics die each yr.

*5.5 million Americans are drug abusers

*5,000 - 10,000 drug abusers die each yr.

400,000 smokers die each yr.

1906

Req'd that ingredients of food products be listed

People found that cocaine was used in some medications and in Coca-Cola

1914

Restricted cocaine, marijuana, and heroin

1919-1933

18th Amendment

1937

Outlawed marijuana

American Drinkers:

1/3 abstains

1/3 are light drinkers

1/3 are moderate-heavy drinkers

Drunk Driving: In '05, 16,885 died in alcohol-related accidents or 39% of all traffic accidents

Fetal Alcohol Syndrome: Physiological and mental deformation in infants caused by the mother drinking during pregnancy

*Difficult to ascertain the extent of the problem because it is illegal and underground

About 112 million Americans report they have used drugs in their lives (36% of the pop.)

About 15% used drugs in the past year

Drug abuse has declined for ages 12-17 but increased slightly for young adults

14.2% of new AIDS cases are IV drug injectors

Programs like DARE have not proven to be effective

Especially true in high-risk neighborhoods

Available to people w/good insurance and the rich

Much less available to the poor

Even w/pmt, resources cannot keep up w/need

SAMSHA reports that after 12 months of treatment, illicit drug use drops significantly (MJ: 51%; cocaine: 55%; crack: 51%; Heroin: 47%)

Long range abstinence has yet to be determined by research

Well-intentioned pain policies + powerful opiate meds are leading to a nat'l epidemic of pill popping - and accidental overdose.

As the medical community has become more attentive to acute and chronic pain, new powerful drugs are prescribed

Drugs like Oxycodone, Oxycontin, and Hydrocodone are sold under various names like Vicodin

1990 - 6,000 deaths in US from accidental drug poisoning

By 2007 - 27,658 deaths

*sharp rise in opioids

*Many workers are becoming private therapists serving clientele w/insurance

*There is good pay (in '08, median income was $62,500)

 *By 2008, 23% of SWs were in private practice

*While respecting this choice, many worry about the profession losing its ID w/serving the poor, esp. minorites, women, children, elderly, & disabled.

*2003: 35% of SWs were in the for-profit sector

1. Preferential Selection: selecting certain clients for service & rejecting others (w/o ins.) Places a huge burden on public agencies. Some call this the YAVIS syndrome: clients selected are young, attractive, verbal, intelligent, and successful. Could add W for white.

2. Deliberate Misdiagnosis: intentional error by clinicians to avoid a more stigmatizing "label" or to collect ins. Tends to cause over-reporting of serious diagnoses.

3. Signing off: PhD psychologist signs off on work done by a SW in order to get a higher rate of reimbursement

4. Accountability: Since the practice is private, more opp. for fraud & unethical practices than pub. agencies

Presently trend is toward more growth as gov't continues to privatize soc. services

More SWs in the future will be in private practice or working for for-profit organizations

Workers opt for private practice in no small part b/c of the problems they encounter in traditional agencies: rigid agency policies, large caseloads, lack of ability to have personal time off, and often low pay.

Employee Assistance Plans

Beginning in 1970s, SWs started working in EAPs b/c they offer a limited amt. of counseling sessions for an employee of a firm that will be held confidential from the employee's business.

Sometimes the EAP is located w/in the sponsoring business.

Some studies show that services offered in-house are considered superior to those contracted out.

MH services have been severely harmed by old policy conflict of whether the fed. gov't or the states should take resp. for the mentally ill.

When the responsibility for the mentally ill was devolved in the 80s, the states failed to properly fund the services that are needed.

Also, effects of deinstitutionalization are still evident in the lg. #s of mentally ill who are homeless or in prisons.

Substance abuse services have been compromised by a different policy dispute: should the approach be interdiction or treatment? So far, the lion's share of the $ has gone to law enforcement, leaving little for treatment.