Mental Health and Mental Illness: Points on a Continuum
As will be evident in the pages that follow, “mental health” and “mental illness” are not polar opposites but may be thought of as points on a continuum. Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. Mental health is indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society. It is easy to overlook the value of mental health until problems surface. Yet from early childhood until death, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem. These are the ingredients of each individual’s successful contribution to community and society. Americans are inundated with messages about success—in school, in a profession, in parenting, in relationships—without appreciating that successful performance rests on a foundation of mental health. Many ingredients of mental health may be identifiable, but mental health is not easy to define. In the words of a distinguished leader in the field of mental health prevention, “. . . built into any definition of wellness . . . are overt and covert expressions of values. Because values differ across cultures as well as among subgroups (and indeed individuals) within a culture, the ideal of a uniformly acceptable definition of the constructs is illusory” (Cowen, 1994). In other words, what it means to be mentally healthy is subject to many different interpretations that are rooted in value judgments that may vary across cultures. The challenge of defining mental health has stalled the development of programs to foster mental health (Secker, 1998), although strides have been made with wellness programs for older people (Chapter 5). Mental illness is the term that refers collectively to all diagnosable mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning. Alzheimer’s disease exemplifies a mental disorder largely marked by alterations in thinking (especially forgetting). Depression exemplifies a mental disorder largely marked by alterations in mood. Attention-deficit/hyperactivity disorder exemplifies a mental disorder largely marked by alterations in behavior (overactivity) and/or thinking (inability to concentrate). Alterations in thinking, mood, or behavior contribute to a host of problems—patient distress, impaired functioning, or heightened risk of death, pain, disability, or loss of freedom (American Psychiatric Association, 1994). This report uses the term“mental health problems” for signs and symptoms of insufficient intensity or duration to meet the criteria for any mental disorder. Almost
everyone has experienced mental health problems in which the distress one feels matches some of the signs and symptoms of mental disorders. Mental health problems may warrant active efforts in health promotion, prevention, and treatment. Bereavement symptoms in older adults offer a case in point. Bereavement symptoms of less than 2 months’ duration do not qualify as a mental disorder, according to professional manuals for diagnosis (American Psychiatric Association, 1994). Nevertheless, bereavement symptoms can be debilitating if they are left unattended. They place older people at risk for depression, which, in turn, is linked to death from suicide, heart attack, or other causes (Zisook & Shuchter, 1991, 1993; Frasure-Smith et al., 1993, 1995; Conwell, 1996). Much can be done—through formal treatment or through support group participation—to ameliorate the symptoms and to avert the consequences of bereavement. In this case, early intervention is needed to address a mental health problem before it becomes a potentially life-threatening disorder.
Communities provide different types of treatment programs and services for individuals with mental illnesses. A complete range of programs and services is called the continuum of care. Not every community has every type of service or program on the continuum however states or regions as a whole often provide an array of services along the continuum. The American Academy of Child and Adolescent Psychiatry has issued the following guide about the continuum of care for children and adolescents. While the continuum differs slightly for adults, the guide provides an in depth look at the various levels of care available.
The Continuum of Care for Children and Adolescents
The beginning point for parents concerned about their child's behavior or emotions should be an evaluation by a qualified mental health professional such as a child and adolescent psychiatrist. the conclusion of the evaluation, the professional will recommend a certain type of service(s) or program(s) from the continuum available locally. The professional is then usually required to obtain approval from the insurance company or organization managing mental health benefits (e.g. managed care organization). In the case of programs funded publicly, a specific state agency must authorize the recommended program(s) or service(s). If the program or service is not authorized, it will not be paid. Many of the programs on the continuum offer a variety of different treatments, such as individual psychotherapy, family therapy, group therapy, and medications. A brief description of the different services or programs in a continuum of care follows: Office or outpatient Visits are usually 30-60 minutes. The number of visits per month depends clinic on the youngster's needs. Intensive case Specially trained individuals coordinate or provide psychiatric, financial, management legal, and medical services to help the child or adolescent live successfully at home and in the community. Home-based treatment A team of specially trained staff go into a home and develop a treatment services program to help the child and family. Family support services Services to help families care for their child such as parent training, parent support group, etc. Day treatment program This intensive treatment program provides psychiatric treatment with special education. The child usually attends five days per week. Partial hospitalization This provides all the treatment services of a psychiatric hospital, but the (day hospital) patients go home each evening. Emergency/crisis 24-hour-per-day services for emergencies (for example, hospital services emergency room, mobile crisis team). Respite care services A patient stays briefly away from home with specially trained individuals. Therapeutic group home This therapeutic program usually includes 6 to 10 children or adolescents
or community residence per home, and may be linked with a day treatment program or specialized educational program. Crisis residence This setting provides short-term (usually fewer than 15 days) crisis intervention and treatment. Patients receive 24-hour-per-day supervision. Residential treatment Seriously disturbed patients receive intensive and comprehensive facility psychiatric treatment in a campus-like setting on a longer-term basis. Click here to access A Resouce for Families Considering Residential Treatment Programs for their Children. A guide issued by NAMI, the National Alliance on Mental Illness. Hospital treatment Patients receive comprehensive psychiatric treatment in a hospital. Treatment programs should be specifically designed for either children or adolescents. Length of treatment depends on different variables