Darrell P. Wheeler
Catherine G. Greeno
Mental illnesses are very common; more than one-quarter of people will develop a mental illness during their lifetime. Mental illnesses are associated with substantial disability in work, relationships, and physical health, and have been clearly established as one of the leading causes of disability in the developing, as well as the industrialized world. Mental disorders are common in every service sector important to social workers, and affect outcomes in every service sector. Mental disorders are strongly associated with poverty worldwide, and are common and often unrecognized in the general health sector, child welfare, and criminal justice settings, among others. Basic information about mental health is thus important to all social workers. Information about classification systems and major categories of mental illnesses, including depression, anxiety, psychotic disorders, and substance abuse disorders, is presented. The service system for mental disorders is badly underdeveloped, and most people who need treatment do not receive it. There is an increasing body of evidence demonstrating effective treatments, and policy is moving toward requiring that treatments offered be evidence based. This is a period of a great explosion of knowledge about mental health, and we can expect considerable advances in the coming years.
This entry focuses on services for adults with severe mental illness, specifically the five psychosocial interventions considered evidence-based practices. The emergence of psychiatric rehabilitation, the only professional discipline designed to serve a specified population, is described. The primary historical practice approaches, which are the foundation for psychiatric rehabilitation, are discussed. Each of the five evidence-based practices is then described with the empirical supporting evidence. The emphasis on this population and interventions were selected as social workers are the major providers for this population and frequent implementers and developers of these interventions.
Matthew Epperson, Julian Thompson, and Kelli E. Canada
This article discusses the emergence, structure, and purpose of the mental health court. It details the therapeutic aspects of the mental health court and its function as a specialized-treatment court serving persons with serious mental illnesses in the criminal justice system. Guiding themes, such as the criminalization of mental illness, therapeutic jurisprudence, and drug-treatment courts are described. It also identifies key legislation that contributed to the funding and proliferation of mental health courts. The effectiveness of mental health court, along with current criticisms regarding its impact on participants’ mental health and recidivism outcomes, are also covered. Last, social work values and the various roles of social workers in the mental health court are highlighted to demonstrate the relevance of mental health court to contemporary social work practice and intervention.
Continuing a history of inequity, private insurers have placed restrictions and limitations on coverage for mental health conditions making access to treatment services increasingly more challenging. A state-by-state advocacy movement has led to the enactment of various state laws to require mental health parity. With the Clinton Administration’s attempt at health care reform, mental health parity became part of the health reform debate and led to the passage of the Mental Health Parity Act of 1996. The inadequacies of this law were partially corrected in the Mental Health Parity and Addiction Equity Act of 2008, which included mandated coverage for substance use conditions. The Obama Administration in 2011 included these provisions in the Patient Protection and Affordable Care Act, which does not require compliance monitoring nor does it provide a definition for “mental health,” which leaves insurers to define it and hence determine what coverage will actually be available.
Shaun M. Eack
Mental health research is the study of the causes and correlates of mental health and illness, approaches to improve mental well-being, and the delivery of effective mental health services to those in need. Social workers have been leading researchers in each of these areas of inquiry, and this article provides an overview of the broad field of mental health research, with particular emphasis on the contributions of social work. A biopsychosocial review of research on the correlates of mental health and illness is provided, followed by a synthesis of studies examining pharmacological and psychosocial approaches to improving mental health. Research on mental health services is then presented, with a focus on studies seeking to improve access to quality care and reduce service disparities. Key directions for future mental health research include identifying specific causal predictors of mental illness, improving existing treatments, and disseminating advances to the community.
Catherine N. Dulmus and Albert R. Roberts
This entry focuses on serious mental illness among adults, including those having serious and persistent mental illness. Social work's historic and current roles in service delivery are reviewed, its present trends in the field (including the recovery movement, evidence-based practices, comorbidity, and the integration of physical and mental health), as well as the service delivery system and the current needs and challenges it faces, are discussed.
The primary focus of the entry is service utilization. As background, the risks for and prevalence of childhood mental disorders are summarized. Then, the current children's mental health services system is described, including the role of nonspecialty sectors of care and informal support systems. Service use barriers and disparities, pathways to services, and strategies to increase service use are discussed. The conclusion notes other current issues in child mental health, including the need to implement evidence-based treatments.
Lonnie R. Snowden
This entry describes the extent of the mental health problem in the United States, trends in treatment rates, and evidence that public recognition of mental illness and related interventions is increasing both in the United States and internationally. Emphasis is given to the structure of the mental health system's major sectors, to the key roles that social workers play, and to the challenges they face, outlined at the conclusion of several sections, in providing effective and quality care against the complex backdrop of this system.
Karen M. Sowers, Catherine N. Dulmus, and Braden K. Linn
In the 2010s, mental health and related issues such as suicide have become major global issues of public health concern. The indirect costs to the global economy of mental illness—encompassing such factors as loss of productivity and the spending on mental health services and other direct costs—amount to approximately $2.5 trillion a year. Global health experts and economists project this amount will increase to approximately $6 trillion by 2030. When gone untreated, mental illnesses account for 13% of the total global burden of disease. By the year 2030 it is expected that depression alone will be the leading cause of the global disease burden. Unfortunately, many persons suffering with mental illnesses do go untreated or receive marginally effective treatments. However, recent advances in technology, evidence-based treatments, and delivery systems of care provide hope for the world’s mentally ill population.
Laurens G. Van Sluytman
Through the efforts of individuals and groups, America has made significant strides in affording civil rights to a majority of its citizens. It has not, however, eliminated individual, institutional, and structural discrimination, and in fact, some efforts to eliminate inequality for certain members of society have elicited subtly coded forms of discrimination. These subtle forms are referred to as microaggressions. This entry defines microaggressions and explores the existing literature concerning its taxonomy. We discuss the impact of microaggression on individuals and groups (for example, social, cognitive, political, and economic) based on race, and extend this discussion to gender, sexual orientation, class, disability, and religion groups. The article makes use of examples within American history, such as the presidency of Barak Obama, voter ID laws and the Defense of Marriage Act (DOMA). Accumulated recommendations on best practices for countering microaggressions on the micro-, mezzo- and macro- level of social work practice are presented.
Kelli Godfrey and David Albright
Although there are many definitions of military social work, this article primarily focuses on social work by uniformed personnel within the United States military. Social work with military and veteran-connected populations is also done by civilian professionals.
The history of military social work in the United States is rooted in the civilian professional social work community and is a microcosm of that sector. Military social work has a rich history of providing services to military men and women and their families during periods of peace, conflict, and national crises. Military social workers have been involved in humanitarian operations and have participated in multinational peace-keeping operations. Social work in the Army, Navy, and Air Force is tailored to the mission of their particular service. However, joint operations between the services are becoming more frequent. Military social workers adhere to the National Association of Social Workers (NASW) code of ethics while providing service to an institution with its own unique culture, standards, and values. The role of military social workers has expanded since the Global War on Terrorism began, in 2001.
Military social work encompasses a wide variety of skills, performed by social workers who are both civilian and military, ranging from crisis to working with families. Military social work is unique and often faces ethical dilemmas even though military social workers still follow the National Association of Social Workers’ Code of Ethics. The history of military social work dates back to the early 1940s, but has evolved with the needs of military members and their families. The Army, Air Force, and Navy all have social workers, both civilian and those who wear the uniform. Due to the number of veterans and military families living throughout the United States, and seeking care in community settings, recommendations to establish competencies for social workers working with military and veteran-connected populations is underway.
B. Michelle Brazeal and Gordon MacNeil
Obsessive compulsive disorder (OCD) is a debilitating anxiety problem. This article reviews the characteristics, etiology, prevalence, and assessment of OCD and presents information on the efficacy of psychological, pharmacological, and combined treatments for this disorder. Early intervention that includes pharmacological agents (typically SSRIs) as well as behavioral and cognitive-behavioral psychotherapies (particularly exposure and response prevention) is the preferred method of intervening with OCD.
Larry W. Bennett and Oliver J. Williams
Perpetrators of intimate partner violence (IPV) use coercive actions toward intimate or formerly intimate partners, including emotional abuse, stalking, threats, physical violence, or rape. The lifetime prevalence of IPV is 35% for women and 28% for men, with at an estimated economic cost of over ten billion dollars. IPV occurs in all demographic sectors of society, but higher frequencies of IPV perpetration are found among people who are younger and who have lower income and less education. Similar proportions of men and women use IPV, but when the effects of partner abuse are considered, women bear the greatest physical and behavioral health burden. Single-explanation causes for IPV such as substance abuse, patriarchy, and personality disorders are sometimes preferred by practitioners, advocates, and policymakers, but an understanding of IPV perpetration is enhanced when we look through the multiple lenses of culture and society, relationship, and psychological characteristics of the perpetrators.
Personalized health care (PHC) is a broad term that describes how we leverage our growing understanding of the human body and developing technology to provide more effective health care. PHC requires that health care providers consider prevention and treatment in the context of available advanced technologies, best practices, and known variables that define us as individuals. These variables or characteristics may run the gamut from genetic, to biologic, to environmental, to even personality, personal values, and choice. By considering how these characteristics interact with specific illnesses and available interventions, outcomes can be improved. The purpose of this article is to: describe PHC’s current conceptualization including relationship with personalized medicine and patient-centered models of care, discuss its development and application by specific stakeholders, and review pertinent economic, legislative, and ethical issues.
Jessica M. Black
Scientific findings from social sciences, neurobiology, endocrinology, and immunology highlight the adaptive benefits of positive emotion and activity to both mental and physical health. Positive activity, such as engagement with music and exercise, can also contribute to favorable health outcomes. This article reviews scientific evidence of the adaptive benefits of positive emotion and activity throughout the life course, with examples drawn from the fetal environment through late adulthood. Specifically, the text weaves together theory and empirical findings from an interdisciplinary literature to describe how positive emotion and activity help to build important cognitive, social, and physical resources throughout the life course.
Selena T. Rodgers
Trauma literature has seen a paradigm shift from pathology to embracing positive trajectories. Posttraumatic growth (PTG), defined as a positive psychological change resulting from a struggle with traumatic or life-changing events, may occur in a variety of populations and events. This entry, therefore, aims to increase our understanding of PTG. The entry begins with the conceptualization of PTG, followed by a discussion of protective factor associations, measures, and psychometric priorities. Nuanced attention is given to global translations and cultural aspects. The entry then presents debates about the challenges, controversy, and biases, as well as an overview of the empirical literature. The entry concludes with PTG contributions for social-work practice and pedagogy, together with recommendations for future research.
Primary prevention involves coordinated efforts to prevent predictable problems, to protect existing states of health and healthy functioning, and to promote desired goals for individuals and groups, while taking into consideration the physical and sociocultural environments that may encourage or discourage these efforts. This entry discusses the history of this basic approach to professional helping from medical, public-health, and social-science perspectives. It also reviews major theories that guide preventive thinking and action. One section sketches the substantial empirical base for evidence-based practice and how such information can be retrieved. This entry concludes with a review of practice methods for increasing individual strengths and social supports while decreasing individual limitations and social stresses, which together characterize most contemporary preventive services.
Practitioners who were presumed to be competent may develop difficulties that interfere with job performance. Such professionals are considered impaired and may suffer from compassion fatigue, substance abuse, mental disorders, and other forms of distress associated with daily living. Practicing while impaired is unethical and can potentially be harmful to clients. Colleague Assistance Programs from professional associations or diversion systems and legal sanctions imposed by state regulatory boards are forms of intervention strategies that are employed. Self-care strategies and consciousness-raising among professionals are the best forms of prevention.
Zebulon C. Taintor
Psychosocial (or psychiatric) rehabilitation is a mixture of skills and support for persons severely impaired by mental illness. The population in need is vast. Practitioners marshal support at the level needed while helping a person develop skills that will gradually reduce the need for support. Financial support is gained by offsetting treatment and other supports such as institutional care. Social workers are especially well qualified for this work on multidisciplinary treatment teams. Recovery is key to most agency mission statements.