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Article

Although the terms older adult and senior citizen are commonly defined as individuals 60 years and above, later adulthood contains various life-course phases and developmental periods. The young-old, defined as individuals in the age range of 60–75 years, often experience various health, social, and economic transitions. Both the individual and family systems must negotiate some of the changes that accompany the journey into later life. Therefore, this first decade of older adulthood is one that can simultaneously be enjoyable, exciting, demanding, and stressful for aging persons and their families.

Article

Depression and bipolar mood disorders are mental disorders that are characterized by mood disturbance combined with decreased functioning of the affected individuals. This entry focuses on major depressive disorder and bipolar I and II disorders among adults in the United States. Bipolar disorder has unique clinical features and intervention options, and so it is discussed in a separate section after depression. Diagnosis, prevalence, comorbidity, risk factors, course, assessment, treatment, service utilization, and international perspectives are reviewed for each disorder. The implications for social work are briefly addressed at the end of this entry.

Article

Vikki L. Vandiver

Since the mid-1980s, managed care has been one approach used to address the economic crisis in the American health-care system. This entry overviews managed care from the perspective of policy, procedure, practice, and system. Specifically, emphasis is given to understanding the emergence and history of managed care, multiple definitions, how it works, and examples of managed care plans, key legislation, existing research, its future, and implications for social-work practitioners.

Article

Darrell P. Wheeler

Article

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.

Article

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.

Article

Hee Yun Lee, William Hasenbein, and Priscilla Gibson

As the older adult population continues to grow at a rapid rate, with an estimated 2.1 billion older adults in 2050, social welfare researchers are determined to fill the shortage of gerontological social workers and structural lag to best serve the baby boomers who are expected to need different services than previous generations. Mental illness impacts over 20% of older adults in the world and the United States. The major mental health issues in older adults include depression, anxiety, loneliness, and social isolation. Depression is considered one of the most common mental health issues among this population; however, the prevalence could be underestimated due to older adults linking relevant symptoms to other causes, such as old age, instead of as possible depression. Like depression, anxiety symptoms are often mistaken as results of aging. It is also difficult for providers to diagnose anxiety in this population due to anxiety frequently being coupled with other illnesses and the psychological stress that comes with old age. Because the presence of loneliness or social isolation can manifest depression and anxiety symptoms in older adults, it is also difficult to separate these two issues. With the anticipated increase of the older adult population within the next few years, measurement tools have been created to assess depression and anxiety specifically for older adults. In addition to adapting assessment tools, interventions tailored to older adults are essential to ensure treatment coherence, even though medications are the go-to treatment option.

Article

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.

Article

Wayne Lindstrom

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.

Article

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.

Article

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.

Article

Marlys Staudt

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.

Article

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.

Article

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.

Article

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.

Article

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.

Article

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.

Article

M. Aryana Bryan, Valerie Hruschak, Cory Dennis, Daniel Rosen, and Gerald Cochran

Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.

Article

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.

Article

Jared Sparks

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.