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Summary Pre-Recorded Lectures - Severe Mental Illness

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Notes on the Pre-Recorded lectures for Severe Mental Illness in Urban Context

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  • December 6, 2021
  • 41
  • 2021/2022
  • Summary

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Pre-Recorded Lectures


Lecture 1: Diagnosis in Context


Severe Mental Illness (SMI)
The National Institute of Mental Health – defined SMI using the following criteria:

1) A major diagnosis of non-organic psychosis or personality disorder
2) Duration of at least 2 years
3) At least three of the five categories of functional disabilities

Diagnosis

A major affective, non-organic psychotic disorder – or a disorder that may lead to a chronic
disability such as BPD

Duration

Treatment history meets one or both of the following criteria:

1) Has undergone psychiatric treatment more intensive than outpatient care more than
once in a lifetime
- E.g., crisis response services, alternative home care, partial hospitalization, or
inpatient hospitalization
2) Has experienced an episode of continuous, supportive residential care – other than
hospitalization – for a period long enough to have sig disrupted the normal living
situation

Disability

Severe recurrent disability resulting from mental illness – the disability results in functional
limitations in major life activities

Individuals must meet at least two of the following criteria on a continuing or intermittent
basis:

1) Is unemployed, is employed in a sheltered setting or supportive work situation – or
has markedly limited skills and a poor work history

, 2) Requires public financial assistance from out-of-hospital maintenance – and may be
unable to procure such assistance without help
3) Has difficulty in establishing or maintaining a personal social support system
4) Exhibits inappropriate social behavior – which results in intervention by the mental
and/or judicial system

The SIDDD Dimensions of Definition of SMI

Dimension Components
Safety  Unintentional self-harm – e.g., self-neglect
 Intentional self-harm
 Safety of others
 Abuse by others – e.g., physical, sexual, emotional, financial
Informal and Formal  Help from informal carers – including friends and relatives
Support
 Help from formal services – such as day centers, paid staff, voluntary services,
hospital admissions, medication and detention under the Mental Health Act
Diagnosis  Psychotic illness
 Dementia
 Severe neurotic illness
 PDs
 Developmental Disorder
Disability  Disability with impaired ability to function effectively in the community – which
may include problems with:
 Employment and recreation
 Personal care
 Domestic skills
 Interpersonal relationships



Duration of any of the above – for periods which may vary between 6 months to 2 years

“Difficult to Treat Patients”

(Urban) contextual factors – include:

1) Poverty 3) Unemployment
2) Low SES 4) Hopelessness

, 5) Criminal/inappropriate social
behavior

Dual diagnosis:

1) In combination with substance use
2) Childhood trauma, abuse, attachment problems
3) Depressive or anxiety symptoms

Perspective on SMI
For much of the 20th century – severe mental illness was considered chronic and
deteriorating – requiring institutional tertiary care or high-intensity secondary care

This approach changed in the 60s – with the advent of anti-psychotic drugs – and
subsequent deinstitutionalization

- Which gave new hope to patients with SMI who were discharged into the
community

From Care to Cure
Severe Mental Illness:

1) Drug-based treatment
2) Disease model
3) Term implies medical discourse of cure

Definitions

Ontology  State/way of being – what we assume the world is like
 With cancer we can look into the body – and see its cause (e.g., tumor)
 With psychology – it is more difficult to touch and grasp what a psych
disorder is – and what its cause is (difficult and vague)
Epistemology  How we can know, understand, describe reality
 “If we want to understand disorders – we have to describe symptoms as
clearly as possible”
Nomothetic Approach  Regular, lawful approach
 Is after universal laws – things that go for everyone

,  Very big in the medical world
Idiographic Approach  Looks to the individual
 Dimensional, developmental, subjective, gradual
 Diagnosis in context – diagnosis is not an explanation but an
understanding and it has to have a utility
 More holistic approach – interaction and person-oriented
 Variation and change in individuals
 Effects of specific interventions – key elements
 The therapist and the patient as individual persons – and their interactions



Nomothetic Approach

The nomothetic approach – i.e., explanation of symptoms by underlying diseases

- Focus on universal/lawful disease states

When person X has disease Y – the disease causes
symptoms x, y, z




The Cure-Paradigm in Psychiatry


Ontology – Theory of Being

Ontology – i.e., theory of being – is a casual disease model

1) Symptoms – are observable signs of the underlying cause
2) Treatment Goal – is to eliminate the cause
3) Treatment Outcome Monitoring – is to observe reduction of symptoms as signs of
elimination of cause
4) End Result – no more symptoms interpreted as no more disease

Epistemology – Theory of Knowledge

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