INDEX A A Mind That Found Itself, 93 Abuse, 229-234,250,25 1, 254-256, 286-289, 335,340,342,368-370,427-430.445-449, 455 Acetylcholine, 36, 252, 361, 362 Acetylcholinesterace (AchE), 362 Acute stress disorder, 233,237 Addictive disorders, 17,23, 36,46,48, 126, 193,244,408 Administration on Aging, 370,37 1 Adolescent Antisocial Self Report Behavior Checklist, 139 Adult day centers, 363, 371-374, 380 Adverse selection, 20,420,423,426,429 African Americans, 73,81-89, 152, 181,225, 227,230,249, 263, 273,282, 288, 289, 348,368,456 Agency for Health Care Policy and Research, 263,280,424 Aging, 19, 335-341, 344,345,348, 349, 357, 360,361,368-372,374-376,379,38 1 Agoraphobia, 47,48, 161,228,233-235. 239, 336 AIDS, 71, 138, 173,286,363,366,439 Air Force Surgeon General, 160 Akathisia, 89, 28 1, 344 Alcohol. See Substance abuse Alcohol and Drug Abuse and Mental Health Administration Reorganization Act of 1992. See Public Law 102321 Alcoholics Anonymous, 94,289 Alprazolam, 242,355 Alzheimer's disease, 356-364 acetylcholinesterase (AChE) inhibitors, 362 assessment and diagnosis of, 357-360 caregivers, 363-364 causes, acetylcholine and, 36 l-362 causes, biological factors, 360-36 1 causes, histopathology and pathophysiology, 36 1 causes of, 360-362 causes, protective factors, 360-36 1 cost of, 360 course of, 359 diagnosis and prevention of progression, 357,358 gender and, 359 graying of America and, 360 memory aids, 363 mild cognitive impairment (MCI), 357-359 prevalence and incidence of, 359-360 primary care providers, 358 societal view of senility, 358 symptoms of, 356,359 treatment of behavioral symptoms, 362-363 treatment, cognitive and behavioral, 363 treatment of depression, 363 treatment, in nursing homes, 364 treatment, pharmacological, 362-363 treatment, psychosocial, of patients and caregivers, 363-364 American Academy of Child and Adolescent Psychiatry (AACAP), 146, 158 American Academy of Pediatrics, 149, 183 American Association of Retired Persons, 370 American Medical Association (AMA), 438 American Psychiatric Association, 5,6,44,45, 145,233,234,241-243,262,266,369, 375,438,445 American Psychological Association (APA), 11,71,91, 140, 147, 155, 162, 166, 438, 445 American Psychological Association Task Force Criteria, 140, 155, 162, 166 Americans With Disabilities Act (ADA), 285, 446,447 Amino acids, 36,37 Amnesia, 237 Amphetamine salts, 146 Amphetamines, 158 Amygdala, 36, 38,239,240 467 Mental Health: A Report of the Surgeon General Anhedonia, 41,42, 245,27 1 Anorexia nervosa, 47,48, 53, 136, 167, 228, 336 Anthony, William, 100 Anticonvulsants, 69, 260, 266,268 Antidepressants, 26 l-266, 352-355 Antioxidants, 361 Antipsychotics, 271, 274, 278-280, 281, 283, 343,362,366,367 Anxiety, 40-4 1 animal model of, 52 anxiety disorder defined, 40 causes and onset of, 40 depression and, 253-54 Anxiety disorders in adults, 225-226, 233-243 acute and post-traumatic stress disorders, 237 acute stress response and the brain, 238-239 agoraphobia, 234-235 anatomic and biochemical bases of, 239-240 causes of, 239-241 combined psychotherapy and pharmacotherapy, 242 counseling and psychotherapy for, 241, ' 243 generalized anxiety disorder, 235-236 neurotransmitter alterations, 240 obsessive-compulsive disorder. 236-237 occurrence and co-occurrences, 233 panic attack and panic disorder, 233-234 pharmacotherapy for, 242-243 psychological theories of, 240-241 social phobia, 235 specific phobias, 235 stressor and stress response defined, 238 treatment of, 241-243 types of, 233-237 Anxiety disorders in children and adolescents, 160-163 CBT and, 162 generalized anxiety disorder, 160 obsessive-compulsive disorder and PANDAS, 162-163 separation anxiety disorder, 160-l 6 1 social phobia, 160-16 1 treatment of, 162 Anxiety disorders in older adults, 364-365 benzodiazepines and, 364-365 buspirone and, 365 post-traumatic stress disorder (PTSD), 364 prevalence of, 364 treatment of, 364-365 Anxiolytics, 69, 71, 242, 243,365 Asian, 81-83,85-88, 182,282,289 Asian/Pacific Islanders, 81-83, 85-88, 182, 242.263,282,289 Aspartate, 37 Asperger's disorder, 137 Assault, 87, 16 1, 230, 237 Assertive community treatment, 80, 92, 99, 227,280,286,287,290,290,295,455 Attachment, 60, 126, 126, 130-132, 165,254 Attention deficit/hyperactivity disorder (ADHD), 142-150 associated disorders and, 144 causes of, 144-145 dopamine hypothesis, 145 inheritance, 145 MTA Study, 148-149 prevalence of, 144 psychostimulants, 146 symptoms of, 142-144 treatment, behavioral, 147-148 treatment, CBT, 148 treatment controversies, 149-150 treatment, multimodal, 148-149 treatment of, 146-150 treatment. pharmacological, 146-147 treatment, psychosocial, 147-148 treatment side effects, 146-147 Attrition factors, 258, 263. 356 Atypical antipsychotics, 69, 345 Auditory hallucinations, 41, 150, 27 1 468 Autism, 23,53, 129, 136, 137, 163, Autistic disorder, 270 Avoidance, 6,41, 82, 161, 229,234 164 ,235,237, 240,254,255,273,343 Axons, 33,37,58 Azopyrine, 243 B Baby boomers, 368,369 Bandura, 57, 126, 162,229 Barriers to treatment, 8, 13, 18-21, 23, 55, 65, 70,72-73,80,86-88,91-92, 138, 160, 192, 193, 226, 244, 256, 257, 280, 294, 296,341.344,346,348-349,352,367, 374, 375, 376, 381,408,416,417,424, 429,453,457 Basal ganglia, 35,55, 163 Bazelon Center for Mental Health Law. 80 Beers, 93 Behavior therapy, 57,66,67, 149, 162-164 Behavioral symptoms, 17, 174, 242, 338, 343, 344,357-360,362-364,374 Benzodiazepines, 69, 142, 162,242,243.268. 343,350,364,365,369,370 Bereavement, 5, 19, 189,230,232, 245,247, 254,335,336,339-341,347,35 1,356,379 Biological models of the mind, 39 Biopsychosocial model of disease, 52 Bipolar disorder. 250, 266. See also Mania Blame, 96, 154, 158, 164, 187, 274 Bowlby, John, 57. 59,60, 126 Boys Town, 177 Brain, 6, 13, 15-17, 239-241,453 anxiety disorders and. 238-240 bottomup studies of, 13 cellular changes in, as result of human experience, 15 as central focus for studies of mental health and illness, 13 genes, role of, 13, 16-17 inseparability of human experience, 15 as mediator of mental function, 13 as mediator of symptoms of mental illness, 453 Index mental disorders and physical changes in. 6 physical changes in as cause of changes in body, 6 prenatal factors, 16 topdown research, 13 Brain damage, 129, 145 Brain, imaging of, 38-39 Brain, neurochemical complexity of, 36-37 aspartate, 37 corticotropin-releasing factor (CFW), 36 dopamine, 36,37 endogenous opiates, 36 gamma ammo butyric acid (GABA), 37 glutamate, 37 ligand-gated channel, 36-37 neurotransmitter receptor, 36 neurotransmitters, 36-37 neurotransmitters as targets of medication, 37 norepinephrine, 37 peptides, 37 serotonin, 37 substance P, 36 Brain, plasticity of, 12, 38 brain structure altered with learning, 38 dual-level examination necessary, 38 genes and, 38 molecular and cellular alterations, 38 as result of stress, substance abuse, and disease, 38 Brain, structural complexity of, 32-37 amygdala, 36 axons, 33,35 basal ganglia, 35-36 cellular level organization, 32-36 cerebral cortex, 33 as distributed information processor, 33 frontal lobe, 33 geographic specialization, 33-36 gray matter, 35 gyc 33 hippocampus, 36 local damage compensated by other regions, 36 469 as mediator of all human behavior, 3 1 and mind, 31 myelin, 33-35 organization of circuits in, 33 occipital lobe, 33 parietal lobe, 33 prefrontal cortex, 33 sulci, 33 white matter, 33-35 Bruner, Jerome, 126, 133 Bupropion, 147,263, 264,266,267,353 Buspirone, 242, 243,244, 365 C California Department of Mental Health, 99 Call to Action on Suicide, 4, 244 Campbell, 95,99, 134, 141, 157, 164, 166,439, 442,443 Cancer diagnosis, reaction to, 52 Carbamazepine, 142, 157, 166, 268 Cardiotoxicity, 263 Caregivers. 21, 59, 60, 133, 165, 187, 188, 189, 232, 343, 356,359,360,363,373, 378-38 1,405,443,449 Carolina Abecedarian Project, 134 Carved-in, carved-out benefits, 376-377,421 Case, definition of, 48 Case management, 94,99, 168, 172-174, 180, 183, 189,193, 280,286-288,290,290,295, 375,376,4 18,426 Case manager, 94, 95, 173, 174 Catatonia, 249, 259, 261 Causation. 10,44,50-52 Causation, difficulty in establishing, 5 l-52 Center for Mental Health Services (CMHS), 24, 80, 82,90,95,107, 186, 188, 189,261, 273,286,290,290,294,295,425 Center for Substance Abuse Treatment, 446 Centers for Disease Control and Prevention, 62, 159 Central nervous system, 42, 61, 129, 145, 163, 25 1,278,338,353 Cerebral cortex. 33,238 Chamberlin. Judi. 93-94 Mental Health: A Report of the Surgeon General 470 CHAMPUS, 192 Child abuse, 130, 132, 135,445,446. See also Abuse Child sexual abuse, 23 1 Children and adolescents, in general, 17-18, 123-194 Children and adolescents, mental disorders in, 123, 136-142 anxiety disorders in. See Anxiety disorders in children and adolescents assessment and difficulty of diagnosis in, 137-138 . attention deficit/hyperactivity disorder, 142-150, 164 autism, 163-164 conduct disorder, 165-166 disruptive disorders, 164-166 eating disorders, 167 evaluation process, 138-l 39 general categories, 136-l 37 medications, off label use of, 141 oppositional defiant disorder (ODD), 164-165 psychopharmacology, and lack of research on medications, 140-142 psychotherapy, and lack of evidence concerning efficacy, 140 shortage of professionals, 138 substance use disorders in adolescents, 166-167 treatment strategies, 139-142 Child and Adolescent Service System Program (CASSP), 188, 189, 192 Child Behavior Checklist, 139 Child Health Insurance Program (CHIP), 183, 407,419 Children and adolescents, 12, 16-18,46,48, 90, 103,247,250,406,409,455,457 Children and Adults with Attention Deficit Disorder (CHADD), 148 Children and Youth Intensive Case Management (CYICM), 173 Children's Services Program, 189, 191 Chlorpromazine, 68, 157, 278, 280 Cholecystokinin, 240 Chronic disability, 337 Index Classical conditioning, 56, 240 Clinical Global Improvement Scale, 156, 157 Clinical psychologist, 138 Clinical research volunteers, 21, 454 Clinician bias, 85, 87, 88, 273,288 overdiagnosis of schizophrenia in African Americans, 88 underdiagnoses, `88 Clomipramine, 164,242 Clonazepam, 242 Clonidine, 147, 166 Clozapine, 268, 278,280-282, 345, 367 Code of Ethics, 438 Coercion, 23,457, Cognition, 39,40,43, 58,62,67, 137, 226, 245,251,269,337,347,359,362,363 Cognitive-behavioral therapy (CBT), 22, 57, 66,67, 126, 140, 148, 155-158, 163, 167, 232,241,265,266,355,356,455 Cognitive capacity, 337 Cognitive decline, 341, 358 Cognitive impairment, 43,48, 146, 228, 260, 336,345,349,354,357-359,363,365,375 Cognitive therapy, 355, 363 Combined services and combined treatment, 18-19,288-289,296,412-413 Community-based interventions, newer, 172 Community Support Program, 290,295 Community treatment, 79, 80,92, 99, 227, 280, 286,287,290,295,455 Comorbid medical illness, 273 and depression, 244 and schizophrenia, 273-274 Comorbidity, 46,47, 63, 72, 166, 167,228, 233, 234, 244, 267, 273,288,338, 340, 342,346,352,354,360.372,377,406,408 Comprehensive care, 225, 289 Conduct disorder, 126, 130-132, 137, 150-152, 164-166, 171, 189 Confidentiality, 13, 20, 21,438,440,447449 Confidentiality: ethical, legal, and policy issues, 437-449 case utilization review and candor, 440 ethical issues, 438439 fostering trust, 439 industry changes, and for profit corporations, 437 more protections may be warranted, 437 protecting privacy, 439-440 reducing stigma, 439 research on confidentiality and treatment. 440-441 technological advances in information usage and storage, 437 values underlying confidentiality, 439-440 Confidentiality of Individually Identifiable Health Information, 447 Confidentiality law, 4404l8 differs for mental health and substance abuse treatments, 448 disclosure, 44345 disclosure to client, and child clients, 443 exceptions to confidentiality, 4424t5 national standard lacking, 441 preemption, 447448 reform proposals, 441-442 in research, 444-445 valid consent rarely defined, 442 waiver of confidentiality, 442 Confidentiality of mental health information, 20-2 1,437-449 information technology and, 2 1 informed consent and, 21 state and Federal laws and, 21 U.S. Supreme Court and, 21 Confusional state, 249 Consent, 21,72,260,261,440,442-449 Consumer advocacy, 29 l-293 Consumer and family, 13, 14,92,96-98, 100, 101 Consumer and family movements, 92-97 blame attributed to families and, 96 consumer groups, origins and goals, 93-94 consumer organizations, accomplishments of, 95-96 consumer roles in research, 95-96 consumers as employees, 95 deinstitutionalization and, 96 family advocacy, 96 471 Mental Health: A Report of the Surgeon General Federation of Families for Children's Mental Health (FFCMH), 96-97 incorporation into other mental health services, 94 National Alliance for the Mentally Ill (NAMI), 96 National Mental Health Association (NMHA), 96-97 Public Law 102-321 and, 95 self-help groups, 94 underrepresentation of ethnic and minority groups in, 93-94 Consumer Bill of Rights and Responsibilities, 20,430,429 Consumer run, 15, 94, 102, 290 Contingency management, 147, 162 Control group, 10, 71, 134, 148, 155, 156, 163, 172, 174, 175, 191,233 Co-occurring mental and substance use disorders combined treatment of, 18-19, 288-289, 296.4 12-l 13 comorbidities. 244 in adolescents, 166-167 in older adults, 368-370 incidence of, 15,46 long-term outcome. 288 post-traumatic stress disorder and, 237 schizophrenia and, 273-274 shortage of services for, 455 Coping and self-monitoring, 284 Correlation, 5 1, 165 Correlational research, 10, 5 1 Corticotropin-releasing factor (CRF), 36 Corticotropin-releasing hormone (CRH), 36, 239,240,242,253 Cortisol, 153 Cost containment, 20,408,417,419,421,429, 437 Cost controls, 423 Counseling, 138, 149, 156, 159, 169, 175, 182, 183,189,232,241, 265, 269, 294, 342, 343, 364,373,406,437 Couples therapy, 65,232 Crisis programs, 178 Crisis services, 12, 16,94, 102, 159, 172, 178-179,288,290 Cultural diversity and mental health services, 45, 55, 80 acculturation, defined, 8 1 Americans and, 88 barriers to treatment of minorities, 86-88 clinician bias, 88 coping and idioms of distress, 83 coping and religious beliefs, 82-83 coping and somatization and folk disorders, 83 coping styles of various cultural groups, 82-83 cost. 87-88 cultural competence, defined, 90 cultural competence in mental health practitioners, 90-9 1 culture and cultural identity, 8 l-82 diversity and demographics, 8 l-83 DSM-IV "Outline for Cultural Formulation," 90 epidemiology and utilization of services, 84 ethnopsychopharmacology, 88-89 family and community as primary resources. 83-85 improving treatment for minority groups, 88-91 income status and role in mental disorders, 82 Indian Health Service (IHS), 90 linguistically and culturally competent services, 81, 225 metabolism, genetic and psychosocial influences, 89 minorities, fear of system by, 80-8 1 minorities poorly served, 80-8 1 minority-oriented services, 89-90 mistrust, 86-87 overdiagnosis of schizophrenia in African Americans, 88 racial or ethnic minority groups, major, Federal designation, 8 1 racist slights, microinsults, 87 rural mental health services, 92 172 Index stigma, 87 treatment effectiveness across race, culture, largely unknown, 9 1 underdiagnoses, 88 under- and overrepresentations in treatment populations, 84-86 unrecognized variations in health-seeking behaviors, 84 Culturally appropriate treatment, 18, 49, 84, 90, 181, 182, 186, Cyclothymia, 226, 244, 245,251 Cystic fibrosis, 53 D Darwin, 60 DATl, 145 Deegan, 97,98 Deinstitutionalization, 7, 8,68,79,93, 96,98, 275, 286, 293, 374,405. See also Institutionalization and deinstitutionalization Delirium, 9,338, 358 Delivery of state-of-the-art treatments, 22, 455 Delusions, 41, 150, 226, 245-247, 249, 270-272,359,362,365,367,371 Demographic characteristics, 405 Dendrites, 33, 61 Department of Health and Human Services, 23, 232,370,413,447 Depression and other mood disorders in adults, 226,228,244-269 acute inpatient treatment, 258 acute phase efficacy in mania, 267-268 anxiety and depression, 253 assessment, 245-25 1 augmentation strategies, 265 biological factors in, 25 l-252 bipolar depression, treatment of, 265-266 bipolar disorder, 246, 249, 250 bupropion, 264 causes, 25 l-257 clinical depression, 244-246 cognitive factors, 254-255 complications and comorbidities, 244-245 continuation phase therapy, 26 1 cyclothymia. 250-25 1 diagnosis and syndrome severity, 245-25 1 dysthymia, 247, 249 electroconvulsive therapy (ECT), 258-26 1 evolving views of, 252-253 female depression, role of environment in, 255-256 gender and, 255-256 heterocyclic antidepressants (HCAs), 262 hippocampus and, 253 learned helplessness, 254-255 maintenance pharmacotherapy vs. psychotherapy, 267 maintenance phase therapies, 261 maintenance treatment in mania, 268 major depressive disorder, 247-248 medication, contributing role in, 25 1 misdiagnosis of schizophrenia in African Americans, 249 monoamine hypothesis, 252 monoamine oxidase inhibitors (MAOIs), 262,264 outpatient treatment, 258 pharmacotherapies, 262-263 pharmacotherapies, alternate, 263-265 pharmacotherapy, psychosocial therapy, and multimodal therapy, 266-267 and primary care, 269 psychosocial and genetic factors in, 254-257 psychotherapy and counseling, 265 relapse, prevention of, 267 remission defined, 26 1 selective serotonin reuptake inhibitors (SSRIs), 262-263,265 service delivery for, 269 social and economic impact, 244 St. John's wort, 264-265 stressful life events, 254 suicide, 244, 245 temperament and personality, 255 therapy, stages of, 257-261 treatment, general. 257-262 173 Index Education. 93-97, 126, 133-136, 183-185, 187-189 Effectiveness and efficacy, 3, lo1 11, 13-15, 21, 22, 65,67, 71, 72,91, 94, 101, 102, 416,418,453 Ego, 56,60,338 Ego integrity, 60, 338 Electroconvulsive therapy (ECT), 65. 93,94, 250,258-262,266-268,354,355 Elmira Prenatal/Early Infancy Project, 134 Employers, 74,289-294, 294,377,407,418, 421 Empowerment, 95,99, 188,289,293 Empowerment Scale, 99 Endocrine factors, 255, 340 Endogenous opiates, 36 Engel, George L., 50 Epidemiologic Catchment Area (ECA), 46-48, 228, 257, 336, 341,348, 349, 364, 369, 406,408 Epidemiology, future directions for mental disorder, case of, defined, 48 mental disorder, establishing threshold for, 48-49 rates of disorder vs. measures of need, 49 treatment, lack of standard measures of need for, 49 Epigenetic influences, 58 Erikson, Erik, 57, 59, 60, 126, 227, 338 Estrogen, 275,342,361,367 Ethical Principles of Psychologists, 438,439 Ethnicity, 80-84, 9 1, 18 1, 182, 262, 282 Ethnopharmacology, 282 Ethnopsychopharmacology, 88-89 Etiology of mental disorders, 3 1,49-57 and age, 5 1 biopsychosocial factors in, 50,52 correlation, causation, and consequences, 51-52 defined, 31 of extroversion, 50 interplay of factors in, 49 of post-traumatic stress disorder, 50-5 1 and stress, 5 1, 52 stressor, defined, 5 1 stress response, defined, 5 1 Etiology research, 11, 3 1, 34 1 Evidence-based interventions, 2 1,454 Evidence-based services, 22,455 Excess disability, 341, 343, 351, 358 Experimental group, 10, 164. 174 Experimental research, 10, 5 1 Extra Organizational Empowerment Scale, 99 Eyberg Child Behavior Inventory, 139 F Family advocacy, 96,98,292 Family Centered Intensive Case Management (FCICM) program, 174 Family Interaction Coding Pattern, 139 Family intervention, 158,283 Family preservation programs, 175 Family support, 22,96, 178, 188, 189,274, 278,364,370,375,380,455 Family therapy, 155, 157, 167, 168, 189 FDA Modernization Act, 141 Fear and anxiety, 31, 36,40, 52, 233-235, 238-240,24 1 Fear of mental health system by minority groups, 80-8 1, 87 Federal Employees Health Benefit Program, 429,458 Federal financing, 376,420 Federal government, role of, in mental health issues, 81, 188, 375,407,415-420,426, 438,447 Federation of Families for Children's Mental Health (FFCMH), 80, 96, 97, 188, 189 Fetal alcohol syndrome, 133, 163 Financial barriers, 20, 23, 257,429,457 Fluoxetine, 147, 156, 164, 243, 262, 263, 353 Flupenthixol, 158 Fluvoxamine, 243,262 Food and Drug Administration (FDA), 10, 11, 70,71, 141,243,262,263,268 Fort Bragg study, 191, 193 Fostering Individualized Assistance Program (FIAP), 174 Freud, Anna. 127 475 Mental Health: A Report of the Surgeon General Freud, Sigmund, 55, 59,66, 124, 126, 127 Frontal lobe, 33, 354, 357 Future directions for epidemiology, 48 G G protein-linked receptors,. 37 Galton, 60 Gamma amino butyric acid (GABA), 37, 240, 242,252 Gatekeepers, 138 Gender, 12, 14, 16. 19, 22, 39,44,55, 63, 81, 86, 101, 102, 153, 159, 171, 228, 235, 244, 2.55: 256,263,275,282,359,426,456. See also Alzheimer's disease; Depression and other mood disorders in adults; Depression and suicide in children and adolescents; Schizophrenia, demographic characteristics in; Schizophrenia in older adults General medical service providers, 4 13 Generalized anxiety disorder, 40,47, 137, 160, 161,225,228,233-236,239.242.243,364 Genetic factors, 50, 127, 153, 163, 226, 237. 251,254,256,276,360 Genetics, 11, 13, 21, 39,52, 53, 100, 129, 144, 257,279,453 Gestalt therapy, 67 Glia, 32 Global Burden of Disease study, 4,411 Glucocorticoids, 239, 240, 25 1 Glutamate, 36, 37 Glycine, 36, 37 Gray matter, 35, 36, 239 Grief, 66, 230, 245, 254, 265, 340, 342, 351, 356 Grob, Gerald, 6,9, 75. 78,93 Group therapy, 65. 177,231 Guanfacine, 147 Gyri, 33 H Hallucinations, 41, 42, 150, 226, 245-247, 249, 26%272,359,365,367 Halopefidol, 69, 164.280,281.367 476 Harvard University, 4 Head Start, 133, 134 Health Care Financing Administration (HCFA), 45,412,416 Health insurance. 20, 182-185, 294,418421, 422.427,438.457 Health insurance benefits, 70,79, 232,292, 407,426-428,455,457 Health maintenance organization (HMO), 374, 376.421,422 Health Security Act, 427 Heart, 147,238.263,268.352,355 Heterocyclic antidepressants (HCAs), 282 Hippocampus, 36,38,61,239,240,252,253 Hispanic Americans, 81, 85, 86, 152, 181, 186-187,256,282,289,368 Histopathology, 36 1 HIV, 54,55,62. 133,251,286,288, 357 Home Based Crisis Intervention (HBCI), 179 Home-based services, 74, 140, 166, 172, 175 Homicide, 244 Hospitalization. 168-173, 286-288, 293, 339, 406,418,423 Human genome project, 52,53 Human services, 22, 23, 73, 75, 133, 232, 289, 292,295.370,378,405-409,413,417,438, 444,447,455. Humanistic approaches. 65-67 Huntington's disease, 53, 357 Hypersomnia, 42, 247 Hyperthyroidism, 234, 250 Hypomania, 151, 153,249,250,25 1.266,348 Hypothalamic-pituitary-adrenocortical (HPA) axis, 239, 252. 253 Hypothalamus, 153, 239, 253 Hypothyroidism, 247,25 1, 256, 338, 357,358 I Id, 56 Illicit drugs, 368, 369 Imipramine, 68, 69, 156, 157, 242, 267, 362 Immune function, 337, 340 Impulsivity, 142-144, 146, 148, 229, 255 Income assistance, 292 Index Kraemer, 129 Kraepelin, 97, 269, 366 L Landscape for aging, 37 1. 372 Language, 5,6,43, 50.62.8 1, 86, 124. 126, 136-138, 149, 163, 164.269,271,337, 356,357,359,437,439,441 Late onset of mental disorders, 244, 347, 350352,366 Late life, 17-19, 23, 104. 335, 339-341, 346, 348,349,354,364,365,367,370 Late-onset depression, 347, 350352 Law enforcement, 133, 191,445,446 Learned helplessness, 254 Lethality, 263 Level of evidence, 10, 11, 142, 159 Lewinsohn, 152, 154, 156 Lifespan, 15, 102 Lifespan approach, 12 Ligand, 36 Limbic system, 163, 238, 239 Limitations in service and insurance benefits, 90,269,288,295,413,417-423,425427 Linguistically and culturally competent services, 8 1, 225 Lithium, 68, 69, 142, 147, 157, 158, 166, 249, 260,265-268 Living With Children, 166 Locus coeruleus, 37 Lorazepam, 242 Lorenz, Konrad, 60 M Madness Network News, 93 Magnetic Resonance Imaging (MRI), 1438, 100,240,347,35 1 Maintenance pharmacotherapy, 26 1,267 Malpractice, 266 Managed behavioral health care organizations (MBHOs), 421 Managed care, 13, 19, - 70, 23, 85,94, 169, 181, 183-185, 268, 282. 290, 336, 370, 371. Income, effects of, in mental health and mental illness, 19,79, 82, 88,99. 135, 180, 183, 189,233,292-294,378,419,422,427 Indemnity, 419,421 Indian Health Service (IHS), 90 Individuals With Disabilities Education Act (IDEA), 183, 184, 188, 189 Inequities in treatment and services, 13, 20, 405,413,426-429,457 Infancy, 44,99, 13 1, 134, 135,342 Infant Health and Development Program. 134 Infections, 52, 133, 163, 251, 278 Informed consent, 2 1, 72, 260,26 1,440,449 Inpatient treatment, 88, 169, 171, 172, 175, 176,258,456 Institute of Medicine (IOM), 5 1,62-64, 94, 96, 225,231,232,255,288,339,343, 374, 380,425 Institutionalization and deinstitutionalization, 68,75, 78-79, 84,93,96,98 Insurance, 407,409,412,413,415-422,424, 426-429,438,440,441,457 Insurance restriction, 426 International Classification of Diseases (ICD), 45,83 Intemeuron, 32 Interpersonal therapy, 22, 66, 125, 155; 157, 167,261,265-267,353,355-356,455 Intervention, 132-136, 140, 155-159,162, 164-166. 177-180, 190192,231,244,260 Invisible Children, 97 Invisible Children's Project, 184 Involuntary commitment, 23,93,457 IQ, 133, 134, 165, 171,337 J Jackson, 84 K Kandel, 6, 57,58, 61, 138, 240 Kaslow and Thomson, 156 Kierkegaard, 67 Knitzer. 97, 171, 187 477 Mental Health: A Report of the Surgeon General 373, 375-378,405,417,420-430,443, treatments and integrative neuroscience, 455,458 100-101 Managed Care Consortium, 291 Mania, 42,43,69, 15 1, 157, 244-246, 249, 25 1,252,258-261,266-268,348 Mann, Horace, 78, 153, 246 MECA Study, 124 Medicaid, 19, 74, 79, 85,.135, 182-186, 294, 360,371,374-377,381,407-409, 415-420,422,458 Medicare, 19, 74,79,294, 360, 369, 371, 375-377,381,407,413,415-420,422,458 Memory, 31,33,36,38,337-338,341, 355-359,362-367 Mendelian disorders, 53 Mendelian transmission, 53 Menninger Clinic, 177 Mental disorders, 4-5, 20, 39-40 brain as mediator in, 39 characterized by, 39 continuum of conditions, 39 cost to the Nation, 20 cultural influence and, 39 defined, 5 Mental Health Parity Act, 427,428 Mental health promotion and illness prevention, 22,454 Mental illness in children and adolescents, 46,48 cluster of signs and symptoms and, 45 co-occurring disorders in adults, 46 cost to the individual, 227 cost to society, 226 costs, 49,225-227,41 l-417 diagnosis of, 43-45 disorder vs. disease, 44 epidemiology, defined, 45 epidemiology of, 45-49 in older adults, 48 demographics and, 39 prevalence of, 20 prevention of, 233 societal burden compared, 34 Mental health, 3-6 defined, 4-5,227 dynamic and ever changing, 16 inseparable from physical health, 5-6 success dependent on, 4-5 vs. somatic health, 6 Mental health and mental illness biological influences on, 52-55 brain and scientific research, 100 causes of, 225 incidence, defined, 45 inseparable from physical illness, 5-6 prevalence, defined, 45 serious emotional disturbance @ED) in children and adolescents, 46 serious mental illness (SMI) in adults, 46 severe and persistent mental illness (SPMI) in adults, 46 symptoms and signs of, 39-40 Mental retardation, 23, 130 Meta-analysis, 11, 167, 168, 175, 266, 355 Metabolism, 88, 89, 154, 238, 263,265, 277, 280,283,342,344 Methodology for Epidemiology of Mental Disorders in Children and Adolescents (MECA) study, 48, 123, 124 Methylphenidate, 145-147, 149, 150, 157, 166 Mild cognitive impairment (MCI), 357, 358 Millon Adolescent Personality Inventory (MAPI), 138 consumer and family movements, 101-102 integrative science of, 57 Kandel and, 57 lifespan and, 102-l 04 organization and financing of care, 101 personality traits, 227-230 psychosocial influences on. 55-57 Mini Mental Status Exam, 359 Minnesota Multiphasic Personality Inventory (MMPI), 139 Minority groups, 23,31,45,73, 80-84, 86-88, 90, 186,233,257,289,456. See also African Americans; Asian/Pacific Islanders; Hispanic Americans; Native Americans/American Indians/Alaska 478 Natives/Native Hawaiians (American Indians) Mirtazapine, 243,263 Modeling, 162, 166 Molecular and cellular biology, 13, 100 Molecular genetics, 11, 13, 21, 39, 100,453 Monoamine hypothesis, 252, 253 Monoamine oxidase inhibitors (MAOIs), 69. 167,243,262,264-266 Moral hazard, 20,420,421,423,426,429 Motor behavior, 33, 27 1 Movement disorders, 343 Multimodal therapies, 139,243 Multimodal Treatment (MTA) Study, 148, 150 Multisystemic therapy (MST), 166, 172, 175 Myelin, 33 N Naltrexone, 370 National Advisory Mental Health Council (NAMHC), 46,424,428,456 National Alliance for the Mentally Ill (NAMI), 80,96,188, 189,292,428,438 National Association of Mental Patients, 94 National Comorbidity Survey (NCS), 46; 47, 167,228,364,406,408 National Household Survey on Drug Abuse, 369 National Institute of Mental Health (NIMH), 24, 32, 52, 53, 54, 61, 84,95, 129, 190, 139, 146, 148, 157, 163, 237, 251, 255, 257,259,260,280,290,342 354,409 National Institutes of Health (NIH), 24, 7 1, 144,259,260,340,341,346,348,349,354 National Mental Health Association (NMHA), 78-80,93,96,97, 133, 183, 189,291 National Mental Health Consumers' Association, 94 National Research Council, 18 1, 232 Native Americans, 86,90, 288 Native Americans/American Indians/Alaska Natives/Native Hawaiians (American Indians), 81, 86, 87,90, 153, 191, 288 Naturalistic studies, 354 Index Nature and nurture, 12. 60.61, 136 Nefazodone. 243,263,267,353 Negative reinforcement, 56, 240 Nerve cells, 13, 32, 33, 37, 100 Neurobiology, 238 Neurocircuits, 239 Neurodevelopmental disruption, 276 Neurodevelopmental theory of schizophrenia. 278 Neuroendocrine systems, 61, 153 Neuroimaging, 239,240,252, 357 Neuroleptic, 68,69, 147, 158, 268, 272, 344. 345,366,367 Neuronal activity, 33 Neurons, 13,32-38,50,54,55,58,61,68, 100, 163, 238, 242,252,253, 262, 361, 362 Neuroscience of mental health, 3 1, 32 Neuroticism, 229,255 Neurotransmitter receptors, 33, 36-38,50, 68-70,262-263,277,280 Neurotransmitters, 33, 36, 37,68,239,240, 252,361 NIMH Diagnostic Interview, 139 Norepinephrine, 36, 37,70,238-240,252,263, 264 Nortriptyline, 353, 354, 356 Nursing, 365, 370-372,374-376,406,413, 417 Nursing homes, 19,71,74,79, 83, 336, 342, 343,350,351,361,364,365,370-372, 374-376,381,406,413,417 0 Obsessive-compulsive disorder (OCD), 55, 236-237 relationship to anxiety, 40-41 Occipital lobe, 33 Off-label usage, 141; 262 Office of the Surgeon General, 23,342 Older adults alcohol and substance use disorders in, 368-370 479 Mental Health: A Report of the Surgeon General anxiety disorders in. See Anxiety disorders in older adults assessment and diagnosis, 340-341 demographics of the near future, and, 19 depression and suicide in. See Depression and mood disorders in older adults interventions for, 19 mental disorders in, 19,`340-346 prevention, 34 l-343 prevention of depression and suicide, 342 prevention of excess disability, 343 prevention of premature institutionalization, 343 prevention, treatment related, 342-343 primary care, 341 primary prevention, 342 schizophrenia. See schizophrenia in older adults treatment for mental disorders, 343-346 Older adults and mental health, 336-340 change and human potential, 338-339 cognitive capacity, 337-338 coping with loss and bereavement, 339-340 normal life-cycle tasks, 337 Omnibus Budget Reconciliation Act, 364, 374, 375 On Our Own, 93 Operant conditioning, 56,57, 166 Oppositional defiant disorder (ODD), 137, 147, 148, 164, 166 Organizational Empowerment Scale, 99 Outpatient treatment, 23,78, 84-87, 168, 169, 180, 189, 192,258,287,456,457 Over-the-counter medication, 353,368 Overdose, 158,262,263 P Panic attacks, 40, 161, 233-236, 239, 241, 243 Panic disorder, 4,4648, 53, 161, 225, 228, 233,234,236,237,239,241-243,257, 336,364,456 Paranoia, 41, 273, 366 Parent Therapist Program, 17 1 Parietal lobe, 33 Parity, 20,96,377,405,426-429,458 Parkinsonism, 89,281,344 Parkinson's disease, 36, 350, 357 Paroxetine, 156,243,262, 353,362 Partial hospitalization/day treatment, 169 Pathophysiology, 253, 350, 361 Patient Bill of Rights, 423 Patient Outcomes Research Team (PORT), 280,283,286,425 Pavlov, Ivan, 56, 125 Pemoline, 146 Peptides, 36 Perception, 7,40,41, 83, 88, 158, 162, 167, 180,240,255,269,27 1,368 Personal Empowerment Scale, 99 Personality disorders, 44, 65, 130, 167, 230, 244,256,258 Personality, theories of, 55-57, 227-229, 243, 246,255 Pharmacodynamics, 282,344,345,353 Pharmacokinetics, 140,242, 282, 345, 368 Pharmacological therapy, 226 Pharmacology, 14 1 Pharmacotherapy, 68,70, 71, 89, 139, 157, 167,226,241-243,257,259,261,263, 265-268,279,280,283,340,343.348, 350,352,353,356,358,363,370 Phenobarbital, 158 Phobia, 40,47,48, 129, 160-162, 225, 228, 232-235,238-239,240,242,243,246, 336 Phobic anxiety, 364 Physical activities, 232 Physical development, 58 Physical health, 5, 6, 71, 128, 225, 230, 274, 348.35 1,355,379,380,448. See also Somatic health Piaget, Jean, 57, 59, 125 Pierce, C. M., 87 Pinel, Philippe, 78 Pituitary gland, 153,239 Placebo effect, 10,65, 70, 71, 88, 89, 147, 156-158, 162, 164, 166,258,261-265, 267,280,352,354-356,362 Planning Board, 24 480 Index Point-of-service plan (POS), 42 1.422 Policy activity, 407 Polypharmacy, 265,342,344,345: 377 Porter. 97 Positive reinforcement. 56. 162 Positron emission tomography (PET) scan, 38, 240 Postsynaptic neuron;33,36 Post-traumatic stress disorder (PTSD). 4,40, 41,47,50, 51,61, 86, 132, 137, 158.225, 228,230-233,237,239,240,242,243. 253,340,364 Preemption. 447,448 Preferred provider organization (PPO), 42 1, 422 Prefrontal cortex, 33, 272 President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 423, 425. 430 President's Commission on Mental Health, 45, 93 Prevention of mental disorders, 62-64, 234 Primary care, 18, 19,49, 73, 75, 90, 92, 193, 233, 263, 269, 285, 341, 342, 346, 348-351,356,358,371-373,376,378, 405,406,416,421,425,455,457 Primary Mental Health Project (PMHP); 135, 137 Privacy, 13,20,21,437-441,445-449 Privacy Act of 1974,446 Privilege, 437,447,448 Probably Efficacious Psychosocial Interventions, 140 Problem-solving capacity, 17, 157, 158, 189, 272,278, 337,355,356.363 Productivity, 4, 13, 18,49, 100, 226,244,257, 271,360,411,413 Project ReEducation (ReEd), 170 Protective factors, 22, 62-64, 244, 274, 342, 361,367 Providers of mental health services, 42 l-424, 428--430,455-457 Psychiatric nosology, 49 Psychoanalysis, 56, 66 Psychodynamic theories, 55,56,240 Psychodynamic therapy, 66.356 Psychoeducation, 22, 148. 233.258, 363, 364. 455 Psychological development. 59. 230 Psychopharmacologic treatments. 15 Psychosis, 4, 7,9,40-43,47,54,68,69.79. 146,228,254,259, 274, 354, 356.359, 374 Psychosocial risk factors, 63, 130,252 Psychosocial treatments, 78, 141, 147, 148, 166,226,257,266,282,283,345.355 Psychotherapy, 65-67, 167, 168, 177, 241, 243,257,258,260,265-267,353-356 Public health model, 3 Public Law 102-331, 95, 190 Q Quality and consumers' rights, 430 Quality assessment, 425 R Racial and ethnic minorities, 39, 55,67, 73, 80-82,84-90,94. See also African Americans; Asian/Pacific Islanders; Hispanic Americans; Native Americans/American Indians/Alaska Natives/Native Hawaiians (American Indians) Randomized controlled trial, 10, 133, 189, 233 Range of treatments, 13, 15, 21,64,65, 102, 453 Rape, 50, 230,237,256 Raphe nuclei, 37 Reaching Across, 94 Recovery, 12, 14, 15, 18, 19,22, 32,55, 80,92, 97-102, 128, 137, 154,227,261,274,275, 279,280,283,284,288-290,349,350, 353,354,366,455 Reducing Risks for Mental Disorders, 62 Rehabilitation services, 79,284,286,287,293, 375,406,418 Relapse, 243, 259, 261, 265-268,274,278, 281,283-285,350,353-356,370 481 Mental Health: A Report of the Surgeon General Remission, 71, 156, 161, 226, 249, 258, 261, 274,283,284,349,350,353,354,356,366 Report's principal recommendation, 13, 2 1 Research methods, 10 Research volunteers, 2 1,454 Rett's disorder. 137 Risk factors, 16, 17, 22,51, 53,55, 57,63, 64, 103, 128-133, 136, 145, 151-158, 161. 165, 170, 175, 187, 193, 231, 241,244, 252.256,278,293,336,340-345,347, 350-352,357,361,368,370,378 Risk factors and prevention in childhood and adolescent mental health, 129-136 Robert Wood Johnson Foundation, 190, 19 1, 289,293,295,409 Rogers, Carl, 67 Residential treatment center (RTC), 170, 171 S Social/health maintenance organization (S/HMO), 374 Schizo-affective disorder, 250, 270 Schizophrenia, 41-42, 227-228, 270-286, 365-367. See also Schizophrenia, demographic characteristics in; Schizophrenia in older adults; Schizophrenia, treatment of brain abnormalities in, 276-279 causes, 276-279 comorbid medical illness and, 273-274 coping and self-monitoring, 284-285 diagnosis and cultural variations, 272-273 drug treatment of, 279-283 DSM-IV diagnostic criteria for, 272-273 epidemiology of, 273-274 genetic relationships in, 276 long-term outcomes in, 273-276, 284-285 natural history of, 274-276 onset of, 75-76 rehabilitation in, 274-275, 283-285 risk factors for, 276-278 m-vices for, 279,283-285, 286 symptoms and signs of, 41-42,269-272, 276-278 482 Schizophrenia, demographic characteristics in age, 275-276 culture, 272-273 gender, 275-276,282 race, 272-273,280-283 sociocultural status, 278 Schizophrenia in older adults, 365-367 causes of late-onset schizophrenia, 366-367 epidemiology of, 365 gender in, 367 natural history of, 366 treatment, 366, 367 Schizophrenia Patient Outcome Research Team, 88 Schizophrenia, treatment of, 279-285 ethnopsychopharmacology, 282-283 family intervention, 283 pharmacotherapy, 280-282 psychosocial, 279,283-285 psychotherapy, 283 Schizophrenics Anonymous, 94 Schizophreniform disorder, 250 School system, 75, 169, 180,409 Science base, 9, 21,453 Sedatives, 237,242 Seizures, 258-260, 264, 281, 353-354 Selective serotonin reuptake inhibitors (SSRIs), 69,80,89, 141, 147, 156-158, 162-164, 167,239,242-243,252,262-267,343, 353 Self-efficacy, 189, 190,229, 241 Self-esteem, 4, 6,42,94, 97, 131, 137, 170, 172, 177,225, 228, 229, 237, 250, 285, 290,339,379 Self-help, 14-16,92-97, 99, 101, 102, 289-292,336,340,370,378-380,406, 408 Self-medication, 167 Selye, Hans, 253 Separation anxiety disorder, 12, 16, 103, 137, 160-162,234 Serious emotional disturbance, 172, 180, 184, 185,190, 191 Serious mental illness (SMI), 46,48 Index Serotonergic. 153,265 Fostering Individualized Assistance Sertraline, 243, 262,263, 353 Program (FIAP), 174 Services interventions for children and home-based services, 175- 176 adolescents, 168-179 inpatient treatment, 171-172 case management, 172- 175 multisystemic therapy (MST), 172 , Children and Youth Intensive Care 175-176 Management (CYICM), 173 crisis services, 178-179 Family Centered Intensive Care Management (FCICM), 174 Family preservation programs, 175 hybridization of system complicates state care acts, 78 Services, mental health, including service service to the most needy, 80 linguistically and culturally competent delivery and service system: services and providers, 455-458 services, 8 1, 225 majority with diagnosable disorder do not coercion, 457 delivery of state of the art treatments must receive treatment, 75 mental health services, in general, 73-80 mental hygiene movement, 78 moral treatment movement, 75-78 patterns of use, 75 recovery, 80 newer community-based interventions, 172-178 outpatient treatment, 168- 169 Parent Therapist Program, 17 1 partial hospitalization/day treatment, 169 Project ReEducation (ReEd), 170-171 residential treatment centers (RTCs), 169-170 serious emotional disturbance, defined, 172 therapeutic foster care, 176-177 team approaches, 174- 175 therapeutic group homes, 177-178 treatment interventions, 168-172 Services, mental health, including service delivery and service system: general, 73-80 barriers to accessibility, 2 1 care settings, 74 community mental health movement, 79 community support movement, 80 de facto mental health system, four sectors of, 73 dementia, 78 and dual policies of community care and deinstitutionalization, 79 financing of, 73-74 Grob, Gerald N., 75 history of, in U.S., 75-80 be ensured, 455-456 entry into treatment must be facilitated, 457 financial barriers to treatment must be reduced, 457-458 first-line contacts, 457 gap between knowledge and actual practice, 456 geographical shortages, 455 inequity of coverage for mental and somatic illnesses, 457 justice systems, 457 new strategies needed, 456 respectful, evidence based, and reimbursable care must be ensured, 458 services and providers must be guaranteed, 455 shortages in cognitive behavioral and interpersonal therapy fields, 455 short supply of certain providers, services, 22,455 treatment must be tailored to age, gender, race, and culture, 456 Services, mental health, including service delivery and service system: organization and financing of, 14, 19-20,405-430 cost containment policies, 20 483 Mental Health: A Report of the Surgeon General discriminatory policies in mental health financing, 20 financial barriers to, 20 insurance financing in, 20 managed care, 20 use of by U.S. population, 19 Services. mental health. including service delivery and service system: financing and managing, 4 18426 coverage policy, fairness in, 420 goals for mental health coverage. 4 18 history of financing and roots of inequality, 418 insurance coverage patterns, 4 18-419 lifetime limits for somatic vs. mental illness. 420 limitations on coverage, 418 moral hazard and adverse selection. 420 traditional insurance and dynamics of cost containment. 419320 Services, mental health. including service delivery and service system: managed care. 420-423 access, measurement system of, needed, 424 access to services, impact on, 424 and regulation. 423 carve-out managed behavioral health care. 421 cost controls in managed care, 423 coverage, percentages of, 422 health maintenance organizations (HMOs), 421 managed behavioral health care organizations (MBHOs), 421 managed care effects on service access and quality, 423-424 managed care plans, major types, 42 1 payer carve-outs and health plan subcontracts. 42 1 point-of-service plans (POS), 421 preferred provider organizations (PPOs), 421 quality assessment and quality indicators, 425 quality of care. impact on. 424-426 quality of care not provided incentives, 425 Services, mental health, including service delivery and service system: mental health service system in the U.S.. 405-411 de facto mental health service system, four components of, 405406 patterns of use, 408-409 public and private sectors, defined. 407-408 school system and, 409 structure of U.S. service system, 405406 substantial majority of adults do not . receive treatment, 408 Services, mental health, including service delivery and service system: parity, 426-428 benefit restrictions and, 426-427 gap widening between somatic and mental coverage. 427 legislative trends affecting, 427428 Mental Health Parity Act, 427-428 minimal costs of parity laws, 428 state efforts for, 428 toward parity in mental health coverage, 426-428 Services. mental health, including service delivery and service system: service delivery for adults. 285-289 assertive community treatment, 286-287 case management, 286 comorbidity and, 288-289 for substance abuse and severe mental illness, 288-289 inpatient hospitalization and community alternatives for crisis care, 287-288 intervention for stressful life events, 232-233 overrepresentation of minorities in inpatient units, 288 psychosocial rehabilitation services, 287 recovery and, 288 substance abuse and. 288 Services, mental health, including service delivery and service system: supports and other services for adults, 289-295 consumer advocacy, 29 1 484 Index consumer-operated programs, 290-29 1 consumer self-help, 289-290 discrimination against the mentally ill and, 292 family advocacy, 292 family self-help, 29 l-292 health coverage and barriers to treatment, 294 housing, 292-293 human services, 292-294 income, education, and employment, 293-294 integrating service systems, 295 Services, mental health. including service delivery and service system: service delivery and supports for children and adolescents, 179-193 Child and Adolescent Service System Program (CASSP), 190-191 Children's Services Program (CSP), 19 1 culturally appropriate social support services, 186- 187 effectiveness of systems of care, 191-193 families. redefinition of and new roles for, 188 family support, 188-l 89 family support groups, 189-190 Fort Bragg study, 191-192 integrated system model, 190-l 9 1 practical support, 190 private sector, 182-l 83 public sector, 183-l 84 public sector, managed care in, 185-186 Robert Wood Johnson Foundation, 190, 191,289,293,295,409 service systems and financing, 182-186 Stark County study, 192-193 support and assistance for families, 187-190 utilization, 179-182 utilization and culture, 18 l-l 82 utilization and early termination of treatment, 180 utilization and poverty, 18 1 utilization in relation to need, 180 Wraparound Milwaukee and. 18% 186 Services, mental health. including service delivery and service system: service delivery for older adults, 370-378 adult day care centers and community care settings, 373-374 carved-in mental health services for older adults, 376-377 deinstitutionalization. 374 demographics of residence and, 370 ethnic diversity and, 37 1 financing services for older adults, 376 for severe and persistent mental disorders (SPMDs), 374-376 home vs. nursing home, 372-374 increased role of managed care, 376 Medicaid and, 376 nursing homes ill equipped to treat mental disorders, 374 outcomes under managed care, 377-378 preadmission screening, 374 primary care poorly equipped to treat chronic mental disorders, 372-373 public policy and managed care and, 370-37 1 research needed on cost-effective models for treatment, 376 service settings and the New Landscape for Aging, 37 l-376 setting, role of, in independent functioning, 372 Services, mental health, including service delivery and service system: supports and other services for older adults, 378-380 abuse of older people and, 380 communities and social services, 380-38 1 education and health promotion, 379 families and caregivers, 379-380 support and self-help groups, 378-379 support for caregivers crucial, 378 Services demonstration projects brief history of, 290 Child and Adolescent Service System Program (CASSP), 190 Children's Services Program, 190-191 Fort Bragg study, 191-192 485 Mental Health: A Report of the Surgeon General Robert Wood Johnson Foundation, 190, 191,289,293,295,409 Stark County study, 192-193 Severe and persistent mental disorder (SPMD), 374,375,377,378 Severe and persistent mental illness (SPMI), 79,289,295,415,419 Sex,43,56,60, 133, 135, 151, 176, 231, 236, 255-257. See also Gender Sexual abuse, 23 1,254-256 Sexual orientation, 22, 81, 155,442,456 Side effects, 39, 68,70,72, 89, 141, 146, 147, 156, 163, 164, 166, 226, 243,257,258, 262-263,268,27 1,272,280-282, 342-345,352,353,355,365,367 Skinner, B. F., 56, 125 Sleep, 42-44, 150, 153,245,246, 249-253, 263,271,346,349,350,355,364,365 Sleep disturbances, 245, 350 Social factors, 13,47,48, 50-52, 100, 253, 274,278 Social phobia, 129, 160, 161, 228,233-236, 242,243,336 Social learning theory, 56, 57, 125 Social portfolio, 379 Social status, role of in mental health, 55, 81-82,84,91 Social support services, 18 1, 186 Sociopathy, 229 Somatic health, 6, 232-234, 272-275, 286, 427. See also Physical health Somatization disorder, 230 Somatoform disorders, 44 Specialty mental health providers, 14, 101,413 Specific phobia, 233-235 Spending for mental health services, 12, 19, 49, 174,249,405,41 1417,429 Spirituality, role of. in mental health, 8 1, 82, 98,99,225,232 486 St. John's wort, 70,264-265 Stark County study, 192 State mental health agencies and efforts, 95, 96,291,417,419,442,446A48 State-of-the-art treatments, 22, 455 Stigma, 3,6-q, 12, 14, 16,20-22,73, 80, 84, 85, 87, 92, 96, 101, 103, 160, 180, 186, 188,226,227,244,257,289,291-294, 346, 349, 376, 379,424,429,439,440, 448,449,453,454 Stimulants, 68,69, 142, 145-150,369 Stress disorder, 4,40,41,47,50,61, 86, 132, 137, 158,225,228,230-233,237,239, 240,242,243,253,340,364 Substance abuse, 150-152, 154, 155, 166, 231-234,286-289,368-370,408,412, 413,422,424,427-430,437,438,440, 44 1) 445449,455 Substance abuse laws, 445,446 Substance P, 36 Substance-induced events, 233 Substantia nigra, 37 Suicide, 4,5, 18, 19,52,86, 136, 150, 152-160, 165,167, 170,226,232-233, 244,246,247,256,259,268,272-274, 288,336,339-342,347,349-352,354, 379 Suicide prevention, 159, 160,244, 342, 351 Sulci, 33 Superego, 56,229 Support groups, 189,232,292,356,378,380 Supportive therapy, 158 Supreme Court, U.S., 21,437,439,445,448, 449 Surgeon General, U.S., 4,23,24, 160,244, 342 Synapses, 33,36,38-39, 50,58,61,69,262 T Tardive dyskinesia, 147,268, 281,282,344, 345,367 Team approaches, 174 Temperament, 12, 31, 57,64, 125, 125, 127, 129-132,255 Temporal lobe, 277, 347,362 Therapeutic foster care, 171, 172, 176-178, 184 Therapeutic group homes, 172, 177, 178 They Help Each Other Spiritually (THEOS), 379 Tourette's disorder, 129, 137, 236 Trauma, 18, 51, 52, 130, 159, 161, 170, 225, 230,231,237,254,256,289 Treatment for children and adolescents, 155-160, 168 Treatment, in general, 64-73 attitudinal barriers, 73 barriers to seeking help, 72-73 behavior therapy, 66-67 cognitive-behavioral therapy, 67 complementary and alternative treatments, 70 demographic barriers, 73 efficacy-effectiveness gap, 72 existential, experiential, or Gestalt therapy, 67 failure to seek, due to stigma, 8 financial barriers, 73 Freud and psychoanalysis, 66 group psychotherapy, 65 humanistic therapy, 67 informal social supports now preferred, 8 interpersonal therapy, 66 mechanism of action, defined, 68-70 neurotransmitter function, 68-69 organizational barriers, 73 pharmacological therapies, 68-70 placebo and, 65, 70-7 1 psychodynamic therapy, 66 ' psychotherapy, defined, 65 rational drug design, 68 tailored treatment, 22-23 Treatment interventions, 19, 128, 139, 140, 168, 176,381 Treatment systems, 6 Tricyclic antidepressants (TCAs), 69, 89, 142, 147, 156, 158, 162, 167,242, 243, 262-265,267,352,353 Trust, 21, 60, 87,91,437,439,449 Twins, 54,61,63, 162,163,165,256,276 u Index Under-treatment, 257,348.423,426,458 Unemployment, 64,272,285,292-294 Unipolar depression, 267, 353, 354 v Valproate, 142, 157 Vascular, 352,354, 358 Venlafaxine, 243,263,267, 353 Ventral tegmental area, 37 Verapamil, 268 Violence, 7, 8, 64, 130, 165, 231, 232, 288, 439 Visual hallucinations, 249, 27 1 Vitamin E, 342,357,360,361 Vocational issues and services, 79, 80,99, 226-227,235,275,278-279,283-286, 287,289,294,406 Volunteers, 2 1,454 W Waiver of confidentiality, 442,443 Watson, J. B., 56, 125 Well-Being Project, 99 Well-Established Psychosocial Interventions, 140 White matter, 35, 352 World Health Organization, 4,45, 284,4 11 World Bank, 4,411 Wraparound process, 173,174, 179, 183, 185-186,455 Wraparound Milwaukee, 185-186 Y Youth Emergency Services (YES), 179,438 U.S. Office of Technology Assessment, 180 Unclaimed Children, 96 Uncontrolled studies, 10, 164, 169-172, 174, 177-179, 191,268 487