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Mental Health:
A Report by the Surgeon General
Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Table of Contents
Executive Summary
Foreword
Preface
Acknowledgments
Table of Contents
Chapter 1
Introduction and Themes
Overarching Themes: Mental Health and Mental Illness: A Public Health Approach
Mental Disorders are Disabling
Mental Health and Mental Illness: Points on a Continuum
Mind and Body are Inseparable
The Roots of Stigma
Separation of Treatment Symptoms
Public Attitudes About Mental Illness: 1950s to 1990s
Stigma and Seeking Help for Mental Disorders
Stigma and Paying For Mental Disorder Treatment
The Science Base of the Report
Overview of the Report's Chapters
Chapter 2
The Fundamentals of Mental Health and Mental Illness
The Neuroscience of Mental Health
Complexity of the Brain I: Structural
Complexity of the Brain II: Neurochemical
Complexity of the Brain III: Plasticity
Imaging the Brain
Overview of Mental Illness
Manifestations of Mental Illness
Anxiety
Psychosis
Disturbance of Mood
Disturbance of Cognition
Other Symptoms
Diagnosis of Mental Illness
Epidemiology of Mental Illness
Adults
Children and Adolecents
Older Adults
Future Directions for Epidemiology
Costs of Mental Illness
Overview of Etiology
Biopsychosocial Model of Disease
Understanding Correlation, Causation, and Consequences
Biological Influences on Mental Health and Mental Illness
The Genetics of Behavior and Mental Illness
Infectious Influences
PANDAS
Psychosocial Influences on Mental Health and Mental Illness
Psychodynamic Theories
Behaviorism and Social Learning Theory
The Integrative Science of Mental Illness and Health
Overview of Development, Temperament, and Risk Factors
Physical Development
Theories of Psychological Development
Piaget: Cognitive Development Theory
Erik Erikson: Psychoanalytic Development Theory
John Bowlby: Attachment Theory of Development
Nature and Nurture: The Ultimate Synthesis
Overview of Prevention
Definitions of Prevention
Risk Factors and Protective Factors
Overview of Treatment
Introduction to Range of Treatments
Psychotherapy
Psychodynamic Therapy
Behavioral Therapy
Humanistic Therapy
Pharmacological Therapies
Mechanisms of Action
Complementary and Alternative Treatment
Issues in Treatment
Placebo Response
Benefits and Risks
Gap Between Efficacy and Effectiveness
Barriers to Seeking Help
Overview of Mental Health Services
Overall Patterns of Use
History of Mental Health Services
Overview of Cultural Diversity and Mental Health Services
Introduction to Cultural Diversity and Demographics
Coping Styles
Family and Community as Resources
Epidemiology and Utilization of Services
African Americans
Asian/Pacific Islanders
Hispanic Americans
Native Americans
Barriers to the Receipt of Treatment
Help-Seeking Behavior
Mistrust
Stigma
Cost
Clinician Bias
Improving Treatment for Minority Groups
Ethnopsychopharmacology
Overview of Consumer and Family Movements
Origins and Goals of Consumer Groups
Self-Help Groups
Accomplishments of Consumer Organizations
Family Advocacy
Overview of Recovery
Introduction and Definitions
Impact of the Recovery Concept
Conclusions
Mental Health and Mental Illness Across the Lifespan
References
Chapter 3 Children and Mental Health
Normal Development
Theories of Development
Development Viewed as a Series of Stages
Intellectual Development
Behavioral Development
Social and Language Development
Parent-Child Relationships
Origins of Language
Relationships With Other Children
Temperament
Developmental Psychopathology
Current Developmental Theory Applied to Child Mental Health and Illness
Overview of Risk Factors and Prevention
Risk Factors
Biological Influences on Mental Disorders
Psychosocial Risk Factors
Family and Genetic Risk Factors
Effects of Parental Depression
Stressful Life Events
Childhood Maltreatment
Peer and Sibling Influences
Correlations and Interactions Among Risk Factors
Prevention
Project Head Start
Carolina Abecedarian Project
Infant Health and Development Program
Elmira Prenatal/Early Infancy Project
Primary Mental Health Project
Other Prevention Programs and Strategies
Overview of Mental Disorders in Children
General Categories of Mental Disorders of Children
Assessment and Diagnosis
Evaluation Process
Treatment Strategies
Psychotherapy
Psychopharmacology
Attention-Deficit/Hyperactivity Disorder
Prevalence
Causes
Treatment
Pharmacological Treatment
Psychostimulants
Dosing
Side Effects
Other Medications
Psychosocial Treatment
Behavioral Approaches
Cognitive-Behavioral Therapy
Psychoeducation
Multimodal Treatments
Treatment Controversies
Overprescription of Stimulants
Safety of Long-Term Stimulant Use
Depression and Suicide in Children and Adolescents
Conditions Associated With Depression
Prevalence
Major Depression
Dysthymic Disorder
Suicide
Course and Natural History
Causes
Family and Genetic Factors
Gender Differences
Biological Factors
Cognitive Factors
Risk Factors for Suicide and Suicidal Behavior
Consequences
Treatment
Depression
Psychosocial Interventions
Pharmacological Treatment
Bipolar Disorder
Pharmacological Treatment
Suicide
Psychotherapeutic Treatments
Psychopharmacological Treatments
Intervention After a Suicidal Death of a Relative, Friend, or Acquaintance
Community-Based Suicide Prevention
Crisis Hotlines
Method Restriction
Media Counseling
Indirect Case-Finding Through Education
Direct Case-Finding
Aggressive Treatment of Mood Disorders
Air Force Suicide Prevention Program—A Community Approach
Anxiety Disorders
Separation Anxiety Disorder
Generalized Anxiety Disorder
Social Phobia
Treatment of Anxiety
Obsessive-Compulsive Disorder
Autism
Treatment
Disruptive Disorders
Treatment
Substance Use Disorders in Adolescents
Eating Disorders
Services Interventions
Treatment Interventions
Outpatient Treatment
Partial Hospitalization/Day Treatment
Residential Treatment Centers
Inpatient Treatment
Newer Community-Based Interventions
Case Management
Team Approaches to Case Management
Home-Based Services
Family Preservation Programs Under the Child Welfare System
Multisystemic Therapy
Therapeutic Foster Care
Therapeutic Group Homes
Crisis Services
Service Delivery
Service Utilization
Utilization in Relation to Need
Early Termination of Treatment
Poverty and Utilization
Culture and Utilization
Service Systems and Financing
Private Sector
Public Sector
Children Served by the Public Sector
Managed Care in the Public Sector
Culturally Appropriate Social Support Services
Support and Assistance for Families
New Roles for Families in Systems of Care
Family Support
Family Support Groups
Practical Support
Integrated System Model
Effectiveness of Systems of Care
The Fort Bragg Study
The Stark County Study
Summary: Effectiveness of Systems of Care
Conclusions
References
Chapter 4
Adults and Mental Health
Chapter 5
Older Adults and Mental Health
Chapter 6
Organizing and Financing Mental Health Services
Chapter 7
Confidentiality of Mental Health Information
Chapter 8
A Vision for the Future
List of Tables and Figures
Back to the Mental Health: The Surgeon General's Report Index