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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

    Reducing Stigma

    The Science Base of the Report

        Research Methods

        Levels of Evidence

    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


 



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