1.Community Conversations About Mental HealthInformation Brief

2. On January 16, 2013, President Barack Obama directed Secretary Kathleen Sebelius of the U.S. Department of Health and Human Services and Secretary Arne Duncan of the U.S. Department of Education to launch a national conversation on mental health to reduce the shame and secrecy associated with mental illness, encourage people to seek help if they are struggling with mental health problems, and encourage individuals whose friends or family are struggling to connect them to help. Mental health problems affect nearly every family. Yet as a nation, we have too often struggled to have an open and honest conversation about these issues. Misperceptions, fears of social consequences, discomfort associated with talking about these issues with others, and discrimination all tend to keep people silent. Meanwhile, if they get help, most people with mental illnesses can and do recover and lead happy, productive, and full lives. This national conversation will give Americans a chance to learn more about mental health issues. People across the nation are planning community conversations to assess how mental health problems affect their communities and to discuss topics related to the mental health of young people. In so doing, they may also decide how they might take steps to improve mental health in their families, schools, and communities. This could include a range of possible steps to establish or improve prevention of mental illnesses, promotion of mental health, public education and awareness, early identification, treatment, crisis response, and recovery supports available in their communities.Pamela S. Hyde, J.D. Administrator SAMHSAPaolo del Vecchio, MSW Director Center for Mental Health Services SAMHSA 3. C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hGoals and Objectives of the Toolkit for Community Conversations About Mental Health The Toolkit for Community Conversations About Mental Health is designed to help individuals and organizations who want to organize community conversations achieve three potential objectives: Getotherstalkingaboutmentalhealthtobreakdownmisperceptionsandpromote recoveryandhealthycommunities;Findinnovativecommunity-basedsolutionstomentalhealthneeds,withafocuson helpingyoungpeople;andDevelopclearstepsforcommunitiestoaddresstheirmentalhealthneedsinaway thatcomplementsexistinglocalactivities.TheToolkitincludes: 1. AnInformation Briefsectionthatprovidesdataandotherfactsregardingmentalhealth andmentalillnessandhowcommunitiescanimprovepreventionofmentalillnesses, promotionofmentalhealth,publiceducationandawareness,earlyidentification, treatment,crisisresponse,andrecoverysupportsavailableintheircommunities. 2. ADiscussion Guidesectionthatisintendedforuseinholdingcommunity conversationmeetingsof8-12peopleeach.(Inacommunityforumwithmore participants,theaudiencewoulddivideintogroupsofthissizeformuchoftheir timetogether.)Itprovidesdiscussionquestions,sampleviews,ideas,andanoverall structurefordialogueandengagementonmentalhealthissues. 3. APlanning Guidesectionthatdescribesavarietyofwaysinwhichpeoplecan facilitatetheircommunityconversationsandtakenextstepsatthelocalleveltoraise awarenessaboutmentalhealthandpromoteaccesstomentalhealthservices. Mentalhealthissuesinourcommunitiesparticularlyforouryoutharecomplexand challenging;but,bycomingtogetherandincreasingourunderstandingandraisingawareness, wecanmakeadifference. 4. Information BriefThe Information Brief for Community Conversations About Mental Health The Information Brief is designed to be used alongside the other elements of the Toolkit for Community Conversations About Mental Health and provides data and information to help community conversations participants consider key issues of importance to their communities. The Information Brief follows the format of the Discussion Guide section of the Toolkit for Community Conversations About Mental Health and has the following sections: Session1:SharingPersonalExperiences Opening Question: What does mental health mean to me? To us as a community?Session2:DiscussionofChallenges Opening Question: What are the challenges and factors we should consider?Session3:ExplorationofHowtoRespond Opening Question: What can we do to support young people?Session4:CommunitySolutions Opening Question: What steps do we want to take as a community? 5. Community Conversations About Mental HealthInformation BriefTable of Contents Goals and Objectives of the Toolkit for Community Conversations About Mental Health ..................................................... iiThe Information Brief for Community Conversations About Mental Health................... iii Mental Health in the Community...........................7Research About the Mental Health of Young People.............................................................10Session 2: Discussion of Challenges...............................11 Terms and Definitions....................................................1 Session 3: Exploration of How to Respond...14 Session 1: Sharing Personal Experiences...........3 Session 4: Community Solutions ......................... 17 Understanding the Basics..........................................3 Appendix: Helpful Resources and Websites............................................................ 19 Attitudes and Beliefs AboutMental Health.....................................................................6 Reference List ................................................................20 6. C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hAcknowledgments ThisguidewaspreparedfortheSubstanceAbuseandMentalHealthServices Administration(SAMHSA)byAbtAssociatesanditssubcontractorstheDeliberative DemocracyConsortium,andEverydayDemocracyundercontractnumber [HHSS283200700008I/HHSS28342002T]withSAMHSA,U.S.DepartmentofHealth andHumanServices(HHS).L.WendieVelozandChrisMarshallservedasthe GovernmentProjectOfficers.Disclaimer Theviews,opinions,andcontentofthispublicationarethoseoftheauthoranddonot necessarilyreflecttheviews,opinions,orpoliciesofSAMHSAorHHS.Thelistingof anynon-Federalresourcesisnotall-inclusiveandinclusioninthispublicationdoesnot constituteendorsementbySAMHSAorHHS.Public Domain Notice Allmaterialappearinginthisreportisinthepublicdomainandmaybereproduced orcopiedwithoutpermissionfromSAMHSA.Citationofthesourceisappreciated. However,thispublicationmaynotbereproducedordistributedforafeewithoutthe specific,writtenauthorizationoftheOfficeofCommunications,SAMHSA,HHS.Electronic Access and Printed Copies Thispublicationmaybedownloadedororderedathttp://store.samhsa.gov.Orcall SAMHSAat1-877-SAMHSA-7(1-877-726-4727)(EnglishandEspaol).Recommended Citation SubstanceAbuseandMentalHealthServicesAdministration,CommunityConversations AboutMentalHealth:InformationBrief.HHSPublicationNo.SMA-13-4763.Rockville, MD:SubstanceAbuseandMentalHealthServicesAdministration,2013.Originating Office OfficeofCommunications,SubstanceAbuseandMentalhealthServices Administration,1ChokeCherryRoad,Rockville,MD20857.HHSPublicationNo. SMA-13-4763.PublishedJuly2013.SAMHSA Descriptor TheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)isthe agencywithintheU.S.DepartmentofHealthandHumanServicesthatleadspublic healtheffortstoadvancethebehavioralhealthofthenation.SAMHSAsmissionisto reducetheimpactofsubstanceabuseandmentalillnessonAmericascommunities. 7. Information BriefTerms and Definitions Before we start looking at these central questions, lets define some terms that will be used heavily throughout this informational brief:Mental Healthisastateofwell-beinginwhichanindividualrealizeshisorherown abilities,cancopewiththenormalstressesoflife,canworkproductively,andis abletomakeacontributiontohisorhercommunity.Inthispositivesense,mental healthisthefoundationforindividualwell-beingandtheeffectivefunctioningofa community.1Mental Illness isdefinedascollectivelyalldiagnosablementaldisordersorhealth conditionsthatarecharacterizedbyalterationsinthinking,mood,orbehavior(or somecombinationthereof)associatedwithdistressand/orimpairedfunctioning. Underthesedefinitions,substanceusemightbeclassifiedaseitheramentalhealth problemoramentalillness,dependingonitsintensity,duration,andeffects.2Mental Health Promotionconsistsofinterventionstoenhancetheabilitytoachieve developmentallyappropriatetasksandapositivesenseofself-esteem,mastery,wellbeing,andsocialinclusionandtostrengthentheabilitytocopewithadversity.3 Thisabilitytocopeisreferredtoasresilience.Mental Health Treatment istheprovisionofspecificinterventiontechniquesbya professionalforconditionsidentifiedinthemostrecenteditionoftheDiagnostic andStatisticalManualofMentalDisorders(DSM).Theseinterventionsshould haveproveneffectiveness,theabilitytoproducemeasurablechangesinbehaviors andsymptoms,andshouldbeperson-andfamily-centeredandculturallyand linguisticallyappropriate.4Prevention isasteporsetofstepsalongacontinuumtopromoteindividual,family, andcommunityhealth;preventmentalandsubstanceusedisorders;supportresilience andrecovery;andpreventrelapse.51 8. 2C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hRecoveryisaprocessofchangethroughwhichindividualsimprovetheirhealthand wellness,liveaself-directedlife,andstrivetoreachtheirfullpotential.Peoplewith mentalillnessescananddorecoverfromtheseconditions,andhopeplaysanessential partinovercomingtheinternalandexternalchallenges,barriers,andobstacles. Controllingormanagingsymptomsispartofthisprocess.Reducingoreliminating substanceuseiscriticalforrecoveryfromaddiction.6Recovery Support Services includeafocusonprovidingforthehealth,housing, vocational,andsocialsupportneedsofpeoplewithmentalhealthproblems.These includepeer-andfamily-operatedservices.7Substance Abuseisdefinedastheuseofalcoholordrugsdespitenegative consequences.8Substance Useisdefinedastheconsumptionofloworinfrequentdosesofalcohol andotherdrugs,sometimescalledexperimental,casual,orsocialuse.9Traumaresultsfromanevent,seriesofevents,orsetofcircumstancesthatis experiencedbyanindividualasphysicallyoremotionallyharmfulorthreateningand thathaslastingadverseeffectsontheindividualsfunctioningandphysical,social, emotional,orspiritualwell-being.10Young People/Youth aredefinedhereaspersonsuptoage25. 9. Information BriefSession 1: Sharing Personal Experiences What Does Mental Health Mean to Me? To Us as a Community? There are many views and opinions about mental illnesses, their causes, and how we can best treat and respond to these conditions. The following information provides some basic facts about mental health and mental illness to help participants begin the conversation.Understanding the Basics Mentalhealthplaysanimportantroleinyouroverallwell-being.Anestimated 19.6percentofAmericansages18andolderaboutoneinfiveadultswill experienceamentalhealthproblemthisyear.11Butstudiesshowthatmostpeoplewith mentalproblemsgetbetter,andmanyrecovercompletely. Mentalhealthincludesouremotional,psychological,andsocialwell-being.Itaffects howwethink,feel,andact.Italsohelpsdeterminehowwehandlestress,relateto others,andmakechoices.Mentalhealthisimportantateverystageoflife,from childhoodandadolescencethroughadulthood. Overthecourseofyourlife,youmayexperiencementalhealthproblems.Your thinking,mood,andbehaviorcouldbeaffected.12 Manyfactorscontributetomentalhealthproblems,including: Lifeexperiences,suchastraumaorahistoryofabuse Biologicalfactors,suchasgenesorchemicalimbalancesinyourbrain FamilyhistoryofmentalhealthproblemsTakingcareofonesmentalhealthisjustasimportantastakingcareofonesphysical health.Overallhealthincludesawell-balancedandnutritiousdiet,regularexercise, stressmanagement,earlyandongoingmentalhealthserviceswhenneeded,andtaking timetorelaxandenjoyfamilyandfriends.Findingagoodbalancebetweenworkand homeisimportanttomentalandphysicalhealth.3 10. 4C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hTypes of Mental Health Problems Peoplecanexperiencedifferenttypesofmentalhealthproblems.Somecanoccurforashort time,andsomeoccuroveranon-goingtimeperiod.Justasotherhealthconditions,theseare realanddiagnosablehealthconditionsthataffectandareaffectedbyfunctioningofthebrain, anorganofthebodyjustlikethekidney,liver,orheart.Mentalhealthproblemscanaffectyour thinking,mood,andbehavior.Commontypescaninclude:13 Anxiety Disorders Peoplewithanxietydisordersrespondtocertainobjectsorsituationswithfearanddread. Anxietydisorderscanincludeobsessive-compulsivedisorder,panicdisorders,phobias,and Post-TraumaticStressDisorder(PTSD). Attention Deficit Hyperactivity Disorder Attentiondeficithyperactivitydisorder(ADHD)isoneofthemostcommonchildhood disordersandcancontinuethroughadolescenceandadulthood.Symptomsincludedifficulty stayingfocusedandpayingattention,difficultycontrollingbehavior,andhyperactivity(overactivity). Eating Disorders Eatingdisordersinvolveextremeemotions,attitudes,andbehaviorsinvolvingweightand food.Eatingdisorderscanincludeanorexia,bulimia,andbingeeating. Co-Occurring Mental and Substance Use Disorders Mentalillnessesandsubstanceusedisordersoftenoccurtogether.Sometimesonedisorder canbeacontributingfactortoorcanexacerbatetheother.Sometimestheysimplyoccurat thesametime. Mood Disorders Thesedisordersinvolvepersistentfeelingsofsadnessorperiodsoffeelingoverlyhappy,or fluctuatingbetweenextremehappinessandextremesadness.Mooddisorderscaninclude depression,bipolardisorder,SeasonalAffectiveDisorder(SAD),andcompulsiontoself-harm. Personality Disorders Peoplewithpersonalitydisordershaveextremeandinflexiblepersonalitytraitsthataredistressing tothepersonand/orcauseproblemsinwork,school,orsocialrelationships.Personalitydisorders canincludeantisocialpersonalitydisorderandborderlinepersonalitydisorder. Psychotic Disorders Peoplewithpsychoticdisordershear,see,andbelievethingsthatarentrealortrue.An exampleofapsychoticdisorderisschizophrenia. Substance Use Disorders Substanceusedisordersinvolvethedependenceonorabuseofalcoholand/ordrugs,including thenonmedicaluseofprescriptiondrugs.14 Suicidal Behavior Suicideisaseriousproblemthatcausesimmeasurablepain,suffering,andlosstoindividuals, familiesandcommunitiesnationwide.Millionsofpeopleconsider,plan,orattemptsuicide eachyear;manydieasaresult. 11. Information BriefPromotion of Mental Health and Prevention of Mental Illnesses Whenwepromotementalhealth,wehelppeopleimprovetheirhealthandwellbeing,havepositiveself-esteem,andtobevaluedandcontributingmembersoftheir communities.Mentalhealthpromotionalsohelpsbuildresiliencyinpeople,helping themcopebetterduringlifeschallenges. Preventioninterventionshelptoreducethelikelihoodofdevelopingamentalillness orasubstanceusedisorderandcanhelpdelaytheonsetorreducetheseverityofa mentalillness.Preventionaddressesproblemsbeforetheyhappenbyaddressing thosethingsriskfactorsthatcanmakeitmorelikelyforapersontodevelop problems.Thesecanincludeworkingtocreatehealthyenvironmentsthatreduce theeffectsofpovertyandtheriskofviolence,childmaltreatment,drug/alcohol misuse,andbullyingandensurethatpeoplehaveaccesstothecarethattheyneed whensymptomsjustbegintoappear.Preventioneffortsfocusoncommunitiesor largepopulationsthroughuniversalstrategiesorinterventionstargetedathigh-risk individualsandthosewhomaybeshowingsomeminimalsignsandsymptomsof developingamentalillnessorasubstanceusedisorder. Someimportantwaysthatwecanpromotementalhealthandpreventmentalillnessand substanceusedisordersistoincreaseprotectivefactorsandusepromisingstrategies thataddresstheneedsofchildren,adults,andfamiliesinthecommunity.Protective factorsincludegoodcommunicationskills,reliablesupportanddisciplinefromparents andcaregivers,supportforearlylearning,qualityhealthcare,healthypeergroups, socialconnectedness,andsucceedingschools.Promisingstrategiesemphasizepublic educationandawarenessaboutissuesrelatedtomentalhealthandsubstanceuse- andincludeearlyidentificationofmentalhealthproblemsandaccesstoappropriate interventions.Treatment for Mental Health Problems Mostpeoplewhoexperiencementalillnesseswillimproveiftheyreceiveappropriate supports,services,andtreatment.Thefirststeptogettingtherighttreatmentisto seeahealthcareprofessionalandreviewyoursymptomsandlifecircumstances. Treatmentoptionsaretailoredtoeachspecificpersonandcondition;however,the mostcommonformsoftreatmentinclude: Psychotherapy, or talk therapy (sometimes called counseling)teaches peoplestrategiesandgivesthemtoolstodealwithstressanduncomfortable thoughtsandbehaviors.Psychotherapyhelpspeoplemanagetheir symptomsbetterandfunctionattheirbestineverydaylife.15Cognitive behavioral therapy (CBT)helpspeoplelearnhowtoidentify unhelpfulthinkingpatterns,recognizeandchangeinaccuratebeliefs,relate toothersinmorepositiveways,andchangebehaviorsaccordingly.CBT canbeappliedandadaptedtotreatmanyspecificmentaldisorders.165 12. 6C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hMedicationsusedtotreatthesymptomsofmanymentaldisorderssuchas schizophrenia,depression,bipolardisorder(sometimescalledmanic-depressive illness),anxietydisorders,andattentiondeficit-hyperactivitydisorder(ADHD). Medicationscanalsobeusedtomanagethecravingsandrelapseassociated withcertainkindsofaddictions.Sometimesmedicationsareusedwithother treatmentssuchaspsychotherapyorcounseling.17Rehabilitative servicesincluderecovery-focusedactivitiesortreatment/ therapeuticinterventionssuchasassistanceinimprovingorrestoringdailyliving skills,socialandleisureskills,groomingandpersonalhygieneskills,andmeal preparationskills;othersupportresources;and/ormedicationeducation.Recovery from Mental Health Problems Studiesshowthatmostpeoplewithmentalhealthproblemsgetbetter,andmanyrecover completely.Recoveryisdefinedasaprocessofchangethroughwhichindividuals improvetheirhealthandwellness,liveaself-directedlife,andstrivetoreachtheirfull potential.Recoveryissupportedbymentalhealthtreatmentandsupportservicesinthe community.18 Recoveryisbuilton: Healthovercomingormanagingonesdisease(s)orsymptomsincluding abstinenceifonehasanaddictionandmakinginformed,healthychoicesthat supportphysicalandemotionalwellbeing.Homeastableandsafeplacetolive.Purposemeaningfuldailyactivities,suchasajob,school,volunteerism,family caretaking,orcreativeendeavorsandtheindependence,income,andresourcesto participateinsociety.Communityrelationshipsandsocialnetworksthatprovidesupport,friendship, love,andhope.Attitudes and Beliefs About Mental Health WeknowalotaboutwhatAmericansbelieveaboutmentalhealthandmentalillnessfrom nationalsurveys.ThesesurveysrevealthatwhileAmericanshavelearnedagreatdeal aboutcharacteristicsandcausesofmentalillnessesoverthelastseveraldecades,negative beliefsaboutpeoplewithmentalillnessescontinuetogrow.19 Thesenegativeattitudesaboutpeoplewithmentalillnessesaremostlyinfluencedbythe misconceptionthatpeoplewithmentalillnessesaremoreviolentthanthegeneralpopulation.20 Peoplewithmentalillnessesarenomoreviolentthanthegeneralpopulationunlesscertain otherriskfactorsareinvolved,includingalcoholabuseoruntreated,activepsychosis 13. Information Briefassociatedwithparanoiaandincludingspecifictypesofcommandhallucinations.21In fact,peoplewithmentalillnessesonlycommitthreetofivepercentofviolentactsevery year.22Peoplewithmentalillnessesaremuchmorelikelytobevictimsofcrimethan perpetrators.23Impact of Attitudes and Beliefs Peoplesattitudesandbeliefsaboutmentalillnesssetthestageforhowtheyinteract withandsupportapersonwithmentalillness. Whenpeoplehavepositiveattitudesaboutmentalhealth,theymayengage insupportiveandinclusivebehaviors(e.g.,willingnesstodateapersonwith mentalillnessortohireapersonwithmentalillness).24Whenattitudesandbeliefsareexpressednegatively,theymayresultin avoidance,exclusionfromdailyactivities,and,intheworstcase,exploitation anddiscrimination.25Attitudesandbeliefsaboutmentalillnessareshapedbypersonalknowledgeabout mentalillnessandknowingandinteractingwithsomeonelivingwithamentalillness. Attitudesandbeliefscanbeinfluencedbyculturalstereotypes,mediastories,and institutionalpractices.Mental Health in the Community Therearemanyintertwinedfactorsthatinfluencethementalhealthofanindividualandthe resourcesavailableinacommunitytomeettheneedsofpeoplewithmentalhealthproblems.Spirituality and Mental Health Manyturntofaithcommunitiesforsupportindealingwithmentalhealthproblems. Faithcanprovideimportantelementsofsolaceandsupportforsuchindividuals.Faith communitiescanalsoplayakeyroleineducatingtheirmembersaboutmentalhealth problems.26Supportiverelationships,suchasfamily,long-termfriendships,and meaningfulonnectionsthroughfaithcanbeimportanttobuildingresilienceandwell-being.Culture and Mental Health Culturecanprovidealensforhowpeoplethinkaboutmentalhealth,whethertheyseek helpformentalhealthproblems,andhowpeopleandmentalhealthprofessionalsinteract withoneanother.27Peopletypicallythinkofcultureintermsofraceorethnicity,but culturealsoreferstoothersocialgroupsdefinedbycharacteristicssuchasage,gender, religion,incomelevel,education,geographicallocation,sexualorientation,disability,or profession.28Ratesandtypesofmentalhealthproblemsandseekingtreatmentcanvary accordingtothepopulation.29Racialandethnicminoritiesbearagreaterburdenfrom unmetmentalhealthneedsandsufferagreaterlosstotheiroverallhealthandproductivity.307 14. 8C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hMental Health is a Public Health Issue Providingforandsupportinggoodmentalhealthisapublichealthissuejustlike assuringthequalityofdrinkingwaterorpreventingandmanaginginfectious diseases.Communitiesprosperwhenthementalhealthneedsofcommunity membersaremet.Unaddressedmentalhealthissuescanhaveanegativeinfluence onhomelessness,poverty,employment,safety,andthelocaleconomy.Foryoung people,mentalhealthisinfluencedbyawebofinteractionsamongtheyoungperson, thefamily,childservicesystems(school,health,fostercare),andtheneighborhoods andcommunitiesinwhichtheylive. ApproximatelyoneinfiveAmericanswillhaveamentalhealthproblemin anygivenyear,yetonlyalittleoveroneinthreepeoplewithamentalhealth problemwillreceivementalhealthservices.31Over38,000Americansdiedbysuicidein2010,makingthenumberof Americanswhodiebysuicidemorethandoublethenumberwhodiedby homicide.32One-thirdofindividualswithseverementalillnesseswhoreceive communitymentalhealthservicesafterlengthystaysinastatehospital achievefullrecoveryinpsychiatricstatusandsocialfunction,andanother thirdimprovesignificantlyinbothareas.33Homelessness, Mental Health, and the CommunityOfthemorethansixmillionpeopleservedbystatementalhealthauthorities acrossthenation,only21percentareemployed.34From the January 2010 HUD Point-in-Time (PIT) counts, Continuums of Care reported that:Supportedemploymentprogramsthathelppeoplewiththemostserious mentalillnessesplacemorethan50percentoftheirclientsintopaid employment.35Between2007-2009,theaverageexpenditureperadultages18-26forthe treatmentofmentalhealthdisorderswasabout$2,000.Ofthispopulation, averageexpenditurefortreatmentofmentalhealthproblemswashigherfor youngadultsages18-21estimatedat$2,300peryearthanforthoseages 2226estimatedat$1,800.36In2006,186,000youngadultsreceivedsocialsecuritydisabilitybenefits becausetheirmentalillnesswassoseverethattheywerefoundtobeunable toengageinsubstantialgainfulactivity.37SeriousmentalillnessescosttheU.S.anestimated$193.2billioninlost earningsperyear.38Effectivenationwideschool-basedsubstanceabuse preventionprogrammingcanofferstatessavingswithin2yearsranging from:39Did You Know?26.2 percent of sheltered adults who were homeless had a severe mental illness, and 46 percent of sheltered adults on the night of the PIT count had a chronic substance abuse problem and/or a severe mental illness.Prejudice and discrimination associated with mental and substance use disorders create enormous housing challenges for these individuals.43o $36millionto$199millioninjuvenilejustice40 o $383millionto$2.1billionineducation41 o $68millionto$360millioninhealthservices42 15. Information Brief9Substance Abuse and Communities SubstanceabusetakesatremendoustollonAmericascommunities.Mentaland substanceuseconditionsoftenco-occur.Inotherwords,individualswithsubstance useconditionsoftenhaveamentalhealthconditionatthesametime,andpersons withmentalhealthproblemsoftenabusesubstancesorexperienceaddictionatthe sametime.Thefollowingincludesstatisticsonsubstanceabuseandco-occurring mentalandsubstanceusedisorders: In2011,anestimated20.6millionpersons(8.0percentofthepopulation aged12orolder)wereclassifiedwithsubstancedependenceorabuseinthe pastyear.4419.3millionpersons(7.5percentofthepopulationaged12orolder)needed treatmentforanillicitdrugoralcoholuseproblembutdidnotreceive treatment.45Approximatelyeightmillionadultshaveco-occurringdisorders.46Only6.9percentofindividualsreceivetreatmentforbothconditionswhile 56.6percentreceivenotreatmentatall.47Co-occurringmentalandsubstanceusedisorderratesarehighamongpeople whoexperiencehomelessness.48Onestudyreporteda23percentlifetimeprevalencerateofco-occurring disordersforindividualswhoexperiencehomelessness,andthesepeople mayfacecomplexphysical,social,andpsychologicalchallengesto recovery.49Withtreatment,emergencyroomvisits,hospitalstays,andperiods ofincarcerationaresignificantlyreduced.50Likewise,high-riskand harmfulsubstanceuseisdecreased.Stablehousingalongwithsupportive servicesprovidesahigherquality,self-directed,andsatisfyinglifeinthe community.51Did You Know?The Treatment Gap in America Almost two-thirds of the over 45 million adults with any mental illness and almost 90 percent of the over 21 million adults with substance use disorders go without treatment in our country every year.52 16. 10C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hResearch About the Mental Health of Young People Theresearchsupportstheneedforpreventionandearlyinterventionstrategiesto addressthemental,emotionalandbehavioralproblemsthatcanoccurthroughouta youngpersonslife. MorethanhalfofadolescentsintheUnitedStateswhofailtocompletehigh schoolhaveadiagnosablepsychiatricdisorder.53Individualswithmentalillnessesdieonaverage8.5yearsearlierthanthe generalpopulation,duemostlytopreventablehealthconditionslikeheart disease,diabetes,hypertension,andtobaccouse.54Bullyingcanhavesignificantmentalhealthconsequencesforbothvictims andbullies.55 o Comparedtoindividualswhowerenotbullied,victimsofbullying werenearlythreetimesaslikelytohaveissueswithgeneralized anxietyasthosewhowerenotbulliedand4.6timesaslikelyto sufferfrompanicattacksoragoraphobia. o Childrenwhoreportedbeingbothbulliesandvictimsshowed anearlyfivetimesgreaterriskofdepressionasyoungadults comparedtothosewhohadonlyexperiencedbeingabullyoronly experiencedbeingavictim.Researchhasdemonstratedthatpreventioneffortscandelaythefirstuseof tobaccoandalcohol.56Bingedrinkingandheavyalcoholusepeaksbetweenthoseaged18-25,with nearly40percentofpeopleinthatagegroupreportingbingedrinkingand 12percentreportingheavyalcoholuse.57Abuseofprescriptiondrugsishighestamongyoungadultsaged18to25, with5percentreportingnonmedicaluseinthepastmonth.58DatafromSAMHSAsChildrensMentalHealthInitiativeindicatedthat amongyouth12andolderwhoidentifiedsubstanceuseproblemsatintake inChildrensMentalHealthInitiative-fundedsystemsofcare,36percent involvedwiththechildwelfaresystemand32percentinvolvedwiththe juvenilejusticesystemreportednosubstanceuseproblemsafter6months.59Bypreventingachildfrombecomingdependentonalcohol,wecansave approximately$700,000overthecourseofthechildslifetime.60Byhelpingachildgraduatefromhighschoolwhowouldotherwisehave droppedout,wecansaveasmuchas$388,000overthecourseofthechilds lifetime.61 17. Information Brief11Session 2:Discussion of ChallengesWhat Are the Challenges and Factors We Should Consider? To make progress on mental health issues, we need to think strategically about the challenges we are facing and the factors that have the greatest influence on mental healthparticularly those that affect young people. This session will help you consider some of those challenges and factors and begin thinking about how to address them.Challenges to Promoting Mental Health Inthepast,thesciencedidnotexistabouthowtoeffectivelypromotementalhealth andpreventmentalillnesses.Now,wehavetheknow-howbutstillneedtoeducate communities,serviceproviders,andothersthatpreventionispossible.Promotion andpreventionwillhelpustoultimatelyreducedisabilityandhardshipbyreducing theprevalenceofmentalhealthdisorders.62 Promotionandpreventioninvolvesanewapproachtomentalhealthissues.This approachrequirespeopleandcommunitiestothinkandactdifferentlybyaddressing mentalhealthissuesbeforetheybecomementalillnesses.Challenges for Youth Transitioning to Adulthood Asyouthbecomeadults,alargenumberhavebehavioralhealthproblems,andvery fewactuallyreceivetreatment. Youthtransitioningtoadulthoodtypicallyhavedifficultiesaccessinghealth careandthehighestuninsuredrateintheUnitedStates.64Additionally,they oftenhavelowperceptionsofrisk65althoughthispopulationhasthehighest rateofhomicide,66andhighratesofhomelessness,67arrests,68mentalhealth problems,69schooldropouts,70andsubstanceabuse.71Itisestimatedthat6-12percentoftransition-ageyouthandyoungadults strugglewithaseriousmentalhealthcondition(2.4-5millionindividuals).72AccordingtotheTreatmentEpisodeDataSetfor2009,amongsubstance abusetreatmentadmissionsaged12to17,fewerthanoneineight(11.9 percent)werereferredbyschools.73 Treatmentadmissionsaged15to17mostfrequentlyreportedmarijuana(71.9 percent)oralcohol(17.7percent)astheirprimarysubstanceofabuse.74Did You Know? The Importance ofInvolving FamiliesFamily-driven care means that families have a decision-making role in the care of their own children as well as the policies and procedures that shape care for children in their community, state, tribe, territory, and nation.63 18. 12C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hAccess to Support, Services, and Treatment Attitudesandbeliefscanpreventapersonfromseekingtreatment,althoughresearch tellsusthattreatmentiseffectiveandpeopledorecover. Only38percentofadultswithdiagnosablementalhealthconditionsget treatment.Ofthe45.9millionpeople18andolderwhohavebehavioral healthconditions,just17.9millionreceivedtreatment.75Lessthanoneinfiveadolescentsgettreatmentfordiagnosablementalhealth conditions.76Aswithotherchronicillnesses,individualswhoseektreatmentandrecovery supportservicesformentalhealthproblemslearnnewlifeskillsandgoon tolivehealthy,empowered,andproductivelives.77Stablehousingisimportanttoindividualsseekingtreatmentandfor deliveringservicestothepersonintheirlivingenvironmentandcommunity. Throughresearchweknowthattreatmentiseffectiveandrecoveryis possiblebutnotwhenapersonsbasicneedforsafetyandhousingare lacking.78Paying for Mental Health Care Lackofabilitytoaffordcareisamongthetopreasonsthatpeoplewithunmetneed reportedfornotseekingtreatment.80 Did You Know? Economic Costs of Mental Health ProblemsThe annual cost of mental, emotional, and behavioral disorders among young people is estimated to be $247 billion including the costs of treatment and lost productivity.79Peoplewithmentalhealthandsubstanceabuseproblemshavehistorically hadhighratesofbeinguninsured.81 Asaconsequence,mentalhealthandsubstanceabusetreatmentspendinghas dependedmoreonpublicpayersthanallhealthcare,withpublicpayers suchasMedicaidaccountingforapproximately60percentofmentalhealth spending.82AsaresultoftheAffordableCareAct,manycurrentlyuninsuredAmericanswith mentalhealthandsubstanceabuseproblemswillbecomeeligibleforaffordable healthinsurancecoverage.Beginningin2014underthelaw,allnewsmallgroup andindividualmarketplanswillberequiredtocovertenEssentialHealthBenefit categories,includingmentalhealthandsubstanceusedisorderservices,andwill berequiredtocoverthematparitywithmedicalandsurgicalbenefits.TheMental HealthParityandAddictionsEquityAct(MHPAEA)requiresgrouphealthplans andinsurersthatoffermentalhealthandsubstanceusedisorderbenefitstoprovide coveragethatiscomparabletocoverageforgeneralmedicalandsurgicalcare.Asa resultofthesetwopiecesoflegislation,anestimated62millionAmericanswillhave improvedaccesstoservicesformentalandsubstanceusedisorders.83 19. Information BriefPerceptions of Violence and Mental Illness Toooften,depictionsandperceptionsofviolenceandmentalillnesscanperpetuate negativeattitudesandmythsaboutindividualslivingwithamentalillness. Peoplewithmentalillnessesonlycommitthreetofivepercentofviolentacts andaremuchmorelikelytobevictimsthanperpetratorsofviolence.84Researchhasdemonstratedthatindividualswhoreceivedtreatmentformental illnessesinthecommunity(outpatient,day,andresidentialtreatment)were11 timesmorelikelytohavebeenthevictimsofviolentcrimethanthegeneral populationinthepastyear.85Criminal Justice Involvement Nevertheless,therearehighratesofmentalillnessesandsubstanceabuseproblemsamong peopleinthecriminaljusticesystem. Approximately70percentofjailinmateswithmentalillnessesare incarceratedfornon-violentoffenses.86 In2005,individualswhoexperiencedmentalhealthproblemsaccountedfor 56percentofstateprisoners,45percentoffederalprisoners,and64percentof jailinmates.87Sixty-seventoseventypercentofyouthinthejuvenilejusticesystemhavea diagnosablementaldisorder.88Sexual Orientation Socialattitudesregardingsexualorientationcanalsoimpacthowweviewpeoplewith mentalhealthproblems: Therejectionoflesbian,gay,bisexual,andtransgender(LGBT)youthbytheir families,orbytheirpeersandcommunity,canhaveprofoundandlong-term impacts,includingdepression,useofillegaldrugs,andsuicidalbehavior.8913 20. 14C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hSession 3: Exploration of How to Respond What Can We do to Support Young People? Young people experience some of the highest prevalence rates of mental illness and yet have some of the lowest help seeking rates of any group. Additionally, childhood emotional and behavioral disorders are the most costly of all illnesses in children and youth.Did You Know? Early Childhood Experiences Help Build Success Later in Life Children begin developing social and emotional skills at a very young age, and these skills form an important foundation for being able to succeed in school, in relationships, and in life.94Early Life Experiences Earlylifeexperiencesareimportantinshapinganindividualslifeintoadulthoodand canimpacthowanindividuallearnsandrespondstostressfulevents.90 Whenyoungchildrenareexposedtorepeatedtraumaticexperiences(e.g., childabuse,witnessingviolence),theyareatincreasedriskofdeveloping mentalhealthproblems,substanceabuse,andchronichealthproblems(like heartdiseaseanddiabetes).91Thenegativeimpactsoftheseearlyexperiences(sometimesreferredtoas toxicstress)canbepreventedorreversedwhenachildhasarelationship withasupportive,responsive,andcaringadultatanearlyage.92AdverseChildhoodExperiences,orACEs,isatermthatdescribesalltypes ofabuse,neglect,andothertraumaticexperiencesthatoccurtoindividuals undertheageof18.Thesecanhaveaprofoundimpactonthatchildsfuture health.Infact,apersonwhoexperiencesfourormoreACEswere7.4times morelikelytoconsiderthemselvesalcoholics,3.9timesmorelikelytohave chronicbronchitisoremphysema,4.6timesmorelikelytoreportbeing depressed,and1.9timesmorelikelytodevelopcancer.93Schools Play an Important Role Schoolsplayacriticalroleinensuringthatbehavioralproblemsareidentifiedearly sothatyoungpeoplecangrowandthriveinahealthyenvironment.Schoolscanlead coordinationeffortsinbringingyouth-servingagenciestogethertoguaranteethat children,youth,andfamiliescaneasilyaccessservicesthatarecommunitybased, childcentered,familyfocused,andculturallyandlinguisticallycompetent. Childrenwhohavenotdevelopedsocialandemotionalskillsbythetimethey enterschoolareatadisadvantage.Forexample,childrenneedtobeableto 21. Information Brief15payattention,respondappropriatelytodirections,interactpositivelywithpeers andadults,andcontroltheiremotionsandbehaviorsinschoolinordertobe successful.95 Studentswithpoorsocialskillsaremorelikelyto:experiencedifficulties ininterpersonalrelationshipswithteachersandpeers;showsignsof depression,aggression,oranxiety;demonstratepooracademicperformance; andhaveahigherincidenceofinvolvementinthecriminaljusticesystemas adults.96Withoutadequatetreatment,youngadultsincollegewithamental illnessaremorelikelytoreceivelowerGPAs,dropoutofcollege,orbe unemployedthantheirpeerswhodonothaveamentalhealthchallenge.97 Thirty-onepercentofcollegestudentshavefounditdifficulttofunction duetodepressioninthepastyear,whilemorethan50percenthavefelt overwhelminganxiety,makingithardtosucceedacademically.98 Approximately50percentofstudentsage14andolderwithamentalillness dropoutofhighschool.Thisisthehighestdropoutrateofanydisability group.99Leftuntreated,childhoodmentalandemotionaldisorderscanleadtopooroutcomes inschool,limitedemploymentopportunities,andothernegativeeconomicimpactsin adulthood.Early Onset of Mental and Substance Use Disorders Mentalhealthproblemsoftenbeginatanearlyageandbecomemoresignificant duringadolescenceandyoungadulthood. Halfofadultmentalhealthproblemsbeginbeforeage14,andthree-quarters beginbeforeage24.100In2007,8.2percentofadolescents,anestimated2.0millionyouthsaged12 to17,experiencedatleastonemajordepressiveepisode.101Amongalladolescentswithmajordepressiveepisodesinthepastyear, nearlytwothirds(62.3percent)didnotreceivetreatmentfortheir depression.8.4percentoffull-timecollegestudentsaged18to22 experiencedmajordepressioninthepastyear.102Ofchildrenandyouthinneedofmentalhealthservices,75-80percentof theseyouthdonotreceiveservices.103Did You Know?The importance of seeking treatment early Delays in receiving treatment after the first onset of symptoms of schizophrenia or psychosis are found to be related to: poorer response to antipsychotic medications, presence of more severe symptoms, more frequent recurrences and hospitalizations, and higher suicide risk.104 22. 16C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hSuicide Prevention is Key Fartoomanyofournationsyouthtaketheirownlives: Onesurveyfoundthatina12-monthperiod,almost13.8percentofhigh schoolstudentshadseriouslyconsideredsuicide,10.9percentofhighschool studentshadmadeasuicideplan,and6.3percentofhighschoolstudents attemptedsuicideatleastonce.106Oneoutofevery53highschoolstudents(1.9percent)reporthavingmade asuicideattemptthatwasseriousenoughtobetreatedbyadoctorora nurse.107Thetollamongsomegroupsisevenhigher.Forexample,thesuicidedeath rateamong1519-year-oldAmericanIndian/AlaskaNativemalesistwoand one-halftimeshigherthantheoverallrateformalesinthatagegroup.108If you or someone you care about is feeling alone, hopeless, or is in crisis, call or chat with caring counselors at the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or (http://suicidepreventionlifeline.org/ GetHelp/LifelineChat2.aspx).Suicideisthethirdleadingcauseofdeathamongyouthages15-24.105Suicidetoucheseveryone,butthereishelpandhopewhenindividuals, communities,andprofessionalsjoinforcestopreventsuicide.See SAMHSAsPreventingSuicide:AToolkitforHighSchools(http://store. samhsa.gov/shin/content/SMA12-4669/SMA12-4669.pdf)andSAMHSAs SuicidePreventionResourceCentersRolesinPreventingSuicide(http:// www.sprc.org/basics/roles-suicide-prevention). 23. Information Brief17Session 4: Community Solutions What Steps Do We Want To Take as a Community? Whether you are part of a small group of concerned citizens or a community-wide planning process, you can start working on local ideas and can focus on identifying individual and community solutions. Itisimportanttofirstidentifywhatmentalhealthresourcescurrentlyexistinthe communityanddeterminewhatelseisneeded.Workwithcommunitymemberstomap outwhatpreventionstrategies,treatment,andrecoverysupportservicescurrentlyexist andhowtheyaremeetingtheneedsofthoseserved. Apersonsmentalhealthcanbeaffectedbymanyelementsofoursociety.Theplaces whereindividualsandcommunitieschoosetofocustheireffortscanbemuchbroader thanmanypeoplemightthink.Forcommunities,itisdifficulttoknowwhereto startsincethetopicinvolvesschools,humanservices,providernetworks,families, neighborhoods,faithcommunities,andmanyotherstakeholders. Thefollowingarealistofcommunityfactorsthatcanimpactmentalhealth.109 Culturalnormssuchasalcoholuse,bullying Discrimination Employmentopportunity Foodinsecuritynotknowingwhereyournextmealwillcomefrom Housingquality Incomeinequality Neighborhoodconditions Physicalisolation Publicservices Socialstatus AccesstohealthservicesGetting the Facts About What Works Toassistwithcommunityplanningandimplementation,thereareavarietyofresources toidentifyeffectiveapproachestomeetthementalhealthneedsofyoungpeople.When choosingevidence-basedapproaches,itisimportanttoidentifyandprioritizetheneeds ofyoungpeopleinthecommunitysothatyoucandeterminewhichtypeofintervention, strategy,orapproachwillbethemostappropriate.110Itisalsoimportanttoassessthe communityscapacity(e.g.,financialresources,organizationalcommitment,community buy-in)toimplementanintervention,strategy,orapproachwhilepreservingthe componentsthatmadetheoriginalpracticeeffective.111Communitiescanworktogether todecidewhatinterventions,strategiesandapproachesmatchtheneedsofyoung peopleinthecommunityandcanbeimplementedwithinthecommunityscapacity.For more information on evidence-based practices, refer to Appendix, Helpful Resources and Websites. 24. 18C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hAdditional Suggestions for Community Planning Tailor your efforts to your community. Everycommunityisdifferentwhenitcomestodevelopingthenextstepsin supportingourchildren,youth,andfamilies. Celebrate what has been done in your community to strengthen mental health. Everycommunityisstartingfromauniquepointwithexistingassetsandresources. Itisimportanttocelebratethethingsthatarealreadytakingplaceinyourcommunity.Highlight what work still needs to be done. Therewillalwaysbemoretodotosupportthehealthydevelopmentofyoungpeople. Taketimetorecognizehoweveryoneinthecommunitycanpitchinandsupport mentalhealth. Describe what direction you plan to take as a community. Createavisionforhowyourcommunitywilladdressthementalhealthneedsof youthandfamilies. Keep working together. Effectiveeffortstoaddressmentalhealthrequiretheneedtoformandsustain partnershipsfrommanydifferentpartsofthecommunity.Communityconversation meetingsshouldbeconsideredjustthestartofanon-goingdialoguetoplan, implement,andevaluateefforts.For more information you could use to host a conversation in your community, please go to www.CreatingCommunitySolutions.org and refer to Appendix, Helpful Resources and Websites. (These materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organizations programs or activities.) 25. Information Brief19Appendix: Helpful Resources and Websites (Note: These organizations, materials and links are offered for informational purposes only and should not be construed as an endorsement of the referenced organizations programs or activities.)Resources InformationAboutMentalHealth http://www.MentalHealth.gov SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA) http://www.SAMHSA.gov NationalInstituteofMentalHealth(NIMH) http://www.nimh.nih.gov Additionalinformationyoucouldusetohostaconversationinyour community http://www.CreatingCommunitySolutions.orgPromoting Mental Health and Preventing Mental Illness SuicidePreventionResourceCenter http://www.sprc.org TheInstituteofMedicinesPreventing Mental, Emotional and Behavioral Disorders Among Young People:ProgressandPossibilities http://www.iom.edu/Reports/2009/Preventing-Mental-Emotionaland-Behavioral-Disorders-Among-Young-People-Progress-andPossibilities.aspx AddressingBullying http://www.stopbullying.gov NationalCenterforMentalHealthPromotionandYouthViolencePrevention http://www.promoteprevent.org FindYouthInfo http://www.findyouthinfo.gov MillionHearts http://millionhearts.hhs.gov/index.htmlAddressing Public Attitudes ResourceCentertoPromoteAcceptance,Dignity,andSocialInclusion http://promoteacceptance.samhsa.gov VoiceAwards http://www.samhsa.gov/voiceawards ChildrensMentalHealthAwarenessDay http://www.samhsa.gov/childrenEvidence-Based Practices for Treatment NationalRegistryforEvidence-BasedProgramsandPractices http://www.nrepp.samhsa.gov NationalCenterforTrauma-InformedCare http://www.samhsa.gov/nctic ChildrensMentalHealthInitiativeTechnicalAssistanceCenter http://www.cmhnetwork.orgRecovery Support Services NationalConsumerTechnicalAssistanceCenters http://ncstac.org/index.php HomelessResourceCenter http://www.homeless.samhsa.gov SharedDecisionMakinginMentalHealthTools http://162.99.3.211/shared.asp CollegeDrinking:ChangingtheCulture http://www.collegedrinkingprevention.gov 26. 20C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t hReference List 1.WorldHealthOrganization.(2001).StrengtheningMentalHealthPromotion(Factsheetno.220). Geneva:WorldHealthOrganization.Retrievedfromhttps://apps.who.int/inf-fs/en/fact220.html2.Ibid.3.Ibid.4.5.6.7.8.9. 10.11.12.13.14.15.16. 17.18.SubstanceAbuseandMentalHealthServicesAdministration.(2013).DefinitionsofTraumaand Resilience.Retrievedfromhttp://www.samhsa.gov/children/trauma-resilience-definitions.asp U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA) 12-4687).Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).SAMHSAsWorkingDefinitionofRecovery(HHSPublicationNo.PEP12RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-WorkingDefinition-of-Recovery/PEP12-RECDEF U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2009).GuidingPrinciplesandElementsofRecovery-OrientedSystemsofCare: WhatDoWeKnowFromtheResearch?(HHSPublicationNo.(SMA)09-4439).Rockville,MD: CenterforSubstanceAbuseTreatment.Retrievedfromhttp://partnersforrecovery.samhsa.gov/docs/ Guiding_Principles_Whitepaper.pdf U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).NationalPreventionWeekParticipantToolkit(HHSPublicationNo.(SMA) 12-4687).Rockville,MD:CenterforSubstanceAbusePrevention,SubstanceAbuseandMental HealthServicesAdministration. Ibid. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Traumadefinition.Retrievedfromhttp://www.samhsa.gov/traumajustice/ traumadefinition/definition.aspx U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:Mental HealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD. Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm U.S.DepartmentofHealthandHumanServices.(2013).WhatIsMentalHealth?Retrievedfrom http://www.mentalhealth.gov/basics/what-is-mental-health/index.html U.S.DepartmentofHealthandHumanServices.(2013).WhattoLookFor?Retrievedfromhttp:// www.mentalhealth.gov/what-to-look-for/index.html U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2008).ResultsFromthe2007NationalSurveyonDrugUseandHealth:National Findings.(DHHSPublicationNo.(SMA)08-4343).Rockville,MD:OfficeofAppliedStudies, SubstanceAbuseandMentalHealthServicesAdministration.Retrievedfromhttp://www.samhsa.gov/ data/nsduh/2k7nsduh/2k7results.pdf NationalInstituteofMentalHealth.(2013).Psychotherapies.Bethesda,MD.Retrievedfromhttp:// www.nimh.nih.gov/health/topics/psychotherapies/index.shtml. Ibid. NationalInstituteofMentalHealth.(2013).MentalHealthMedications.Bethesda,MD.Retrieved fromhttp://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).SAMHSAsWorkingDefinitionofRecovery(HHSPublicationNo.PEP12RECDEF).Rockville,MD.Retrievedfromhttp://store.samhsa.gov/product/SAMHSA-s-WorkingDefinition-of-Recovery/PEP12-RECDEF 27. Information Brief19.20.21.22.23.24.25. 26.27.28.29.30. 31.32.33.34.35.Smith,T.W.,Marsden,P.,Hout,M.,&Kim,J.(2011).GeneralSocialSurvey,1972-2010[machinereadabledatafileandcodebook].Storrs,CT:TheRoperCenterforPublicOpinionResearch, UniversityofConnecticut/AnnArbor,MI:Inter-universityConsortiumforPoliticalandSocial Research[distributors].Retrievedfromhttp://dx.doi.org/10.3886/ICPSR31521.v1. Pescosolido,B.,Martin,J.,Link,B.,Kikuzawa,S.,Burgos,G.,Swindle,R.,etal.(2000).Americans ViewsofMentalHealthandIllnessatCenturysEnd:ContinuityandChange.Publicreportonthe MacArthurMentalHealthModule,1996GeneralSocialSurvey.Bloomington,Indiana:Indiana ConsortiumforMentalHealthServicesResearchandJosephPMailmanSchoolofPublicHealth, ColumbiaUniversity. Monahan,J.,Steadman,H.,Silver,E.,Appelbaum,P.,Robbins,P.,Mulvey,E.,etal.(2001). RethinkingRiskAssessment:TheMacArthurStudyofMentalDisorderandViolence.NewYork: OxfordUniversityPress. Appelbaum,P.&Swanson,J.(2010).Law&Psychiatry:GunLawsandMentalIllness:HowSensible AretheCurrentRestrictions?PsychiatricServices,61(7),652-654. Teplin,L.,McClelland,G.,Abram,K.,&Weiner,D.(2005).Crimevictimizationinadultswith severementalillness:ComparisonwiththeNationalCrimeVictimizationSurvey.ArchivesofGeneral Psychiatry,62(8),911-921.doi:10.1001/archpsyc.62.8.911. CentersforDiseaseControlandPrevention,SubstanceAbuseandMentalHealthServices Administration,NationalAssociationofCountyBehavioralHealth&DevelopmentalDisability Directors,NationalInstituteofMentalHealth,&TheCarterCenterMentalHealthProgram.(2012). AttitudesTowardMentalIllness:ResultsfromtheBehavioralRiskFactorSurveillanceSystem. Atlanta,GA:CentersforDiseaseControlandPrevention. Ibid. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2004).BuildingBridges:MentalHealthConsumersandMembersofFaith-Based andCommunityOrganizationsinDialogue(DHHSPub.No.3868).Rockville,MD:CenterforMental HealthServices,SubstanceAbuseandMentalHealthServicesAdministration. U.S.DepartmentofHealthandHumanServices.(2001).MentalHealth:Culture,Race,and EthnicityASupplementtoMentalHealth:AReportoftheSurgeonGeneral.Rockville,MD:Center forMentalHealthServices. 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Atlanta,GA:NationalCenterforInjuryPreventionandControl.Retrievedfromhttp://www.cdc.gov/ injury/wisqars/pdf/10LCID_Violence_Related_Injury_Deaths_2010-a.pdf Harding,C.,Brooks,G.,Ashikaga,T.,Strauss,J.S.,&Breier,A.(1987).TheVermontlongitudinal studyofpersonswithseverementalillness.AmericanJournalofPsychiatry,144(6),727735. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2009).2009CMHSUniformReportingSystemoutputtables.Retrievedfromhttp:// www.samhsa.gov/dataoutcomes/urs/urs2009.aspx Cook,J.,Leff,H.,Blyler,C.,Gold,P.,Goldberg,R.,Mueser,K.,etal.(2005).Resultsofamultisite randomizedtrialofsupportedemploymentinterventionsforindividualswithseverementalillness. ArchivesofGeneralPsychiatry,62(5),505512.21 28. 22C o m m u n i t y C o n ve r s a t i o n s A b o u t M e n t a l H e a l t h36.37.38.39.Davis,K.(2012).StatisticalBrief#358:ExpendituresforTreatmentofMentalHealthDisorders amongYoungAdults,Ages18-26,2007-2009:EstimatesfortheU.S.CivilianNoninstitutionalized Population.Rockville,MD:MedicalExpendituresPanelSurvey,AgencyforHealthcareResearchand Quality. UnitedStatesGovernmentAccountabilityOffice.(2008).YoungAdultswithSeriousMentalIllness: SomeStatesandFederalAgenciesAreTakingStepstoAddressTheirTransitionChallenges(Reportto CongressionalRequestors,GAO-08-678).Retrievedfromhttp://www.gao.gov/new.items/d08678.pdf Kessler,R.,Heeringa,S.,Lakoma,M.,Petukhova,M.,Rupp,A.,Schoenbaum,M.,etal.(2008).The individual-levelandsocietal-leveleffectsofmentaldisordersonearningsintheUnitedStates:Results fromtheNationalComorbiditySurveyReplication.AmericanJournalofPsychiatry,165(6),703-11. doi:10.1176/appi.ajp.2008.08010126. Miller,T.&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-Benefit Analysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention, SubstanceAbuseandMentalHealthServicesAdministration.40.Ibid.41.Ibid.42.Ibid.43.44.45. 46.47. 48.49.50.51.U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessment ReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/docum ents/2010homelessassessmentreport.pdf;Folsom,D.,Hawthorne,W.,Lindamer,L.,et.al.(2005). Prevalenceandriskfactorsforhomelessnessandutilizationofmentalhealthservicesamong10,340 patientswithseriousmentalillnessinalargepublicmentalhealthsystem.AmericanJournalof Psychiatry,162(2),370-376. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:Summary ofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD: SubstanceAbuseandMentalHealthServicesAdministration Ibid. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:Mental HealthFindings.(NSDUHSeriesH-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD: SubstanceAbuseandMentalHealthServicesAdministration. Ibid. U.S.DepartmentofHousingandUrbanDevelopment.(2011).The2010AnnualHomelessAssessment ReporttoCongress(HUDNo.11-121).Retrievedfromhttps://www.onecpd.info/resources/documents/ 2010homelessassessmentreport.pdf U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2005).SubstanceAbuseTreatmentforPersonsWithCo-OccurringDisorders. TreatmentImprovementProtocol(TIPSeries42,DHHSPublicationNo.(SMA)12-3992).Rockville, MD.Retrievedfromhttp://www.ncbi.nlm.nih.gov/books/NBK64197/pdf/TOC.pdf;PolcinD.& Henderson,D.M.(2008).Acleanandsoberplacetolive:philosophy,structure,andpurported therapeuticfactorsinsoberlivinghouses.JournalofPsychoactiveDrugs,40(2),153-159;Hannigan, T.,&Wagner,S.(2003).DevelopingtheSupportinSupportiveHousing:AGuidetoProviding ServicesinHousing.RetrievedfromCorporationforSupportiveHousingwebsiteathttp://documents. csh.org/documents/pubs/DevelopingSupport-full.pdf;Larimer,M.E.,etal.(2009).Healthcareand publicserviceuseandcostsbeforeandafterprovisionofhousingforchronicallyhomelesspersons withseverealcoholproblems.JournaloftheAmericanMedicalAssociation,301(13),13491357. Culhane,P.,Metraux,S.,&Hadley,T.(2002).Publicservicereductionassociatedwithplacementof homelesspersonswithseverementalillnessinsupportivehousing.HousingPolicyDebate,13(1), 107-163. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2010).PermanentSupportiveHousing:BuildingYourProgram(HHSPub.No.SMA10-4509).Rockville,MD:CenterforMentalHealthServices. 29. Information Brief52.53.54.55.56.57.58. 59.U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:Mental HealthFindings(NSDUHSeries,H-45,HHSPublicationNo.(SMA)12-4725).Rockville,MD. Retrievedfromhttp://www.samhsa.gov/data/NSDUH/2k10MH_Findings/2k10MHResults.htm U.S.DepartmentofEducation.(2001).Twenty-thirdannualreporttoCongressontheimplementation oftheIndividualswithDisabilitiesEducationAct.Washington,D.C.:U.S.DepartmentofEducation. Druss,B.(2011).UnderstandingExcessMortalityinPersonswithMentalIllness.MedicalCare, 49(6),599-604. Copeland,W.,Wolke,D.,Angold,A.,&Costello,E.(2013).AdultPsychiatricOutcomesofBullying andBeingBulliedbyPeersinChildhoodandAdolescence.JAMAPsychiatry,70(4),419-426. Miller,T.,&Hendrie,D.(2008).SubstanceAbusePreventionDollarsandCents:ACost-Benefit Analysis(DHHSPub.No.(SMA)07-4298).Rockville,MD:CenterforSubstanceAbusePrevention, SubstanceAbuseandMentalHealthServicesAdministration. U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServices Administration.(2012).Resultsfromthe2011NationalSurveyonDrugUseandHealth:Summary ofNationalFindings(NSDUHSeriesH-44,HHSPublicationNo.(SMA)12-4713).Rockville,MD: SubstanceAbuseandMentalHealthServicesAdministration. Ibid. 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