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