Deck 14: Prevalence and Management of Behavioral Health Care

Question 1

How were you raised to think about mental illness? In what ways, if any, did your upbringing influence your thoughts about mental illness?

Answer 1

I was raised to think about mental illness as nothing wrong with the individual just a different way of thinking, behaving and socializing. If someone has a mental illness they do not act like everyone else but I do not have to treat him or her differently. I was taught that if an individual is harmful to themselves or others then they have to be institutionalized.
Some people are born with a mental illness or other develops it because they cannot handle a situation or are traumatized. It is also something an individual should not be ashamed of. They should talk to professionals and get the help they need.
My upbringing only taught me that everyone is different and everyone handles situations differently. I do not need to judge them but I should just learn and support them. Everyone is different and we can all learn from each other. You just need to respect everyone and be patient.

Question 2

When psychiatrists and other mental health professionals are sent abroad for training they often do not return. This presents a particular problem for developing countries such as Ghana and India that are experiencing difficulty retaining qualified mental health professionals. To what do you attribute this problem? In what way(s), if any, might this problem be effectively addressed?

Answer 2

Professionals are most likely not returning to their home country because they are getting paid more in other countries; there are more opportunities and safer areas for them to work. They may also be getting more benefits. If a country is unable to pay their physicians then they will not want to work there. Professionals are not afraid of their home country or do not want to leave it for good but they want to be able to make a living and get all the opportunities that they can get.
If governments gave more money to healthcare then physicians would be able to get paid more. They would also be able to get better facilities to work in and do whatever procedure they need to. There could be benefits or rewards given for coming back. They could get a leave for a few months if they decided to come back to their home country for most of the year. I believe they need an incentive or a good opportunity to be willing to come back.
They have to take care of their family so working in other countries helps them provide for their families. Developing countries usually do not have the equipment or facilities to be able to help the citizens of that country. Some physicians want to teach other physicians their techniques so they will travel to other countries to.
I think hospitals and medical schools should pay for medical school as long as they help out in their country for a certain amount of years. It is not a bad think but it is helping them and their country. Hospitals and the government should also work with the physicians to see what they would like or need help with in order to stay in their home country.

Question 3

Discuss the relationship of regional differences and access to behavioral/ mental health care.

Answer 3

Some countries have regional differences with mental health access. Certain regions in countries do not have enough physicians to support the community. There may be a primary physician in the area by not a physician who works with mental or behavioral instability. Many countries do not have enough money to pay physicians so they may lack physicians for many regionals.
There are regionals that are poorer than others and those areas may not have good access to a physician. Regions may defer in means of transportation too. Some regionals do not have good employment so individuals are more prone to being mentally instable. If a region in a country is very unstable those individuals are most likely not mentally okay. Depending on the amount of people in one region will determine the amount of physicians available.
The surroundings and environment can also determine the stress and mental instability levels an individual can have. A person who is near an ocean and has to deal with tsunamis will be more stressed out and worried than an individual who is inland and does not have to ever worry about getting their home destroyed from a storm. Each region in a country is different and each individual in that region has different thing they have to deal with that makes their area unique.

Question 4

Some people feel that work is one thing and politics are another. To what extent do you feel health practitioners should be involved in politics to improve mental health services in their community? In your opinion, is political activity something that falls outside of your work responsibilities? Explain your point of view.

Question 5

Have you experienced psychological stress in your own life? How did you handle it? Did you seek out professional help? Was your family supportive? Is your behavioral problem something you would share at work? Why or why not?

Question 6

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
In what country are you most likely to experience this scenario and why?

Question 7

Discuss the incidence and prevalence of mental illness.

Question 8

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
In your opinion, which of the countries studied would provide the best support for addressing these issues, and why?

Question 9

Have you worked with someone with a behavioral disorder? How is mental illness among staff addressed in your workplace?

Question 10

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
What family support is most needed to assist in addressing this situation?

Question 11

Discuss the mental healthcare system in terms of impact and future challenges.

Question 12

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
Select one of the following endings and respond to the questions which follow:
a. The son arrived in time-he called emergency services and the mother was saved. What happens now?
b. The son found the mother too late. She is dead. What happens now?

Question 13

To what extent does religion play a role in helping families cope with mental illness in the population you serve?

Question 14

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
How might either of these endings been averted? Replay the scenario for a more positive ending.

Question 15

If you do not have formal preparation and training to work with people with mental illness, would you feel equipped to work with them in a primary care setting? Would you be able to pick up on any signs of mental distress? For example, would you be able to identify depression or suicidal tendencies in a patient?

Question 16

Case Scenarios
Introducing the Scenarios:
The following scenarios are based on true events. The scenarios are purposefully generic and contain essential information for discussion. You will notice that identifying information such as names and locations are not included in an attempt to stimulate your thinking about how these events would play out in the 11 countries we have studied in this chapter.
Scenario 1: The Weekend
The son was at his wit?s end. He was home from college for what he had hoped would be a fun weekend with his mother to celebrate the grandmother?s 75th birthday. He was also looking forward to seeing his married older brother, his charming sister-in-law, and their new 6-month-old baby boy. But he had been home for less than 24 hours and things were unraveling. Since he had arrived Friday night, the mother had come up to him at least five times and asked: ?Do you think I?ve been a good mother? Do you still love me?? No matter how he tried to reassure her, the mother kept pushing. Where were these questions coming from? When he pressed her for answers, she stared at him for a few seconds and then walked away.
Since his father had walked out on them five years ago, his mother had gone in and out of strange moods. It was clear she was bitter; being left for another woman was something she could not get over. The mother even watched from across the street, the apartment where the new woman lived just to see what she looked like. Last summer, the mother was hospitalized for ?nervous exhaustion? and after one week, she was released with the doctor?s advice to take things easy. Following this episode, the son made more of an effort to call his mother from school as frequently as possible. This wasn?t always easy between classes and practice sessions required to keep his athletic scholarship.
Sometimes the mother sat up all night smoking; other times she would say very little and just curl up on the couch and sleep most of the day away?especially on weekends. Despite her dark periods, the mother was able to hold down her teaching job at the elementary school and was highly regarded as one of the best teachers in the system. But she worried about money constantly. Once the son overheard his mother say to her sister: ?You know it?s all on me now. I really can?t depend on anyone else. My ex-husband hasn?t got any money; I was always the stable breadwinner if you think about it, and I am not up to going to court to get blood out of a stone.? The sister advised her to go for counseling or at least join a self-help group but the mother insisted she could work out things for herself?what 266 Chapter 15: Prevalence and Management of Behavioral Health Care did those doctors know anyway? Besides, she did not want anyone in her business?her faith would pull her through.
Saturday afternoon the son and the mother joined everyone for the party at his aunt?s home. Surprisingly, his mother was less agitated today and she seemed to enjoy the grandmother?s birthday celebration. Everyone remarked on how attractive the mother looked in her bright red sweater.
On Sunday morning the son decided to accompany his mother to church and then treat her to breakfast afterwards. He would meet up with friends later that afternoon and then catch the evening train back to school. He went to her room to discuss the plan. The door was half-way open. Calling her name, the son knocked briefly, opened the door, and found his mother drooping over the side of the bed with an empty pill bottle on the floor.
Do you think the family might worry about the possibility of the mother's problem transferring to younger members of the families?

Question 17

What screening tools do you have to identify mental illness in your work setting? Are there certain protocols to follow if you find you are working with a mentally distressed patient?

Question 18

Scenario 2: The Brother
No one was ever sure what to think about the brother. When he was born, one of his aunts noticed that he rocked back and forth while standing in the crib. Another aunt commented that the mother smoked while carrying him and that may have had something to do with his excessive rocking.
When he was about 8 years old, the parents were concerned about his capabilities and had him tested. The parents never explicitly shared the results of the testing with the rest of the family but the word was that the boy was ?educable.? At least, one relative observed, the boy was not ?retarded.? The boy?s mother went as far as to say she thought her son might be ?emotionally immature.?
As he grew older, it was noticeable that the brother did not seem to start conversations but only repeated what people said. Also, the family seemed to press him into housework activities. As educated people themselves, the parents wanted to make sure their son had a degree in something. They sent the brother to an electronics school but he never seemed to get a job in the field.
When the mother fell ill, the son took up her care with little assistance from the older sister. She was raising three children and in the middle of a divorce. Another brother lived 200 miles away and rarely kept up with the family.
One of the aunts had a fit when she learned that the brother was bathing his very ill mother. Why didn?t they get a woman to help out with something that personal? She would do it but her arthritis made it hard for her to help anyone. Why couldn?t the daughter at least help out with the mother?s hygiene? The brother took care of his mother until her death.
Several years later, someone heard that a 50-year-old man was found dead on the street. Later, the family learned that the man was their brother. He had died of a heart attack. For approximately 5 ? years after his mother?s death, he had survived on cigarettes, beer, and ate only food that he liked?usually meat and potatoes. Since his mother?s death, he had worked for the past six years in an entertainment hall, setting up chairs and buffet tables at minimum wage. The owner let him stay rent free in a room above the hall. His married sister had enough room for the brother but never invited him to stay with her. At his service, a family friend remarked. ?It?s a shame. If the parents would just have admitted their child needed special help in the first place, the brother might be alive today.?
In what country are you most likely to experience this scenario and why?

Question 19

Describe mental health services in your community? Are they effective? Is your workplace part of the network of community-based services for the mentally ill?

Question 20

Scenario 2: The Brother
No one was ever sure what to think about the brother. When he was born, one of his aunts noticed that he rocked back and forth while standing in the crib. Another aunt commented that the mother smoked while carrying him and that may have had something to do with his excessive rocking.
When he was about 8 years old, the parents were concerned about his capabilities and had him tested. The parents never explicitly shared the results of the testing with the rest of the family but the word was that the boy was ?educable.? At least, one relative observed, the boy was not ?retarded.? The boy?s mother went as far as to say she thought her son might be ?emotionally immature.?
As he grew older, it was noticeable that the brother did not seem to start conversations but only repeated what people said. Also, the family seemed to press him into housework activities. As educated people themselves, the parents wanted to make sure their son had a degree in something. They sent the brother to an electronics school but he never seemed to get a job in the field.
When the mother fell ill, the son took up her care with little assistance from the older sister. She was raising three children and in the middle of a divorce. Another brother lived 200 miles away and rarely kept up with the family.
One of the aunts had a fit when she learned that the brother was bathing his very ill mother. Why didn?t they get a woman to help out with something that personal? She would do it but her arthritis made it hard for her to help anyone. Why couldn?t the daughter at least help out with the mother?s hygiene? The brother took care of his mother until her death.
Several years later, someone heard that a 50-year-old man was found dead on the street. Later, the family learned that the man was their brother. He had died of a heart attack. For approximately 5 ? years after his mother?s death, he had survived on cigarettes, beer, and ate only food that he liked?usually meat and potatoes. Since his mother?s death, he had worked for the past six years in an entertainment hall, setting up chairs and buffet tables at minimum wage. The owner let him stay rent free in a room above the hall. His married sister had enough room for the brother but never invited him to stay with her. At his service, a family friend remarked. ?It?s a shame. If the parents would just have admitted their child needed special help in the first place, the brother might be alive today.?
In your opinion, which of the countries studied would provide the best support for addressing these issues, and why?

Question 21

A frequent complaint of many city dwellers is dealing with the panhandling of the homeless who, in their estimation, require psychological assistance. Describe your experiences with displays of public behavior of the mentally ill. What should be done about the homeless and other types of individuals who seem to wander the streets? Is deinstitutionalization a good idea? Why or why not? In what way, if any, can deinstitutionalization efforts be more effectively addressed?

Question 22

Scenario 2: The Brother
No one was ever sure what to think about the brother. When he was born, one of his aunts noticed that he rocked back and forth while standing in the crib. Another aunt commented that the mother smoked while carrying him and that may have had something to do with his excessive rocking.
When he was about 8 years old, the parents were concerned about his capabilities and had him tested. The parents never explicitly shared the results of the testing with the rest of the family but the word was that the boy was ?educable.? At least, one relative observed, the boy was not ?retarded.? The boy?s mother went as far as to say she thought her son might be ?emotionally immature.?
As he grew older, it was noticeable that the brother did not seem to start conversations but only repeated what people said. Also, the family seemed to press him into housework activities. As educated people themselves, the parents wanted to make sure their son had a degree in something. They sent the brother to an electronics school but he never seemed to get a job in the field.
When the mother fell ill, the son took up her care with little assistance from the older sister. She was raising three children and in the middle of a divorce. Another brother lived 200 miles away and rarely kept up with the family.
One of the aunts had a fit when she learned that the brother was bathing his very ill mother. Why didn?t they get a woman to help out with something that personal? She would do it but her arthritis made it hard for her to help anyone. Why couldn?t the daughter at least help out with the mother?s hygiene? The brother took care of his mother until her death.
Several years later, someone heard that a 50-year-old man was found dead on the street. Later, the family learned that the man was their brother. He had died of a heart attack. For approximately 5 ? years after his mother?s death, he had survived on cigarettes, beer, and ate only food that he liked?usually meat and potatoes. Since his mother?s death, he had worked for the past six years in an entertainment hall, setting up chairs and buffet tables at minimum wage. The owner let him stay rent free in a room above the hall. His married sister had enough room for the brother but never invited him to stay with her. At his service, a family friend remarked. ?It?s a shame. If the parents would just have admitted their child needed special help in the first place, the brother might be alive today.?
What family support is most needed to assist in addressing this situation?

Question 23

Families of the mentally ill experience significant stress psychologically and even financially. Have you observed this situation? How is this problem addressed in your community? Describe support programs to assist families of people with behavior disorders including your opinion of their effectiveness.

Question 24

Scenario 2: The Brother
No one was ever sure what to think about the brother. When he was born, one of his aunts noticed that he rocked back and forth while standing in the crib. Another aunt commented that the mother smoked while carrying him and that may have had something to do with his excessive rocking.
When he was about 8 years old, the parents were concerned about his capabilities and had him tested. The parents never explicitly shared the results of the testing with the rest of the family but the word was that the boy was ?educable.? At least, one relative observed, the boy was not ?retarded.? The boy?s mother went as far as to say she thought her son might be ?emotionally immature.?
As he grew older, it was noticeable that the brother did not seem to start conversations but only repeated what people said. Also, the family seemed to press him into housework activities. As educated people themselves, the parents wanted to make sure their son had a degree in something. They sent the brother to an electronics school but he never seemed to get a job in the field.
When the mother fell ill, the son took up her care with little assistance from the older sister. She was raising three children and in the middle of a divorce. Another brother lived 200 miles away and rarely kept up with the family.
One of the aunts had a fit when she learned that the brother was bathing his very ill mother. Why didn?t they get a woman to help out with something that personal? She would do it but her arthritis made it hard for her to help anyone. Why couldn?t the daughter at least help out with the mother?s hygiene? The brother took care of his mother until her death.
Several years later, someone heard that a 50-year-old man was found dead on the street. Later, the family learned that the man was their brother. He had died of a heart attack. For approximately 5 ? years after his mother?s death, he had survived on cigarettes, beer, and ate only food that he liked?usually meat and potatoes. Since his mother?s death, he had worked for the past six years in an entertainment hall, setting up chairs and buffet tables at minimum wage. The owner let him stay rent free in a room above the hall. His married sister had enough room for the brother but never invited him to stay with her. At his service, a family friend remarked. ?It?s a shame. If the parents would just have admitted their child needed special help in the first place, the brother might be alive today.?
In your opinion, what was wrong with the brother? Was it caused by something the mother did when she carried him? Do you think the family might worry about the possibility of this problem being passed down through generations?

Question 25

Community-based behavioral health involves multi-professional teams. Describe the advantages and drawbacks of this team approach to care.

Question 26

Describe treatment programs for substance and alcohol abuse in your community (or work setting). Are these programs effective? Which programs are viewed positively? What accounts for their success? How would you "fix" less successful programs?

Question 27

In your opinion, what types of education and training should be provided in the workplace regarding behavioral health?

Question 28

Describe how mental health care is structured and financed in selected countries.

Question 29

What outstanding differences have you noticed among developing and developed (industrialized) countries regarding true access to mental health services?