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This Document Contains Chapters 12 to 14 Chapter 12: The Mental Hospital Patient Test Questions Part I. Multiple Choice Questions Circle the response that best answers the following questions. 1) The increased and widespread use of __________ has caused a dramatic change in the case of mental patients since the mid-1950s. A) psychotropic drugs B) electroshock therapy C) inpatient mental hospitals D) community resource centers Answer: A 2) The number of resident patients has __________ over the years. A) increased slightly B) increased significantly C) decreased slightly D) decreased significantly Answer: D 3) The number of admissions for long- and short-term care __________ between 1955 and 1997. A) increased B) decreased C) increased then decreased D) decreased then increased Answer: C 4) General hospitals accounted for about __________ of all mental patient admissions. A) one-quarter B) one-third C) half D) two-thirds Answer: C 5) Approximately __________ percent of mental hospital admissions are voluntary. A) 20 B) 45 C) 55 D) 70 Answer: D 6) Who is most likely to initiate hospitalization for high-income persons? A) police officers B) distant relatives C) spouses D) siblings Answer: C 7) Who of those listed below is the most likely to be admitted for hospitalization? A) an upper-class married person B) an upper-class unmarried person C) a lower class married person D) a lower class unmarried person Answer: A 8) Rushing found that those with more rather than fewer resources were more likely to be admitted to hospitals __________. A) temporarily B) permanently C) voluntarily D) involuntarily Answer: C 9) Why does Rushing suggest that those with more resources are more likely to be admitted to hospitals voluntarily? A) they have a better sense of self B) they have resources to fight involuntarily commitment C) they seek more medical attention D) they have bigger support networks Answer: B 10) Goffman argues that __________ for admission to mental hospitals. A) there are no universal standards B) standards have improved C) standards vary by diagnosis D) treatment is improved with universal standards Answer: A 11) Rosenhan’s pseudo patients were released from the mental hospital when __________. A) the treatments worked B) other patients outed them as fakes C) the researchers came to get them out D) they convinced staff that the schizophrenia was in remission Answer: D 12) The primary legal rational for using an insanity defense is that they __________. A) were a danger to themselves B) caused pain to others C) damaged property D) committed a crime Answer: A 13) In Scheff’s research, he found that approximately __________ percent of patients who used the insanity defense were not necessarily dangerous. A) 10 B) 25 C) 45 D) 60 Answer: D 14) In most cases, a verdict of insanity __________. A) gives the judge the right to seek the death penalty B) is equivalent to a not guilty verdict C) does not release an individual back into society D) is used very limitedly Answer: C 15) Recent research has concluded that male clinicians overestimate dangerousness among which group? A) white male B) white females C) black males D) black females Answer: C 16) Goffman defined mental hospitals as a __________. A) representative city B) total institution C) prison D) full camp Answer: B 17) A total institution is a place where a large number of people live and work. Characteristic of a total institution include all of the following, except __________. A) the group is isolated from the wider population B) the group is largely regulated C) the group is under the authority of leaders D) the group is similar to one another Answer: D 18) Which of the following is not an example of a total institution? A) prison B) mental hospital C) schools D) military camps Answer: C 19) Who is at the bottom of the status hierarchy of a mental hospital? A) patients B) nurse’s aides C) psychologists D) maintenance personnel Answer: A 20) Goffman notes that all total institutions have some form of __________, the status of staff as superior and patients as inferior. A) degree B) deference C) depersonalization D) dehumanization Answer: B 21) Rosenhan attributed the origins of depersonalization to which of the following? A) social norms and legal restrictions B) the total institution C) societal attitudes and hospital structure D) interaction with doctors and nurses Answer: C 22) Which of the following is not one of the types of adjustment to the total institution, according to Goffman? A) translation B) colonization C) intransigence D) situational withdrawal Answer: A 23) Which of the following is the most common mode of adaptation to the total institution? A) conversion and colonization B) rebellion and conversion C) situational withdrawal an intransigence D) conversion, colonization, and loyalty Answer: A 24) __________ space is a space in a total institution where patients are allowed but will be under strict observation. A) Off-limits B) Free C) Surveillance D) Underlife Answer: C 25) Institutionalization refers to __________. A) securing a place within the institution B) a prolonged living in a state of enforced dependency C) gradually learning to play the role of a sick person D) finding friends within an institution Answer: B Part II. Essay Questions Answer the following questions in your own words. 1) What are the modes of adapting to life in a mental hospital? Answer: Adapting to life in a mental hospital typically involves several modes of adjustment and coping strategies. Here are some common ways individuals might adapt: 1. Establishing Routine: Creating a daily schedule helps in adjusting to the structured environment of a mental hospital. This routine often includes meal times, therapy sessions, recreational activities, and rest periods. 2. Engaging in Therapy: Participating actively in individual therapy, group therapy, or counseling sessions can help individuals understand their conditions better, learn coping skills, and develop strategies for managing symptoms. 3. Building Relationships: Developing connections with other patients or staff members can provide emotional support and a sense of community within the hospital setting. This social interaction can alleviate feelings of isolation and loneliness. 4. Adhering to Medication: Many individuals in mental hospitals are prescribed medications to manage their symptoms. Adapting involves taking medications as prescribed and communicating openly with healthcare providers about any concerns or side effects. 5. Self-Care Practices: Incorporating self-care activities such as exercise, relaxation techniques, journaling, or hobbies can promote well-being and aid in managing stress. 6. Understanding Hospital Rules: Becoming familiar with and following hospital rules and guidelines helps maintain a safe and respectful environment for oneself and others. 7. Advocating for Needs: Learning to advocate for personal needs and preferences within the hospital environment can improve comfort and satisfaction with care. 8. Planning for Discharge: For individuals with a goal of returning to the community, working with healthcare providers to set discharge goals and participating in discharge planning activities can facilitate a smoother transition. These modes of adaptation may vary based on individual circumstances, diagnoses, and treatment plans, but they generally aim to support adjustment, recovery, and eventual reintegration into daily life outside the hospital. 2) What is institutionalization? Answer: Institutionalization refers to the process by which individuals adapt to and become accustomed to living within an institutional or organizational structure, such as a mental hospital, prison, nursing home, or similar facility. It involves the following key aspects: 1. Adaptation to Institutional Environment: Individuals adjust their behaviors, routines, and expectations to fit within the structured environment of the institution. This includes following rules, adhering to schedules, and interacting with staff and other residents according to institutional norms. 2. Dependency on Institutional Services: Institutionalized individuals often become reliant on the services and resources provided within the institution, such as meals, medication administration, therapy sessions, and recreational activities. 3. Loss of Autonomy: There is typically a reduction in personal autonomy as institutionalized individuals may have limited control over decisions that affect their daily lives, such as when they eat, sleep, or engage in activities. 4. Social and Psychological Effects: Institutionalization can lead to changes in social relationships and psychological well-being. Some individuals may experience social isolation, loneliness, or a sense of disconnection from the outside world. Others may develop institutional behaviors or coping mechanisms specific to the institutional environment. 5. Long-term Effects: Prolonged institutionalization can potentially affect individuals' ability to reintegrate into community settings or adjust to life outside the institution once discharged. It may also impact their self-esteem, independence, and overall quality of life. In summary, institutionalization involves the process of adapting to and living within the structured environment of an institution, often resulting in changes to individuals' behaviors, dependencies, social interactions, and psychological well-being. 3) How does social class influence voluntary and involuntary commitment? Answer: Social class can influence both voluntary and involuntary commitment to mental hospitals or psychiatric facilities in several ways: 1. Access to Mental Health Services: • Voluntary Commitment: Individuals from higher social classes often have greater access to resources such as private health insurance, which may cover mental health services more comprehensively. They may also be more aware of available treatment options and have the financial means to seek care voluntarily. • Involuntary Commitment: Social class can affect access to legal resources. Those from lower social classes may have less access to legal representation or advocacy to challenge involuntary commitment orders, potentially leading to prolonged stays in psychiatric facilities. 2. Perception and Stigma: • Voluntary Commitment: Social class can influence how mental health issues are perceived within different socioeconomic groups. Individuals from higher social classes may feel more empowered to seek voluntary treatment without fear of stigma or judgment. • Involuntary Commitment: There can be biases in the perception of behavior associated with mental illness across social classes. Lower social class individuals may be more likely to be involuntarily committed due to societal perceptions or misunderstandings about their behavior. 3. Treatment Options and Quality: • Voluntary Commitment: Higher social class individuals may have access to more varied and potentially higher-quality treatment options, including private facilities or specialists, which may influence their decision to seek voluntary commitment. • Involuntary Commitment: Quality of care in psychiatric facilities can vary based on funding and resources available. Those from lower social classes may be more likely to be placed in facilities with limited resources and less comprehensive treatment options. 4. Legal and Advocacy Factors: • Voluntary Commitment: Higher social class individuals may have better access to legal assistance and advocacy, allowing them to navigate the voluntary commitment process more effectively and potentially ensuring their rights are respected during treatment. • Involuntary Commitment: Social class can influence access to legal resources to challenge involuntary commitment orders or to advocate for improved conditions and treatment within psychiatric facilities. 5. Social Support Networks: • Voluntary Commitment: Social class often correlates with the strength and diversity of social support networks. Higher social class individuals may have access to supportive family and friends who can encourage and facilitate voluntary commitment when needed. • Involuntary Commitment: Individuals from lower social classes may have less robust social support networks, which can impact their ability to challenge involuntary commitment decisions or to receive adequate support during and after treatment. In conclusion, social class intersects with various factors influencing both voluntary and involuntary commitment to mental health facilities, including access to resources, stigma, treatment options, legal advocacy, and social support. These factors can significantly shape individuals' experiences and outcomes within psychiatric care settings. 4) How does a mental hospital fit the definition of a total institution? Answer: A mental hospital often fits the definition of a total institution, a concept introduced by sociologist Erving Goffman. Here’s how a mental hospital aligns with the characteristics of a total institution: 1. Controlled Environment: Mental hospitals are highly structured and controlled environments where every aspect of daily life, including schedules, activities, and interactions, is regulated by institutional rules and routines. Patients' movements, behaviors, and access to resources are typically managed and supervised by staff. 2. Isolation from Outside World: Mental hospitals often physically isolate patients from the outside world to varying degrees. This isolation can limit patients' contact with family, friends, and the broader community, thereby creating a distinct social environment within the institution. 3. Uniformity: Total institutions enforce uniformity among patients through standardized procedures, dress codes, and behaviors. Patients may be required to adhere to specific rules and norms governing their conduct and appearance while within the institution. 4. Hierarchy and Authority: Mental hospitals typically operate under a hierarchical structure with clear lines of authority. Staff members, including psychiatrists, nurses, and administrators, hold authority over patients, making decisions about treatment, medication, and daily routines. 5. Routine and Predictability: Daily life in mental hospitals follows a strict routine designed to manage and stabilize patients' conditions. This routine includes mealtimes, therapy sessions, medication schedules, and recreational activities, providing a predictable environment aimed at promoting stability and recovery. 6. Social Roles: Patients in mental hospitals often adopt new social roles and identities within the institutional setting. These roles may be defined by their diagnoses, treatment plans, or assigned responsibilities within the hospital community. 7. Normalization of Institutional Behaviors: Over time, patients may internalize institutional behaviors and routines, adapting to the structured environment of the mental hospital. This adaptation can lead to a normalization of behaviors that are specific to the institutional context. 8. Totalizing Environment: Mental hospitals encompass all aspects of patients' lives during their stay, from basic needs like food and shelter to complex psychological and medical care. This totalizing environment aims to address all aspects of patients' mental health and well-being within the institution. Overall, a mental hospital fits the definition of a total institution by exerting significant control over patients' lives, providing a structured and isolated environment, enforcing uniformity and routines, and shaping patients' behaviors and identities within the institutional framework. These characteristics contribute to both the benefits and challenges of psychiatric care within such settings. 5) What is the social structure of the mental hospital ward? Answer: The social structure of a mental hospital ward can vary depending on factors such as the hospital's size, the patient population, treatment philosophy, and staffing levels. However, there are several key components that typically define the social structure within a mental hospital ward: 1. Staff Hierarchy: • Psychiatrists and Psychologists: These are typically at the top of the hierarchy, responsible for diagnosis, treatment planning, and overseeing patient care. • Nurses and Nursing Assistants: They play a crucial role in daily patient care, medication administration, monitoring patient health, and providing support and supervision. • Support Staff: This includes administrative personnel, social workers, occupational therapists, and other specialized healthcare professionals who contribute to patient care and treatment. 2. Patient Roles and Dynamics: • Inpatients: These are patients who reside within the ward for intensive treatment and stabilization. Their roles within the social structure may be influenced by their diagnoses, treatment plans, and level of functioning. • Day Patients: Some mental hospitals have day programs where patients attend treatment during the day but return home in the evenings. Their roles and interactions within the ward may differ from inpatients. • Long-term Residents: Patients who require extended care or who are in long-term psychiatric facilities may establish more stable roles and social connections within the ward. 3. Social Interaction and Groups: • Therapy Groups: These are structured sessions led by therapists or counselors focusing on specific therapeutic goals, such as cognitive-behavioral therapy groups, support groups, or psychoeducation sessions. • Recreational Activities: Organized activities such as art therapy, music therapy, exercise groups, and social events provide opportunities for patients to interact in a less structured environment. • Informal Peer Groups: Patients may form informal social groups based on shared interests, diagnoses, or treatment progress, providing peer support and companionship. 4. Rules and Norms: • Mental hospitals typically have strict rules and norms governing patient behavior, interactions, and daily routines. These rules contribute to maintaining order, safety, and therapeutic efficacy within the ward. • Patients are expected to adhere to these rules, which may include guidelines for personal conduct, noise levels, visiting hours, and participation in therapy and activities. 5. Impact of Diagnosis and Treatment: • The social structure can be influenced by patients' diagnoses and treatment needs. Patients with similar diagnoses or treatment plans may be grouped together for therapy sessions or activities, facilitating targeted interventions and peer support. 6. Dynamic and Fluid Nature: • The social structure of a mental hospital ward is not static and may evolve over time as patients enter and leave treatment, respond to interventions, and progress in their recovery journeys. • Changes in patient dynamics, such as new admissions, discharges, or shifts in treatment focus, can influence the social dynamics and structure within the ward. Understanding the social structure of a mental hospital ward helps healthcare providers, patients, and families navigate the treatment environment effectively, fostering therapeutic relationships, support networks, and positive treatment outcomes. Chapter 13: Residing in the Community Test Questions Part I. Multiple Choice Questions Circle the response that best answers the following questions. 1) Stigma is a social process and is characterized by __________. A) feelings of inadequacy based on past performance B) purposeful exclusion from social groups C) arbitrary denial of rights and privileges D) feelings of devaluation because of negative social judgments Answer: D 2) Which of the following, according to Goffman, is not one of the three types of stigma? A) abominations of the body B) blemishes of individual character C) radicalism and injustice D) stigma or race, religion, and nationality Answer: C 3) In ancient Greece, a/an __________ referred to marks on the body that indicated that the individual was entitled to be treated poorly. A) alienation B) blemish C) markers D) stigma Answer: D 4) In the case of mental disorder, stigmas may cause __________. A) others to keep their social distance B) discrimination and prejudice C) delayed treatment D) changes in behavior Answer: A 5) Stigmatizing achieves three goals, according to Link and Jo Phelan. Which of the following is not one of these goals? A) exploitation B) enforcement of social norms C) avoidance D) stereotyping Answer: D 6) __________ is the major reason for stigmatizing, according to Link and Jo Phelan. A) Exploitation B) Enforcement of social norms C) Avoidance D) Stereotyping Answer: A 7) In an effort to limit the negative consequences of stigmatization, the stigmatized person __________. A) becomes violent B) behaves differently C) responds in a limited way D) withdraws from society Answer: B 8) __________ rates for the mentally ill tend to be higher than those for the general public. A) Marriage B) Divorce C) Birth D) Abortion Answer: B 9) When someone is rejected by their family, it is most likely the individual’s __________. A) child B) parent C) spouse D) sibling Answer: C 10) What factor seems to account for why some people are less prejudiced against former mental patients? A) Genetic predisposition B) Previous relationships with mental patients C) Legal restrictions D) Symptoms themselves Answer: B 11) The likelihood and ability of a family to cope with stigma is related in part to the __________’s response. A) nation B) community C) patient D) legal system Answer: B 12) The relationship between community attitudes and mental disorder is __________. A) well-established B) controversial C) limited by small samples D) un-researched Answer: B 13) Although the issue has a much longer history, the first systematic studies of community attitudes toward mental disorder did not occur until the __________. A) 1900s B) 1950s C) 1970s D) 1990s Answer: B 14) Early research on community attitudes toward mental illness suggested that public attitudes were __________. A) generally positive B) somewhat tolerant C) questioning D) rejecting Answer: D 15) Gove and Fain’s research suggested the negative stereotypes of the mentally ill persist and that actual behavior toward the mentally ill is __________. A) very negative B) supportive C) concerned D) limited Answer: B 16) Research shows that some groups are more negative toward the mental ill than others. Which of the following statements is not true in this regard? A) older people are more negative than younger people B) blacks are more negative than whites C) men are more negative than women D) the lower class is more negative than the upper class Answer: C 17) Over time, the attitudes toward former mental patients have become __________. A) much less liberal B) a little less liberal C) somewhat more liberal D) much more liberal Answer: C 18) The improved attitudes toward former mental patients are due in part to __________. A) increased knowledge about mental disorder B) research about mental illness C) increased number of mental patients D) legal improvements Answer: A 19) One of the major reasons people avoid those with mental illnesses is the concern that they are __________. A) contagious B) annoying C) violent D) needy Answer: C 20) According to __________ theory, once an individual is identified as a mental patient, s/he will always be seen that way. A) conflict B) functionalist C) stigma D) labeling Answer: D 21) The key to adequate readjustment to the outside world is __________. A) constructing a competent social-psychological framework B) having a supportive family C) earning enough money to live independently D) developing a sense of self that is congruent with their former self Answer: A 22) According to Miller, which of the following is not one of the elements significant for keeping mental patient’s ability to stay out of the mental hospital? A) source of material support B) a close and supportive relationship C) a sense of purpose D) control over new situations Answer: C 23) Which of the following are most responsible for a former mental patient’s future fate? A) Family support B) Adequate supervision C) Ability to cope D) Persistence of symptoms Answer: D 24) According to Goffman, a person with a form of stigma is seen as __________. A) different, in a good way B) different, in a bad way C) similar, in a good way D) similar, in a bad way Answer: B 25) What is the likelihood that family members terminate relationships with an insane family member? A) rare B) about half C) surprisingly common D) nearly all Answer: A Part II. Essay Questions Answer the following questions in your own words. 1) What is stigma? What are the consequences for mental patients? Answer: Stigma refers to negative attitudes, beliefs, stereotypes, and discrimination directed towards individuals or groups based on certain characteristics or attributes. In the context of mental health, stigma arises from misconceptions, fear, lack of understanding, and societal prejudices about mental illness. Stigma can manifest in various ways, including: 1. Social Stigma: This involves negative attitudes and beliefs held by the general population towards individuals with mental illness. It can lead to social rejection, isolation, and avoidance of those perceived as "mentally ill." 2. Self-Stigma: Individuals with mental illness may internalize negative stereotypes and beliefs about their condition, leading to feelings of shame, low self-esteem, and reluctance to seek help or disclose their illness to others. 3. Structural Stigma: This refers to societal and institutional policies and practices that perpetuate discrimination against people with mental illness, such as limited access to healthcare services, housing, education, and employment opportunities. The consequences of stigma for mental patients can be profound and detrimental: • Barriers to Treatment: Stigma can prevent individuals from seeking or accessing mental health treatment due to fear of judgment, rejection, or discrimination. This can delay diagnosis and intervention, leading to worsened symptoms and outcomes. • Social Isolation: Stigmatizing attitudes may result in social exclusion and isolation for individuals with mental illness. They may experience difficulties forming relationships, maintaining employment, or participating in community activities. • Impact on Self-Esteem: Internalized stigma can erode self-esteem and self-worth, leading to feelings of hopelessness, shame, and reluctance to engage in activities that could promote recovery. • Reduced Opportunities: Stigma can limit opportunities for education, employment, and housing, as individuals with mental illness may face discrimination in these areas based on misconceptions about their capabilities and reliability. • Physical Health Consequences: Stigma and the associated stress of discrimination can contribute to physical health problems, such as cardiovascular issues, immune system suppression, and exacerbation of existing medical conditions. • Quality of Life: Overall, stigma diminishes the quality of life for individuals with mental illness by restricting their social, economic, and personal opportunities, and by negatively impacting their mental and physical well-being. Addressing stigma requires collective efforts to promote education, awareness, empathy, and respectful treatment of individuals with mental illness. It involves challenging stereotypes, advocating for policies that protect the rights of people with mental health conditions, and fostering inclusive communities where individuals feel supported and valued regardless of their mental health status. 2) Why do people stigmatize others? Answer: Stigmatization of others, including those with mental illness, can stem from various underlying factors and mechanisms: 1. Lack of Knowledge and Understanding: Misinformation or lack of accurate knowledge about mental illness can contribute to stereotyping and stigmatizing beliefs. People may rely on myths, misconceptions, or outdated information about mental health conditions, leading to fear or discomfort around individuals with such conditions. 2. Fear and Uncertainty: Mental illness can be perceived as unpredictable or challenging to understand, which may evoke fear or discomfort in some individuals. This fear can lead to avoidance, prejudice, or discriminatory behaviors towards those perceived as different or potentially unpredictable. 3. Cultural and Social Norms: Cultural beliefs and societal norms influence perceptions of mental illness. In some cultures, mental health issues may be viewed as a personal failing, weakness, or moral deficiency rather than a medical condition. These beliefs can perpetuate stigma and discrimination against individuals with mental illness. 4. Media Portrayals: Media representations of mental illness often focus on extreme or sensationalized cases, which can reinforce stereotypes and stigma. Portrayals in movies, television shows, news stories, and social media may contribute to negative perceptions and misrepresentations of mental health conditions. 5. Historical Context: Throughout history, individuals with mental illness have been marginalized, institutionalized, and subjected to mistreatment or neglect. Historical experiences and narratives can shape current attitudes and perceptions towards mental health and influence stigmatizing behaviors. 6. Personal Experiences and Biases: Personal experiences, including interactions with individuals with mental illness or stories heard from others, can shape attitudes and biases. Negative or challenging experiences may reinforce stigmatizing beliefs or attitudes towards mental health conditions. 7. Perceived Threat to Social Order: Stigma may arise from a perceived threat to social norms or expectations. Individuals with mental illness may be viewed as disrupting social harmony, productivity, or stability, leading to social exclusion or marginalization. 8. Self-Preservation and Distancing: Stigmatizing attitudes and behaviors can serve as a mechanism for individuals to distance themselves from perceived threats or vulnerabilities. By stigmatizing others, some people may attempt to reinforce their own sense of security, normalcy, or superiority. Addressing stigma requires efforts to promote education, empathy, and awareness about mental health conditions. It involves challenging stereotypes, fostering open dialogue, promoting accurate information, and advocating for policies that protect the rights and dignity of individuals with mental illness. By understanding the factors that contribute to stigma, communities can work towards creating more supportive and inclusive environments for everyone, regardless of their mental health status. 3) How do family members respond to current and former mental patients? Answer: Family members' responses to current and former mental patients can vary widely based on their understanding, beliefs, and the specific circumstances of the individual's mental health condition. Here are some common responses family members might have: 1. Supportive and Understanding: Many family members are empathetic and supportive, offering encouragement and understanding during challenging times. They may actively participate in the individual's treatment and recovery process, advocating for their needs and providing emotional support. 2. Stigma and Misunderstanding: Unfortunately, some family members may hold stigmatizing attitudes towards mental illness. This could lead to feelings of shame or embarrassment about the individual's condition, and they might be less supportive or avoid discussing the issue altogether. 3. Educational and Informative: Some families take proactive steps to educate themselves about mental health. They may attend workshops, read books, or seek guidance from mental health professionals to better understand the challenges their loved one is facing and how they can provide effective support. 4. Overprotective or Overbearing: In some cases, family members may become overly protective or controlling out of concern for the individual's well-being. While well-intentioned, this can sometimes hinder the person's independence and recovery process. 5. Denial or Avoidance: Coping with a loved one's mental health issues can be overwhelming, leading some family members to deny or minimize the severity of the condition. This may result in delays in seeking treatment or inadequate support for the individual. 6. Resentment or Frustration: Caring for someone with a mental illness can be emotionally draining and challenging. Family members may experience feelings of resentment, frustration, or burnout, especially if they perceive the situation as impacting their own lives negatively. 7. Admiration and Respect: Many families deeply admire the resilience and courage shown by their loved one in managing their mental health challenges. They may express pride in the person's achievements and efforts towards recovery. 8. Seeking Community and Support: Some families actively seek support from others who have experienced similar challenges. They may join support groups, online forums, or participate in family therapy sessions to learn coping strategies and share their experiences. Overall, family responses to current and former mental patients can range from highly supportive and understanding to potentially negative due to stigma or lack of knowledge. Effective communication, education about mental health, and seeking appropriate support can significantly influence how families navigate these complex situations and support their loved ones effectively. 4) Why have attitudes toward mental patients improved over time? Answer: Attitudes toward mental patients have improved over time due to several key factors: 1. Increased Awareness and Education: There has been a significant increase in awareness and education about mental health issues among the general public. Efforts by mental health organizations, advocacy groups, and healthcare professionals have helped dispel myths and stereotypes surrounding mental illness. 2. Advocacy and Destigmatization Campaigns: Advocacy campaigns have played a crucial role in challenging stigmatizing attitudes and promoting understanding. Personal stories shared by individuals with mental illness and their families have humanized the experience, encouraging empathy and support. 3. Legislative and Policy Changes: Legal reforms and policies aimed at protecting the rights of individuals with mental illness have helped reduce discrimination and improve access to treatment. These include laws ensuring parity in insurance coverage for mental health services and promoting community-based care over institutionalization. 4. Advancements in Treatment and Research: Scientific advancements in understanding mental illnesses, as well as developments in treatment options (such as medications, therapies, and interventions), have contributed to more effective management of symptoms. This has helped reduce the fear and stigma associated with mental disorders. 5. Media Representation and Cultural Shifts: Media portrayals of mental illness have become more nuanced and realistic, reflecting diverse experiences and emphasizing recovery and resilience. This has helped challenge stereotypes and foster more empathetic attitudes. 6. Supportive Social Movements: Movements advocating for the rights and inclusion of people with mental illness, alongside broader social movements promoting equality and human rights, have influenced public attitudes and policies. 7. Integration of Mental Health into Public Health: There is a growing recognition of mental health as a critical component of overall health and well-being. Governments, healthcare systems, and communities are increasingly prioritizing mental health promotion, prevention, and early intervention. Overall, these factors have collectively contributed to a shift in societal attitudes toward mental patients, moving away from fear and discrimination toward greater acceptance, support, and understanding. While challenges and stigma still exist, ongoing efforts in education, advocacy, and policy continue to drive positive change in how mental illness is perceived and addressed globally. 5) What factors are important for mental patients following hospitalization or treatment? Answer: Following hospitalization or treatment, several factors are crucial for mental patients to ensure continued stability, recovery, and well-being: 1. Follow-Up Care: Regular follow-up appointments with healthcare providers, including psychiatrists, therapists, and primary care physicians, are essential. These appointments help monitor progress, adjust treatment plans if necessary, and address any emerging issues. 2. Medication Management: Adherence to prescribed medications is vital for managing symptoms of mental illness. Patients should understand the importance of their medications, potential side effects, and how to take them as prescribed. 3. Therapy and Counseling: Continuing therapy or counseling sessions provide ongoing support, help develop coping strategies, and address psychological and emotional challenges. Therapy can be individual, group-based, or family-focused depending on the patient's needs. 4. Social Support: Strong social support networks contribute significantly to recovery. This can include family, friends, support groups, and community resources. Social connections reduce isolation, provide emotional support, and offer practical assistance if needed. 5. Healthy Lifestyle: Adopting a healthy lifestyle can support mental health recovery. This includes regular exercise, balanced nutrition, adequate sleep, and avoiding substances that can exacerbate symptoms (e.g., alcohol, drugs). 6. Stress Management: Learning and practicing stress management techniques such as mindfulness, relaxation exercises, and time management can help patients cope with stressors and prevent relapse. 7. Education and Self-Management: Understanding one's mental health condition and learning about triggers, warning signs of relapse, and self-management strategies empower patients to take an active role in their recovery. 8. Crisis Planning: Developing a crisis plan with healthcare providers and loved ones outlines steps to take in case of a mental health crisis. This plan may include emergency contacts, coping strategies, and directions for accessing immediate help. 9. Employment and Vocational Support: For patients returning to work or seeking employment, vocational rehabilitation services and workplace accommodations can support successful integration into the workforce. 10. Continued Monitoring and Adjustment: Mental health needs can change over time. Regular monitoring of symptoms and treatment effectiveness allows for timely adjustments to treatment plans to optimize outcomes. 11. Peer Support and Advocacy: Engaging with peer support groups or advocacy organizations can provide understanding, validation, and practical advice from others with similar experiences. 12. Family Involvement: Involving family members in the treatment process, where appropriate, can enhance support and understanding. Family therapy or educational sessions can help improve communication and strengthen relationships. By addressing these factors comprehensively, mental patients can enhance their recovery process, maintain stability, and improve their overall quality of life following hospitalization or treatment. Each individual's needs may vary, so personalized care plans tailored to specific circumstances are essential for effective long-term management of mental health conditions. Chapter 14: Community Care and Public Policy Test Questions Part I. Multiple Choice Questions Circle the response that best answers the following questions. 1) Most people who are psychologically distressed __________. A) seek and receive B) seek but do not receive C) do not seek but receive D) do not seek or receive Answer: D 2) The majority of people with mental disorders receive professional help from __________ care. A) outpatient B) inpatient C) community D) specialty Answer: A 3) About seventy percent of the mentally ill are seen and/or treated by __________. A) psychologists B) psychiatrists C) physicians D) psychics Answer: C 4) The most common mental disorders seen in hospital emergency rooms include all of the following, except __________. A) substance use B) conduct disorders C) schizophrenia D) bipolar disorder Answer: B 5) Approximately __________ percent of mental patients are served by the general hospital and nursing home sector and __________ are served by the specialty mental health sector. A) 1; 50 B) 40; 15 C) 5; 25 D) 10; 20 Answer: C 6) Psychiatric assistance is limited in __________. A) geographic setting and cost of services B) number of doctors and services provided C) geographic setting and number of doctors D) cost of services and services provided Answer: C 7) The National Mental Health Act of 1946 __________. A) promoted an increase in research, training, and community programs B) increased the number of outpatient clinics C) encouraged the use of psychotropic drugs D) established the Commission on Mental Illness and Mental Health Answer: A 8) The most significant recent change in mental health policy has been __________. A) a movement towards more humane care B) the shift to outpatient services C) the improvement in nursing home care D) improved diagnostics of mental illness Answer: B 9) The community mental health movement was made possible by all of the following, except __________. A) the use and success of psychotropic drugs B) public campaigns C) a good economic situation D) government commitment Answer: B 10) Community mental health programs were designed for the __________ of mental disorder. A) identification B) prevention C) intervention D) treatment Answer: B 11) The most important public role of community mental health centers is __________. A) departation B) deinstitutionalization C) dehumanization D) deindividualization Answer: B 12) __________ provides limited inpatient coverage for older persons and little for outpatient services. A) Social Security B) Medicare C) Medicaid D) Supplemental Security Income Answer: B 13) Which of the following is not one of the major provisions of the Patient Protection and Affordable Care Act? A) mental illness could not be used to deny coverage B) children could remain on their parent’s plans until age twenty-six C) most Americans would be required to purchase health insurance D) all health insurance plans must include basic mental health provisions Answer: D 14) __________ care refers to health organizations that control the cost of care. A) Micro B) Marketed C) Managed D) Monitored Answer: C 15) Managed care changes the patient-provider relationship by adding a __________. A) case manager B) caregiver C) co-provider D) social worker Answer: A 16) Which of the following is not one of the problems that exists as a result of an illogical system of mental health? A) inadequate quality of care B) a duplication of services C) poorly distributed location of services D) lack of continuity of care Answer: A 17) In 2004, __________ accounted for the smallest number of mental health facilities. A) non-federal general hospitals B) private psychiatric hospitals C) VA psychiatric services D) treatment centers for children Answer: C 18) The average stay at a state or county hospital in 1970 was __________ days and is __________ days today. A) 15; 51 B) 23; 8 C) 41; 10 D) 22; 31 Answer: C 19) Between 1972 and 2007, the number of community mental health centers in the United States __________. A) was cut in half B) remained the same C) doubled D) tripled Answer: D 20) Community mental health centers were initially intended to be __________. A) short-term B) self-supporting C) free and accessible D) supported by Medicare Answer: B 21) The public likely gets most of its information about mental health from __________. A) personal stories B) the media C) public policy D) government reports Answer: B 22) Community mental health centers have failed to __________. A) cure mental illness B) remove the causes of mental disorder from community life C) reduce the social costs of mental illness D) help the mentally ill adjust to daily life Answer: B 23) One of the major reasons for the failure of community mental health centers to provide basic needs is __________. A) a lack of government support B) little available inexpensive housing C) poor community relations D) insufficient professional support Answer: B 24) __________ financing is a paid fixed monthly sum that guarantees specific services at no cost. A) Managed B) Insurance C) Public D) Capitation Answer: D 25) The current health care system is based on __________. A) government funding B) fee-for-service C) a welfare system D) per capita financing Answer: B Part II. Essay Questions Answer the following questions in your own words. 1) What has caused the shift from an emphasis on inpatient care to outpatient care in the United States? Answer: The shift from an emphasis on inpatient care to outpatient care in the United States has been driven by several factors: 1. Advancements in Treatment Options: The development of effective medications and therapeutic interventions for managing mental health conditions has made it possible for many patients to be treated in outpatient settings. This includes therapies such as cognitive-behavioral therapy (CBT), medications with fewer side effects, and other evidence-based treatments that can be administered without hospitalization. 2. Cost-Effectiveness: Outpatient care is generally less expensive than inpatient care. This has motivated healthcare systems and insurance providers to prioritize outpatient services as a more cost-effective option for managing mental health conditions. It reduces the burden on healthcare budgets and allows resources to be allocated more efficiently. 3. Preference for Community-Based Care: There is a growing recognition of the benefits of community-based care in promoting recovery and integration into daily life. Outpatient settings enable patients to receive treatment while remaining in their homes and communities, which can enhance social support and reduce the stigma associated with hospitalization. 4. Focus on Recovery and Rehabilitation: Outpatient care aligns with the recovery-oriented approach to mental health treatment, which emphasizes individualized care plans, empowerment, and fostering independence. It supports the goal of helping patients achieve meaningful goals and improve their overall quality of life while managing their mental health conditions. 5. Legal and Ethical Considerations: There have been shifts in legal and ethical perspectives regarding involuntary hospitalization. Laws and regulations now prioritize least restrictive treatment options and emphasize the rights of individuals to receive care in the least restrictive environment possible, provided it is safe and effective. 6. Technological Advancements: Telehealth and digital health technologies have expanded access to outpatient mental health services. Patients can now receive counseling, medication management, and support remotely, which reduces the need for in-person visits and facilitates continuity of care. 7. Public and Professional Awareness: Increasing awareness and education about mental health issues have contributed to reduced stigma and improved early detection and intervention. This has encouraged more proactive and preventive approaches to mental healthcare, often delivered through outpatient settings. Overall, the shift towards outpatient care reflects broader trends in healthcare towards patient-centered, cost-effective, and community-integrated services. It supports the goal of providing comprehensive, accessible, and effective care for individuals with mental health conditions while promoting recovery and well-being. 2) How have mental health insurance programs for mental illness changed over time? Answer: Mental health insurance programs in the United States have evolved significantly over time, driven by various legislative, regulatory, and societal changes. Here are some key ways in which mental health insurance programs have changed: 1. Parity Laws: One of the most significant changes has been the enactment of mental health parity laws. The Mental Health Parity and Addiction Equity Act (MHPAEA), passed in 2008 and expanded by the Affordable Care Act (ACA) in 2010, requires insurance plans to provide coverage for mental health and substance use disorder services on par with coverage for medical and surgical services. This means insurers cannot impose higher copayments, deductibles, or treatment limitations on mental health services compared to other medical services. 2. Expansion of Coverage: Historically, mental health coverage was often limited or excluded from insurance plans, leading to disparities in access and affordability. With parity laws and the ACA, insurance coverage for mental health services has expanded, making treatment more accessible to individuals with mental health conditions. 3. Integration of Behavioral Health and Medical Care: There has been a push towards integrating behavioral health (mental health and substance use disorder) services with primary medical care. Integrated care models aim to address both physical and mental health needs comprehensively, improving coordination of care and health outcomes. 4. Coverage for Evidence-Based Treatments: Insurance programs increasingly cover evidence-based treatments for mental health conditions, such as psychotherapy (e.g., cognitive-behavioral therapy, dialectical behavior therapy) and medications. This shift reflects a growing recognition of the effectiveness of these treatments in managing mental health disorders. 5. Expansion of Medicaid Coverage: Medicaid, a federal-state program providing health coverage for low-income individuals and families, has expanded its coverage of mental health services under the ACA. States have the option to expand Medicaid eligibility to include more low-income adults, many of whom have mental health needs. 6. Telehealth and Digital Health Coverage: Insurance programs have adapted to include coverage for telehealth and digital health services for mental health. This allows patients to receive counseling, medication management, and other mental health services remotely, improving access for individuals in rural or underserved areas. 7. Efforts to Address Disparities: There is increasing recognition of disparities in mental health care access and outcomes among different populations, including racial and ethnic minorities. Efforts are underway to address these disparities through targeted interventions, cultural competency training, and policies aimed at reducing barriers to care. Overall, the evolution of mental health insurance programs reflects broader efforts to improve access, affordability, and quality of care for individuals with mental health conditions. While challenges remain, such as ensuring adequate provider networks and addressing workforce shortages, ongoing reforms continue to shape mental health insurance coverage to better meet the needs of diverse populations across the country. 3) What are the major provision of the Patient Protection and Affordable Care Act? Answer: The Patient Protection and Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, introduced several major provisions aimed at expanding access to healthcare, improving quality of care, and reducing healthcare costs in the United States. Here are the key provisions of the ACA: 1. Health Insurance Marketplaces (Exchanges): The ACA established health insurance marketplaces, also known as exchanges, where individuals and small businesses can shop for and compare health insurance plans. These marketplaces offer a range of private health insurance options with standardized benefits and costs. 2. Individual Mandate (No Longer in Effect): Initially, the ACA included an individual mandate requiring most Americans to have health insurance coverage or pay a penalty. This provision was intended to expand the risk pool and stabilize premiums. However, the penalty for not having insurance was effectively eliminated starting in 2019. 3. Medicaid Expansion: The ACA aimed to expand Medicaid eligibility to cover more low-income individuals and families. The expansion was designed to include adults with incomes up to 138% of the federal poverty level (FPL), though a Supreme Court decision made the expansion optional for states. 4. Subsidies for Premiums and Cost-Sharing: The ACA provides subsidies to help eligible individuals and families afford health insurance premiums and reduce out-of-pocket costs (such as deductibles and copayments) for plans purchased through the health insurance marketplaces. These subsidies are based on income and household size. 5. Protections for Pre-existing Conditions: The ACA prohibits health insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. This provision ensures that individuals with pre-existing health conditions have access to affordable health insurance coverage. 6. Coverage of Essential Health Benefits: Health insurance plans offered through the marketplaces and certain other plans must cover a set of essential health benefits. These benefits include services such as preventive care, prescription drugs, mental health and substance use disorder services, maternity care, and pediatric services. 7. Young Adults Coverage: The ACA allows young adults to stay on their parents' health insurance plans until age 26, regardless of whether they live with their parents, are married, or are financially independent. 8. Quality Improvement Initiatives: The ACA includes provisions aimed at improving the quality of care and patient outcomes. This includes initiatives to promote coordinated care, reduce hospital readmissions, and incentivize healthcare providers to focus on value-based care. 9. Tax Credits for Small Businesses: Small businesses may be eligible for tax credits to help offset the cost of providing health insurance to their employees, provided they meet certain criteria regarding size and average employee wages. 10. Medicare Improvements: The ACA includes various provisions to improve Medicare, such as closing the prescription drug "donut hole," enhancing preventive care coverage, and promoting payment reforms to encourage quality and efficiency in Medicare services. These provisions of the ACA have had significant impacts on the healthcare landscape in the United States, expanding coverage to millions of Americans, enhancing consumer protections, and driving reforms aimed at improving healthcare delivery and affordability. 4) What are the problems associated with community mental health centers? Answer: Community mental health centers play a crucial role in providing accessible, community-based mental health care. However, they also face several challenges and problems that can impact their effectiveness and ability to meet the needs of individuals with mental health conditions. Some of these problems include: 1. Underfunding and Resource Constraints: Many community mental health centers operate with limited funding and resources, which can lead to insufficient staffing, inadequate facilities, and limited access to necessary medications and therapies. This can strain their ability to provide timely and comprehensive care to patients. 2. Workforce Shortages: There is often a shortage of qualified mental health professionals, including psychiatrists, psychologists, social workers, and psychiatric nurses, working in community mental health settings. This shortage can result in long wait times for appointments, difficulty in accessing specialized care, and increased workload for existing staff. 3. Lack of Integration with Primary Care: Integration of mental health services with primary care is crucial for holistic patient care. However, many community mental health centers struggle to establish effective partnerships and collaborations with primary care providers, which can lead to fragmented care and gaps in treatment. 4. Barriers to Access and Equity: Individuals from marginalized or underserved populations, including racial and ethnic minorities, LGBTQ+ individuals, and those with lower socioeconomic status, may face barriers to accessing community mental health services. These barriers can include lack of culturally competent care, language barriers, stigma, and discrimination. 5. Crisis Management and Emergency Services: Community mental health centers often serve as frontline providers for individuals experiencing mental health crises. However, inadequate resources and infrastructure for crisis intervention and emergency services can lead to delays in care, inappropriate use of emergency departments, and challenges in providing timely crisis interventions. 6. Complex Regulatory and Administrative Requirements: Compliance with regulatory requirements, such as documentation, reporting, and billing procedures, can be burdensome for community mental health centers. This administrative burden can divert resources and attention away from direct patient care and service delivery. 7. Stigma and Public Perception: Stigma surrounding mental illness can impact community mental health centers in various ways. It may deter individuals from seeking help, influence funding decisions by policymakers, and contribute to negative perceptions of mental health services within the community. 8. Sustainability and Financial Stability: Many community mental health centers operate on precarious financial footing, relying on a mix of public funding, grants, and reimbursements from insurance providers. Fluctuations in funding sources and economic challenges can threaten their sustainability and ability to maintain consistent services. Addressing these challenges requires coordinated efforts at multiple levels, including increased funding and resources, workforce development initiatives, improved integration of mental health and primary care services, enhanced cultural competence, and efforts to reduce stigma and promote mental health awareness. Supporting community mental health centers is essential for ensuring equitable access to high-quality mental health care for all individuals in need. 5) How would you design a policy or program to improve community mental health care? Answer: Designing a policy or program to improve community mental health care involves considering a comprehensive approach that addresses various aspects of service delivery, accessibility, quality of care, and sustainability. Here are key components to consider in designing such a policy or program: 1. Needs Assessment and Stakeholder Engagement: • Conduct a thorough needs assessment to identify gaps, barriers, and priorities in community mental health care. • Engage stakeholders, including community members, mental health professionals, advocacy groups, and policymakers, to gather diverse perspectives and input. 2. Enhanced Funding and Resource Allocation: • Increase funding for community mental health centers to ensure adequate staffing, facilities, equipment, and resources. • Implement funding mechanisms that support sustainable, long-term operations and address financial stability challenges. 3. Workforce Development and Training: • Expand training programs and incentives to recruit and retain qualified mental health professionals, including psychiatrists, psychologists, social workers, and peer support specialists. • Provide ongoing professional development opportunities and support for cultural competency training. 4. Integration of Services: • Promote integration of mental health services with primary care settings to facilitate coordinated and holistic care. • Establish partnerships between community mental health centers, primary care providers, schools, social services, and other relevant agencies to enhance service delivery and continuity of care. 5. Expansion of Telehealth and Digital Health Services: • Expand access to telehealth and digital health platforms for delivering mental health services, particularly in rural and underserved areas. • Ensure reimbursement policies support telehealth services and address technological infrastructure needs. 6. Crisis Intervention and Emergency Services: • Develop and strengthen crisis intervention teams and mobile crisis units to provide timely response and support in mental health emergencies. • Establish protocols for diverting individuals in crisis away from emergency departments to appropriate mental health services. 7. Promotion of Evidence-Based Practices: • Encourage the adoption and implementation of evidence-based practices in assessment, treatment, and recovery support within community mental health settings. • Provide training and technical assistance to ensure fidelity to evidence-based interventions. 8. Peer Support and Community Engagement: • Integrate peer support services into community mental health care models to enhance engagement, empowerment, and recovery-oriented practices. • Foster partnerships with community organizations, faith-based groups, schools, and employers to promote mental health awareness and reduce stigma. 9. Evaluation and Quality Improvement: • Establish mechanisms for ongoing evaluation and quality improvement, including outcome monitoring, patient satisfaction surveys, and adherence to clinical guidelines. • Use data-driven approaches to identify areas for improvement and inform policy adjustments. 10. Advocacy, Education, and Public Awareness: • Conduct public awareness campaigns to educate the community about mental health issues, available services, and resources. • Advocate for policies that promote mental health parity, reduce stigma, and address social determinants of health impacting mental well-being. 11. Policy Coordination and Collaboration: • Ensure coordination among federal, state, and local agencies, as well as private and nonprofit sectors, to maximize resources and avoid duplication of efforts. • Foster collaborative approaches that leverage community strengths and assets in addressing mental health needs. Implementing a policy or program to improve community mental health care requires a multifaceted approach that considers the unique needs of the community, engages diverse stakeholders, promotes equity and accessibility, and supports sustainable service delivery models. Continuous monitoring, adaptation based on feedback and data, and commitment to long-term investment are essential for achieving meaningful improvements in mental health outcomes at the community level. Test Bank for Sociology of Mental Disorder William C. Cockerham 9780205960927

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