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Key Concepts

Here we sort out some of the key concepts, history and background in behavioral and mental health issues.

Access to care 

Agnosia

Behavioral health disorders

Behavioral modification therapy

Cognitive skills

Individualized Education Program

Non-psychotic/non-psychoses

Parity

Psychedelics-assisted mental health therapy

Psychotic/psychosis

Psychotropic medicine

Shortage of psychiatric/psychological workforce nationwide


Access to care

Mental Health America’s review of the first six years, following 2010’s Affordable Care Act, concluded that the mental health of U.S. youth was worsening. Mainly, the mental health of adults, based on that 2020 report of pre-Covid-19 American life, had barely changed, though thoughts of suicide among adults had increased.

Nationally, roughly 57 percent of adults with mental illness went untreated during those six years; and more than 10 percent of the untreated adults lacked insurance coverage for such treatment. The rates of un-treated mental illness among adults varied by state, from a proportionate low of 40.7 percent in Vermont to a proportionate high of 64.6 percent in California.

Among youth, for example, with major depression, 59 percent nationally were untreated, according to the report. The problem was the most severe in North Carolina, where 74.3 percent of depressed youth were untreated; on the other end of the spectrum, with the lowest proportionate rate, 39.5 percent of mentally youth went untreated in Rhode Island.

Lack of providers, insurance costs and coverage were among the reasons for lack of treatment.

Agnosia

Agnosia is the biggest reason that roughly half of persons diagnosed with schizophrenia and, to a lesser extent, those diagnosed with bi-polar disorder, are unwilling to take their prescribed medications or, more fundamentally, to seek treatment. Agnosia prevents them from correctly perceiving objects, distances, other individuals, others’ facial features, situations, etc.

Theirs is not a conscious denial of treatment, but an inability to recognize their medical need or real-time, actual circumstances. That’s true, even as many people with agnosia often maintain cognitive abilities — the capacity to process information/knowledge thoughtfully, rationally, reasonably — in many other areas.

Agnosia results from damage to the brain’s frontal lobe, preventing those with mental illness from updating, if you will, the information and experiences before them.

Behavioral health disorders

Behavioral health disorders include substance abuse, sexual addictions, gambling addictions and other chronic, bad habits that erode everyday quality-of-life and normal functioning on the job, within families, within an individual. These disorders sometimes co-exist with mental illness; and sometimes are treated in conjunction with psychiatric medicine and/or psychological counseling.

Behavioral modification therapy

A therapeutic counseling practice that employs positive and negative reinforcements to encourage patients to voluntarily change or eliminate problematic behaviors that accompany, among others, anxiety, attention deficit hyperactivity disorder, autism, obsessive-compulsive disorder and substance abuse or addition. Its development is traced back to 1911 when psychologist Edward Thorndike published “Provisional Laws of Acquired Behavior or Learning," an articled based on his initial analysis of animal behavior. (Psychologist B.F. Skinner’s work on behavior conditioning was based on Thorndike’s  “law of effect” linking stimuli to responses.) Behavior modification came into fuller use in the 1940s and 1950s, and the field particularly began to flourish in the 1970s. 

Several tenets shape this rewards-and punishments-based practice to help patients develop positive behaviors. Among them are these: 1)  Antecedents, which existed before the problematic or disagreeable behavior. 2) Consequences. 4) Response costs. 5) Avoidance. 6) Fear reduction. 7) Extinction.

Types of behavior modification therapy include flooding therapy, which uses fear-inducing techniques; aversion therapy, which associates something unpleasant or repulsive with problematic behavior; and systematic desensitization, which aims to lessen severe phobia by conditioning patients to receive stimuli that yields a relaxation response.

Cognitive skills

Cognitive skills include memory, problem-solving, reason, learning and paying attention. They can be impaired as a result of mental and/or behavioral disorders (and neurological and physiological ailments, for that matter). Likewise, they may be improved or refined through certain therapeutics.

Individualized Education Program

Mandated by the Individuals With Disabilities Education Act of 1975, the Individualized Education Program — sometimes called an individualized education plan — is drafted collaboratively by teachers, mental/ behavioral health and other health clinicians, and parents. The IEP aims to ensure an optimal academic/educational experience for students with emotional, mental and behavioral disorders. The numbers of students with IEPs has been declining in recent decades, even though, clinicians and advocates argue,  mental/behavioral disorders among students have not declined.

Non-psychotic/non-psychoses

They include depressive disorders, anxiety, phobias panic attacks and obsessive-compulsive disorder (OCD). The severity of symptoms can vary widely, person  by person. Symptoms of non-psychosis include insomnia, extreme worrying, lack of concentration, irritability, restlessness, feelings of worthlessness, suicidal thoughts, social withdrawal, lethargy, needless obsessing over minutia, et cetera. Non-psychotic disorders often are triggered by such life circumstances as job loss, death of a loved one and other disruptions or upheaval in life circumstances.

Parity (of mental health treatment, policy, etc. versus that of physical health care)

In 1996, the Mental Health Parity Act was enacted as a forerunner to the Mental Health Parity and Addiction Equity Act of 2008 and, eventually, 2010’s landmark Affordable Care Act, a progression resulting in large employer-based group insurance plans having to offer commensurate benefits for surgical/medical care for physical ailments and wellness as they did for mental health care. The ACA imposed that same standard of care on individual and small-group insurance plans.

Analysts says those are markers of ample progress in mental health care. But they also issued some cautions. The Commonwealth Fund’s 2020 analysis suggested, among other challenges, parity enforcement for large companies continues to vary, state by state. It also cited racial disparities in mental health care; the lack of mental health care for the incarcerated and formerly incarcerated. It noted that the Trump administration’s de-regulation has made room for non-ACA compliant plans to deny mental health care altogether.

Psychedelics-assisted mental health therapy

In 2019, Denver became the first U.S. city, and in 2020, Oregon became the first U.S. state to decriminalize psilocybin, the active ingredient in wild mushrooms, to allow its use as a medically certified mental health treatment. Mushrooms and a relative handful of psychedelic drugs continue to be researched, promoted and win acceptance as treatments for certain mental illnesses (and for, say, anxiety, depression or other mental trauma triggered by cancer and other serious physiological diseases that are not fundamentally rooted in mental illness.)

Psychedelics are hallucinogenic drugs but not considered addictive nor to cause brain or physiological injury. When prescribed for those with mental illness, they do not prompt the kinds of uncontained hallucinations commonly associated with recreational use of psychedelics such as LSD and ecstasy (also is known as MDMA, an acronym for methylenedioxymethamphetamine).

Psychedelics work by altering serotonin levels in the brain and, thereby, altering perception, mood and cognition.

After several decades of banning research on potential medical uses of psychedelics, the federal government in 1992 allowed such research to resume.  In 1993, the Heffter Research Institute launched as the only U.S. center solely dedicated to the studying medical uses of psychedelics, mainly psilocybin, for such illnesses as panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, post-traumatic stress disorder and, schizophrenia and others categorized as non-affective psychosis.

Psychotic/psychosis

A person with mental illness who is non-psychotic suffers changes in mood, feelings and behavior but no symptoms (including hallucinations, delusions, et cetera) reflecting that he/she is disconnected from reality.

Conversely, a person suffering with psychosis includes persons diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, bi-polar disorder and paraphrenia.

Generally speaking, non-psychotic disorders, which formerly were labeled as neuroses, often are less severe and can be easier to medically treat than psychotic disorders.

Psychotropic and other mental health medications

There are legal, prescription drugs to combat anxiety, depression, acute mood disorders and such severe psychoses as delusions and hallucinations, among other mental illnesses They function by altering and adjusting the brain’s neurotransmitters, including levels of dopamine, gamma aminobutyric acid, norepinephrine, serotonin, et cetera.

Because they can have serious side effects, they must be carefully prescribed and monitored. Also, their therapeutic effects are achieved after taking them for a certain amount of time, not overnight or after ingesting only a few doses.

Shortage of psychiatric/psychological workforce nationwide

The Kaiser Family Foundation, in 2019, reported that 113 million people reside in places without enough mental health care providers.

That report’s interactive, state-by-state map also showed that only 27 percent of 112.9 Americans in 6,069 designated “health professional shortage areas” had their mental health needs met.

Kaiser’s is among several studies highlighting shortages that professional organizations representing mental health clinicians say they are struggling to address, especially in rural and minority communities. The U.S. Department of Health and Human Services has projected, through 2030, demand for mental health services and clinical workforce capacity to meet that demand.