Significant advances in understanding and treating serious mental illness.

Abstract

This article discusses the significant transformation that is occurring in conceptualizing serious mental illness (SMI) and its treatment. Three key areas of that transformation are discussed: a change from a pathology perspective of people, their dysfunction, and treatment to a competence perspective; new ways of understanding the relationship between biology and human experience; and changes in the notions of causality in SMI. Significant advances are also occurring in the development of empirically validated pharmacological and psychosocial interventions, in the identification of the critical components of an effective service delivery system, and in the discovery of significant recovery rates for people with SMI. Finally, some implications for psychologists' practitioner roles, for public-private partnerships in organized health care systems, and for the role of state psychological associations are noted.During the past 10 years, dramatic advances have taken place in psychology's understanding and treatment of, attitudes toward, and service delivery for people with serious mental illness (SMI). This article, the first in the special section, focuses on some of the new ways psychology now understands SMI and provides service delivery, the exciting advances in effective

The Role of Environment in Mental Health

“…More effective than individual intervention are the collaborate efforts of all segments of society to eliminate unemployment, poverty, illiteracy, economic inequality, and social alienation and to strengthen social solidarity and the assurance of a safe environment (Lomas, 1998). Thus, society needs to invest in much-needed prevention and community-based primary care services and in support of structural changes that have demonstrated effectiveness (Coursey et al, 1997).…”

“…In addition to independent living under supervision, there are emerging organizational systems of effective residential psychosocial care that stress the achievement of competency over the traditional notion of pathology (Coursey, Alford, & Safarjan, 1997). Relying on a biopsychosocial explanation of pathology, Paul and Lentz (1977) devised the evidence-based, residential, decentralized Social-Learning Program (SLP) for persons with severe chronic mental illness.…”

Psychotherapy as an Element in Supported Employment for Persons with Severe and Persistent Mental Illness

“…Work was conceptualized as a cornerstone of healthy human function, and a closely integrated team approach was embraced. Therapists were also familiar with recent developments in the treatment of severe mental illness (Coursey et al 1997) and agreed with the principals of postmodern therapies (e.g., Kogan and Gale 1997). Specifically, an authoritarian or hierarchical relationship with consumers was avoided, and every attempt was made to minimize participating in interactional patterns that reinforced a "sick" role for consumers.…”

“…Although psychotherapy has been acknowledged as a potential contributor to rehabilitation (e.g., Coursey, Alford, and Safarjan 1997;Munich and Lang 1993), it is unclear how it should interface with other team tasks. For example, it seems sensible that therapy, whether provided by an identified psychotherapist (e.g., Franklin, Solovitz, Mason, Clemens, and Miller 1987) or included as a case management function (e.g., Wolff et al 1997), should "support" a consumer trying to return to work.…”

A psychological view of people with serious mental illness

“…Our focus does not negate or disregard the biological; the two play integrated complementary roles. (We have addressed the integration of biology and psychology in Coursey, 1994, andCoursey, Alford, andSafarjan, 1997. ) We present some alternative approaches to understanding and organizing interventions for people with disabling psychiatric disorders.…”