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Services for Persons with Mental Illness Services for Persons with Mental Illness Informational Paper 49 Wisconsin Legislative Fiscal Bureau January, 2005 Services for Persons with Mental Illness Prepared by Yvonne M. Onsager, Jessica Stoller, and Rachel Carabell Wisconsin Legislative Fiscal Bureau One East Main, Suite 301 Madison, WI 53703 Services for Persons with Mental Illness Introduction diminished level of functioning in the primary as- pects of daily living and an inability to cope with The National Institute of Mental Health esti- the ordinary demands of life, which may lead to an mates that 22% of American adults have a diag- inability to maintain stable adjustment and inde- nosable mental disorder. Four of the ten leading pendent functioning without long-term treatment causes of disability in the United States and other and support and which may be of lifelong dura- developed countries are mental disorders -- major tion." This definition includes schizophrenia, as depression, bipolar disorder, schizophrenia, and well as psychotic and other severely disabling psy- obsessive-compulsive disorder. Some individuals chiatric diagnostic categories, but does not include may have more than one mental disorder. infirmities of aging or a primary diagnosis of men- tal retardation or of alcohol or drug dependence. This paper describes public mental health These definitions are used to determine eligibility services available to people in Wisconsin. The first for services provided under Chapter 51 of the stat- section briefly describes common types of mental utes. disorders and the factors that are believed to cause these disorders. The second section describes the Under federal law, adults with serious mental provision of community-based services to persons illness are people 18 years of age or older who with mental disorders and the programs that currently have, or at any time during the past year provide these services. The final section describes had, a diagnosable mental behavior or emotional the institutional services that provide care and disorder of sufficient criteria specified in the treatment for persons with mental disorders, Diagnostic and Statistical Manual of Mental except services provided for persons committed as Disorders (DSM-IV), published by the American sexually violent persons, which are described in a Psychiatric Association, that has resulted in separate Legislative Fiscal Bureau informational functional impairments, which substantially paper entitled "Civil Commitment of Sexually interferes with or limits one or more major life Violent Persons," and services provided to activities. People with serious mental illness incarcerated individuals. include individuals who have a twelve-month DSM-IV diagnosis and one or more of the following: Mental Illness • Non-affective psychosis or mania, major depression or panic disorder with evidence of severity indicated either by hospitalization or use Wisconsin statutes define mental illness as a of major psychotropic medications; "mental disease to such extent that a person so af- flicted requires care and treatment for his or her • A planned or attempted suicide at some own welfare, or the welfare of others, or of the time during the last 12 months; community." Chronic mental illness is defined as "a mental illness which is severe in degree and per- • The lack of a legitimate productive role; sistent in duration, which causes a substantially 1 • A serious role impairment in their main inability to concentrate, remember things, or make productive role; and decisions; (g) fatigue or loss of energy; (h) restless- ness or decreased activity noticed by others; and (i) • A serious interpersonal impairment, as thoughts of suicide or death. A diagnosis of major defined through the client's self-report of isolation depression can be made if an individual has one or and loss of capacity to interact with others. more episodes of depression, characterized by at least two weeks of depressed mood (sadness, The clinical definition of a mental disorder, as hopelessness, or feeling discouraged) or loss of in- defined in the DSM-IV, is "a clinically significant terest in nearly all activities accompanied by at behavioral or psychological syndrome or pattern least four other symptoms of depression. Indivi- that occurs in an individual and is associated with duals between 24 and 44 years of age are most present distress or disability or with a significantly likely to have depression. Annually, nearly twice increased risk of suffering death, pain, disability, or as many women (6.5%) as men (3.3%) have major an important loss of freedom. In addition, this depressive disorder. syndrome or pattern must not be merely an expectable and culturally sanctioned response to a Bipolar disorder is another mood disorder, particular event." characterized by severe mood changes that shift between mania and major depression. It is Mental Disorders Affecting Adults. The estimated that 1% of adults have bipolar disorder. Department of Health and Family Services (DHFS) Bipolar disorder has two phases – manic and estimates that approximately 5.7% of non- depressive. Symptoms of the manic phase include: institutionalized adults in Wisconsin have a severe (a) extreme happiness, optimism, or self- mental illness. There are many types of mental confidence; (b) distractibility; (c) rapid, disorders. Anxiety disorders, major depression, uncontrollable ideas and speech pattern; (d) bipolar disorder, and schizophrenia are among the decreased need for sleep; (e) poor judgment; and most common mental disorders affecting adults. (g) sudden irritability, rage, or paranoia. Without treatment, the manic phase could last up to three Anxiety disorders are disorders that are months. The individual may experience a period of characterized by overwhelming anxiety and fear. normal mood and behavior before the depressive They include panic disorder, obsessive-compulsive stage begins with the "normal" period lasting disorder, post-traumatic stress disorder, social between hours and months, depending on the phobia, specific phobias, and generalized anxiety individual. The symptoms of the depressive stage disorder. The common theme among these are the same as those listed previously for major disorders is "excessive, irrational fear and dread." depression. Men and women are equally likely to Depending on the anxiety disorder, men or women be affected by this disease. may be more often affected. Schizophrenia involves dysfunction in one or Depression is a mood disorder, of which the more major areas of functioning, such as most common is major or unipolar depression. An interpersonal relations, self-care, or work or estimated 10% of American adults between the education, with the dysfunction lasting at least six ages of 18 and 54 have major depression. The months and including at least two of the following symptoms of major depression include: (a) feelings symptoms: (a) delusions; (b) hallucinations; (c) of sadness or irritability; (b) loss of interest in ac- disorganized speech; (d) grossly disorganized or tivities that were once enjoyed; (c) changes in catatonic behavior; or (e) restrictions in the range weight or appetite; (d) changes in sleeping pat- and intensity of emotional expression, in the terns; (e) feeling guilty, hopeless, or worthless; (f) fluency and productivity of thought and speech, 2 and in the initiation of goal-directed behavior. In a birth to 18 months of age, were ill, experienced given year, approximately 1% of the adults in the forced separations, emotional, sexual, or physical United States have schizophrenia. Symptoms abuse or neglect, or were at least two years old usually first appear between the ages of 15 and 25 when an adoptive/foster placement occurred are and men usually experience symptoms earlier than more likely to experience attachment disorder. women. There are many symptoms of an attachment disorder, including, but not limited to: (a) being Mental Disorders Affecting Children. The an- superficially engaging or charming; (b) avoiding nual prevalence of mental disorder in children and eye contact with parents; (c) being indiscriminately adolescents is not as well documented as that for affectionate with strangers; (d) being destructive to adults. About 20% of children are estimated to themselves, others, and material things; (e) being have mental disorders with at least mild functional cruel to animals and other people; (f) being unable impairment. While many mental disorders that to connect cause and effect, action and affect adults can also affect children, there are cer- consequence; (g) demonstrating a lack of tain mental disorders that tend to be associated conscience; (h) lying obviously; (i) failing to form most often with children, including attention-defi- deep relationships; (j) having learning disabilities cit/hyperactivity disorder, attachment disorder, or disorders; and (k) having trouble recognizing and conduct disorder. and expressing feelings. Attention-deficit/hyperactivity disorder (AD- An estimated 10% of children and adolescents HD) occurs in up to 5% of children. Boys are al- have conduct, or disruptive behavior, disorder. most three times as likely to have ADHD as girls. These children repeatedly violate the personal or There are three types of ADHD: (a) inattentive; (b) property rights of others and the basic expectations hyperactive-impulsive; and (c) combined attention- of society. The symptoms of conduct disorder deficit/hyperactive disorder. Children with inat- include: (a) aggressive behavior that
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