1. ADVANCED CLINICAL
ASSESSMENT AND
DIAGNOSIS - I
Jeffrey Karaban, LCSW
Module #1

2. WHAT IS MENTAL ILLNESS?
Observe the following clips. There is a person
experiencing some powerful emotions and symptoms
in each. Which one of these persons would you
consider mentally ill? Why?
http://www.youtube.com/watch?v=gHi6eBMxT7U
http://www.youtube.com/watch?v=hlhzH9jdAsA
http://www.youtube.com/watch?v=zA1hyqA6UTY
http://www.youtube.com/watch?v=ZmzCyLcG0Pc

3. WHAT IS MENTAL ILLNESS?
In professional terms, mental illness (and that
includes addictions) is:
A conglomeration of signs, symptoms and issues that
affects a person’s thinking and behavior. Normal
coping skills fail which causes significant distress and
impairs daily functioning.
 Mental illness is culturally defined (eg.
homosexuality, hysteria, religious experiences)

4. WHAT IS MENTAL ILLNESS?
“Mental illnesses are medical conditions that disrupt a person's
thinking, feeling, mood, ability to relate to others and daily
functioning. Just as diabetes is a disorder of the pancreas,
mental illnesses are medical conditions that often result in a
diminished capacity for coping with the ordinary demands of life”
(National Alliance on Mental Illness).
“A Mental Disorder is a health condition characterized by
significant dysfunction in an individual’s cognitions, emotions, or
behaviors that reflects a disturbance in the psychological,
biological, or developmental processes underlying mental
functioning. Some disorders may not be diagnosable until they
have caused clinically significant distress or impairment of
performance. A mental disorder is not merely an expectable or
culturally sanctioned response to a specific event such as the
death of a loved one. Neither culturally deviant behavior (e.g.,
political, religious, or sexual) nor a conflict that is primarily
between the individual and society is a mental disorder unless
the deviance or conflict results from a dysfunction in the

5. PREVALENCE OF MENTAL
ILLNESS-1
About 6 percent, or 1 in 17 Americans-who live with a
serious mental illness. The National Institute of Mental
Health reports that one in four adults-approximately
57.7 million Americans-experience a mental health
disorder in a given year .
The U.S. Surgeon General reports that 10% of
children and adolescents in the United States suffer
from serious emotional and mental disorders that
cause significant functional impairment in their day-to-
day lives at home, in school and with peers.
The World Health Organization has reported that four
of the 10 leading causes of disability in the US and
other developed countries are mental disorders. By
2020, Major Depressive illness will be the leading
cause of disability in the world for women and
children.

6. PREVALENCE OF MENTAL
ILLNESS-2
Approximately 20.9 million American adults, or
about 9.5% of the U.S. population age 18 and
older in a given year, have a mood disorder.
In 2006, 33,300 (approximately 11 per 100,000)
people died by suicide in the U.S in one year!!
Approximately 2.4 million American adults, or
about 1.1% of the population age 18 and older in
a given year, have schizophrenia.
Approximately 40 million American adults ages 18
and older, or about 18.1% of people in this age
group in a given year, have an anxiety disorder.

7. PREVALENCE OF MENTAL
ILLNESS-3
ADHD, one of the most common mental disorders
in children and adolescents – 5.2 million (8.4%) of
all minors ages 3-17.
ADHD also affects an estimated 4.1% of adults,
ages 18-44, in a given year.
A recent study by the Centers for Disease Control
and Prevention (CDC) reported the prevalence of
autism among 8 year-olds to be about 1 in 110.
Among American adults ages 18 and over, an
estimated 9.1% have a diagnosable personality
disorder.
(Statistics from the National Institute of Mental Health)

8. SUBSTANCE ABUSE PREVALENCE
In 2010, an estimated 22.6 million Americans
aged 12 or older—or 8.9% of the population—had
used an illicit drug or abused a psychotherapeutic
medication (such as a pain reliever, stimulant, or
tranquilizer) in the past month.
There were 3.0 million new users (initiates) of
illicit drugs in 2010, or about 8,100 new users per
day. Over one-half (57%) were under 18.
In 2010, 30.9% of men 12 and older and 15.7
percent of women reported binge drinking.
(Statistics from the National Institute for Drug Abuse)

9. SUBSTANCE ABUSE PREVALENCE

10. STIGMA RELATED TO MENTAL
HEALTH STATUS
Stigma refers to “SHAME” or a “spoiled
identity.”
It is a mark that labels a person as
deviant, flawed or undesirable.
Stigma is related to our cultural values,
beliefs, norms and laws.
It is experienced both externally and
internally.

11. HOW DO PEOPLE REACT TO
STIGMA?
Fears of being stigmatized leas to people
avoiding seeking treatment or delay treatment.
Lack of knowledge (or denial) of the one’s own
mental status.
Fear of being shunned by family and friends.
Fear of workplace or school-based discrimination.
Social isolation.
Minimization of illness by individual and family.
Stigmas contributes to chronic stressors that
might contribute to coping difficulties.

12. HOW DO PEOPLE REACT TO
STIGMA?
By concealing their status to others.
Problems with medication adherence, concern
about medications and their side-effects.
Lack of motivation for treatment adherence.
Partner abuse.
Self medicating (with illegal drugs and/or alcohol).
Internalize negative stereotypes and perceptions.
Acting out behaviors.
Suicidal ideation.

13. MENTAL ILLNESS
TREATMENT STATISTICS

14. TREATMENT OF MENTAL ILLNESS
AND ADDICTIONS
The economic cost of untreated mental illness is
more than 100 billion dollars each year in the
United States.
The best treatments for serious mental illnesses
today are highly effective; between 70 and 90
percent of individuals have significant reduction of
symptoms and improved quality of life with a
combination of pharmacological and psychosocial
treatments and supports.
(Statistics from the National Institute of Mental Health)

15. TREATMENT OF MENTAL ILLNESS
AND ADDICTIONS-2
When should a family member, loved one or
professional intervene?
Rights of a mentally ill person to self-
determination
Voluntary vs. Involuntary Treatment
Type of treatment:
Crisis intervention
Continuous
After-care
Intermittent

16. TREATMENT OF MENTAL ILLNESS
AND ADDICTIONS-3
The mental health treatment system works on
insurance reimbursements from Medicaid,
Medicare and private insurers.
Most insurers require a diagnosis in order to
approve treatment.
Is a diagnosis a label?
What if a client doesn’t quite meet the criteria for
a mental disorder, but still needs treatment?
Would you give them a diagnosis to help them?