Mental Health (Powerpoint)

Mental Health Made Simple

Prepared by

Ty Ragan Psy.D; LPL;

May 17, 2011


Dr.T.R. Ragan holds a doctorate in Psychology, a Masters and Bachelor’s in Leadership & Ministry with a focus on community building, integration, and
action.  He has a 25+ years experience as
a human rights and peace activist, outreach worker to those experiencing
homelessness across mainland Canada
that has earned him a shamanic designation of Wisdom Keeper, 2 honourary
doctorates and an ordination.  His work
history has been centered on working with individuals reintegrating from young
offender’s facilities; high risk for dropping out of school; street involved
youth; children in the sex trade; close to 12 years of involvement on the front
lines with Calgary’s Mustard Seed Society, and working as a vocational
counsellor for differently abled adults through Hull Child & Family
Services.  He has taught courses in
spiritual formation, and vocational discernment at the University
of Calgary and Spiritual Directions in
Calgary, pulpit supply through a variety of
Christian Denominations throughout Western Canada
and is the author of 4 published books, and many articles centred on improving
practices and building community.




is a simple article to explain how the DSM-IV-TR works, how diagnoses are
handled, and medication possibilities.
It is not meant to replace a formal mental health clinician (i.e.:
therapist, psychologist, psychiatrist) but to guide one’s referral process with
presented information.



            Mental health is an
often misunderstood, stigmatized, or maligned piece of holistic care. It can
often go ignored, in the past they were the “eccentric” or the “special” family
member.  Why should Mental Health matter
to our population? Simple, in 1993 following the first steps of the Waterloo
Model (1984) of integration, the Alberta Progressive Conservative Government
closed extended care facilities for those with severe mental illness and
discharged them to the community.

The full Waterloo Model was discharge into community
based housing with supports such as home care, mental health ACT teams, and
social networks, this was not followed in Alberta and overnight the population
demographics on the streets changed and created a revolving door with medical
facilities for lack of care for those most vulnerable within our
populations.  Current estimates place
between 60-85% of people experiencing homelessness are experiencing life with
severe mental health issues, yet it is a chicken and egg scenario currently on
which factor caused which currently.

This short paper will explore process of diagnosis,
DSM-IV-TR made simple, assessments simplified, and rudimentary
psychopharmacological treatments.



            This simple process
of diagnosis is adapted from James Morrison’s’ Diagnosis Made Easier: Principles and Techniques for Mental Health

There is an inciting incident that precipitates the individual
seeking help.  At this juncture is
preliminary information gathering:

  1. Patient
    First Interview
  2. Informants-
    personal & professional individuals involved closely in the person’s life.
  3. Psychological
  4. Laboratory
    Data & Imaging
  5. Medical
  6. Psychological

information is gathered to discern a syndrome: a gathering of major symptoms to
produce a diagnosis (i.e.: alcoholism; depression) (p.5).

From the Syndromes then all possible diagnosis are listed
(Differential Diagnosis).  Through taking
into account the full history, and please note the person’s history trumps
variables present during crisis, a working diagnosis is chosen and if needed
comorbid diagnosis which are ranked in order of importance.

These working diagnoses then bring around a treatment
team for a holistic approach that engages nutrition, health,
psychopharmacological treatments, monitoring, therapy, and spiritual

Throughout the course of treatment the clinician will
continue to be the funnel for information, 1 to 1 meetings with the individual,
retesting and adjustments to treatment as needed.



            The American
Psychiatric Associations’ Diagnostic and Statistical Manual of Mental
Disorders Fourth Edition Text Revision
(2000) is the benchmark used for
diagnosis of Mental Health in the world by clinicians.  The manual uses a multiaxial diagnostic tool,
and provides one psychological language throughout professions for aiding those
in need.  The Fifth Edition is expected
for release in 2013 after final approval and will continue to broaden the
spectrum of understanding for mental health in the world and continue to strive
to remove stigmatization of the individual for how the experience the world.

Axis I

Axis I diagnosis are listed in
Figure 1.

Figure 1: Clinical

Diagnosis pre-18 yrs Schizophrenia and other psychotic disorders Factitious Disorders
Delirium, dementia, Amnestic and other Cognitive
Mood Disorders Dissociative Disorders
Mental disorders due to a General Medical Condition Anxiety Disorders Sexual & Gender Identity Disorders
Substance related disorders Somatoform Disorders Eating Disorders
Sleep Disorders Impulse-Control Disorders Not Elsewhere Classified Adjustment Disorders

In addition to Figure 1,
Axis I also includes other conditions that may be a focus of clinical
attention. Axis I is the first foray into diagnosis that can usually be
quantified through testing, and for the most part treated with therapy and

Axis II


Where Axis I is fairly quantifiable, Axis II moves more
into the social science or artistic form of psychological practice.  It includes all Personality Disorders (see
Figure 2 for a list.) and Mental Retardation, which for the Canadian ear is an
abrupt term, but equates to lower mental acuity than average.


Paranoid Schizoid Schizotypal Antisocial Borderline
Histrionic Narcissistic Avoidant Dependent Obsessive-Compulsive
Not Otherwise Specified

Personality Disorder is
defined in Miriam Webster’s Medical Dictionary (2007) as:

psychopathological condition or group of conditions in which an individual’s
entire life pattern is considered deviant or nonadaptive although the
individual shows neither neurotic symptoms nor psychotic disorganization.

Axis III


Axis III are mental disorders arising from a medical
diagnosis as found in the International
Statistical Classification of Diseases and Related Health Problems
(ICD-10-CM/ICD-9-CM).  These medical
triggers include diseases such as: (a) Infectious/Parasitic (001-139); (b) Neoplasms
(140-239); (c) Endocrine, nutritional, & Metabolic, Immunity (240-279); (d)
blood & blood forming organs (320-389); (e) Circulatory system (390-459);
(f) Respiratory (460-519); (g) Digestive Systems (520-579); (h) Genitourinary
System (580-629); (i) Complications in pregnancy, childbirth, and the pueperium
(630-676); (j) Skin and subcutaneous tissue (680-709); (k) Muscoloskeletal
System and connective tissue (710-739); (l) Congenital Anomalies (740-759); (m)
Certain conditions originating in Perinatal Period (760-779); (n) Symptoms,
Signs, and Ill defined Conditions (780-799); and (o) Injury and Poisoning

Axis IV


IV is where the information gathering of the diagnostic puzzle becomes the most
important.  For this is the Axis that
feeds needed information to inform the diagnosis of an Axis I or II
diagnosis.  These are the intangibles if
you will. The problems that arise within the following spectrum: (a) Primary Support Group (Family. e.g.: death, health
issues; abuse); (b) Related to Social Environment (e.g.: racism, retirement,
death of friend); (c) Educational (e.g.: school environment, literacy); (d)
Occupational (e.g.: un/underemployed; stressful work schedule); (e) Housing
(e.g.: homelessness; safety); (f) Economic (e.g.: insufficient governmental
supports; insufficient Income); (g) Access to health services (e.g.:
inadequate, transportation, insurance); (h) Legal (e.g.: judicial involvement –
perpetrator or victim); and (i) Other (e.g.: disasters; war; famine; hostility;
discord with professional supports; lack of governmental supports).

Axis V


The Fifth Access is a Global Assessment of Functioning
(and other functionality assessments).
It is multiple questions that the clinician ranks from 0 to 100 and then
averages the score for there complete G.A.F. score with the caveat of score
placed in brackets afterwards.

i.e.: Axis V: G.A.F. = 32
(at discharge).

What is not brought into the assessment is functioning
that is impeded by physical or environmental limitations are not included. In a
team care environment the functionality assessments could be carried out by an
Occupational Therapist for the Axis V.




The psychological quantifiable piece of assessment is
found in many spectrums.  They range from
those that need specialized training, to a standard set of questionnaire
answers that are applied to a set matrix for results.  The list of assessments are:

  1. Behavioural – looks at antecedents,
    conditions surrounding behaviour, and consequence.
  2. Weschsler Intelligence Scales – 3 IQ
    rankings (Full, Verbal, & Performance) in which the main thrust is
    predicting future behaviour, long term behaviours however fall short and
    results can be skewered based on gender, culture, ethnicity, and
  3. Weschsler Memory Scales – core
    component of any cognitive assessment, takes up to 42 minutes to
  4. Minnesota
    Multiphasic Personality Inventory (MMPI) – is a standardized questionnaire
    for the diagnosis of Axis I disorders.
  5. Millon Clinical Multiaxial Inventory
    (MCMI) – is a self report assessment used in the diagnosis of Axis II
  6. California
    Psychology Inventory (CPI) – is a culturally relevant interpersonal
    assessment for typically developing young adults.
  7. Rorschach – is 10 inkblot assessments
    given systematically to aid in bypassing one’s conscious inhibitions.
  8. Thematic Apperception Test (TAT) – 20
    pictures given in sequence to aid in revealing dominant drives, emotions,
    sentiments, complexes and conflicts of personality.
  9. Neuropsychological impairment – a
    battery of tests designed to seek out any brain injuries.

nine of these assessments can be or are used to aid in the diagnosis process
for an individual presenting with minor to severe mental health issues.  It is another piece of the puzzle, another
block in building the foundation.




Once one enters the treatment phase, one needs to explore
all options and through informed consent choose a method of treatment. The
reason for the holistic approach in information gathering leads one to these
assessments for treatment:

  • Psycho-Therapeutic
    • This is meeting 1 to 1 with a
      counsellor or team of clinicians to address the underlying root emotional
      causes of the presenting mental health issue.
  • Medical-physical
    • Many mental health issues as noted in
      the diagnostic phase can be tied to medical issues, or cholesterol, part
      of any treatment plan needs to eliminate or work with these as these
      could be either a catalyst or a symptom of the presenting mental health
  • Psycho-pharmacological
    • The important aspect of any treatment
      is a trusted pharmacist and consistent pharmacy to work with the
      individual.  Through testing, and
      trial & error the right combination of pharmaceuticals can be found
      to treat the chemical imbalances or misalignments of the presenting
      mental health issue.
    • The pharmacist is imperative as they
      will be able to guide the individual through all their behind the counter
      medications, and over the counter remedies and herbal remedies.  Essentially they are the pharmaceutical
      case worker to ensure nothing interacts badly with the individual’s
    • A consistent pharmacy is needed
      because each pharmacist has a slightly different mixture for their
      pharmaceuticals and with some, it could be a drastic change in effect
      with a change in pharmacy.

As you would not be a
trained pharmacists or prescribing physician it is best to partner with a
reputable professional, and work through them to ensure that this facet of care
is handled safely and professionally.



            Diagnosing and
working with mental illness is 1/3 quantifiable test results, 1/3 qualifiable
information gathering, and 1/3 putting the pieces together to solve the mystery.  It is the hope of this writer that there is a
better understanding of mental health disorders that will aid in removing
stigmatization and fear, but also equip and enable workers to be able to
communicate more effectively with the clinicians in the field.


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