Chapter 01: The History of Mental Health Care
Morrison-Valfre: Foundations of Mental Health Care, 8th Edition

MULTIPLE CHOICE

	1.	The belief of the ancient Greek philosopher Plato that the rational soul controlled the irrational soul could be compared with the belief of the more recent psychological theorist:
a.	Freud.	
b.	Pinel.	
c.	Fisher.	
d.	Rush.	

ANS:	A
Sigmund Freud believed that mental illness was, in part, caused by forces both within and outside the personality. Philippe Pinel advocated acceptance of mentally ill individuals as human beings in need of medical assistance. Alice Fisher was a Florence Nightingale nurse who cared for the mentally ill, and Dr. Benjamin Rush was the author of the book Diseases of the Mind.

DIF:	Cognitive Level: Comprehension	OBJ:	2	
TOP:	Early Years of Mental Health	KEY:	Nursing Process Step: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	2.	During the mid-1500s, behaviors associated with mental illness were more accurately recorded by professionals. This practice led to ______________ for different abnormal behaviors.
a.	classifications	
b.	diagnosing	
c.	treatment	
d.	education	

ANS:	A
Classification of abnormal behaviors did not begin until this time, after the practice of more accurate recording of behaviors was begun. Diagnoses, treatment guidelines, and any education regarding mental health disorders were not available during this period.

DIF:	Cognitive Level: Knowledge	OBJ:	3	
TOP:	Mental Illness During the Renaissance		
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	3.	During the latter part of the 18th century, psychiatry became a separate branch of medicine, and inhumane treatment was greatly diminished by the French hospital director:
a.	Dix.	
b.	Beers.	
c.	Pinel.	
d.	Carter.	

ANS:	C
Philippe Pinel advocated acceptance of the mentally ill, as well as proper treatment. Dorothea Dix crusaded for construction of mental health hospitals. Clifford Beers wrote the book A Mind That Found Itself. President Jimmy Carter established the President’s Commission on Mental Health in 1978.

DIF:	Cognitive Level: Knowledge	OBJ:	4	
TOP:	Mental Illness in the 18th Century	KEY:	Nursing Process Step: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	4.	In 1841, _______________ surveyed asylums, jails, and almshouses throughout the United States, Canada, and Scotland and is credited with bringing about public awareness and reform for the care of the mentally ill.
a.	Sigmund Freud	
b.	John Cade	
c.	Florence Nightingale	
d.	Dorothea Dix	

ANS:	D
Dorothea Dix spent 20 years surveying facilities that housed mentally ill individuals and is credited with major changes in the care of the mentally ill. Sigmund Freud introduced the concept of psychoanalysis, John Cade discovered lithium carbonate for the treatment of bipolar disorder, and Florence Nightingale trained nurses in England in the 1800s.

DIF:	Cognitive Level: Knowledge	OBJ:	4	
TOP:	Mental Illness in the 19th Century	KEY:	Nursing Process Step: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	5.	As a direct result of Clifford Beers’ work and book, A Mind That Found Itself, the Committee for Mental Hygiene was formed in 1909 with a focus on prevention of mental illness and:
a.	early detection of symptoms of mental illness.	
b.	education of caregivers.	
c.	current treatment options.	
d.	removing the stigma attached to mental illness.	

ANS:	D
Clifford Beers’ book reflected on his attempt at suicide followed by the deplorable care he received for the next 3 years in mental hospitals. Beers’ work and book raised the consciousness of people throughout the country regarding prevention and removal of the stigma of having a mental illness. Early detection of symptoms, education of caregivers, and current treatment options regarding mental illness were not the focus of his book, nor were they a priority for the Committee for Mental Hygiene.

DIF:	Cognitive Level: Knowledge	OBJ:	4	
TOP:	Mental Illness in the 20th Century	KEY:	Nursing Process Step: Assessment
MSC:	Client Needs: Psychosocial Integrity		

	6.	During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma that could last as long as 50 hours?
a.	Electroconvulsive therapy	
b.	Insulin therapy	
c.	Humoral therapy	
d.	Amphetamine therapy	

ANS:	B
Insulin therapy was believed to successfully treat schizophrenia in the early 1900s. Amphetamines were used to treat depression, and electroconvulsive therapy was used for severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a belief that mental illness resulted from an imbalance of the humors of air, fire, water, and earth.

DIF:	Cognitive Level: Knowledge	OBJ:	5	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	7.	In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often used to treat?
a.	Schizophrenia	
b.	Bipolar disorder	
c.	Severe depression	
d.	Violent behavior	

ANS:	C
ECT was found to be an effective treatment for severe depression in the 1930s. During this period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder.

DIF:	Cognitive Level: Knowledge	OBJ:	5	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	8.	In the early 20th century, a frontal lobotomy was a common treatment for violent behaviors. Which description of this procedure is accurate?
a.	A procedure that delivers an electrical stimulus to the frontal lobes of the brain.	
b.	A surgical procedure that drills holes in the front of the skull to drain fluid.	
c.	A surgical procedure that severs the frontal lobes of the brain from the thalamus.	
d.	A surgical procedure that inserts implants into the frontal lobes of the brain.	

ANS:	C
A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed from the thalamus.

DIF:	Cognitive Level: Knowledge	OBJ:	5	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	9.	In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of mental health because it funded:
a.	research on drugs for the treatment of mental health disorders.	
b.	training of mental health professionals.	
c.	construction of psychiatric units in facilities throughout North America.	
d.	development of community mental health clinics.	

ANS:	C
The Hill-Burton Act provided money for the construction of psychiatric units in the United States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health professionals was funded by the National Mental Health Act of 1946, and community mental health centers were not instituted until the 1960s.

DIF:	Cognitive Level: Knowledge	OBJ:	5 | 9	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	10.	The National Mental Health Act of 1946 provided a means for funding of programs that promote research on mental health and:
a.	development of mental health clinics in the community.	
b.	training of mental health professionals.	
c.	treatment for veterans suffering from mental health disorders.	
d.	educating the public about mental illness.	

ANS:	B
The National Mental Health Act of 1946 provided much needed training for individuals who cared for patients with mental health disorders. Community mental health clinics were initiated in the 1960s, treatment for veterans was not funded by this act, and education of the public occurred later.

DIF:	Cognitive Level: Knowledge	OBJ:	5 | 9	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	11.	Which of the following best describes the disorder that was first recognized in veterans following the Korean and Vietnam Wars?
a.	Depression	
b.	Bipolar disorder	
c.	Post-traumatic stress disorder	
d.	Paranoid schizophrenic disorder	

ANS:	C
Post-traumatic stress disorder was initially discovered in veterans who had been involved in armed conflicts. The other disorders also occur in veterans but were not first recognized in soldiers who were fighting wars.

DIF:	Cognitive Level: Knowledge	OBJ:	5	
TOP:	Influences of War on Mental Health Therapies	
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	12.	The introduction of ___________ in the 1950s led to the deinstitutionalization of many mentally ill individuals.
a.	psychotherapeutic drugs	
b.	community mental health clinics	
c.	residential treatment centers	
d.	state mental health facilities	

ANS:	A
Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone during the 1950s. Patients were being released from state mental health facilities as a result of psychotherapeutic drug therapy. Community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients.

DIF:	Cognitive Level: Knowledge	OBJ:	6	
TOP:	Introduction of Psychotherapeutic Drugs		
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	13.	In 1949, an Australian physician discovered which therapy to be an effective treatment for bipolar (manic-depressive) illness?
a.	Insulin therapy	
b.	Water/ice therapy	
c.	Lithium carbonate therapy	
d.	Electroconvulsive therapy	

ANS:	C
To this day, lithium is a treatment that is used to effectively balance the manic states and depressive states of bipolar disorder. None of the other therapies listed are effective for bipolar disorder.

DIF:	Cognitive Level: Knowledge	OBJ:	6	
TOP:	Introduction of Psychotherapeutic Drugs		
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	14.	In the early 1960s, a committee appointed by President John F. Kennedy recommended the development of a new approach to the way mental health care was administered, with an emphasis on the introduction of:
a.	psychotherapeutic drugs.	
b.	state mental health care systems.	
c.	community mental health centers.	
d.	deinstitutionalization of patients.	

ANS:	C
The emergence of community mental health centers was necessary, in part because of the massive deinstitutionalization of patients from state mental health care facilities after the introduction of psychotherapeutic drugs in the 1950s.

DIF:	Cognitive Level: Knowledge	OBJ:	7	
TOP:	Introduction of Psychotherapeutic Drugs		
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	15.	The Mental Health Systems Act of 1980 was one of the most progressive mental health bills in the history of the United States, but its enactment was interrupted by the:
a.	election of a new president.	
b.	appointment of a new Surgeon General.	
c.	rapid expansion of community centers.	
d.	National Alliance on Mental Illness (NAMI) surveys.	

ANS:	A
The election of a new president and his administration led to drastic cuts in federal funding for mental health programs. None of the other three choices were a part of the Mental Health Systems Act of 1980.

DIF:	Cognitive Level: Knowledge	OBJ:	9	TOP:	Congressional Actions
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	16.	The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with chronic mental illness in:
a.	nursing homes.	
b.	state mental health facilities.	
c.	residential treatment centers.	
d.	homeless shelters.	

ANS:	A
Many mentally ill, especially elderly, people were inappropriately placed in nursing homes with personnel who were not trained to care for these people. OBRA prevented this practice. State mental health facilities, residential treatment centers, and homeless shelters were not addressed in the OBRA of 1987.

DIF:	Cognitive Level: Knowledge	OBJ:	9	TOP:	Congressional Actions
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	17.	In the late 1980s, government funding for mental health care dwindled, and most insurance companies __________ coverage for psychiatric care.
a.	withdrew	
b.	increased	
c.	decreased	
d.	added	

ANS:	A
Unfortunately, insurance companies followed the trend of the national government to the point of actually dropping coverage for psychiatric care.

DIF:	Cognitive Level: Knowledge	OBJ:	9	TOP:	Congressional Actions
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	18.	In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey and grading of state mental health care for adults and learned that the overall grade for care was:
a.	“A.”	
b.	“B.”	
c.	“C.”	
d.	“D.”	

ANS:	D
The NAMI gave a grade of “D” to the mental health care system based on poor funding, limited availability of care, and patients’ lack of access to mental health care.

DIF:	Cognitive Level: Knowledge	OBJ:	9	TOP:	Congressional Actions
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	19.	In the early 1900s, the first theory of mental illness that showed behavior could be changed is attributed to:
a.	Beers.	
b.	Dix.	
c.	Freud.	
d.	Pinel.	

ANS:	C
Freud was the first person who succeeded in explaining human behavior in psychological terms and in demonstrating that behavior can be changed under the proper circumstances.

DIF:	Cognitive Level: Knowledge	OBJ:	5	TOP:	Psychoanalysis
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

	1.	The humoral theory of disease embraced by Hippocrates required a balance of which elements? (Select all that apply.)
a.	Fire	
b.	Water	
c.	Light	
d.	Air	
e.	Earth	

ANS:	A, B, D, E
Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental elements of air, fire, water, and earth. Each basic element had a related humor or part in the body.

DIF:	Cognitive Level: Knowledge	OBJ:	2	TOP:	Greece and Rome
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity

	2.	Which aspects of adult mental health care systems did the National Alliance on Mental Illness survey focus on? (Select all that apply.)
a.	Availability of care	
b.	Access to care	
c.	Regulation of medications	
d.	Increased funding	

ANS:	A, B, D
In 2006, the National Alliance on Mental Illness (NAMI) conducted the “first comprehensive survey and grading of state adult mental health care systems conducted in more than 15 years” (NAMI, 2006). Their results revealed a fragmented system with an overall grade of D. Recommendations focused on increased funding, availability of care, access to care, and greater involvement of consumers and their families.

DIF:	Cognitive Level: Knowledge	OBJ:	9	TOP:	21st Century
KEY:	Nursing Process Step: Assessment	MSC:	Client Needs: Psychosocial Integrity