Family Experiences of Caring for Relatives Who Have Received Electroconvulsive Therapy (ECT)

The research literature on family members’ experiences of the use of electroconvulsive therapy (ECT) is limited. This article explores the perspectives of family members whose relatives had received ECT. Drawing on a social constructionist perspective, this qualitative study collected data using in-depth interviews with nine families in South Australia, to examine how family members constructed the supports and challenges they experienced. The research found that families experienced a range of social and service system barriers, including social stigma and isolation, and limited support from health professionals. They had to negotiate caring expectations within a social context that stigmatised both mental illness and ECT. A need for ECT-specific mental health support groups was identified.

IMPLICATIONS

• Social workers’ roles in Australian hospitals could be further expanded to accommodate supporting families whose relatives have received ECT, referring families to community support, and advocating for specialist support post-ECT treatment.

• Social workers can further articulate their unique contribution to community care post-ECT treatment and advocate for supporting families.

• Increased focus on ongoing and preventative care for supporting families is a potential growth area for social workers in mental health.

     

Wraparound Services: An Effective Intervention for Families Impacted by Severe Mental Illness

ABSTRACT

Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy and a system of care with a promising evidence base that could enhance collaboration of child welfare, mental health, and community services to work more effectively with families impacted by SMI.     

Teaching Family Policy

Abstract

Preparing students to engage in family policy education and advocacy is a challenge and opportunity for departments that teach family studies and family policy courses. Students not only need to know theoretical implications of family policy and how research enhances the theory, but also understand the policy process and how research-based information about family can inform policymaking. These students also need to acquire advocacy skills in order to work effectively in different policy arenas. This article illustrates how university family policy educators can structure curricula to provide students with both knowledge and skills vital to effective participation in family policy formation, analysis and critique.     

Independent Mental Health Advocacy: A Model of Social Work Advocacy?

ABSTRACT

Advocacy has received less attention in social work research than other aspects of social work practice. This paper draws attention to two tensions in social work advocacy; between worker-led advocacy and person-led advocacy, and between individual advocacy and system level advocacy. We argue that human-rights-based social workers must choose a person-led approach over a worker-led approach while advocating with both systems and individuals. This argument is made by drawing on findings of an evaluation of Independent Mental Health Advocacy (IMHA) in Victoria, Australia. It is shown that social work training had not prepared social workers for rights-based, person-led advocacy and that social workers in public mental health services were struggling to maintain the rights of people in their services even with assistance from IMHA.

IMPLICATIONS

• Independent Mental Health Advocacy (IMHA) is a model of advocacy influenced by social work theory and delivered in part by social-work-trained advocates.

• Social work training is not preparing social workers for person-led, human-rights-based advocacy.

• Public mental health social workers are struggling to maintain the rights of people in mental health services even with the support of external advocacy services.

     

The New Sisters of the Road: Homeless Women and Their Children

ABSTRACT

This article examines the growing social problem of homeless women and their children. It provides a historical perspective, reasons for the increased incidence of family homelessness, the negative effects of homelessness on women and children, and programmatic responses. It also makes recommendations for effective program services and policy reforms. It urges family social workers to adopt a policy advocacy orientation. The article concludes that there is a need for further research to separate causes from effects when studying homeless women and children, and that researchers need to attend to the significance of gender for the social problem of family homelessness.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

Towards Hybridization: The Roles of Swedish Non-Profit Organizations Within Mental Health

In many parts of the Western world, interventions for people with mental illness have radically changed in recent decades. In the deinstitutionalized system of today, the role for non-profit organizations is generally characterized by dual goals: political advocacy and service provision. Here, the role and function of the user movement in the Swedish mental health system is examined through a case study of all local branches of the largest non-profit organization within the Swedish mental health field. The empirical material consisted of annual reports from all local branches, and was analysed through two analytical schemes, concerning voice/service and conflict/consensus. The analysis pointed to a user movement that still retained the basic ideas of peer support and mutual aid, but were also increasingly being asked by formal service providers to represent the need of users. A hybrid organization category, a ‘Social Movement Peer Organization’, was identified that where social recreational activities are combined with local political advocacy.     

Literary clinical practice: desire,depression and toxic masculinity in Hamlet

ABSTRACT

This essay introduces the notion of a literary clinical practice for which it remains essential to continue to consider those texts that open up a place for a readership, or audience, or even a civilization to consider the endlessly generative failure of its literature to write mental health. Concerned with mental illness that is an effect of language on the subject, the body, and of the enigma of the truth as cause, psychoanalysis is the crucial interlocutor for any literary clinical concern with the maladies of literature and society. In order to re-assess the utility of Shakespeare’s Hamlet to contemporary problems such as depression – perhaps the dominant symptom of our time – this essay attempts a reconsideration of Jacques Lacan’s famous seminar on Hamlet from the perspective of the contemporary clinic of the Lacanian orientation in psychoanalysis led by Jacques-Alain Miller.     

Advocacy strategies for health communication

This article presents a new way of using advocacy communication strategies for health communication. The traditional perspective on advocacy, promoted in mainstream public relations and marketing circles, is being replaced by a more interactive and integrated view on the role of advocacy communication. Newer theoretical and applied contributions to the health communication field support the need to explore (a) a broader understanding of the role of communication to promote and sustain health behavior; (b) a broader social scientific approach to public health as a social construct and the social determinants of health with stronger emphasis on health policies and management such as governance, accountability and leadership; and (c) policy perspectives that deal with resource allocation, human resources and capacity building, enabling environments for health communication, and recognition of the value and contribution of health communication to public health.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

Talking About Gender in Motion

Abstract

This is an interview with noted Norwegian sexologists Elsa Almas and Esben Esther Pirelli Benestad, who is bigender and married to Almas. In conversation with narrative therapist Christopher Behan, they discuss, both professionally and personally, working with those who have a transgender family member, the importance of community work to support the transgender child or adolescent, and the continued need for advocacy within the mental health and medical fields for transpeople and their loved ones.     

Family violence laws: Traditional narratives and the (in)visibility of lesbian relationships and lesbian-parented families

Abstract

Feminist advocacy and activism over the last 40 years broke historic ground in shining a light on “domestic” or “family” violence, traditionally conceptualized as male violence against female intimate partners and their children. This has resulted in a large body of research, particularly in the United States, United Kingdom, Australia, and similar jurisdictions, around the gendered nature of family violence and violence within heterosexual relationships and heterosexual-parented families. As a consequence, the predominant narrative—in political, policy, and advocacy settings—is largely heteronormative. Less research has focused on family violence in non-heterosexual relationships. The data that do exist have employed different methodological approaches and there are limitations on the extent to which they can be compared to the data on violence within heterosexual relationships. However, the existing research does demonstrate that family violence within lesbian, gay, bisexual, transgender, and intersex (LGBTI) communities is a significant issue. Even so, the current narrative does not acknowledge this, and predominantly reflects heterosexual norms of intimate relationships and family structures in society. LGBTI relationships are described as “invisible” in policy and practice responses to family violence, due to the failure to acknowledge violence in such communities. This article explores these claims in relation to lesbian relationships in the context of Australian legislative responses to family violence. It considers the extent to which family violence laws in two Australian jurisdictions recognize and frame lesbian identity in intimate relationships and lesbian-parented families. This is considered in light of the emerging conceptualization of family violence in lesbian relationships and lesbian-parented families, as evidenced by the wider scholarly literature on the nature and dynamics of such violence.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

Practice Wisdom on Custodial Parenting with Mental Illness: A Strengths View

ABSTRACT

Social work principles of strengths, empowerment, and consumer-centered care for persons with mental illness are currently being adapted to broader contexts. This article presents study findings on practice wisdom about custodial parents with mental illness, a potentially increasing group of consumers in light of mental health reform. The research team organized thirty-six professionals with practice experience into five focus groups. Findings reflect strengths perspective categories of resilience, social support, family functioning, self-care, and parents' positive experience of their symptoms. Implications discuss how providers who work with custodial parents and their children can apply these findings in assessments and interventions.     

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT

This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.     

Ethical Issues in Child Custody and Dependency Cases

Abstract

The emotional and psychological risks to children of high conflict divorce have led to the increased involvement of mental health professionals in child custody cases. Numerous service models (Greenberg & Gould, 2001; Johnston, 2000; Johnston & Roseby, 1997) have been developed to assist divorcing families in minimizing family conflict and supporting children'S needs. This underscores the need for judges and attorneys to understand the ethical and professional standards that underlie competent mental health practice in forensic cases. The practices of mental health professionals providing court-related services may have a substantial impact on the validity of their professional opinions, the effectiveness of services provided to children and families, and children'S development and adjustment. The authors suggest core ethical and clinical issues to be considered by all psychologists who work in the context of custody disputes. It is hoped that these professional practice suggestions will also be useful to attorneys and judicial officers in assessing the quality of mental health professionals' opinions.     

Medicare Funded Mental Health Social Work: Better Access to What?

ABSTRACT

Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Scheme initiative (Better Access), is an Australian Federal Government scheme aiming to improve access to mental health services. Accredited mental health social workers have been involved in the delivery of services under Better Access for more than a decade. In this time, there have been significant changes in the field of mental health services, with consequent increases in size and costs for Better Access. Better Access now represents public spending of more than one billion dollars per annum, yet there is no ongoing account of its impact. In this paper we consider the policy chronology and evaluation of the program, using current available data to question the impact of Better Access on both the service system and the nature of mental health social work practice. This case highlights the importance of a clear articulation of the scope of mental health social work, and ongoing monitoring of the impact of policy in a policy environment increasingly characterised by individualised funding and service delivery structured according to the principles of New Public Management.

IMPLICATIONS

• Social workers' increasing involvement with Better Access has reshaped the scope of mental health social work practice.

• The impact of Better Access on outcomes for service users and mental health social work is not currently a focus of research attention.

• Better Access is a case study illustrating the potential of the policy context to directly shape social work practice, therefore critical engagement with the impact of Better Access is an essential professional imperative.

     

Creating a Family Centered Wellness Team: Lessons learned in creating an integrated continuum of care for families facing homelessness,addiction, and trauma recovery.

Abstract

Homelessness is often experienced by women and children, and recent evidence suggests that women and children are the fastest growing segments of the homeless population. Homelessness is often accompanied by mental illness, substance abuse, and histories of violence, for both women and their children. While trauma informed care has been incorporated into women's treatment systems there has not been widespread application of this knowledge to family centered work with homeless families. This paper explores the need for family strengthening approaches and identifies one model currently being evaluated that seeks to decrease service fragmentation, increase positive family interaction, and deepen the family's connections with each other and with the community.     

Minority Stress,Emotion Regulation,and the Parenting of Sexual-Minority Youth

ABSTRACT

Despite increasing societal acceptance of sexual-minority individuals, there are still gay, lesbian, and bisexual (GLB) adolescents who experience negative mental health outcomes. Minority stress theory posits that stigma-related stress associated with sexual-minority status drives increased risk among GLB individuals. Furthermore, recent evidence suggests that minority stress impacts emotion regulation (ER), identified as a particularly important risk factor for sexual-minority youth (SMY). Current research has identified some aspects of parenting contribute to GLB youth's mental health. We review the literature in these areas, and also integrate research from the broader developmental field on families and emotion socialization in order to identify the need for studies of parenting that go beyond existing data on parental acceptance and supportiveness of youth's sexual orientation. Limitations of the current literature and directions for future research are discussed, with specific focus on implications for interventions with SMY and their families.     

“Spokes in the wheel” and how policy gains can diversify a social movement

ABSTRACT

Activists often use their resources to pursue protective legislation, like anti-discrimination or environmental protection laws, and the results are often compromised versions of what they wanted. This process of political institutionalization requires ongoing and robust mobilization to strengthen these resulting policies or prevent them from being rescinded all together. Therefore, to understand the pros and cons of political institutionalization we must understand the recursive effects between policy reform and consequent mobilization. Quantitative and qualitative data on the animal advocacy movement, a movement existing for over a century, are used to explore the effects of policy gains on consequent mobilization and explore whether policy gains were followed by de-escalation of protest forms. The findings indicate that policy gains for animal welfare do not de-escalate mobilization, both in terms of the use of disruptive collective action and proliferation of organizations. The article explores the ways that infighting over the terms of policy reform may be an important factor in diversifying the movement.