Ethical Issues in Preventive Programmes for Mental Health

“ ‘In that direction,’ said the Cat, waving its right paw round, ‘lives a Hatter: and in that direction,’ waving the other paw, ‘lives a March Hare. Visit either you like: They're both mad.’     

School Violence and Adolescent Mental Health in South Africa: Implications for School Health Programs

This study examines the perceptions of high-school adolescents about gang violence in a periurban community near Cape Town and the implications for school health in South Africa. Using the qualitative focus group discussion (FGD) guide, data were collected from 60 high-school adolescents, between 10 and 20 years of age. Trained moderators conducted nine FGDs with small groups of six to eight students. The constant comparative ethnographic method was used to analyze the data. Results indicate that gang violence is very common among high-school adolescents living on the Cape Flat. Gangs, perceived by many as part of the rite of passage among adolescents, are a major threat to the public health, mental well-being, general welfare, happiness, and development of high-school populations on the Cape Flat. Gang activity interlock with many other social problems, including drug and alcohol abuse, school unrest and violence, and the increasing prevalence of sexually transmitted diseases, especially HIV and AIDS. These findings suggest an urgent need for concerted efforts to develop mechanism to protect school pupils from gangs and develop healthier social alternatives to gang-related activites. Ties among government, school, parents, and community education and participation are urgently necessary to implement a school-based approach to adolescent health promotion.     

Gay Men in the Workplace: Issues for Mental Health Counselors

The author looks at major issues that affect gay men who are deciding on, competing for, and working in the jobs and careers available in today’s changing job market, and the implications for mental health counselors who may serve them. Included is an in-depth review of the current academic counseling literature on gay men in the workplace, highlighted by reports from the national gay press.     

Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse

ABSTRACT

Recent studies on elder abuse suggest that the pathology or impairment of the abuser may be a stronger predictor of elder abuse than characteristics of the victim. To examine the relationship between elder abuse, abuser pathology, and the criminal justice system, the New York City Department for the Aging (DFTA) undertook a survey of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Preliminary findings from the survey indicate that impaired abusers were significantly younger than unimpaired abusers and more likely to live with their elderly victims, to be unemployed, and to have a history of involvement with the criminal justice system.     

Training Mental Health Professionals on Ethical Issues and HIV/AIDS

This report describes the importance of ethics training for mental health professionals working with persons infected or affected by HIV/AIDS. We first describe three major ethical dilemmas (confidentiality, duty to warn, and suicide) faced by mental health providers serving persons with HIV/AIDS, and the legal and clinical aspects of these dilemmas. We present data from the South Texas AIDS Training Project describing the types of mental health professionals who have attended workshops on ethical issues and HIV/AIDS. Finally, we report observations about the impact of the ethics training sessions on the participants' knowledge and attitudes.     

Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents

SUMMARY

This paper will focus on ethical dilemmas that arise in the treatment of adolescents with gender dysphoria. We will begin with a discussion of ethical and legal issues pertinent to the treatment of any adolescent, and then proceed to the gender dysphoric adolescent, since there is a great deal of overlap between the two areas. The authors re-view legal decisions, the existing data on adolescent decision-making, and ethical principles that may help the clinician in resolving some very complex situations. Utilizing case vignettes of three gender dysphoric adolescents, the authors provide a pragmatic illustration of the ethical dilemmas involved in evaluation and treatment of these youth. It is the authors' belief that treatment interventions should be based on respect for the adolescent's autonomy and confidentiality where he or she is deemed competent to make decisions.     

Challenging the Silence of the Mental Health Community on Adoption Issues

As traditional secrecy surrounding adoption has waned, the behavioral sciences, particularly the mental health community, have remained largely silent, particularly on postadoption issues. Reasons for this silence are suggested. Research on adoption is difficult to conduct. The mental health community may desire to see adoption as professional problem-solving and as a favor done to all involved. Problems in adoption thus represent both a failure on the part of those professionals and a favor gone bad. Fear that discussing adoption-related problems will lead to adoption itself being labeled as pathological is also likely operating to support the silence. Privacy issues for the adoptive and birth families are also important. Sexuality and childbirth have long been areas not sufficiently addressed, but with the addition of the illegitimacy common in adoption they are even more controversial. Issues of poverty, powerlessness, social class, and race also are difficult to face, as is the business aspect of adoption. Acknowledging the reasons for the silence may be the first step in addressing it. Other steps, such as continuing education programs and publication of information on postadoption issues are also suggested.     

Coming Out Issues of Gay and Lesbian Mental Health Professionals in Voluntary and Involuntary Settings

Abstract

Mental health professionals are increasingly called upon to provide consultation and treatment in settings different from the traditional outpatient and hospital inpatient settings. This paper provides an overview of the unique problems posed when considering self-disclosure by gay or lesbian mental health professionals working with institutionalized populations. A review of literature concerning self-disclosure to patients in outpatient settings is provided and applied to institutionalized settings. Benefits of, as well as cautionary notes regarding, self-disclosure of homosexuality by mental health staff are reviewed.     

Ethical Issues in the Provision of Online Mental Health Services (Etherapy)

ABSTRACT

A number of ethical issues involved in face-to-face therapy are examined in relation to online therapy (etherapy). Etherapy is defined and its strengths and weaknesses discussed. Specific ethical issues addressed include boundaries of competence, basis in science, avoidance of harm, confidentiality, avoidance of false or deceptive statements, forums, testimonials, solicitation of clients, fees, and informed consent. A concluding section briefly addresses legal issues, particularly interstate etherapy. It is recommended that federal licensing legislation be enacted, informed by the NASW, the APA, and similar groups.     

New Issues in an Old Dilemma: The Confidentiality of Mental Health Records

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the ACHA in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, the ACHA compiles aggregate data from participating institutions in a reference group report for data comparison. Results from the Spring 2004 Reference Group (N = 47,202) are presented in this article.     

Implementation Issues for Consumer-Directed Programs

Summary

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs “closer to the people.” Consumer-direction goes even further by placing resources directly in the hands of consumers.

Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective “dialogue” that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Using E-Health Programs to Overcome Barriers to the Effective Treatment of Mental Health and Addiction Problems

E-Health programs for mental illness and addictive behaviors have recently emerged as potentially useful self-help resources. Health care professionals will soon have the option of referring clients to free-to-end-user online, expert-moderated e-health programs as complementary means of assisting clients. Such programs will have significant implications for developing improved stepped models of care. This article describes various e-health programs and lessons learned related to access, promotion, user demographics, and patterns of use. In addition, validation procedures, effectiveness and attrition rates, fitting and tailoring, and qualitative analyses of social networks are described. It is difficult to validate e-health programs that are completely anonymous and do not require registration, personal interaction, or membership fees. As competition emerges in the budding e-health industry, best practice guidelines will need to be developed for collecting data and evaluating the utility of these programs.     

Youth Sexual Exploitation on the Internet: DSM-IV Diagnoses and Gender Differences in Co-occurring Mental Health Issues

This paper explores conventional (non-Internet-related) mental health issues and DSM-IV diagnoses seen among a sample of 512 youth receiving mental health services for an Internet-related problem, with particular attention to victims of online sexual exploitation. Youth victims of online sexual exploitation were more likely to have a post-traumatic stress disorder than youth with other Internet-related problems. Specific attention was given to differences among subgroups of female and male youth victims of online sexual exploitation as compared with same-gender youth with other Internet-related problems. Findings suggest the importance of including Internet use and victimization as part of a standard clinical assessment.     

Community Mental Health and the Educational Dilemmas of the Mental Health Professions

Liberation theory from a Third World adult educator is seen as consistent with social work ideals and an avenue for social work education to travel in developing better learning and more motivated, knowledgeable, critical, responsible, and autonomous learners. Conscious choice can free professional education from its pedagogical overtones, recast it in an androgogical perspective, and help it produce learners who are creative subjects rather than receiving objects.     

Online Mental Health Information Seeking in Young Adults with Mental Health Challenges

Barriers such as stigmatization and access to health care may lead young adults with mental health conditions (YAMHC) to try to find alternatives to more traditional means of obtaining care. One possible alternative is to seek information online. The purpose of this article is to better understand how YAMHC use the Internet to access information about mental health, and the challenges they face when trying to access that information. Semistructured focus groups were conducted to investigate how YAMHC use the Internet for information and support regarding their mental health. Three major themes about mental health information seeking emerged from the data: (a) Topics searched, (b) Motivations for going online to search for information, and (c) Barriers to successful searching. Findings indicate that YAMHC look up information related to their mental health for a variety of reasons that are unique to the online experience, and use that information to help them with their care, despite at times feeling overwhelmed by, and not always trusting of, the information available.     

An Evaluative Review of Outcome Research on Universal Mental Health Promotion and Prevention Programs for Higher Education Students

Abstract

Objective: This review is the first large-scale attempt to evaluate the effectiveness of universal promotion and prevention programs for higher education students on a range of adjustment outcomes. Participants/Methods: The current review examined 83 controlled interventions involving college, graduate, and professional students, with a focus on 3 main outcomes: social and emotional skills, self-perceptions, and emotional distress. Results/Conclusions: Skill-oriented programs that included supervised practice demonstrated the strongest benefits, thus showing promise as a successful mental health promotion and preventive intervention. In comparing different intervention strategies, mindfulness training and cognitive-behavioral techniques appear to be the most effective. Furthermore, interventions conducted as a class appear to be effective, suggesting the potential for exposing higher education students to skill training through routine curricula offerings. This review offers recommendations for improving the experimental rigor of future research, and implications for enhancing campus services to optimize student success in psychosocial—and thus ultimately academic—domains.     

Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Anti-oppressive Practice in Mental Health

This article identifies the challenges to incorporating an anti-oppressive practice approach in the field of mental health, which has traditionally utilized a discourse and perspectives of a bio-medical model. Schools of Social Work often teach anti-oppressive and social justice approaches which make it difficult for students to link theory and practice in fields such as mental health. In this article, seven principles of practice are presented as a framework for working with people with disabling conditions of mental health. Specific strategies for implementing these principles are presented.