Accountability in research using persons with mental illness

Although medical research involving the use of persons with mental illness is critically important, in order for the research to be ethical and legal there are certain considerations and restrictions which should be immediately readdressed in order to insure that the welfare of these vulnerable research subjects is protected, and their best interests are assured. A brief historical examination of medical research codes, guidelines, recommendations and Federal Regulations reveals the various considerations and restrictions on informed consent and accountability applicable to the use of persons with mental illness in medical research. Several concerns are raised about how these considerations and restrictions have been interpreted, and specific recommendations are offered to improve them immediately by means of representation from consumers and/or their families, and organizations, e.g., NAMI members.     

Telephone Support Groups for Caregivers of Persons with AIDS

Caregivers of persons with AIDS experience numerous stressors in their caregiver role and could benefit from support groups. However, caregiving responsibilities make it difficult for many to attend face-to-face groups. This article describes experience with a telephone support group pilot project for this population. The time-limited, semi-structured groups used conference call technology; the eight session group protocol war designed to meet caregiver needs for information about resources and coping skills. Pilot data from interviews with group members from the first two completed groups on this project indicated that participants valued the group experience highly.     

INDIVIDUALS WITH INTELLECTUAL DISABILITY AND MENTAL ILLNESS: A LITERATURE REVIEW

This review highlights the urgency for a seamless and co‐ordinated approach to service delivery for people with intellectual disability and mental illness. There is emerging evidence of the high prevalence of mental illness in persons with intellectual disability. The notion that people with intellectual disability can have mental illness has only been recently acknowledged. Furthermore, people with intellectual disability also experience a wide range of psychiatric disorders often seen in the general population. Despite of recent developments in treatment options for these people, many of them continue to experience barriers in accessing mental health services.     

Groupwork in a Hospice Setting

Hospice has developed rapidly to become a major health care orovider for those with a life threatening illness and their families. As part of their services, hospices offer several types of groups for their clients, volunteers and staff as well as social support groups for their own team members. This paper examines the functions of groupwork in hospice, focusing particularly on the use of hospice staff support groups. Research on the use of a group perspective and group methods in a hospice setting is presented.     

Identifying Themes Regarding the Benefits and Limitations of Caregiver Support Group Conversations

Support groups continue to be one of the most needed and desired forms of help for family caregivers to persons with dementia. Though the effects of caregiver support group participation have been examined, the benefits and limitations of the dynamics of support group conversations have been neglected. This study focuses on the perceived consequences of group dynamics. Three themes—balance, sameness, and individuality—emerged through analysis of open-ended interviews with support group members following observations of their meetings. The consequences of these themes are illustrated with a case study and the implications of these themes for practitioners are discussed.     

Support for and From Aging Mothers Whose Adult Daughters are Seriously Mentally Ill

This article discusses, from the grandmother’s perspective, the ways in which support is exchanged in families coping with serious mental illness. A strengths perspective was utilized to identify ways in which family members help each other. Employing a qualitative approach, this study focuses on interviews obtained from a sample of 22 aging mothers, aged 52–90, who are in contact with their daughters who have a mental illness. Grandmothers provided several kinds of support to their mentally ill adult daughters and to their grandchildren, who also supported the aging mother in numerous ways. As social workers seek to assist individuals with mental illness, it is important to assess the existing strengths of their intergenerational family context.     

Support for Parents of Children with Cancer

Self-help and mutual support groups play an important role in the spectrum of resources useful to parents of children with cancer. These groups can provide parents with opportunities to share their experiences with other parents in similar situations, to learn from and teach others, and to create a new social network. While much has been written about such groups, very little attention has focused on factors related to parents evaluation of their group experience. This paper examines factors related to parents' perceptions of the value of self-help groups.     

Drumming and Mindfulness Integrations into an Evidence-Based Group Intervention

Community mental health, to protect the integrity of service to a highly vulnerable population, has sought to increase the use of evidence-based practice. However, most evidence-based practices have a narrow scope challenging the breadth of effectiveness with consumers with higher levels of comorbidity. This article explores the use of mindfulness and drumming integrated into an evidence-based program: Seeking Safety. In response to the challenges of conducting a cognitive-focused intervention for members diagnosed with posttraumatic stress disorder, addictions, and co-occurring severe/persistent mental illness, mindfulness principles and drumming are used to help manage the emotional needs of group members. This article outlines the foundational principles supporting the group program.     

Vital Conversations with Family in the Nursing Home: Preparation for End-Stage Dementia Care

Family members of persons with advanced dementia may be asked to make complex treatment decisions without having adequate knowledge regarding the risks and benefits. This 6-month, prospective, randomized trial tested the effect of an intervention consisting of a face-to-face, structured conversation about end-of-life care options with family members of nursing home residents with advanced dementia. A comparison group received only social contact via telephone. Structured conversations between a palliative care team and intervention group family members included goals of care and how best to achieve those goals, and provision of psychosocial support. Psychosocial support was also provided via telephone at three 2-month intervals. Family members participated in three telephone interviews: baseline, 3, and 6 months. Specific advance directives for persons with dementia were extracted from medical records. Results showed that intervention families had higher satisfaction with care than comparison families at the 6-month time point, and they were more likely to have decided on medical options listed in residents' advance directives (Do Not Resuscitate, Intubate, Hospitalize) over time. Study findings reinforce the need for increased education and support for families around issues of end-of-life care decisions for advanced dementia.     

Goal setting in recovery: families where a parent has a mental illness or a dual diagnosis

Goal setting is an important element within mental health recovery models; however, parenting and children are rarely recognized in such approaches. This study outlines a family recovery planning model where a parent has a mental health or dual substance and mental health problem. The differences between family types (parent with a mental illness or parent with dual diagnosis) and family members (parent and children) are illustrated in terms of goals across 11 domains. There were a total of 33 parents and 50 children from 10 mental illness and 10 dual diagnosis families. Education and specifically mental health knowledge are important goals across all families and appear especially important for children whose parent has a dual diagnosis. Specific goals and achievement levels for each type of family and parents and children are also outlined. Clear areas for action by clinicians and family members are indicated by this study.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

Hepatitis C psychoeducation curriculum topics generated by group members

ABSTRACT

Educational programs for hepatitis C (HCV) have been created by professionals. There has not been a focus on whether what clients want to know about HCV differs from what providers want patients to know. This study addresses this gap by examining topics selected by participants in an education/support group model. Data were collected as part of a randomized psychoeducation trial for patients with HCV. Topics were systematically generated by the members uniquely for each group. Topics and rank order for each group were generated and a combined variable was created. Twenty-eight different topics were identified across 12 groups. The total number of topics was 102, averaging 8.5 per group. Topics are divided into three separate conceptual groups, members’ personal relationship to HCV, medical aspects of HCV, and unique concerns. A patient-centered approach that addresses the needs of HCV patients first provides an optimal starting point to discuss HCV disease management.     

Differences by Race in Social Work Students’ Social Distancing,Treatment Options,and Perceptions of Causes of Mental Illness

ABSTRACT

Research has shown that racial and cultural differences are related to the degree of social distancing associated with mental illness, beliefs about what causes mental illness, and what treatment options are best; however, there is little information on how this may manifest in social workers’ perceptions of these issues. This cross-sectional survey analyzed the differences in perceptions by race of 835 students enrolled in social work classes in the United States. Results indicated that individuals who self-identify as African American/Black expressed the greatest social distance concerning mental illness. Whites were most likely to endorse the use of medication and were least likely to normalize mental illness. The most frequently endorsed mental health provider varied according to racial/ethnic groups. Our findings show that future research may be needed to further investigate the conceptualization of the role of social work among different groups. The need for self-reflection and keeping biases in check are discussed as implications for social work practice and education. Suggestions for working with diverse clients, including religious diversity, are offered as well.     

A Support Group for Spouses of Nursing Home Residents

This article describes a closed group for spouses of nursing home residents, in which group composition was carefully considered through a process of staff referral and pre-group interviews of potential members identified as persons who might be especially helped through group participation. The group provided opportunities for needed support and sharing and also empowered its members to influence agency policy.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

Collective citizenship: From citizenship and mental health to citizenship and solidarity

Although the concept of citizenship is a widely used theoretical framework within political philosophy, its use in the field of mental health remains underexplored. Within this context, citizenship emphasises the social inclusion and participation of people who are marginalized and offers a more social and relational view of services and support for people with mental health problems than has been common in mental health systems of care. At the same time, however, the citizenship approach has operated in the context of systems of care in the United States that favour highly individualized conceptions of, and approaches to, care, and these systems of care operate in the social and political context of highly individualized concepts of the citizen. In this article building on the work of other citizenship scholars, we argue that a collective form of citizenship, grounded in the 5Rs framework, holds the individual and collective in creative tension. Furthermore, the paper applies this model to the domain of mental health, where people are treated in individualistic ways and experience marginalisation, making the collective dimension imperative and promoting participation, empowerment and the contribution for social change to people with mental health problems. Our theoretical framework of collective citizenship, while geared toward the needs of persons with mental health problems, also contributes to recent citizenship theory on the inclusion of marginalized, stigmatised, and excluded groups. We illustrate the application of this approach through an ethnographic-participant observation case study of a collective citizenship group with which we are associated.     

Common Ground: The Development of a Support Group for Survivors of Homicide Loss in a Rural Community

ABSTRACT

Losing a loved one from human-perpetrated violence can lead to a debilitating process of stigma-generated isolation and trauma. Layers of social services are needed to support surviving family members, all secondary victims of homicide. Although urban populations have enriched access to victims-of-crime services, rural-bound populations often do not. This article describes homicide-specific trauma and the development of a community support group for rural-bound persons suffering homicide loss. The support group process offers potential for real help in areas where few trauma-informed options exist. The authors chronicle their journey of group-work practice with underserved persons coping with homicide loss.