Social Enterprise in Mental Health: An Overview

ABSTRACT

This article provides an overview of the models and concepts of social enterprise utilized for and by people with serious mental illness histories. Although social enterprise in mental health is not new, the naming of it as social enterprise and the attention these efforts have garnered is new. This article will provide a brief history of social enterprise in formal social services; review some conceptual issues and differences between social enterprise in Europe and North America—the two major current centers of its activity; and conclude with some observations of the ways in which mental health social enterprises are developing.     

Socioeconomic Status and Mental Illness in Japan*

Abstract Since the pioneering work of Faris and Dunham (1938), a number of studies in the United States have documented an inverse association between socioeconomic status (SES) and mental illness both at the aggregate and the individual levels, and both for the treated and the general population. However, there are few studies of whether this relationship holds in other countries. This study examines socioeconomic characteristics and mental illness in Japan, which has a very different social stratification system from that of the United States. It was found that, at the aggregate level, the “inverse” association between socioeconomic characteristics and the rate of treated mental illness does not hold in Japan. Instead, the relationship is curvilinear: mental illness is higher in districts with large numbers of blue collar and upper white collar workers than in districts with large numbers of lower white collar workers. The effect of SES on mental illness operates through economic stress embedded in the macro social context. Because different social structures lead to different patterns of economic stress, the inverse relationship between socioeconomic status and mental health cannot be assumed to hold in all countries.     

“A Geography of Disparate Spirits”: Pathology as Oppression in “A Woman is Talking to Death” and “Mental”

This article foregrounds Judy Grahn's commitment to social justice and chiefly considers her nine-part poems: “A Woman is Talking to Death” and “Mental.” These poems illuminate the socially constructed nature of mental illness and challenge readers to consider how and why the characters within them are deemed mentally ill. Little, if any, scholarship has been devoted to using Grahn's poetry, and particularly “Mental,” as a framework for analyzing the pathologization of people, especially women, relative to the system of mental health. Her work remains relevant to critical conversations that illuminate contemporary issues of oppression that still haunt us today.     

A Comparative Study of Campus Experiences of College Students With Mental Illnesses Versus a General College Sample

Abstract

Objective: Examine campus experiences and relationships of college students with mental illnesses compared to general student norms using the College Student Experiences Questionnaire to understand potential sources of distress and retention issues. Participants: Responses were obtained from 449 former and current students with mental illnesses from more than 300 colleges and universities around the country. Methods: Participants completed an online survey available from July 2005 to July 2006. Results: Multivariate analysis of variance and t test results indicate that college students with mental illnesses report less engagement on campus and poorer relationships, and that these factors were associated with lower graduation rates. Students reporting they were treated differently “most of the time” because of a mental illness had the lowest levels of engagement and poorest relationships. Conclusions: More attention is needed to developing interventions that enhance social functioning and engagement and address stigma on campus in order to reduce distress and enhance retention.     

The accommodation and support needs of people with a mental illness: A process and framework for action

Abstract

This paper reports the results of a consumer-focused assessment of the accommodation and support needs of people with a mental illness living in a regional city. The study utilises a 'pathway to stability' approach to assess the phase-contingent accommodation and support needs of mental health consumers through interviews and focus groups with consumers, carers and service providers. The study identifies five broad phases of the life course impacted by mental illness—beginnings, long-term needs become clearer, instability as needs evolve, finding stability and ongoing. Five key issues—information, self-competence, comorbidity, coordination and flexibility were expanded upon in focus groups. Principles for planning future service delivery are identified. The implications of the findings and research methodology for social work practice and research are discussed.     

Social Inclusion as an Agenda for Mental Health Social Work

Summary

Following New Labour's election to office in the UK in 1997, policy initiatives have proliferated relating to mental health. Much of this policy innovation emphasises the social dimensions of mental health and distress, with an emphasis on employment and social inclusion. Paradoxically, this modernization of the mental health agenda comes at a time when mental health social work is struggling to establish its role and contribution within recently integrated health and social services. The paper considers whether New Labour's flagship programme, Mental Health and Social Exclusion, constitutes a “New Deal” for mental health, and whether it provides a perspective that will help mental health social work to define its distinctive contribution to integrated services.     

From past trauma to post-traumatic growth: The role of self in participants with serious mental illnesses

Studies have shown that people with serious mental illness are more likely to have experienced trauma compared to the general population. This qualitative study employed a grounded theory approach to explore how trauma histories influenced the process of triggering, developing, and recovering from serious mental illness. Findings based on in-depth interviews with 15 participants illustrated the intersection of trauma, serious mental illness, and post-traumatic growth. Experiencing trauma compromised participants’ self-functioning, causing issues such as affect dysregulation, distorted self- and other- concepts and relationship difficulties, meaninglessness, and existential fears, all of which negatively impacted participants’ mental health and behavior. At the same time, participants with serious mental illness were able to achieve post-traumatic growth with the “transformed-self” via self-acceptance, self-exploration, self-worth, and self-fulfillment. Findings of this study have useful implications for trauma-informed care in mental health treatment. Mental health professionals should address clients’ trauma histories to prevent re-traumatization and design trauma-informed programs that use and build clients’ inner resources and strengths to promote post-traumatic growth.     

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.     

Exploring Epistemologies: The Debate Continues

ABSTRACT

Stigma is a significant barrier to recovery and full community inclusion for people with mental illnesses. Social work educators can play critical roles in addressing this stigma, yet little is known about their attitudes. Social work educators were surveyed about their general attitudes about people with mental illnesses, attitudes about practice with people with mental illnesses, and attitudes about students with mental illnesses. On average, educators’ general and practice attitudes were not negative. However, respondents did view a student with a mental illness differently from a “typical social work student.” Findings suggest that we, as social work educators, must raise our awareness and address our own attitudes to support students and uphold our social work values.     

Promoting young people’s musical identities to facilitate recovery from mental illness

The new ‘youth mental health paradigm’ (IAYMH. 2015. “International Association for Youth Mental Health.” Accessed February 15, http://www.iaymh.org/) promotes the need for youth-friendly mental health options. Music therapy initiatives offer innovative modes of working towards young people’s recovery in ways that align with the ethos of these services (McCaffrey, Edwards, and Fannon. 2011. “Is There a Role for Music Therapy in the Recovery Approach in Mental Health?” The Arts in Psychotherapy 38 (3): 185–189). This paper details a participatory research project investigating how and why promoting young people’s musical identities can facilitate their recovery from mental illness. Young people accessing a music therapy programme in a youth mental health service in Australia participated in collaborative qualitative interviews that were analysed using constructivist grounded theory techniques. Cycles of action and reflection resulted in a grounded theory explaining the recovery of musical identity, and mapping young people’s community-based music needs for wellbeing. We propose that promoting young people’s musical identities facilitates recovery through: the construction of a health-based identity; facilitating meaning-making; and supporting social participation. Findings are discussed in relation to recovery literature and social justice issues that arise in response to findings about young people’s needs for appropriate music access.     

The Mark of Madness

Abstract

Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.     

The Role of Work on Family Relationships

Abstract

Work and family are two major institutions in society. Family has been considered as an important socializing agent for an individual's growth and development, while work provides the individual opportunities to develop a sense of identity and a self-image. For people with mental illness, work has been recognized as an important tool for facilitating psychiatric rehabilitation. In fact, the work experiences of those with mental illness have an effect on their family relationships, which may in turn affect their mental health. Using an intensive interview method, this article shows that work experiences from sheltered workshops have a significant impact on the family relationships of workers in Hong Kong.     

The Attitudes of Social Work Students and Practicing Psychiatric Social Workers Toward the Inclusion in the Community of People with Mental Illness

Abstract

This study measured and compared the attitudes of social work students and practicing psychiatric social workers to the inclusion in the community of people with mental illness. The Community Living Attitude Scale Mental Illness (comprising the four subscales of Empowerment, Exclusion, Sheltering, and Similarity) was administered to a random sample of 68 Israeli BA social work students (first year: n = 35; third year: n = 33) and 28 practicing psychiatric social workers. Overall, the participants endorsed Empowerment and perceived the Similarity of persons with mental illness to themselves more than they agreed with the Exclusion attitude of segregating those persons from community life. First-year students rated Empowerment and Similarity significantly lower than did the third-year students and rated Sheltering significantly higher than did psychiatric social workers. Psychiatric social workers did not differ from third-year students and did not have stronger attitudinal commitment to the inclusion paradigm. They differed from first-year students only in the sheltering attitude; they showed lower support for sheltering people with mental illness.     

What Do Social Workers Need to Know About Mental Health Courts?

Abstract

Mental health courts are an emerging strategy to engage mentally ill offenders in treatment and to avoid unnecessary incarceration. These courts began in 1997 based upon the drug court model; there are currently over 70 courts nationwide. These courts are heterogeneous in structure, work with interdisciplinary teams, and seek to engage the consumer in treatment rather than use judicial sanctions. Social workers are integral members of these teams; yet, no research has been published in social work journals on mental health courts. This article explains the background and context of the courts, describes their features, discusses what social workers need to know about mental health courts, and concludes with ideas for how social workers may work effectively with mental health courts.     

Theoretical and Practical Imperatives for Reflective Social Work Organizations in Health and Mental Health

Summary

This article describes the common challenges to health and mental health organizations that require these agencies to become more “reflective” in their culture and structures. This necessitates integrating practice and research at all organizational levels. Schon's concept of reflective practice to health and mental health organizations is extended to develop the construct of a reflective organization, in which direct practitioners are integral to organizational learning through ongoing service evaluation and redesign. The theoretical and practical reasons why social work administrators and clinicians alike are obliged to integrate practice and research are discussed. University-based models of practice-research integration impede this process; Epstein's Practice-Based Research approach facilitates it.     

The Association Between Mental Health and Acute Infectious Illness Among a National Sample of 18- to 24-Year-Old College Students

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. Methods: The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. Results: The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. Conclusions: Poor mental health is associated with acute infectious illness among college students.     

Wo'Lakol Kiciyapi

ABSTRACT

This pilot study hypothesized that the ancient traditions of help and healing among traditional Lakota people represent an alternative or complementary model for understanding a distinctive approach to American social work theory and practice which includes “shamanic” or spirit healing as a constituent part of the help and healing process. Thirty-two individuals, Including traditional Lakota elders, educators, leaders, and mental health providers, were interviewed about their views on traditional ideas of help and healing and about social work and social service practices. The findings show that there were distinctive approaches to ensure social health and well-being among pre-reservation Lakota peoples, and that the traditions of help and healing are intimately linked to the “natural law” and to the ceremonial life of the tribe. The findings show a resurgence of traditional healing practices among the Lakota with important implications for Social Work theory and practice.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

Emerging adult identity following adolescent experiences with psychotropic medications: A retrospective study

This study examines the perceptions of mental illness identity among a group of emerging adults based on their retrospective experiences with diagnoses and psychotropic medication use during their earlier formative adolescent years. A short questionnaire was administered via online social media platforms to volunteers between the ages of 19 and 30 and who self-identified as having taken psychotropic medication between the ages of 12 and 18 (N = 46). Correlation analysis revealed that several variables were associated with a stronger illness identity, including participant’s happiness with their medication experiences, the belief that medication made them more like their “true” selves, and the belief that their diagnosis was accurate. Content analysis of participant narratives suggested themes related to discontinuation and barriers to adherence. These results contribute to the growing knowledge base around lived experiences of psychiatric medication use and suggest further study on how to advance more informed and compassionate mental health care.     

Mental health and the media: From illness to wellbeing

The media are a main source of information about mental health for many people, and an ever‐growing body of literature is evaluating their coverage of the topic. To help keep track of such research, several comprehensive but now dated literature reviews have been published. We assess more recent studies (2007–2017) and suggest future directions by integrating (a) the “circuit of mass communication” model from media and communication studies which posits that production, content, and reception need to be analysed for an in‐depth understanding of the media, (b) the holistic view of mental health as comprising both illness and wellbeing, and (3) the critical psychiatry literature questioning the assumptions underlying psychiatric knowledge and practice. We find that recent studies have focused on content and “the illness side” of mental health by examining the representation of particular mental disorders and events involving individuals with specific diagnoses. We identify as a promising development the growing interest in “the wellbeing side” of mental health whereby authors have started to analyse recovery messages. We invite more production and reception research and more critical content studies which use diagnostic labels cautiously and analyse the representation of people with mental health problems as the victims of violence.