Severe self-neglect: an epidemiological and historical perspective

Older adults with severe self-neglect have multiple deficits in various social, functional and physical domains, and often live insqualor. These individuals often present with poor personal hygiene, domestic squalor and hoarding which results in a threat to their own health as well as personal and public safety. Severe self-neglect occurs along a continuum with older adults often having cognitive and affective disorders compared with younger individuals presenting with psychiatric illnesses. In cases of severe self-neglect with hoarding, evidence has shown this behavior occurs in diverse social strata and not among the wealthy and professionals alone as believed earlier. Due to the multiple conditions associated with severe self-neglect, this population will require an interdisciplinary, multidimensional approach to reduce morbidity and mortality rates including nursing home placement. Research on this group has been limited and is rarely described in the medical and nursing literature. Future research is needed to provide practitioners with effective screening instruments and interventions on cases of severe self-neglect.     

Working with a multidisciplinary team in secure psychiatric environments

1. Research on working with a multidisciplinary team in inpatient mental health care is underdeveloped. 2. Knowledge of how to work as part of a team is taken for granted within the realm of professional training. 3. In effective teams, members value the support, knowledge, and professional development that membership offers. 4. Training teams to be more effective requires diverse educational strategies.     

Managing moods and parenting: Perspectives of former system youth who struggle with emotional challenges

Young adults who were served in public systems of care as children are much more likely than their peers to be parenting in adolescence and young adulthood. They are also more likely than their counterparts to have a history of mental health problems. This study examined the perspectives of young adult parents with mood problems who had been involved in public systems of care before age 18. Qualitative interviews with twenty-eight participants were analyzed to examine the experience of managing moods and parenting. Young parents described how their symptoms impact their parenting and how parenting impacts their coping. They also described the strengths and challenges of using mental health services while parenting. Findings highlight the need to provide interventions that include supports for both parenting and symptom management and for providers to include both tangible and emotional support in their interventions.     

There's More Than Meets the Eye: The Nuances of Case Management

In this exploratory study, 50 mental health case managers from 2 Midwestern states were interviewed to capture their observations about the consumers they serve; aspects of the job they like and dislike; and their beliefs about the concept, process, and possibility of recovery from mental illness. The nature of the professional relationship in case management is described from the perspective of these professionals, as well as the methods these informants identify as key to the helping process. It is argued that effective case management requires complex and nuanced professional skills that might go unrecognized and underappreciated in community mental health.     

Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.     

Understanding hoarding in older adults

Compulsive hoarding is a debilitating disorder that is only recently becoming understood. Hoarding has been studied primarily in the general population, with only a few researchers focusing on hoarding in older adults, even though the prevalence and severity of the disorder appears to increase with aging. Hoarding seriously affects the quality of one's life and can also cause safety and health problems for individuals and the community. Established treatments for hoarding are relatively new and often need to be extended over a long period of time. Nurses can play an important role in helping identify the problem of hoarding in older adults, determining the types of safety and health hazards that need to be addressed, and contacting the appropriate community agencies.     

Attitudes and beliefs about mental health among African American older adults suffering from depression

Depression among older adults is a major public health concern leading to increased disability and mortality. Less than 3% of older adults utilize professional mental health services for the treatment of depression, less than any other adult age group. And despite similar rates of depression, African Americans are significantly less likely to seek, engage and be retained in professional mental health services than their white counterparts. Cultural differences in the way depression symptoms are manifested, defined, interpreted and labeled may in part explain some of these racial differences in help-seeking behaviors. Focus group methodology was utilized to identify and explore attitudes and beliefs about depression and mental health treatment utilization among 42 older African Americans who had recently suffered a major depressive episode. Thematic analysis of identified six overarching themes: (a) perceptions of depression, (b) the African American experience, (c) seeking treatment as a last resort, (d) myths about treatment, (e) stigma associated with seeking treatment and (f) culturally appropriate coping strategies. We discuss implications for practice, education and research.     

How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

Going social: Championing a holistic model of mental distress within professional education

Within the context of current debates as to how to raise the profile of social perspectives within mental health social work education, this paper seeks to assemble various elements that might belong within a social (or psychosocial) model of mental health practice. A clarification of what may actually be meant by a social model would be helpful in starting to set the parameters of future social work curricula, both at qualification and post-qualification levels, in terms of an appropriate value base and theoretical orientation. This may be seen to be important if social workers are to be properly prepared for taking on some form of leadership around the promotion of social approaches within the practice of multi-disciplinary teams.     

Over 1000 Aluminium Cans for Forty Dollars: The Provisioning Contributions of Older Children from the Perspectives of Welfare‐Reliant Lone Mothers

In this article, as a child and family mental health therapist, I connect the feminist concept of ‘provisioning’ and the experiences of ‘young carers’ to critically examine the family care contributions made by older children living in poverty. I present the findings of a qualitative study consisting of two focus groups in which ten (n = 10) welfare‐reliant lone mothers living in Toronto, Canada described the nature and significance of the contributions made by their older children (11–17 years old) to help their families ‘make ends meet’. Using grounded theory, two main categories emerged: (1) the nature of the provisioning by older children, and (2) the significance of the contributions. The implications of the findings suggest that mental health approaches with older children living in poverty inappropriately misrepresent and pathologise their emotional distress and family contributions.     

The impact of mental illness on employment: consumers' perspectives

This paper is based on a qualitative study of employment for people with mental illness. Forty-one consumers of mental health services were interviewed to obtain their perspectives on employment. One of the major issues they discussed was the ways in which mental illness affected their employment experiences. These effects were complex and interrelated and varied between individuals depending on their unique characteristics and circumstances. Participants described effects relating to the need to maintain mental health, difficulties with work performance, and work confidence and work goals. Understanding consumers' perspectives on how mental illness affects employment is necessary for practitioners and researchers seeking to explain or improve consumers' employment outcomes.     

Mental health disaster response: nursing interventions across the life span

In the aftermath of a natural disaster, adult survivors often move through the following phases of disaster response: Heroic Phase, Honeymoon Phase, Disillusionment Phase, and Reconstruction Phase. Understanding age-related responses to traumatic events such as a tornado enables mental health clinicians to individualize appropriate interventions and prevent or diminish emotional sequelae such as post-traumatic stress disorders. Psychiatric-mental health nurses are encouraged to attend local Red Cross disaster training to be prepared should the need arise for mobilization of mental health disaster response teams in your community.     

Experiences of Biological Parents and Their Older Children in Out-of-Home Care for the First Time

This article will examine the parenting characteristics and challenges that faced a cohort of families participating in an exploratory qualitative research study. This study sought to describe the experiences and characteristics of parents whose children were placed in the child welfare system in early-to-late adolescence (ages 12–18), thus gaining an understanding of the parenting challenges faced as they were able to maintain their children in their homes for a significant portion of their lives. The families of older youths entering care for the first time described how alcohol and drug abuse impacted their relationships with children, significant others, jobs, and their mental health status. A significant issue that emerged in several of the cases were older children who initiated a report to child welfare themselves.     

Male gamblers – suicide victims and living controls: comparison of adversity over the life course

The objective of this research is to investigate the possible difference in accumulation of adversity over the life course among decedent gamblers and living control gamblers in the province of Quebec, Canada. A sample of 90 adult men, 41 living participants and 49 suicide decedents, met the criteria for at-risk and problem gambling over the last five years. Data were obtained from informants in the case of suicide and directly from living controls during semi-structured face-to-face interviews using SCID I and II, SOGS, Module K and a recount of life trajectories methodology. The results showed a high level of adversity throughout the life trajectories of both groups. However, the living gamblers faced more difficulties during their lifespan than the suicide victims. In the last six months before their death, suicide victims had a significantly higher number of mental health disorders, especially co-morbid mental health disorders and anxiety, compared to the living controls. We also observed a rapid escalation of difficulties, more life events and more psychological distress in the last six months of their lives among the suicide decedents. Suicidal behaviour needs to be carefully investigated by medical staff and mental health practitioners, especially when gamblers demonstrate evidence of mental health disorders or financial difficulties.     

Linking Systems and Community Services:

A panel of experts from the legal, medical, adult protective services, criminal justice, and family counseling/mental health professions discuss, in depth, two difficult elder abuse case studies. The goal is to showcase as "interdisciplinary team approach" in developing solutions to the problems of victims of abuse and their abusers.     

Status differences in cross-functional teams: effects on individual member participation, job satisfaction, and intent to quit

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective.     

Experimenting with Change: An Exercise in Team Consultation

This article introduces a practical contribution to consultancy with teams experiencing difficulties in maintaining group cohesion. Taking the position that options for change are reduced as teams feel more and more en trenched, the author outlines a way in which one particular exercise can help team members experiment with creating different and more useful perspectives.