Becoming culturally competent in ethnic psychopharmacology

People from minority backgrounds who have a mental illness experience double discrimination associated with both mental illness and race. In 2001, the Surgeon General's landmark report on race, culture, ethnicity, and mental health compellingly documented racial and ethnic disparities in mental heath care related to issues of misdiagnosis, underuse, overrepresentation, and improper treatment. The report called for sound research, including investigation into the area of psychopharmacology, to determine the extent to which the variability of an individual's response to medications is accounted for by factors related to race, ethnicity, age, gender, family history, or lifestyle. This article will focus on the realm of ethnic psychopharmacology and propose a practice model for nurses to become culturally competent in the area of ethnic psychopharmacology.     

The labeling paradox: stigma, the sick role, and social networks in mental illness

Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic "sick role" concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

Hospice and palliative care for terminally ill individuals with serious and persistent mental illness: widening the horizons

Terminally ill individuals with serious and persistent mental illness (SPMI) are currently underserved by palliative care. However, palliative care nurses can expect to see more patients with SPMI because an estimated 6% of the adult population has chronic mental illness, and mortality and morbidity rates are higher in this group. Reasons for these increased rates are discussed. Literature regarding the provision of palliative care to those with SPMI is sparse, but what literature there is does offer suggestions for improvements in clinical practice. These suggestions for improvement are explored, and conclusions are drawn about the need for future research.     

Continuity of ambulatory medical care: An exploratory study

Utilization and continuity of care are usually considered to be conceptually distinct. However, in this study continuity of care is defined as an attribute of the utilization of medical care. A sample of 16,881 urban middle-aged and elderly individuals is divided into three groups based on their pattern of utilization: 1) those with no utilization; 2) those using medical services with continuity of care; and 3) those using medical services without continuity of care. A polytomous logit model is used to study the effects of gender, age, chronic illness, past visits to specialists, and past volume of utilization on these patterns. The effects of gender and chronic illness are found to diminish with age. The effect of past volume of utilization is also significant, suggesting that regularity of use is an effective predictor of continuity. The findings suggest that utilization of medical care has many dimensions including volume, regularity, and continuity of care. These and other dimensions should be considered jointly in utilization studies.     

Health status risk factors of people with severe and persistent mental illness.

High rates of medical comorbidity and premature death have become normative health outcomes for individuals with mental illness. On average, people with mental illness die 10 to 15 years earlier than the general population. To date, little research and programmatic attention has focused on the health promotion and prevention needs of people with mental illness. Many factors have been cited as contributing to this problem, including the stigma of being mentally ill, poverty, and limited knowledge and access to health promotion services. Future health planning interventions should restructure the funding mandates of current health care delivery system from an illness and treatment model to one of illness prevention and health promotion.     

Nursing home admissions and long-stay conversions among persons with and without serious mental illness

The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.     

Maximizing potential: innovative collaborative strategies between one-stops and mental health systems of care

Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.     

The relationship between medical education and trans health disparities: a call to research

According to the National Transgender Discrimination Survey, 28% of trans respondents reported postponing medical care due to discrimination, and 28% reported being harassed by providers when they did seek out care. Scholars have proposed that what is taught (or not) in medical schools might play a role in the unequal health care experienced by many trans people. As medical education becomes a site of intervention for reducing transgender health disparities, it presents opportunities for sociologists to study and explain the processes by which medical training creates, reinforces, and potentially challenges stigma‐related health disparities. In this paper, we propose three areas of inquiry that might help explain this situation: the hidden curriculum, patient health movements and consumerism, and medical competency. By employing these concepts, we argue that sociologists can develop more comprehensive explanations for the relationship between medical education and transgender health inequalities and offer solutions to address this disparity.     

Providing nursing leadership in a community residential mental health setting

The worldwide burden of mental illness is increasing. Strong leadership is increasingly emerging as a core component of good mental health nursing. The aim of this article is to demonstrate the ways in which nurses can provide strong and consistent leadership in a values-based practice environment that embodies respect for individuals' dignity and self-determination within a community residential mental health service, which provides a structural foundation for effective action. This is accomplished through the presentation of two vignettes, which highlight how the seemingly impossible becomes possible when an economic paradigm such as agency theory is exchanged for a sociological and psychological paradigm found in leadership as stewardship at the point of service. It is through stronger nursing leadership in mental health that stigma and discrimination can be reduced and better access to treatments and services can be gained by those with mental illness. Nurse leadership in mental health services is not new, but it is still relatively uncommon to see residential services for "high needs" individuals being led by nurses. How nurses meet the challenges faced by mental health services are often at the heart of effective leadership skills and strategies.     

Mental Illness and Criminal Behavior

The tragic events in Aurora, CO and Newtown, CT have renewed public perception of mentally persons as ‘dangerous’ and ‘criminal.’ Unfortunately, this perception is based more on conjecture and fear than research. The following essay takes stock of the empirical research on mental illness and criminal behavior. Three noteworthy trends emerge from this literature. First, the prevalence of mental illness is substantially higher among individuals who have come in contact with the criminal justice system relative to the general population. Second, individuals with psychotic and externalizing behavioral disorders, particularly those who also abuse drugs and alcohol, tend to engage in higher levels of violence than individuals with other forms of mental illness. Third, mental illness does not determine whether someone will break the law; rather, it is but one of many criminogenic risk factors that interact in complex ways to influence individual behavior.     

Impact of Psychological Disorders on Postpartum Mothers and Child: Current Issue in Remediation in India

ABSTRACT

India is a multicultural, multiethnic, pluralistic society with enormous socioeconomic disparities, and it is a formidable task to provide affordable and effective mental health care, especially to the remote rural corners of the country. The unfortunate aspect of the Indian mental health scenario is that there exists very poor awareness of the maternal health risks of the postpartum period. It is during this period that serious psychological disturbances can manifest and seriously jeopardize safe and normal motherhood. Currently, there is neither a national agenda for mental health care among pregnant and postnatal women nor a viable training program to equip health workers to recognize and manage postpartum psychological disorders. This article attempts to provide a viable module for training future health providers to gain an understanding of the illness pattern that constitutes postpartum disorders through experiential learning and problem solving.     

Mental health disparities in the older Afro-Caribbean population living in the United States: cultural and practice perspectives for mental health professionals

Cultural characteristics play an important role in the lives of many older Afro-Caribbean as they continue to migrate, acculturate, and assimilate in the United States. Many among this unique cultural subgroup will develop mental illness; however, despite the availability of effective treatment, seeking appropriate care within the formal mental health system continues to be a challenge for this group as a consequence of their cultural heritage. This review describes how these cultural determinants often lead to mental health disparities among older Afro-Caribbean living in the United States. Suggestions are also included for how mental health nurses and other professionals can incorporate research and practice into the caring model of cultural humility as they continue to come in contact with this population in various clinical settings.     

The case for mandatory outpatient treatment

Research on the effectiveness of mandatory outpatient treatment, which is court-ordered mental health follow up, supports its use with individuals who have serious mental illness. Many states already have some kind of mandatory outpatient treatment in place, but it is often underused. Much of the criticism of mandatory outpatient treatment is based on the fact that research demonstrating its efficacy is limited and that its implementation infringes on individuals' rights. However, sufficient evidence can be found in the literature to support its use for some individuals with chronic mental illness living in the community. In addition, the ethical principles of beneficence, utilitarianism, and communitarianism support its use in some situations. Mandatory outpatient treatment is an ethical and effective method shown to be helpful with individuals who have mental illness and are nonadherent to treatment. Expanding its use in appropriate situations is in the best interest of those with serious mental illness and society in general.     

Heterosexism,racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts. Implications for change advocates, mental health providers, and researchers are offered.     

Global Mental Health in Action: Reducing Disparities One Community at a Time

There are great disparities in mental health care around the world. Traditional approaches to mental health care have not been found to be transferrable to many parts of the world and are inadequate to address these disparities. Unconventional approaches are needed that match the traditions of care‐seeking and care‐giving within the communities where they are delivered. The authors review the global mental health literature and discuss how marriage and family therapists are in a particularly good position to have worldwide impact on mental health disparities. Five principles of global mental health are presented along with an example of how these principles are applied through the Reducing Mental Health Disparities One Community at a Time (RD1CT) model.     

Differential labeling of mental illness by social status: a new look at an old problem

Whether the higher rates of mental hospitalization and involuntary treatment for marginal social groups are due to differential labeling or simply to the occurrence of higher rates of disorder in these groups remains unresolved. I reexamine this issue with data from the National Comorbidity Survey (N = 5,877) that allow comparisons between disturbed individuals living in the community untreated and disturbed persons who have been hospitalized or seen a professional for their mental health problems under pressure or voluntarily. Contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have been hospitalized or seen a professional against their will. Consistent with self-labeling theory, persons with greater education and those not in poverty are disproportionately present among individuals who sought treatment by choice. Additional analyses show that factors that predict service utilization are important determinants of mental health service use but do not account systematically for status disparities in hospital or outpatient treatment, especially disparities by poverty status. Although I do not confirm a central tenet of labeling theory here, the negative consequences of labeling and stigma continue to be well-supported in the literature.     

The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.