Voices from the margins of recovery: relocated Cantabrians in Waikato

No two disasters are the same. Accordingly, sociocultural geographers are aptly positioned to include the place-based and temporal aspects of disasters in their analyses. By examining the experiences of 19 Cantabrian families who have relocated to the Waikato region, this paper offers stories from the margins of ‘traditional’ disaster research. Often researchers know a great deal about the population at the site of the disaster, but little about the people who move away. Further, by investigating relocation, the insider/outsider dichotomy is challenged, as participants in this research are simultaneously inside and outside the earthquake events and their ongoing impacts. ‘Ownership’ of the disaster narratives, including research, lays open ideas of who can speak for whom. What and who is inside and/or outside a disaster event also allows a finer distinction of how place attachment filters experience and ideas of recovery, which are not diminished under internal migration.     

Disaster impact and recovery: what children and young people can tell us

Christchurch's earthquakes revealed children's vulnerability to disaster but also their ability to respond and play an active role in recovery. We argue that children's voices need to be heard and given priority in the recovery process because the disaster impacts on them and their families in ways that are not recognised or well understood. We report the findings of a study undertaken with 94 Christchurch children. Its aim was to give voice to children's experiences of post-earthquake Christchurch and in doing so contribute to post-disaster recovery. The experiences of these Christchurch children offer other children, parents, government and agencies valuable insights into how to manage the recovery process in ways that best meet children's needs. In the post-disaster recovery period, decision-makers need to recognise children as authentic actors in the recovery process and should commit to hearing children's voices throughout the rebuilding. Children and young people's resilience and positive commitment to Christchurch are assets that should be capitalised on in the longer-term recovery process.     

Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts

People with serious mental disorders (PSMDs) are overrepresented both in prison deaths and during fatal encounters with the police in the community (deaths after police contact, DAPC). To identify common factors present across cases of who died during contact with the criminal justice system in Queensland, publicly available coroners reports were analysed (N = 38). The findings of the study indicated psychosis and mood disorders were the most common diagnosis in incarcerated PSMD deaths, and suicide was the most common cause of death for incarcerated PSMDs. Within incarcerated settings, access to healthcare records, medication compliance, risk assessment and monitoring, and safe housing of at‐risk prisoners may be potential areas to explore with regard to prevention. Similarly, PSMD DAPCs were more likely to be experiencing mood or psychosis disorders than other forms of mental disorder, and suicide and police shootings were the most common causes of death. In PSMD DAPC, inadequate mental health access, treatment noncompliance and comorbid substance use were included as potential areas that could direct research efforts toward prevention.     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness

ABSTRACT

Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

An agenda for future research regarding the mental health of young people with care experience

Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high-quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under-studied populations; under-studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.     

Changes in attitude towards people with mental illness in P-city,S. Korea: a comparison between the years 2000 and 2010

The objective of this study was to investigate changes in the attitudes towards people with mental illness in a city located in South Korea (P-city) between 2010 and 2000. Since it was not accessible to raw data of 2000, to compare with 2000 results, the results from the previous research article were used. Results from t-tests and ANCOVA analyses showed positive changes in P-city residents’ attitudes towards people with mental illness, particularly in authoritarianism and social restrictiveness. Discussion includes the role of a successful community mental health centre in bringing about such positive attitudinal changes.     

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.     

Associations between ongoing COVID-19 lockdown and the financial and mental health experiences of Australian families

In 2020, Australia's successful COVID-19 public health restrictions comprised a national “initial lockdown” (March–May) and “ongoing lockdown” (July–November) for metropolitan Victorian residents only. We evaluated associations between ongoing lockdown and family finances and mental health. In the June and September 2020 Royal Children's Hospital National Child Health Polls, caregivers of children in Victoria and New South Wales (NSW) reported the following: job/income loss; material deprivation (inability to pay for essential items); income poverty; mental health (Kessler-6); perceived impact on caregiver/child mental health; and caregiver/child coping. Data from caregivers (N = 1207/902) in June/September were analysed using difference-in-difference modelling (NSW provided the comparator). During Victoria's ongoing lockdown, job/income loss increased by 11% (95%CI: 3%–18%); Kessler-6 poor mental health by 6% (95%CI: −0.3%–12%) and perceived negative mental health impacts by 14% for caregivers (95%CI: 6%–23%) and 12% for children (95%CI: 4%–20%). Female (vs. male) caregivers, metropolitan (vs. regional/rural) families, and families with elementary school-aged children (vs. pre-/high-school) were the most affected. The ongoing lockdown was associated with negative experiences of mental health, employment and income, but not deprivation or poverty, likely because of government income supplements introduced early in the pandemic. Future lockdowns require planned responses to outbreaks and evidence-informed financial and mental health supports.     

Pathway planning with unaccompanied young people leaving care: Biographical narratives of past,present, and future.

This article presents findings from a qualitative study with Unaccompanied Young People (UYP) who have sought asylum alone in the UK without a parent or guardian. The findings explore how UYP create biographical narratives of their past, present, and future as they prepare to leave care, suggesting that UYP who have settled immigration status create coherent biographical narratives that reconcile the past with a positive imagined future. Themes of return and reciprocity emerged in their narratives as they developed aspirations to reunite with their families and return support received in the past by succeeding in education and careers. Unaccompanied young people who did not have settled status struggled to create biographical narratives and could not imagine the future or the past. These findings have significant implications for pathway planning with UYP, suggesting the need to recognise the interconnected nature of the past, present, and future as well as the role of families and education in future plans. Pathway planning for UYP with uncertain immigration status can be complex as young people struggle to maintain a biographical narrative. Further research is necessary to support young people and professionals with these challenges.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

Prevalence of mental health problems among children placed in out-of-home care in Denmark

This paper concerns the prevalence of mental health problems among children in family foster and residential care within a Danish context. All children, born in Denmark in 1995, who are or formerly have been placed in out-of-home care ( n = 1072), are compared with a group of vulnerable children of the same age, subjected to child protection interventions but living at home ( n = 1457, referred to as the 'in home care children'), and to all contemporaries who are not child protection clients ( n = 71 321, referred to as the 'non-welfare children'). Prevalence data are established on the basis of national administrative register data, including data on psychiatric diagnoses of the children, and on survey data scoring children in out-of-home care, in home care children, and non-welfare children by means of the Strengths and Difficulties Questionnaire (SDQ). Results show that 20% of children in out-of-home care have at least one psychiatric diagnosis compared to 3% of the non-welfare children. Almost half of the children in care (48%) are, furthermore, scored within the abnormal range of SDQ, compared to 5% of the non-welfare children.     

Reviewing the latest national policies and services for people with severe mental health disorders in government-funded institutions in Vietnam,and policy recommendations for service improvements

The aim of this paper is to provide the international community with a broad and updated picture of key policies and services for people with severe mental health disorders in Vietnam. In particular, the paper (1) reviews the most important national policies governing care for people with mental health disorders, (2) reviews the status of free-of-charge care provided to people with severe mental health disorders in a network of government-funded facilities across the nation and (3) discusses the future policy directions of Vietnam regarding people with mental health disorders.     

How I wonder what you are: Children's songs as a source of mental and internal state information

This study investigated (1) whether children's songs could be potential sources of internal state information and (2) cross-cultural/linguistic differences in the availability of such information. We coded for expressions of mental states and other internal states in 255 English songs, likely accessed by children in the United States, and 255 Japanese songs, likely accessed by Japanese children. The majority of the songs in both samples contained at least one internal state expression, with songs containing four to five tokens and two types of internal state expressions on average. Japanese songs had more types of internal state expressions than English songs when comparing the two samples in proportion scores that controlled for the length of songs. However, differences between English and Japanese songs were negligible in the absolute frequency of tokens and types of internal state expressions, with the exception that Japanese songs were richer in ambiguous internal state expressions.     

Employment programs for people with psychiatric disability: the case for change

This paper evaluates the effectiveness of disability employment policy in assisting people with psychiatric disability to find, or return to, paid work. We argue that the poor employment outcomes from current programs establish the need for a paradigmatic shift in the form of a state‐provided Job Guarantee (JG) for people with psychiatric disability. In the absence of measures to generate suitable jobs, forthcoming changes to the eligibility criteria for Disability Support Pension will create risks rather than opportunities. Under the JG, the Federal Government would maintain a ‘buffer stock’ of minimum wage, public sector jobs to provide secure paid employment for this highly disadvantaged group. The role of the state in this alternative model is two fold. First, the state must provide the quantum of JG jobs required. Second, the state must ensure the design of jobs is flexible enough to meet the heterogeneous and variable support needs of workers. This will require effective integration of the JG scheme with mental health, rehabilitation and employment support services.     

Community care for adults with severe mental disorders in rural China: A case study

In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community‐care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community‐care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.     

The relationships between organisational networking,quality of life,and community integration among people with mental illnesses in South Korea: a multi-level analysis

This study investigated the relationships between organisational networking and the outcomes of people with mental illnesses (MI) and the extent to which the relationships are mediated by availability of services. Two levels of data were collected: organisational-level data from 22 community-based mental health service agencies and consumer-level data from 431 consumers. A multi-level analysis found that organisational networking increased the availability of services. However, service availability was not found to have a mediating effect on the relationship between organisational networking and client outcomes. Service coordination in the same mental health sector should be addressed.     

Unemployment and mental health: evidence from research in the Nordic countries

In this article we examine research on effects of unemployment on mental health in Denmark, Finland, Norway and Sweden. We describe studies that use cross-sectional, longitudinal and time-series data, and we discuss studies that investigated the duration-dependence issue in exit rates out of unemployment. Not surprisingly, cross-sectional studies reveal that unemployed persons have worse mental health than do others. Most longitudinal studies suggest that unemployment is associated with deteriorating mental health, even though it is somewhat unclear how long such an effect persists. Most duration-dependence studies were done using Swedish data. It turns out that unemployment benefits and labour-market policies affect the pattern of exit rates out of unemployment.     

Perspectives on family caregiving of people aging with intellectual disability affected by dementia: Commentary from the International Summit on Intellectual Disability and Dementia

ABSTRACT

This article, an output of the 2016 International Summit on Intellectual Disability and Dementia, examines familial caregiving situations within the context of a support-staging model for adults with intellectual disability (ID) affected by dementia. Seven narratives offer context to this support-staging model to interpret situations experienced by caregivers. The multidimensional model has two fundamental aspects: identifying the role and nature of caregiving as either primary (direct) or secondary (supportive); and defining how caregiving is influenced by stage of dementia. We propose staging can affect caregiving via different expressions: (1) the “diagnostic phase,” (2) the “explorative phase,” (3) the “adaptive phase,” and (4) the “closure phase.” The international narratives illustrate direct and indirect caregiving with commonality being extent of caregiver involvement and attention to the needs of an adult with ID. We conclude that the model is the first to empirically formalize the variability of caregiving within families of people with ID that is distinct from other caregiving groups, and that many of these caregivers have idiosyncratic needs. A support-staging model that recognizes the changing roles and demands of carers of people with ID and dementia can be useful in constructing research, defining family-based support services, and setting public policy.