Assessing mental health and service needs among refugees in Malaysia

Refugees in Malaysia often experience economic insecurity and poverty, poor health, poor mental wellbeing and limited legal rights. Using a survey with quantitative measures and open‐ended questions, we assessed socio‐demographic characteristics, mental health (RHS‐15), and service needs, including interest in group support services, among 86 Dari‐ and Arabic‐speaking refugees living in Kuala Lumpur. High levels of emotional distress were found, as nearly all participants scored positive for distress and average scores were 2.5 times above the cut‐off signifying distress. Distress scores did not vary based on most factors examined, although being married was associated with lower levels of distress. All but one participant expressed interest in participating in a support group. Barriers to potential participation included childcare, sickness and transportation. Additional mental health and social supports are needed among refugees residing in Malaysia. Key Practitioner Message: ? Emotional distress is high among Dari‐ and Arabic‐speaking refugees sampled in Malaysia; ? Participants expressed strong interest in accessing supportive mental health services, including group supports.     

Young people's and carers' perspectives on the mental health needs of looked-after adolescents

While the mental health needs of looked‐after young people have been described in a number of clinical studies, the views of looked‐after adolescents themselves concerning their mental health needs have only rarely been reported. This study used focus groups to elicit the ideas and experiences of looked‐after young people in two local authorities in England. Front‐line carers in the region were also surveyed. Young people and carers were agreed in highlighting the damaging effects of the discontinuity and change experienced in the looked‐after system. Young people emphasized the importance of exercising choice and control when seeking and receiving support and identified the value of positive role models provided by ‘survivors’ of the care system. Carers reported high levels of risk behaviour, particularly self‐harm, among young people in children's homes. These differing perspectives need to be openly acknowledged and negotiated within care settings in order that relevant and accessible therapeutic and support services can be offered to looked‐after adolescents.     

The impact of managed care on Massachusetts mental health and substance abuse providers

Medicaid managed care programs are becoming more widespread. To investigate the clinical, organizational, and financial impacts on service providers, a stratified, random sample of providers in the Massachusetts Managed Mental Health/Substance Abuse Program were surveyed by phone in Years 3 and 4 of the initiative. Providers reported that they were making widespread clinical changes such as more use of group, brief, and episodic therapies. They were increasing utilization review, Total Quality Management, and outcomes measurement. They were increasing in size, affiliating with other agencies, and providing a greater range of services. They were preparing for capitation. Compared to before the program and a year earlier, about 40 percent of providers were doing better financially and a quarter were doing worse. The study documents the hypothesis that a widespread and continuing transformation is taking place in response to managed care.     

Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

Models of 'ordinary' and 'special' daily living: matching residential care to the mental-health needs of looked after children

This paper proposes a set of distinctions between ‘ordinary’ and ‘special’ modes of everyday living in residential settings for young people in the ‘looked after’ system. The paper begins by reviewing both quantitative and qualitative evidence on the mental‐health needs of the young people, arguing that there is evidence of very high levels of mental distress and disturbance within this group, and that this distress is often undiagnosed and untreated both by psychiatric professionals and within the residential care system itself. There follows a commentary on the tacit assumptions underpinning much residential practice, especially the emphasis in some policy and legal documentation on the young people’s need for ‘ordinary’ everyday experience. The concept of the ‘ordinary’ is problematized, and it is argued that while young people do need to be supported towards mainstream ‘ordinary’ everyday living, they also need specialized everyday care in which their emotional and psychological needs can be recognized and responded to. Four models of ‘special everyday living’ are proposed, based upon existing literature on residential practice, and it is argued that residential care programmes should be based upon a mix of these special and ordinary provisions if the young people’s emotional needs are to be met.     

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.     

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.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.     

Care without coercion – mental health rights,personal recovery and trauma‐informed care

Australian mental health services continue to use involuntary measures in response to consumers' mental distress. Regardless of the intent behind these practices, the experience of being forced to receive treatment, be secluded or restrained is traumatic and can cause further distress and harm. Other parts of the health or social service system have shifted to approaches that emphasise agency, social context, prevention, and rights. Three frameworks currently used in mental health services – human rights, personal recovery, and trauma‐informed – are consistent with a shift away from the use of force. We applied these frameworks to the text of the National Standards for Mental Health Services 2010 to analyse the degree to which it reflects a shift. We also analysed the public text of speakers' notes from the Care Without Coercion Conference 2012 concerning lived experiences of force in mental health services. The analysis highlights force in many aspects of policy. The findings have implications for directions of change, including freedom from violence; support for decision making; access and choice about community and inpatient options; safety and risk management; and greater understanding of current policy frameworks through engagement with people with lived experience about the options and impact of support processes that exclude the use of force.     

Exploring perceptions of mental health clients and professionals about Buddhism‐based therapies at mental health hospitals in Vietnam

With 80% of Vietnamese people holding key Buddhist beliefs, Buddhism has great impact on the thoughts, emotions, and behavior of Vietnamese people. However, almost no Buddhism‐based psychosocial interventions are offered at formal psychiatric hospitals across Vietnam, nor is there any plan to incorporate these interventions into mental health care. This exploratory study examines the perceptions of mental health clients and staff regarding the effectiveness of Buddhism‐based therapies (BBTs) in mental health treatment in Vietnam, using ethnographic observation and in‐depth interviews with 24 patients and eight professionals at the only psychiatric hospital employing BBT. Participants strongly believed in the positive impact of BBT to help clients manage or improve their symptoms. However, clients and staff advised that BBT should not be used alone; rather it should be used in combination with medication and was best employed for stress‐related disorders. They unanimously supported incorporating BBT into the formal mental health system, especially if the therapies were well developed through collaboration between Buddhist monastics and mental health professionals. Results of the paper suggest that Vietnam should think strategically about developing and incorporating BBT into the formal mental health care system.     

Deinstitutionalization reconsidered: geographic and demographic changes in mental health care in British Columbia and Alberta, 1950-1980

Using demographics on admission to, and discharge from, mental hospitals in Alberta and British Columbia, this paper analyzes the social process commonly framed as deinstitutionalization between 1950 and 1980. A focus on the two most western Canadian provinces permits an exploration of these changes in these regional contexts. Pressured by new funding arrangements, a shift towards community care, and growing criticism of the alleged oppressive nature of large institutions, the three main mental hospitals scaled down as of the 1950s. This trend did not mean, however, that the overall number of hospitalized patients decreased during this time period. The total number of hospitalizations, particularly short-term admissions, actually expanded, while trans-institutionalization also occurred. This case study mirrors larger trends of postwar mental health care, illustrating the social, political, and cultural challenges experienced in the reconstruction of institutional care.     

The health care system of the People's Republic of China: Between privatization and public health care

Chinese health care policy has undergone numerous reforms in recent years that have often led to new challenges, inciting the need for further reform. The most recent reforms attempt to find a middle path between public health care provision and commercial private insurance. In this way, China is following in the footsteps of countries that initially increased the role of privatization in the 1990s and at the beginning of the 21st century, but are now gearing towards public health care. However, this process of constant reform has led to a lack of transparency in the functioning of the health care system, provoking a loss in public trust. There remains an important degree of uncertainty about the future direction of developments in China. Nonetheless, a dual financing approach to health care using tax finance and social insurance might yet crystallize, offering a potential model to inform developments in other countries.     

Social functioning and mental health among children who have been living in kinship and non‐kinship foster care: results from an 8‐year follow‐up with a Norwegian sample

Studies have shown relatively high rates of emotional and behavioural problems among children living in out‐of‐home care. This study reports the prevalence of social problems at an 8‐year follow‐up for a group of children/young adults. Predictors for prevalence and change in emotional and behavioural problems at the follow‐up are examined. A prospective cohort design with 233 children who had been living in foster care was used. Forty‐eight per cent (n = 111) of those interviewed at baseline were located and interviewed at follow‐up. Mean age was 17.4 (standard deviation = 2.9) years. Mental health symptomatology was measured with Child Behaviour Checklist and Adult Self‐Report. Linear and generalized mixed model analyses were used. Changes in internalizing and externalizing problems from baseline to follow‐up was associated with gender. Boys showed more problems at a young age, whereas girls developed more problems later. Predictors for social problems at follow‐up were mental health at baseline, kinship care and care placement away from the local community.     

Family contact in foster care in Portugal. The views of children in foster care and other key actors

This is a pilot study on the sensitive issue of how children and young people experience family contact in foster care, and the views of key adults in their lives on the same issue. There is a special focus on the children's experiences, opinions, and feelings. The study is a response to the relative scarcity of literature on family contact based on the experiences of children and adults in caring roles. This is a qualitative and exploratory study, with a sample of 10 children and young people in care in the district of Porto, aiming to identify key issues and areas for further examination. The results allow us to conclude that the possibility of maintaining contact is positively evaluated. However, perspectives on the relationships involved, and on the reactions to and difficulties associated with visits, revealed considerable disagreement among the actors. A possible set of implications drawn from the findings pointed out to the importance of developing a monitored cooperation that improves communication processes in order to take into account the children's and young people's views in the decision‐making process; and to develop more attentive and open working relationships with parents throughout the foster care placement.     

Worries and problems of young carers: issues for mental health

This paper reports on a research study which explored the worries and problems of young carers in Edinburgh. Sixty‐one young carers took part in the study, conducted between April and June 2002. Findings indicate that young carers identify significant worries and problems in relation to their well‐being, and that these come over and above any ‘normal’ adolescent difficulties. It is suggested that these findings may have important implications for young carers’ mental health, now and in the future, and contain important lessons for child and family social work in general.