Jerk: A Tic-Inspired View of the Self-Determination Paradox in Our Mental Health System

Historically, the mental health field has been dominated by the medical model, placing the “patient” into the backseat of their own treatment. Sometimes this aspect of being controlled can be as hurtful as the out-of-control experience individuals with mental health conditions often face. In recent years, a number of people with mental health conditions have stepped up, showing not only that they can recover but also that they can lead the way in recovery-oriented mental health services. This article provides a commentary on this form of input that is rooted in the author's personal experiences with the system of care.     

RISING AUTISM PREVALENCE: REAL OR DISPLACING OTHER MENTAL DISORDERS? EVIDENCE FROM DEMAND FOR AUXILIARY HEALTHCARE WORKERS IN CALIFORNIA

Autism is a development disorder that has increased in prevalence from 0.5 to 14.7 per 1,000 children over 1970–2010. Using annual wages and provider counts from the American Community Survey and information from 21 regional development centers in California, we estimate the labor demand for auxiliary health providers. We focus on this subset of providers because, unlike physicians and psychologists who can diagnose autism, these workers cannot induce their own demand. If the incidence of autism is increasing independently of other mental disorders, then the demand for auxiliary health providers should increase, leading to higher wages and labor supply. Otherwise, the increase in autism diagnosis is merely displacing other mental disorders. We find that a 100% increase in autism cases increases the wages of auxiliary health workers over non‐autism health occupations by 8–11% and the number of providers by 9–14%. Furthermore, we find that one of every three new autism diagnoses is merely supplanting mental retardation diagnoses, but does not displace other mental disorders. These estimates suggest that at least part of the increase in autism diagnoses, about 50–65%, reflects an increase in the true prevalence of the disorder. (JEL L11, J2, J3)     

Mental health of the oldest-old

As more individuals live past age 100, it is important for health professionals to better understand characteristics important to the mental health of the oldest-old in our society. Few studies have been conducted on mental health in this group, but current literature suggests these individuals are very resilient with respect to mental health and life satisfaction, despite their health disadvantages. In interviews in a variety of studies, participants talked of the importance of both inner and outer resources for empowerment. Greater understanding of mental health in aging can inform policy makers as they draft new legislation and programs to enhance quality of life for the oldest-old.     

The child in hospital

Group therapy is assuming considerable popularity in the field of alcoholism as in other mental health areas. Its efficacy in the treatment of alcoholism has not been well established, but many therapists believe it holds the most promise.     

The mental health dimension in the new social work degree: starting a debate

The Mental Health in Higher Education Project (mhhe) aims to increase networking and debate about the learning and teaching of mental health, both within and across the disciplines and professions in higher education. Despite the recent prominence that has been given to mental health in terms of policy development and new practice models, there has so far been little discussion as to what should constitute the mental health component of the new social work degree that is currently being introduced in England. This paper sets the context for the debate and reports on the outcome of an mhhe workshop on this theme held at the 2003 Social Work Education Conference in Warwick.     

Managerial audit and community mental health: a study of rationalising practices in Finnish psychiatric outpatient clinics

In many European welfare states the reform of mental health services has been accompanied by the implementation of new forms of governance, including the introduction of managerial audit systems. While such systems have been developed for ‘good causes’, such as quality assurance, financial management and monitoring staff performance, they may simultaneously produce diverse and contradictory effects on practice. The aim of this article is to examine the role of one managerial audit system, introduced in psychiatric outpatient clinics in central Finland, and assess its impact on practice. Reference is made to modernising mental health policy in the UK as that has producedsimilar practics outcomes. The research was an empirical study of practice using a mixed-method case study design involving documentary research and semi-structured interviews. Insights from Mitchell Dean's notion of governmentalisation of government were utilised in the analysis. It was found that, although the audit system primarily served administrative needs, it began to reshape practice by reinforcing certain modes of working and excluding others. The analysis of community mental health work in Finland, with similar trends in the UK, highlights the connection between documentation, resource allocation and managerial priorities that reinforce particular styles of practice. In community mental health services it would appear that the problems of professional practice have become the problems of administration.     

Treating mental health problems in primary care: Discrepancies between therapist expectations and clients’ attendance

ABSTRACT

Models of collaborative primary health care were introduced in Ontario in 2005 with the goal of providing comprehensive care, including that of mental health, to patients. While the success of this model of health care delivered through Family Health Teams (FHT) has been established, evidence based guidelines to guide mental health therapists regarding the number of sessions needed to treat common issues such as depression and anxiety seen within this model is lacking. The goal of this study was to gain a better understanding of how therapists conducted therapy, including type of intervention, under a physician determined eight session cap. Questionnaires completed by the therapists after the first session and again when therapy ended, a focus group and a chart review were conducted over an eight month period involving a total of 147 patients. Several key findings were identified including the unanticipated outcome of a discrepancy between how many sessions were initially thought to be required by the mental health therapist compared to how many sessions were determined helpful by the patient. Conversely, it was also identified that eight sessions was insufficient to treat more severe mental health issues such as trauma. Such results suggest that the treatment of mental health issues within Family Health remains a little understood and explored issue, with the authors suggesting better ways of negotiating session caps reflective of mental health issues addressed within this model of care.     

Research assessing consumer satisfaction with mental health treatment: A review of findings

This article reviews the findings of studies examining consumer satisfaction with mental health treatment. Typically, published studies find the vast majority of patients satisfied with treatment. Despite the numerous methodological problems in this research, it remains highly probable that the majority of consumers are satisfied with the services received. More specific findings in this literature remain less well demonstrated; there generally are few studies relevant to each specific question and the methodology of these studies often has been weak. However, trends point to weak relationships between patient demographic variables and satisfaction; significant relationships between patient diagnosis, treatment history, and psychological status and satisfaction; strong relationships between length of treatment and manner of termination and satisfaction; a strong relationship between satisfaction and patient global report of outcome; and a weak relationship between satisfaction and therapist rating of outcome. Satisfaction also appears to be multidimensional, although a large general factor is evident in most studies. A number of additional findings are catalogued; and research lying outside the formal domain of satisfaction research, but relevant to this body of research, is reviewed.     

When a colleague commits suicide: how the staff reacts

1. A literature review on the subject of suicide by mental health professional indicates that research has been limited to family member survivors. There is some data on reactions to patient suicide by psychiatrists and psychologists. 2. The results of this study show that mental health professional survivors of peer suicide experience similar reactions to the studied groups. These include anger, guilt, loss of self-esteem, disruption of relationships, and concern about assessing for suicidality. 3. Subjects felt the victim did not reach out for help because she feared stigmatization; mental health professionals are not permitted to have serious problems. 4. The clinical nurse specialist can perform an important role by addressing this dynamic and working to provide a supportive and nonpunitive environment for mental health professionals experiencing problems.     

Measuring Attitudes Toward Empirically Supported Treatment in Real-World Addiction Services

Mental health workers with favorable attitudes toward empirically supported treatments (ESTs) are more likely to break through implementation barriers. The Evidence-Based Practice Attitude Scale has been shown to be reliable for mental health workers, but it has not been validated with addiction workers. This study investigates the use of the scale with a convenience sample of addiction workers from 4 agencies in 1 city. Results show that compared to mental health providers, addiction workers were more likely to view ESTs favorably if they were mandated and intuitively appealing. They also tended to rely more heavily on practical experience in forming attitudes toward treatment options. These results might help addiction agencies understand which types of workers are more likely to implement ESTs and inform effective engagement approaches specific to addiction workers.     

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.     

Ethnics and minorities: A review of the literature

Summary Numerous studies have suggested that ethnicity has at least as powerful an influence on mental health and mental illness as socio-economic status. The influence of ethnicity becomes particularly significant in those studies where social class is held constant. Yet, while professionals have readily accepted socio-economic differentials, ethnic variation is still often ignored or, worse, denied outright.The studies reviewed here underscore the need for new models of treatment, as well as serious research on the values and attitudes of ethnic groups and their implications for health and illness. Studies such asBlack Rage (Cobb and Grier, 1968) andThe Mental Health of the Poor (Reissman and Pearl, 1964), for example, have already influenced the development of new models and treatment programs. It is becoming increasingly clear that it takes different methods and programs to reach the varied groups within our society, and that we will have to reshape our current mental health policies and programs to make access to services easy for all of them.     

Conceptual and methodologic issues in the evaluation of children's satisfaction with their mental health care

The assessment of client satisfaction has become an important aspect of evaluation research in the adult mental health field, but there has been relatively little extension of that approach to the child client population. This is due to the lack of adequate methodologies for assessing treatment satisfaction in children and to the overriding conceptual issues which make it difficult to develop such measures. Further information is needed to clarify developmental differences in the way both healthy as well as medically and psychiatrically ill children conceptualize illness and treatment. The authors suggest that specific methodologies for assessing child satisfaction with treatment can be systematically developed once a more explicit developmental framework has been delineated in the area of children's understanding of medical and psychiatric disorders and their treatments.     

Social Control and Community Care

Community mental health is often viewed as an alternative to the more segregative forms of treatment/control that prevailed before World War II. It has been regarded as a self-determinate system best characterized by the notions of community care, community treatment, and community control. This paper takes issue with the more traditional understanding of community mental health. Drawing on a historical and political-economic analysis of the wider processes of social reproduction and social control and on a general theory of capitalist regulation, it identifies three processes- expansion, neutralization, and privatization-that link the rise of community mental health during the post-war period to basic tendencies of U.S. capitalist formation.     

Questioning the professionalization of recovery: a collaborative exploration of a recovery process

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery primarily becomes defined by treatment providers. This study aims to keep the debate on recovery alive through a collaborative exploration of Pete’s recovery process by means of a bricolage approach. This resulted in an idiographic portrait of Pete’s experiences of recovery and treatment, clustered around four themes: life rebuilding, identity, continuity of care and the role of drugs. His experiences illustrate a number of contradictions in the operationalization of the recovery ethos in today’s mental health care; whilst recovery appears as a hopeful vision of empowerment, it also risks being reduced to a tokenistic model that fails to address the social realities of people in recovery and in which the assumption that mental illness is chronic is still latently present.     

Balanced on the Horns of a Dilemma: Observations on Work with Chronic Depression

There are patients who present in treatment with depression that is chronic and unmoving over many years. This article proposes that this type of patient is attached to and defensively uses the symptom in a way that may be described as narcissistic. The amelioration of the symptom is experienced as a threatened loss that must be defended against, despite the patient's unbearable suffering. This dynamic is illustrated as it appeared in three cases treated at a community-based mental health clinic. In each, modification of the symptom was aggressively resisted, creating an insurmountable impasse in the guise of seeking treatment.     

Managed care and the rationalization of mental health services

Managed care represents a response to the wider institutional demand for technical rationality and efficiency, and it may be in conflict with professionally generated logics of mental health care which emphasize the delivery of quality care, as well as providing services to all who need care. The organizational and policy conundrum is to balance conflicting institutional demands for efficiency (cost savings) and effectiveness (access and quality). This paper examines managed care in one public sector mental health care system that has attempted to incorporate the principles of managed care into a community based system of care and to overcome the potential contradictions between demands for efficiency and professional logics of care. Both qualitative and quantitative data are used to examine changes in organizational structure and service offerings; providers' experience of managed care, and the effect of managed care on working conditions and work experiences, and changes in the goals of the organization as measured by the specification of client outcomes. I find that, while increased performance accountability and outcome assessment (in keeping with demands for efficiency) have the potential to improve mental health care services, in fact, providers report that the primary effect of managed care has been an emphasis on cost containment, and there has been a corresponding de-emphasis on the provision of community based services for clients with long term care needs. However, there is potential for professional logics to be maintained by larger institutional forces demanding quality care.     

Children’s Mental Health Providers’ Perceptions of Mental Health Literacy Among Parents and Caregivers

Mental health disorders are prevalent among children, yet many do not receive treatment. Parents and caregivers play a vital role in recognizing mental health disorders in children and accessing treatment. But a substantial number of parents lack essential knowledge of children’s mental health disorders, including risk factors, symptom recognition, and treatment options. Little focus has been given to parents in the children’s mental health literacy literature. The purpose of this article is to begin filling that gap by using a survey to describe the perceptions of child and family mental health providers’ perceptions regarding the amount, accuracy, and origin of mental health literacy in the parents of the children they treat. The impact of those perceptions on the work of providers is also explored. Eighty-seven mental health providers completed a survey to assess their perceptions of parent mental health literacy in the area of children’s mental health. Providers perceived parent mental health literacy as low, inaccurate, and inconsistent. In addition, providers indicated that parents rely on informal sources of support, such as friends and family for information about children’s mental health. Implications for social work researchers, practitioners, and the children and families they serve are discussed.     

The mental health of the never-married

Although the interaction between mental health and marital status has been the object of much social scientific research, little is known about the mental health of never-married people. This article reviews research relevant to mental health and marital status as it pertains to never-marrieds. Methodological problems and current gaps in such research are pointed out. The mental health of never-marrieds is examined from three popular models of mental health—the social protection, social reaction, and social selection models. Each model offers competing explanations for differences in rates between married and unmarried people and between unmarried men and women. Suggestions are offered for improvement in researching the mental health of this neglected group.