The Emergence and Attributes of Second-Generation Community Support Systems for Persons with Serious Mental Illness

Abstract

This paper examines the original model of community support for people coping with psychiatric disabilities and illuminates four emergent factors that are bringing about what the author identifies as second-generation community support systems. The author discusses the important role of recovery in refraining the purpose and aims of second-generation community support systems and draws implications for how case management can function within these systems to make them more responsive to recipients.     

Disability Identity Formation and Affirmation: The Experiences of Persons with Severe Mental Illness

This article examines the pervasive nature and extent of the debilitating sense of shame associated with disability. It then explores the emergence of disability identity, pride, and culture to challenge such shame—illustrated in personal narrative accounts of the individual and collective journeys of people coping with severe mental illness.     

Family Intervention and Services for Persons with Mental Illness in the People's Republic of China

ABSTRACT

Family services and intervention for persons with mental illness is crucial in mental health services. In this paper, the writer attempts to describe family intervention and services for persons with mental illness in the People's Republic of China. Family intervention and services like home-based care, guardianship network, family counseling, and psychoeducational programs are only preliminarily developed. Their effectiveness and challenges in future development are discussed.     

Protection and Advocacy for Individuals with Mental Illness Act

Abstract

This study explored the perceptions of one state's policy stakeholders toward the implementation of the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI Act). This congressional act established state programs authorized to investigate abuse, neglect, and civil rights violations against individuals with mental illness in residential facilities. A qualitative case study approach was selected to study the perceptions of the impact of this law. Participants were chosen using a maximum variation sampling of four diverse stakeholder groups. In-depth interview responses were developed into a series of proposed assertions regarding the impact of the PAIMI Act.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

Socioeconomic Status and Mental Illness in Japan*

Abstract Since the pioneering work of Faris and Dunham (1938), a number of studies in the United States have documented an inverse association between socioeconomic status (SES) and mental illness both at the aggregate and the individual levels, and both for the treated and the general population. However, there are few studies of whether this relationship holds in other countries. This study examines socioeconomic characteristics and mental illness in Japan, which has a very different social stratification system from that of the United States. It was found that, at the aggregate level, the “inverse” association between socioeconomic characteristics and the rate of treated mental illness does not hold in Japan. Instead, the relationship is curvilinear: mental illness is higher in districts with large numbers of blue collar and upper white collar workers than in districts with large numbers of lower white collar workers. The effect of SES on mental illness operates through economic stress embedded in the macro social context. Because different social structures lead to different patterns of economic stress, the inverse relationship between socioeconomic status and mental health cannot be assumed to hold in all countries.     

Homelessness Among Older Adults with Severe Mental Illness

ABSTRACT

This article tackles a problem that is often overlooked in the literature-the plight of homeless elders with severe mental disabilities. Drawing on his personal experience working with sheltered homeless persons who were mentally ill, the author argues for a focus not on self-sufficiency but on closely supervised care for this vulnerable population.     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

Community Context of Social Resources and Adolescent Mental Health

This study investigated cross‐level mediational and moderational community and family influences on adolescent depressive symptoms. Using multilevel data from the National Longitudinal Study of Adolescent Health, we predicted that structural community characteristics such as community poverty and ethnic heterogeneity would influence community social resources, which in turn would influence adolescent depressive symptoms. We further predicted that community social resources would influence adolescent depressive symptoms through family social resources. Findings also suggested that the influence of the parent‐child relationship on adolescent depressive symptoms is weaker in more adverse communities than in less adverse communities. The findings underscore the importance of placing family process models within the community context when adolescent outcomes are investigated.     

Mental Illness as a Barrier to Marriage Among Unmarried Mothers

This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study (N= 2,351). We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a 5‐year period following a nonmarital birth. Diagnosed mental illness was obtained from the survey respondents’ prenatal medical records. We find that mothers with mental illness are about two thirds as likely as mothers without mental illness to marry, even after controlling for demographic characteristics, and that human capital, relationship quality, partner selection, and substance abuse appear to explain only a small proportion of the effect of mental illness on marriage.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Caring for Persons with Serious Mental Illness

Abstract

This article places evidenced-based knowledge of practice within the social context of care and proposes five policy objectives and specific policy and program changes to address care needs of people with serious mental illness. In spite of demonstration programs that provide the basis for proposed policy initiatives throughout the United States, treatment provision for this population remains inadequate and their safety and well-being continues to be at risk. The authors suggest that treatment initiatives need to be tied to stable policies protecting the mentally ill from adverse social context changes. The authors conclude that policies are needed that will enhance housing assistance, independent social functioning, personal empowerment, and treatment engagement. In addition, efforts are needed to make better use of inpatient hospital care, to better understand the role of assisted treatment, and to better develop consistent long-term fiscal support for the seriously mentally ill. They offer specific policy recommendations for changes in HUD programs, Medicaid and Medicare funding, and treatment programming that address these needs.     

Listening to Older Adult Parents of Adult Children With Mental Illness

This article uses qualitative research and narrative analysis to examine the experience of women age 55 and older who are parents caring for adult children with mental illness. Knowledge about the conflicts of older parents with dependent children is underdeveloped. In this study, analysis of women's stories about parenting in later life reveal that the women have two sets of feelings: wanting to be free from the responsibility of caregiving and feeling responsible to continue the support and protection of their adult vulnerable children. The women's conflicts are palpable and are found in the ideational themes of the narratives, as well as the structure of how the narratives are spoken. The discussion highlights the relevance of the theory of ambivalence for clinical practice when working with older women who are caregivers for their adult dependent children.     

Elders with Serious Mental Illness: Lost Opportunities and New Policy Options

This article reviews key federal Medicaid policies affecting older adults with serious, long-term mental illness: (a) the Medicaid exclusion of coverage for Institutions for Mental Diseases, (b) the Preadmission Screening and Resident Review Process, and (c) the Medicaid Home and Community Based Services waiver policy. Documenting the incentives and restrictions in these policies provides an historical context for understanding the current gaps in treatment for elders with mental illness. New federal options under the Deficit Reduction Act may provide opportunities for reducing the institutional bias for older adults with mental illness and for improving mental health services for elders under Medicaid.     

The Attitudes of Social Work Students and Practicing Psychiatric Social Workers Toward the Inclusion in the Community of People with Mental Illness

Abstract

This study measured and compared the attitudes of social work students and practicing psychiatric social workers to the inclusion in the community of people with mental illness. The Community Living Attitude Scale Mental Illness (comprising the four subscales of Empowerment, Exclusion, Sheltering, and Similarity) was administered to a random sample of 68 Israeli BA social work students (first year: n = 35; third year: n = 33) and 28 practicing psychiatric social workers. Overall, the participants endorsed Empowerment and perceived the Similarity of persons with mental illness to themselves more than they agreed with the Exclusion attitude of segregating those persons from community life. First-year students rated Empowerment and Similarity significantly lower than did the third-year students and rated Sheltering significantly higher than did psychiatric social workers. Psychiatric social workers did not differ from third-year students and did not have stronger attitudinal commitment to the inclusion paradigm. They differed from first-year students only in the sheltering attitude; they showed lower support for sheltering people with mental illness.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

Walking a Tightrope: Case Management Services and Outpatient Commitment

Effective case managers in community mental health are successful at forging a working alliance with recipients. This article explores one key aspect of case management practice, serving involuntary clients, specifically those on outpatient commitment orders. In 19 intensive interviews, a subset of a larger study, case managers shared their perceptions of the utility of outpatient commitment with a focus on how such orders impacted the professional relationship. We argue that the use of advance psychiatric directives and shared decision-making processes can reduce the need for coercive practice.     

Family Social Networks and Recovery From Severe Mental Illness of Clubhouse Members

This study examined the contribution of family social network variables to recovery among Clubhouse members. A random sample of 118 members from one Clubhouse was recruited for this cross-sectional study. Among all respondents, greater overall family support and better relationship quality with the most supportive network member were correlated with greater levels of recovery. Clubhouse members perceived higher quantity and quality of support and more criticalness from their most supportive network members, principally family members, compared to the rest of their family members. Longitudinal studies are needed to further investigate the relationship between family support and recovery.     

Understanding Parental Grief as a Response to Mental Illness: Implications for Practice

ABSTRACT

Parents who are raising children with mental illness struggle with feelings of grief and loss. Kubler-Ross' (1969 Kubler-Ross , E. ( 1969 ). On death and dying . New York : Scribner . [Google Scholar]) stages of grieving (denial, anger, bargaining, depression, and acceptance) are examined as experienced by parents raising children with chronic mental illness. Practice implications for social workers who are working with children and their parents are discussed. Acknowledging and understanding parental grief, while providing emotional support, leads to a more effective working partnership. This collaboration of parents and social worker can result in more effective treatment for the child with mental illness. Examples from one of the co-author's personal experiences are included.