Workers' perspectives on self-directing mainstream return to work following acute mental illness: Reflections on partnerships

Objective: To examine barriers and facilitators influencing self-direction of return to mainstream work following acute mental illness.Participants: Five individuals who had attempted return to mainstream work following acute mental illness. Methods: In depth, semi-structured qualitative interviews with the five participants selected through purposive sampling. Results: The three main themes related to the workers' self-direction of their return to work experience were (a) worker self-management, (b) workers' 'personal' partnerships and (c) workplace partnerships. Conclusion: Personal and workplace partnerships are integral to supporting workers as they take ownership of their full potential and self-direct return to mainstream work.     

Understanding loss: The origins and value of current theories of loss

Abstract

This article discusses the origins of concepts concerning the nature of loss and its consequences for mental health. It suggests that, while the experience of loss is self-evidently of importance for individuals, the view that loss represents a major risk factor in mental health has led to unwarranted professional intervention in the belief that grief must be 'resolved' in order to prevent a negative psychological impact. It is suggested that this view has not been sufficiently explored theoretically and that professional helpers, such as social workers and counsellors, should use models which purport to facilitate mourning with some caution.     

Educating for mental health practice: Results of a survey of mental health content in Bachelor of Social Work curricula in Australian schools of social work

Health problems are amongst the most pressing encountered by social workers in practice. Health policy, largely through deinstitutionalisation, has placed mental health problems in the mainstream of health practice. One in 25 Australians will require professional assistance with mental health problems. Moreover, other professions are increasingly claiming that mental health is their area of expertise. Social work needs to reclaim this area as their own and hence it is incumbent on social work education to prepare students to practise in this area. As the second of a two-part survey of health and mental health curricula in Australian schools of social work, the findings of the survey on mental health curricula conducted in 1997 are presented in this article. Based on responses from 95% of the schools, nine of the 20 respondent schools were found to offer a separate mental health unit. The remaining 11 schools' coverage ranged from no coverage at all through to considerable integration in other subjects. Overall it was concluded that the majority of students received a significant amount of input on mental health. A number of recommendations are made to improve mental health input including more skill development, greater local contextualisation, more attention to an anti-oppressive agenda, and more explicit links to field education.     

Miscarriage in the Workplace: an Authoethnography

This paper is an extension of the literature on pregnancy and work, and it introduces miscarriage as an important topic of study in management. Miscarriage starts with a pregnancy, so a woman who has miscarried deals with many of the same workplace issues as women who carry to term. The experience of miscarriage, however, often leads to physical and emotional trauma and/or grief that many women hide from their co‐workers. In this paper we also explore how secrecy is an integral part of the miscarriage experience. The combination of secrecy and grief that is layered on top of a difficult physical experience makes miscarriage a unique experience that, to date, has mostly been ignored in management literature and practice. It is well documented that contemporary corporate structures have little room for addressing procreation, health and grief, it is perhaps unsurprising then that despite miscarriage being seen as a relatively common event it remains silenced.     

‘Sitting on the Mourning Bench’: Mental Health Workers and an Elderly Client

Abstract

The present article documents the experience of a first year social work student on fieldwork placement in an Aged Persons Mental Health Service. The student was part of a team providing service to a long-term client of the service when he was diagnosed with a life-threatening illness. The student's compassionate response to the client raises questions about grief and professionalism, which she explored through a journal and in discussion with her supervisor and other team members working with the client. As part of their reflective practice, the student, her supervisor and the client's mental health workers formed a collective to document their experience and present a staff education session. This article is the outcome of these processes and explores important grief issues in Aged Psychiatry and demonstrates the valuable contribution made by a student to the work of the team in the rich learning environment of a fieldwork placement in aged psychiatry. It is published with the kind permission of the client's next of kin.     

Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

Grief and loss of a caregiver in children: a developmental perspective

Grief is one's response to loss. Each person's expression of grief is unique and influenced by factors such as age, culture, and previous exposure to loss. Whether or not children grieve has been debated, with some proponents stating that children do not grieve at all until they are adolescents, and others asserting that infants are capable of grief. The most common conclusion is that children of all ages do grieve, although their grief is different from that of adults. Children's grief is also closely related to developmental stage, so children of varying ages also grieve differently. Therefore, supporting a grieving child is relative to his or her stage of development. For this reason, it is important for practitioners working with grieving children to understand the manifestations of grief at various developmental stages, to provide competent support to children of all ages who experience loss.     

Death in Public Child Welfare

Child welfare workers are in a unique position to help children and youth in out-of-home care who have experienced the death of a significant person. This article discusses the response of children to death from a developmental perspective and offers suggestions on how child welfare workers can use an ecological perspective to help youngsters cope with their grief.     

‘Them that runs the country don't know what they're doing’: political dissatisfaction amongst members of the white working class

There are signs that a significant number of British people do not feel that their concerns are being addressed by the mainstream parties or the political system. This paper attends to the quality of that political dissatisfaction amongst members of ‘the white working classes’. There is a need to extend typical concerns about youth disengagement to adults and to consider the role that class plays. Lower participation in formal democratic processes may not mean disengagement from all forms of politics, but could have considerable consequences for who gains power and for the tone and focus of political debates and policies. Our project contributes to exploring political dissatisfaction by engaging with low wage workers in Yorkshire and the North West, where high support for the far‐right BNP and low voter turnout are signs that mainstream politics and politicians are failing to impress. We asked people about their feelings in relation to mainstream politics and their concerns. These participants feel distanced from governing elites, formal political processes and old ideologies. They are searching for ways to make sense of their struggles to live a decent life, and in doing so must contend with the dominance of racist discourses.     

Humanitarian response and stress in Kenya: gendered problems and their implications

ABSTRACT

Stress-related conditions such as burnout and post-traumatic stress disorder are a growing concern in the humanitarian sector. Aid workers themselves report not only that mental health problems are common, but that the support they receive from their employers is insufficient. Problematically, the experience of the international aid worker – particularly those who are white and from the global North – is often foregrounded in explaining what constitutes stress and related mental health problems. This indicates a wider problem of what is required of ‘the perfect humanitarian’ – a personality that is gendered and racialised – and how this influences the different experiences and treatment of national and international staff from aid agencies. This article explores the organisational culture and working conditions of humanitarian settings and their impact on the mental health and well-being of staff. It argues that there is a structural dimension to stress that is less to do with external security threats and more to do with the specific infrastructure, policies, and practices of humanitarian operations, with implications for aid workers which cut across dimensions of race, gender, and nationality.     

Hard times and vulnerable people: initial effects of plant closing on autoworkers' mental health

Large-scale 1987 General Motors plant shutdowns offered an unusual opportunity to study effects of actual and anticipated unemployment on mental health. Workers from four closing and 12 nonclosing plants (Ns = 831 and 766 respectively) were interviewed approximately three months before scheduled plant closings. Dependent variables were baseline frequencies of somatic, depressive, and anxiety symptoms. The quasi-experimental design made it possible to explore systematically the mental health problems of individual autoworkers as a function of their employment status, their demographic characteristics, and the interaction of the two. Three groups were formed by dividing workers at closing plants into those already laid off and those anticipating layoff; the third group consisted of workers in nonclosing plants. Results revealed a pattern of interaction between unemployment and demographic variables, showing differential vulnerability to job loss. Less educated blacks were especially affected; follow-up analyses showed that their more distressed mental health could not be attributed entirely to other, prior stressors.     

Adult Protective Services workers' experiences with serious illness and death

This study examined the emerging issue of experiences with end-of-life issues in adult protection. A national survey of adult protective services (APS) workers (N=508) examined encounters with serious illness, injury, death, and bereavement and how these situations were handled professionally and personally. APS workers often encountered clients and caregivers with life-threatening illnesses, and clients receiving hospice services. About three-quarters had worked on at least one case involving a client's death. Overall, more education and training about serious and terminal illness, death, grief, and bereavement is needed to prepare APS workers to work with clients and their families facing a variety of end-of-life situations.     

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns.MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained.ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation.ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.     

Social workers’ perspectives on the recovery-oriented mental health practice in Tshwane,South Africa

The challenge facing the mental health field today is the lack of knowledge related to interventions and services that will help people recover from severe mental health problems. In addition, the reluctance of social workers to embrace the recovery-oriented mental health practice is attributed to their lack of knowledge. Hence, they regard recovery in mental health as misleading and unrealistic.The article provides the findings on the social workers’ lack of knowledge and understanding of the recovery-oriented mental health practice. The social workers are based in non-governmental organizations in Tshwane, South Africa. Semi-structured interviews were conducted to gather data from social workers. Findings confirmed the lack of knowledge regarding the recovery-oriented approach, which has not yet been implemented in South Africa. Mental health services continue to be informed by the traditional medical model.     

Parental Grief and Serious Mental Illness: A Narrative

Serious mental illness is associated with substantial personal and interpersonal distress and life disruption for the sufferer and for his/her family. A common response to having and caring for a family member with a serious mental illness is feeling loss and grief. This paper presents a representative narrative that attempts to capture the essence of the experience as conveyed by 22 parents of adult children with a serious mental illness. The implication of the narrative is examined.     

From Freaks to Savants: disability and hegemony from The Hunchback of Notre Dame (1939) to Sling Blade (1997)

At the turn of the century the Protestant ethic combined with Victorian morality helped turn audiences away from 'Freaks Shows'. This act isolated the performers (who were generally labeled with a physical or mental disability) from not only the rest of society but also from the economy. However, images of people with disabilities did not disappear. The 'mainstream' film industry took over as chief exhibitors stigmatizing characters with disabilities as either violent psychotic offenders or child like savants. However, in 1932, Tod Browning resurrected the 'Freak Show' and made a remarkable film celebrating and starring actual performers from 'Freak Shows'. The film, Freaks , managed to 'normalize' the performers but was a box office and critical disaster. MGM banished the film to the vaults for twenty years, while in England it was banned for over forty. It is blamed for bringing Browning's career to an end and the stars were forced back into isolation. The purpose of this paper is to examine the criticism of Freaks by comparing and contrasting it with images of the more 'successful' mainstream films. Through this analysis I will demonstrate that the criticism for Freaks as it stands is unsupported. I argue what truly offends, shocks audiences and critics alike and the reason for the film's continued 'banishment' is not only the visibility of the actors with disabilities, but also the fact that Browning and his actors found no shame in showcasing their diversity. It is within both the criticism of the film and the mainstream films depicting characters with disabilities where the institutional rejection of diversity is found, not in the images Browning showcased.     

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.     

Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

Survivor research and Mad Studies: the role and value of experiential knowledge in mental health research

The body of knowledge referred to as ‘survivor research’ has grown significantly in recent years, challenging the basis of mainstream mental health knowledge and most recently manifesting in the emerging field of enquiry known as ‘Mad Studies’. The roots of these developments lie in the experiential knowledge of service users engaged in sharing their experiences and knowledge, often through peer support. I aim to challenge some of the assumptions underlying what we think we know about mental health from the mainstream mental health disciplines; and to demonstrate the value of experiential knowledge in helping us to reach a better understanding of mental health and mental distress. This article explores the nature of, and challenges to, mental health knowledge and evidence, drawing on the work of survivor researchers and people contributing to the emerging discipline of Mad Studies.