Health status risk factors of people with severe and persistent mental illness.

High rates of medical comorbidity and premature death have become normative health outcomes for individuals with mental illness. On average, people with mental illness die 10 to 15 years earlier than the general population. To date, little research and programmatic attention has focused on the health promotion and prevention needs of people with mental illness. Many factors have been cited as contributing to this problem, including the stigma of being mentally ill, poverty, and limited knowledge and access to health promotion services. Future health planning interventions should restructure the funding mandates of current health care delivery system from an illness and treatment model to one of illness prevention and health promotion.     

Health,wellness, and workplace experiences of lesbian,gay, and bisexual social workers

Abstract

Using data from an online survey of 6,112 licensed social workers in 13?U.S. states, rates of reported behavioral health problems and service utilization, physical health problems, adverse childhood experiences, workplace stress, and compassion satisfaction were compared between heterosexual male, heterosexual female, gay/bisexual male, and lesbian/bisexual female respondents. Sexual minority workers reported far higher rates of mental health problems and service utilization, higher rates of physical problems, more frequent reporting of adverse childhood experiences, with no differences found between groups regarding workplace stress and compassion satisfaction. Minority stress theory and historical trauma are used as frameworks to conceptualize the findings.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.     

Exploring Posttraumatic Outcomes as a Function of Childhood Sexual Abuse

There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically significant post-traumatic stress disorder symptomatology related to their childhood sexual abuse. In conjunction with these high levels of negative symptoms, the population evidenced posttraumatic growth levels that were comparable to other trauma samples. This research has clinical relevance in terms of adding to the knowledge base on sexual abuse and the usefulness of this knowledge in therapeutic interventions and relationships.     

A Review of Lesbian Depression and Anxiety

SUMMARY

The Surgeon General's first report on mental health identified depression and anxiety as significant mental health issues that disproportionately affect women. Research indicates that lesbians experience depression at rates that parallel those of the general female population, suggesting that depression is an important mental health issue for lesbians. Given the high rate of comorbidity between depression and anxiety disorders, it is likely that many depressed lesbians have struggled with problems related to anxiety as well. This paper reviews literature pertaining to lesbians and depression including incidence rates, risk factors, suicidality and treatment approaches, and stress and anxiety that may also contribute to the experience of depression among lesbians.     

Utilizing cognitive-behavioral techniques in psychodynamic practice with clients diagnosed as borderline

Many factors, including theoretical controversies, treatment constraints, and an increasing awareness of the high incidence of childhood trauma, compel practitioners to reevaluate both theory and practice in the treatment of clients diagnosed as borderline. Our purpose in this paper is to encourage clinicians who practice primarily from a psychodynamic perspective to reconsider the judicious use of relevant cognitive/behavioral techniques with this population. We focus on the rationale of utilizing relevant cognitive/behavioral techniques in out-patient settings, and discuss specific problem areas where these techniques might be useful. These problem areas include (1) cognitive and affective splitting, (2) affective dysregulation, and (3) faulty attributions. Each problem area is discussed with clinical illustrations of appropriate cognitive/behavioral interventions. The vignettes also illustrate the essential role the therapeutic relationship plays in order for cognitive/behavioral interventions to be effective.     

Statewide dissemination of trauma-focused cognitive-behavioral therapy (TF-CBT)

Despite evidence linking childhood trauma to subsequent social, emotional, psychological, and cognitive problems, many children who have experienced trauma do not receive mental health treatment that has been proven to be effective. Large-scale dissemination of evidence-based practices (EBPs) is one possible solution to enhance the current negative state of mental health treatment for these children. This article describes a dissemination effort of an EBP (i.e., Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT]) for childhood symptoms of post-traumatic stress disorder throughout Arkansas. The effort targeted mental health professionals within child advocacy centers and community mental health centers across the state. The article describes the process of dissemination and implementation. Lessons learned and recommendations for future dissemination efforts are highlighted.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Psychosocial interventions used to treat children with ADHD: safety and efficacy

Although stimulant therapy is the most common treatment for attention-deficit/hyperactivity disorder (ADHD) in children, it is not always effective in reducing behavioral symptoms. As a result, research on psychosocial interventions has progressed in recent years. This article provides a synopsis of psychosocial interventions for childhood ADHD, with an emphasis on basic behavior management principles, evidence-based interventions, and safety issues. Developmental issues that distinguish psychosocial interventions for children and adolescents are highlighted, and practical recommendations for collaborating with mental health professionals are provided.     

Borderline personality disorder: nursing interventions using dialectical behavioral therapy

Psychotherapeutic treatment of people with borderline personality disorder (BPD) is one of the greatest challenges confronting mental health professionals today. Clients with BPD are often difficult for nurses to work with, perhaps due to a lack of understanding of the underlying dynamics of the disorder. This article describes effective treatment strategies for BPD with a central focus on dialectical behavioral therapy (DBT). In typical mental health settings, nurses can effectively implement interventions using the concepts of DBT to help people with BPD build effective coping strategies and skillful behavioral responses for improved quality of life.     

Baseline Characteristics of Dependent Youth Who Have Been Commercially Sexually Exploited: Findings From a Specialized Treatment Program

ABSTRACT

Commercial sexual exploitation of children has emerged as a critical issue within child welfare, but little is currently known about this population or effective treatment approaches to address their unique needs. Children in foster care and runaways are reported to be vulnerable to exploitation because they frequently have unmet needs for family relationships, and they have had inadequate supervision and histories of trauma of which traffickers take advantage. The current article presents data on the demographic characteristics, trauma history, mental and behavioral health needs, physical health needs, and strengths collected on a sample of 87 commercially sexually exploited youth. These youth were served in a specialized treatment program in Miami-Dade County, Florida, for exploited youth involved with the child welfare system. Findings revealed that the youth in this study have high rates of previous sexual abuse (86% of the youth) and other traumatic experiences prior to their exploitation. Youth also exhibited considerable mental and behavioral health needs. Given that few programs emphasize the unique needs of children who have been sexually exploited, recommendations are offered for providing a continuum of specialized housing and treatment services to meet the needs of sexually exploited youth, based on the authors’ experiences working with this population.     

Comprehensive behavioral medicine in community mental health. A needs assessment that needs assessment.

It is suggested that the massive costs incurred nationally in health care are in large part a fitting concern of Community Mental Health (CMH). There is considerable data available to suggest that as much as half of the variance in common health disorders is associated with behavioral factors. There is a rapidly growing movement to provide interventions geared toward these behavioral components in health disorders, but much of this has occurred outside of the traditional mental health environment. There are arguments to suggest that CMH should be more involved in the development of comprehensive behavioral medicine services, both in terms of the expertise and resources that it can bring to bear upon these problems, and its potential to reach segments of the population which are otherwise likely to be underserved, if served at all. Implications for CMH planning and financing are discussed, drawing upon a selective literature review and clinical illustrations.     

The mental health of young people aging out of care and entering adulthood: Exploring the evidence from England and France

This paper explores the research evidence from England and France on the mental health of young people aging out of care and into adulthood. It represents the first comparative review based on the evidence from these two countries. Set in the legal, policy and service framework for both countries, it reviews evidence on the mental health of young people in the general population, young people living in care, young people aging out of care, and young adults. It shows: the high levels of psychological adversity of young people entering care; the high rates of mental health problems of young people in care compared with the general population of young people; the increased risk of mental and physical problems at the time of aging out of care, and the general improvement in longer-term outcomes for young adults, although some continue to have serious mental health problems. In conclusion, it suggests that interventions across the life course of young people are needed.     

Evaluating a multiple-family group access intervention for refugees with PTSD

The purpose of this study was to analyze the effects of a multiple-family group in increasing access to mental health services for refugees with posttraumatic stress disorder (PTSD). This study investigated a nine-session multiple-family group called Coffee and Families Education and Support with refugee families from Bosnia-Herzegovina in Chicago. Adults with PTSD (n = 197) and their families were randomly assigned to receive either the intervention or a control condition. The results indicated that a multiple-family group was effective in increasing access to mental health services and that depression and family comfort with discussing trauma mediated the intervention effect. Further well-designed studies of family interventions are needed for developing evidence-based interventions for refugee families.     

Cognitive behavioral interventions for depression among Hispanic people: promising meta-analytic evidence for deep cultural adaptations

ABSTRACT

Depressive disorders are common among Hispanic people. Evidence-informed guidelines indicate cognitive behavioral interventions (CBI), but they were developed primarily with non-Hispanic White people. Narrative studies of clients and workers along systematic review evidence suggested that well-defines cultural adaptations of CBIs would likely improve outcomes among Hispanics people with diverse mental health problems. We advanced the meta-analytic hypothesis that CBIs incorporating so-called “deep structure” cultural adaptations will be more effective than otherwise similar, but more superficially, “surface structure” or non-adapted interventions with depressed Hispanic people. This meta-analysis synthesized evidence from nine typically randomized trials in the United States with one subsample from the Commonwealth of Puerto Rico. Most clients were young women, living in poverty and suffering a reactive depressive episode. We found statistical and practical support for our hypothesis. In most practice contexts, CBI success rates were between 15% and 30% better than those typically observed with other usual practices. Moreover, these effects were maintained at 6- to 12-month follow-up. Given the size and growth of the Hispanic American population, their prevalent experience of depression, and the size of the intervention effects, these synthesized findings seem of potentially great human, clinical, and policy significance.     

Recovery capital: what enables a sustainable recovery from mental health difficulties?

There is increasing international interest in recovery approaches in mental health—and this connects with an emerging focus within European social work around promoting capability and sustainability. Research at a population level would suggest that social factors rather than medical interventions are the main determinants of recovery from mental health difficulties—but this is not yet reflected in social work practice, which can still be dominated by biomedical perspectives and a focus on risk management. Drawing upon and extending analyses of social and other forms of capital, this paper outlines the basis for a new paradigm for mental health social work that is specifically oriented towards enabling the development of personal efficacy and social capability—an approach that is explicitly focused on achieving longer-term sustainability rather than shorter-term problem solving.     

U.S. Army combat operational stress control throughout the deployment cycle: a case study

As military conflicts around the world persist, a comprehensive approach in managing behavioral health issues will continue to be a key component of military healthcare. Deployed military personnel frequently exposed to trauma are well-known to be at high risk for developing behavioral health disorders, including combat stress reactions and posttraumatic stress disorder. In the U.S. Army, members of combat operational stress control (COSC) units have unique skills to assist soldiers and their families not only throughout all phases of a deployment, but also throughout a soldier's entire career. The purposes of this article are twofold, first to describe the role of COSC operations with an emphasis on interventions in a deployed environment. The second purpose is to present a case study from Operation Iraqi Freedom highlighting the efficacy of the COSC approach to meet a Soldier's behavioral health needs in a deployed environment.     

From past trauma to post-traumatic growth: The role of self in participants with serious mental illnesses

Studies have shown that people with serious mental illness are more likely to have experienced trauma compared to the general population. This qualitative study employed a grounded theory approach to explore how trauma histories influenced the process of triggering, developing, and recovering from serious mental illness. Findings based on in-depth interviews with 15 participants illustrated the intersection of trauma, serious mental illness, and post-traumatic growth. Experiencing trauma compromised participants’ self-functioning, causing issues such as affect dysregulation, distorted self- and other- concepts and relationship difficulties, meaninglessness, and existential fears, all of which negatively impacted participants’ mental health and behavior. At the same time, participants with serious mental illness were able to achieve post-traumatic growth with the “transformed-self” via self-acceptance, self-exploration, self-worth, and self-fulfillment. Findings of this study have useful implications for trauma-informed care in mental health treatment. Mental health professionals should address clients’ trauma histories to prevent re-traumatization and design trauma-informed programs that use and build clients’ inner resources and strengths to promote post-traumatic growth.     

Teaching Note—Oppression of People With Mental Illnesses: Incorporating Content Into Multiple-Issue Diversity Courses

Many social workers practice in settings serving people with mental illnesses, but social work education in the United States has given minimal attention to helping students understand the systemic nature of prejudice and discrimination experienced by this population. Some courses address prejudice (stigma) toward people with mental illnesses, but a critical consideration of systemic oppression appears to be lacking. We explain how an oppression framework used to understand the systemic nature of racism, sexism, and other forms of oppression is useful in illuminating experiences related to (perceived) mental health status. We offer suggestions for incorporating content into courses that focus on diversity and oppression with the goal of preparing students to engage in antioppressive practice with people who have mental illnesses.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.