Viewing psychopathology through a trauma lens

Many symptoms and behaviors associated with a range of psychiatric disorders, including those not designated as trauma- or stressor-related, result from unprocessed and unintegrated traumatic experiences, requiring therapeutic assessments and interventions that consider the complex dynamics brought on by trauma. While the focus on symptoms in the Diagnostic and Statistical Manual of Mental Disorders (DSM) may lead practitioners away from a consideration of etiology when choosing interventions, the exclusions of “disorders of extreme stress not otherwise specified” in DSM-IV and “developmental trauma disorder” from DSM-5 may further predispose practitioners to disregard traumatic etiology and symptoms when assessing, diagnosing, and treating clients. Because a majority of recipients of public mental health services suffer deleterious effects from trauma exposure, social work and other mental health professionals have an ethical responsibility to incorporate trauma-based screenings, assessments, and interventions with clients. Thus, trauma-informed evaluation and treatment approaches must be included in graduate curricula, practitioners must seek continuing education to supplement their knowledge and practice skills, and agency administrators must provide inservice training to professional staff.     

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.     

Refugee integration and social media: a local and experiential perspective

The refugee crisis has spurred the rapid development of creative technology and social media applications to tackle the problem of refugee integration in Europe. In this article, a qualitative study with 18 refugees from Syria, Eritrea and Afghanistan is presented in order to investigate the uses and purposes of social media associated to the different areas of refugee integration in the Netherlands. The results indicate that social media networking sites were particularly relevant for refugee participants to acquire language and cultural competences, as well as to build both bonding and bridging social capital. Another important finding concerns the role of government, host society and the agency of refugee actors in determining the way refugees experience social media. Building on these results, a theoretical model for analyzing refugee integration through social media is demonstrated.     

Employment among unaccompanied women experiencing homelessness

ABSTRACT

Women represent one of the fastest growing segments of the homeless population and employment is often central exiting homelessness. However, little research considers employment experiences among unaccompanied women, a particularly vulnerable sub-population. This study explored how unaccompanied women experiencing homelessness (n?=?20) perceived and negotiated employment in a mid-sized community. Thematic analysis revealed four themes: limited work experience, limited aspirations, the holding pattern, and individual barriers. Findings endorse the need for Housing-First interventions to prioritize stable housing and employment-friendly shelters.     

Patterns of evolutions of social enterprises in France: a focus on work integration social enterprises

The objective of this paper is to characterize the patterns of emergence and evolution of social enterprise in France with a focus on work integration social enterprises (WISEs). After a review of the history of social and solidarity economy practices, identifying the processes that brought these practices to develop, we discuss the boundaries of the notion of social enterprise in the French case. We then briefly present the historical evolution of work integration. On that basis, two models of social enterprise applied to the case of work integration are extracted, crystallizing crucial tendencies. The limits and prospects of social enterprise in the field of work integration in France are discussed in the conclusion.     

Counseling with Muslim Refugees: Building Rapport

Recent social work literature has stressed the importance of considering culture when working with individuals with mental health problems. This paper presents my personal experience, journaling, reflections, and research as a mental health social work practitioner and researcher working with refugee clients with mental health problems from a Muslim background. It also draws on my research experience in cross-cultural mental health. The paper emphasizes the significance of building rapport especially in the earlier stages of the professional relationship.     

Perspectives on How Social Business Can Engender Work Identity Among People with Mental Illness

ABSTRACT

Social businesses use market strategies to advance the employment and economic situation of people with mental illness who have experienced high levels of social marginalization. They have the potential to achieve these goals by fostering the work identity of the workers within the business, and to themselves acquire an identity as a viable commercial entity that contributes to the prosperity and social fabric of the local community. This study used in-depth case study methods enhanced by comparisons with international social businesses to understand the processes by which social businesses influence work identity. Six business processes that are salient to the development of a strong work identity were identified. Eight propositions for how work identity can be supported by social businesses are offered. The propositions may be useful as a guide for the development of social businesses that are organized and implemented to positively develop work identity, regardless of the nature of the business model.     

Differential association between unemployment status and mental health among veterans and civilians

This study aims to examine the negative effect of unemployment on mental health among 2,762 veterans and 45,095 civilians aged 18 to 50 years. The data were from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey. We used ordinary least squares regression to test the interaction association between employment status and veteran/civilian status with mental health status. Findings revealed that long-term unemployed veterans had a significantly greater number of days with poor mental health than long-term unemployed civilians. The study highlights the need for future research concerning the negative effects of long-term unemployment on veterans’ mental health as well as the reciprocal relationships between mental health and occupational functioning for veterans. The findings challenge researchers to question the meanings that are associated with employment status for veterans as compared to those of their civilian peers. In addition to this, the study raises the need for further exploration into the topics of identity, self-perception, and the notion often present in the military/veteran culture that there is “dignity in labor.”     

Labour market integration and transnational lived citizenship: Aspirations and belonging among refugees in Germany

Transnational lived citizenship has gained prominence as a means to analyse mobility and foreground activist notions of citizenship over legal status. I argue that lived citizenship and transnational movements are strongly intertwined with aspirations and belonging. I use the material example of labour market integration as the space of enactments of citizenship and analyse the patterns of belonging those create and contest. I develop my argument through the empirical example of labour market integration of refugees in Germany. I demonstrate how such integration transforms social, and more importantly, economic location and in turn creates complex and often contradictory forms of transnational allegiances. I ultimately argue that lived citizenship can in important ways advance aspirations of refugees and migrants. At the same time, transnational lives and multiple allegiances are often hindered by state-based citizenship and the rights this confers. Legal status thus remains an important marker of citizenship.     

Clinical Social Worker as Patient Advocate in a Community Mental Health Center

As a profession, social work has always advocated for clients. Yet clinical social work settings often ignore this important aspect of practice. For mental health services in public agencies, patient advocacy is a particularly vital element because these systems are not always responsive to the individual client. The clinical social worker, trained in advocacy, systemic intervention, and psychotherapy, is the professional most qualified to fill this role. The author summarizes the history of advocacy, provides a conceptual framework for the clinical social work advocate, and provides examples from 20 years of experience as a patient advocate in community mental health.

An Integral Approach to Mental Health Recovery: Implications for Social Work

The term recovery has become increasingly popular in the area of mental health care. Recently, it has been described by policy makers as the guiding vision for transforming the mental health system. Problematic, however, is that a lack of clarity continues to exist regarding how recovery is to be defined. Definitional attempts often appear to have competing opinions about what the concept exactly stands for. This causes confusion for both professionals and consumers desiring to adopt a recovery approach. Ken Wilber's integral theory is presented as a framework for organizing and connecting various viewpoints related to the “recovery” concept. Implications for social work are discussed.     

Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment

Despite the high prevalence of depression among children and adolescents, most that need mental health treatment do not seek care. This is especially true for ethnic minority adolescents. Prior research has shown that perceived stigma may act as a barrier to the initiation of and adherence to depression treatment, yet few studies have examined the relationship between stigma and depression among Black adolescents. This exploratory study examined the relationship between Black adolescents' depression severity and their current level of perceived stigma in an outpatient sample. Face-to-face interviews were conducted with a clinical sample of adolescents referred for mental health services at a community-based outpatient clinic (n =108), participating in a prospective pilot study on adolescents' patterns of mental health service use. The analyses revealed that greater depression severity was significantly associated with higher perceived stigma (p < .05), particularly among females. The results also suggest that Black adolescents appear to exhibit an appropriate level of self-assessment regarding their need for mental health services. These results are interpreted in relation to previous literature, and limitations and directions for future research are discussed.     

Comparison of Treatment Response among GLB and non-GLB Street Living Youth

Researchers have found that adolescents who identify as gay, lesbian, or bisexual (GLB) are at a higher risk for increased substance use and mental health symptoms. The current study is a secondary analysis of two clinical trials for street-living youth. This analysis examines self-identification as GLB as a moderator of treatment effects and addresses whether street-living GLB youth respond differently to a therapeutic intervention than non-GLB street-living youth. Comparisons were made of treatment outcomes on two categories of variables (drug use and mental health symptoms) among 244 homeless GLB and non-GLB identified adolescents. Overall, GLB and non-GLB adolescents showed similar reductions in drug use and mental health symptoms. However, compared to non-GLB adolescents, GLB adolescents showed greater improvement in reduction of drug use and internalizing and depressive symptom scores. While both groups reported less drug use and fewer mental health symptoms from baseline to post-intervention, GLB youth's scores improved more drastically. Implications of using the identified treatment intervention are discussed.     

Incentive Structures Within Mental Health Financing Strategies

Abstract

This paper analyzes the incentive structure contained in traditional fee-for-service and capitated managed care models and finds both to be inadequate in encouraging the attainment of client outcomes. An incentive financing scheme is proposed that links funding to outcomes, and describes the necessary elements of such a system. This framework is then applied to the New Hampshire and Colorado incentive financing systems.     

Narratives from the neighbourhood: The discursive construction of integration problems in talkback radio1

This paper examines how speakers deploy narrative devices in talking about Sudanese refugees. Particularly, we show how narrative constructions form an important basis for the advancement of accounts about integration problems into the local polity. We analyse talkback ‘phone‐in’ calls to a local Adelaide radio station that provide callers an opportunity to give accounts of events and social phenomena that concern them in their local settings. Analysis shows that speakers regularly deployed narrative constructions, first‐hand ‘witnessing’ devices that functioned to legitimate accounts as veridical versions of events, and contrast devices to explicate the moral and behavioural aberrance of Sudanese refugees. The analysis illustrates how these discursive devices function rhetorically in interaction, in ways that differentiate Sudanese refugees as problematic. Through this analysis, we contend that narrative devices precipitate and bolster socio‐political policies that have serious, negative consequences for Sudanese refugees.     

What Do Social Workers Need to Know About Mental Health Courts?

Abstract

Mental health courts are an emerging strategy to engage mentally ill offenders in treatment and to avoid unnecessary incarceration. These courts began in 1997 based upon the drug court model; there are currently over 70 courts nationwide. These courts are heterogeneous in structure, work with interdisciplinary teams, and seek to engage the consumer in treatment rather than use judicial sanctions. Social workers are integral members of these teams; yet, no research has been published in social work journals on mental health courts. This article explains the background and context of the courts, describes their features, discusses what social workers need to know about mental health courts, and concludes with ideas for how social workers may work effectively with mental health courts.     

Learning to gamble: early gambling experiences among young people in Denmark

This article presents results from the first phase of a longitudinal qualitative study of gambling among young people in Denmark. The longitudinal study is designed to capture the trajectories of young gamblers and to explore how social and cultural factors and processes impact on young people's gambling careers. The first stage of analysis places a special emphasis on young people's introduction to gambling and the social contexts of these early gambling experiences. Theoretically, this first study is guided by a symbolic interactionist approach. We conclude that early experiences with gambling are socially mediated and that significant social contexts such as the family and peer groups form important contexts of these early experiences. Our evidence suggest that becoming engaged in gambling is a social process involving a transfer of skills and knowledge in which novices learn how to play and to attribute specific meanings to gambling. Overall, our findings indicate that young people start gambling not because of purely individual characteristics or deviant motivations but through social processes within significant social networks. Implications for prevention and further research are briefly discussed.     

Predictors of employment among sheltered homeless women

The effect of homelessness on the psychological and physical health of women is damaging and long lasting. Understanding of the personal factors that enable homeless women to secure employment and re-enter mainstream society is of utmost importance. A sample of homeless women residing in a US Midwestern nonprofit treatment and transitional living shelter for homeless women and their children were surveyed regarding the extent to which life satisfaction, social self-efficacy, and hopeful thinking predicted women's expected capabilities to obtain employment above and beyond social support provisions, while controlling for participants' age, ethnicity, and education level. Findings failed to reveal that social psychological (i.e., life satisfaction and social self-efficacy) and intrapersonal (i.e., hope) variables predicted homeless women's job procurement self-efficacy above and beyond perceived social support. The social support provision of social integration and younger age significantly predicted women's self-efficacy to secure employment. Implications of results for social justice initiatives and interventions are discussed.     

Anti-oppressive Practice in Mental Health

This article identifies the challenges to incorporating an anti-oppressive practice approach in the field of mental health, which has traditionally utilized a discourse and perspectives of a bio-medical model. Schools of Social Work often teach anti-oppressive and social justice approaches which make it difficult for students to link theory and practice in fields such as mental health. In this article, seven principles of practice are presented as a framework for working with people with disabling conditions of mental health. Specific strategies for implementing these principles are presented.     

Legal capacity and the mental health social worker role: an international comparison

ABSTRACT

New capacity laws have been introduced to many jurisdictions over the last decade. These laws have substantially changed the way in which mental health social workers and other professionals approach decisions about, and for, clients. Most notably, there is now an expectation that mental health social workers engage more in supported decision-making to prevent the need for substitute decision-making. This article describes the legal and policy drivers that have led to these changes in practice, with a particular emphasis on the significance of the United Nations Convention on the Rights of Persons with Disabilities (the UNCRPD) and the importance of recovery approaches in mental health services. It then uses selected literature to explore the efficacy of the laws and decision-making in this area. The second part of the article identifies the role that mental health social workers can play in supporting legal capacity, drawing from the authors’ experience and knowledge of mental health social work and law in four jurisdictions: Victoria, Australia; Ontario, Canada; England and Wales; and Northern Ireland. It is concluded that mental health and other social workers need to refine skills, knowledge and values to accommodate this paradigm shift in law, policy and practice.