Recovery From Mental Health Problems: Scratching The Surface Without Ethnography

This article examines a central plank of mental health policy (‘recovery’) in societies which have attempted to reverse the long-term warehousing of those with a diagnosis of mental disorder (de-institutionalisation). The emergence of the concept is traced in relation to the shift from an institutional to a more dispersed and community-based form of service organisation. Different usages of the term ‘recovery’, each with distinct implications for practice are considered on the part of three main interest groups (traditional bio-medical psychiatrists; social psychiatrists emphasising social skills training; and dissenting service users). These different usages suggest that ‘recovery’ is a polyvalent concept that creates an uneasy consensus point to define the management philosophies of local services enacting mental health policy. Also mental health work is about more than the group of patients mainly considered in relation to recovery (those with ‘severe and enduring mental health problems’). Practice-near research strategies are now required to investigate the varied practical scenarios these contradictions generate and ethnographic research is therefore indicated. Without multiple ethnographies, we will be left with competing rhetoric about recovery and its meaning or meanings may be rendered worthless.     

Recovery,Managed Care,and the Reflective Practitioner

ABSTRACT

Conflicting priorities between the recovery movement among consumers of mental health services and managed behavioral health care planners result in turbulence and ambiguity in the service delivery system. Based upon information from both published and unpublished written sources, areas of strain are described. The utility of a reflective practice model, as conceptualized by Schon (1983), for addressing a recovery vision within a managed care environment is explored.     

Understanding paid peer support in mental health

This study aimed to explore, articulate and expand on existing concepts of recovery and paid peer support within consumer-operated mental health organizations. Focus groups and interviews were conducted with 32 participants to identify elements of paid peer support work in two organizations in Queensland, Australia. Participants included peer-supported consumers, paid peer support workers, managers and other key stakeholders. Through a grounded theory analysis, eight categories of paid peer support were identified. For the most part, the categories aligned well with evidence in the literature. However, two of these categories, issues of power and the ‘dark side’ of peer support, have been relatively unexplored and understated in previous studies. These findings provide an expanded understanding of the role of paid peer support as part of the recovery process in mental health service delivery. The effective use of paid peer support workers can be enhanced through attention to the issues identified.     

Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Using the Personal Computer in Disaster Intervention

We describe in this paper the contributions of the personalcomputer to a rural mental health program designed to address disaster-induced psychological problems following a flood. The computer served a vital role in several areas. First, we were able to use the computer in desktop publication of pamphlets for disaster survivors. Second, we used the computer for managing data to assess the needs of survivors, evaluate effectiveness, and generate reports. And third, we used the computer to mail letters to all survivors, providing them with updated information regarding available services and continuing concerns. In evaluating the success of the program, we conclude that the computer enabled us to implement a program that was inexpensive, responsive, efficient and effective.     

Improving mental health assessments in child protection through audit

Existing agency records, together with questionnaires completed by social services referrers and mental health providers, were used to identify problems in current arrangements for obtaining specialist mental health assessments in child protection cases. Standards were set and implemented through a multi‐agency steering group. The practice of referrers and providers was then reaudited. Sixty‐nine social workers, six mental health specialists and 27 child protection initial case conferences (involving 31 children) were involved in the reaudit over a 4‐month period. Initially, main problems concerned communications, unclear referral and access arrangements, waiting times and disagreements over prioritization. Standards concerned consultation and decision‐making arrangements within the child mental health service, the format of referral and reply letters, the sharing of information and the attendance of mental health professionals at child protection case conferences. There appeared to be improvements in all these areas at reaudit. In conclusion, some shared views of problems, additional support funding and the audit process appear to have helped to improve inter‐agency collaboration and develop more efficient referral and care arrangements. There is a need to maintain and further develop this work, and audit would again be a useful means. Copyright © 1999 John Wiley & Sons, Ltd.     

On-Campus Programs to Support College Students in Recovery

Abstract

The author argues that referral of alcohol-abusing college students to off-campus treatment services, although necessary for some, is not optimal for many. He advocates the implementation of comprehensive on-campus services for students committed to recovery in order to optimize their treatment while allowing them to remain in school and work towards their degree. The author suggests that such on-campus recovery services provide additional benefits to the college or university as well as to other students, and he proposes that on-campus alcohol-abusing students in recovery can serve as important opinion leaders and role models for their peers.     

Exploring the Relationship Between Experiential Avoidance,Alcohol Use Disorders,and Alcohol-Related Problems Among First-Year College Students

Abstract

Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010. Methods: Participants completed a diagnostic interview and online self-report survey. Results: Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems. Conclusions: These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.     

Reclaiming Life: Six Consumers of Mental Health Services Talk About What Helped and What Did Not Help Them Get Their Lives Back

This article summarizes a roundtable discussion held at Thresholds in Chicago, Illinois in September 2012, where six people diagnosed with serious mental illness talked about what helped and did not help them recover and successfully reclaim their lives. Their comments, taken as part of their personal narratives, can help enhance understanding of the recovery process. The discussion is organized by the themes that emerged: considering life as distinct from diagnosis, meeting basic needs, empowerment, education, community, faith and hope, healthy thinking, peers, and focus on wellness. Panel members also offer advice for mental health service providers.     

Psychosocial experiences of concussed collegiate athletes: The role of emotional support in the recovery process

Abstract

Objective: Understand from whom concussed football players seek and receive emotional support, and whether this support is associated with injury perceptions. Participants: Football players (N?=?26) from three NCAA Division I programs. Methods: With approval from the head athletic trainer, concussed athletes (2017 season) completed short surveys within 4–6?days of diagnosis and when cleared to return. Results: Concussed athletes perceived their injury as a normal consequence of playing football, not serious, and reported little, if any, depression and anxiety. Athletes reported the most support from athletic trainers; the least from coaches and teammates. Emotional support was associated with fewer adverse psychosocial reactions, more sport-injury related growth, and greater intentions to report future concussion symptoms. Conclusion: Results from this pilot study suggest that emotional support during the concussion recovery process should be understood and fostered by university officials charged with the health and well-being of collegiate football players.     

Green Care services in the Nordic countries: an integrative literature review

This article reviews Nordic literature on Green Care for people out of work or school, or with mental health- and/or drug-related problems, published from 1995 to April 2014. Green Care is a well-established international concept that uses animals, plants and nature in an active process to offer health-promoting activities for people. Reports, evaluations and scientific articles are included. The main finding was that the Green Care services described in the literature provided positive activities for our target group. Seven main categories emerged during the analysis: mastery and coping, positive effects on mental health, physical activity, structure and meaningfulness, the feeling of dignity produced by performing a decent ordinary job, social gains, animals and nature experienced as being supportive. Essential intervention factors identified can be described as: (i) contact with animals, (ii) supportive natural environments, (iii) the service leader as a significant important other, (iv) social acceptance and fellowship with other participants and (v) meaningful and individually adapted activities in which mastery can be experienced. These five components interact in a holistic way; the synergetic effects extend the sum of the single factors.     

Predicting job satisfaction of mental health peer support workers (PSWs)

ABSTRACT

The Mental Health Recovery Model is an empowering service philosophy which has been transforming the field of mental health. An important service approach to actualizing this model is hiring peer support workers (PSWs) who are peers advanced in recovery and employed to assist other peers in their recovery process. This study reports on factors hypothesized to affect PSW job satisfaction. Using multiple regression analyses, organizational culture and relationship with peers predicted 29% of job satisfaction. Based on these findings, suggestions are offered to assist social work administrators in effectively integrating and supporting PSWs in the workplace.     

The journey effect: how travel affects the experiences of mental health in-patient service-users and their families

The qualitative study presented in this paper explored the perspectives of service-users, family members and staff about the impact of travel issues on the lives of mental health in-patients and carers. This topic was chosen because it was prioritised by members of Xplore, a service-user and carer research group, and has received little research attention. Travel problems were a significant issue for many service-users and carers, bound-up with mental health issues and the recovery experience. Travel facilitation through the funding of taxis and the provision of guides was appreciated. A few service-users and carers positively valued distancing from their previous home environment. The meaning of travel issues could only be understood in the context of individuals’ wider lives and relationships. The significance of the findings is discussed in relation to the social model of disability.     

The Recovery Approach to Rehabilitation: Implementation in Supervision

The recovery approach to psychiatric rehabilitation has introduced a new set of challenges, enabling consumers to set goals and redefine their role in obtaining them. This has revolutionized the management of the relationship between service providers and consumers. In the present paper, we suggest that one of the important ways to supervise professionals interested in internalizing the recovery approach is to implement its major principles in the supervision work itself. The paper draws on intersubjective therapy concepts and guiding principles, which emphasize the development of the professional–consumer relationship in which the consumers' sense of agency can be respected and promoted. The principles we suggest here which may underlie supervision are: (1) clients or supervisees, with their own decisions and interests, are at the center of the rehabilitation therapy and supervision; (2) mutuality in the rehabilitative/supervisory relationship and ongoing discussion of the interactants' power and authority; and (3) the promotion of positive and empowering narratives and self-perceptions in the process of rehabilitation/supervision.     

Predicting help-seeking behavior: The impact of knowing someone close who has sought help

ABSTRACT

Objectives: This study sought to replicate and extend research on social facilitators of college student's help seeking for psychological problems. Participants: We collected data on 420 ethnically diverse college students at a large public university (September 2008–May 2010). Methods: Students completed a cross-sectional online survey. Results: We found that students who were aware of close others' (eg, family, friends) help seeking were two times more likely to have sought formal (eg, psychologist) and informal (eg, clergy) help themselves. Tests of moderation revealed the incremental effect (ie, controlling for help-seeking attitudes, internalizing symptoms, cultural demographics) of close others' formal help seeking was strong and significant for men (R² = 0.112), while it was negligible and nonsignificant for women (R² = .002). Conclusions: We discuss the importance for students—particularly men—to learn about close others' help seeking for facilitating their own help seeking during times of distress.     

Understanding the longer-term effects of family group conferences

Few studies estimate the longer-term effects of family group conferences (FGCs), as previous research has been mainly qualitative or has focused only on the shorter-term effects of FGCs. This study analyses, using a randomised controlled design, the longer-term effects of adult FGCs in terms of social support, mental health and re-employment. A total of 149 Norwegian longer-term social assistance recipients were randomly assigned to intervention and control groups. Participants were followed up 12 months after baseline. To gain in-depth knowledge of the FGC process, 15 participants were interviewed. Despite high shares of participant satisfaction and significant shorter-term effects, the one-year follow-up identified neutral effects of the intervention. Qualitative interviews demonstrated that lack of reciprocity in social relationships and lack of follow-up were the main reasons for the stagnation of an initially positive FGC process.     

Understanding the antecedents of aggressive behavior in Persian Gulf War veterans within individual,interpersonal, and community contexts

ABSTRACT

The present study applies the social-ecological framework to examine multiple level correlates of aggressive behavior of veterans of the first Gulf War in 1991. Data were collected from the VA‘s Persian Gulf Family Support Programs (PGFSP), and the sample includes 1,519 veterans who participated in the PGFSP. At the individual level, the study finds that younger and female veterans and those with higher self-esteem were less likely to report displaying aggressive behavior. At the interpersonal level, veterans who displayed misconduct in the home are more likely to display aggressive behavior. At the community level, veterans who were in the Air Force was less likely, while those in the Marines were more likely to be aggressive. Implications for practice are discussed.     

The Role of Shame in Women's Recovery from Alcoholism

Abstract

This study compares the recovery experience of female members of Alcoholics Anonymous (AA) who reported a history of childhood sexual abuse (68%) with those who did not report experiencing childhood sexual abuse. A sample of 53 women was obtained from AA. A significant relationship was found between shame and two measures of difficulties in recovery-problems in social adjustment and relapse. Though the hypothesis that experiences of child sexual abuse predicted difficulty in recovery was not supported, these data suggest that shame may be an important variable in both the etiology and treatment of alcoholism in women.     

Improving Tobacco-Free Advocacy on College Campuses: A Novel Strategy to Aid in the Understanding of Student Perceptions About Policy Proposals

Abstract

Objective: Tobacco-control policy proposals are usually met with opposition on college campuses. Research to understand students’ viewpoints about health-related policy proposals and messaging strategies, however, does not exist. This study investigated students’ perceptions about a smoke-free policy proposal to help understand their positions of support and opposition and to inform the development of effective messaging strategies. Participants: In January 2012, 1,266 undergraduate students from a midwestern university completed an online questionnaire about smoke-free campus policies. Methods: Responses were coded and analyzed using Linguistic Inquiry and Word Count software and chi-square, independent-samples t tests, and binary logistic models. Results: Most students who supported a smoke-free policy considered environmental or aesthetic conditions, whereas most opponents used personal freedom frames of thought. Supporters viewed smoking policies in personal terms, and opponents suggested means-ends policy reasoning. Conclusions: Taken together, points of reference and emotions about proposed policies provided insight about participants’ perspectives to help inform effective policy advocacy efforts.