Community orientation of services for persons with a psychiatric disability. Comparison between Estonia,Hungary and the Netherlands

This article explores the way mental health services and social services are orientated on assisting people with a psychiatric disability to participate in different areas of community life. A large research project about community participation in three different countries (Estonia, Hungary and the Netherlands) confirms the findings of other studies that – regardless of geographical location – people with a psychiatric disability have difficulty fulfilling social roles in the community. They are often faced with fewer opportunities than other citizens, due to their health problems, stigma, discrimination and poverty [World Health Organisation. (2011). World report on disability. Geneva: WHO]. An important objective of social work is to help people find their way in society. Surprisingly enough, in all three countries, most social workers are mainly focused on solving individual problems, and not on community participation. Shifting the focus starts by having a clear awareness of the notion of community participation. Social workers have to work both on supporting individuals to find their way in the community (individual support), and on supporting social networks in the community to accommodate persons with a disability on the basis of equal and valued citizenship (community support).     

Collaborative care for individuals with bipolar disorder or schizophrenia and co-occurring physical health conditions: A systematic review

While rates of chronic physical health conditions are increasing for the general population, individuals with severe mental illness are at greater risk. Co-occurring mental and physical health conditions are associated with poor health care utilization, socioeconomic, and patient-reported health status outcomes. This study used systematic review procedures to investigate the effectiveness of collaborative care models for improving the health of adults with bipolar disorder or schizophrenia and co-occurring chronic physical health conditions. Six studies met inclusion criteria, and included outcomes related to quality of life, physical health, and mental health. Collective and study-level results are reported and discussed, including implications for social work practice and research.     

Case management for people with psychiatric disabilities in rural Sweden; experiences from the implementation of a national policy

The aim is to analyse the implementation of a case manager-model in rural Sweden. A sample of 15 case management teams was selected. Written materials were collected and interviews on location were carried out. Results: rural case managers design their work methods themselves, which entail several deviations from the national policy guidelines in this field. The case management boards have a low capacity to direct and manage the activities of the case managers. Consequently, case managers develop into ‘welfare entrepreneurs’. One salient risk is that teams become isolated from the surrounding welfare system. In conclusion, the Swedish version of case management in rural areas is a result of local processes of adaptation and negotiation that result in services that differ from those envisaged in national policy guidelines.     

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.     

Promoting choice and control in residential services for people with learning disabilities

This paper discusses the gap between policy goals and practice in residential services for people with learning disabilities. Drawing on a nine month ethnographic study of three residential services, it outlines a range of obstacles to the promotion of choice and control that were routinely observed in the culture and working practices of the services. Issues discussed include conflicting service values and agendas, inspection regimes, an attention to the bigger decisions in a person's life when empowerment could more quickly and effectively be promoted at the level of everyday practice, problems of communication and interpretation and the pervasiveness of teaching. We offer a range of suggestions as to how these obstacles might be tackled.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

A rights-based conceptual framework for the social inclusion of children and young persons with an intellectual disability

There is a basic principle that all children and young persons with intellectual disabilities should be able to enjoy citizenship on an equal basis with others. This includes enjoying personal dignity and exercising choice, control and freedom in social, community and cultural life, in keeping with their individual lifestyle preferences and aspirations. There is a need for a stronger human rights narrative to achieve this. This article identifies a conceptual framework for a rights-based approach to the integration of children and young persons with disabilities. Seven components of such a framework are identified: citizenship and social inclusion; recognition; agency; voice; capabilities; equality; and self-realisation. This framework was developed as part of an Irish case study involving consultation with young persons with intellectual disabilities, their parents or guardians and professional staff delivering support services. The rights of children/young persons with intellectual disabilities are essentially those of children generally. While this principle may be obvious in many respects, its implementation presents significant challenges. The need for a transformative narrative and its components are outlined.     

Access Barriers to Mental Health Services for Older Adults from Diverse Populations: Perspectives of Leaders in Mental Health and Aging

This project is based on the results of telephone surveys with 52 local, state, and national informed respondents including policymakers, county leaders, planners, and advocates in mental health and aging with a particular focus on the states of California and Florida. This article addresses challenges to access to mental health services for diverse older adults including barriers related to race and ethnicity, socioeconomic status, location, age, gender, immigrant status, language, sexual orientation, and diagnosis. The article also highlights broad themes that emerged including (1) the importance of outreach and transportation tailored to diverse elders, and (2) recruitment of diverse staff and training related to diversity. The article concludes with policy and practice recommendations to reduce these disparities in access to mental health services for diverse populations of older adults.     

Learning how to be (a) patient: visual analysis of accessible health information leaflets for people with intellectual disabilities

Creation of jargon-free Easy Read health texts, incorporating carefully chosen words and images, is promoted as a way of removing health access barriers for people with intellectual disabilities. Using a social semiotic framework, this article explores the social construction of the patient with intellectual disabilities within a sample of adapted health texts, focusing on the visual images used. Images were coded and analysed according to dimensions suggested by Kress and van Leeuwen’s work on ‘visual grammar’. Images highlight the inclusion of patients with intellectual disabilities in mainstream healthcare settings. However, these patients are depicted as being inserted into somewhat idealized healthcare routines that are pre-determined and micro-managed through to completion. Consideration of risks and choices associated with healthcare use are downplayed. The article concludes that the care of patients with intellectual disabilities continues to constitute potential trouble for mainstream healthcare providers, rather than being an expected aspect of everyday practice.     

Perceived need for care and mental health service utilization among college students with suicidal ideation

ABSTRACT

Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Results: Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Conclusions: Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.     

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

Outcomes of a model care coordination program for adults with mental illness under guardianship/conservatorship

Adults with serious and persistent mental illnesses, such as schizophrenia, schizoaffective disorder, and bipolar disorder, who are under guardianship/conservatorship, may experience health care, social, financial, and housing concerns, which can be addressed by care coordination programs. In such programs, providers assist with communication across service sectors, assistance with monitoring of psychiatric care, and support with practical needs. Such programs are understudied in the context of guardianship/conservatorship. Through a review of electronic records for 217 consumers who were enrolled in a model program continuously for 3 years or more, we examined trends before and after enrollment in a model care coordination program for adults with serious and persistent mental illnesses under guardianship/conservatorship. We sought to describe the number of days and rates of hospitalization, emergency room visits, and arrests before and after receiving program services. Comparing utilization among consumers three years pre- to three years post-enrollment, we identified statistically significant reductions in hospitalizations and imprisonment, but no change in state hospitalizations. We also saw some (non-significant) reduction in emergency room visits. Findings provide preliminary evidence of effectiveness of the model program; future efforts could expand its reach to more adults with serious and persistent mental illnesses.     

A Social Constructivist Perspective on the Potential Relevance of Selected DSM‐5 Disorders for South African Children and Youth

In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM‐5 category changes — regarding post‐traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post‐colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.     

Examining the impact of social media on mood and body dissatisfaction using ecological momentary assessment

Abstract

Objective: To assess the effects of social media consumption on body dissatisfaction and negative affect using ecological momentary assessment, a method of assessment over time in the participants’ naturalistic environment. Participants: Woman college students (N?=?30) from a large public university participated in the study in Fall 2015. Methods: Participants were contacted via their smartphones five times per day for five days and asked to complete a battery of measures which assessed social media use, body dissatisfaction, and negative affect. Results: Results demonstrated that the number of social media sites visited was a significant predictor of body dissatisfaction while time spent using social media was not. The number of sites visited and time spent on social media were both significant predictors of general negative affect, sadness, and guilt. Conclusions: Results demonstrate the negative impact that social media use can have on body dissatisfaction and negative affect.