Family separation and refugee mental health–A network perspective

How do the structure and relational features of family networks affect refugees’ mental health after migration, particularly when refugees are geographically separated from their family? Using the first wave of the IAB-BAMF-SOEP Survey of Refugees, which is representative of the population of refugees who arrived in Germany between 2013 and 2016, this study finds that the size of the nuclear family has a significant positive relationship with refugees’ mental health, whereas family separation has a significant negative relationship. In addition to members of the nuclear family, only fathers show a significant positive correlation with refugees’ mental health. The structural and relational aspects are discussed in light of health literature focusing on migration stressors and their relationship with mental health as well as in the context of changing family reunification policies in Germany amid the increase in immigration of refugees since 2015.     

Role sequencing: does order matter for mental health?

Role sequencing refers to the ordering of social roles. According to the normative order hypothesis, adults who follow a certain sequencing of their social roles will be better adjusted than their peers who follow other life course patterns. The normative order is defined as first entering the paid labor force, getting married, and later having children. This study tests this hypothesis by analyzing retrospective life history data from three subsamples of adults who completed the 1987--1988 National Survey of Families and Households: (1) married, working parents; (2) divorced, working parents; and (3) married, unemployed parents. The findings indicate significant race/ethnic (black/white), gender, and cohort differences in the type of role sequencing patterns that are conducive to positive mental health. For example, African Americans who work first, then have children, and later get married report better mental health than their peers who followed the normative order White men and women seem to benefit from following the normative course of role transitions. Among women, however, the psychological benefits of following typical life course patterns are especially evident among those born during the baby boom.     

Coping with perceived discrimination: does ethnic identity protect mental health?

Using data (N = 2,109) from a large-scale epidemiological study of Filipino Americans, this study examines whether ethnic identity is linked to mental health and reduces the stress of discrimination. The strength of identification with an ethnic group is found to be directly associated with fewer depressive symptoms. In other words, having a sense of ethnic pride, involvement in ethinic practices, and cultural commitment to one's racial/ethnic group may protect mental health. Self-reports of racial/ethnic discrimination over a lifetime and everyday discrimination in the past month not due to race/ethnicity are associated with increased levels of depressive symptoms. Yet ethnic identity buffers the stress of racial/ethnic discrimination. This suggests that ethnic identity is a coping resource for racial/ethnic minorities that should not be overlooked. The strong link between ethnic identity and better mental health has implications for social-psychological theories on race/ethnicity and assimilation in the United States.     

How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

On being unreasonable in modern society: are mental health problems special?

There are many grounds for arguing that people with a range of disabilities have more in common than they have differences. However, those grounds to date have not resulted in a unified social movement. This paper examines one possible reason for that lack of unity: the particular force of being unreasonable in modern society. However, being unreasonable is not limited to those with a psychiatric diagnosis, nor does a lack or loss of reason take a simple common form within that group: it is a highly nuanced and context-specific matter. This complexity is discussed in relation to a set of inter-related questions about legalism, morality and post-enlightenment concerns with order and rationality. The paper concludes with a discussion of scenarios available to new social movements concerned with disability.     

The new mentality: Youth–adult partnerships in community mental health promotion

Youth–adult partnerships (Y-APs) engage young people in meaningful community activity and in the institutions and decisions that affect their lives. The current study is an examination of the process of The New Mentality, a multi-site pilot program intended to mobilize Y-APs to raise community awareness of child and youth mental health, reduce the stigma surrounding mental illness, and advocate for a mental health service system that is more responsive to the needs of children and youth. Data were gathered through individual interviews, focus groups, observations, and questionnaires with youth and adult stakeholders at various levels of the project. A number of themes emerged from the data. These included the critical nature of relationships youth experienced, the cultural differences and advocacy opportunities presented in the child and youth mental health system, the program's level of structure, and individual learning and knowledge sharing.     

Outcomes for the sociology of mental health: are we meeting our goals?

In this paper I argue that a fruitful discussion of the choice of outcomes in the sociological study of the social antecedents of mental health problems would benefit from a consideration of the goals that we are trying to achieve. The most clearly articulated goal is that of uncovering those aspects of society that produce harm. I examine the premises of the current conceptual framework--the stress paradigm--in light of its ability to fulfill this goal, and I discuss the implications for the types of outcome measures we use.     

Evaluation in the community mental health centers program: A bold new reproach?

The Federal Community Mental Health Centers Program (CMHC)-from 1963 to 1981-was heralded as a revolution in mental health care. Championed by many, and severely criticized by others, the actual impact of the program on the nation's mental health remains unclear. The authorization to evaluate the CMHC Program came originally from congressional legislation (PL 90-174), and later from the policies and regulations of NIMH under a series of Federal laws, notably PL 94-63. From 1976-1980, two dominant evaluation strategies were prevalent: funds expended by NIMH each year for studies of CMHC services or program-wide evaluations, and a much larger expenditure by CMHCs to conduct their own, independent evaluations following federal guidelines. As the Center's Program was turned over to the states in the form of block grants (PL 97-35), a group of professionals involved with setting and carrying out federal CMHC evaluation policy of both varieties met in public forum to debate the impact of these two evaluation approaches. While some participants cited gains in evaluation technology and impact upon local management of CMHCs, others found the lack of a coordinated and systematic approach to evaluating the CMHC Program to have been an opportunity missed. The impact of CMHC evaluation efforts are also discussed in terms of their major contribution to the field of evaluation research as a whole.     

Are case management services associated with increased utilization of adolescent mental health treatment?

Retention in treatment is one of the strongest predictors of positive mental health outcomes. Adolescents, however, are particularly challenging to retain in mental health treatment. Concurrent case management services may offer one strategy for retaining youth in mental health treatment as it aims to reduce barriers to services, coordinate multiple services, and establish a consistent relationship between each client and a single contact person. This study combines three extant data sources from the state of Kansas to examine whether youths' participation in case management is associated with increased utilization of individual and group mental health treatment, controlling for client satisfaction, severity of mental health symptoms, and demographic factors. Linear regression results indicate that participation in case management services predicts increased utilization of both individual and group mental health treatment. Case management may be a useful tool for retaining adolescent clients in mental health services. Practical implications for community mental health service delivery are discussed.     

What is the role of e-technology in mental health services and psychiatric research?

In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.     

From pathology to postmodernism: a debate on ‘race’ and mental health

This article suggests that ‘race’ and psychiatry are inextricably linked and as such ‘mental illness’ constitutes a precondition of black people's psyche. Postmodernist and poststructuralist analysis are used to question the way in which mental health problems have been socially constructed in western psychiatry. In order for health and social care workers to effectively respond to racism within psychiatry and community care provision it is necessary for them to understand the relationship that exists between and informs ‘race’ and psychiatry.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Who is accessing family mental health programs? Demographic differences before and after system reform

Childhood mental health disorders are on the rise in the United States. To ensure equitable access to care, it is important to examine the characteristics of children and families who access services. This study compares the demographic characteristics of two samples of families who participated in National Institute of Mental Health-funded studies of a Multiple Family Group model, entitled the 4Rs and 2Ss Multiple Family Group (4Rs and 2Ss) in New York City. One sample is currently receiving services, and the other received services a decade ago. Significant differences in demographic characteristics were found between the two samples pertaining to child race, child nativity, caregiver age, primary caregiver, caregiver marital status, caregiver race, caregiver education, caregiver employment, and family income. Families currently engaging in the public mental health service system are primarily White, and are less disadvantaged than families a decade ago. These differences are examined in light of changing policy and epidemiological trends, and potential unintended consequences 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.     

Harmonizing databases? Developing a quasi-experimental design to evaluate a public mental health re-entry program

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007-2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.     

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) who had been placed in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9–12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR = 2.50, p = .06) and/or educational (OR = 3.54, p = .04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.