Teaching and Providing Recovery-oriented Care Through Problem-posing Dialogue

As the recovery paradigm proliferates throughout systems of mental health care, social workers are being required to provide recovery-oriented services. Yet there has been little discussion about what changes need to be made in social work education to produce recovery-oriented social workers. This article uses Paulo Freire's theory of pedagogy to help social work educators understand how they can develop problem-posing relationships with their students in order to teach students about the relationships that social workers ought to have with people in recovery.     

精神残疾群体的社会保障需求与供给:现状、问题与发展建议

精神残疾人多生活困难,构成社会最为弱势的群体。本文采用实地研究与文献研究的方法,对精神残疾人的社会保障需求与供给进行专门考察。研究发现,精神残疾群体的主要需求包括治疗、基本生活支持、康复、长期照护与监管以及社会参与。对此,我国政府已通过多项社会保障制度安排予以回应,基本满足了精神残疾人的基本生活与治疗需求,但还存在社区康复服务匮乏、替代性照护服务供给不足、就学、就业难等问题。基于以上发现,本文认为精神残疾人的基本生存权虽得到较好保障,但是对其发展权和参与权依然关注不足。原因在于当前精神残疾人社会保障存在三个不平衡:经济保障与服务保障发展的不平衡,医疗服务与社会服务发展的不平衡,以及卫健、民政、残联不同部门能力与投入的不平衡。针对这些问题,笔者对未来政策的完善提出了参考建议。     

Ancient Greek psychotherapy for contemporary nurses

Ancient Greek physicians as well as philosophers were fully cognizant of a human being's psychological function and used their particular art to influence individual or social behavior in accordance with their pursuit. This art or technique favorably compares with several of the methods currently called supportive psychotherapy. This psychotherapy was the first form of care for people with mental health problems. Nurses who base their practice on ancient Greek psychotherapy see the patient as a whole, a person who creates meaning in life. Applying the philosophical principles of ancient Greeks helps nurses understand the behavior of people with mental health problems and recognize and facilitate adaptive satisfaction of these psychological needs. In addition, psychiatric nurses are able to help distressed individuals understand their fears and anxieties, so they are freed from the causes of their symptoms that led them to seek therapy in the first place. Consequently, this understanding can make psychiatric nurses' work a living experience and add meaning to their work.     

Looking Forward Not Looking Back: The Evaluation of Community Living

This article outlines the development of evaluative methods within the field of mental handicap services. It suggests that evaluators have too often taken for granted the tacit assumptions underlying service models, using these to determine the criteria for evaluating success. It argues that evaluators should be more explicit about the values they adopt, and what patterns of life services should be enabling people to achieve. By more closely linking evaluation criteria to what people with a mental handicap should achieve, evaluation can become more effective in promoting positive change in service models. The article describes an approach developed by the authors for the evaluation of the 'All-Wales Strategy for the Development of Services for Mentally Handicapped People'.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

Personality, Negative Interactions, and Mental Health

Research suggests that an individual's personality traits may mediate the relationship between social support and mental health. This study uses two national data sets to test a conceptual model that integrates personality, social support, negative interactions, and psychological distress. Results suggest that, beyond the influence of personality, social support is negatively associated with psychological distress, and negative interactions are positively associated with such distress. The findings also suggest that personality has direct and indirect effects, through social support and negative interactions, on psychological distress. Findings specify how positive and negative facets of relationships and personality influence mental health outcomes.     

Mental health, social relations, and social selection: a longitudinal analysis.

A wide body of literature documents the effect of social networks and social supports on mental health. Fewer studies, however, have examined the reciprocal effect of mental health on social relationships. This problem is examined using data from a national panel survey of adults aged 20-64. For the sample as a whole, support was found for a social selection process, since psychological distress predicted decreases in primary, but not secondary, social relationships. The extent of primary relationships also were found to be associated with subsequent distress, providing evidence that the relationship between mental health and social environment may be transactional. When examined separately by gender, males but not females were found to be vulnerable to the process of social selection, supporting the hypothesis that the expression of distress is less role-appropriate for men and therefore more likely to invite social sanctions. Social causation effects also were observed only among males.     

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.     

Social Class and the Prevalence of Handicapping Conditions

A series of hypotheses concerning relationships between age, sex, social class and the prevalence of handicapping conditions were developed and tested against the data from two large British cross-sectional surveys. The data showed that, as predicted, the prevalence of handicapping conditions was most strongly associated with indicators of social class among the middle-aged and that class related differences on physiological and lifestyle health indicators occurred at an earlier age than differences in the prevalence of handicaps. The relationship between social class and handicap prevalence was found for a variety of types of handicap. One interpretation of the pattern of relationships between indicators of social class and the prevalence of handicap in different age groups is that the risk of experiencing a handicapping condition is affected by long-term environmental effects associated with class. The methodological limitations of cross-sectional surveys in relation to propositions about causality are discussed.     

The school-to-work transition of people with mental handicap in Hong Kong

The purpose of this study was to examine the school-to-work experience of people with mental handicap in Hong Kong. Fourteen young adults with mild mental handicap participated in in-depth interviews. An interview guide was utilized which included topics related to the participants' vocational preferences, work motivation and post-school placements. Data were analyzed according to a constant comparative method and content analysis. Three-quarters of the participants expressed job preferences. Three-quarters of the participants had taken a vocational training program unrelated to their job preferences. Half of the participants who had taken up open employment had not obtained their preferred jobs. None of the participants who had completed vocational training obtained job placements that matched their vocational training programs. All of the participants except five were not involved in making independent decisions regarding employment. The need to improve the quality of vocational services and empower people with mental handicap to take up self-determining roles are discussed.     

Do People with a Mental Handicap Have Rights?

The notion of 'rights' in relation to people with a mental handicap has become increasingly fashionable in policy statements in Britain and elsewhere. However, the concept has rarely been used in a clear way, and the application of it has been weak. This article distinguishes between 'claim rights' and 'moral rights' and relates each to specific discriminatory domains. It is argued that in Britain, people with a mental handicap are routinely denied both types of rights, and that this is a sobering context within which to set policies structured upon 'normalisation' principles. It is suggested that more conceptual analysis is needed, alongside a clearer commitment to enforcement through a code of practice and the application of adult rights.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Are attitudes to people with learning disabilities negatively influenced by charity advertising?

This paper investigated the hypothesis that the images presented by charity posters can have an effect on attitudes towards those that they portray. Ninety-nine school-children were shown one of two MENCAP posters; one from a much-criticised campaign in the 1980s and one a poster from the 1991 campaign. Subjects who saw the older poster were more likely to report that it made them feel pity and guilt, and were less likely to agree that people with a mental handicap are able to care for themselves. However, subjects did not differ significantly on how likely they would be to donate money to the charity on seeing the poster. These results suggest that it is possible to present a positive image whilst still encouraging the possibility of donation. The implications of these findings are discussed.     

'Talking to Top People': Some Issues Relating to the Citizenship of People with Learning Difficulties

The author discusses the citizenship of people with learning difficulties (mental handicap). Whilst there is evidence that people with learning difficulties can develop the skills required of 'active citizens', there are many socio-structural and ideological barriers to the exercise of full citizenship rights by people with learning difficulties. In addition, the citizenship claims of other groups, particularly women, are likely to be in conflict with the citizenship claims of people with learning difficulties. These issues are discussed. Finally some suggestions are made for policy changes which can promote the citizenship of people with learning difficulties.     

Psychiatrist–consumer relationships in US public mental health care: consumers’ views of a disability system

The US public mental health system is a disability system. By this is meant that public programs for people with mental illness serve consumers who are seriously and chronically ill, functionally disabled and eligible for benefits by virtue of their disability. This study explores, through focus groups and qualitative data analysis, the perceptions of these consumers of their relationships with public sector psychiatrists. Thematic analysis finds relationships of three types – compliance, collaboration and contention – and constituent sub‐themes that specify these further. Issues of poverty and powerlessness arise in every category, but especially in contentious relationships. Although the converse is widely believed to be true, this paper argues that the economic and political empowerment of people with psychiatric disabilities is vital to the success of their clinical care     

Resilience as Reflexivity: A New Understanding for Work with Looked-After Children

This article argues that the current model of resilience in the social work literature, through its predominant focus on outcomes and behaviours rather than the underlying processes of development involved, risks superficiality and appears to lack an underpinning psychological theory of the way in which resilience develops. In response, I propose a psychodynamic understanding of this process, which sees resilience as rooted in the capacity for reflexivity (defined here as an awareness of one's own mental state and the mental states of others), and which describes how this capacity develops. This holds that a strong-enough ego, with the capacity for resilience-as-reflexivity, is the necessary precursor of the child's ability to make use of positive experiences. This psychodynamic understanding of resilience development aims to give social workers a greater appreciation of how the mental health of children in the care system may have been affected by their experiences, and how they can be helped to develop the psychological foundations of resilience and therefore better mental health. I suggest that workers can use this understanding to assess the stage of resilience-development a child has reached, and to inform therapeutic work aimed at strengthening their resilience.     

A multimodal intervention for grandparents raising grandchildren: results of an exploratory study

This article describes the results of an exploratory study of a multimodal, home-based intervention designed to reduce psychological stress, improve physical and mental health, and strengthen the social support and resources of grandparents raising grandchildren. The six-month intervention included home visits by registered nurses, social workers, and legal assistants; the services of an attorney; and monthly support group meetings. The intervention resulted in improved mental health scores, decreased psychological distress scores, and increased social support scores. Participants also experienced improvement in the level of public benefits received and in their legal relationships with their grandchildren. Implications of these findings for practice are highlighted.     

Sexuality and mental handicap

Abstract

In the twenty years since the appearance of Janet Martinson's important and immensely readable book, many wide-ranging changes have taken place in the field of mental handicap. These changes have had important consequences for the way in which we now discuss sexuality in relation to people who have a mental handicap or learning difficulties.     

Social work and resettlement

Summary

This paper describes counselling in a social work agency that provides hostel accommodation for single homeless women, and works to resettle them into permanent accommodation. Given that the Barclay Report described the practice of social work as made up of the two elements of counselling and social care planning, the paper explores the way counselling is influenced when carried on in an agency with a specific ‘social care’ function. This is contrasted with counselling in agencies that offer a counselling service alone. Examples will be given of people using an attachment to a hostel, and to a worker, as they cope with change and make psychological growth. The power of such workers can only be exercised if they are true to the agency function, and gear their interventions to the task of resettlement. If workers do this they may find that as well as resettling people into accommodation, they are resettling them into life.     

Survival and Abuse: What We Can Learn From It

This article is about a journey involving survival, abuse and learning. It is written by two people who have considerable experience of being involved with mental health services; both are currently making an active contribution to social work education. It describes the way in which, in situations of survival and abuse, service users can use their experience and knowledge to learn how to support and advocate for each other. It suggests that the relationships that are built between service users as a result of these experiences can be used to address some of the gaps in service provision. At the same time these relationships can provide mutual learning which can be used to improve the education and training of social workers and other professionals.