Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

‘Not a good person’: family stigma of mental illness from the perspectives of young siblings

The purpose of this paper is to critically examine family stigma as one form of the stigma of mental illness in child and youth mental health. Presented are the outcomes of a thematic content analysis of in‐depth, semi‐structured interviews conducted with seven (n = 7) young siblings, ages 13 to 21 years old, with a brother or sister identified as having a mental‐health issue. The focus of the interviews was on the ways the siblings experienced their other sibling's mental health and how those experiences shaped their sense of self and family. From the analysis, young siblings had predominately negative experiences, struggled with making sense of their brother or sister and the family as ‘flawed’ against the mental illness as ‘bad’ and experienced considerable family stress and overt family stigma. Current practice theories fail to consider the complexity of these factors and, in doing so, fail to adequately explain the nature and extent to which stigmatization occurs for immediate family members. The importance of peer support and understanding stigma in social work practice with children and their families is discussed.     

Mothering after child removal: Living under the rule of Greek gods

Many women who experience mental illness are mothers. Evidence suggests that the role of mother is of great importance and value to these women, yet they are more likely than other women to have their children removed from their care. Little is known about the experiences of these mothers after their children are removed. This paper presents a phenomenological analysis of in‐depth interviews with 8 women to answer the following question: How do mothers living with severe mental illness experience mothering after removal of their children by child protection services? The analysis showed that mothering continued to be a major life role for these women, but the way they enacted this role was transformed. Their mothering was now constrained and prescribed by external agents, likened to Greek gods, which imposed both boundaries to what they could do and an obligation to prove themselves worthy. Like Greek gods, these external agents were seen as all powerful, unpredictable, and flawed. The study highlights the need for child protection services and support services to recognize and support noncustodial mothering activities.     

Poverty,Partner Abuse,and Women's Mental Health: New Knowledge for Better Practice

ABSTRACT.

To better understand how poverty and poor mental health impact women who are abused by intimate partners, a convenience sample of 300 abused women using shelters or justice services for the 1st time were interviewed. The 300 women were categorized as having no income, being above poverty, and being below poverty according to U.S. Poverty Guidelines. Results indicated that no direct effect of income on poor mental health was noted; however, an interaction between type and severity of abuse and income level had an impact on poor mental health. Abused women who were above poverty with the highest incomes reported the highest levels of depression in the presence of high physical and sexual abuse. In contrast, women reporting no income reported no significant effect of severity or type of abuse on depression scores. Women just above the poverty level who experienced severe abuse were at highest risk for mental health problems. Poverty impacts the mental health of abused women according to the degree of poverty and type and severity of abuse. More research is needed to specify programs to maximize the mental health functioning and economic solvency of abused women.     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

Gaining knowledge about parental mental illness: how does it empower children?

This study examined the utility of a digital video disc (DVD) intervention, designed to educate children, whose parents have depression and/or anxiety. Twenty‐nine children completed pre‐ and post‐DVD exposure questionnaires, on mental health knowledge and help seeking, and 18 were interviewed about their experiences and use of the DVD. Post‐DVD, children's knowledge of mental illness improved. The DVD also challenged mental illness misconceptions. Most children preferred watching the DVD with a parent. The study explains how children utilize information about mental illness.     

“It's hard work,believe me!”: Active efforts to optimise housing by people who live with mental illness and access housing assistance

Secure and appropriate housing is critical for the well‐being of people living with mental illness (consumers). Yet it is often difficult to achieve. Housing assistance is available, but is often difficult for consumers to access and negotiate. While the need for support is well‐recognised, little is known about the active part consumers play in finding and keeping appropriate accommodation. This paper addresses the research question: How do consumers who use housing assistance actively manage their housing situations? In‐depth interviews were conducted with 18 consumers who had used housing assistance within the past five years. These were analysed using constant comparative analysis, based on a grounded theory approach. Participants engaged in a range of activities to address six major concerns: working toward my home; following the rules to keep what I have; managing and improving my accommodation; working with housing services; living within my current situation; and finding and using supports. All participants described times when their mental health negatively affected their ability to do these activities. The findings highlight the need for housing services and mental health services to collaborate to develop policies and protocols that place reasonable demands on consumers and support their abilities to actively manage their housing situations.     

Schizophrenia: The Impact of Parental Illness on Children

This research sets out to discover what impact parental schizophreniamakes on a child’s life. It focuses on the daily lifeand experiences of children. Their health, education, familyand leisure activities are examined. Contact with helping agenciesand their unmet needs are investigated. The sample was drawnfrom the children of patients attending the mental health servicesin South West Dublin. They were matched with a control groupof children of well parents. The majority of children who haveone parent with schizophrenia had similar profiles to the childrenof well parents in the areas of physical health, positive familyfeelings, friendships, hobbies and household tasks. In a numberof other areas, however, differences were found. Sample childrenhad more psychiatric disturbance, more problems associated withschool, less contact with relatives and spent more time at home.The children had little access to services and were upset byhospital visiting. The need for an educational programme andsupport for these children was demonstrated. It is recommendedthat a more co-ordinated approach is required by both adultand child mental health services in order to meet their needs.     

“The Wisdom of Age”: Perspectives on Aging and Growth among Lesbian Older Adults

Older lesbian-identified women are a health disparate yet resilient population about whom knowledge is limited and emerging. Among the areas in need of research are older lesbians’ experiences of later life and stress-related growth. This article presents the findings from a qualitative study that investigated older lesbians’ experiences of adversity and adaptation as they age. In-depth, exploratory interviews were conducted with 12 lesbian-identified women who were between the ages of 65–80. This study applied grounded theory methodology to identify respondents sources of stress and fear, their strengths and coping strategies and how those relate to each other and to their growth in later life. We advance a model of adaptive change that shows how spirituality, social support, and resistance to cultural norms help older lesbian adults cope with loss, illness, and discrimination and develop wisdom in later life. Knowledgeable practitioners can help older lesbian women identify and maintain sources of social support, explore spirituality, and facilitate continuous growth through the end of life. Social workers can advocate for services that are welcoming and affirmative so as to reduce fears of isolation and dependence associated with health decline.     

Adult children of parents with mental illness: navigating stigma

The experiences of children who live with parental mental illness are becoming increasingly recognized. However, there remains a limited body of knowledge in relation to an individual's longer term experiences. This study sought adult children's experiences of childhood parental mental illness. It generated reflections of 13 adult children who had lived with parents with mental illness during their childhood. The narrative design of the study facilitated a voice for participants. The paper presents one main theme of the findings. The findings offer a unique insight into childhood awareness of social stigmas and children's behavioural changes to avoid disclosure of parental mental illness. Participants noted that they were aware of social stigmas associated with mental illness during their childhood. This contributed to their fear of disclosure to others that fuelled a culture of familial secrecy, reinforcing the children's own sense of difference. Further work is required to enhance community understanding about the familial journeys of parental mental illness and the impact of negative‐natured stigmas.     

Serving Former Foster Youth and Homeless Students in College

ABSTRACT

Many universities have developed campus support programs for former foster youth and homeless college students; however, there are no studies focusing on long-term programs in the college-setting with a mentoring component that focuses on developing relationships with supportive adults. To address the gap, this study examined both mentors' and program staff's experience with providing services to students in a campus support program. The authors collected qualitative data from one success coach (i.e. program staff) and eight mentors through focus group meetings and interviews. Results indicated that the success coach reported the students in the program improved their overall academic performance, while most mentors did not know their mentees' grades. The success coach coordinated most services of the program, assigned financial and academic support, and made service referrals. Mentors helped their mentees to improve academic and independent living skills. However, mentors reported that they received limited support, especially when working with mentees with mental health problems. Recommendations to improve the program include: using a multidisciplinary team for students with mental health problems and adopting systematic approaches to better support mentors' services. Future studies should go beyond program staff and mentors to include students' perspectives regarding their experiences with receiving mentoring services.     

Practice challenges at the intersection of child protection and mental health

This paper examines the complexity of collaboration between child protection and mental health services, where a parent has a mental illness and there are protection concerns for children. The paper reports on data from focused in‐depth interviews with 36 child protection workers, adult mental health workers and child and youth mental health workers. Data were analysed thematically, using NVivo to facilitate data management and analysis. Two dimensions were identified. The first, the process of collaboration, relates to four factors that assisted the collaborative process: communication, knowledge, role clarity and resources. The second dimension considers the challenges presented to collaborative work when a parent has a mental illness and a child is in need of protection, and identifies issues that are inherent in cases of this kind. Two types of challenge were identified. The first related to characteristics of mental illness, and included the episodic and/or unpredictable nature of mental illness, incorporating information from psychiatric and parenting capacity assessments, and the provision of ongoing support. The second type of challenge concerned the tension between the conflicting needs of parents and their children, and how this was viewed from both the adult mental health and the child protection perspective. Implications for policy and practice are identified in relation to the need for service models that provide ongoing, flexible support that can be intensified or held back as needed.     

Treatment Barriers to Social and Health Care Services from the Standpoint of Female Substance Users in Finland

Abstract

This qualitative study discusses barriers affecting female substance user’s treatment access to welfare services. The study consisted of seven group discussions and three individual meetings with 13 women in Helsinki, Finland. Institutional ethnography was used as the theoretical framework for the study. The research questions are: (a) What treatment barriers do women face?, (b) What reasons are there for them not receiving services?, and (c) How do the ruling relations coordinate women’s experiences? Women faced multiple barriers affecting their access to services. They could be interpreted as being: determined by the service system, such as a difficulty in meeting the various criteria in order to be granted access to services; determined by the lack of trust; or determined by personal choices. The study suggests that the service system should be organized according to the needs of the service users. Future research is needed to address the questions such as how social and health care services could better co-operate, and how the different sectors of the service system could break down the institutional barriers.     

Enriching our understanding of vulnerability through the experiences and perspectives of individuals living with mental illness

ABSTRACT

Vulnerability is a central concept in research ethics and typically serves to identify individuals or groups whose participation in research prompts specific concerns or warrants special consideration. While theoretical discussions on vulnerability have contributed valuable insights to discussions of mental health research and care, they have not been enriched thus far by stakeholder perspectives. This oversight has important consequences for the ways in which we frame vulnerability. It misses the far-reaching insights and experiential knowledge of mental health research participants whose experiences this ethics concept ultimately seeks to capture. In view of this gap, our study combines a pragmatist ethics framework and interpretive phenomenological analysis of qualitative interviews to explore user perspectives on the notion of vulnerability through the lived experiences of mental health research participants and patient-advocates. Importantly, these perspectives offer essential clues to address the difficulties of operationalizing concerns for vulnerability in concrete and practical ways. They help refine our understanding of this key ethics concept.     

Differences by Race in Social Work Students’ Social Distancing,Treatment Options,and Perceptions of Causes of Mental Illness

ABSTRACT

Research has shown that racial and cultural differences are related to the degree of social distancing associated with mental illness, beliefs about what causes mental illness, and what treatment options are best; however, there is little information on how this may manifest in social workers’ perceptions of these issues. This cross-sectional survey analyzed the differences in perceptions by race of 835 students enrolled in social work classes in the United States. Results indicated that individuals who self-identify as African American/Black expressed the greatest social distance concerning mental illness. Whites were most likely to endorse the use of medication and were least likely to normalize mental illness. The most frequently endorsed mental health provider varied according to racial/ethnic groups. Our findings show that future research may be needed to further investigate the conceptualization of the role of social work among different groups. The need for self-reflection and keeping biases in check are discussed as implications for social work practice and education. Suggestions for working with diverse clients, including religious diversity, are offered as well.     

Racial Differences in Attitudes Toward Professional Mental Health Treatment: The Mediating Effect of Stigma

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.     

Incremental Validity of Stressful Life Experiences in Predicting Psychiatric Comorbidity Among Women in Substance Abuse Treatment

ABSTRACT

The dynamic contribution of stressful life experiences in predicting psychiatric comorbidity continues to challenge clinical practice and research. This study tested incremental validity of stressful life experiences related to psychiatric comorbidity among 128 young women in a Midwestern substance abuse treatment facility. Respondents reported low income, homelessness, and health and mental health issues. Using the Addiction Severity Index (ASI), Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision, and Stressful Life Experience (SLE) Screen as correlates, hierarchical linear regression demonstrated support for incremental validity of SLE uniquely accounting for 6.5% of variance in ASI psychiatric scores. Findings support future use of SLE in clinical settings for assessment and intervention purposes.     

Psychological distress among women who were sexually abused as children

One of the aims of the study was to investigate how participants in self‐help groups (SHG) for women (n = 87) who had been sexually abused in childhood rated their mental health and to what extent they were at risk of developing posttraumatic stress disorder (PTSD). A further aim was to investigate the relationship between the ratings of mental health, occurrence of PTSD, women's interpersonal relationships, reasons for participating in an SHG and characteristics of the childhood sexual abuse (CSA). The participants completed questionnaires regarding their personal relationships, reasons for joining a group, abuse characteristics, mental health (Symptom Checklist‐90‐Revised) and PTSD (Impact of Event Scale‐Revised). The women showed poor mental health, and more than half of them were at risk of developing PTSD. Lack of social support and feelings of shame correlated with poor mental health, whereas guilt did not. Relationships with female friends had a positive association. Further research is needed to determine whether participating in an SHG could provide adequate social support and reduce feelings of shame, thereby contributing to the healing process in the aftermath of CSA. Key Practitioner Message: ? Child abuse is a significant component of the global burden of disease; ? Both social workers and public health care providers meet sexually abused girls and it is important that they have knowledge about the subject; ? An important clinical implication for adequate treatment would be to assess and recognise childhood sexual abuse and to link diagnosis to trauma.     

Are the Homeless Mentally Ill?

In Australia, it is widely believed that most homeless people have mental health issues and that mental illness is a primary cause of homelessness. This paper uses information from a study of 4,291 homeless people in Melbourne to investigate these propositions. The research found that 15 per cent of the homeless had mental health issues prior to becoming homeless. This challenges the community perception that mental illness is the primary cause of homelessness. The research also found that 16 per cent of the sample developed mental health issues after becoming homeless. Homelessness causes mental health issues for some people, particularly anxiety and depression. The claim that most homeless people are mentally ill sends the wrong message to policy makers about the services that are needed to assist homeless people.