Mental health and wellbeing of care leavers: Making sense of their perspectives

Despite considerable quantifiable data about the circumstances of care leavers in the United Kingdom, there is less qualitative data about how these circumstances are experienced. This article is underpinned by positioning theory, with a particular focus on the unfolding personal narratives of young care leavers in relation to their mental health and wellbeing and the role of a life‐skills programme in supporting them in this respect. The research illustrates that leaving care projects, such as the one in the current study, are more focused on employment and housing issues than on addressing the mental health and wellbeing needs of young people. Our analysis of interviews with young people illustrates the ambiguity of understandings of concepts such as “mental health” and “wellbeing,” and the complexity of responses to questioning around this area. This illustrates one of the major problems in evaluating the outputs and outcomes of such projects in terms of simplistic targets, where mental health and wellbeing are not clearly defined or understood by young people themselves. The current research provides a more complex picture. More research is needed that involves in‐depth and longitudinal assessment of specific mental health needs of care leavers and how they can be addressed successfully.     

Applying the international wellbeing index to investigate subjective wellbeing of New Zealanders with European and with Maori heritage

Abstract

The International Wellbeing Index (IWI), a global measure for investigating subjective wellbeing, consists of a Personal Wellbeing Index (PWI) and a National Wellbeing Index (NWI). The index is applied to the two largest ethnic populations in New Zealand—New Zealanders with European heritage and New Zealanders with Maori heritage. Psychometric characteristics of the IWI for both subsamples compare favourably to those found in other countries. However, for both subsamples, the absolute value of reported subjective wellbeing is lower than expected. Consistent with other social indicators, New Zealanders with Maori heritage show even lower values of PWI and NWI than New Zealanders with European heritage.     

Two‐dimensional mental health and related predictors among adolescents in Korea

This study examined whether the factor structure of mental health consists of two dimensions (positive and negative mental health) and whether the two dimensions are associated with different predictors. For this purpose, data from the 471 adolescents who participated in the 2012 Children Supplementary Survey of Korean Welfare Panel Study were used. Confirmatory factor analysis indicated that the two‐factor correlated model fits the data significantly better than the one‐factor model. Multivariate analyses revealed that factors associated with positive mental health differ from factors associated with negative mental health. These findings suggest that mental health professionals should consider the dual structure of subjective well‐being and suicidal ideation in the process of assessment and intervention.     

Multiple assessors of child welfare youths' mental‐health functioning: comparing perceptions of adolescents,caregivers and teachers

For youth involved with the child welfare system, accurate assessment of mental‐health functioning is a critical factor in case planning. To assess correspondence among multiple reporters of child welfare youths' mental‐health difficulties, this study, using data drawn from the National Survey of Child and Adolescent Well‐being dataset, examined the caregiver, teacher and youth (aged 11–16 years) reports on the Child Behavior Checklist (n = 464). Perceptions about symptomatology on a variety of externalizing and internalizing behaviour problem scales were measured with a correlation analysis. Subsequently, logistic regression models were created, which explored how each reporter category matched a fourth reporter category: the child welfare investigation caseworkers' identification of youths' mental‐health needs. Results show that in several models, the odds of matching caseworkers' determination of youths' mental‐health needs significantly increased as youths' perceptions of psychopathology increased. A similar pattern was found for caregivers' perceptions in some of the models, across both internalizing and externalizing domains. Implications for child welfare practice and research with child welfare youth are discussed.     

Adolescents at risk of mental health problems in the COVID-19 pandemic: A prospective population-based study of the effects of government mandates and school closures

There is increasing evidence that the COVID-19 pandemic has had substantial mental health impacts for adolescents. Yet, few definitive studies have investigated which adolescents were at higher risk of poor mental health and well-being during the pandemic. Data were drawn from the Childhood to Adolescence Transition Study, a prospective cohort study of students in Australia (N = 1211). Prevalence of mental health outcomes (depressive symptoms, anxiety symptoms, self-harm and good subjective well-being) was estimated in school Years 5–12, where Years 11 (2020) and 12 (2021) coincided with the pandemic. The age- and sex-adjusted relative risk of each mental health outcome for each priority group during the pandemic were estimated. During the pandemic, over 50% of study participants reported depressive symptoms, and one quarter reported anxiety symptoms. There was a decrease in good subjective well-being compared with pre-pandemic years, while self-harm prevalence remained similar. History of mental health problems, school disengagement and frequent peer victimisation increased the risk of experiencing mental health problems during the pandemic. Schools play a central role in maintaining the mental health and good subjective well-being of students, and this is particularly important during periods of social disruption, such as the COVID-19 pandemic.     

Drinking patterns and attitudes about alcohol among New Zealand adolescents

ABSTRACT

Questionnaires about alcohol use were administered to consenting Year 10 students at 10 secondary schools located in regions of Southland, Otago and Hawkes Bay (n?=?579) to examine drinking patterns and attitudes about alcohol of 14–15-year-olds. The average age of first drink was 12.6 years, two years younger than previously reported, with no difference in age of first drink for different socioeconomic statuses or ethnicities. Fifty-four per cent self-reported having consumed alcohol, and 23% had done so at least once within the last four weeks, with 13% reported regularly drinking more than five drinks in one session. While almost half of the 14–15-year-olds in this study reported never drinking alcohol, 75 individuals reported regular binge drinking. This was more common for students in lower socioeconomic schools; almost a third of students in the lowest socioeconomic group reported drinking five or more drinks every time they drink. There may be benefits of alcohol education resources for children as young as 12 years.     

Community Treatment Orders for People with Serious Mental Illness: A New Zealand Study

New Zealand legislation allows for the involuntary outpatienttreatment of people with serious mental illness. This studyexamines the views of service users, family members and mentalhealth professionals (MHPs) about the impact of this regime.Semi-structured interviews were completed with forty-two serviceusers, twenty-seven family members and ninety MHPs, with recentexperience of the regime. Participants were asked to commenton the functions of community treatment (or non-resident) orders,their benefits and restrictions, decisions about their terminationand any impact on relationships. Most service users believedthe main purpose of the order was to ensure they took medication.They also believed the order provided better access to othertreatments, supported accommodation and care from MHPs. Familiesconsidered the orders provided relief for them and a supportivestructure for their relative’s care. MHPs found the ordersuseful for engaging service users in a continuing therapeuticrelationship, and for promoting treatment adherence. In eachgroup, a majority of those interviewed viewed involuntary communitytreatment in a generally positive light, while acknowledgingthe restrictions imposed on service users’ freedom.     

Predictors of mental health literacy among parents of youth diagnosed with mood disorders

Research reveals limited knowledge of children's mental health among caregivers. This paper identifies predictors of mental health literacy among parents of children diagnosed with mood disorders that are seeking or already receiving help. Secondary data analysis using multivariate regression was conducted on data from a randomized, controlled efficacy trial with a sample of 165 children. Mental health literacy was higher for parents who were female, white, higher educated and had children who were older, had a bipolar diagnosis or received more services. Lifetime experience with mental health disorders also predicted literacy. Public mental health efforts are needed to raise caregiver mental health literacy.     

Extending health care coverage: Potential linkages between statutory social security and community-based social protection

Abstract   The extension of social health protection in developing countries is widely recognized as a priority. Various financing and institutional methods can be used in pursuing this objective, but none of them can achieve universal coverage in the short term. Based on an analysis of the respective strengths and weaknesses of social health insurance and community-based health care schemes, this article demonstrates the high potential of coverage extension strategies that use a pluralistic institutional approach to establish linkages and exploit complementarities optimally. A typology of potential linkages among different methods is presented and their value added illustrated using country examples.     

Young people's and carers' perspectives on the mental health needs of looked-after adolescents

While the mental health needs of looked‐after young people have been described in a number of clinical studies, the views of looked‐after adolescents themselves concerning their mental health needs have only rarely been reported. This study used focus groups to elicit the ideas and experiences of looked‐after young people in two local authorities in England. Front‐line carers in the region were also surveyed. Young people and carers were agreed in highlighting the damaging effects of the discontinuity and change experienced in the looked‐after system. Young people emphasized the importance of exercising choice and control when seeking and receiving support and identified the value of positive role models provided by ‘survivors’ of the care system. Carers reported high levels of risk behaviour, particularly self‐harm, among young people in children's homes. These differing perspectives need to be openly acknowledged and negotiated within care settings in order that relevant and accessible therapeutic and support services can be offered to looked‐after adolescents.     

Suicide and mental health problems among Swedish youth in the wake of the 1990s recession

The purpose of this explorative study is to bring together a variety of Swedish data sources with indicators of youth mental health and living conditions in order to illuminate trends during the last decades, elucidate possible determinants of mental ill health and develop hypotheses to explain the observed trend patterns. The analyses in the study reveal some surprising inconsistencies with respect to the mental health trends among young people during the 1990s. Most striking is the pattern of increasing youth unemployment coinciding with almost inverse trends in the rates of suicide. The secular trends in fatal suicides during this period do not show any increase but some actual decrease in sub‐populations despite high sustained levels of unemployment. In contrast, survey data indicate that the general mental health of youth during this period appears to have deteriorated.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.     

Punitive welfare reform and claimant mental health: The impact of benefit sanctions on anxiety and depression

Internationally, policymakers assume that sanctioning claimants of unemployment benefits will engender both improved employment outcomes and wider positive effects. A growing evidence‐base challenges these expectations, though additional insight is needed from large‐scale longitudinal research. This article contributes by conducting a quantitative investigation into the mental health impacts of benefit sanctions. To do so, it focuses on a recent period in UK sanctions policy in which rates of sanctions varied markedly and their length was substantially increased. Using quarterly panel data for local authorities in England (Q3 2010–Q4 2014) and fixed effects models that control for important confounders, the analysis provides robust evidence that Jobseeker's Allowance (JSA) sanctions lead to increases in self‐reported anxiety and depression. Evidence of this adverse impact is particularly clear following the increase in the length of sanctions in October 2012. The results have important implications for contemporary social security policy, which is underpinned by a similarly punitive sanctions regime. Whilst additional individual‐level research is needed to fully consider the causal relationships in operation, the findings support a precautionary approach that should seek to minimise the harm associated with sanctions. This implies taking steps to reduce both the severity and frequency of applied sanctions.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

Employment status,material hardship,and mental health among low-income working-age adults in South Korea

The current study examines the associations between employment status and mental health and the mediating role of material hardship among low-income households in South Korea. This study uses regression models with a rich set of control variables and lagged dependent variable models with a nationally representative sample of 1113 low-income working-age household heads from the Korean Welfare Panel Study (KOWEPS). We find that the nonstandard employment and unemployment statuses are associated with a higher level of depression and a lower level of self-esteem, when compared to a standard employment status. These negative associations are partially mediated by an increased material hardship risk. Policy implications to improve employment conditions and mitigate material hardship are discussed.     

Work,welfare, and wellbeing: The impacts of welfare conditionality on people with mental health impairments in the UK

The personal, economic, and social costs of mental ill health are increasingly acknowledged by many governments and international organisations. Simultaneously, in high-income nations, the reach of welfare conditionality has extended to encompass many people with mental health impairments as part of on-going welfare reforms. This is particularly the case in the UK where, especially since the introduction of Employment and Support Allowance in 2008, the rights and responsibilities of disabled people have been subject to contestation and redefinition. Following a review of the emergent international evidence on mental health and welfare conditionality, this paper explores two specific issues. First, the impacts of the application of welfare conditionality on benefit claimants with mental health impairments. Second, the effectiveness of welfare conditionality in supporting people with experience of mental ill health into paid work. In considering these questions, this paper presents original analysis of data generated in qualitative longitudinal interviews with 207 UK social security benefit recipients with experience of a range of mental health issues. The evidence suggests that welfare conditionality is largely ineffective in moving people with mental health impairments into, or closer to, paid work. Indeed, in many cases, it triggers negative health outcomes that make future employment less likely. It is concluded that the application of conditionality for people with mental health issues is inappropriate and should cease.     

Unemployment and mental health among white‐collar workers – a question of work involvement and financial situation?

We examine whether it is a psychosocial or an economic need for employment that affects mental health among the unemployed. The relevance of both aspects are examined, concentrating on two measures of each dimension. Two perspectives of work involvement – the degree of connection to working life and the perceived employment commitment – and two perspectives on financial situation – economic security and perceived economic concern – have been analysed, using empirical data collected by means of a cross-sectional survey of 1297 unemployed white-collar workers from the public sector in Sweden. The degree of connection to working life was not significantly linked to the mental health of the unemployed, although there was a strong link between the perceived employment commitment and mental health among this group. The stronger the perceived employment commitment, the poorer the state of the person's mental health. Perceived economic concern was also tightly linked to mental health: the greater the economic concern, the poorer the mental health. Economic security also played – at least, partly – a moderate but significant role. The results provide strong support for the existence of both a psychosocial need and an economic need for employment. The analysis demonstrates that it is the perceived assessed measures of work involvement and financial situation that are linked to mental health.     

Mental health and educational difficulties in children in contact with Children's Social Services

The British Child Mental Health Survey 1999 collected data from 10 438 children aged 5–15 years, selected at random from the child benefit register. At 2 and 3 years, all those with a psychiatric disorder and a random third without were followed up with further detailed interviews about the services contacted if parents reported service contact or if parents expressed concern about their child's mental health at baseline and follow‐up, but reported no service use. We compared children in contact with Children's Social Services with children in contact with Child and Adolescent Mental Health Services (CAMHS) or no services. The children in contact with Children's Social Services had a high level of psychopathology and considerable educational difficulties. Despite this, they often had no contact with CAMHS or access to provision for special educational needs. It also became clear that parents were often using Children's Social Services as a first‐line service, i.e. a way of trying to access help. The results provide us with an interesting insight into the level of need of those children in contact with Children's Social Services and we hope to stimulate discussion about how liaison between all the services children access can better provide for their needs.     

Self-reported mental health problems and post-traumatic growth among children in Pakistan care homes

ABSTRACT

Children in care experience multiple risk factors, particularly in low-income countries such as Pakistan. The aim was to establish rates of mental health problems and their relationship with posttraumatic growth, as reported by 132 children aged 9–19 years, living in three care homes in Pakistan. Children reported high rates of posttraumatic stress (70.45%) and common mental health symptoms (43.94%) within the clinical range, but also high levels of posttraumatic growth. These findings highlight the high levels of mental health needs among children in residential care, as well as the importance of understanding factors that promote their posttraumatic growth and resilience.     

Connecting and engaging with health and social care: Exploring the core components of a telephone and web-mediated family navigation prevention service

Early engagement with health care, mental health care, and social services can promote the well-being of children and families. How practitioners can best support family engagement with these services however remains largely unknown. To address this gap in knowledge, data from a voluntary 12-week telephone and web-mediated family navigation preventive intervention called Navigate Your Way were subject to mixed-methods analysis. Twenty-nine caregivers and five family navigators contributed data to the study. Thematic analysis of weekly navigator check-ins, participant closing interviews, navigator discharge notes, and lab meeting notes was conducted and followed by quantitative analysis of navigator effort across project activities. Results were then mixed to illuminate the essential conditions for supporting family connection to health care, mental health care, and social services. Qualitative analysis identified themes related to empathic engagement and person-centred navigation as central to connecting families to needed services. Quantitative analysis of navigator effort identified participant outreach, weekly check-ins, service identification, and ongoing supervision as essential navigation activities. Together, providing an environment that is supportive, consistent, flexible, person-centred and tailored to families' specific needs are important for connecting to health and social care.