Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

Mental Health Law: Innovations in Education and Representation

What do we know about the lives of people with learning difficulties? What do we know about the lives of people who have used mental health services? People require legal representation to obtain access to the basics of life. Legal representation for people with mental disabilities or learning difficulties also provides a forum for client empowerment. Legal representation has historically been dominated by professionals trained in traditional methods. A mental health law clinic, based upon consumer objectives, provides an opportunity to apply critical legal theory to the practice of law. Legal and citizen advocacy are combined to provide maximum participation in obtaining results. In this article, the author traces the development of a mental health law clinic by documenting the value of clinical legal education and the necessity of commitment to consumer-centred representation.     

Feminism and gendered impact of COVID‐19: Perspective of a counselling psychologist

When women, girls and gender‐diverse people — who have been disproportionately impacted by the COVID‐19 pandemic outbreak since the public health crisis has also become a crisis for feminism — will identify and acknowledge their organismic phenomenological self, wholeness and growth will be fully functioning. Psychological aspects for the public health emergency operated through counselling psychologists to manage mental health, emotional, psychological, cognitive, behavioural, relational and social impacts are fundamental. And the role of counselling psychologists in maintaining personal mental health and their clients is a crucial indicator of collective wellbeing. This perspective is embedded in the gendered approach and feminist framework which attempts to explore and offer the embodied intersectional and divergent impact on living during the COVID‐19 pandemic lockdown.     

An integrative approach to threat assessment and management: security and mental health response to a threatening client

Workplace violence threat assessment and management practices represent an interdisciplinary approach to the diversion of potentially dangerous employees and clients. This case study illustrates such an intervention in a complex situation involving a social service agency and its client. Following a curtailment of services and an arrest, the client developed an escalating homicidal anger toward the agency administrator. Once a Tarasoff warning was received, the agency contacted a security company who organized a threat assessment and management plan involving interdisciplinary collaboration. Information developed in the course of the assessment was presented to prosecutors, who facilitated the client's arrest and involuntary psychiatric commitment until he was judged to be no longer dangerous. This case ultimately involved an integration of the services of security, law enforcement, mental health professionals, prosecutors, the courts and the state mental health system in leading to a successful diversion of the client from a path of intended violence.     

Threats on campus. Need for faculty response

Be calm and decisive in all your actions. Threats are meant to intimidate and instill fear. Do not assume someone else will handle the situation. Report the threat immediately to your supervisors. Make a crime report to campus public safety officers and law enforcement officials in the appropriate jurisdiction. Follow up to determine the status of the investigation. Refer the student to campus and/or community mental health services. Document the student's behavior and threats. Don't spend time alone with students who exhibit warning signs that could result in violence. Arrange your office so you have easy access to an exit. Be sure that the desk and chair are not between you and the door. Save all written and electronic threats and provide them to law enforcement officials. There is a mechanism for determining the origin of e-mail threats. Obtain a restraining order if necessary.     

The influences of relationship quality with external partners and required levels of approval of messaging on crisis preparedness

As funding for public health promotion is increasingly limited in the U.S., public relations research informing management of crises that threaten public health is especially critical. Crisis planning models such as Reynolds and Seeger’s (2005, 2014) crisis and emergency risk communication model offer comprehensive directives for crisis managers and present opportunities to extend the utility of best practice recommendations. A survey of public information officers (PIOs) (n=208) at local public health departments across the U.S. examines the quality of their relationships with partners in public health crisis management, including first responders, media, law enforcement, and hospitals, and reveals that relationships with key publics in crisis management are lacking. Further, PIOs at state governed health departments may face critical delays in releasing crisis messages, as their messages are required to clear more levels of approval than locally (city/county) governed departments. Implications and future research for these key variables extending public relations crisis communication research with a focus on inter-organizational relationships are discussed.     

Older Drivers Retiring From the Road: An Application of the Selection,Optimization, and Compensation Model

Purpose: This study uses the selection, optimization, and compensation (SOC) model to compare older adults who have given up driving, those who still drive, and those who drive less to identify differences in the three groups. Design and Methods: This cross-sectional study of 281 older adults is part of the Naturally Occurring Retirement Community Demonstration Project. Study participants completed interviews that included questions on demographics, health and functioning, mental health, social support, and current levels of engagement in activities including current driving status. Results: Data suggest that driving retirement is a process and that a substantial number of people are in the transitional stage, where they are less functional than those who still drive and more similar to those who have retired from the road. Implications: Given the similarity of those who drive less to those who have given up driving, front-line professionals and policy makers must work together to ease the transition to driving retirement for those without adequate ability to effectively compensate for their inability to continue to drive safely.     

Building a better mental health workforce: 8 core elements

The field of behavioral health is facing a national crisis surrounding its workforce. Critical issues include problems in recruitment and retention and a serious lack of relevant preparation for work in mental health settings. This article identifies the challenges inherent in providing effective education and training to mental health staff who hold a bachelor's degree or less formal education. Key theories, concepts, and general principles of critical importance to all staff expected to work in a redesigned or transformed mental health system are described. Best and promising practices are contrasted with current practices, and specific recommendations including core concepts and competencies are listed, leading to the development of a training curricula targeted to meet these needs.     

Providing mental health care to veterans in rural areas: using telehealth in mobile clinics

The purpose of this article is to provide information to improve the quality of care of veterans living in geographically isolated areas who require treatment for mental health issues. Because interactive care solutions are currently hot topics in the health care community, they should be viewed as possible strategies to meet the needs of this specialty group of veterans. An intervention using a mobile clinic and clinical video telehealth reduces distance barriers by making it possible for mental health specialists to come to rural veterans instead of the veteran attempting to find a way to get to the practitioner, who may be located in a clinic or hospital many miles away. This article focuses on an alternate strategy-telehealth in mobile clinics-as a possible solution to the mental health crisis of veterans in rural areas.     

Interview: Tatyana Lipovskaya,Sisters Sexual Assault Recovery Centre,Moscow, Russia

The Sisters' Sexual Assault Recovery Center was established in Moscow, Russia, in 1993, to address the needs of victims of sexual violence. The Center's help-line received 4029 crisis calls in 1994-97. Most clients are seeking information about medical services or legal aid. Others call about employment, HIV/AIDS, alcoholism, and drug abuse. Services are available without regard to age, sex, occupation, or sexual orientation. Program funding has come entirely from Western foundations and organizations. Although Russia has not passed a law on domestic violence, the post-Communism government is reluctantly starting to acknowledge that rape and domestic violence are serious social problems. The Center runs an educational program for law enforcement officers to increase their sensitivity and create an environment of safety for women who report sexual violence.     

Bachelor of Social Work Students and Mental Health Stigma: Understanding Student Attitudes

Bachelor-level social work students (n = 198) at a midsized Midwestern public university were surveyed to evaluate their attitudes toward those with mental health concerns. Additionally, students were surveyed regarding their willingness to seek treatment for their own mental health needs. Results of the analyses suggest that the majority of students do not hold stigmatizing attitudes toward mental illness. Students who believed mental health work is rewarding were less likely to be afraid or uncomfortable around people with mental illness. In addition, these students were more likely to report attitudes that acknowledge the capabilities of people with mental illness and were less concerned with others knowing their own mental health status. Implications for social work education and directions for future research are discussed.     

The history, economics, and financing of mental health care. Part 2: The 20th century

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.     

‘The Bad People Go and Speak to Her’: Young People’s Choice and Agency when Accessing Mental Health Support in School

Concerns about the mental health and well‐being of children and young people have been articulated in health and education policy fields as a call for closer working between schools and providers of mental health support services. Drawing from a Scottish study, this article explores issues of access, when mental health initiatives are sited in formal educational settings. In particular, it focuses on the implications for the agency of children and young people seeking support from those services when and how they choose. The study argues that over‐reliance on teachers as the main referral route to service influences what is deemed to be a problem, who is thought to need support and how the interventions are viewed by the children and young people. Alternative approaches are discussed, which offer opportunities for children and young people to explore the available services and make their own choices about their level of engagement.     

Devils and deep blue seas: the social worker in-between

This paper examines the role of the approved social worker, as defined by s.114 of the Mental Health Act 1983, with particular regard to ethical dilemmas in crisis intervention. Issues of management accountability, health and safety are set against the approved social worker's statutory responsibility to assess people experiencing mental health problems and, where necessary, admit to psychiatric hospital under compulsion. Consideration is given to the impact of this work upon the worker, on whom extreme and sometimes conflicting demands are made. An attempt is made to integrate these viewpoints within a fundamentally psychodynamic perspective.     

Out‐of‐Home Placement of Children Exposed to Violence

There is growing concern about the increasing number of children in the USA who are exposed to community violence and the need to remove some of them from their families. This study examines risk factors for out‐of‐home placement among a large pool of children and adolescents who were referred for general clinical assessment following exposure to violence and/or psychological trauma in their communities or homes. Children with greater familial and environmental support and children exposed to incidents involving a non‐parental personal threat were associated with a significantly lower risk of out‐of‐home placement. A greater likelihood of being placed out of home was associated with older age (adolescents), history of mental health service use, involvement with law enforcement agencies, higher clinical ratings of depression or impaired thought processes, lower clinical functioning and greater exposure to traumatic events. Evidence of maltreatment and a threat to life was associated with 13.6 times greater likelihood of being placed out of the home. This study raises an important issue in respect to the children's past use of mental health service and current symptoms. It is not just the risk of violence but also evidence of psychiatric problem that trigger out‐of‐home placement. Further studies are needed to assess the quality and effectiveness of mental health services provided to children exposed to violence. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau.     

SAME‐SEX EXPERIENCE AND MENTAL HEALTH DURING THE TRANSITION BETWEEN ADOLESCENCE AND YOUNG ADULTHOOD

Previous research has demonstrated that people who report same‐sex experience tend to have poorer mental health than heterosexual people in adolescence and adulthood. Yet, little is known about how same‐sex experience is associated with changes in mental health between the two life stages. Using data from the National Longitudinal Study of Adolescent Health (n = 12,056), this study assesses patterns of same‐sex experience between adolescence and young adulthood and their consequences for changes in depressive symptoms, binge drinking, and drug use. Compared to people with no same‐sex experience, those who report such experience only in adolescence show greater levels of mental health problems in adolescence, but they do not show any worse mental health changes during the transition into young adulthood. People who develop their first same‐sex experience in young adulthood, however, tend to show worse changes, consistent with the argument that entry into a stigmatized role is psychologically harmful. Among females, those who report same‐sex experience in both life stages also show worse mental health changes, indicating that the continuity in minority status contributes to their cumulative disadvantage. However, these differences are modest, and substantial amounts of variations in mental health changes are observed within each group. Findings are used to address the dynamic aspect of mental health disparity linked to sexuality.     

Disarming people with words: strategies of interactional communication that crisis (hostage) negotiators share with systemic clinicians

This qualitative study examined the interactional communication strategies used by law enforcement officers during a hostage-taking incident at a high school. The research involved analysis of the negotiation conversation between police crisis (hostage) negotiators and a hostage taker who entered his former high school to take revenge on a teacher. A condensed version of the talk was micro-analyzed with the actual negotiators from the incident, using ethnographic and Interpersonal Process Recall interviewing methods. Results illustrated that the negotiators used interactional communication strategies valued by systemic family therapists to reach a peaceful conclusion to the incident.     

The Power of Peer Support: The Development of the Empowerment Center

ABSTRACT

This article discusses the events and influences that led to the author’s contribution to the development of a mental health consumer-run organization, The Empowerment Center in Mount Vernon, NY. The author traces some events that influenced him personally and the evolution of the Empowerment Center from an organization that provided advocacy services (to those with mental health problems who were hospitalized) and community-based support services to people in mental health recovery, to an organization focusing on economic empowerment and economic development for the community of those in recovery. The transition of the Empowerment Center into an organization focused on economic empowerment underscores the importance of economic independence for people in recovery and the consumer-run organizations that support them. The Empowerment Center endeavors to demonstrate that mental health consumer-survivors can take control of their economic health as well as their physical and mental health.     

The production of understanding

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the contextual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us"/"them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power. The production of understanding serves as an important counterbalance to this tendency. Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides understanding about why health and mental health are mal-distributed among people from different social circumstances.