Self-Care Practices and the Professional Self

ABSTRACT

Consistently and actively engaging in self-care has been shown to improve the performance of mental health practitioners by reducing burnout, vicarious trauma, compassion fatigue, and other stress-related psychological problems. Not only is this important to the individual practitioner’s well-being, but ethical standards also mandate the recognition and remediation of any physical, mental, or emotional self-impairment to maintain high standards of care for clients. Professionals in small communities, like the Deaf community, however, confront unique challenges in attending to their self-care. This article investigates these challenges—as well as the rewards—experienced by Deaf and hearing counselors working in mental health care with deaf clients.     

Sexual Health in the Netherlands: Main Results of a Population Survey Among Dutch Adults

ABSTRACT

In 2006, the Rutgers Nisso Groep conducted an extensive population survey to assess the epidemiology of sexual health in the Netherlands. The sample consists of a random selection of the adult population living in the Netherlands (N= 4147) who were approached through internet panels. The study assesses the prevalence of a broad range of sexual health issues, including sexual and relational satisfaction, experience of sexuality, sexual identity, paraphilia, excessive desire, sexual dysfunctions, contraception, abortion, infertility, testing for sexually transmitted infections and HIV, condom use, and sexual violence. The data show, among other findings, that a small half of the adult Dutch population was basically without sexual health-related problems or stress during the year preceding the study. The other half experienced problems to a varying extent in one or more areas. Overall, 24% of the women and 19% of the men have experienced a need for professional sexual health care during the previous year. For women and men alike, relational problems are the most common complaint. About half of those in need of one or another form of sexual health care actually received it. Young people and people with an ethnic minority background show an elevated need for sexual health care.     

Impact of Psychological Disorders on Postpartum Mothers and Child: Current Issue in Remediation in India

ABSTRACT

India is a multicultural, multiethnic, pluralistic society with enormous socioeconomic disparities, and it is a formidable task to provide affordable and effective mental health care, especially to the remote rural corners of the country. The unfortunate aspect of the Indian mental health scenario is that there exists very poor awareness of the maternal health risks of the postpartum period. It is during this period that serious psychological disturbances can manifest and seriously jeopardize safe and normal motherhood. Currently, there is neither a national agenda for mental health care among pregnant and postnatal women nor a viable training program to equip health workers to recognize and manage postpartum psychological disorders. This article attempts to provide a viable module for training future health providers to gain an understanding of the illness pattern that constitutes postpartum disorders through experiential learning and problem solving.     

Achieving Harmony from Tension: Contemporary Patterns and Pitfalls of Family Advocacy

ABSTRACT

Advocacy in illness and aging is a formidable challenge. Physical illness, financial dependence or constraint, social-emotional problems, and the changing political and demographic structure of caregiving force severe demands on intervention programs and possibilities. This paper provides an uncommon but, hopefully, reasonable framework for freeing clinicians, educators, and helping professionals from their own ideas which periodically are rendered problematic in providing successful intervention. Several illustrations of these practical problems are presented. Finally some postures for advocacy and intervention are considered.     

Factors Associated With the Psychological Well-Being and Distress of University Students

Objective: Because of the serious nature of psychiatric illness and related problems, the authors attempted to identify demographic, individual, and behavioral factors linked to university students' psychological health. Participants: They surveyed 353 (60.9% female) predominately Caucasian (88.7%) university students attending a large public university. Methods: The authors used a self-report questionnaire including valid and reliable psychometric instruments for all study variables. They conducted multiple regression analyses to examine associations among study variables using a cross-sectional design. Results: More favorable health states (ie, greater psychological well-being and less distress) were positively associated with optimism, health values, and religiousness and were negatively associated with spirituality and number of sexual partners. Conclusions: Results demonstrated that multiple protective and risk factors contribute to the psychological well-being and distress of university students. Health promotion practitioners should adopt strategies that strengthen the personality characteristics and values associated with university students' psychological health.     

Physical health characteristics of student service members and veterans by sexual orientation

Abstract

Objective: Little is known about the health status of the diverse population of student service members and veterans (SSM/V) enrolling in higher education in great numbers. The objective of this study was to explore the differences in physical health characteristics by sexual orientation among a national sample of SSM/V. Methods: Using secondary data, a series of maximum likelihood (ML) logistic regression models were estimated to explore physical health characteristics by sexual orientation in a sample of SSM/V. Results: SSM/V that identify as lesbian or gay reported higher rates of treatment and diagnosis for some physical health matters (respiratory illness and HIV) when compared with their heterosexual counterparts. Conclusions: Our findings support the need for campus health officials and policymakers to develop services to address the physical health needs of this population that differ from their peers.     

Policy recommendations for rare disease centres of expertise

AimRare diseases are a serious public health concern and are a priority in the EU. This study aims to develop policy recommendations for rare disease centres of expertise (CoEs) in order to improve standards and quality of care.Subject and methodsA modified 3-round Delphi technique was used. Participants included rare diseases patients, carers, patient representatives and healthcare professionals (HCPs) from CoEs in two countries—Denmark and the UK.ResultsThe results suggest the need to make improvements within current CoE environments, access to CoEs and the need for coordination and cooperation of services within and outside CoEs. It is recommended that CoEs are not overly ‘medicalised’, while at the same time they should be established as research facilities. The importance of including patient representatives in CoE performance management was also highlighted. Raising awareness and provision of appropriate training amongst non-specialist HCPs is seen as a priority for early and correct diagnosis and ensuring high quality care. Similarly, provision of targeted information about patients’ illness and care was considered essential along with access to social assistance within CoEs.ConclusionsPolicy recommendations were developed in areas previously recognised as having gaps. Their implementation is expected to strengthen and improve current care provision for rare disease patients. In member states where national plans and strategies are being developed, it is recommended to replicate the methodological approach used in this study as it has proven to be a helpful tool in rare disease centres of expertise policy development.     

Integrative Behavioral Health Clinic: A Model for Social Work Practice,Community Engagement,and In Vivo Learning

ABSTRACT

Missouri did not expand Medicaid, leaving about 500,000 Missourians without health insurance. To address community needs and provide additional social work training opportunities, a free integrated behavioral health clinic was established. This article discusses the need, describes the clinic, and presents 1-year evaluation results. Sixty-nine clients received services, and 30 students received intensive training during the first year. Almost half of the clients were diagnosed with depressive disorders, and more than half had comorbid medical conditions. Psychiatric symptoms were lower following treatment. Quality of life increased in physical and psychological domains. Collaborative clinics with social work and medical students are a viable option for experiential learning and providing quality care for uninsured or underinsured people with comorbid medical conditions.     

Taming predators through photography

In this article we examine an innovative application of visual communication and social science methods, moving the study of indigenous media from the purely academic realm into pediatric health research. Through Video Intervention/Prevention Assessment (VIA), children and adolescents who share a medical condition create visual narratives of their lives with chronic disease to show and tell their illness experiences to health care providers. Clinicians routinely plan medical management with limited knowledge of how patients interact with disease in their “real life” physical, psychological, and social environments. VIA asks young patients to teach clinicians the realities of day‐to‐day life with illness, yielding unique insights that can guide the development of more realistic, more humane, and ultimately more effective medical care. We describe the VIA methodology, a pilot study of asthma, and the illness experiences shown and told by VIA Asthma participants. Not only did VIA generate useful research findings, it also produced visual documents of the child's illness experience that can serve as tools for influencing policy, advocating for patients, and educating health care providers, patients, and their families.     

Trauma Screening in Students Attending a Medical University

Abstract

Clinicians seldom assess trauma history in patients who seek treatment for psychological problems, yet trauma exposure is often related to psychological distress. Assessing trauma history can provide valuable information for treatment conceptualization and provision, although patients may not spontaneously share their histories because of embarrassment, avoidance, or other concerns. The authors compared 73 students at a southeastern US medical university who sought counseling and psychological services and completed intake paperwork without a trauma screen with 130 students whose intake procedures included trauma screening. They found that (a) patients who were specifically asked about trauma history were more likely to report such events, (b) previous physical assaults with a weapon were related to current psychological distress, and (c) physical assaults with or without a weapon were related to clinically significant psychological distress. These findings suggest that screening for lifetime trauma history should be a standard part of mental health screenings in similar medical university counseling centers.     

Exploring the Climate for Overweight and Obese Students in a Student Health Setting

Attitudes and beliefs of health care providers, in conjunction with a nonthreatening physical environment, are important components in establishing a constructive and supportive climate for care of overweight and obese students. Objective: The authors explored providers' attitudes about obesity and assessed the physical environment in a student health clinic to identify areas that may be detrimental to the care of overweight and obese students. Participants: Eighteen direct care providers participated in the project. Methods: The authors conducted focus groups with direct care providers and assessed their experiences and perceived challenges in working with overweight and obese students. The authors also conducted a walk-through assessment of the physical environment. Results: Direct care providers expressed discomfort in deciding how and when to discuss weight with students. The authors found that elements of the physical environment could present barriers to care for overweight and obese students. Conclusions: The authors make recommendations for improving the health care climate for overweight and obese students.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

Mental Health Care for American Indians in Prison

Abstract

Based on an earlier finding that as many Native Americans in upstate New York received mental health care in prison as outside of prison during a 10-month period, this study was designed to investigate if prisons had become an alternative treatment option for Native Americans with a mental illness in New York State. The study was not able to answer this question due to the limited number of cases and to outside constraints. However, it is possible from the results to provide a picture of mental health needs and attitudes among Native American inmates which is surprising and instructive for those who provide psychiatric care to American Indians, either within or outside of prison walls. A noteworthy finding was the importance placed by these inmates on the use of culturally appropriate ceremonies to assist in their rehabilitation. Low rates of serious mental illness among the American Indian sample highlight the need for further study in this area.     

Alcoholism in College: Early Case Finding

Abstract

Alcohol is a mind-altering drug which is unique, being legal in nonmedical use generally socially acceptable, and widely employed. It is also probably the greatest current drug abuse problem in the United States. Alcohol is used by most college students, and for some, its use becomes dysfunctional. Problem drinking occurs on college campuses and attempts at early case finding by health professionals may prove valuable as a form of secondary prevention of a potentially serious illness, alcoholism. Such an effort will be helped by cognizance of the various ways in which inappropriate use of alcohol can lead to contact with the health care system; by an understanding of alcoholism as an illness which has behavioral prodromata; and by establishment of rapport and mutual respect between the patient and health professional. Without depriving young patients of responsibility for self-care, early alerting to alcohol-related problems can lead to early referral for diagnosis and treatment.     

Families and Mental Illness: Contested Perspectives and Implications for Practice and Policy

Abstract

Mental health research, policy, and service provision over the last 50 years have constructed families and their connections with mental illness in various and contradictory ways. Three distinct but intersecting perspectives derive from the clinical mental illness literature, the family advocacy movement, and mental health policy. Within the clinical literature, the perspective of families is largely one of blame and pathology. By contrast, the family advocacy movement has generated the perspective of the burdened family, whereas mental health policy has created the perspective of the obligated caregiver. The result is an ambiguous understanding of the role of the family in both contributing and responding to mental illness. Implications for policy and practice include the need for a commitment to the principles of partnership with families, a recognition of diversity within families, recognising the difference between carer and family positions, and a need for policy to reflect the position of family as both intimately concerned, but not necessarily responsible, for patient care.     

Barriers to substance use disorder treatment in a sub-acute setting

ABSTRACT

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to substance use and mental health diagnosis. With the current opioid epidemic there is a need to address substance use disorders when treating patients in different health care settings. Despite the necessity of integrated care, there are barriers to addressing addiction in sub-acute care settings. With the lack of buy-in from the patients and health care providers and the stigma surrounding addiction it is time to address the barriers that prevents integration of care where it is most needed.     

Alternative Practicum in Health Education

Abstract

Young African American men in the inner city have higher rates of mortality and morbidity from potentially preventable causes than other American men of the same age. They suffer disproportionately high rates of preventable illness from violence, sexually transmitted diseases, and HIV infection. These young men present with problems related to sexual concerns, mental health issues, substance abuse, and violence. They also report substantial risk-taking behaviors, including unprotected sex, substance use, and weapon carrying, as well as exposure to violence. Access to and use of preventive primary care services has been limited for these patients in the past because of financial barriers and competing social issues. Racism and historical oppression have created barriers of mistrust for young men of color. Factors that contribute to their adverse health status, as well as ways to address these problems, are discussed.     

Lesbian Health

ABSTRACT

Health care research suggests that lesbians may face unique physical and mental health risks, yet few studies make use of gender and sexuality theories to explain lesbian health. In this study, a social constructionist view of sexuality is used to examine the impact of lesbian identity on well-being. Drawing from nineteen intensive interviews with women who self-identify as lesbians, the results show that individuals' sexual identities change over time and are affected by their social environments. The data also demonstrate that sexual identity and social context have implications for well-being. Specifically, hostile environments, which are characterized by animosity toward gay men, lesbians, and others who do not conform to heteronormative gender expectations, are associated with distress over lesbian identity and with physical and mental health problems. By contrast, supportive environments, which many women report finding through feminism, facilitate the construction of a positive lesbian identity and enhance well-being.     

The Association Between Mental Health and Acute Infectious Illness Among a National Sample of 18- to 24-Year-Old College Students

Poor mental health is associated with physical illness, but this association is poorly characterized among college students. Objective and Participants: Using American College Health Association-National College Health Assessment data, the authors characterized poor mental health (depression, anxiety, negative affect) and examined the relationship between poor mental health and acute infectious illnesses (bronchitis, ear infection, sinusitis, strep throat) among 47,202 US college students. Methods: The authors used frequency and cross-tabulation analyses to characterize mental health and determine univariate associations among variables. They used binary logistic regression to determine the association between poor mental health and acute infectious illness, controlling for research-derived covariates. Results: The prevalence of acute infectious illness ranged from 8% to 29%. The prevalence of anxiety and depression ranged from 12% to 20%, respectively. Depression, anxiety, and exhaustion were associated with acute infectious illness across all dependent measures, with odds ratios ranging from .56 to .91. Conclusions: Poor mental health is associated with acute infectious illness among college students.