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.     

Critical Discourse,Applied Inquiry and Public Health Action with Urban Middle School Students: Lessons Learned Engaging Youth in Critical Service-Learning

The Nuestro Futuro Saludable partnership designed a critical service-learning intervention focused on health equity and action. The 10-week afterschool intervention was implemented in a Boston middle school. Youths who took part in the intervention were knowledgeable about the social determinants of health in their communities, as well as to the barriers to health. Our findings indicate that engaging young people in a meaningful way will be critical if health improvement efforts are to be realized. We found that a critical service-learning framework that incorporates elements of applied inquiry and critical pedagogy was effective as a health intervention and provided opportunities for action.     

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.     

The Efficacy and Impact of the Alien Transfer Exit Programme: Migrant Perspectives from Nogales,Sonora, Mexico

The Alien Transfer Exit Programme (ATEP) is a US deportation strategy created in 2008 whereby migrants are returned to border regions of Mexico distant from their initial place of apprehension. The goal of this strategy is to geographically separate migrants from their coyotes [paid crossing guide], who are often waiting for them in Mexico, in an attempt to discourage people from attempting additional border crossings. The official government stance concerning this programme is that it is both effective at deterring migration and that it protects migrants from abusive coyotes who often “force” them to cross the harsh Sonoran desert. The effectiveness of this new policy or its impact on the experiences of migrants has yet to be examined. Using a combination of ethnography and archaeology, I describe ATEP and its impacts on the social process of border crossing with an emphasis on the experiences of migrants who have been deported from California to the Mexican border town of Nogales. I argue that recent formalized deportation strategies such as ATEP build on previous lateral relocation programmes that have long been ineffective at slowing migration. In addition, ATEP contributes to sustaining previous migration control policies of exclusion (based on age, gender, and health) that now produce new dangers for both those included and excluded from this programme. ATEP should be viewed as an enforcement strategy aimed at systematically placing migrants in harm's way by relocating them geographically and by undermining the resources (i.e., human and social capital) that people have come to rely on for successful (and safer) border crossings. These findings contribute to the growing literature on the anthropology of deportation and the critical phenomenology of illegality.     

Intersex or Diverse Sex Development: Critical Review of Psychosocial Health Care Research and Indications for Practice

Intersex or diverse sex development (dsd) can be conceptualized as an aspect of bodily diversity that has particular psychosocial implications. This is a review of psychosocial health care literature, published from 2007 to 2017, focusing on the well-being of people with a diagnosis relating to sex development. The analysis I offer here takes a critical psychological approach, questioning norms and taken-for-granted assumptions. This approach works from the understanding that how we know and how we talk about a phenomenon affects people in material and life-changing ways. This article offers recommendations concerning health care communication, the importance of taking time for emotion, and the process of building supportive relationships. The research reviewed provides clear evidence of psychosocial harm that is done through genital intervention and evidence that parents do not routinely give fully informed consent before their children undergo treatment. Finally, I highlight key points and recommendations for health professionals, indicating how psychosocial professionals can contribute to health care and well-being in the context of dsd when appropriately resourced and trained.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Consumer-operated self-help services

To create a mental health system focused on recovery, consumer-operated services, for which an evidence base is emerging, should be promoted. Consumer-operated services have become a viable, cost-effective model designed to provide social support and recovery opportunities for people diagnosed with a psychiatric disability who are living in the community. This article describes the consumer-operated services model and uses a self-help center as an example. The core components of consumer-operated self-help centers are outlined. Qualitative data gathered through a larger study of self-help centers is presented. The article highlights the benefits of and areas for improving this innovative resource, which offers many advantages and opportunities for people living with a psychiatric disability in the community.     

Planned change in the disability community

Planned change with people, who are physically or mentally disabled, as with other special populations, requires a range of skills and knowledge; several specific aspects of the change process are identified and discussed in this article: the characteristics of the change agent, the timing of the change event, and creating a vision for change. These aspects are illustrated through the writer's own experiences as a change agent working a long-range change event to improve access1 to mental health services in the US with and for people who are deaf and hard of hearing.     

Costs and Outcomes of an Extra Care Housing Scheme in England

Extra care housing, which provides support and care for people in specially designed accommodations, has now been part of the range of housing and care services available to older people in England for several years. Currently, the United Kingdom evidence base tells us little about the financing, estimation of the costs, or burden to the public purse of housing with care. The United Kingdom has significant state welfare provision in the areas of health and social care. The objective of this in-depth case study was to investigate the cost and outcome consequences for a sample of people who moved into an extra care housing scheme in Bradford, England, and to reflect on the methodological implications for future research in this developing area. The main finding of the study was that the overall cost per person increased after a move to extra care housing, but that this increase was associated with improved social care outcomes and improvements in quality of life.     

Evaluation of a system designed to link people living with HIV/AIDS with mental health services at an AIDS-service organization

This study evaluated the Rapid Response System, an initiative designed to link people living with HIV/AIDS with mental health services at an AIDS service organization. Data were extracted from agency records for 314 clients who had contact with the Rapid Response System over a 6-month period. Of the 281 clients who scheduled an appointment for an evaluation to initiate mental health services, 64% completed the evaluation. In the multivariate analysis, Latinos were significantly less likely than whites to complete the mental health evaluation. Further, there was a significant decrease in the likelihood of completing the mental health evaluation as the number of days between the Rapid Response System contact and the date of the evaluation appointment increased.Strategies that reduce the period of time between the initial referral and initiation of services may facilitate linkage with mental health treatment, particularly in the context of larger multi-service organizations.     

Participatory video analysis in disability research

This article sets out critical framing as an analytical approach in participatory video by which people investigate and analyze a topic through arts-based engagement, storyboarding, and collaborative editing. Participatory video as an action research method in self-advocacy has been discussed elsewhere. Here, the author examines critical framing and the role of generative themes in participatory analysis by describing a case study in which adults with developmental disabilities explored the dimensions of sexual health through participatory video. The author proposes that critical framing provides a more nuanced approach to participatory analysis. Credibility and trustworthiness with data triangulation and overall findings are also described.     

Availability of Mental Health Services for Individuals Who Are Deaf or Deaf-Blind

A survey of state mental health agencies found that a majority have no specific policy or procedure regarding how to provide mental health services to persons who are deaf or who are deaf-blind. Agency representatives report that staff lack knowledge of how to provide mental health services to persons who are deaf-blind and the agencies lack qualified interpreters. They recommend training for social workers and counselors to address best practices in working with people who are deaf-blind concerning communication methods and strategies, physical interaction, cultural issues, everyday life, sensory deprivation, ethics, use of an interpreter, and other general issues.     

Healthier and Happier? The Urban-Rural Divide in Thailand

This study aims to explain the relationship between socioeconomic factors and physical health and happiness outcomes of the Thai people. The study specifically investigates the differences between health and happiness outcomes of people who live in urban and rural areas in Thailand. Unlike results found in other countries, income is found to not affect the level of happiness of those who live in either urban or rural areas. Urbanization is found to have no effects on physical health, but it does have an adverse impact on the level of pleasure among Thai people. However, overall happiness levels of those who live in urban areas and those who live in rural areas are not statistically different.     

Online Peer Support Programs for Young People with a Parent Who has a Mental Illness: Service Providers’ Perspectives

Young people with a parent or parents who have mental illness are at a higher-than-average risk of experiencing emotional and behavioural difficulties. Notwithstanding the difficulties experienced by these young people, opportunities to interact with and obtain support from peers living in similar families can be beneficial. While young people face several barriers to participating in face-to-face peer support programs, online approaches potentially provide a different way of obtaining peer support. This paper aims to explore service providers’ perspectives on current Victorian peer support programs, as well as the strengths and weaknesses of online approaches to peer support. Semistructured interviews were conducted with 17 mental health professionals who work with families affected by parental mental illness. Participants recognised that many young people miss out on face-to-face peer support programs, and were highly supportive of the idea of online programs. This study suggests that online peer support programs for young people could occupy an important position in the evolving suite of services for Australian families affected by mental illness.     

High-cost religion, religious switching, and health

Previous research has devoted significant attention to understanding the link between health and personal religious beliefs and practices, typically finding that more religious people tend to have better health. However, almost no attention has been given to how switching religious groups or leaving religion altogether is related to self-reported health. Due to selection and causation mechanisms, switching from high-cost groups that are theologically and culturally exclusive could be associated with poor health more than switching from other religious groups. Using data from the 1972 through 2006 General Social Surveys, we examine the relationship between health and religious switching as moderated by the religious tradition of origin. We find that people who are raised and stay in high-cost sectarian groups, such as the Latter-day Saints and Jehovah's Witnesses, have better self-reported health than those raised and staying in other religious traditions. However, people who leave such groups are more likely to report worse health than those who leave other groups.     

In search of a level playing field – the constraints and benefits of sport participation for people with intellectual disability

This paper presents the results of a study seeking to examine the experiences of people with intellectual disability in a sporting context. The research design employed an online, interviewer-completed questionnaire in both a standard and an easy English version designed for administration by a third party for those requiring assistance to respond. Questions sought both quantitative responses about levels of participation and qualitative responses about constraints experienced and benefits received from participation. The results of the study show high levels of participation reported by people who are independent or have lower to moderate support needs, whereas people with high to very high support needs had substantially lower levels of participation. Constraints are examined for both those who participate in sport and those who do not. For those who do participate, the benefits were identified as overwhelmingly social in nature, including belonging, companionship and achievement.     

Quality of life of older people in Israel: a comparison between older people living at home who are members of a ‘supportive community’ and nursing home residents

The supportive community is a program that was developed in Israel for older people who live at home. The program provides its members with a service package that includes medical and social services, emergency call-button, cultural activities, and a ‘community parent’ who is responsible for the members. Using quantitative method, this study compared the level of quality of life between 55 older people living in their homes who are members of a supportive community (average age = 74.7) and 60 elderly people living in nursing homes (average age = 75.8). As expected, results indicate that quality of life among the older people living at their homes who are members of a supportive community was higher than among the older people living in a nursing home. In addition, the quality of life of married, educated, functionally independent older people in good health and with a good economic situation was higher. Predictor variables of quality of life were: the place of residence, health status, and age. In light of increased life expectancy and the growing need to care for the older population, the practical application of the study focused on a recommendation for the social services to continue the support community development program.     

‘The seal of approval’: referring adults with intellectual disabilities and challenging behaviour to community learning disability teams

This article describes a study that involved interviewing eight managers of residential services, who have made referrals to community learning disability teams (CLDTs) for challenging behaviour. Thematic analysis and a critical perspective are combined to analyse and interpret what referrers said about the process of the referral. The study found that managers referred people with intellectual disabilities to the CLDT primarily in order to manage organisational problems rather than to directly manage challenging behaviour. The referrals enlisted the services of professionals to legitimise the residential services, to confirm their practices and to provide credibility to existing decisions by managers. In referring a man or woman with intellectual disabilities to the CLDT, the managers submit themselves, their staff and the person with the intellectual disabilities to the power of the health and psy-complex professionals.     

The Coalition,austerity and mental health

In the United Kingdom, the Coalition government’s recent commitment to improving mental health provision masks the extent that their policies of austerity have already brought harm to those same services. Government-driven policies have led to significantly reduced funding within mental health, increasing pressure on a system that was already chronically under-resourced. Further, people who are experiencing mental distress, and mental health service users, have been especially vulnerable to the harms of the current austerity programme, including being at the sharp end of the assault on public services and welfare spending. This piece discusses the impact of austerity, exploring the effects of government policies and with a critical perspective of the dominant discourses around mental health. It argues that by exacerbating social inequality, government policies are also directly leading to worsening mental health in the United Kingdom.     

Moving the Boundaries of Feminist Social Work Education with Disabled People in the Neoliberal Era

Until recently social work education in Australia has either marginalised or neglected disability by omission. Given the increasing number of disabled people in the community, the teaching of social work within a disability studies emancipatory paradigm as an essential part of the curriculum is long overdue. As many social work educators have suggested, we are at a critical moment in Australia, where the policy environment in which social work is embedded has largely been reframed in line with neoliberal trends. For disabled people, this has meant an ongoing state campaign to diminish disability entitlements, from decreasing disability social security regimes through to the rationalisation of adult disability support and care schemes. Social workers are negotiating the competing demands of these policy constraints alongside the needs of the disabled people they work with. New moral dilemmas have emerged where they are actively faced with the question of ‘who to serve?’.