Structuring mental health within senior services: a case study of an outpatient mental health clinic serving latinos

The article presents a case study of an outpatient mental health clinic serving Latino older adults. The study explored staff perceptions on the clinic development and the context within an immigrant multicultural community. The study used in-depth, semistructured interviews with support staff, clinical social workers, and administrators. Interviews were analyzed using a thematic content analysis. The mental health clinic formation was perceived by staff as an ecological process stemming from the needs of the Latino immigrant senior clients. A close knit and interdependent culture allowed the clinic to adjust to diversity and changing cultural contexts.     

A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.     

Assessing an Adult Mental Health Clinic for Age-Related Issues

A community mental health clinic in an urban setting is the subject of an exploratory assessment to determine whether its 55 + patients are being treated according to the special diagnostic and treatment issues that tend to affect older people. Depression is found to be high on the list of diagnoses in this age group. As many as 40% of the group are considered to be at risk for suicide. The interrelationship of medical and psychological factors is emphasized. Sixty-two percent of those studied are determined to be socially isolated. Treatment techniques recommended in the literature for older patients are summarized, and it is determined that, while therapists at the clinic.have not been trained in geriatric psychology, many are instinctively utilizing these techniques. Recommendations are made for increased use of groupwork with older patients, inservice education for staff, attention to medical complications, improved outreach, and involvement of family.     

The Impacts of Acculturative Stress and Social Competence on the Mental Health of Mainland Chinese Immigrant Youth in Hong Kong

Correspondence to Dr Daniel Fu Keung Wong, Associate Professor in the Department of Social Work and Social Adminstration, 1317 K K Leung Building, The University of Hong Kong, Pokfulam Road, Hong Kong.E-mail: dfkwong{at}hkucc.hku.hk Summary Attempts were made to examine migration stressors, social competence,and mental health status of immigrant youth in Hong Kong andto examine the effects of social competence on stress and themental health of immigrant youth. Data on 106 immigrant youth,which were collected through a structured questionnaire, wereanalysed. It was discovered that immigrant youth found survivalissues and losses, rather than cultural differences and unfulfilledexpectations, to be stressful. Male immigrant youth exhibitedmore psychological distress symptoms than female immigrant youth.Hierarchical regression analyses revealed that social competenceexerted moderating effects on stress and the mental health ofimmigrant youth. Immigrant youth who had a higher level of socialcompetence, in terms of self-control, empathy, assertivenessand the ability to read social cues, had less stress and enjoyedbetter mental health. In conclusion, personal and socio-culturalreasons are put forward to explain the findings. Practice andpolicy implications are also discussed.     

Differential Impacts of Stressful Life Events and Social Support on the Mental Health of Mainland Chinese Immigrant and Local Youth in Hong Kong: A Resilience Perspective

Based on a resilience perspective, this study attempted to explorethe risk and protective factors influencing the mental healthof immigrant and local youths in Hong Kong. A structured questionnairewhich consisted of The Chinese Adolescents Life Events Checklist,The Perceived Satisfaction of Social Support Scale and The BriefSymptoms Inventory was used. Two hundred and ten local and immigrantyouths between the age of 15 and 20 were individually interviewedby the trained interviewers. Contrary to our hypotheses, thefindings revealed that immigrant youth had better mental healthand similar levels of stress than local youth. Moreover, peersupport was found to exert a strong impact on the mental healthof immigrant youth. While ‘Interpersonal relationshipdifficulties’ was identified as a common risk factor facedby local and immigrant youths, immigrant youth faced additionalrisk factors in relation to a change to a new school and parentalconflicts. On the other hand, endurance of hardship, socialcompetence and peer support were considered as the protectivefactors that might be associated with better mental health inimmigrant youth. The implications of this study included: toadopt a resilience perspective to understand the protectivemechanisms that enhance the mental health of immigrant youth;to develop a national strategy to build up the interpersonalrelationship skills of youth in a society; and to organize specificprogrammes to strengthen the peer system and tackle parentalconflicts in immigrant youths.     

Overcoming Barriers to Serving the Aging/Mental Health Client

This paper presents a model, based upon a series of state-level initiatives in the Commonwealth of Pennsylvania, for improving coordination between the aging and mental health systems to better serve elderly persons with mental health problems. The mental health needs of the elderly are discussed and service delivery obstacles - systemic, individual, and agency/staff - are reviewed and synthesized. Policy initiatives by the Commonwealth of Pennsylvania that relate to these issues are presented as a case study, with a focus upon a series of regional conferences held around the state for providers in the aging and mental health networks to encourage better coordination of services. The process and outcomes of these conferences are discussed, together with an analysis of the implications for practice, policy, and teaching.     

Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care

Correspondence to Professor John Carpenter, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.uk Summary This study investigated the relationships between the organizationof community mental health services and professional and teamidentification, team functioning and the psychological well-beingand job satisfaction of staff working in multidisciplinary communitymental health teams (CMHTs). Staff in four districts in theNorth of England completed anonymous questionnaires on two occasions,twelve months apart. There were systematic differences in teamfunctioning, favouring teams in districts where mental healthand social care services were integrated. However, service organizationhad no evident impact on professional or team identificationor on outcomes for staff in terms of stress or job satisfaction.There were differences between social workers (n = 31) and healthservice professionals (n = 82) indicating that social workershad poorer perceptions of team functioning and experienced higherlevels of role conflict. Controlling for other factors includingthe study districts, role conflict was a significant predictorof stress and of job dissatisfaction, while role clarity promotedjob satisfaction. We conclude that support and supervision aimedat ensuring a social work contribution to multidisciplinaryworking should be provided in the course of establishing CMHTsand integrated health and social care services.     

Fitting in: the roles of social acceptance and discrimination in shaping the daily psychological well-being of Latino youth

Objectives: We examine how acculturation experiences such as discrimination and social acceptance influence the daily psychological well-being of Latino youth living in newly emerging and historical receiving immigrant communities. Methods: We use data on 557 Latino youth enrolled in high school in Los Angeles or in rural or urban North Carolina. Results: Compared to Latino youth in Los Angeles, Latino youth in urban and rural North Carolina experienced higher levels of daily happiness, but also experienced higher levels of daily depressive and anxiety symptoms. Differences in nativity status partially explained location differences in youths’ daily psychological well-being. Discrimination and daily negative ethnic treatment worsened, whereas social acceptance combined with daily positive ethnic treatment and ethnic and family identification improved, daily psychological well-being. Conclusions: Our analysis contributes to understanding the acculturation experiences of immigrant youth and the roles of social context in shaping adolescent mental health.     

Predicting Burnout Syndrome in Greek Mental Health Professionals

The aim of the study was to explore predictors of burnout in clinicians working across different mental health settings in Greece. The Maslach & Jackson Inventory (Maslach Burnout Inventory, MBI; Maslach & Jackson, Journal of Organizational Behavior, 1981, 2(2), 99–113) was used to evaluate burnout syndrome and assess the relationship between demographic factors (age, children, education, and job experience) and each sub-factor (emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA)) of the MBI. Results revealed that out of three burnout factors, EE and PA demonstrated one significant predictor each whereas DP showed no significant predictors. In addition, job experience (years in the job) was found to be a significant predictor of EE in clinical staff. Further analysis showed no significant differences across job type for EE, DP, and PA. The findings are discussed with a focus on prevention and coping strategies for clinicians working in mental health settings.     

Assisted Living Facility Administrator and Direct Care Staff Views of Resident Mental Health Concerns and Staff Training Needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Stress and Pressures in Mental Health Social Work: The Worker Speaks

Two-thirds of councils with social services responsibilities(CSSRs) took part in a UK survey of mental health social workers.A one in five sample of front line workers was drawn, and 237respondents completed a questionnaire and diary about theirwork context and content, and their attitudes to their work,their employer, mental health policy and the place of mentalhealth social work in modernized mental health services. Thequestions, that called for free-text responses, were completedin detail and at length. This paper reports the results of aqualitative analysis of these responses using NVIVO software.The paper is structured around the themes emerging from theanalysis: pressure of work; staffing matters; job satisfactionand well-being; recruitment and retention issues; and beingvalued. The conclusions are that the social workers value faceto face contact with service users, and that their commitmentto service users is an important factor in staff retention.The most unsatisfactory aspects of their work context arisefrom not feeling valued by their employers and wider society,and some of the most satisfactory from the support of colleaguesand supervisors. Without attention to these factors, recruitmentand retention problems will remain an unresolved issue.     

Chapter 17. Rural Mental Health

SUMMARY

Mental health services available in many rural communities are too limited in scope and availability to meet the needs of rural citizens. The future of mental health services for the rural poor will be impacted by state government decisions about Medicaid funding priorities. It is important that rural practitioners, especially those that work in the fields of mental health, health, and aging services, engage in advocacy for better coverage of the rural poor and low-income elderly persons. This chapter discusses issues of advocacy related to improving the provision of mental health services to older rural citizens as an important goal in the larger effort to expand and improve rural mental health service delivery throughout the nation.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

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.     

经济社会地位、年龄与心理健康：一项基于上海的实证研究

本文从社会结构的角度出发,以“2008年中国家庭动态调查（上海卷）”的数据为基础,考察了心理健康在社会各阶层间的分布以及这些分布在年龄组间的变化。结果显示,教育、收入、职业地位、社会地位与心理健康正面相关,而经济困难和不公正待遇则与心理健康负面相关。年龄和心理健康的关系呈现出“∩”型发展趋势;职业类型及教育程度对心理健康的作用在不同年龄组中出现了不同程度的变化。失业者较好的心理状态及青年技术人员较差的心理健康状况则需要做进一步的研究。     

Changing Places: Men Replace Women in Mental Health Beds in Britain

Based on census materials collected in England and Wales from 1921 to 1991, this study focuses on gender differences in occupancy rates in hospitals and other mental health facilities in Britain. The results suggest that since 1991, or for the first time in the twentieth century, there are more males than females in residential mental health facilities in Britain. Furthermore, this pattern of association holds for all age groups except those aged 65 years and over. Second, there are currently two distinct subpopulations in mental health facilities—a male group which is predominantly of working age, and a female group, which is predominantly of retirement age. The existence of these two "care" populations will impact significantly on current and future resourcing of mental health services. The policy implications of the research findings are discussed within the context of the debates on the changing relationship between gender and mental health.     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

Community Mental Health Services in a Remote Rural Area

A programme was developed by the authors to provide community mental health services to an isolated rural region situated within the large catchment area of a state psychiatric hospital. The programme functioned without psychiatrist or medical officer in the team. The authors believe their programme to be effective and economical both of monetary cost and of the scarce services of psychiatrically trained professional workers. They hope it will serve as a model for other community mental health workers.     

Socioeconomic Status,Gender Inequality and Women's Mental Health: Some Findings from the Canberra Mental Health Survey

Data from the Canberra Mental Health Survey are utilized to answer questions concerning the mental health status of women (especially married women). Using the Langner Scale as the main index it is shown that there is a complex relationship between the socio-economic status of a married woman's occupation, and the status of her husband's job. It is also shown that there is an association between sex, marital status and mental health that runs in the direction of Jessie Bernard's summary ‘marriage is good for men, but not for women’.