Show Me the Way to go Home: A Narrative Review of the Literature on Delayed Hospital Discharges and Older People

Correspondence to Jon Glasby, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Edgbaston, Birmingham B15 2RT, UK. E-mail J.Glasby{at}bham.ac.uk Summary This Research Note reports findings from a narrative reviewof the literature on the rate and cause of delayed hospitaldischarge in the UK. In addition to summarizing our knowledgeto date in this important area, the Research Note raises a seriesof questions about aspects of current hospital discharge policyand practice (and in particular, the recent reimbursement policyto charge social services departments for delayed discharges).     

On the Inside: A Narrative Review of Mental Health Inpatient Services

This paper describes and discusses the results of a narrativereview of inpatient mental health services in the UK. Four mainthemes emerge from the review: the growing pressure on inpatienthospital services; the negative experience of inpatient servicesreported by many service users; the problematic nature of hospitaldischarge; and possible alternatives to hospital admission.This review also suggests that a failure to recognize and acton what appears to be happening in hospitals could result ininpatient care once again being subject to the scrutiny andcriticism that cast a shadow over psychiatric services in the1960s and 1970s. To stop this happening, current governmentpolicy is right to focus attention back onto acute care throughnew guidance and by commissioning research. However, changesalso need to take place at a practice level so that front lineworkers are familiar with conditions in local acute servicesand can challenge unacceptable behaviour/services in supportof their service users. With current changes in the make-upof local mental health services and a greater emphasis on partnershipworking between health and social care, it may be that socialcare practitioners can do this not only from the outside, butincreasingly ‘on the inside’ (from within integratedhealth and social care organizations).     

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.     

An Inclusive Approach to Knowledge for Mental Health Social Work Practice and Policy

As the integration of health and social care services progressesin the mental health sector, there is concern that mental healthsocial workers are disadvantaged, relative to health professionals,because they cannot identify the knowledge base for their practice.This paper argues that this concern is partly the product ofassuming that the knowledge base has to be premised upon randomizedcontrolled trials. Instead, it proposes a non-hierarchical frameworkbased on that developed in health research in Canada by Upshurand colleagues that generates a typology of knowledge whichis congruent with the main forms of inquiry that are relevantto mental health social work practice. The framework recognizesthe contribution of randomized controlled trials to the knowledgebase but also validates knowledge drawn from qualitative, epidemiological,practitioner and user knowledge. It is argued that the frameworkprofiles a wider knowledge base than that promoted by conventionalevidence-based practice, and also could be a basis for futuredevelopment of the research agenda in mental health social work.     

Shame and recognition: Social work practice with vulnerable young people

Drawing on the findings from a longitudinal study of vulnerable young people's transitions to adulthood, this paper explores the ideas of shame and recognition. The young people, aged between 12 and 17 years at the first interview, had experienced chronic exposure to adversity from an early age (abuse, violence, mental health issues, addictions, and expulsion from school). They were clients of statutory and non‐governmental services: child welfare, juvenile justice, remedial education, and mental health services. This paper draws on the qualitative phase of the study (n = 107); young people and a trusted other, nominated by the young person, participated in three annual qualitative interviews. Interviews focused on young people's experiences of services, key transitions, their relationships, and the strategies they used to locate support and resources. Experiences of shame, misrecognition, and seeking recognition emerged as dominant themes in the young people's accounts, and these are explored in this paper. The paper concludes with a discussion on responsive social work interventions that generate a deeper understanding of young people's experiences of shame and misrecognition. Central to this practice are critical and relational social work practices that actively support young people to achieve recognition.     

Youth and Provider Perspectives on Social Service Providers' Roles in Mental Health Services

ABSTRACT

In 1994 and 1996, the Youth Services Project interviewed 792 youths from St. Louis City. Although the youths showed a high need for mental health services (20% met diagnostic criteria), less than half of the youths with problems received services. Past contact with a social service provider, but not a teacher, physician, etc., significantly predicted care for mental health problems (odds ratio = 1.5). Social service professionals (largely social workers) served more youths than did any other profession. Of youths with persistent problems, 25% received services from social service professionals, 3% from MD/PhD level psychiatrists or psychologists, 7% from primary care medical doctors, 12% from teachers/coaches, 15% from other helpers, and 37% received no services at all.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

Poverty, Social Exclusion and the Politics of Disability: Care as a Social Good and the Expenditure of Social Capital in Chuadanga, Bangladesh

People labelled with disabilities in Chuadanga, Bangladesh, are denied equitable access to social networks and formal services. In terms both of funding future formal service programmes and of designing community‐based outreach programmes, this lack of access is not a simple reflection of one's impairment but a facet of the social exclusion and stigma that is culturally ascribed to disability in Chuadanga. We utilize a social model to focus on the cultural processes initiated by the onset of illness or impairment. Our participants are drawn from four types of diagnosed disability: blindness, orthopaedic impairment, hearing impairment and mental disorder. Although this inquiry is in line with Daly's focus on how future spending on formal services to promote care and equity in Europe can be helped by searching out information that is often ignored, the particular focus of this study is Chuadanga and the research questions incorporate a disability studies perspective. The authors consider care as a social good and an expenditure of social capital, in reviewing findings from a recent empirical study of disability and employment in the Bangladesh district of Chuadanga. Regardless of disability, poverty can be a morally and socially devastating ordeal. However, the authors conclude that the added loss of social solidarity and equitable access, due to the social exclusion and stigma of disability for the families concerned, make it statistically far less likely that they will access formal services or be able to escape poverty.     

Putting the parity into service‐user participation: An integrated model of social justice

Models of service‐user participation have derived from citizenship or consumerist agendas, neither of which has achieved the structural reforms important for the most marginalised social work clients. This article proposes Fraser's model of ‘parity of participation’ as an appropriately multifaceted frame for capturing the social justice aspirations of service‐user participation. A qualitative case study compared the experiences and expectations of people who had used Australian mental health services with a sample who had used Australian homelessness services to examine their expectations of participation at individual and representative levels. The findings reinforce concerns from Fraser's research about the tendency for identity‐based consumerist notions of participation to reify group identity. This leads to tokenistic service‐user involvement strategies that have little impact on participation at a structural level. Fraser's parity of participation is shown to have untested potential to reshape service‐user participation to meet the social justice aspirations of social work clients. Key Practitioner Message: ● Innovative, service‐user driven strategies for collaboration will be those which challenge existing power structures; ● Service users want their contributions to decision making to generate identifiable change in the system of social services; ● The success of service‐user participation strategies might be the extent to which political, economic and cultural opportunities are enhanced.     

Mergers and Acquisitions in the Private Sector: What Are the Lessons for Health and Social Services?

In seeking a more seamless provision of health and social care, the government is promoting the merger of the functions of primary and community health services and social services. In the private sector, mergers have been commonplace. The primary aim of this paper is to identify the key concepts and explanatory frameworks in the literature on mergers and acquisitions in the private sector that are relevant to the development of new organizational structures in health and social care. The evidence suggests that it is difficult to merge two organizations successfully. Reasons for this are explored and the implications for health and social care mergers drawn out.     

Parenting challenges of African immigrants in Alberta,Canada

African immigrant children and youth have some of the poorest social and mental health outcomes in Canada. Although parenting challenges have been widely documented as a key driver of these outcomes, limited systematic research has investigated this phenomenon. In this paper, we report the results of a study examining parenting challenges among a sample of African immigrant parents in Alberta, Canada. We relied on the theoretical lens of transnationalism to collect and analyse data from a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), and a range of stakeholders (n = 30). Our thematic data analysis revealed several intricately intertwined parenting challenges, organized around six overarching themes, namely, cultural incompatibility, family tension, state interference, limited social supports, poor access to services, and low socioeconomic status. We present these themes and the policy and service implications of our findings.     

Inside the Black Box: what constitutes a day in a residential treatment centre?

Residential Treatment Centres (RTCs) provide 24-hour care and mental health services to young people, many of whom are referred from county departments that oversee services to young people involved with child welfare services, mental health services and corrections. While RTCs are required to provide mental health services to young people, the regulations governing these programmes have few specific requirements about the process, content or duration of treatment. Therefore, many questions have arisen about what a typical RTC day looks like and whether it differs among providers or differs based on the severity or type of the young person's mental-health related behaviours and symptoms. This study conducted interviews with RTC providers in the State of Colorado on this topic. Most RTC services were relatively uniform across case types within each RTC. It appears that with a few exceptions, a similar set of services is provided to all young people, regardless of their problems.     

Social Exclusion, Poverty, Health and Social Care in Tower Hamlets: The Perspectives of Families on the Impact of the Family Support Service

to Ben Gray, 6B Park Road, Wivenhoe, Essex CO7 9NB, UK. Summary This paper describes the work of the Family Welfare Association's(FWA's) Tower Hamlets Family Support Services projects (FSSs).Tower Hamlets is a multiracial area in East London, which accordingto the 1991 census has high levels of poverty, overcrowdingand unemployment. Increasing poverty and social exclusion, whichfurther entrench inequalities in health, are reported by sourcessuch as Government, health and social services departments asrequiring innovative local responses to meet pressing welfareneeds. Innovative projects are especially urgent with vulnerablefamilies whose experiences of racism, bullying, mental healthdifficulties, domestic violence and child abuse are the rulerather than the exception. In common with other initiativesin the United Kingdom and abroad, the FSS aims to be non-stigmatizing,non-intrusive and responsive to the ethnicity, views and specificneeds of families. The paper focuses on the FSS's participatorywork with families to illustrate effective methods of qualitysupport, detail outcomes and draw lessons for policy and practice.     

Medicalization of Social Workers in Mental Health Services in Hong Kong

Correspondence to Dr Kam-shing Yip, Associate Professor, Department of Applied Social Studies, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong. E-mail: ssksyip{at}polyu.edu.hk Summary Medical dominance is a crucial problem in social work practicein mental health services. This paper is an examination of theresponse of social workers to medical dominance in mental healthservices in Hong Kong. To explore the process and the effectsof medicalization of social workers, sixty-three social workersin various areas of mental health service settings were interviewed.Their reaction and daily performance in facing medical dominancewere analysed and evaluated. The findings show that facing medicaldominance was a common occurrence for social workers in variousmental health services in Hong Kong. Conflict existed betweenthe rationalization of medical knowledge by medical professionals,and social work rationalization of social work knowledge bysocial workers. The process of medicalization consisted of fivestages: ignorance of medical dominance, confronting medicaldominance, compromise with medical dominance, acceptance ofmedical dominance and internalization of medical dominance.The findings also show that medicalization was influenced bythe organizational and team context.     

Economic distress and health: A fixed effects analysis of low‐income persons in Singapore

Using fixed effects regressions, this study examined the transactional effects of different types of economic status on the physical and mental health of low‐income persons in Singapore. Among the economic variables considered, unemployment and arrears had the most significant effects. This signals the physical and psychological distress of being out of work and possessing arrears while income is low. The insignificant effects of poor health on household earnings suggest possible earnings supplementation by other household members. The findings imply the fruitfulness of dually improving employment prospects and health, work activation that takes into consideration mental health effects, increasing affordability of health services in liberal welfare systems, improving mental bandwidth through reducing arrears accounts, and short lag time from application to receipt of assistance. These implications point to a larger question on health and welfare systems in an increasingly uncertain economic environment for households in poverty. Key Practitioner Message: ? Employment and health are inter‐related: employment assistance incorporating physical and mental health interventions and vice versa can be more effective than either alone; ? Compared with decreasing arrears amounts, reducing the number of arrears can more effectively relieve mental distress; ? Effects between economic distress and health materialise quickly; minimising the lag time between application and receipt of assistance will provide great relief.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Care without coercion – mental health rights,personal recovery and trauma‐informed care

Australian mental health services continue to use involuntary measures in response to consumers' mental distress. Regardless of the intent behind these practices, the experience of being forced to receive treatment, be secluded or restrained is traumatic and can cause further distress and harm. Other parts of the health or social service system have shifted to approaches that emphasise agency, social context, prevention, and rights. Three frameworks currently used in mental health services – human rights, personal recovery, and trauma‐informed – are consistent with a shift away from the use of force. We applied these frameworks to the text of the National Standards for Mental Health Services 2010 to analyse the degree to which it reflects a shift. We also analysed the public text of speakers' notes from the Care Without Coercion Conference 2012 concerning lived experiences of force in mental health services. The analysis highlights force in many aspects of policy. The findings have implications for directions of change, including freedom from violence; support for decision making; access and choice about community and inpatient options; safety and risk management; and greater understanding of current policy frameworks through engagement with people with lived experience about the options and impact of support processes that exclude the use of force.     

Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns

ABSTRACT

This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.     

Assessing mental health and service needs among refugees in Malaysia

Refugees in Malaysia often experience economic insecurity and poverty, poor health, poor mental wellbeing and limited legal rights. Using a survey with quantitative measures and open‐ended questions, we assessed socio‐demographic characteristics, mental health (RHS‐15), and service needs, including interest in group support services, among 86 Dari‐ and Arabic‐speaking refugees living in Kuala Lumpur. High levels of emotional distress were found, as nearly all participants scored positive for distress and average scores were 2.5 times above the cut‐off signifying distress. Distress scores did not vary based on most factors examined, although being married was associated with lower levels of distress. All but one participant expressed interest in participating in a support group. Barriers to potential participation included childcare, sickness and transportation. Additional mental health and social supports are needed among refugees residing in Malaysia. Key Practitioner Message: ? Emotional distress is high among Dari‐ and Arabic‐speaking refugees sampled in Malaysia; ? Participants expressed strong interest in accessing supportive mental health services, including group supports.