From pathology to postmodernism: a debate on ‘race’ and mental health

This article suggests that ‘race’ and psychiatry are inextricably linked and as such ‘mental illness’ constitutes a precondition of black people's psyche. Postmodernist and poststructuralist analysis are used to question the way in which mental health problems have been socially constructed in western psychiatry. In order for health and social care workers to effectively respond to racism within psychiatry and community care provision it is necessary for them to understand the relationship that exists between and informs ‘race’ and psychiatry.     

Child Welfare Workers' Adoption of Decision Support Technology

Child welfare workers must process complex information in deciding to refer clients to appropriate mental health services. Decision support systems have been demonstrated in other fields to be an important tool, yet little research has been done in child welfare. This study focused on the adoption of a specific decision support system into child welfare practice. Quantitative analysis was used to demonstrate the diffusion of innovation process among a sample of state child welfare workers, while qualitative analysis was used to explain the facilitators and barriers to decision support systems adoption. Results indicate that for decision support systems to be widely adopted in child welfare practice, they should be integrated into the referral system and include workers' knowledge and experiences with referral resources. For successful adoption, decision support systems need to respect the natural logic and flow of worker interaction as well as organizational constraints.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Interprofessional collaboration between residential child care and mental care practitioners: a cross-country study in six European countries

ABSTRACT

The severe mental health problems of many of the young people living in residential settings pose a great challenge and demand on child protection and mental care (MC) services. Drawing on comparative research and debates from six European countries, this study examines demands for integrated care and interprofessional collaboration practices between residential child care (RCC) and MC. In this article, research data will be brought together from Denmark, Finland, Germany, Lithuania, the UK (Scotland) and Spain. In total, 61 practitioners from RCC and MC were interviewed. Given the complexity of the residential care service context and service system differences across national contexts, the original hypothesis was that this would differentiate the collaboration practices. However, the similarity between the countries is greater than anticipated. The concluding findings are organised by matrix technique into a content-analytic summary table. The main finding was that in spite of encouragement for integrated RCC, obstacles for collaboration and lack of coordination between systems remain, often related to understanding the professional role and tasks, lack of shared knowledge, attitudes and ways of communication. One significant finding in the cross-country comparison was the evident and unrealistic expectations for the ‘other’ provider to help and care.     

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.     

RELEASING POTENTIAL — THE FUTURE OF SOCIAL WORK AND CAMHS

Several recent UK government initiatives are set to have an impact on child and adolescent mental health services. As a result new primary mental health worker and similar posts are being established. These jobs are proving attractive to social workers seeking to develop their special interest in child and adolescent mental health. This article sets out some of the problems and prospects for social workers undertaking them seeking to develop a modern psycho‐social practice using psychodynamic skills.     

The Right Tools for the Right Job: Social Work Students Learning Community Development

The place of community development within social work varies across nations and time. The tensions in the 1970s in the UK gave way to decades when social work has been dominated by issues relating to protecting and caring for individuals. We now have a resurgence of community development activity, bringing together varied disciplines such as urban planning and health promotion as well as social work. Within the UK there are now requirements for community development knowledge and skills within qualifying social work training. This paper reflects on experiences in promoting community development practice learning in social work qualifying placements within Health and Social Care Trusts in Northern Ireland. Issues are raised about the diversity and complexity of expectations on qualifying training, and the challenges that face universities, colleges and employing organisations in developing practice learning in this curriculum area. The prospects for improving community development learning within both qualifying and post qualifying education and training are considered particularly in the light of inter-professional and inter-organisational initiatives that put community development in the context of health promotion, housing, crime, poverty and other social issues that might be addressed at community level to improve the health and social well-being of citizens.     

The Evolution of Community Mental Health Services in Asian American Communities

This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.     

Improving mental health assessments in child protection through audit

Existing agency records, together with questionnaires completed by social services referrers and mental health providers, were used to identify problems in current arrangements for obtaining specialist mental health assessments in child protection cases. Standards were set and implemented through a multi‐agency steering group. The practice of referrers and providers was then reaudited. Sixty‐nine social workers, six mental health specialists and 27 child protection initial case conferences (involving 31 children) were involved in the reaudit over a 4‐month period. Initially, main problems concerned communications, unclear referral and access arrangements, waiting times and disagreements over prioritization. Standards concerned consultation and decision‐making arrangements within the child mental health service, the format of referral and reply letters, the sharing of information and the attendance of mental health professionals at child protection case conferences. There appeared to be improvements in all these areas at reaudit. In conclusion, some shared views of problems, additional support funding and the audit process appear to have helped to improve inter‐agency collaboration and develop more efficient referral and care arrangements. There is a need to maintain and further develop this work, and audit would again be a useful means. Copyright © 1999 John Wiley & Sons, Ltd.     

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.     

The social practice of sustainable agriculture under audit discipline: Initial insights from the ARGOS project in New Zealand

One of the most interesting recent developments in global agri-food systems has been the rapid emergence and elaboration of market audit systems claiming environmental qualities or sustainability. In New Zealand, as a strongly export-oriented, high-value food producer, these environmental market audit systems have emerged as an important pathway for producers to potentially move towards more sustainable production. There have, however, been only sporadic and fractured attempts to study the emerging social practice of sustainable agriculture - particularly in terms of the emergence of new audit disciplines in farming. The ARGOS project in New Zealand was established in 2003 as a longitudinal matched panel study of over 100 farms and orchards using different market audit systems (e.g., organic, integrated or GLOBALG.A.P.). This article reports on the results of social research into the social practice of sustainable agriculture in farm households within the ARGOS projects between 2003 and 2009. Results drawn from multiple social research instruments deployed over six years provide an unparalleled level of empirical data on the social practice of sustainable agriculture under audit disciplines. Using 12 criteria identified in prior literature as contributing a significant social dynamic around sustainable agriculture practices in other contexts, the analysis demonstrated that 9 of these 12 dimensions did demonstrate differences in social practices emerging between (or co-constituting) organic, integrated, or conventional audit disciplines. These differences clustered into three main areas: 1) social and learning/knowledge networks and expertise, 2) key elements of farmer subjectivity - particularly in relation to subjective positioning towards the environment and nature, and 3) the role and importance of environmental dynamics within farm management practices and systems. The findings of the project provide a strong challenge to some older framings of the social practice of sustainable agriculture: particularly those that rely on paradigm-driven evaluation of social motivations, strong determinism of sustainable practice driven by coherent farmer identity, or deploying overly categorical interpretations of what it means to be ’organic’ or ’conventional’. The complex patterning of the ARGOS data can only be understood if the social practice of organic, integrated or (even more loosely) conventional production is understood as being co-produced by four dynamics: subjectivity/identity, audit disciplines, industry cultures/structure and time. This reframing of how we might research the social practice of sustainable agriculture opens up important new opportunities for understanding the emergence and impact of new audit disciplines in agriculture.     

An Experiment in Overseas Field Instruction

This paper reports on a study that examined the knowledge needed for practice in community mental health and the primary source for this knowledge. Differences were found in knowledge areas needed for practice in community mental health settings when contrasted with practice in more traditional mental health agencies. The most frequently indicated source of knowledge for social work roles in community mental health was on-the-job experience. Courses in social work schools were not a primary source of knowledge for the many nonclinical roles undertaken by social workers in community mental health.     

Mental health social work in Northern Ireland and the Republic of Ireland: challenges and opportunities for developing practice

Drawing on their experience of mental health social work in Northern Ireland and the Republic of Ireland, the authors examine the impact of current legislative and policy change in both jurisdictions. The paper applies Lorenz's theoretical framework to develop a comparative analysis of how global and country specific variables have interacted in shaping mental health social work. The analysis identifies linkages between factors and indicates similarities and differences in mental health social work practice. The paper highlights emerging discourses in this field and explores the impact on practice of developments such as de-institutionalisation, community care, and ‘user rights’ versus ‘public protection’. The article concludes with a review of key challenges facing social workers in both jurisdictions and identifies opportunities for developing mental health social work in ways that can positively respond to change and effectively address the needs of mental health service users and their carers. The analysis provides an opportunity to evaluate Lorenz's theoretical framework and the paper includes a brief critical commentary on its utility as a conceptual tool in comparative social work.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Mental Health Workforce Change Through Social Work Education: A California Case Study

The 2004 CaliforniaMental Health Services Act requires large-scale system change in the public mental health system through a shift to recovery-oriented services for diverse populations. This article describes an innovative strategy for workforce recruitment and retention to create and sustain these systemic changes. The California Social Work Education Center Mental Health Program provides stipends to master's of social work students at 17 California universities. In return, students must work for 1 year postgraduation in community mental health practice. Results of a 5-year study show that stipend recipients closely mirror the diverse demographics of the state, and 94% have remained in community mental health practice. The article also discusses lessons learned and implications for social work education in California and other states.     

Comparing child protection decision-making in England and Finland: supervised or supported judgement?

ABSTRACT

Systems for the protection of children have evolved differently across nation states. Studies have identified contrasting system ‘orientations’, related to how child protection problems are framed and how organisations respond in different contexts. In this study, the influence of national and organisational factors on practice-level decision reasoning by social workers has been compared. Interviews were conducted with 30 child protection social workers in sites across England and Finland, structured around two hypothetical case vignettes. While similarities were observed in how the social workers responded to the vignettes, there were differences in the nature and extent of managerial involvement described, with the English social workers appearing to rely on managerial input for decision-making to a greater extent than the Finnish social workers. These findings suggest evidence for two distinct organisational approaches to decision-making: ‘supervised’ and ‘supported’ judgement. Here, supervised judgement describes a hierarchical, ‘top-down’ form of decision-making, while supported judgement describes a more horizontal and shared decision-making approach. The lens of comparative methodology has revealed how these organisational factors come into play in different child protection systems. The practice implications of supervised, manager-led approaches to decision-making, as contrasted with supported, team-led approaches, are discussed.     

Barriers and Promoters of Mental Health Services Utilization in a Latino Context: A Literature Review and Recommendations from an Ecosystems Perspective

ABSTRACT

This article focuses on the problems of disparities in mental health service utilization in the Latino population in the United States. It begins with an overview of the Latino population within the United States, an exploration of the diversity within this group, and shared cultural values and traits with a particular focus on the problems of Latino poverty. A review of the literature follows, including identified barriers to and promoters of mental health services utilization. These are contextualized in a Latino perspective using an ecosystems framework. Recommendations are made for future practice, research, and policy regarding mental health and mental health services utilization in the Latino community.     

Interprofessional education for community mental health: Attitudes to community care and professional stereotypes

Social workers are considered key members of community mental health teams, yet difficulties in interprofessional collaboration between social workers and health care professionals, particularly psychiatrists and nurses, have been reported. This paper examines some sources of these difficulties in terms of perceived differences in models of mental illness, attitudes and values, including stereotyping, professional identification and role clarity. Interprofessional education (IPE) may diminish negative stereotypes and promote multidisciplinary teamwork. A theoretical framework is described and findings from the evaluation of a 1-year programme of interprofessional education for community mental health are presented. These findings suggest that attitudes and values concerning community care for people with mental health problems are largely shared by different professions, but they do confirm the existence of interprofessional stereotypes and of perceived status differences. In contrast to previous research, there was no evidence of changes in stereotypes. These findings are discussed in terms of the theoretical framework and the design of the programme.     

Secondary victimization of rape victims: insights from mental health professionals who treat survivors of violence

Rape victims may turn to the legal, medical, and mental health systems for assistance, but there is a growing body of literature indicating that many survivors are denied help by these agencies. What help victims do receive often leaves them feeling revictimized. These negative experiences have been termed "the second rape" or "secondary victimization." If indeed secondary victimization occurs, then these issues may be raised in rape survivors' mental health treatment. In the current study, probability sampling was used to survey a representative sample of licensed mental health professionals about the extent to which they believe rape victims are "re-raped" in their interactions with social system personnel. Most therapists believed that some community professionals engage in harmful behaviors that are detrimental to rape survivors' psychological well-being. Implications for future research on secondary victimization are discussed.     

Participatory action research with asylum seekers and refugees experiencing stigma and discrimination: the experience from Scotland

Using evidence from a participatory action research process with over 100 asylum seekers and refugees in Scotland, this study explores participants’ views on mental health problems, stigma and discrimination. The study found that migration can have adverse effects on mental health and well-being, due to racism and the asylum process, and this is worsened by stigma and discrimination. This stigma is influenced by both social and cultural causal factors, including fear, past trauma, isolation, racism and the stress of the asylum process coupled with negative cultural beliefs about mental health problems. The paper considers the international relevance of this approach and the value of a model grounded in principles of community development and grassroots action.