How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

Stigmatization of People With Pedophilia: A Blind Spot in Stigma Research

ABSTRACT. Stigmatization restricts people's opportunities in life and has severe consequences on mental health and psychological well-being. This article focuses on stigmatization research on pedophilia. Based on an extensive literature search, it reviews studies that have empirically determined lay theories, stereotypes, prejudices, and discrimination against people with pedophilia, as well as the effect of stigma on this group. The review reveals a scarcity of empirical studies on the subject (11). Although the majority of studies give at least an indication that stigma against people with pedophilia is highly prevalent, we also identified severe methodological limitations and a lack of a unifying and systematic research agenda. We discuss the need for more theory-driven, rigorous, and representative empirical studies and propose perspectives and requirements for the scientific study of stigma against people with pedophilia.     

The Role of a Psychiatric Pharmacist in College Health

Abstract

Published evidence indicates there is a growing prevalence of psychiatric illnesses on college campuses, and that approximately one quarter of students may be taking psychotropic medications. But attracting and retaining experienced mental health care professionals to college health settings is a challenging task. The psychiatric pharmacist is one professional resource that can serve as both a clinical and educational consultant for college mental health services. A pilot psychiatric pharmacist service project is described.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

Mental health literacy beliefs. A comparison of psychiatric trained nurses and enrolled nurses in Singapore

The views of mental health professionals may influence diagnosis and management options. This study reports nurses' views about the management of three common psychiatric disorders--schizophrenia, depression, and mania. Results demonstrate the effect of greater psychiatric education and training, received by psychiatric trained nurses, on mental health literacy.     

Treatment of Pedophilia with Leuprolide Acetate

Abstract

To date, the literature on the treatment of individuals who have committed sexual offenses has focused primarily on psychotherapeutic interventions and the use of antiandrogens. Recently case reports and small series supporting the efficacy of other psychiatric medication, such as serotonin reuptake inhibitors, have been published. Only a few publications have looked at the efficacy of leuprolide acetate, an LH-RH antagonist, in treatment of sex offenders. Leuprolide acetate has advantages in terms of less side effects and greater safety during administration when compared to other antiandrogens. In this paper we report on the use of leuprolide acetate in an individual who meets criteria for pedophilia and has multiple other comorbid psychiatric diagnoses. The case report illustrates that leuprolide acetate can be effective in decreasing pedophilic fantasies, urges and behaviors. In addition, individuals who receive effective individualized pharmacotherapeutic treatment for compulsive sexual urges and comorbid psychiatric conditions also respond better to psychotherapeutic interventions.     

Psychiatric supervision for social work?

There are increasing efforts by psychiatrists and insurance companies to maintain psychiatric control in mental health settings and thus limit the autonomous functioning of clinical social workers. This paper presents facts indicating that psychiatrists actually are only peripherally involved in mental health facilities. Clinical social workers as autonomous professionals diagnose and treat mental disorders and often hold key positions in administration and in program and staff development. The attempt to maintain a facade of psychiatric control amounts to a distortion of the reality of professional roles and results in inefficiency, increased costs, and a lowering of the quality of care.     

Professional support for family caregivers of people with serious and persistent mental illnesses.

1. Professional support for family caregivers of people with serious and persistent mental illnesses is essential to ensuring the well-being of the caregivers and maximizing the functioning of the ill person. 2. Significant percentages of family caregivers had never received critical elements of instrumental and affective support from mental health care professionals. 3. The role of psychiatric nurses encompasses the responsibility to address these deficits, as well as multiple opportunities to do so.     

A Critical Analysis of the Social Work Literature on Disabilities

Abstract

The principles of empowerment and demedicalization have been central to the formulations of rehabilitation and social service practices as well as case management, a core community support service provided to people with psychiatric disabilities. This study describes empowering and demedicalized practices in mental health case management. Semi-structured interviews were conducted with thirty leaders in the mental health consumer movement and five professionals. Twenty-five categories of such practices were developed and are presented. Findings have implications for both the nature of the interaction between case manager and client and for program structures, activities, and missions.     

Rupture Resistance: An Archaeology of Pedophilia Crisis Communication

The national attention brought to high-profile sex crimes such as the Penn State scandal of 2011 and the Catholic Church scandal of 2002 has elevated public awareness of what can be appropriately referred to as pedophilia. Perceived as a public health threat, pedophilia has become a priority news item for its lascivious and predatory characteristics that instill fear within a widespread audience. This article conveys three ideas essential to pedophilia crisis communication. First, a brief introduction of pedophilia is offered as a social construct and catalyst for moral panic within organizations and their communities. Second, a review of modern and postmodern crisis frameworks is offered to examine an organizational approach to pedophilia and its Foucauldian conception as a rupturing, discursive formation. Third, a call for organizations to embrace ruptures in their pedophilia crisis response is advanced to align their activities with the prevailing historical moment rather than within metaphysical traditions.     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

Popular opinion is not empirical data

Conclusion It is not the purpose of this paper to defend psychiatric diagnosis; the reliability, validity, and the process itself have been found lacking in many respects (Zigler & Phillips, 1961) and it is becoming increasingly difficult to justify the current system. Rather, the purpose of this paper has been to examine the claims and conclusions concerning psychiatric diagnosis as presented in Rosenhan's article, On Being Sane in Insane Places. As has been pointed out, this study has methodological and logical difficulties which render its conclusions, as stated, invalid or questionable in nature.The currentzeitgeist is in favor of criticizing psychiatric and psychological thinking and practice in relation to mental illness. It is suggested that there is no such thing as mental illness (Szasz, 1960), that diagnosis is useless (Sarbin, 1967), that symptoms are socio-psychological in nature (as if this makes them less real), and that self-fulfilling prophecy accounts for the current overcrowding in mental hospitals. All of these things may be true. Or, they may be erroneous assumptions. Certainly, they are factors which mental health professionals must consider. However, this consideration must be careful, objective, and analytic in nature in order to avoid the bandwagon effect. It is hoped that his paper may contribute to a more evaluative demeanor on the part of all mental health professionals.     

Lay theories and criticisms of mental health news: elaborating the concept of biocommunicability

Abstract

This article examines how mental health service users/consumers, advocates, professionals and researchers interpret and theorise the impacts of mental health news. It focuses on the following themes: Creating fears about mental illness by focusing on criminal and violent acts; Reinforcing power imbalances by privileging biomedical issues and sources; and Sanitising mental health issues through the selective use of personal narratives. The study draws upon the concept of biocommunicability, which casts light on the performative power of health news in reinforcing ideas and expectations about the appropriate role for different actors to adopt in relation to health knowledge. Previous research on health news has identified biomedical authority, patient-consumer and public sphere as three predominant models of biocommunicability and this article examines how these are bound up with criticisms of mental health news. The findings are related to the ‘mediatisation of psychiatric culture’ as one of extremes and perspectives from Mad Studies.     

Promoting public/academic linkage.

1. Collaborative linkages between public mental health/mental retardation service systems and academic institutions have evolved in response to several problems: increasing numbers of individuals requiring long-term mental health care; the nursing shortage; and a decline in enrollment and students graduating from psychiatric mental health nursing programs. 2. Evidence suggests that a public/academic linkage in the form of a multidisciplinary training course in the care of seriously mentally ill patients promotes a recruitment of mental health professionals to work with these patients. 3. The establishment of academic/health care system linkages can enhance client care, expand and improve clinical experiences and education for students, and provide opportunities for collaborative research among clinical staff, faculty members, and graduate students.     

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.     

Young people with complex needs meet complex organizations: an interview study with Swedish professionals about sustainable work practices

ABSTRACT

This paper concerns preconditions for the well-being of young people with mental ill-health combined with social vulnerabilities, also referred to as youth with complex needs. Research questions are: What barriers to sustainable work practices for young people labelled as having complex needs do professionals encounter? What do professionals identify as possible ways to overcome these barriers? Sustainable work practices are reflected in three themes: empowerment, relationships and collaboration. The findings are based on semi-structured interviews with 24 professionals, 3 men and 21 women, working in psychiatric care and the social services in two Swedish municipalities in 2016 and 2017. Major barriers are lack of continuity and co-ordination in staff and support, and fragmentation of work practices. As a consequence of the increased specialization of human service organizations, young people have to interact with many different professionals which could cause disparate interventions. Possible ways mentioned to overcome these barriers are supported through good interactional skills, using keyworkers as well therapeutic alliances, wrap-around services and case management. Complexity is linked to organizations and work practices rather than to young people. An often dysfunctional service delivery system in organizations with rigid boundaries may also affect professionals’ aim for sustainable support.     

Social Psychopathy,Social Distress,Family Breakdown,and Custody Disputes in the 1990s: Implications for Mental Health Professionals

The decade of the 1990s will probably contain more challenges to the role of the mental health practitioner in child custody cases than ever before in history. Because of increasing social stress and family disintegration, custody disputes are destined to become more frequent, bitter, and traumatic for all parties. Mental health professionals, in particular, need to develop a coherent structure regarding their own participation in this process. Issues of moral changes among our leadership and our citizenry are examined and guidelines for the behavior of the mental health practitioner in the courtroom are formulated and illustrated as they pertain to custody decisions. Parlicular attention is paid to custody decisions as an a11 rather than a science, the role of empirical research, the need to anticipate certain unintended circumstances, the need for the application of mental health principles on an individual case-by-case basis, the nature of the mental health professional’s expertise, and the problems with the concepts of “parental unfitness” and the use of psychiatric diagnosis as a way of defining such alleged unfitness.     

Workplace stress among psychiatric nurses. Prevalence,distribution, correlates, & predictors

Vicarious trauma and burnout are serious manifestations of workplace stress. Both can have substantial consequences for health care professionals, health services, and consumers. This article reports results of a study examining the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (RPNs). A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale (i.e., a measure of vicarious trauma), and a section on symptoms of posttraumatic stress disorder (PTSD). The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high burnout) and even higher levels of personal accomplishment (i.e., low burnout). No significant differences were found between respondents' total scores on the Traumatic Stress Institute Belief Scale and instrument norms for mental health care professionals. Predictors of burnout and vicarious trauma also are presented in this article. Stress experienced by RPNs, as well as strengths on which to build, clearly are evident in the study results. Strategies for reduction in workplace stress may benefit psychiatric nurses, clients, and health services.     

The Psychiatrist's Role in Implementing an Open Dialogue Model of Care

The Open Dialogue approach is a family‐oriented early intervention model for mental health problems developed in the health district of Western Lapland, Finland. Since the 1990s the psychiatric service system in Western Lapland Health Care District has been organised according to Open Dialogue principles and applied to the treatment of any mental health concerns. The Open Dialogue approach considers the client and their family as active participants rather than as objects of treatment in its planning and implementation with a psychotherapeutic focus. In daily work, the responsibility for the treatment process is shared with the case‐specific team. The model of care requires a dialogical orientation from all staff members, psychiatrists included, to interact with the team and the client's network. In this article I describe the role of the psychiatrist in implementing an Open Dialogue model of care in psychiatric services leaning on my experiences of clinical work in the adolescent psychiatric team in Western Lapland.