Mental Health Recovery

Abstract

Strengths-based approaches that emphasize culturally competent services and naturally occurring community support may be more appropriate than traditional mental health services for African American adults with psychiatric disabilities. An examination of the literature on service utilization and treatment needs for this population highlights the paucity of empirical studies in these areas, while an exploration of the literature related to psychiatric recovery, a prominent strengths-based framework, reveals insufficient application of the approach to the specific interests of African American service recipients. We suggest that recovery is in fact highly compatible with such culturally relevant approaches as the Afrocentric model, and argue that the concept of recovery may therefore provide a resonant and particularly useful framework for practice with this population. Implications for research, practice and policy are discussed.     

Involuntary Mental Health Treatment: The Mental Health Consumer as Expert

Involuntary treatment in mental health has existed since society first began trying to tackle the issue of mental illness (Dennis & Monahan, 1996 Dennis, D. L. and Monahan, J. 1996. Coercion and aggressive community treatment: A new frontier in mental health law, New York, NY: Plenum Press. [Crossref] , [Google Scholar]). Despite controversy on both sides of the issue, involuntary treatment continues to be used in current mental health service delivery. Practitioners and policy makers have engaged in lively debates about the merits of involuntary treatment, but few studies have engaged affected consumers in this discussion. This article reports on a small qualitative study in North Carolina that attempted to collect the stories of mental health consumers who had been involuntarily hospitalized due to symptoms of mental illness at some point in their lives. Study participants were also asked to critique the elements of the contemporary involuntary treatment and offer their ideas about improving it.     

An Integral Approach to Mental Health Recovery: Implications for Social Work

The term recovery has become increasingly popular in the area of mental health care. Recently, it has been described by policy makers as the guiding vision for transforming the mental health system. Problematic, however, is that a lack of clarity continues to exist regarding how recovery is to be defined. Definitional attempts often appear to have competing opinions about what the concept exactly stands for. This causes confusion for both professionals and consumers desiring to adopt a recovery approach. Ken Wilber's integral theory is presented as a framework for organizing and connecting various viewpoints related to the “recovery” concept. Implications for social work are discussed.     

An Evaluation of Mental Health Services for the Culturally Diverse

ABSTRACT

The purpose of this project was to examine the needs of multicultural populations in the mental health system, and see how these needs get addressed in current policies. As a social worker in the mental health system, I wanted to investigate the strengths and weaknesses of service providers in their ability to meet the needs of diverse populations. In doing this research, I hoped to make a space for people whose families have had to deal with mental health services, and explore the experiences of those who have not had the opportunity to discuss them. In addition, the purpose of this paper is to contribute to a body of increased knowledge on how the mental health system treats people who belong to a cultural minority.     

Incentive Structures Within Mental Health Financing Strategies

Abstract

This paper analyzes the incentive structure contained in traditional fee-for-service and capitated managed care models and finds both to be inadequate in encouraging the attainment of client outcomes. An incentive financing scheme is proposed that links funding to outcomes, and describes the necessary elements of such a system. This framework is then applied to the New Hampshire and Colorado incentive financing systems.     

Identified Problems and Service Utilization Patterns Among Kinship Families Accessing Mental Health Services

Abstract

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.     

Reclaiming Life: Six Consumers of Mental Health Services Talk About What Helped and What Did Not Help Them Get Their Lives Back

This article summarizes a roundtable discussion held at Thresholds in Chicago, Illinois in September 2012, where six people diagnosed with serious mental illness talked about what helped and did not help them recover and successfully reclaim their lives. Their comments, taken as part of their personal narratives, can help enhance understanding of the recovery process. The discussion is organized by the themes that emerged: considering life as distinct from diagnosis, meeting basic needs, empowerment, education, community, faith and hope, healthy thinking, peers, and focus on wellness. Panel members also offer advice for mental health service providers.     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

The Seven Challenges: An Effective Treatment for Adolescents with Co-Occurring Substance Abuse and Mental Health Problems

ABSTRACT

Recent developments in the provision of the substance abuse treatment for adolescents has included a focus on age appropriate treatment with consideration for adolescents' relatively low level of motivation for treatment and high incidence of co-occurring substance use and mental health problems. This study examines 3- and 6-month substance use and mental health outcomes for youth (n = 36) participating in The Seven Challenges Program. Results indicate significant reductions in both substance use and mental-health-related measures at 3 months with all measures except substance abuse frequency continuing to improve at the most distal 6-month assessment. The Seven Challenges treatment model is presented along with a discussion of the findings.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Including At-Risk Adolescents in Their Own Health and Mental Health Care

Summary

As urban adolescents encounter serious health and mental health risks, they present the allied health professions with important opportunities for health promotion and risk reduction interventions. However, the prevailing emphasis on adolescents' risk behaviors rather than on their vulnerability has limited our capacity to understand and serve them. Further limiting are the widely held myths that adolescents as a whole have few health problems and that they are poor judges of their own needs. This article presents an overview of current theories of adolescent risk and vulnerability and suggests Youth Development as an overarching framework for understanding both. Experience within a comprehensive, adolescent health and mental health center demonstrates how to meaningfully engage adolescents in their own health care from the start.     

Deviations From Desired Age at Marriage: Mental Health Differences Across Marital Status

Although several factors condition mental health differences between married and never‐married adults, given recent increases in marriage delay and permanent singlehood, one modifying factor—deviation from desired age at marriage—has yet to be examined. Using data from the National Longitudinal Survey of Youth 1979 (N = 7,277), the author tested whether deviation from desired age at marriage shapes the mental health of married and never‐married adults as well as mental health differences between them. The results showed that most respondents failed to meet their initial preference for age at marriage. Marrying both earlier and later than desired (compared to on time) resulted in poorer mental health and fewer benefits compared to never marrying. For the never‐married, mental health was best, and differences compared to the married were nonsignificant, for those nearest their desired age at marriage. As timing deviations increased, however, a mental health deficit among the never‐married emerged.     

Adult Day Centers and Mental Health Care

ABSTRACT

This research focused on the mental health issues at adult day centers and used a cluster analysis to profile older persons who received these services. The sample included 280 participants who attended adult day care. The data were collected from intake files using a biopsychosocial framework to guide the selection of variables from January 1, 1999 to December 31, 2000. A cluster analysis revealed two distinct profiles of participants. The first profile was characterized by women, who were single, African-American, had low incomes, relied more on public funding, and had no psychiatric diagnoses. The second profile was differentiated with more men, who were married, relied more on private funding, and had higher incomes and psychiatric diagnoses. Participants clustered in the second profile, including those diagnosed with psychiatric disorders, disenrolled at a faster rate than those in the first profile, including older adults without psychiatric disorders. Both profiles were similar in age, education, caregiving, religious affiliation, household size, and service intensity. They also resembled each other with respect to functional limitations, nutrition risk, and prior nursing home placement. Slight differences were found in frequency of previous hospitalizations and years of education. Recommendations for strengthening the mental health training of social workers employed at adult day centers were made.     

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain,Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.     

The Function of Avoidance in Improving the Understanding of Disaster Recovery

Functional avoidance as an intermittent coping mechanism is a necessary component in disaster recovery. By temporarily avoiding losses after disaster, survivors can secure basic needs and begin rebuilding. It is not until recovery projects are completed that mental health outcomes become apparent. Many individuals begin a healthy grieving process; however, for others, where avoidance extends past the completion of normalizing tasks it becomes pathological. This study presents the concept of functional avoidance and investigates the point at which it becomes dysfunctional using case examples and data from a mental health clinic. Findings suggest increased emotional distress, depression, and posttraumatic stress disorder over 3 years after Hurricane Katrina.     

Students Left Behind: The Limitations of University-Based Health Insurance for Students With Mental Illnesses

Abstract

A growing trend in college and university health care is the requirement that students demonstrate proof of health insurance prior to enrollment. An increasing number of schools are contracting with insurance companies to provide students with school-based options for health insurance. Although this is advantageous to students in some ways, tying health insurance coverage to school enrollment can leave students vulnerable when they are most in need of help. Students whose health insurance is contingent upon their enrollment face significant lapses in coverage when they are required to leave school. This is especially challenging for students with mental illnesses whose treatment needs often go unmet in the absence of that coverage. The limitations in this system must be addressed as an increasing number of universities and students opt for university-based health insurance plans.     

Passing a Mental Health Levy

ABSTRACT

The “devolution revolution” has decreased federal and state roles in the funding of social services and increased the burden on local sources, both public and private. This article describes how a community passed an initially unpopular property tax levy earmarked to support local drug, alcohol and mental health services. The article illustrates how social workers employing specific community practice knowledge provided leadership to the successful campaign. This example of community practice leadership includes building and maintaining coalitions, managing group tension and conflict and demonstrating fundamental social work values.     

A DSM-5-Based Online Mental Health Referral Inventory: A Large-Scale Validation Study

In 2007, a comprehensive mental health referral inventory based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was posted online as an alternative to the informal tests the public now uses to self-diagnose mental health problems. A validation study was published in 2011 (Epstein &; Muzzatti, 2011 Epstein, R., &; Muzzatti, L. (2011). Preliminary validation of an online DSM-based mental health referral inventory. Journal of Technology in Human Services, 29, 284–295. doi:10.1080/15228835.2011.638421[Taylor &; Francis Online] , [Google Scholar]). In 2013, a revision of that inventory that was consistent with the DSM-5 was posted. The present study evaluates the new inventory with a diverse sample of 201,625 people from 184 countries (mainly the United States, Canada, and the United Kingdom). The 63-item inventory screens for 21 common problems and typically takes about 5?min to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalization, history of therapy, current participation in therapy, and employment. Females were found to have slightly more mental health problems than males, and effects were also found for education and race/ethnicity. The revised test is more accessible than the original, reducing the reading level from grade 10.2 to 6.6. It is not designed to diagnose; rather, its primary purpose is to refer people to mental health professionals for further evaluation. It can also be used in clinical settings for quick screening purposes.     

House Demolition and Mental Health: Victims and Witnesses

This research examines the immediate effects of losing one's home and witnessing the demolition of others' houses on the mental health of Palestinian adults and children. The loss group consisted of 47 adults whose homes were demolished, the witness group of 24 adults who witnessed the house demolition, and the control group of 33 adults. The groups were compared for their anxiety, depression, and paranoiac symptoms. In addition, 38 children in the loss group, 36 children in the witness group, and 50 children in the control group were compared for their psychological symptoms. The results showed that adults who were exposed to house demolition showed a higher level of anxiety, depression, and paranoiac symptoms than the witness and control groups. The children in the loss group showed a higher level of psychological symptoms than the children in the witness and control groups. The witness group differed from the control group in having more depression among women and more psychological symptoms among children. Women suffered more from anxiety, depression, and paranoiac symptoms than men in the loss and witness groups but not in the control group.