Personal reflection and experience of a Fulbright Scholar: teaching a mental health course in Vietnam’s changing culture

This paper documents the experience of developing and teaching a course on mental health for undergraduate social worker students during a semester in Vietnam. Social work is a profession at the early stages of development in Vietnam, requiring much curriculum development. There are over 40 universities with undergraduate social work education programs, but few of the faculty have had training or experience in practicing social work. The paper will summarize the main reasons for developing such a course given the current state of mental health need and services in a changing culture, as well as the current state of professional social work education and the newly established profession of social work. The author describes the contexts underlying the course—the status of social work and social work education in Vietnam, the context of mental health and mental illness in Vietnam, and curriculum adaptation to the cultural context. From this experience, the lessons learned about the role of cross-cultural critical thinking, cultural knowledge, and other strategies will be discussed about teaching a subject like mental health internationally.     

Treating mental health problems in primary care: Discrepancies between therapist expectations and clients’ attendance

ABSTRACT

Models of collaborative primary health care were introduced in Ontario in 2005 with the goal of providing comprehensive care, including that of mental health, to patients. While the success of this model of health care delivered through Family Health Teams (FHT) has been established, evidence based guidelines to guide mental health therapists regarding the number of sessions needed to treat common issues such as depression and anxiety seen within this model is lacking. The goal of this study was to gain a better understanding of how therapists conducted therapy, including type of intervention, under a physician determined eight session cap. Questionnaires completed by the therapists after the first session and again when therapy ended, a focus group and a chart review were conducted over an eight month period involving a total of 147 patients. Several key findings were identified including the unanticipated outcome of a discrepancy between how many sessions were initially thought to be required by the mental health therapist compared to how many sessions were determined helpful by the patient. Conversely, it was also identified that eight sessions was insufficient to treat more severe mental health issues such as trauma. Such results suggest that the treatment of mental health issues within Family Health remains a little understood and explored issue, with the authors suggesting better ways of negotiating session caps reflective of mental health issues addressed within this model of care.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Do youth in out-of-home care receive recommended mental health and educational services following screening evaluations?

For children in out-of-home care, a significant gap exists between those who need services and those who receive them. Screening all children in out-of-home care is recommended to reduce this gap. This study was designed to determine if recommendations from mental health and educational screening evaluations were related to service implementation for youth in out-of-home care. Screening evaluations were completed with 171 maltreated youth (ages 9 to 11) who had been placed in out-of-home care within the prior year. Written reports summarizing the findings were provided to children's caseworkers. Service utilization was assessed at baseline (T1; before screening reports were completed) and follow-up (T2; 9–12 months later) interviews. For children not already receiving services at T1, logistic regression analyses tested the association between T1 recommendations for services and new service implementation by T2. Mental health (youth-report) and educational (teacher-report) outcomes were analyzed separately. Screening evaluations identified 22% of children with unmet mental health needs and 36% with unmet educational needs at T1. Children who received a recommendation for new services (i.e., all of those with unmet needs) were more likely to receive mental health (OR = 2.50, p = .06) and/or educational (OR = 3.54, p = .04) services by T2 than children who did not receive recommendations for services. While recommendations increased the odds of receiving services, almost half of the children with unmet mental health needs did not receive services, and 84% of children with unmet educational needs did not receive services by T2. Much work remains to ensure youth receive needed services.     

Breadwinning as care? The meaning of paid work in mothers’ and fathers’ constructions of parenting

As some scholars have argued for a distinct conceptualisation of breadwinning and for understanding breadwinning as a form of care, this study addresses parents’ constructions of breadwinning and its connections to care. It is based on an in-depth interpretive analysis of multiple-perspective, qualitative longitudinal interviews with 22 Austrian mothers and fathers from three points in time during their transition to parenthood. The analysis revealed four different types of breadwinning concepts by considering the jointly constructed meaning of mothers’ and fathers’ paid work within a parental couple and further relied on Tronto’s [(1993). Moral boundaries. A political argument for an ethic of care. New York, NY: Routledge] conceptualisation of care as a four-step process. The results indicate that respondents construct a clear difference between earning money and breadwinning. Additionally, a difference is made between breadwinning and taking care of the family’s subsistence, predominantly so for mothers. In conclusion, breadwinning can definitely be considered a form of care and thus a form of involvement in parenting, but it cannot be regarded a form of involvement in caregiving. The holistic picture of parents’ joint constructions enabled us to contribute to the existing conceptualisations of breadwinning and of parental involvement, thus providing a novel perspective on matters of gender equality.     

What is the role of e-technology in mental health services and psychiatric research?

In this article, the role of e-technology is explored, with an emphasis on the advantages and disadvantages of its use for health care and mental health research. E-technology is broadly understood to include the Internet and related information technologies, and in recent years, its use has grown rapidly. The Internet is a major source of health information, and there is potential to deliver enhanced services through this medium. In addition, e-technology's role in future mental health service delivery and research will continue to expand as increased numbers of consumers, caregivers, health professionals, and the general population go online, particularly as the technology is refined and made even more user friendly.     

Outcomes in the sociology of mental health and illness: where have we been and where are we going?

Sociologists of mental health and illness have traditionally used outcome measures that they have obtained from other disciplines, especially psychiatry and psychology. These include official statistics, symptom scales, and diagnostic measures. Answers to the central sociological question of how social arrangements affect mental health might require the development of explicitly sociological outcome measures. This introduction provides an overview of several issues that arise in grappling with this question. These include whether symptom scales or diagnoses best capture the mental health consequences of social arrangements; when single or multiple outcomes are necessary to compare the consequences of social arrangements across different groups; if sociologists should explore the positive as well as the negative consequences of social forces; and when sociological attention should be directed toward social-level as well as individual-level outcomes. The papers in this symposium that follow provide more detailed analyses of each of these issues.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

“Give us respect,support and understanding”: Women veterans of Iraq and Afghanistan recommend strategies for improving their mental health care

Although women veterans of Iraq and Afghanistan have experienced war-related mental health challenges, they underutilize Veterans Affairs (VA) health care relative to men. Quantitative studies have identified barriers that limit women veterans’ use of health care, but there is a dearth of research asking recent women veterans to volunteer their own recommendations for improving their mental health care. The current qualitative study sought to increase representation of the client voice by asking 29 women veterans of the recent wars to recommend strategies for improving VA and community-based mental health services. 16 strategies were identified in three thematic areas, including the therapeutic relationship, clinical care environment, and health care system. Implications of the findings for enhancing access, use, and quality of mental health services for this cohort of women veterans are discussed.     

The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.     

How do changes in income,employment and health insurance affect family mental health spending?

Using eight two-year panels from the Medical Expenditure Panel Survey data for the period 2004 to 2012, we examine the effect of economic shocks on mental health spending by families with children. Estimating two-part expenditure models within the correlated random effects framework, we find that employment shocks have a greater impact on mental health spending than do income or health insurance shocks. Our estimates reveal that employment gains are associated with a lower likelihood of family mental health services utilization. By contrast employment losses are positively related to an increase in total family mental health. We do not detect a link between economic shocks and mental health spending on behalf of fathers.

     

Pictures in the classroom: can teachers and mental health professionals identify maltreated children's drawings?

The aim of this paper is to investigate whether teachers and mental health professionals are able to identify drawings produced by maltreated children, at a level greater than chance, when these drawings are presented to them at the same time as drawings created by non‐maltreated matched control children. In a relatively small study, a group of 33 mental health practitioners (MHPs) and a group of 10 teachers were shown sets of drawings and asked whether they could identify the maltreated children's drawings. It was found that there was no significant difference between mental health practitioner and teacher groups in identifying child maltreatment from Favourite Kind of Day Drawings (FKDs) (Manning, 1987) and Kinetic Family Drawings (KFD) (Burns and Kaufman, 1970). The results also point to the KFD as a more reliable drawing technique, but only when it is known that maltreatment is definitely present, and in a situation with no a priori knowledge it should not be used for the identification of maltreatment. Copyright © 2000 John Wiley & Sons, Ltd.     

Commentary: what role for the family and Medical Leave Act in long-term care policy?

The Family and Medical Leave Act provides unpaid leave but a key component is its intergenerational structure, permitting employees to take time off from work to care for an infant as well as an ill elderly parent. However, in an effort to provide paid leave, 23 of 28 states dropped the elder care provision in new initiatives introduced between 2000 and 2003. This article argues that in reforming leave policy in the future, the leave should be paid, remain intergenerational, cover more workers, and be adaptable to changing family patterns in an aging society. Also discussed is California's paid leave law, which meets these criteria.     

The circle of social reform: the relationship social work—social policy in Addams and Richmond

This article presents some results of a broader purpose of research on the thought and work of Addams and Richmond, particularly about the relationship between social work and social policy. First, we aim to contribute to deeper knowledge on the thought of these two pioneers on this relevant subject for social work nowadays and, particularly, to remove a relative veil of ignorance Richmond's involvement in social reform activities and elaboration on social reform in the context of the public and social policies process. Second, our proposal is to support a revision of the orthodox account on the antagonistic or irreconcilable nature of the two major traditions—social casework (or psychosocial approach) and social reform (or socio-political approach)—founded by two of the most influential figures of social work. Based on secondary and primary sources, the article focuses on the inseparable relationship between social policy and social work, clearly present in the thought and intervention of these seminal authors, and sheds new light on on-going debates and the disputed role of social policy perspectives within professionalised social work and the articulation between direct intervention with individuals, groups and communities and policy practice.