Intervention options: Participation in work activities for people with schizophrenia

Vocational rehabilitation is a method by which people with disabilities are able to learn skills and receive supports that are necessary to take part in work activities. Vocational rehabilitation interventions can be used in a wide variety of settings with many different populations of people with disabilities, including those with schizophrenia. However, there is little available research to help guide clinicians to identify which vocational rehabilitation intervention methods may be the most effective for their clients. OBJECTIVES: The purpose of this paper is to identify what is the best practice for obtaining and maintaining participation in work activities for people with schizophrenia. STUDY DESIGN: This paper reviewed sixteen previously conducted studies (seven specific solely to schizophrenia) to identify which vocational rehabilitation method is the best practice to aid those with schizophrenia to obtain and maintain participation in work activities. RESULTS: The reviewed literature suggests that there are a variety of vocational rehabilitation intervention methods that may be effective treatment interventions. The effective interventions were those programs that had a client-centered approach and enabled the client to play an active role in his/her vocational rehabilitation. CONCLUSION: With this study review, clinicians will be able to examine a variety of successful client-centered vocational rehabilitation methods that may aid in helping their clients with schizophrenia to obtain and maintain participation in work activities.     

Correlates of caregiving burden in schizophrenia:A cross-sectional,comparative analysis from India

Schizophrenia is a global mental health issue that has serious implications not only for the person with the diagnosis, but for caregivers as well. In Asian societies, the family tends to be the “natural” caregiver in such situations and the caregiving function is usually shouldered by parents or the spouse. Asian communities tend to be more closely knit, and it would be expected that more social support would be available to those facing distressing circumstances such as managing the demands of a person with mental illness. This study seeks to explore the perceived burden in family caregivers of persons diagnosed with schizophrenia, the coping strategies that come into play, as well as the extent of social support available to them. Standardized instruments were administered to collect data at a teaching cum treatment facility in south India. A quantitative methodology was used to analyze cross-sectional data from 75 primary caregivers of people with a diagnosis of schizophrenia and a reference group of caregivers of patients with general medical ailments. Results indicate higher levels of burden, low social support, and poor coping in the caregivers of people with schizophrenia than the reference group. Implications for intervention with caregivers are also discussed in this article.     

(Mis)interpreting urban youth language: white kids sounding black?

The language of young people is often viewed very negatively by some sections of the mainstream media and by some social commentators in the UK. While this is nothing new – older generations routinely despair of how the youth of today are ruining the language – what is different now is the added element of ethnicity, whereby young people of various ethnicities are perceived as using some kind of ‘ghetto grammar’ or ‘Jafaican’ which carry often explicit connotations of ‘sounding black’. This paper challenges the mainstream view by firstly introducing the linguistic take on this emerging Multicultural Urban British English, and then exploring the views of young people themselves on how they use language by taking qualitative data from a linguistic ethnography project involving 14–16-year-olds in a non-mainstream urban educational setting. The young people provide insights into their language that are in complete opposition to the views so often expressed in the media, and which instead suggest that linguistic features that were previously strongly associated with specific ethnicities are being used in new and innovative ways. Refreshingly, it would appear that for many young people ethnicity is simply not a consideration, at least in relation to language.     

Revisiting the identity issue in anorexia

Anorexia nervosa is considered an enigmatic disease with a multitude of predisposing factors and no empirically confirmed effective treatment. However, all people with the disease relentlessly pursue a common idealized goal--the state of severe emaciation. In this article, the perspective that this condition epitomizes a life-time struggle for self-acceptance and self-definition is reexamined. People afflicted with anorexia come to define themselves through their emaciated form, and maintenance of this form becomes their major focus and primary means of fulfillment. Therapy must address the identity issue, which is fundamental to the onset and perpetuation of the disease. Use of interpersonal techniques is advocated as most appropriate in serving this purpose.     

Worthy of Discussion: Collaborative Group Therapy

In this paper the development of a new approach to group therapy is presented. Collaborative group therapy has been successfully used in working with people with schizophrenia. It has provided both participants and therapists with the opportunity to move away from a restrictive view of mental illness toward alternative self knowledge and empowerment. New ethnographic methodology has been used to measure both process and outcome of the group therapy.     

Schizophrenia in older adults

Although the number of people older than 55 with schizophrenia is expected to double during the next 20 years, the research data on older adults with schizophrenia are limited. This appears to be because until the middle of the 20th century, it was assumed that mental illness in older adults was a part of the aging process and because older adults are often excluded from research investigations. Nursing research is needed to explore how people with schizophrenia learn to manage their problems as they age, as well as how those who are first diagnosed with schizophrenia in later life adapt to their illness. Mental health nurses need to be cautious in assigning premature labels to older adults with mental illness that may lead to unsubstantiated assumptions about levels of disability. Instead, nurses should realize individual potential regarding undiscovered strengths and should attempt to create interventions that recognize and foster personal development for older adults with schizophrenia.     

A Swedish Prevalence Study of Deaf People Using Sign Language: a prerequisite for Deaf studies

A widely used estimate claims that one per thousand individuals is deaf, but few recent studies exist on the actual prevalence. The aim of this study was to investigate the prevalence of deaf people, defined as deaf individuals who use sign language as their main mode of communication, in the county of Scania, Sweden. To achieve high validity, data were collected from a large variety of sources including both public institutions and voluntary associations, working with deaf people. The study demonstrates a prevalence of 0.7 per thousand inhabitants, a figure considerably lower than the traditional estimate. One interpretation of this finding is that the prevalence of deafness is on the decrease. Another interpretation reflects the problem to define deafness. As prevalence figures vary with the definition used, one single estimate valid for the prevalence of deafness is not possible to make. We therefore question the traditional one-per-thousand estimate of deafness.     

What’s in a name? Exploring use of the word queer as a term of identification within the college-aged LGBT community

ABSTRACT

The language one uses for self-identification can be instrumental in the development and integration of one’s sense of self. This is particularly true regarding gender, gender identity, and sexual orientation. This seems to be particularly marked with use of the term “queer.” This research project explored terms that college-aged people use for self and other reference, especially use of the word queer. The results from this study provide empirical evidence that college-aged people have reclaimed the word queer as acceptable for gender or sexual orientation identification, although it is not the most frequent term used for their own self-identification.     

An education intervention for families of people with schizophrenia in China: development and evaluation

In China, nurses and physicians are the main care providers for people with schizophrenia. This care is provided primarily in institutions because community services are in their infancy, and families carry the burden of care. In the absence of published nursing research in the area, this article reports the rigorous development and evaluation of a culturally sensitive patient/family intervention, which was implemented in a large psychiatric hospital in Beijing, China. A random sample of 15 nurses responded to an open-ended questionnaire to explore what they believed people with schizophrenia and their family members should learn. A convenience sample of 51 family members who lived with a person with schizophrenia were also interviewed to explore what they understood and needed to know about schizophrenia. Common learning needs were integrated with the literature and presented as the Comprehensive Patient/Family Education Guide, which was implemented with an experimental group of 42 family members, while a control group of 45 received the usual hospital treatment. The effect of the intervention was evaluated by interviewing a random sample of 19 of the family members. The results revealed some useful information for the future planning and implementation of such programs, and although focused on a Chinese sample, do offer insights for nurses around the world.     

Living and loving with dementia: Negotiating spousal and caregiver identity through narrative

In this paper, we examine how Alzheimer's disease and related disorders (ADRD) affect caregivers' perceptions of change in the identity of their afflicted spouse and the ways in which accompanying changes in caregiver identity influence intimate relations. We also explore how gender shapes the ADRD caregiving experience among married couples, specifically, the extent to which intimate relations are also gendered relations. The study group was comprised of spousal caregivers recruited from support groups in the two Midwestern states and from the Alzheimer's Disease Center (ADC) at a large Midwestern university hospital. In-depth interviews were conducted with 13 men and 15 women whose spouses had ADRD. The intensive interviews confirmed that identity change on the part of sick spouses had important implications for intimacy, although not always in adverse ways. The majority of caregiver husbands and wives reported diminished intimacy as a result of the ADRD. Many men and women believed they would retain feelings of closeness to their afflicted spouses as long as they were alive. Wives were more likely than husbands to report that changes in their spouses' identity altered how they identified themselves within their marriage. This has important implications for intimate relations between people with ADRD and those who care for them. Our findings suggest that caregiving and intimacy are very different experiences for men and women, and point to the need for caregiver education and support.     

Decreased psychopathology & family burden. Associated with clozapine treatment of patients with refractory schizophrenia

1. Intensive multimodal treatment produces measurable gains in community functioning of people with schizophrenia and reduces family burden. 2. Families that were more involved with patients were more satisfied. 3. Money directed at intensive management and rehabilitation decreases hospitalization and increases community functioning of people with schizophrenia.     

'Service user': regressive or liberatory terminology?

The term 'service users' has come to be increasingly used both in the UK and beyond to describe people on the receiving end of health, welfare and social care policies and services, including disabled people. This use of language is contentious. It has come in for criticism as presenting people in passive, consumerist terms. However, many disabled people, and others, use the term of themselves. This article seeks to develop discussion about this terminology and suggests that as well as being used by state and service system in regressive and pejorative ways, it may also serve as a unifying concept which has helped groups to act with solidarity and to challenge and seek to improve their status in society. In this way, it may parallel the terms 'disabled' and 'disability' as used within social approaches to disability.     

Lunacy revisited. The influence of the moon on mental health and quality of life

The idea that the stars and planets may influence human health and behavior can be traced to at least Roman times, and research suggests a high proportion of health professionals continue to hold this belief. Nevertheless, evidence for the supposed influence of the moon on human behavior has proved particularly elusive, and research has tended to suffer from weaknesses in methodology and data analysis. This article reports findings drawn from a re-analysis of data from a research study into the functioning of a sample of mentally ill people living in the community. The mental health and quality of life of a sample of 100 people were assessed on four occasions during a 30-month period. Data were aggregated to represent the span of one lunar month, with scores being allocated to the relevant week of the lunar cycle during which each assessment was made. Comparison of mean values across the weeks of the lunar cycle was preformed using the ANOVA, Results showed significant change at the time of the full moon only in subjects with a diagnosis of schizophrenia (n = 56), where deterioration was observed in three areas of psychopathology and one area of quality of life. Some implications for nursing practice are discussed, and it is suggested that future research into the possibility of a lunar effect on human life should focus on the direct measurement of functioning in people with schizophrenia.     

Cultural Differences: Deaf and Hearing Researchers Working together

This article is based on several years of research done by the two authors, one of whom is Deaf and the other hearing. The paper discusses research done within the Deaf community using sign language. This is an estimated 50,000 people-the same number as those whose first language is Welsh. The Deaf community sees itself as a linguistic and cultural minority and as such is quite distinct from people with an acquired hearing loss, or those who are hard of hearing and who usually rely on written and spoken English through lipreading or writing things down. The paper sets this research in the context of cross-cultural research and looks at its connections with emancipatory research. The central discussion is in the form of a dialogue between the Deaf and hearing researchers and their personal responses to cultural differences. In the past Deaf people have been denied the opportunity of making their opinions known because research has used written or spoken language. Our research, using videocameras to record sign language and Deaf research using sign language to interview, provides a means of interviewing more suited to Deaf people than to hearing researchers. However, as the hearing culture is likely to be perceived as the dominant culture, there are bound to be differences when a hearing and Deaf researcher are working together within the Deaf community. These are the issues which we discuss within Deaf research.     

Language Reversion among People with Dementia from Culturally and Linguistically Diverse Backgrounds: The Family Experience

Abstract

Culturally and linguistically diverse (CALD) older people with dementia, along with their families, face many unique challenges and have unique needs. One such challenge is language reversion, an issue that has received little research attention. This paper presents the findings of an exploratory study of the experiences of family members of people with language reversion emanating from dementia. Using a qualitative, phenomenological approach, in-depth interviews were conducted with seven participants. The study found that the presence of language reversion created additional challenges for family members of someone with dementia, particularly if the family member did not share the person's first language. Community-based aged care services have the potential to offer valuable support, but barriers of negative past experiences, lack of communication, stigma, cultural understanding, and locality need to be overcome. While further research is recommended, these findings have implications for both policy and social work practice in community-based aged care with CALD populations.     

Problems in community living identified by people with schizophrenia

1. Problems in community living were identified by a group of people with schizophrenia who received a telephone nursing intervention after discharge from a state psychiatric facility. 2. The most frequently reported problems were medication side effects, financial concerns, and anxiety. 3. A telephone nursing intervention has the potential to reduce the negative effects of stressors on people with schizophrenia living in the community.     

Are we doing enough? Stigma,discrimination and human rights violations of people living with schizophrenia in India: Implications for social work practice

ABSTRACT

In India, the human rights of people living with mental illness (PLMI) are poorly articulated and hence less researched. Using in-depth and focus group interviews, this study explores multiple perspectives on stigma, discrimination, and human rights violations of people living with schizophrenia (PLS) within their web of relationships in the city of Mumbai, India. Thematic analysis shows that abusive experiences at home, stigma associated with mental health services and barriers to meaningful employment contribute to human rights violations. Implications for strengthening the role of mental health professionals including social workers to promote, protect and actualize the rights of PLS are stressed.     

Telecommunication relay services as a tool for deaf political participation and citizenship

It has long been recognised that deaf people experience barriers to political participation and that notions of citizenship do not take into account the needs of deaf sign language users. In light of an effort at the European level to increase the potential for deaf sign language users to participate in political processes through technology, this paper provides results from a survey study of deaf sign language users across Europe as to their preferences in using Telecommunications Relay Services (TRS), whether they would like to see the establishment of a pan-European multilingual TRS and if they would make use of such a service for the purposes of political participation. Responses from 74 deaf people across 14 European member states confirm that deaf people want to see such a service, and would be willing to use it in order to make contact with European institutions. Therefore, the establishment of such a service has the potential to contribute to improved access to, and increased willingness to engage in, democracy through telecommunications and thus enhance the citizenship status of deaf Europeans, and therefore enhance their political participation and access to information and communication in society.     

Crime Victimization in Latin America and Intentions to Migrate to the United States

Among the challenges faced by Latin America at the onset of the 21st century is the increase in crime and violence that began in the mid-1980s, and which, to one degree or another, has afflicted most countries in the region. In this study we explore the potential implications of the upsurge in crime on migration by testing the hypothesis that crime victimization in Latin America increases the probability that people have given serious thought to the prospect of migrating with their families to the United States. Using Latinobarometro public opinion surveys of approximately 49,000 respondents residing in 17 countries in 2002, 2003, and 2004, the results of a Hierarchical Generalized Linear Model found that, net of individual and country-level control variables, the probability of seriously considering family migration to the United States was around 30 percent higher among respondents who reported that they or a member of their family was a victim of a crime sometime during the year prior to the survey. Evidence that victimization promotes the propensity to emigrate is a finding that contributes to an understanding of the transnational consequences of the increase in crime in Latin America, and adds a new variable to the inventory of factors that encourage people to migrate to the United States.     

Illness and the disruption of autobiography: accounting for the complex effect of awareness in schizophrenia

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients' internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.