Responding to Adolescent Violence in the Home – A Community Mental Health Approach

Family violence perpetrated by adults is increasingly understood as a health issue, and we argue that this pertains even more strongly to violence by adolescents. The co-dependence of the parent–child bond, lack of maturity in the adolescent, and often related issues of disability or mental illness make these young people both complex and also vulnerable. This research paper reviews the current literature relating to adolescent violence in the home, identifies known best practice, and evaluates the importance of taking a family-focused, therapeutic approach to adolescent family violence, in place of a punitive one. It describes the use of a co-design workshop to unpack gaps in service provision and develop a potential family focused model of care to address the needs both of young people who use violence, and their families. The findings indicate that an inclusive family approach is a key element in addressing adolescent violence in the home across a spectrum of behaviours and mental health care needs. The use of a coordinated, family-inclusive response through mental health care services is recommended to address the complexity of this issue, as well as to provide support both to adolescents and to their families and carers.     

The Life Course: A Sociological Introduction

Abstract

Recognition of the deleterious effects of domestic violence on women's mental health has highlighted the potential benefits for women of collaboration between mental health and domestic violence services. Yet the different histories, knowledge bases, and organisational cultures of the mental health and domestic violence sectors present formidable challenges to the development of effective collaborative work. This article draws on a large research enquiry, involving four separate but related studies, which explored aspects of collaboration between these two service sectors. It focuses particularly on data collected in interviews with practitioners from mental health and domestic violence services who were participants in an action research study (one of the four studies), which was aimed at discovering the factors that contributed to enhanced collaboration and the benefits of this for women who experience both domestic violence and mental health issues.     

Associations Between Psychological,Physical, and Sexual Intimate Partner Violence and Health Outcomes Among Women Veteran VA Patients

Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.     

Violence and trauma: predicting the impact on the well-being of African American women with severe mental illness

Exposure to violence and trauma has become a major mental health and public health problem in the United States. This study assesses the rates of exposure to traumatic events of 55 adult African American women receiving treatment in an urban community mental health clinic. The study examined three research questions. First, what is the rate of exposure to violence and trauma among African American women in an urban community mental health clinic? Second, what effect does violence and trauma exposure have on mental health? Finally, does exposure to violence and trauma have an effect on well-being as measured with the Medical Outcomes Survey (MOS/SF-36)? A significant negative relationship between diagnostic burden and well-being was found. A negative nonsignificant relationship was found between Posttraumatic Diagnostic Scale (PDS) and wellbeing. Study findings suggest that use of a screening and assessment tool for violence and trauma exposure may have important clinical implications in providing appropriate mental health services to African American women.     

Out‐of‐Home Placement of Children Exposed to Violence

There is growing concern about the increasing number of children in the USA who are exposed to community violence and the need to remove some of them from their families. This study examines risk factors for out‐of‐home placement among a large pool of children and adolescents who were referred for general clinical assessment following exposure to violence and/or psychological trauma in their communities or homes. Children with greater familial and environmental support and children exposed to incidents involving a non‐parental personal threat were associated with a significantly lower risk of out‐of‐home placement. A greater likelihood of being placed out of home was associated with older age (adolescents), history of mental health service use, involvement with law enforcement agencies, higher clinical ratings of depression or impaired thought processes, lower clinical functioning and greater exposure to traumatic events. Evidence of maltreatment and a threat to life was associated with 13.6 times greater likelihood of being placed out of the home. This study raises an important issue in respect to the children's past use of mental health service and current symptoms. It is not just the risk of violence but also evidence of psychiatric problem that trigger out‐of‐home placement. Further studies are needed to assess the quality and effectiveness of mental health services provided to children exposed to violence. © 2007 The Author(s). Journal compilation © 2007 National Children's Bureau.     

Old battles,new frontiers: A study of television violence and social work with children

This article describes the place of television violence in social work practice with children. It is based on interviews with twenty-one social workers who work primarily with children in schools, in community mental health agencies and in private practices. Although the influence of television violence on children has been well documented by other disciplines, there has been a general lack of attention by social work. Because television is so much a part of children's social environment and because the social environment is so much a part of social work practice this study seeks to address that lack. Grounded theory methodology was utilized to analyze the interviews.This paper is adapted from her dissertation in partial fulfillment of a doctorate at Simmons College School of Social Work, Boston, Massachusetts. The author wishes to thank the dissertation committee members, carol Swenson (Chairperson), Deanna Brooks and Margaret Rhodes for their contributions.     

A Social Work Perspective on Seclusion and Restraint in Australia’s Public Mental Health System

A social work perspective of the nature of seclusion and restraint in Australia’s public mental health systems is presented. The article suggests a theme of seclusion and restraint as a regulatory mechanism despite evidence of harm and even death. The case that the use of seclusion and restraint constitutes a social justice issue as it can be understood as an abuse of human rights and form of torture is established. An incident of a person dying in an Australian mental health facility after being secluded is presented to substantiate this claim. An over focus on individual expressions of violence or risk can be at the expense of understanding the systemic and cultural nature of violence in mental health systems. It is important to understand the nature of, and perhaps to question the presumed necessity of, seclusion and restraint practices to ensure that social workers are not breaching their professional obligations to people who are mental health clients.     

Men's and women's use of intimate partner violence in clinical samples: toward a gender-sensitive analysis

Early research with nationally representative samples suggested that women reported initiating violence as often as men. Such research has been criticized as focusing only on participation rates, and not assessing gender differences in impact, context, and motivation for using partner violence. Furthermore, research with nationally representative samples has been largely a-theoretical and may lack relevance to those working with clinical samples. Research with clinical populations has begun to address gender similarity and differences in the commission and experience of partner violence. The present article reviews research on men's and women's partner violence using a model for examining such gender differences that incorporates key elements of partner violence, including initiation of the overall pattern of partner violence, proportional initiation rates of violent episodes, physical and mental health impacts of partner violence, behavioral and emotional responses to partner-initiated violence, motivations for using partner violence, and fearfulness of partner-initiated violence. The review concludes that, within and across clinical samples, women are disproportionately victimized by partner violence compared to men. Implications for research, clinical programs, and policy development are discussed.     

The Social Process Behind Inequalities in Children's Mental Health: Incorporating an Illness Career Framework

More advantaged children (both in terms of social class and racial/ethnic membership) appear protected from symptoms of mental health problem, but a pattern has emerged in which these children who tend to have better mental health are more likely to be diagnosed with certain mental health disorders. These patterns have led some researchers and professionals to wonder if the qualifications for diagnosis are culturally biased or might unfairly favor the mental health needs of more advantaged individuals in society. Evidence that White and middle‐class children are more likely to be diagnosed with certain mental health disorders raises important and legitimate concerns about the mental health profession, but this problem of social advantage leading to mental health diagnosis has often overlooked the role of social process in how children become diagnosed. Mental health diagnoses represent the culmination of a process that involves several stages and requires initiation and (often times) persistence on the part of the individual being diagnosed. This idea of process has previously been referred to as the “illness career,” and applying this logic to the study of children opens the door for renewed inquiry into understanding who is and who is not diagnosed with a mental health problem.     

Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.     

Prevention of homicidal violence in schools in Germany: the Berlin Leaking Project and the Networks Against School Shootings Project (NETWASS)

Since 1999, Germany has experienced at least twelve serious cases of targeted school violence. This article describes two projects designed to fill the gap between universal prevention and emergency response in preventing severe forms of school violence in Germany. The Berlin Leaking Project examined the viability of preventive efforts based on early identification of leaking behavior that often precedes targeted school attacks. Leaking refers to any behavior or communication that indicates a student is preparing to carry out a violent attack. This would include explicit or implied threats of violence, apparent fascination with prior acts of violence such as Columbine, and any evidence of planning or preparation to carry out an attack. The NETWASS project will test a training program and intervention strategy based on those findings, examining the usefulness of a threat assessment approach to prevent violence by training teachers to recognize leaking behavior by students. This approach is extended by training teachers on a larger scale to identify leaking and then having a school-based team evaluate the student and initiate appropriate interventions, such as mental health services, and in some cases, law enforcement action.     

Homelessness,housing instability,intimate partner violence,mental health,and functioning: A multi-year cohort study of IPV survivors and their children

Abstract

Homelessness and housing instability frequently accompany intimate partner violence and can negatively impact health and functioning. When children are exposed to homelessness or housing instability their ability to develop and function is compromised. The purpose of this study is to examine the differential impact of homelessness and unstable housing on health and functioning of women and their children over a 2-year period. Two hundred and seventy-seven mothers reporting intimate partner violence (stalking, physical, or sexual violence by an intimate partner) were asked about housing stability, abuse, risk for murder, mental health, employment/wages, and their child's functioning over a 2-year period. Outcomes of mothers reporting homelessness and unstable housing were compared to mothers reporting stable housing. Over one-third (36%) of the mothers reported at least one episode of unstable housing over the 2-year period and 11% reported homelessness. Measures of maternal mental health and child functioning were worse for both unstably housed and homeless women, compared to stably housed women, with a higher risk for sexual abuse and risk for murder for homeless women. New models of rapid rehousing are needed that address not only the housing problems of women who have experienced intimate partner violence but also the mental health and safety issues that the women and their children face.     

Premature Return to School following a Psychotic Episode

Abstract

A college mental health service professional often finds that a student who has had an episode of psychiatric illness is eager to return to fulltime status before he or she seems ready for this undertaking. The mental health professional may advise that the student stay out of school for a longer period, but often this advice is rejected.

Approaches to dealing with the problem of return to school following an academic leave prompted by a psychotic episode include the requirement that the student maintain a minimum time out of school and be in treatment during the attempt to return to academic life. The assessment of a student's psychological status at the time of a proposed return often raises the problem of dual agency. Although the college mental health professional is apt to place a high value on maximizing the student's chances of having things work out to his or her liking, the administrator to whom the mental health professional is ultimately responsible is probably inclined to place the needs and well-being of the campus community above those of the student seeking to return.

While the proposed return of a student to academic work following a psychotic episode poses many difficult questions, considerable experience is available to aid in the task of those charged with making this decision. The authors propose two helpful approaches.     

From “whom to blame” to “nothing to fear”: documentary narratives,voices, and “dependent destigmatization” of severe mental patients (SMPs) in Hong Kong

Media often stigmatize severe mental patients (SMPs) by portraying them as dumb, sluggish, or violent. Conversely, TV documentaries, as a particular media genre, have the potential to destigmatize SMPs by entrusting them with an authentic presence and a direct voice. Illuminated by Couldry’s (2010) discussion on voice and drawing on narrative analysis, this article examines the evolving and joint endeavor of media and mental hospitals in systematically destigmatizing SMPs and in promoting the rehabilitation mode of mental health care in Hong Kong. From 1989 to 2011, Hong Kong Connections produced three documentaries. Shifting the narrative from “whom to blame” to “nothing to fear,” the documentaries establish a destigmatization agenda jointly formulated by the media and mental hospitals. SMPs’ voices steadily increase in length and prominence in the narrative’s temporal line, yet they are strictly orchestrated within the sealed narrative that is subject to the institutional interest of promoting the rehabilitation mode of mental health care in Hong Kong. The voice/narrative inequality between SMPs and mental institutions leads to the “dependent destigmatization” that indicates a dependent power relation between SMPs and powerful institutions.     

Violence and the costs of caring for a family member with severe mental illness

Drawing on the stress paradigm and using data from the Duke Mental Health Study, this paper investigates the links between violence by and against persons with severe mental illness and their caregivers' financial burden (e.g., number of financial contributions and perceived financial strain). In addition to violence, substance use and medication noncompliance are included in a series of multivariate regression models predicting caregiver financial burden that include measures for disruptive behaviors, personal needs, social supports, and caregiver characteristics. The findings show that violent perpetration and violent victimization increase the number of financial contributions and perceived financial strain. Nonviolent victimization, in contrast, decreases caregiver financial burden. Number of financial contributions and perceived financial strain are greatest when the family member is violent and extremely disruptive or needs assistance with personal care. Neither substance use nor medication noncompliance contributed to caregiver financial burden. Co-residence, female sex, parenthood, and instrumental social support were also associated with financial burden.     

The need for policy direction in the provision of care to the mentally ill: an interdisciplinary view

This paper argues that mental health care is underprovided, and that the role of nonprofit providers should be expanded for three major reasons. First, a positive externality exists since society, as a whole, benefits when those in need of mental health care consume care. External benefits include lower crime rates, lower unemployment, and less homelessness. Second, consumers of mental health care are mentally ill and often do not believe that they need care, underestimate their need, or believe that care is not worth the time or expense. Third, common law, to a large extent, is based on individual liberty, largely ignoring the benefits individuals receive from treatment. It is argued that government policy is needed to increase the supply of mental health care, through nonprofit agencies.     

Gender differences in the experience of violence,discrimination, and stress hormone in African Americans: Implications for public health

Violence is more prevalent in African American communities than in other American communities. This has impacts not only on criminal justice interventions but also on the physical and mental health of these communities including their risk for acquiring life-threatening diseases. While many studies have focused on the effects of violence on African American males, we sought to understand the relative gender effects that violence has on African American females. This is of particular interest given the wide array of scientific literature suggesting maternal health has inter-generational health effects. Understanding gender differences associated with exposure to violence, depression, and immune function is an important step in understanding how young women perceive and internalize societal violence directed toward and around them. We analyzed a cohort of 557 young African American adults aged 18–25 years old from the Washington, DC area. We use sociological, epidemiological, mental health, computational biology, and quantitative genetics approaches to build a predictive portrait of the effects of violence on African American health. This study demonstrates that African American males and females experience different constellations of societal violence, that African American women report greater perception of racial and gender bias, and that cortisol, an indicator of stress response, is correlated to perceived discrimination. This work contributes to current understandings of how violence contributes to negative health outcomes and lays the foundation for a predictive model for sociological, health, and behavior risk that young African Americans encounter.     

A comparative study of experiences of client violence and its impact among Iranian and Swedish social workers

Client violence toward social workers has been recognized as a serious problem, and major concern has been raised with regard to its impacts on social workers' practice and physical and psychological health. There is recognition among researchers and policy-makers that it is time for the international social work community to develop conventions and agreements to address this issue globally. A cross-cultural study between Sweden and Iran was conducted to compare and contrast levels of violence between the two countries. Prevalence of violence was 72% in Sweden and 68% in Iran. Iranian social workers show a significantly higher increase in general mental health problems regarding client violence compared to Swedish social workers. Despite differences in rules and regulations between Sweden and Iran, client violence was found to be common in the two countries. Preventive policies for detecting potential violence situation are good but not enough. We suggest taking actions on building trust and supportive structures within organisations.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Intimate sexual victimization among women with protective orders: types and associations of physical and mental health problems

Intimate sexual violence was examined among a sample of women who had recently obtained protective orders against male partners using three groups: no sexual victimization (n = 368), sexual insistence (n = 114), and threatened and/or forced sex (n = 117). Differences in childhood sexual abuse as well as types of partner psychological abuse, stalking, and severe physical violence experiences were found across the groups. Multivariate analysis showed that women with no sexual victimization had significantly fewer mental health problems than women who had experienced sexual insistence and women who had been threatened or forced to have sex. Findings from this study underscore the importance of health, mental health, and criminal justice professionals assessing for a range of sexually abusive acts when working with victims of partner violence.