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.     

The Post-Hospital Mental Patient and Family Therapy: Prospects and Populations*

Changes in the pattern of delivery of mental health services have led to dramatic increases in the number of patients discharged from mental hospitals. These post-hospital mental patients represent a new challenge to the field of family therapy. Of the approximately 1 million patient admissions to state and county mental hospitals, general hospitals, and private psychiatric hospitals, over 380,000 are married, and more than half of the remaining patients are estimated to be living with family. Almost 135,000 admissions receive family therapy during their hospitalization, and an estimated 650,000 mental patients will return to their families upon discharge.     

Psychiatric nursing in the 1990s & beyond.

In the decade of the '90s, psychiatric mental health nursing will need to take stock of itself--its practice, its education, and its research--if it is to successfully prepare for the changes in care of the mentally ill. Like psychiatrists, we will need to rethink our agendas in light of new science and technology and rationalize the mental health delivery system and our role in it through systematic research and advocate for a system that provides quality care for the chronically ill and the poor. In the next century, we will need to rethink the basics of nursing care and the leadership roles of nurses as hospitals and the doctor's role within them changes. Psychiatric mental health nurses will need to be at the forefront in advocating for a delivery system that listens to patients and families, that humanizes the dehumanizing experience of hospitalization. The challenges before us are formidable.     

Therapeutic stations and the chronically treated mentally ill

Readmissions to mental hospitals are often cited as evidence of the failure of the contemporary mental health system. This essay proposes a different interpretation of readmission. Building on fieldwork and participant observation methods, the authors argue that the "veteran" patient is less a victim of poor psychiatric care and misdirected reform than he is a citizen with few personal resources, using public services to cope with the exigencies of life. Lacking family, job, and income, the ex-patient incorporates the hospital and other "therapeutic stations" into a resource pool upon which he or she can call when the need arises. The essay also discusses the implications of these findings for assessments of the community mental health movement.     

Mental Illness and the Criminal Justice System

This is the second essay in a two‐part series exploring the relationships between mental illness, criminal behavior, and the criminal justice system. The number of mentally ill persons in prisons and jails has increased substantially over the last several decades, and there are currently more people with mental illness behind bars than there are in mental hospitals. In this essay, we place these trends within a broader historical context of the social control of mental illness in the United States. We identify how and why mentally ill persons have come to be overrepresented in the criminal justice system and highlight the unique challenges this population poses for police, courts, and correctional facilities. Finally, we review several recent innovations in policy and practice that may help alleviate that burden of criminal justice involvement on mentally ill offenders, as well as the burden of mentally ill offenders on the criminal justice system.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

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.     

HIV among people with mental illness: contributing factors, prevention needs, barriers, and strategies

1. Findings suggest that PWMI, including those with serious mental illness, are sexually active although some individuals, including mental health professionals, perceive them to be asexual or not sexually active. 2. PWMI may be particularly susceptible to HIV risk-related behaviors due to poor judgment, limited impulse control, deficits in problem-solving skills, and suicidal intent and self-destructive behavior. 3. Nurses, due to their close interaction with PWMI, are in key positions to document HIV risk-related behaviors and to advocate for integrating HIV risk reduction strategies into the therapeutic milieu.     

“I Am Not Who I Thought I Was”: Use of Grief Work to Address Disrupted Identity Among Hispanic Adolescent Immigrants

Immigration from Latin America to the United States is often an escape from difficult circumstances, but with this gain comes a loss of identity. This can be a special burden for adolescents, who are thrown into a new culture and environment while in the process of identity formation. Using case studies from my work as a psychotherapist in a community mental health clinic, I will describe this special turmoil and a way in which Latino immigrant teenagers can be helped to resolve it. Psychodynamic grief work aimed at helping them mourn the loss of identities and valued capacities through emigration can reduce self-destructive enactments and support them in the adolescent task of forming an identity.     

Some obstacles to the effective investigation and registration of children at risk—issues gleaned from a worker's perspective

Abstract

This paper describes a woman who is both damaged and damaging. The mental disorder/disturbance felt by this woman generates levels of anxiety that she cannot contain, and this anxiety is passed onto the others who constitute her community. For community care to work it must be possible within the community system to identify, think about and manage the anxieties generated by such mental disturbance. The new legislation of community care may encourage us to ignore the reality of mental illness and issues of power, conflict and pain, and their underlying anxieties. Current examples are given of the acute anxieties felt by many workers in the field which, if uncontained, lead to defensive anti-task strategies. When disturbance is projected and disowned it is put out of mind and may then be passed between parts of the system. Even though it may no longer be possible, except as a short term measure, to put the mentally ill out of sight in mental hospitals, the mental disturbance and those in whom it is located may still be marginalised. The paper proposes a model of community care which encompasses mental illness, professional workers and the community. These three elements are seen as the corners of a triangular space which theoretically becomes the container of mentally disturbing anxieties and within which these anxieties can be addressed, thought about and managed

It is argued that this model could enable workers to foresee some difficulties and to address others in a manner that would lead to greater containment and more effective management of mental illness in the community     

Caribbean Families: Social and Emotional Problems

Families from the English-speaking Caribbean now comprise 30% of immigrants in New York State. Given the increase of Caribbean referrals to psychiatric hospitals and mental health clinics, it is important to begin examining more seriously the needs of this immigrant group. The concept of mental illness, risk factors that can lead to mental disorders, commonly accepted psychopathological disorders, issues in assessment and treatment as they apply to this cultural group are discussed in this article. A model for treatment—the multiculutral/multimodal/multisystems approach is examined.     

Mental health and the aging: A review of the literature for clinical social workers

This article is a review of the literature on recent trends in mental health services to the elderly. The focus is on clinical services to elderly living outside of mental hospitals but includes services to residents of community nursing homes and homes for the aged. It is concluded that there is currently a non-system of services failing to meet present mental health needs. Current restrictive government reimbursement policies and national health insurance proposals are focused on treatment for acute episodic illness. This orientation does not permit a broader preventive perspective or a comprehensive mental health care approach.     

The collective approach to psychiatric practice in the People's Republic of China

This paper describes and analyzes the effects of the dramatic changes of social values in China on the approach to treatment of the mentally ill since the 1949 revolution. It is mainly based on observations, interviews, and experiences in mental hospitals during three recent trips to the People's Republic of China. Attention here is focused on the effects of four new social values on psychiatric practice: first, the value of collective responsibility as reflected in the new program to integrate mental hospitals with the community; second, the application of the value of sharing and "serving the people" to methods of psychiatric therapy; third, the value of "minimization of elitism" as practiced in the role relationships among members of different categories in mental hospitals; and fourth, the reaffirmation of faith in human ability to conquer difficulties, as shown in changes of patients' outlook on life and behavior. Finally, the implications of this alternative approach on our established assumptions and methods of psychiatric therapy in the West are discussed, and the future direction of theoretical formulation is suggested.     

Towards an Integrated Approach to a Family Intervention for Co‐occurring Substance Abuse and Schizophrenia

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate.     

An ergonomic study on the onset of mental fatigue among the load handling workers of a central market area in Kolkata

It is a well recognized fact that manual material handling (MMH) entails enormous physical labor and associated discomfort feeling, which invariably culminate into musculoskeletal disorders. However mental fatigue, in such instances, becomes an unexplored parameter that needs definite attention during assessment of work status of MMH workers. The present study is being performed among 75 porters of a central market in Kolkata to ascertain the extent of physical and mental exhaustion among them. SF-12 health status questionnaire followed by another questionnaire involving psychosocial questions were performed among them. The analysis of both the questionnaires clearly revealed that most of the porters are under severe physical exertion as they alone carry about 120 kg load at a time and such activity is repeated at least 40 times throughout the day. They always suffer from pain and discomfort feeling at different body parts and this interferes with their normal work activity to a great extent. Moreover absenteeism means no financial return and even a day's rigourous work fetches meagre income. The inability to support family convincingly even after performing such hazardous tasks makes them feel low. Monotony, boredom, fatigue and mental trauma form an integral part of their daily work schedule.     

Psychiatry in the age of neuroscience: the impact on clinical practice and lives of patients

Due to the progress being made in the neurosciences, higher expectations for the use of medication, even against the patient’s will, are arising in mental hospitals. In this article, we will discuss whether the neurosciences and new psychopharmacological solutions really support patients who suffer from mental illnesses. To answer this question, we will focus on the perspective of patients and their experiences with psychiatric (coercive) treatments. The analysis of one person’s story shows that other issues besides appropriate medication are important for recovery from a mental illness. In daily life, issues such as coping, rehabilitation and social support are of major importance for a patient suffering from psychiatric disease. Thus, although progress in the neurosciences is a positive development for clinical practice, it does not mean that (coercive) medication alone will carry a patient into recovery. A patient’s recovery is dependent, not only upon the process of finding the appropriate medication and trust between the psychiatrist and the patient, but also upon relational aspects, such as being recognised as a person, belonging, accepting responsibilities, developing friendships and trusting others. These findings lead to the conclusion that dealing with psychiatric diseases is more complex than what the biomedical model of neuroscience suggests and that one should include the social context of the patient in the recovery process.     

Madness and work: short- and long-term effects of mental illness on occupational careers

This study assesses the impact of mental illness on occupational careers. Thirty-six married men who first entered mental hospitals in the 1950s were followed up in 1972 and eighteen men who were first hospitalized in 1973-74 were interviewed. Their histories reveal the importance of the development of competence in the work role prior to the onset of mental illness. Those who were able to develop competence were likely to retain their jobs through the initial episode of illness and to remain occupationally stable in the ensuing years even in the face of persistent symptomatology. The data are interpreted as evidence that the label, "mental patient," does not constitute a master status and in and of itself does not significantly affect occupational careers.     

Wearing two hats. Consumer & provider.

To change public attitudes toward people with mental illness, consumers need positive visibility and a strong community voice. We are making progress, although slowly, to eliminate the stigma surrounding mental illness. Progress can be attributed to the fact that the mentally ill are now living in our communities among us, and people are beginning to understand them more.     

The history, economics, and financing of mental health care. Part 1: 17th to 19th centuries

Families in colonial times cared for their mentally ill members at home, with little assistance from their communities. Community treatment is an old idea, not a new one. Early laws about containing the disturbances created by individuals with mental illness made no mention of clinical dimensions. The focus was strictly on the social and economic consequences of the mental disorders. Legislation about public mental hospitals in the mid-19th century was hardly enlightened. There were no particular plans, other than not to expend more dollars than actually necessary.     

Economic antecedents of mental hospitalization: a nineteenth-century time-series test

More than 100 studies have cited M. Harvey Brenner's (1973) claim that fluctuations in the economy increase the onset of mental illness and thus generate increases in mental hospitalization. Published attempts to replicate Brenner, however, have considered only twentieth-century data. One of Brenner's most memorable claims was that a stable inverse relationship between mental illness and the economy could be seen over a 127-year span beginning in the early nineteenth century. Unfortunately, no research since Brenner's has considered nineteenth-century populations. In this paper we analyze the hypothesis that economic change provokes a substantial fraction of first admissions to mental hospitals. We used admissions registers from the three institutions to construct a data base that approximates a psychiatric case register for a nineteenth-century American city from 1881 to 1891. Time-series tests show no support for the "provocation" hypothesis.