Negotiating narratives surrounding children's mental health diagnoses: Children and their contribution to the discourse

Despite increasing numbers of children diagnosed with mental health disorders, there is limited research on how children come to understand these diagnoses in childhood. This study examines the retrospective accounts of emerging adults who were diagnosed with mental health disorders in childhood to better understand how they made sense of their diagnoses over time. In-depth, semi-structured interviews were conducted with 42 emerging adults (ages 18 to 22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depression, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Interviews elicited participants' experiences learning about their diagnoses and suggestions for how diagnoses should best be explained to children. Findings demonstrate that participants actively sought and obtained information about their diagnoses over time. They negotiated narratives from several sources, including parents, teachers, mental health professionals, peers, siblings, the media, reading materials, and the Internet. Many of those who embraced medical accounts of their diagnoses did so as they obtained in-depth medical information over time. Meanwhile, those whose parents were open and communicative without using medical narratives suggest it is possible to share information with children without utilizing the terminology of “disorder.” Participants emphasize the importance of being open with children and providing them assurances, explaining that their problems are legitimate, common, and “not their fault.” Implications for social work practice are discussed.     

Religion, suffering, and health among older Mexican Americans

Pain and suffering are deeply embedded in the ethos of Mexican American culture. Consequently, it is not surprising to find that many Mexican Americans turn to their faith in an effort to deal with the pain and suffering that arise in their lives. The purpose of the current study is to explore the interface between pain, suffering, religion, and health among older Mexican Americans. Three major themes emerged from in-depth qualitative interviews with 52 older Mexican Americans. The first is concerned with whether pain and suffering are a necessary part of religious life, the second has to do with the potential benefits that pain and suffering may provide, and the third involves whether it is necessary to bear pain and suffering in silence. In the process of reviewing these themes, an effort is made to show how they may be linked with the physical and mental health of older Mexican Americans.     

The production of understanding

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the contextual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us"/"them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power. The production of understanding serves as an important counterbalance to this tendency. Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides understanding about why health and mental health are mal-distributed among people from different social circumstances.     

Young people and social networking sites: exploring the views and training opportunities of CAMHS social workers in Ireland

ABSTRACT

Social Networking Sites (SNS) (e.g. Facebook, Instagram) have become a fundamental part of the daily lives of many young people. SNS engagement has been associated with a number of risks and benefits, some of which are particularly relevant to young people who access child and adolescent mental health services (CAMHS). Consequently, understanding how and why young people engage with SNS, and the associated risks and benefits, may become an increasingly important part of CAMHS social work.

This small-scale study (n = 15) utilised an online survey to explore the importance that a sample of Irish CAMHS social workers attribute to maintaining an awareness of how young people use SNS, whether they, in their professional lives, have been offered the opportunity to learn about SNS engagement among young people, and whether they have taken it upon themselves to learn about this topic.

Findings suggest that participants consider an understanding of SNS to be an important part of CAMHS practice. However, participants report that they do not feel sufficiently aware of SNS trends among young people, suggesting that there is scope for SNS-focused training/learning opportunities among this sample of CAMHS social workers. Implications for practice and suggestions for future research are outlined.     

Symptoms of Mental Health Problems: Children’s and Adolescents’ Understandings and Implications for Gender Differences in Help Seeking

Amidst concerns that young people’s mental health is deteriorating, it is important to explore their understandings of symptoms of mental health problems and beliefs around help seeking. Drawing on focus group data from Scottish school pupils, we demonstrate how they understood symptoms of mental health problems and how their characterisations of these symptoms as ‘rare’ and ‘weird’ informed participants’ perceptions that peers, teachers and parents would respond to disclosure in stigmatising ways. Consequently, participants suggested that they would delay or avoid disclosing symptoms of mental health problems. We highlight subtle gender and age differences and outline implications for policy and practice.     

Moving toward recovery within clients' personal narratives: directions for a recovery-focused therapy

Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how to best help people do this in individual psychotherapy. In this article, we explore how psychotherapy might help people construct new narratives or storied understandings of their lives and thereby promote recovery from schizophrenia. Exemplified with two individual examples, we first discuss the barriers that challenge and the techniques that help psychotherapists seeking to enter into dialogue with people with severe mental illness. We also offer a theoretical model of how the revitalization of dialogues within therapy can be conceptualized as a process that promotes recovery and discuss the objective measurement of such outcomes.     

Engaging suffering: towards a mindful re-visioning of family therapy practice

The myth of problem-free living is easily identifiable in Western culture through its childhood fairy tales and modern love stories. Even if inadvertently, the field of mental health perpetuates this myth with the very concept of "mental health," which implies a state without suffering. Using mindfulness, Buddhists assume an alternative stance towards suffering: rather than eliminate it, they compassionately engage it. This article explores the potentials of mindfulness as an alternative approach to suffering within the context of marriage and family therapy. Family therapists can integrate mindfulness principles into their work to help clients shift how they relate to the unique forms of suffering that one encounters in intimate relationships, such as abuse, divorce, rejection, and loss.     

Children’s Concerns about their Parents’ Health and Well‐being: Researching with ChildLine Scotland

This paper reports on collaborative research conducted with ChildLine Scotland, a free, confidential, telephone counselling service, using their database. We focussed on children’s calls about parental health and well‐being and how this affected their own lives. Children’s concerns emerged within multi‐layered calls in which they discussed multiple issues and problems in their lives such as alcohol misuse, drug misuse, domestic violence, family relationships, depression, mental health problems and bereavement. We discuss how children were making sense of these experiences; how they were trying to get by in difficult family circumstances; whose help they valued; and conclude with implications for policy and practice.     

BIG DATA AND BIG CITIES: THE PROMISES AND LIMITATIONS OF IMPROVED MEASURES OF URBAN LIFE

New, “big data” sources allow measurement of city characteristics and outcome variables at higher collection frequencies and more granular geographic scales than ever before. However, big data will not solve large urban social science questions on its own. Big urban data has the most value for the study of cities when it allows measurement of the previously opaque, or when it can be coupled with exogenous shocks to people or place. We describe a number of new urban data sources and illustrate how they can be used to improve the study and function of cities. We first show how Google Street View images can be used to predict income in New York City, suggesting that similar imagery data can be used to map wealth and poverty in previously unmeasured areas of the developing world. We then discuss how survey techniques can be improved to better measure willingness to pay for urban amenities. Finally, we explain how Internet data is being used to improve the quality of city services. (JEL R1, C8, C18)     

A qualitative investigation into military veterans’ experiences in a problem-solving court: Factors that impact graduation rates

Veterans treatment courts (VTCs) are designed to offer a rehabilitative approach to criminal justice, focusing on treatment for mental health and substance use disorders. This qualitative study develops an in-depth understanding of a Midwestern VTC by asking participants (n = 15) their views on the most helpful aspects of the program and how the program could be more helpful. Three themes emerged from the data. 1) Military veterans felt that they were treated in a compassionate and caring manner, while also being held accountable for their behaviors. 2) Military veterans felt that they were not labeled by their mental health diagnoses, but that their identities as people and military veterans were more fully recognized. 3) Military veterans were dissatisfied with some of the services they received from the local VA. These findings are discussed in the context of problem-solving courts and military veterans’ experiences of services.     

A habitus of instability: youth homelessness and instability

This research introduces the concept of a habitus of insecurity to account for the lives of homeless young people. It outlines how conditions of existence are internalised and how homeless young people come to expect and in turn recreate instability in their lives. This research addresses the internalisation and naturalisation of experiences of instability, insecurity and marginalisation and how people can come to subjectively aspire to what they are socialised to see as objectively probable or ‘for the likes of them'. The research draws on ethnographic research and participant observation to examine the complex lives of homeless young people and how they are shaped by instability and insecurity inculcated before, during and after experiences of homelessness. This research highlights that people should not be defined merely by their experiences of homelessness of housing status, but by the complex array of conditions that shape their lives.     

Personal agency in the stress process

Stress researchers have typically controlled for the role of personal agency, or self-selection, in the stress process, rather than examining it. People in better mental health (those with high levels of coping resources and low levels of distress or disorder) should be more likely to exercise agency. Such individuals should, through problem-solving efforts and purposeful acts, experience fewer negative controllable events and more positive controllable events in their lives and be able to transform or compensate for stressors that they cannot avoid or eliminate. These agentic processes may account for the stress-buffering effects of coping resources; and, because coping resources are unequally distributed by social status, these processes should further help to explain how status differences in mental health are maintained and amplified over time.     

Teaching Note—Oppression of People With Mental Illnesses: Incorporating Content Into Multiple-Issue Diversity Courses

Many social workers practice in settings serving people with mental illnesses, but social work education in the United States has given minimal attention to helping students understand the systemic nature of prejudice and discrimination experienced by this population. Some courses address prejudice (stigma) toward people with mental illnesses, but a critical consideration of systemic oppression appears to be lacking. We explain how an oppression framework used to understand the systemic nature of racism, sexism, and other forms of oppression is useful in illuminating experiences related to (perceived) mental health status. We offer suggestions for incorporating content into courses that focus on diversity and oppression with the goal of preparing students to engage in antioppressive practice with people who have mental illnesses.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Children and Young People Living Through a Serious Family Illness: Structural,Interpersonal and Personal Perspectives

This study explores the experiences of children and young people in Britain living through a serious family illness. The study considers the interplay between social structures, social relationships and individual agency. We draw on data from the Millennium Cohort Study to estimate the number of children and young people affected nationally and on seven in‐depth interviews to understand young people’s experiences and the effects on their daily lives. Living through a serious family illness impacts on young people’s educational achievements, mental health and social relationships over long periods. Policy and service responses are suggested.     

Classed,raced, and gendered biographies: young people's understandings of social structures in a boomtown

As young people attempt to adapt to a rapidly changing society, how they experience school and work has undergone significant changes in recent decades. Youth researchers attempting to understand these changes have drawn heavily on the concepts of agency and structure. In the process, researchers often end up taking a ‘middle-ground’ approach and in turn have critiqued the theorizing of Ulrich Beck for being too focused on agency. This article engages with this debate by examining young people's understandings of the social structures shaping their lives within the constantly changing environment of a boomtown. Drawing on qualitative in-depth interviews with high school students, post-secondary students, and young workers, it was found that most young people were able to recognize how class had shaped their lives, only Aboriginal young people discussed how race/ethnicity had shaped their lives, and only young women understood how gender had shaped their lives. The findings suggest that the specific local context that young people experience their school and work lives within is important in their reflexive understandings of their biographies. In this case, the boomtown environment helped to highlight difference and make only certain social structures visible to particular young people.     

Making connections: Severe mental illness and closeness with other people

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

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.