COMBAT EXPOSURE,CIGARETTE CONSUMPTION,AND SUBSTANCE USE

This study estimates the relationship between combat exposure and several risky health behaviors: cigarette consumption, binge drinking, and drug use. We find that the U.S. active duty military personnel deployed to combat zones with enemy firefight are more likely to subsequently smoke cigarettes, consume alcohol, and use illicit drugs than their counterparts deployed to noncombat operations. Our results suggest that the mental health effects of combat can explain up to two‐thirds of the estimated association between combat exposure and risky health behaviors. (JEL H56, I12)     

The bidirectional relationship between gambling and addictive substances

This study aims to analyse the co-occurrence of gambling activity and the consumption of addictive substances, such as tobacco, alcohol and drugs. By using a sample of 709 gamblers in Sardinia (Italy), a multivariate probit approach is proposed since it allows simultaneous study of the extent of correlation between the consumption of different substances.

Our findings document that, on the one hand, betting more money leads to an increase in the propensity to consume tobacco in the middle of the game, and, on the other hand, the simultaneous co-occurrence of smoking, alcohol and drugs drives up the probability of getting more involved in gambling activity. Knowing the positive reinforcing effects of addictive substances is the first step towards implementing the most effective prevention and treatment modalities for problem/pathological gamblers.     

Nursing home admissions and long-stay conversions among persons with and without serious mental illness

The appropriateness of nursing homes for individuals with serious mental illness remains a controversial issue in long-term care policy more than a decade since the landmark U.S. Supreme Court Olmstead decision in 1999 , which affirmed the rights of persons with disabilities to live in their communities. Using national nursing home Minimum Data Set assessments from 2005, the authors compared the demographic, clinical, and functional characteristics of persons with and without serious mental illness newly admitted to nursing homes. They found that newly admitted people with serious mental illness were younger and more likely to become long-stay residents than those admitted with other conditions, despite a higher proportion of residents with serious mental illness, including the elderly, classified as low-care status. The most substantial and clinically significant difference for rates of low-care status 90 days after initial admission are for persons younger than 65 with serious mental illness versus those younger than 65 without serious mental illness (33% vs. 8.5%, or 3.9 times greater). There is a notable difference in low-care status between persons aged 65 and older with serious mental illness and those aged 65 and older without serious mental illness (14% vs. 6.6%, or 2.1 times greater). These results suggest that a substantial number of adults with serious mental illness residing in nursing homes may have the functional capacity to live in less restrictive environments.     

ADDICTION, COMPULSION, AND THE TECHNOLOGY OF CONSUMPTION

The consumption technology model of Lancaster and Becker is extended to include addictive activities. Assuming a utility function in which the individual places a premium on maintenance of self-esteem, the model generates empirically verified patterns of habituation, withdrawal, and the compulsive restarting of an abandoned habit. It is then applied to the analysis of public policies toward drug abuse. Their frequent ineffectiveness is shown to result from an unwarranted emphasis on deterring the addictive activity rather than on encouraging atceptable behavior.     

Smoking and persistent mental illness: an exploratory study

The rate of smoking is alarmingly high among persons with persistent mental illness and they are no less susceptible to the harmful effects of smoking. Nicotine is a potent, addictive drug which affects neurotransmitters. Smoking can affect psychiatric symptoms as well as blood levels of psychotropic and other medications. Most persons with mental illness are aware of the detrimental health risks of smoking and many are interested in quitting. Poor physical health is associated with efforts to quit. Personal commitment is important to successfully quitting.     

Bachelor of Social Work Students and Mental Health Stigma: Understanding Student Attitudes

Bachelor-level social work students (n = 198) at a midsized Midwestern public university were surveyed to evaluate their attitudes toward those with mental health concerns. Additionally, students were surveyed regarding their willingness to seek treatment for their own mental health needs. Results of the analyses suggest that the majority of students do not hold stigmatizing attitudes toward mental illness. Students who believed mental health work is rewarding were less likely to be afraid or uncomfortable around people with mental illness. In addition, these students were more likely to report attitudes that acknowledge the capabilities of people with mental illness and were less concerned with others knowing their own mental health status. Implications for social work education and directions for future research are discussed.     

Addiction and intrapersonal externalities in the labour market

This paper attempts to model individual decision-making with respect to alcohol consumption as an intrapersonal game among different temporal selves. A temporal self’s decision regarding alcohol consumption is shown to affect the utility of other selves. This externality gives rise to a potential co-ordination problem. The co-ordination problem may lead to the existence of multiple intrapersonal equilibria which are Pareto rankable. The analysis of alcohol addiction is likely to yield very different conclusions when based upon such a framework as compared to Becker and Murphy’s (1988) rational addiction approach. For example, the reinforcement process characterising addiction emerges not because of the increased marginal benefits associated with alcohol consumption, but rather due to the decreased marginal productivity in the production of substitute commodities. The reasons for the persistence of addictive behaviour and potential for recovery are explored and the effect of depression on addictive consumption is illustrated.     

Students' Attitudes to the Inclusion of People with Disabilities in the Community

This study measures and compares the attitudes of students studying different subjects to the inclusion of people with mental retardation and mental illness in the community. The Community Living Attitude Scale (comprising the four subscales of Empowerment, Exclusion, Sheltering, and Similarity) was administered to a random sample of 149 Israeli college freshmen and women (social work: n = 43: law: n = 24; natural science: n = 42; and social science: n = 40). Overall, the students endorse Empowerment and perceive the Similarity of persons with disabilities to themselves more than they agree with the Exclusion attitude of segregating persons with disabilities from community life. Social work students showed more positive inclusion attitudes to people with disabilities than other students. Students were more likely to endorse Exclusion for people with mental illness than for people with mental retardation.     

From past trauma to post-traumatic growth: The role of self in participants with serious mental illnesses

Studies have shown that people with serious mental illness are more likely to have experienced trauma compared to the general population. This qualitative study employed a grounded theory approach to explore how trauma histories influenced the process of triggering, developing, and recovering from serious mental illness. Findings based on in-depth interviews with 15 participants illustrated the intersection of trauma, serious mental illness, and post-traumatic growth. Experiencing trauma compromised participants’ self-functioning, causing issues such as affect dysregulation, distorted self- and other- concepts and relationship difficulties, meaninglessness, and existential fears, all of which negatively impacted participants’ mental health and behavior. At the same time, participants with serious mental illness were able to achieve post-traumatic growth with the “transformed-self” via self-acceptance, self-exploration, self-worth, and self-fulfillment. Findings of this study have useful implications for trauma-informed care in mental health treatment. Mental health professionals should address clients’ trauma histories to prevent re-traumatization and design trauma-informed programs that use and build clients’ inner resources and strengths to promote post-traumatic growth.     

Mental Illness as a Barrier to Marriage Among Unmarried Mothers

This study explores how mental illness shapes transitions to marriage among unwed mothers using augmented data from the Fragile Families and Child Wellbeing study (N= 2,351). We estimate proportional hazard models to assess the effects of mental illness on the likelihood of marriage over a 5‐year period following a nonmarital birth. Diagnosed mental illness was obtained from the survey respondents’ prenatal medical records. We find that mothers with mental illness are about two thirds as likely as mothers without mental illness to marry, even after controlling for demographic characteristics, and that human capital, relationship quality, partner selection, and substance abuse appear to explain only a small proportion of the effect of mental illness on marriage.     

Peer connections as an intervention with children of families where a parent has a mental illness: Moving towards an understanding of the processes of change

Prevention and early intervention programmes have been found to impede the transmission of mental illness from parents to children. However, the extant processes of change in such programmes are less clear. This study focuses on the impact of a peer support programme developed for children and adolescents who have a parent with a mental illness and examines the processes of change which might promote positive outcomes for youth. A mixed methods research approach was employed with participants aged between 8 and 12 years old; 69 completed pre- and post-questionnaires and 18 of these same participants engaged in telephone interviews post programme. Results demonstrate improved mental health knowledge and children reported that they were more likely to use an anonymous telephone helpline after attending the programme. Children indicated that the programme provided a place of respite from caring for their parent with a mental illness, an opportunity to connect with peers, and a positive change in perception of their parent's mental illness. The reported findings are moving towards an understanding of the process of change in programmes.     

Child abuse and neglect in Cambodian refugee families: characteristics and implications for practice

This study examines the characteristics and patterns of child maltreatment among Cambodian refugee families in Los Angeles and assesses the implications for child welfare practice with Cambodian refugee families. Data were extracted from 243 active Cambodian case files maintained by the Los Angeles County Department of Children and Family Services (LAC-DCFS). Some of the major findings include (1) Cambodian child maltreatment cases were most frequently reported to the LAC-DCFS among various Asian Pacific ethnic groups; (2) Cambodian refugee families were more likely to be charged with neglect, while their Asian Pacific counterparts were more likely charged with physical abuse; (3) the circumstances under which maltreatment occurred most frequently were parental substance abuse and mental illness; and (4) while fathers who maltreated their child were likely to use alcohol, mothers were also more likely to have a mental health problem such as depression. This study suggests the importance of collaboration between Child Protective Service agencies, substance abuse programs, traditional healers, mental health services, and other social service agencies for effective child abuse prevention and intervention efforts.     

The labeling paradox: stigma, the sick role, and social networks in mental illness

Although research supports the stigma and labeling perspective, empirical evidence also indicates that a social safety net remains intact for those with mental illness, recalling the classic "sick role" concept. Here, insights from social networks theory are offered as explanation for these discrepant findings. Using data from individuals experiencing their first contact with the mental health treatment system, the effects of diagnosis and symptoms on social networks and stigma experiences are examined. The findings suggest that relative to those with less severe affective disorders, individuals with severe diagnoses and more visible symptoms of mental illness have larger, more broadly functional networks, as well as more supporters who are aware of and sympathetic toward the illness situation. However, those with more severe diagnoses are also vulnerable to rejection and discrimination by acquaintances and strangers. These findings suggest that being formally labeled with a mental illness may present a paradox, simultaneously initiating beneficial social processes within core networks and detrimental ones among peripheral ties.     

Heterosexism,racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts. Implications for change advocates, mental health providers, and researchers are offered.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al, 1994) and the Indiana Mental Health Services and HTV Risk Study (Wright, 1999). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations’ and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HFV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.     

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.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

Mental illness, supported education, employment and recovery: Ben's story

Supported education programs aim to facilitate the successful return to higher education for people living with mental illness who may have experienced educational interruptions due to their illness. This article shares the story of Ben who lives with mental illness and his experience of participating in an Australian supported education course. The two authors draw on a qualitative life history approach as they reflected on Ben's experiences of mental illness, educational disruption and returning to education and employment. The losses associated with educational disruption and the positive and empowering experience of becoming a student again are described as positively impacting recovery. Ben's story is shared in anticipation that other people living with mental illness, their family and carers, or workers supporting those people, may draw from his determination and success, in their own journeys of recovery.     

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.