The Baby as Subject: The Hospitalised Infant and the Family Therapist

This article is concerned with the experience of infants who endure long hospitalisations. It explores the concept of the baby as subject; that is, infants as active, psychic participants in their earliest relationships. It explores therapeutic possibilities with hospitalised infants from an infant mental health perspective. It advocates for family therapists to equip themselves for infant—parent therapeutic work.     

Understanding paid peer support in mental health

This study aimed to explore, articulate and expand on existing concepts of recovery and paid peer support within consumer-operated mental health organizations. Focus groups and interviews were conducted with 32 participants to identify elements of paid peer support work in two organizations in Queensland, Australia. Participants included peer-supported consumers, paid peer support workers, managers and other key stakeholders. Through a grounded theory analysis, eight categories of paid peer support were identified. For the most part, the categories aligned well with evidence in the literature. However, two of these categories, issues of power and the ‘dark side’ of peer support, have been relatively unexplored and understated in previous studies. These findings provide an expanded understanding of the role of paid peer support as part of the recovery process in mental health service delivery. The effective use of paid peer support workers can be enhanced through attention to the issues identified.     

The practical utility of the Welch Emotional Connection Screen for rating parent–infant relational health

Emotional Connection (EC) measured by the Welch Emotional Connection Screen (WECS) was related to the Parent–Infant Interaction Rating System (PIIRS), a 5‐point adaptation of the rating system developed for the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (e.g., NICHD Early Child Care Research Network, 1999, Developmental Psychology, 35, 1399). Parent–infant dyads (n = 49 mothers; 43 fathers) were videotaped during face‐to‐face interaction at infant age 6 months; interactions were coded with both the WECS and PIIRS. At age 3, mothers completed the Child Behavior Checklist. WECS ratings of EC were associated with PIIRS rating items for both mother–infant and father–infant dyads. Mother–infant EC related positively to maternal sensitivity and positive regard for child, child positive mood and sustained attention, and dyadic mutuality, and negatively with maternal intrusiveness. Father–infant EC related positively to fathers' positive regard for child, child positive mood and sustained attention, and dyadic mutuality. Mother–infant EC predicted child behavior problems at age 3 better than mother–infant PIIRS ratings of dyadic mutuality. With fathers, neither EC nor dyadic mutuality ratings predicted mother‐reported child behavior problems. Findings highlight the practical utility of the WECS for identifying potentially at‐risk dyads and supporting early relational health.     

Service user/survivor-led research in mental health: epistemological possibilities

This paper considers possible epistemologies for user-led and survivor research by drawing on four discourses: the mainstream English tradition, Canadian Mad Studies, critical theory more generally and feminist standpoint epistemology. It discusses general, universalising epistemologies, the extent to which these characterise the discourses at stake and the problems with knowledge claims that rest on such singular conceptualisations. The institutional and political concomitants are considered. The paper has an additional double aim: to engage with survivor scholarship around critical theory and to insert that scholarship into the field of critical theory itself in a novel manner.     

A principles-focused evaluation of community mental health short-term case management

Principles-focused evaluations allow evaluators to appraise each principle that guides an organization or program. This study completed a principles-focused evaluation of a new community mental health intervention called Short Term Case Management (STCM) in Toronto, Canada. STCM is a time limited intervention for clients to address unmet needs and personalized goals over 3 months. Findings showcase that a principles-focused evaluation, assessing whether program principles are guiding, useful, inspiring, developmental and/or evaluable (GUIDE), is a practical formative evaluation approach. Specifically, offering an understanding of a novel intervention, including its key components of assessment and planning, support plan implementation and evaluation and care transitions. Findings also highlight that STCM may work best for those clients ready to participate in achieving their own goals. Future research should explore how best to apply the GUIDE framework to complex interventions, including multiple principles, to increase evaluation feasibility and focus.     

Chronic care,integrated care,and mental health: Moving the needle now

Healthcare reform is currently a hot topic in the United States, and the Chronic Care Model has frequently been cited as the foundation of recent attempts to integrate mental health and physical health care. However, challenges exist to fully integrated care that have delayed adequately meeting the multiple needs of mental health service recipients. This article highlights multiple changes that can be incorporated into mental health care now, derived from the Chronic Care Model, to better meet clients’ physical and mental health needs. These changes include focusing on population-level data and incorporating technology and multidisciplinary teams in treatment and prevention efforts.     

Walking the tightrope of a mental health act assessment

This article is an attempt to capture something of the atmosphere of a Mental Health Act assessment, and was inspired by a recent article by Professor Harry Ferguson on child protection (2010). Here, the focus is on adult mental health practice and, in particular, on Mental Health Act assessments which may take place in any location including police stations, hospital wards or care homes. The following article mainly concentrates on assessments that take place in the service user's home. The Mental Health Act 2007 replaced Approved Social Workers with Approved Mental Health Professionals (AMHPs) in England and Wales; prior to this change the role was, as the name stated, entirely performed by social workers and they remain the predominant profession within the ranks of AMHPs.     

Navigating stormy waters: Challenges and opportunities for social work in mental health

The reforms driven by the National Mental Health Strategy have created both opportunities and challenges for social work as a profession. This paper examines the rapidly changing context for practice in mental health, including policy change, and developments in the education and training of the mental health workforce. Key practice issues identified for social work include: (i) the need to establish a viable paradigm for practice; (ii) a more positive response to the challenge of evidence-based practice models; (iii) a national agenda for education and training; and (iv) the importance of working collaboratively with consumers and families in a way that values their human rights and the lived experience of mental illness.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

Traditional versus Western perceptions of mental illness: women of Moroccan origin treated in an Israeli mental health center

This paper focuses on the problems encountered in providing Westernized psychiatric treatment to a population with traditional healing beliefs. The sample comprised women of Moroccan origin living in Israel undergoing treatment for psychiatric disorders (N=38), and their treating psychiatrists (N=9). Ethnographic interviews were conducted among both groups. The results revealed that the symptoms, perceptions of the illness, and problems encountered in the therapeutic relationship differed across three age groups, young women (20–30 years), more mature women (31–42 years), and older women (43–60 years). While cultural conflict appeared to affect the development of mental illness in each group, this was most pronounced among women in the middle age range. Moreover, problems in the therapeutic alliance were greatest in this age group. The data from the therapists indicated that they maintained a Western perspective in both their understanding and diagnoses of these patients' illnesses. The different perspectives of the therapists and each of the three groups of women are discussed. It is concluded that professionals treating traditional populations must avoid imposing Western standards, and consider the treatment in the context of cultural beliefs. The developmental stages of the individual, and the stage of acculturation must also be taken into account if treatment is to be effective.     

Children of adult consumers of mental health services: Towards principles of practice

Abstract

This paper discusses the development of a peer support and advocacy Network, Young Mothers for Young Women. The Network evolved through a participatory action research project into young mothers experiences of violence. Through the Network, young women participate in a community development approach to violence reduction. As part of the Network, young women offer peer support to other young women. Network members also engage in ongoing community education and advocacy about issues, such as poverty, isolation and sexism which increase young womens vulnerability to violence. An important aim of this paper is to make visible the dialogue between social workers and young women on which the Network relies. This paper is motivated by the concern that as social work enters an era of increasing accountability it is critical that workers articulate the often invisible role they play in facilitating participatory processes.     

Parental mental health as a child protection issue: data from the NSPCC national child protection helpline

Analysis of a sample of 2084 child abuse referrals to the NSPCC Child Protection Helpline showed that in 10% a parent or carer was reported as having a mental health problem. Mothers were the parent affected in the majority of these cases. The mental health sample differed from the other referrals in an increased concern about emotional abuse and less about sexual abuse; greater levels of violence and discord between parents; and more agency involvement. Issues of potential labelling and therapeutic needs are discussed. Copyright © 1999 John Wiley & Sons, Ltd.     

Enabling social support and resilience: outcomes of Family Group Conferencing in public mental health care

Family Group Conferencing (FGC) is a decision-making model where clients with their social network formulate their own plan. There is little experience with FGC in mental health care. We studied the outcomes of 41 conferences in a public mental health setting in the north of the Netherlands. We interviewed 312 respondents out of a total of 473 conference participants. In 33 cases, it was possible to obtain scores from 245 respondents on scales ranging from 0 to 10 about the situation prior and after the conference on three outcome measures, namely the quality of: (1) social support, (2) resilience and (3) living conditions. In the 33 cases, t-tests and multilevel analyses indicate on all of the three outcomes measures significant positive changes after the conferences. On average, the scores on the quality of social support (5.04–6.73), resilience (4.09–6.32) and the living conditions (3.73–6.64) had been increased since the conferences were organised. The results are modest but remarkable. That the impact of FGC is not more substantial can be explained. The clients referred to a conference in this particular study, mostly had a limited network and few recourses from whom little support could be expected.     

Incremental Change: The Pace of Progress in Health

Abstract

In a prospective study of acute diarrheal illness among college students, during one academic year, the incidence of Campylobacter enteritis was 5.57 per 1,000. Approximately 17% of all patients with acute diarrheal illness had Campylobacter enteritis. Campylobacter enteritis is briefly discussed. The value of the stool wet-mount examination is emphasized. It can serve as a guide to which stools to culture and often can lead to a presumptive diagnosis of Campylobacter enteritis. Student health center labs are urged to perform stool wet-mount exams and to provide cultures for isolating the Campylobacter organism.     

Translating knowledge into practice: using simulation to enhance mental health competence through social work education

ABSTRACT

Simulation-based learning (SBL) is an innovative experiential teaching method where students and instructors interact with a simulated client to foster students’ holistic competence in practice. Considering the context of North America where social workers are the largest service provider in the field of mental health, it is critical for educators to enhance competencies in students during the social work program. Guided by competency- and simulation-based, adult learning frameworks, this paper illustrates the development and integration of a range of educational activities into a treatment-focused advanced mental health course in the social work curriculum. We conclude by discussing how SBL enhances students’ mental health competence and provide recommendations when developing SBL in the mental health curriculum in social work education.     

Navigating the ‘shadow of loss’ in mental health social work

ABSTRACT

The human experience of loss has been at the centre of psychoanalytic understandings of the human condition since Freud’s first writings on ‘melancholia’. This essay draws on psychodynamic theory to show how workers who are attuned to the experience of loss in service users can shape their interventions accordingly. By reflecting on how a diagnosis of ‘depression’ might better be understood as the rippling wave of past grief, professionals can utilise the dynamics of projection, transference and containment to help understand the emotional pain of individuals they support. But this essay also suggests that the use of psychodynamic practice works best when it is bolstered by other frameworks – in this case an understanding of systems theory. When the two traditions are utilised together, they provide an understanding of psychic phenomena which can enable social workers to build a basis for effective interventions with service users experiencing mental distress.     

The necessity of an attention to Eurocentrism and colonial technologies: an addition to critical mental health literature

Critical perspectives in mental health and the highly influential contributions of those who identify with and/or ally with the psychiatric-survivor, consumer-survivor, ex-patient, or mad movements have provoked an appreciation of the many exposed epistemological, methodological, and ethical issues that (re)produce violence within biomedical psychiatry. What is often left uninterrogated is the reliance on a Eurocentric conceptualization of history within articulations of struggle and when attending to the political and social contexts of critique. The effect of this enduring Eurocentrism is often an inattention to the complicit influences of colonial and imperial projects on the practices and technologies of dehumanization, taxonomization, and the establishment of human hierarchies to rationalize violence through the implementation of racial and eugenic rationale. The imperative of this attention to Eurocentrism is suggested from a synthesis of contributions from critical mental health, postcolonial, and critical race literature.     

Agency among young people in marginalised positions: towards a better understanding of mental health problems

ABSTRACT

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister’s four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today.