Assessing mental health and service needs among refugees in Malaysia

Refugees in Malaysia often experience economic insecurity and poverty, poor health, poor mental wellbeing and limited legal rights. Using a survey with quantitative measures and open‐ended questions, we assessed socio‐demographic characteristics, mental health (RHS‐15), and service needs, including interest in group support services, among 86 Dari‐ and Arabic‐speaking refugees living in Kuala Lumpur. High levels of emotional distress were found, as nearly all participants scored positive for distress and average scores were 2.5 times above the cut‐off signifying distress. Distress scores did not vary based on most factors examined, although being married was associated with lower levels of distress. All but one participant expressed interest in participating in a support group. Barriers to potential participation included childcare, sickness and transportation. Additional mental health and social supports are needed among refugees residing in Malaysia. Key Practitioner Message: ? Emotional distress is high among Dari‐ and Arabic‐speaking refugees sampled in Malaysia; ? Participants expressed strong interest in accessing supportive mental health services, including group supports.     

Public Satisfaction with the Health System and Popular Support for State Involvement in an East Asian Welfare Regime: Health Policy Legitimacy of Hong Kong

The legitimacy of social policies has gained increasing attention in the past decade, against the backdrop of fiscal austerity and retrenchment in many nations. Policy legitimacy encompasses public preferences for the underlying principles of policies and the actual outcomes as perceived by citizens. Scholarly knowledge concerning the legitimacy of health policy – a major element of modern social policy architecture – is, unfortunately, limited. This article seeks to extend the scholarly debates on health policy legitimacy from the West to Hong Kong, a member of the East Asian welfare state cluster. A bi‐dimensional definition of health policy legitimacy – encompassing both public satisfaction with the health system and the normative expectation as to the extent of state involvement in health care – is adopted. Based on analysis of data collected from a telephone survey of adult Hong Kong citizens between late 2014 and early 2015, the findings of this study demonstrate a fairly high level of satisfaction with the territory's health system, but popular support for government responsibility presents a clear residual characteristic. The study also tests the self‐interest thesis and the ideology thesis – major theoretical frameworks for explaining social policy legitimacy – in the Hong Kong context. Egalitarian ideology and trust in government are closely related to both public satisfaction with the system and popular support for governmental provision of care. However, the self‐interest thesis receives partial support. The findings are interpreted in the context of Hong Kong's health system arrangements, while implications for the territory's ongoing health policy reform are discussed.     

Gender‐sensitive intervention to improve work with fathers in child welfare services

Although the importance of including fathers in child welfare services has been increasingly recognized, social workers' engagement with fathers is still limited and sometimes fraught with negative bias. This paper attempts to lay some needed foundation to meet the challenge of working with fathers. It presents in succinct form the existing knowledge on how fathers experience and manifest their distress and on how they view the social services and social workers. It discusses, in some detail, three main issues – power relations, mutual fear and communication differences – in the interactions between female social workers and the fathers in the social welfare services. And it emphasizes the need for social workers to be aware of how their experiences with their own fathers may affect their interventions with men. It ends with observations and recommendations for developing the gender awareness that is necessary for effective practice with fathers.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

Social Advocacy for Equal Marriage: The Politics of "Rights" and the Psychology of "Mental Health"

Using the contemporary issue of equal access to marriage for same-sex couples as a case study, we examine two distinctive frameworks within which social advocacy may be pursued. We argue that when we speak as psychologists, we use a discourse of mental health; when we speak as social activists, we use a discourse of human rights and justice. Although these two frameworks may converge in supporting equal access to marriage, they represent radically different ways of understanding inequality and advocating for social change. A discourse of mental health focuses on psychological damage or deficit (caused, for example, by the social exclusion of particular groups or individuals. A discourse of rights asserts universally-applicable principles of equality, justice, freedom, and dignity. Further, the paradigmatic framework of psychology as an approach to understanding human beings in the world seems fundamentally antithetical to the conceptual framework of human rights, as a basis for social justice.     

Children living with parental substance misuse: A cross‐sectional profile of children and families referred to children's social care

Parental substance misuse is a significant public health and children's rights issue. In the United Kingdom, social workers frequently work with children and families affected by substance misuse. However, relatively little is known about this population, particularly at point of referral to children's social care. This paper reports on the largest known study of parental substance misuse as a feature of children's social care work in England. The paper provides a cross‐sectional profile of 299 children living with parental substance misuse and referred to children's social care in one local authority in England. Data were collected from social work case files at the point of referral to social care about the child, family, the wider environment, and parental substance misuse. The findings show that children affected by parental substance misuse frequently had other support needs relating to their well‐being and mental health. Children were also likely to be experiencing other parental and environmental risk factors. The significant historical—and in some cases intergenerational—social care involvement for some families indicates potential issues with the capacity of services to meet needs. Recommendations for practice are discussed with a particular focus on the need for early, comprehensive support for children and families.     

A critical review of mental health and mental health‐related policies in China: More actions required

In China, there are over 170 million people suffering from mental illness. However, there is a lack of a critical review of the policies governing the provision of mental health services. Drawing on the framework of mental health policy developed by the WHO, this article critically examines mental health policies regarding legislation, financing, model of care and delivery, as well as manpower and the training of mental health professionals in China. This analysis raises a number of policy‐related questions concerning the lack of community‐based psychiatric services, inadequate coverage of mental health services in the rural areas, poor standard of education and an insufficient number of trained mental health professionals, and insufficient protection of the human rights of people with mental illness. The article ends by urging the various levels of governments to make a firm commitment to improve mental health care for people with mental illness in China.     

‘Disability is not a word we use’: Social workers' professional judgements about support for disabled young people leaving care

Disabled young people leaving care often experience a more complex transition to adulthood than other youths. Still, policy and services can fail to recognize the intersection between a young person's care experiences and disability. Drawing on data from a qualitative interview study with 14 social workers who work with aftercare in the Norwegian child welfare services, we investigate social workers' professional judgements about support for this subgroup of the leaving care population. Our analysis uses the theoretical construct of institutional logics and shows that social workers did not include concepts of disability in their judgements about support for these young people. Instead, the social workers' considerations were guided by three other organizing principles: a ‘medical logic’, an ‘activation logic’ and an ‘aftercare logic’. We discuss these findings in light of critical disability studies and argue for a more nuanced understanding of disability in social work practice with care leavers. Highlighting disability rights and going beyond diagnosis and categorisations of disabled people can challenge a medical model approach to service provision.     

Introducing social insurance for long‐term care in Taiwan: Key issues

Nadash P, Shih Y.‐C. Introducing social insurance for long‐term care in Taiwan: Key issues Taiwan will shortly complete its comprehensive social safety net, which includes national health insurance, retirement security, and unemployment insurance, by introducing long‐term care (LTC) insurance – putting it ahead of the many countries that rely on a patchwork of policies to address the need for LTC. The program, to be implemented in 3 to 5 years, will cover all citizens on a primarily social insurance basis. The range of LTC policy options considered is discussed, particularly how to structure the program, how to finance and regulate it, and how to develop its inadequate LTC infrastructure and workforce. Particularly thorny issues include the choice of social insurance, the feasibility of cash benefits, and how to address Taiwan's heavy reliance on foreign workers. Taiwan's increasingly democratic character, along with high levels of public support for the program, creates significant pressure on politicians to deliver on their promises to implement LTC reform. Key Practitioner Message: ?Emphasizes the importance of policy learning from other environments; ?Highlights the need for a strong regulatory and provider infrastructure for delivering long‐term care services; ?Emphasizes the need for training, support, and appropriate regulation of the long‐term care workforce.     

The well‐being of children of parents with a mental illness: the responsiveness of crisis mental health services in Wellington,New Zealand

Little is known about how mental health services consider the parenting role and the well‐being of children when assessing parents with acute mental illness. This paper investigated how crisis mental health services addressed child well‐being in the Wellington region, New Zealand. This mixed‐method case study included: (i) an audit of the electronic clinical records of all adults presenting to the crisis assessment team; (ii) interviews with 22 key informants; and (iii) a documentary review. We found that data about children were not systematically collected. Less than half of (49 of the 104) the records of patients who were parents included information on their child's well‐being; only six (6%) contained a specified plan for action. The focus for services was the adult patient. Key informants were unclear about their role. They identified inadequate training and institutional support, inflexible funding models and limited availability or inappropriateness of referral services as problems. They saw a need for children to become more visible, for collaborative working to improve the use of existing services and for new funding models, resources and roles. Existing national policy documents contained little guidance and no practice guidelines were in use. These were lost opportunities to improve support for the parenting role and promote child well‐being.     

Household stress and adolescent behaviours in urban families: the mediating roles of parent mental health and social supports

Using exploratory data analysis techniques, we propose a model of parent psychosocial well‐being that links financial strains and household stressors to adolescents' pro‐social behaviours and vulnerability through parent mental health and social supports. Parents of urban youth (n = 781) who planned to attend a summer camp for at‐risk youth responded to questions surveying household, parent and child factors related to early adolescent development. We expected that the relationship of household stressors – including financial strain and household difficulties – with adolescent behaviours would be mediated by parent depression and anxiety. We also anticipated that parent social supports would have both direct and indirect effects (via parent mental health) on adolescents' pro‐social behaviours. Study findings are consistent with our hypotheses and the model performed similarly for both adolescent males and females. Implications for practice and policy in the context of programmes for urban youth are discussed.     

‘More time for what?’ Exploring intersecting notions of gender,work, age and leisure time among people with cognitive disabilities

This article explores intersecting notions of leisure among middle‐aged people with intellectual disabilities in the setting of the Swedish welfare state. The participants are recipients of long‐term disability services and have experienced the changing ideological frameworks of the welfare effort, which has recently focused on normalisation, inclusion and participation. Structured activities are arranged by disability services in order to normalise living conditions and provide recreation for disabled people. However, the range of activities is constrained by financial resources, by notions of gender and age and by an institutionalised emphasis on the work ethic – leading to constructions of leisure partly as ‘time beside’ where ‘free time’ activities should not interfere with the duties of the working week. The participants' limited resources and their lack of a strong voice limit their ability to demand their legal rights and leave many of them with ‘too much time with too little to do’. Key Practitioner Message: ● A common idea of leisure is the relationship between social and physical activities, well‐being and health; ● People with disabilities, regardless of age, engage in fewer leisure activities than the general population due to a lack of resources; ● Even with legal rights, the lack of a strong voice as well as institutional constraints limit their leisure opportunities.     

‘Reasonable and necessary’ care: the challenge of operationalising the NDIS policy principle in allocating disability care in Australia

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of ‘reasonable and necessary’ care. As a universal rights‐based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three‐year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS.     

Thrown back: Reintegration experiences of National Guard/Reserve mothers of young children

Few studies have examined the experiences and perceptions of servicewoman mothers and their children, even as an increasing number of them have experienced deployment and combat exposure. The present paper describes a qualitative study that explored National Guard/Reserve (NG/R) mothers' experiences with mothering and co‐parenting during reintegration and their perceived priorities, supports, challenges and needs. Interpretive phenomenological analysis of seven in‐depth qualitative interviews produced themes including reunion and loneliness, the importance of time, help seeking and gendered experiences. Notably, all participants transitioned immediately back into primary caregiver roles upon homecoming, and several described how difficult it was to readjust while privately dealing with unmet mental health needs. Findings underscore the importance of a flexible suite of service options that meet key needs, most importantly, child care, social–emotional support for children and peer‐based parenting support specific to servicewoman mothers. For NG/R mothers, who may live far from base, community‐based services are essential, but as participants described, civilian social workers and other professionals must develop specialized knowledge, skills and experience to provide appropriate support.     

Delayed Hospital Discharge and Mental Health: The Policy Implications of Recent Research

In 2003, the Community Care (Delayed Discharges etc.) Act introduced charges for social services departments unable to discharge patients from hospital within agreed timescales. As details of this reimbursement policy have begun to emerge, it has become apparent that the new system may also be extended to mental health services. In response, this narrative review of the literature on delayed hospital discharges and mental health reports findings from 12 studies, which raise important and timely concerns about the feasibility of reimbursement. Although a significant number of people experience delayed discharges from acute psychiatric services, the task of defining delayed discharges is complex and subjective, dependent on the professional background and seniority of the person making the judgement. Reasons behind delayed discharges are also multi‐factorial in nature and cannot be attributed to social services departments alone.     

AUSTRALIAN WELFARE REFORM: FROM CITIZENSHIP TO SOCIAL ENGINEERING

This paper examines the changes in the terms of citizen‐state relations that are coded in Australia's current program of welfare reform. It argues that welfare reform entails a shift from welfare as a limited social right of citizenship to welfare as a form of support conditional upon completing specified obligations, and from the provision of support as a cash payment to support coupling cash with personal services. Together, these shifts have the scope transform the relation between citizen and state fundamentally. This is no less than a shift from social policy citizenship in which claimants are presumed to act on their own behalf to paternalistic support and care directed to reforming character and values as well as to meeting need. The paper argues that this shift violates the fundamental equality essential to social policy citizenship.     

The Role of Mastery and Social Support in the Association Between Life Stressors and Psychological Distress in Older Canadians

Gerontological social workers and other health professionals are often dealing with older adults in psychological distress. Greater clarity on the relationship between stress and psychological distress will enhance the efficacy of outreach and treatment initiatives for older adults. This study explored the underlying causal structure of the relationships of common life stressors and psychosocial resources for Canadians 65 years and older (542 men and 835 women). Using structural equation modeling of data collected in the National Population Health Survey in 2004–2005 and 2002–2003, the roles played by socioeconomic conditions, physical health, chronic stress, sense of mastery, and perceived social support in the stress–psychological distress relationship were estimated and compared. Findings revealed that chronic stress was the strongest determinant of the level of psychological distress for both genders; however its effect was higher for men compared to women. Poor physical health played a more important role in determining women's psychological distress compared to men. Higher levels of mastery and perceived social support were associated with lower levels of psychological distress for both men and women. These associations were somewhat stronger for men compared with women. Socio-economic conditions played a minor role in the stress–mental health relationship for both genders.     

Social Support for Mothers of Children With Disabilities in China

ABSTRACT.

This article analyzes the gendered parenting experiences of mothers of children with disabilities in China. These mothers struggle to meet their children's needs, including daily care, financial security, and child development. In the context of China's social welfare development, are social services responding to their needs, so that mothers can share responsibility for the needs of their children with disabilities? The research analyzed qualitative data about 6 case-study children in rural and urban China. The data were derived from observation and interviews with their parents and other family and community members. The analysis revealed that the capacity of the mother, community, and local social services had an impact on the rights of the children and mothers. They experienced social discrimination, insufficient social support, and local failure to implement central policy social services and income support. These findings are consistent with international research about disability rights. They reinforce the importance of economic redistribution to enable local implementation of the national disability rights policies, rather than merely relying on ephemeral concepts of cultural change. Further research about the comparative impact of economic and social change in China on mothers and children with disabilities would extend these findings.     

Ageing-in-place in studio apartments in Singapore: maintaining independence in community living

Abstract

Living alone in later life is increasingly a common style of living in Singapore. We investigated the extent of maintaining independent living in a studio apartment using a survey of older residents (n = 925), focusing on three aspects of coping strategies: self-care management, social support, and use of social services. As compared to older adults who lived with others, those who lived alone had better self-care management, tended to rely more on friends and neighbours, and indicated higher use of social services. Those living alone also showed higher awareness in managing their health. This study provides valuable insights to understand the issues on coping strategies involved with living alone in later life.     

Public Opinion against Markets? Attitudes towards Market Distribution of Social Services – A Comparison of 17 Countries

This article studies how citizens view the appropriateness of market criteria for allocating services commonly associated with social citizenship rights and welfare state responsibility. The article focuses specifically on a potential role for the market in the provision of social services. The relationship between welfare policy institutions, socio‐economic class and attitudes is explored by comparing attitudes across 17 countries of the Organisation for Economic Co‐operation and Development, using multilevel modelling and data from the 2009 International Social Survey Programme. Results show that public support for market distribution of services is relatively weak in most countries, a result suggesting that public opinion is unlikely to pose a driving force within ongoing processes of welfare marketization. Still, attitudes are found to vary a lot across countries in tandem with between‐country variation in welfare policy design. First, aggregate public support for market distribution of services is stronger in countries with more private spending on services. Second, class differences in attitudes are larger in countries with more extensive state‐led delivery of services. Together, these results point to the operation of normative feedback‐effects flowing from existing welfare policy arrangements. The theoretical arguments and the empirical results presented in this article suggest that future research exploring the relationship between welfare policy and public opinion from a country‐comparative perspective is well advised to place greater focus on the market institutions that, to varying extents in different countries, act as complements to the state in the administration of social welfare.