Independence, Risk and Compulsion: Conflicts In Mental Health Policy

During the second half of the 20th century the mental hospital population in England and Wales has fallen by some two-thirds. This dramatic shift in mental health policy has been based, in part, upon a policy assumption concerning the therapeutic benefits of hospital discharge for mental patients. This view derives from an acknowledgement of the potentially negative impact of institutional life and, conversely, a recognition of the beneficial effect of a return to independent living in the community. Yet, in recent years, concern has grown about the risks posed to the health and safety of patients and to the safety of other members of the community as a result of hospital discharge. In turn this has led to a policy shift in favour of increasing use of compulsory community powers. This article identifies the tensions in policy that exist between the goal of independence, the recognition of risk and the implementation of compulsory community powers, and seeks to provide an assessment of the extent to which they can be reconciled.     

Care Programming in Mental Health: assimilation and adaptation

Correspondence to Justine Schneider. PSSRU. University of Kent, Canterbury CT2 7NF. Summary Two years after the care programme approach in mental healthwas introduced there is still widespread confusion about itsmeaning and its relation to other changes in the arena of communitycare. This paper looks at how care programmes are being implementedand at whom they are being targeted. It also examines the relationbetween care management and care programming and raises somequestions about future developments in the light of communitycare reforms. It draws on data collected during 1992 from threecontrasting health districts, all of which had made considerableprogress in care programming. Sixty practitioners were interviewedabout the theory and practice of care programming. Their experienceis presented here in the context of a review of community careplans for 1992/93 which characterizes the responses of differentlocal authorities to the approach.     

The Trials of Homecoming: Odysseus Returns from Iraq/Afghanistan

This lecture introduces some of the poignant challenges and stressors facing service members and their families as they return from combat in Iraq and Afghanistan. A focus on the nature of psychological injuries, as compared with disorders, sets the stage for discussing some central factors necessary for a harmonious transition back home. The article stresses the vital role played by a community of Veterans in healing moral injuries. The importance of effective leadership, sound sleep, and supportive unit cohesion are stressed as vital protective factors in theater. To assist mental health and health clinicians working with Veterans, the article asserts that the prevention of secondary trauma should be ethically obligatory self‐care supported by mental health centers and academic institutions.     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.     

Caring for mentally disabled people in Scotland

Scotland's mental health agencies face a major challenge with the appearance of Caring for People. The arrival of the community care White Paper has coincided with the appearance of renewed concern over hospital inpatient provision and over the perceived lack of progress in the development of community care. This article examines some of the differences which arise from the construction of community care policy in Scotland and some of the evidence available for assessing the present state of care in the community for the younger mentally disabled. It is found that some 630,000 adults under the age of 65 (or 19% of all adults in this age group) are suffering from some form of mental disability, some 22% of whom are in severe need of care. 93% of this group are located in the community. Problems for carers are created by the presence of significant shortfalls in resources and by the balance of care which exists in Scotland.     

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.     

Is Housing First for Mental Health Community Support Possible During a Housing Shortage?

Supported housing programmes for people with chronic mental health needs have shifted towards approaches that rely on housing first, which prioritizes access to a permanent home in the community. How do support programmes with this assumption manage the market constraints of a shortage of affordable housing? The article examines empirical mixed method data (interviews and programme data) about the experience of managing this problem in the Mental Health Housing and Accommodation Support Initiative (HASI) in New South Wales, Australia. HASI provides clinical mental health services, housing support and housing if needed, for people who are not yet living independently in the community. It found that the housing shortage affected the ability of the providers to implement the intended programme design at three early steps in the support: determining eligibility; prioritizing access between people with and without housing; and managing entry to the programme when they did not have housing. As a result, some otherwise suitable applicants were not prioritized for entry into the programme or their entry was delayed until they were housed. The providers adjusted the programme to the housing market realities, which compromised the programme intentions. The policy lessons are that programmes need strategies to provide housing for people who require it; assist people to find or apply for housing; and support people while they wait for housing. These approaches enhance the coherence of programmes, build on integration mechanisms and respond to the housing context.     

The HOPE Family Project: A Family-Based Group Intervention to Reduce the Impact of Homelessness on HIV/STI and Drug Risk Behaviors

The HOPE Family Project (HIV Prevention for Parents and Early Adolescents) is an eight- session, family-based group intervention modeled on three evidence-based curricula targeting HIV/AIDS and alcohol and drug abuse prevention. The design and implementation of the HOPE Family Project was carried out by an established community collaborative board. The project aims to educate and provide tailored support to families and their youth (ages 11–14), residing in homeless shelters, regarding HIV and alcohol abuse prevention. The group model proved successful in offering an informal social support network for families living in homeless shelters and improving family functioning and youth mental health outcomes.     

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.     

Reviewing the latest national policies and services for people with severe mental health disorders in government-funded institutions in Vietnam,and policy recommendations for service improvements

The aim of this paper is to provide the international community with a broad and updated picture of key policies and services for people with severe mental health disorders in Vietnam. In particular, the paper (1) reviews the most important national policies governing care for people with mental health disorders, (2) reviews the status of free-of-charge care provided to people with severe mental health disorders in a network of government-funded facilities across the nation and (3) discusses the future policy directions of Vietnam regarding people with mental health disorders.     

重庆市城市社区心理卫生现状调查及其对策思考

本文通过问卷调查、现场走访等方式,分析、描述了设为直辖市后重庆主城区社区居民心理健康观念、社区心理健康教育状况及其成因。作者认为,在现代社会,由于生活节奏的加快,各种竞争的加剧,人们在享受不断丰富的物质生活的同时,精神生活方面却越来越觉得并不十分完美,“亚健康”成为一个相当普遍的社会问题,增加人文关怀,进行城市社区心理健康教育,建立心理危机干预系统就显得很有必要。     

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland

In mental health services over recent decades, the positivemove away from hospital-based care to community-based serviceshas entailed that people with higher levels of need are beingsupported by community mental health services. This paper beginsby reviewing the literature on coercion in the field of community-basedmental health care and treatment. It is argued that the lackof a critical understanding of the concept and how it is usedby practitioners and agencies can have serious repercussionsfor the rights of service users. Using a quasi-experimental,longitudinal design, the authors then seek to test some of theideas about coercion by comparing the activities of assertiveoutreach and community mental health teams in Northern Ireland,particularly the key ideas of perceived coercion, workers’strategies and engagement with services. Key findings were thatassertive outreach appeared to be more successful at reducingperceived coercion, minimizing the need for coercive strategies,engaging high-risk clients and reducing inpatient bed use. Thesefindings are compared with other studies in this area. The authorsalso argue that there is a need for greater transparency inthe way that practitioners use coercive measures and more explicitguidance is required in this crucial area of mental health practice.     

Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Assisted Living Facility Administrator and Direct Care Staff Views of Resident Mental Health Concerns and Staff Training Needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

Into the Community: A Comparison of Care Management and Traditional Approaches to Resettlement1

The resettlement of people with learning disabilities (mental handicap) from long-stay hospitals has been under way for a number of years in England. This process has generally been dominated by the exigencies of the available services. A needs-led approach, emphasized in recent community care legislation, in which new services are sought on the basis of the specific requirements of service users, has been used infrequently for this purpose. This paper compares the process of implementing a needs-led care management approach to resettlement with the implementation of a more traditional service-led approach. It also suggests some important lessons for the application of a needs-led approach to hospital resettlement.     

城市社区老人心理健康服务现状调查——来自重庆市主城社区的调查数据

以重庆市主城社区老人为调查对象,从老人的基本情况、心理健康状况、心理健康服务需求、心理服务支持系统等方面的调查数据进行详细分析,得出了家庭、邻里同辈群体是老人心理健康的重要支持系统、需要建立完善的城市社区老人心理健康服务体系等结论。     

An Analysis of Selected Pension and Health Care Initiatives for Informal Sector Workers in India

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.     

昆明市空巢老人健康与照顾需求的评估

“空巢”是中国科技与社会发展、独生子女政策落实的必然。日益增长的“空巢老人”为国家福利、代际和谐和社区照顾带来了严峻挑战。本文从社会保障的视角,采用健康自测量表（SRHMS）,从生理、心理和社会健康的维度,对昆明市10所养老机构和18个社区的289位空巢老人和212名非空巢老人进行了比较分析,发现空巢老人社会健康与心理支持令人担忧。文章就构建“空巢老人”长期照顾网络作了讨论和建议。     

The Care Programme Approach: Dimensions of Evaluation

Correspondence to Barbara Hatfield, Mental Health Social Work Research Unit, School of Psychiatry and Behavioural Sciences, University of Manchester, 12th Floor, Mathematics Building, Oxford Road, Manchester M13 9PL, UK. Summary The study examined the first six months of implementation ofthe Care Programme Approach (the CPA) at a psychiatric unitof a district general hospital. From an analysis of the researchliterature on case management, and from current policy, a frameworkwas developed which was used to analyse the implementation understudy. The framework included such features as: a keyworkeroffering a continuous relationship and co-ordinated care; assessmentand intervention over a range of ‘needs’; multidisciplinaryworking in the community; and involvement of user and carer.The objectives were to ensure continuity of care and reducehospital admission. The targeted service users were to be thosewith severe and enduring mental health problems. The study showsthat most of these features were achieved in the implementation,although there is no evidence that hospital admission was avoided.A number of factors were found to be associated with re-admission,and these are discussed in the light of the findings of otherstudies.