Using Social Media to Change the Narrative Around Chronic Illness

Chronic illness is a prevalent issue for many individuals. Various theoretical approaches have been employed in the psychotherapeutic treatment of chronic illness and the effects it has on the individual with the illness. These approaches frequently overlook the strengths of the person living with the illness as well as fail to address aspects of modern life such as social media use of the client and the influence it holds for those living with a chronic illness. This paper proposes the application of narrative therapy and social media use as a narrative therapeutic technique when treating those who suffer from chronic illness. A clinical vignette is used to illustrate possible applications of therapeutic techniques in conjunction with therapist-directed social media use. Implications for clinical practice and limitations are discussed.     

Mental Illness and the Criminal Justice System

This is the second essay in a two‐part series exploring the relationships between mental illness, criminal behavior, and the criminal justice system. The number of mentally ill persons in prisons and jails has increased substantially over the last several decades, and there are currently more people with mental illness behind bars than there are in mental hospitals. In this essay, we place these trends within a broader historical context of the social control of mental illness in the United States. We identify how and why mentally ill persons have come to be overrepresented in the criminal justice system and highlight the unique challenges this population poses for police, courts, and correctional facilities. Finally, we review several recent innovations in policy and practice that may help alleviate that burden of criminal justice involvement on mentally ill offenders, as well as the burden of mentally ill offenders on the criminal justice system.     

Hospice and palliative care for terminally ill individuals with serious and persistent mental illness: widening the horizons

Terminally ill individuals with serious and persistent mental illness (SPMI) are currently underserved by palliative care. However, palliative care nurses can expect to see more patients with SPMI because an estimated 6% of the adult population has chronic mental illness, and mortality and morbidity rates are higher in this group. Reasons for these increased rates are discussed. Literature regarding the provision of palliative care to those with SPMI is sparse, but what literature there is does offer suggestions for improvements in clinical practice. These suggestions for improvement are explored, and conclusions are drawn about the need for future research.     

Health status risk factors of people with severe and persistent mental illness.

High rates of medical comorbidity and premature death have become normative health outcomes for individuals with mental illness. On average, people with mental illness die 10 to 15 years earlier than the general population. To date, little research and programmatic attention has focused on the health promotion and prevention needs of people with mental illness. Many factors have been cited as contributing to this problem, including the stigma of being mentally ill, poverty, and limited knowledge and access to health promotion services. Future health planning interventions should restructure the funding mandates of current health care delivery system from an illness and treatment model to one of illness prevention and health promotion.     

The professionalization of psychiatric nursing. From doctors' handmaidens to empowered professionals

The professionalization of psychiatric nursing in the United States has been subject to political, economic, and theoretical influences, and prominent individuals such as Florence Nightingale and Hildegard Peplau have caused changes over time. Throughout history, professional and societal beliefs about mental illness have affected the nature of psychiatric nursing. In colonial times, people with mental illnesses were considered to be either possessed by demons or inferior and treated as animals. Today, psychobiological causes of mental illness are better understood, and treatment is aimed at adjusting disordered physiology and implementing psychosocial interventions. Care of people with mental illnesses has echoed this shift with increasing professionalization of psychiatric nurses. Attention to the lessons of history can help psychiatric nurses identify current societal influences, act on them according to their own vision, and further increase their professionalism.     

Conceptual and methodologic issues in the evaluation of children's satisfaction with their mental health care

The assessment of client satisfaction has become an important aspect of evaluation research in the adult mental health field, but there has been relatively little extension of that approach to the child client population. This is due to the lack of adequate methodologies for assessing treatment satisfaction in children and to the overriding conceptual issues which make it difficult to develop such measures. Further information is needed to clarify developmental differences in the way both healthy as well as medically and psychiatrically ill children conceptualize illness and treatment. The authors suggest that specific methodologies for assessing child satisfaction with treatment can be systematically developed once a more explicit developmental framework has been delineated in the area of children's understanding of medical and psychiatric disorders and their treatments.     

Well balanced: 8 steps to wellness for adults with mental illness and diabetes

Serious mental illness places a tremendous burden on clients, their families, and behavioral and medical health care providers. The co-occurrence of diabetes with mental illness may further compromise daily functioning. Psychiatric nurses can make a significant difference in improving the health and medical outcomes of this client population. A partnership was developed between the University of Rochester School of Nursing and the Western New York Care Coordination Program to evaluate a novel nursing model for adults with both serious mental illness and diabetes mellitus. The Well Balanced program incorporated health promotion, disease management, nursing care management, and evidence-based practice guidelines into 8 Steps to Wellness for a community-based mental health population. During a 16-visit intervention period, psychiatric nurses interacted with 74 clients. As a result of the program, clients experienced improvements in health risk status and in their hemoglobin A1C and reported high satisfaction with the Well Balanced program.     

Family interventions in early psychosis service delivery: A systematized review

The objective of this study was to explore the development of family intervention in an early psychosis context. The role played by family members and friends in the recovery of individuals with early psychosis is extremely important, and there is a growing body of literature that reflects this. However, how mental health services can best support and utilize family and friends as a core component in recovery from early psychosis is not yet established. The methodology entailed a systematic review of the international literature. Results from the current review highlight the principles of family engagement, its effectiveness to enhance service user outcomes, the need to differentiate early psychosis psycho-education from that provided in enduring illness, and challenges in implementation. The number of studies generally, and the number explicitly articulating and trialling family interventions being used in practice, are limited. This seems to highlight that—although practice guidelines acknowledge the importance of family support—there are challenges in implementation of evidence-based practice principles in this area. Changes in policy and service delivery are recommended for programs and services to better achieve family-sensitive and family-inclusive practice as core business in mental health service delivery.     

How to work with elderly patients on a general psychiatric unit

Currently, there are specialized geropsychiatric units being used for elderly psychiatric inpatients. However, these units are not always available to the growing elderly population. The general inpatient psychiatric unit seems to be well suited for treating the medical and mental illness of elderly psychiatric patients (Billig, 1989; Conwell, 1989; Liptzin, 1987). As identified earlier, nurses may not be enthusiastic about adding this population to their unit. Our society is youth-oriented and the elderly tend to be viewed as slow, needy, and sick. It is essential for nurses to explore their own feelings regarding aging and what it means to be old. If the nurse has not dealt with issues such as her own mortality and that of her parents and close friends, it may be difficult for her to understand and work with the elderly. The ability to understand the feelings of another and to communicate this understanding has been identified as a crucial variable related to positive therapeutic outcome (Kirk, 1982). Inservice programs and groups that give the staff opportunities to explore their attitudes and feelings toward the elderly may result in more effective therapeutic interventions (Farley, 1983). To many elderly patients, nurses are seen as supportive figures, interpreters of the unknown, and potential allies who have an empathic regard for them (Davis, 1968). The nurse can use these impressions to initiate interventions. This, along with coming to terms with one's own feelings about aging, can result in a greater understanding of these patients. This article has given a very brief overview of the many issues related to the care of the elderly psychiatric inpatient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Psychiatric rehabilitation: Current practices and professional training recommendations

Emphasis on community-based treatment, along with the development of effective psychotropic medication, has resulted in a major shift in treatment methods for individuals with severe mental illness over the past several years. The primary strategies emphasized in current psychiatric rehabilitation efforts include the strengthening of (a) client skills and competencies and (b) environmental supports. The purpose of this article is to discuss successful psychiatric rehabilitation models and their impact on the social integration of people with severe mental illness.     

Equally unequal: gender discrimination in the workplace among adults with mental retardation

Gender discrimination in the work place has been widely reported. Women are usually discriminated against both with respect to level of occupation and salary. The current study explored the correlation between gender and employment among adults with mental retardation, specifically, whether gender discrimination in the work place is as prominent among people with mental retardation as in the general population. Level of occupation and salary earned were studied in 227 adults with mild and moderate mental retardation residing in institutions, hostels, and sheltered homes in Israel. The findings suggest a correlation between gender and employment similar to that in the general population. Women were found to be employed mainly in sheltered workshops and lower levels of occupation, and to earn significantly less than the men. However, closer examination of each work place revealed that within each level of occupation there were no significant gender differences in salary. The finding suggests that while women with mental retardation earn lower salaries than men, this is mainly the result of their lower level of occupation. Rehabilitation efforts should therefore be directed toward ensuring higher levels of occupation as well as community employment among women with mental retardation.     

Necessary Steps in Designing a Successful Contract

Abstract

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.     

Mental illness and problematic sexual behaviors. A review of the recent literature

Advanced practice nurses and other health care professionals have increasingly been working with individuals with mental illnesses who also have a history of sexual misconduct. Unfortunately, due partly to minimal research on the subject--especially in the nursing field--these professionals are addressing the needs of this population without adequate preparation. This article provides an overview of mental illness and problematic sexual behaviors (MI/PSB) and highlights the importance of additional research for the MI/PSB population as a subgroup of sex offenders.     

An Exploration of Common Elements in Dialectical Behavior Therapy,Mentalization Based Treatment and Transference Focused Psychotherapy in the Treatment of Borderline Personality Disorder

A number of leading practice models have been found to be effective in the treatment of Borderline Personality Disorder (BPD). These include Dialectical Behavior Therapy, Transference Focused Psychotherapy and Mentalization Based Treatment. This article reviews the current evidence for these dominant practice models, and concludes that no single treatment has been found to be consistently superior in the treatment of BPD. Given the lack of evidence priviledging one single model of treatment, and the fact that it is not always feasible or desirable for social workers to practice using pure manualized treatment models, there is a need to develop more integrative approaches to treatment with this vulnerable population. By highlighting specific similarities and differences between practice techniques, this paper attempts to pave the way toward developing a more integrative treatment approach to working with individuals with BPD, an approach where interventions are selected based on appraisal of the evidence, clinical expertise, and client need.     

Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Expert views of children's knowledge needs regarding parental mental illness

Children of parents with a mental illness are at significant risk of developing a mental illness. This risk may be reduced if appropriate interventions are provided that include information and knowledge about mental illness. While there are some interventions for children of parents with a mental illness, research is lacking about the type of mental health information children need and why they need that knowledge. This study presents the perspectives of a purposive sample of international research experts in the field of parental mental illness about the kind of mental health literacy information children with parents with a mental illness need. Twenty-three participants completed a self-constructed short answer questionnaire about the knowledge needs of children of parents with a mental illness. The qualitative data indicates that ‘identifying information’, ‘making sense of parents behaviour’, ‘coping better’ and ‘respecting safety’ are key knowledge needs of children. Given the views presented, these findings suggest that health care professionals should advocate for policies that support individual-, peer-, and family-focused programs driven by strong evaluation and rigorous research. If this is done, children of parents with mental illness may experience ‘myth busting’ of incorrect information about mental illness.     

Very Brief Interventions in College Mental Health

Abstract

Although short encounters account for one-half of college mental health practice, they're often viewed as an unavoidable evil rather than a desired outcome. In order to evaluate client satisfaction with very brief interventions the authors mailed questionaires to 215 clients who had mental health encounters lasting no more than three sessions. Seventy-two percent of respondents were satisfied with their treatment. Thirty-six percent reported that they terminated because they felt they satisfied the conditions of the consultation, as opposed to 16% who left dissatisfied and 29% who left because they were referred elsewhere. A chart review revealed that in 45% of cases the decision to terminate was made unilaterally by the client. These findings suggest that very brief interventions are more often associated with rapid goal achievement than with client dissatisfaction.     

Perceptions of the Ways of Mattering by People With Mental Illness

The Ways of Mattering questionnaire (N. E. Amundson, 1993, 2003) was developed to evaluate clients' perceptions of a counseling relationship. This study reports the construct and convergent validities of the Ways of Mattering as well as the internal consistency of each of its subscales for people with mental illness who were registered in supported employment programs. The questionnaire demonstrated satisfactory validity and reliability with this population. The instrument could be useful for identifying the basic and positive elements required to establish a solid foundation for developing a working alliance between the counselor and the client.     

Forensic Patients and Forensic Mental Health in Victoria: Legal Context,Clinical Pathways,and Practice Challenges

Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.