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.     

Building Community Capacity to Help Persons with Mental Illness

Abstract

In a time of crisis, persons with mental illness who encounter the police are often sent to jail or are involuntarily committed for psychiatric evaluation when mental health services are not readily available. To better serve these persons and the community, law enforcement and mental health professionals in one Iowa county joined together to ensure these individuals received the assessment and treatment needed. The results of a mixed methods program evaluation are detailed and suggest that the process to develop the program was as critical as the conduct of the program itself. Implications for program development are discussed.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

Creating a bridge to healing: a professional/paraprofessional team approach

This paper describes a therapeutic model in which an English-speaking licensed clinician and a bilingual paraprofessional provide psychotherapy using a team approach in working with Cambodian refugee survivors of the Khmer Rouge. The team approach model differs from professionals who use interpreters in psychotherapy. The strengths and challenges of this approach are discussed. Agencies that serve refugees may not have professionally trained mental health providers who are from the country of origin of their clients. This model holds promise to provide culturally sensitive treatment. However, it is a model that is in its infancy in terms of knowing what works and how to duplicate that to other agencies and populations. This paper shares some of the benefits as well as some of the drawbacks.     

Gay Men in the Workplace: Issues for Mental Health Counselors

The author looks at major issues that affect gay men who are deciding on, competing for, and working in the jobs and careers available in today’s changing job market, and the implications for mental health counselors who may serve them. Included is an in-depth review of the current academic counseling literature on gay men in the workplace, highlighted by reports from the national gay press.     

The history, economics, and financing of mental health care. Part 2: The 20th century

1. To understand how mental health nursing practice was affected by the financing and policy changes occurring rapidly in the second part of the 20th century, sources can only be found in the literature in psychiatry, the social sciences, and economics. There was no psychiatric nursing journal until the 1950s, and no article by a nurse in the general nursing literature about finances. 2. Deinstitutionalization was really transinstitutionalization. Changes in regulations in Medicaid allowed the shifting of mentally ill people who were older than age 65 to nursing homes. 3. Community mental health centers never developed programs to serve people who were seriously mentally ill. Rather than serving clients who were psychotic, the community mental health centers marketed their treatment programs to people with anxieties, who were undergoing divorce, or who had mildly troubled children.     

Causal inferences on the effectiveness of complex social programs: Navigating assumptions,sources of complexity and evaluation design challenges

This paper explores avenues for navigating evaluation design challenges posed by complex social programs (CSPs) and their environments when conducting studies that call for generalizable, causal inferences on the intervention’s effectiveness. A definition is provided of a CSP drawing on examples from different fields, and an evaluation case is analyzed in depth to derive seven (7) major sources of complexity that typify CSPs, threatening assumptions of textbook-recommended experimental designs for performing impact evaluations. Theoretically-supported, alternative methodological strategies are discussed to navigate assumptions and counter the design challenges posed by the complex configurations and ecology of CSPs. Specific recommendations include: sequential refinement of the evaluation design through systems thinking, systems-informed logic modeling; and use of extended term, mixed methods (ETMM) approaches with exploratory and confirmatory phases of the evaluation. In the proposed approach, logic models are refined through direct induction and interactions with stakeholders. To better guide assumption evaluation, question-framing, and selection of appropriate methodological strategies, a multiphase evaluation design is recommended.     

Diversity Within Diversity

Summary

Asian American elderly form a heterogeneous group with respect to immigration history, ethnic/cultural background, socioeconomic position, and health and mental health status. This paper provides an overview of the internal heterogeneity within the Asian American elderly population and identifies those who experience multiple stressors affecting their quality of life. Then it discusses barriers to formal service utilization as well as strengths and deficits of informal support systems. To better serve Asian American elders with their multiple needs for health, mental health, and social services, increased funding is recommended for research on this group, diversification of social service programs in coethnic communities, and increased cultural competence in non-Asian social service agencies.     

Talking About Gender in Motion

Abstract

This is an interview with noted Norwegian sexologists Elsa Almas and Esben Esther Pirelli Benestad, who is bigender and married to Almas. In conversation with narrative therapist Christopher Behan, they discuss, both professionally and personally, working with those who have a transgender family member, the importance of community work to support the transgender child or adolescent, and the continued need for advocacy within the mental health and medical fields for transpeople and their loved ones.     

Psychiatrist–consumer relationships in US public mental health care: consumers’ views of a disability system

The US public mental health system is a disability system. By this is meant that public programs for people with mental illness serve consumers who are seriously and chronically ill, functionally disabled and eligible for benefits by virtue of their disability. This study explores, through focus groups and qualitative data analysis, the perceptions of these consumers of their relationships with public sector psychiatrists. Thematic analysis finds relationships of three types – compliance, collaboration and contention – and constituent sub‐themes that specify these further. Issues of poverty and powerlessness arise in every category, but especially in contentious relationships. Although the converse is widely believed to be true, this paper argues that the economic and political empowerment of people with psychiatric disabilities is vital to the success of their clinical care     

Mental health and firearms in community-based surveys: implications for suicide prevention

Suicide rates are higher among those who own a handgun and among those who [corrected] live in a household with a hand gun. This article examines the association between [corrected] gun ownership and mental health, another risk factor for suicide. Data from the General Social Survey, a series of surveys of U.S. adults, are analyzed to compare general emotional and mental health, sadness and depression, functional mental health, and mental health help seeking among gun owners, persons who do not own but live in a household with a gun, and those who do not own a gun. After taking into account a few basic demographic characteristics associated with both variables, there appears to be no association between mental health and gun ownership. Nor is there any association between mental health and living in a household with a firearm. Findings suggest that the high risk of suicide among those who own or live in a household with a gun is not related to poor mental health. Implications for prevention are discussed.     

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.     

Maximizing potential: innovative collaborative strategies between one-stops and mental health systems of care

Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.     

Helping Adolescents Cope with the Mental Illness of a Parent Through Bibliotherapy

This paper highlights some of the needs of adolescents who have parents with a mental illness and examines the usage of bibliotherapy as a treatment modality. Eleven young adult fiction books are examined and considered for use as a bibliotherapeutic tool among the adolescent audience whose parent suffers from a mental illness.     

PRAGMATISM AND GRIEVING: INCORPORATING MEAD AND DEWEY TO UNDERSTAND THE GRIEVING OF PEOPLE WITH MENTAL RETARDATION

Although the philosophy of pragmatism influenced American sociology, specifically that of symbolic interactionism, its use as a tool for explanation of everyday life has been underutilized throughout sociology. In this article, pragmatism, specifically the ideas of George Herbert Mead and John Dewey provide a framework for the understanding of grieving, specifically as it relates to people with mental retardation. Both Mead and Dewey's use and inclusion of physics into their philosophies proved paramount in their assertions regarding Cartesian or ontological dualism. They then demonstrated through the inclusion of quantum physics how to avoid positivism, thereby creating the necessary link of science with human perception and human action. Mead's use of the Theory of Relativity, as well as Sociality; and Dewey's incorporation of the Uncertainty Principle, and addressing the sum of possibilities, provides a context where the grieving process of people with mental retardation will be much more pronounced. People with mental retardation, by definition, through their neural networks have an inability to perceive existence in a manner that is functionally the same as the rest of the population. Their abilities influence how people with mental retardation relate to themselves or environment, thereby creating either fewer realities or systems from which to interact, or creating ones that are functionally dissimilar from the typical population, hence the label “mental retardation;” therefore, the loss of someone or something creates a greater hole or emptiness for people with mental retardation than the rest of society.     

Forgiveness as a positive contributing factor on the mental wellbeing of Congolese refugees and asylum seekers post-war experience

ABSTRACT

The ongoing political violence in the Democratic Republic of Congo (DRC) has exposed female Congolese to traumatic events and adverse situations such as sexual violence, genocide, torture, political persecution, and the loss of loved ones, which have made them to leave their country. These traumatizing experiences negatively affect the mental wellbeing of Congolese. The study explored the impact of forgiveness on mental wellbeing among Congolese refugees and asylum seekers post-war experience. Ten female Congolese refugees and asylum seekers with post-war experience were purposely selected and interviewed through semi-structured interviews. Key findings of the study showed that forgiveness resulted in the improved mental wellbeing of Congolese female refugees and asylum seekers, with reduced anger, anxiety, depression, stress, and rumination. Forgiving participants reported that their mental wellbeing improved compared to those who found it difficult to forgive rebels and state forces causing war in DRC. These findings indicate the importance of incorporating forgiveness in mental wellbeing interventions to improve the mental wellbeing of war survivors. The study provides recommendations on how mental health practitioners can incorporate forgiveness in mental wellbeing interventions.     

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.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

Subjective distress from trauma in older clients with severe mental illness

There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.     

Toward a Better Understanding of the Use of Psychodynamically-Informed Treatment with Latinos: Findings from Clinician Experience

Latinos in the United States constitute a significant and sizable population that mental health professionals must serve appropriately. Therefore, the question of what types of mental health treatment approaches are useful in working with this population is of increasing concern. A strong sentiment against the use of psychodynamic treatment with Latinos persists in the literature in the absence of rigorous data that would support such a stance. Thus, it is important to examine systematically the use of psychodynamically-informed treatment with Latinos in order to address the question of its potential relevance and utility with this population. This article presents the results of a qualitative study of Latino therapists who employ psychodynamic approaches with Latino clients. Findings suggest that the clinicians interviewed have expanded the psychodynamic framework to include a flexible focus on the relationship, consideration of each client as an individual, and an acknowledgment and understanding of external reality and its impact on the client. Modifications these clinicians have made in technique, such as increased self-disclosure, support and maximize this expansion of the frame. Simultaneously, such modifications enhance the cultural sensitivity of these clinicians' work and are congruent with contemporary psychodynamically-informed relational theories.