The mental health recovery movement and family therapy, part I: consumer-led reform of services to persons diagnosed with severe mental illness

In 2004, the U.S. Department of Health and Human Services issued a consensus statement on mental health recovery based on the New Freedom Commission's recommendation that public mental health organizations adopt a "recovery" approach to severe and persistent mental illness, including services to those dually diagnosed with mental health and substance abuse issues. By formally adopting and promoting a recovery orientation to severe mental illness, the United States followed suit with other first-world nations that have also adopted this approach based on two decades of research by the World Health Organization. This movement represents a significant paradigm shift in the treatment of severe mental health, a shift that is more closely aligned with the nonpathologizing and strength-based traditions in marriage and family therapy. Furthermore, the recovery movement is the first consumer-led movement to have a transformational effect on professional practice, thus a watershed moment for the field. Part I of this article introduces family therapists to the concept of mental health recovery, providing an overview of its history, key concepts, and practice implications. Part II of this article outlines a collaborative, appreciative approach for working in recovery-oriented contexts.     

Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification.     

A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings are discussed.     

A model of group treatment to facilitate recovery from chemical dependence

In this article, a model of group treatment is proposed that incorporates four different group approaches (i.e., experiential, physiological-cognitive-behavioral, mutual support, advocacy) sequentially to achieve recovery outcomes among people coping with chemical dependence. The model identifies two strategies (i.e., reflection and restoration, action and support) as overarching frameworks guiding the use of these four treatment approaches. The first strategy of reflection and restoration incorporates experiential and physiological-cognitive-behavioral group approaches to promote precontemplation, contemplation, preparation, and tentative action among group members. The second strategy of action and support uses mutual support and advocacy approaches to help group members achieve and maintain treatment gains, learn from setbacks, and adopt new personal and social roles.     

Recovery capital: what enables a sustainable recovery from mental health difficulties?

There is increasing international interest in recovery approaches in mental health—and this connects with an emerging focus within European social work around promoting capability and sustainability. Research at a population level would suggest that social factors rather than medical interventions are the main determinants of recovery from mental health difficulties—but this is not yet reflected in social work practice, which can still be dominated by biomedical perspectives and a focus on risk management. Drawing upon and extending analyses of social and other forms of capital, this paper outlines the basis for a new paradigm for mental health social work that is specifically oriented towards enabling the development of personal efficacy and social capability—an approach that is explicitly focused on achieving longer-term sustainability rather than shorter-term problem solving.     

Questioning the professionalization of recovery: a collaborative exploration of a recovery process

While the recovery concept strongly resonates in clinical mental health care today, it first arose in service user-led contexts. A major risk of this professionalization shift is that recovery primarily becomes defined by treatment providers. This study aims to keep the debate on recovery alive through a collaborative exploration of Pete’s recovery process by means of a bricolage approach. This resulted in an idiographic portrait of Pete’s experiences of recovery and treatment, clustered around four themes: life rebuilding, identity, continuity of care and the role of drugs. His experiences illustrate a number of contradictions in the operationalization of the recovery ethos in today’s mental health care; whilst recovery appears as a hopeful vision of empowerment, it also risks being reduced to a tokenistic model that fails to address the social realities of people in recovery and in which the assumption that mental illness is chronic is still latently present.     

Social workers’ perspectives on the recovery-oriented mental health practice in Tshwane,South Africa

The challenge facing the mental health field today is the lack of knowledge related to interventions and services that will help people recover from severe mental health problems. In addition, the reluctance of social workers to embrace the recovery-oriented mental health practice is attributed to their lack of knowledge. Hence, they regard recovery in mental health as misleading and unrealistic.The article provides the findings on the social workers’ lack of knowledge and understanding of the recovery-oriented mental health practice. The social workers are based in non-governmental organizations in Tshwane, South Africa. Semi-structured interviews were conducted to gather data from social workers. Findings confirmed the lack of knowledge regarding the recovery-oriented approach, which has not yet been implemented in South Africa. Mental health services continue to be informed by the traditional medical model.     

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.     

Neighborhood processes, self-efficacy, and adolescent mental health

Self-efficacy beliefs are central to mental health. Because adolescents' neighborhoods shape opportunities for experiences of control, predictability, and safety, we propose that neighborhood conditions are associated with adolescents' self-efficacy and, in turn, their internalizing problems (i.e., depression/anxiety symptoms). We tested these hypotheses using three waves of data from the Project on Human Development in Chicago Neighborhoods (N = 2,345). Results indicate that adolescents living in violent neighborhoods tended to report lower self-efficacy beliefs, partly because they were more likely to experience fear in their neighborhood. However, moving out of Chicago neighborhoods marked by violence and low collective efficacy to neighborhoods outside of the city was associated with adolescents' increased self-efficacy (vs. staying in such neighborhoods), an association explained by adolescents' school-related experiences. Finally, through self-efficacy, these neighborhood processes had an indirect association with adolescents' internalizing problems. Results partially support a model linking neighborhood conditions, cognitions about the self, and emotions.     

Stereotypies as behavioral indices in mental patients

Stereotypies, defined here as monotonous and undirected behaviors (e.g., walking in place, foot swinging) were observed in inpatients at an intensive-treatment psychiatric center. Stereotypies were found to be especially sensitive to situations; the most stressful contexts produced the most stereotypies. In situations that seemingly made patients anxious, stereotypies were repetitive and typically took the form of incipient flight movements. In contexts where patients were apparently bored, their stereotypies were dominantly nonrepetitive and somewhat playful, suggesting a function of increasing arousal. Frequencies of stereotypies did not distinguish most diagnostic types (e.g., schizophrenia, organic brain damage) from each other. But stereotypies seemed to be markedly less characteristic of patients diagnosed as situation adjustment types, by far the most benign diagnosis of pathology represented in this sample. Overall, stereotypies showed promise as practical and reliable indices to be used as adjuncts to traditional measures of pathology.     

Positive and negative intergroup contact in school and out-of-school contexts: A longitudinal approach to spillover effects

This study aims to tackle positive and negative intergroup contact in school and out-of-school contexts to test whether a spillover effect (i.e., the extent to which experiences that individuals have in one context spill over into another) applies to intergroup contact. Participants were 984 adolescents (M_age = 14.66; 62.7% female; 24.8% ethnic minority). Results indicated that positive contact in school was related over time to higher positive contact in out-of-school contexts and vice versa (i.e., valence consistent spillover effect). Positive contact in school was linked over time to lower negative contact in out-of-school contexts (i.e., valence inconsistent spillover effect). Overall, this study provides novel insights into the transmission of adolescents' intergroup contact across socialization contexts by emphasizing the leading role of positive contact in schools.     

Teaching and Providing Recovery-oriented Care Through Problem-posing Dialogue

As the recovery paradigm proliferates throughout systems of mental health care, social workers are being required to provide recovery-oriented services. Yet there has been little discussion about what changes need to be made in social work education to produce recovery-oriented social workers. This article uses Paulo Freire's theory of pedagogy to help social work educators understand how they can develop problem-posing relationships with their students in order to teach students about the relationships that social workers ought to have with people in recovery.     

User‐oriented mental health reform in Sweden: featuring ‘professional friendship’

In developing new forms for society‐based support for mental health service users, authorities implemented a service in Sweden, called Personligt ombud (PO), with the assignment to support service users exercising their rights. The aim of this article is to describe what service users find to be significant features of their working relationships with their PO. Using a phenomenological approach, 23 users were interviewed sharing their experiences of their PO. The results show that service users describe their relationships with the PO as a ‘professional friendship’. The friendship‐like feature refers to reciprocity in sharing life experiences and forming a trustful relationship in which professional assistance can be offered, promoting well‐being and recovery. Conclusions are that the PO provides a service that calls for re‐interpretation of professional and user roles, where both give and receive.     

Workplace stress among psychiatric nurses. Prevalence,distribution, correlates, & predictors

Vicarious trauma and burnout are serious manifestations of workplace stress. Both can have substantial consequences for health care professionals, health services, and consumers. This article reports results of a study examining the prevalence, distribution, correlates, and predictors of vicarious trauma and burnout among registered psychiatric nurses (RPNs). A survey was distributed to all practicing RPNs in Manitoba, Canada (N = 1,015). The survey contained the Maslach Burnout Inventory, the Traumatic Stress Institute Belief Scale (i.e., a measure of vicarious trauma), and a section on symptoms of posttraumatic stress disorder (PTSD). The RPNs were found to be experiencing high levels of emotional exhaustion (i.e., high burnout) and even higher levels of personal accomplishment (i.e., low burnout). No significant differences were found between respondents' total scores on the Traumatic Stress Institute Belief Scale and instrument norms for mental health care professionals. Predictors of burnout and vicarious trauma also are presented in this article. Stress experienced by RPNs, as well as strengths on which to build, clearly are evident in the study results. Strategies for reduction in workplace stress may benefit psychiatric nurses, clients, and health services.     

Art as therapy: an effective way of promoting positive mental health?

The aim of this study is to evaluate the contribution that creative arts can play in promoting positive mental health and well-being. The research is based on a case study of an innovative art therapy programme delivered by a community-based mental health organisation in Northern Ireland, as part of a supported recovery programme. The study reported here explored the experiences and perceptions of the service users through in-depth interviews and focus groups. The art as therapy course was credited with improvements in self-esteem and self-confidence. It provided a safe space for reflection on mental health issues. Participants described the programme as cathartic and a springboard for engagement in a wide range of further projects. It is concluded that this type of project which addresses mental health issues in a supportive, positive, non-clinical environment can encourage and facilitate empowerment and recovery through accessible creative programmes. However, to date these programmes are time-limited, small-scale and marginal to the approach adopted by statutory service providers.     

The evaluation of the PACA regional public health plan: reconciling the managerial, scientific and democratic finalities

For more than a decade now, evaluation has developed considerably in France, thanks in particular to the Société Fran?aise de l'évaluation, whose charter sets out a number of principles designed to guide the work of evaluators. This article examines how the evaluation process surrounding a regional public health plan (referred to as PRSP)--itself being a new instrument for regional planning in France--accords with one of these principles, which specifies that evaluation must be framed according to "a three-fold logic involving public management, democracy and scientific debate." Our analysis shows that while this evaluation was driven primarily by managerial concerns (i.e., assessing the capacity of the plan to structure health policy in a region), it also provided an Opportunity for restoring dialogue with a range of actors by opening up a space of cooperation and consultation. In addition, in order to ensure the legitimacy of the evaluation's conclusions, the knowledge produced by the evaluators had to rest on an irreproachable methodology. This example illustrates how evaluation, in the French tradition, is a process that strives to reconcile the viewpoints and expectations of managers, scientists and the general public; it is also a process that brings out lines of tension and areas of complementariness between these three logics.     

Simple measures of case mix in mental health services.

The concept of Case Mix in community mental health service program evaluation can be useful in mental health program evaluation if the definition of case mix is expanded beyond Diagnostic Related Groups (DRG), where DRG is solely based upon diagnosis and length of hospitalization stay. A case mix definition based upon two principal characteristics is offered. One characteristic is clinical status defined in terms of diagnostic signs and symptoms, level of functioning, and age. The other characteristic is typical treatment strategy for a given period of time (e.g., 13 weeks). Two cases mixes typical of services designed for the chronically mentally ill are discussed.     

Tracing disorder across theories of autism,empathy, and mental health care

Abstract

Categories of mental disorders are generally understood through a biomedical paradigm of clinical research, diagnosis, and intervention. Here, diagnoses operate as professional tools, facilitating care organization and information exchange across diverse social contexts. In this article, I focus on how the diagnosis of autism-spectrum disorder operates in this manner. Autism conceived as a biomedical disorder is then contrasted with proposals by the neurodiversity movement, who understand core qualities of autism as alternative expressions of otherwise normal processes of brain development. Finally, I supplement these conversations with insights from Gerald Edelman’s theory of neural plasticity and Felix Guattari’s paradigm of ethico-aesthetic care. Understood together, these allow mental disorders and community care generally to be reconceived in terms of networks of expressive, embodied, and dynamically embedded rhythms that transcend individual persons. This serves, additionally, to illustrate a concept of empathy that traverses neurological, psychological, and sociocultural domains.     

Open spaces for dialogue promoting mental health as a social work education methodology

ABSTRACT

The authors discuss service user involvement as a key approach regarding training of social workers. In many European Union countries this is a stable practice with a lengthy tradition in research and application. However, in Poland it is almost entirely absent and marginalized. This article presents the results of a participatory action research project conducted at the Institute of Sociology of the Jagiellonian University in Krakow, the objective of which was to identify and critically analyze the key substantive and formal aspects of training of social workers with the participation of individuals with experience of mental illness. This research project adopted an open approach to cognizing reality based on qualitative co-participatory methods. In the conclusion, the authors emphasize that the fundamental criterion for the success of this particular form of training is voluntary and differentiated participation of students—both in the role of people sharing their own experience and as learners—as well as shaping a culture of open dialogue, educational alliances of recognition and recovery, the foundation of which is axiological experience.