The accommodation and support needs of people with a mental illness: A process and framework for action

Abstract

This paper reports the results of a consumer-focused assessment of the accommodation and support needs of people with a mental illness living in a regional city. The study utilises a 'pathway to stability' approach to assess the phase-contingent accommodation and support needs of mental health consumers through interviews and focus groups with consumers, carers and service providers. The study identifies five broad phases of the life course impacted by mental illness—beginnings, long-term needs become clearer, instability as needs evolve, finding stability and ongoing. Five key issues—information, self-competence, comorbidity, coordination and flexibility were expanded upon in focus groups. Principles for planning future service delivery are identified. The implications of the findings and research methodology for social work practice and research are discussed.     

The Social Relationships and Social Support of Aging Mothers Whose Adult Daughters Are Mentally Ill

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These findings suggest that social resources in the form of social relationships and support are embedded in the networks of aging mothers who have adult daughters with serious mental illness. Practitioners should assess support contributions to the aging mothers of adult daughters with serious mental illness from a wide range of social relationships including their daughters.     

Psychosocial distress,physical illness,and social behaviour of close relatives to people with substance use disorders

ABSTRACT

This study explores how a family member with substance use disorder (SUD) affects the psychosocial, behavioral, and physical states of other family members. Sixteen in-depth interviews with relatives of Icelandic individuals afflicted with SUD were performed. The interviewees were selected from a pool of Icelandic families whose members included one or more chronic SUD users. They represented different relations to the user (spouses, parents, children, and siblings) and both genders. All participants except for siblings expressed that SUD had negatively affected their mental health by inducing depression, anxiety, and stress-related physical illness. All had experienced physical violence, mental abuse and financial loss. Parents indicated that the SUD of the family member had isolating psychosocial impacts on their children and caused a loss of connection among their family members. All participants, except the siblings, regarded their workplace as a shelter. The study’s findings can help social professionals to better understand the effects of SUD on families, family systems, and public health in general.     

Understanding paid peer support in mental health

This study aimed to explore, articulate and expand on existing concepts of recovery and paid peer support within consumer-operated mental health organizations. Focus groups and interviews were conducted with 32 participants to identify elements of paid peer support work in two organizations in Queensland, Australia. Participants included peer-supported consumers, paid peer support workers, managers and other key stakeholders. Through a grounded theory analysis, eight categories of paid peer support were identified. For the most part, the categories aligned well with evidence in the literature. However, two of these categories, issues of power and the ‘dark side’ of peer support, have been relatively unexplored and understated in previous studies. These findings provide an expanded understanding of the role of paid peer support as part of the recovery process in mental health service delivery. The effective use of paid peer support workers can be enhanced through attention to the issues identified.     

Financial insecurity and risk experiences of justice involved persons with severe mental illness

More information is needed about the financial experiences of justice-involved persons with severe mental illness. Qualitative and quantitative methods were used to examine the financial resources, financial risk experiences, and financial literacy of a random sample of 12 mental health court participants. Mental health court participants had limited financial resources, frequently ran out of money, and had engaged very few financial tools to manage their money. Justice-involved persons with severe mental illness need financial management interventions to help develop strategies for managing depleted resources and to develop the financial resources needed to live in community settings.     

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.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

From past trauma to post-traumatic growth: The role of self in participants with serious mental illnesses

Studies have shown that people with serious mental illness are more likely to have experienced trauma compared to the general population. This qualitative study employed a grounded theory approach to explore how trauma histories influenced the process of triggering, developing, and recovering from serious mental illness. Findings based on in-depth interviews with 15 participants illustrated the intersection of trauma, serious mental illness, and post-traumatic growth. Experiencing trauma compromised participants’ self-functioning, causing issues such as affect dysregulation, distorted self- and other- concepts and relationship difficulties, meaninglessness, and existential fears, all of which negatively impacted participants’ mental health and behavior. At the same time, participants with serious mental illness were able to achieve post-traumatic growth with the “transformed-self” via self-acceptance, self-exploration, self-worth, and self-fulfillment. Findings of this study have useful implications for trauma-informed care in mental health treatment. Mental health professionals should address clients’ trauma histories to prevent re-traumatization and design trauma-informed programs that use and build clients’ inner resources and strengths to promote post-traumatic growth.     

Helping partnerships that facilitate recovery from severe mental illness

The intent of this study was to learn how consumers experience helping partnerships that assist them in recovery to inform families, professionals, and peers about meaningful actions and strategies that promote the healing process. In-depth interviews were conducted with a purposeful sample of 10 individuals who had a self-reported diagnosis of severe mental illness. Using the phenomenological research process, helping partnerships and how they develop were described. Six key themes emerged from the data and included Networks of Helping Partnerships, Teaching-Learning, Spirituality, Creative Drive, Time, and Medication Adherence. Characteristics and behaviors of helping partners were identified, as well as structures that promoted their development. Educating the public, consumers, and mental health professionals about how to promote recovery, the role of spirituality and creativity, the benefits of medication and therapy, and the impact of learning on progressing through recovery can go a long way toward eliminating the mystery and fear associated with mental illness.     

Heterosexism,racism, and mental illness discrimination: Experiences of people with mental health conditions and their families

Experiencing discrimination related to race/ethnicity, sexual orientation, or having a mental health condition is associated with negative outcomes. Research comparing types of discrimination or considering intersectionalities is lacking. This study reports findings from interviews with people with mental illnesses (PWMI) or family members of PWMI; all study participants also are of color and/or lesbian, gay, or bisexual. Findings include the following: participants experienced multiple forms of discrimination, mental illness discrimination shares characteristics with racism and heterosexism, and heterosexuals and people of color reported more mental illness discrimination than their counterparts. Implications for change advocates, mental health providers, and researchers are offered.     

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.     

Navigating stormy waters: Challenges and opportunities for social work in mental health

The reforms driven by the National Mental Health Strategy have created both opportunities and challenges for social work as a profession. This paper examines the rapidly changing context for practice in mental health, including policy change, and developments in the education and training of the mental health workforce. Key practice issues identified for social work include: (i) the need to establish a viable paradigm for practice; (ii) a more positive response to the challenge of evidence-based practice models; (iii) a national agenda for education and training; and (iv) the importance of working collaboratively with consumers and families in a way that values their human rights and the lived experience of mental illness.     

Making connections: Severe mental illness and closeness with other people

Much has been written about social lives of people with severe mental illness (SMI). Before social lives can flourish, however, people with SMI must first get close to other people. We studied this closeness by holding three hour-long focus groups at Fountain House, a community mental health agency in New York City. We found that closeness between two people with SMI is challenging because someone with depression, for example, may have trouble understanding someone with a different disorder (e.g., schizophrenia). Romantically, closeness is also challenging—SMI is hard to explain to partners. In the workplace, closeness is difficult because SMI can alienate co-workers. It could push them away. In mental health programs, we found that closeness has more of a chance to develop (1) during evening and weekend activities; (2) when activities are planned often enough to prevent isolation; and (3) when staff reach out to people before extended absence causes distance.     

Outcomes of a model care coordination program for adults with mental illness under guardianship/conservatorship

Adults with serious and persistent mental illnesses, such as schizophrenia, schizoaffective disorder, and bipolar disorder, who are under guardianship/conservatorship, may experience health care, social, financial, and housing concerns, which can be addressed by care coordination programs. In such programs, providers assist with communication across service sectors, assistance with monitoring of psychiatric care, and support with practical needs. Such programs are understudied in the context of guardianship/conservatorship. Through a review of electronic records for 217 consumers who were enrolled in a model program continuously for 3 years or more, we examined trends before and after enrollment in a model care coordination program for adults with serious and persistent mental illnesses under guardianship/conservatorship. We sought to describe the number of days and rates of hospitalization, emergency room visits, and arrests before and after receiving program services. Comparing utilization among consumers three years pre- to three years post-enrollment, we identified statistically significant reductions in hospitalizations and imprisonment, but no change in state hospitalizations. We also saw some (non-significant) reduction in emergency room visits. Findings provide preliminary evidence of effectiveness of the model program; future efforts could expand its reach to more adults with serious and persistent mental illnesses.     

Genetic counseling students’ experiences with mental illness during training: An exploratory study

Mental illness is a substantive issue for graduate students. We investigated experiences of mental illness during training among genetic counseling students, a subgroup of graduate students for which little data exists on this topic. Genetic counseling students and recent graduates (n?=?227) completed an online survey, from who 11 were selected to participate in semi-structured telephone interviews. Thematic analysis and member checking were employed to interpret the interviews. An overarching theme of importance to participants’ mental health during genetic counseling training was safety, with subthemes of: trust/confidentiality, stigma and fear of labeling, developing a unique professional identity, and ability to engage in self care strategies. Our data could help genetic counseling training programs develop strategies to support students’ mental health.     

Experiences of Family Carers for Persons Using Antipsychotic Medication

Given the emphasis on the use of antipsychotic medication for severe mental illness, it is important to understand family carers’ perspectives on these medications and their effects on consumers’ lives. Such information may enable providers of family interventions to better understand families’ circumstances and more effectively support them in caring for mental health service users. Snowball sampling was used to recruit 29 family carers. Family carers acknowledged the calming effect of antipsychotic medication on service users, but also noted that there were few other therapeutic benefits. Moreover, the positive influence of antipsychotic medication was in most cases largely offset by the detrimental impact of antipsychotic medication on service users’ quality of life. The family carers in rationalising the trade‐off between beneficial and adverse antipsychotic medication effects typically experienced resignation, which was often accompanied by a sense of frustration that resulted from the reliance on medication.     

The impact of mental illness on employment: consumers' perspectives

This paper is based on a qualitative study of employment for people with mental illness. Forty-one consumers of mental health services were interviewed to obtain their perspectives on employment. One of the major issues they discussed was the ways in which mental illness affected their employment experiences. These effects were complex and interrelated and varied between individuals depending on their unique characteristics and circumstances. Participants described effects relating to the need to maintain mental health, difficulties with work performance, and work confidence and work goals. Understanding consumers' perspectives on how mental illness affects employment is necessary for practitioners and researchers seeking to explain or improve consumers' employment outcomes.     

Sense of community through supportive housing among formerly homeless individuals with serious mental illness

Much research documents the correlation between homelessness and mental illness. Often, existing research focuses on deficits that live at the intersection of these phenomena. The present study utilizes a sense of community (SOC) framework to interrogate the ways in which formerly homeless individuals with serious mental illness perceive and experience community in supportive housing. Through focus groups with 18 consumers, this study contextualizes dimensions of SOC (membership, emotional connection, needs fulfillment, and influence) for the aforementioned population. Analysis of focus group data produced 16 themes and subthemes that support and extend our understanding of SOC for a population often conceptualized as isolated and alone. Implications for policy and practice emphasize: (1) the importance of supportive housing communities and the call for policymakers to increase funding for such programing; and, (2) that practitioners facilitate housing members’ voices to effectuate change in supportive housing and increase SOC.