Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Applying health determinants and dimensions in social work practice

Dimensions and determinants related to physical health, mental health and well-being can be used as tools in social work practice. These frameworks are useful for assessment, planning and intervention activities in complex client situations, alerting social workers to consider diverse features and processes that influence well-being in people's lives. They can be applied in social work with individuals, families, groups, and communities. In our view health and well-being need to be viewed holistically, broadly and in each unique situation, changing over time over the life course. Literature based on key word searches of concepts we use in our teaching and research and that has informed our conceptualisation of dimensions and determinants in physical health, mental health and well-being, is reviewed. A case illustration is presented to illustrate how the dimensions and determinants are used to inform practice and compare and apply alternative frameworks. Finally, the implications of these and other frameworks for social work, not only in health care settings, but also in other fields of social work practice, are discussed.     

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.     

The psychosocial benefits of work for people with severe and enduring mental health problems

Perceptions of the value of work for people with severe and enduring mental health problems have changed frequently over the last two decades. With the new social inclusion agenda manifest in the Disability Discrimination Act and in the NHS modernization agenda, work is once again in vogue. There is a need for a way of evaluating work which draws on its potential contribution to psychological well-being as well as its provision of a valued social role and which is less susceptible to fluctuations in health and social policy. Jahoda's work on the psychosocial functions of work provides such a framework and this study sets out to explore its utility among workers who are severely disabled by mental health problems. Twelve of the psychosocial functions of work were rated by 50 people attending two sheltered work placements according to how important they were perceived to be and the extent to which the functions were fulfilled through their attendance. Satisfaction of the psychosocial functions through work was compared with their satisfaction through other aspects of the respondents’ lives. All functions were perceived as important, but self-confidence/self-esteem was rated as more important than most of the others. Structure to the day, self-confidence and social contact were better satisfied through work than were decision making, practising old skills and having goals to aim for. In general, the results showed that the functions were fulfilled better by work than by other aspects of the respondents’ lives. The study supports the notion that work is of value in the rehabilitation of people with severe and enduring mental health problems and offers a possible framework for the further exploration of this theme, both within mental health services and the community at large.     

Green Care services in the Nordic countries: an integrative literature review

This article reviews Nordic literature on Green Care for people out of work or school, or with mental health- and/or drug-related problems, published from 1995 to April 2014. Green Care is a well-established international concept that uses animals, plants and nature in an active process to offer health-promoting activities for people. Reports, evaluations and scientific articles are included. The main finding was that the Green Care services described in the literature provided positive activities for our target group. Seven main categories emerged during the analysis: mastery and coping, positive effects on mental health, physical activity, structure and meaningfulness, the feeling of dignity produced by performing a decent ordinary job, social gains, animals and nature experienced as being supportive. Essential intervention factors identified can be described as: (i) contact with animals, (ii) supportive natural environments, (iii) the service leader as a significant important other, (iv) social acceptance and fellowship with other participants and (v) meaningful and individually adapted activities in which mastery can be experienced. These five components interact in a holistic way; the synergetic effects extend the sum of the single factors.     

The journey effect: how travel affects the experiences of mental health in-patient service-users and their families

The qualitative study presented in this paper explored the perspectives of service-users, family members and staff about the impact of travel issues on the lives of mental health in-patients and carers. This topic was chosen because it was prioritised by members of Xplore, a service-user and carer research group, and has received little research attention. Travel problems were a significant issue for many service-users and carers, bound-up with mental health issues and the recovery experience. Travel facilitation through the funding of taxis and the provision of guides was appreciated. A few service-users and carers positively valued distancing from their previous home environment. The meaning of travel issues could only be understood in the context of individuals’ wider lives and relationships. The significance of the findings is discussed in relation to the social model of disability.     

Translating knowledge into practice: using simulation to enhance mental health competence through social work education

ABSTRACT

Simulation-based learning (SBL) is an innovative experiential teaching method where students and instructors interact with a simulated client to foster students’ holistic competence in practice. Considering the context of North America where social workers are the largest service provider in the field of mental health, it is critical for educators to enhance competencies in students during the social work program. Guided by competency- and simulation-based, adult learning frameworks, this paper illustrates the development and integration of a range of educational activities into a treatment-focused advanced mental health course in the social work curriculum. We conclude by discussing how SBL enhances students’ mental health competence and provide recommendations when developing SBL in the mental health curriculum in social work education.     

Introduction

SUMMARY

This introduction to Lesbian and Bisexual Women's Mental Health reviews the need for research specific to lesbian and bisexual women's mental health. We also emphasize the need to provide research sensitive to the multidimensional nature of lesbian and bisexual women's lives. We provide a human ecological perspective consistent with lifespan developmental psychology and compatible with Clinical Social Work and Counseling Psychology as well as other interdisciplinary disciplines. With a strong emphasis on empirical research, this volume introduces readers to research that explores and reexamines the interactions between lesbian and bisexual women's mental health and the diverse social contexts in which they (we) live.     

Young people and social networking sites: exploring the views and training opportunities of CAMHS social workers in Ireland

ABSTRACT

Social Networking Sites (SNS) (e.g. Facebook, Instagram) have become a fundamental part of the daily lives of many young people. SNS engagement has been associated with a number of risks and benefits, some of which are particularly relevant to young people who access child and adolescent mental health services (CAMHS). Consequently, understanding how and why young people engage with SNS, and the associated risks and benefits, may become an increasingly important part of CAMHS social work.

This small-scale study (n = 15) utilised an online survey to explore the importance that a sample of Irish CAMHS social workers attribute to maintaining an awareness of how young people use SNS, whether they, in their professional lives, have been offered the opportunity to learn about SNS engagement among young people, and whether they have taken it upon themselves to learn about this topic.

Findings suggest that participants consider an understanding of SNS to be an important part of CAMHS practice. However, participants report that they do not feel sufficiently aware of SNS trends among young people, suggesting that there is scope for SNS-focused training/learning opportunities among this sample of CAMHS social workers. Implications for practice and suggestions for future research are outlined.     

Video conferencing applications in social work: Work locally,think globally

Abstract

Video conferencing is a technology that facilitates the provision of high quality education, health-care and consultation to clients and families served by rural area health professionals via visual and audio transmissions. It also plays an important role in the education, and training of rural health professionals and the development of a multidisciplinary team dialogue between rural and metropolitan partners. This paper describes our experience of a video conferencing program conducted at the Goulburn Valley Mental Health Service and St George's Older Persons Mental Health Service. We have found a number of benefits of this technology for clients, their families and for health professionals themselves. The development of expertise in the use of video conferencing technology has empowered social workers in their work places. Video conferencing has been extended to other aspects of social work practice. A pertinent example of this is the use of video conferencing in Guardianship and Administration hearings for patients who would otherwise be unable to attend because of health problems (physical, mental and mobility).     

Preliminary Validation of an Online DSM-Based Mental Health Referral Inventory

A brief online inventory was developed as a much needed corrective for the hundreds of unscientific tests that are used now by millions of people to self-diagnose mental health problems. The primary purpose of the new inventory is to refer people to mental health professionals for further evaluation when they are experiencing problems that might be diagnosable under DSM guidelines; it is not designed to diagnose, however. The inventory was found to be a valid and reliable measuring instrument based on analysis of data obtained from 3,403 subjects. The 54-item checklist looks for 18 common problems identified in the DSM-IV and takes from 5 to 10 min to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalization, history of therapy, current participation in therapy, employment, and level of education. Females were found to have slightly more mental health problems than males, but no differences in scores were found by race or ethnicity.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Physical health decision making and decision aid preferences of individuals with severe mental illness

Individuals with severe mental illness (SMI) often suffer from comorbid physical health conditions that reduce quality of life and longevity. The integrated care movement has improved access to primary care services, but system change does not necessarily impact health behaviors. In an effort to better understand health behaviors of persons with SMI in integrated care, we explored physical health decision making and decision aid preferences. We conducted three focus groups, including two consumer groups and one mental health staff group. Data were analyzed using a grounded theory approach, employing independent coding, thematic analysis, and meaning-making processes. Data suggest that overall, the consumer groups preferred a shared decision making process, with the doctor making the final treatment decision. Staff indicated that decision making depended on a consumer’s functioning level. Consumers liked the idea of using a decision aid, and reported preferring the computerized aid. Staff felt that decision aids were dependent on consumer level of functioning. Consumers generally view primary care doctors as experts, but like the idea of using decision aids to assist in making medical decisions. Staff feel that consumers may need help in both decision making and decision aid use in primary care.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

Social Networks,Substance Use,and Mental Health in College Students

Abstract

Objectives: The relationship between social network risk (alcohol-using close friends), perceived peer closeness, substance use, and psychiatric symptoms was examined to identify risk and protective features of college students’ social context. Participants: Six hundred and seventy undergraduate students enrolled in a large southeastern university. Methods: An online survey was administered to consenting students. Results: Students with risky networks were at a 10-fold increase of hazardous drinking, 6-fold increase for weekly marijuana use, and 3-fold increase for weekly tobacco use. College students’ who feel very close to their peers were protected against psychiatric symptoms yet were at increased risk for marijuana use. Perceived closeness of peers was highly protective against psychiatric symptoms, adding a natural preventive effect for a population at great risk for mental illness. Conclusions: Results support targeting college students through network-oriented preventive interventions to address substance use as well as mental health.     

University Students’ Views on the Utility of Psychiatric Advance Directives

Abstract

Objective: Rates of serious mental illnesses (SMIs) among university students are increasing, and universities are struggling with how to respond to students who show SMI symptoms. Psychiatric advance directives (PADs) allow individuals, when well, to document their wishes for treatment during a psychiatric crisis. This project explored the feasibility of using PADs in university settings by examining students’ views towards PADs. Participants: Forty university students with SMIs were recruited for this study from 1 large university. Methods: A mixed-methods design was used, with both quantitative survey instruments and qualitative interviews with students. Results: Respondents were positive about PAD utility for students. Respondents saw PADs as beneficial because PADs gave students control over their treatment. However, students also considered PADs potentially problematic because PAD use raised a risk of breaching student privacy and stigmatizing students with SMIs. Conclusions: Although a promising intervention for students with SMI, this approach requires further research.     

Measurement for a human science

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control.     

Counseling with Muslim Refugees: Building Rapport

Recent social work literature has stressed the importance of considering culture when working with individuals with mental health problems. This paper presents my personal experience, journaling, reflections, and research as a mental health social work practitioner and researcher working with refugee clients with mental health problems from a Muslim background. It also draws on my research experience in cross-cultural mental health. The paper emphasizes the significance of building rapport especially in the earlier stages of the professional relationship.