The Four S Model in action for de-escalation. An innovative state hospital-university collaborative endeavor

In this article, the Four S Model is presented as a working clinical framework for generating structured nursing interventions and treatment plans. The de-escalation process, formalized by the De-escalation/Alternative to Restraint Flowsheet, is one way in which the model is being operationalized to reduce seclusion and restraints. As shown by the flowsheet, the model allows for integration of mental health and mental illness. It spans the scope of nursing practice at all levels, from para-professional to advanced practice nurse, by integrating the mental health concepts of communication, leadership, clinical judgement, critical thinking, and caring within its framework. Most important, the flexibility to individualize treatment that is built into the model allows for generalization to all psychiatric presentations.     

The mental health dimension in the new social work degree: starting a debate

The Mental Health in Higher Education Project (mhhe) aims to increase networking and debate about the learning and teaching of mental health, both within and across the disciplines and professions in higher education. Despite the recent prominence that has been given to mental health in terms of policy development and new practice models, there has so far been little discussion as to what should constitute the mental health component of the new social work degree that is currently being introduced in England. This paper sets the context for the debate and reports on the outcome of an mhhe workshop on this theme held at the 2003 Social Work Education Conference in Warwick.     

What White Mental Health Professionals Need to Understand About Whiteness: A Delphi Study

This Delphi study surveyed an interdisciplinary panel of diversity expert trainers (N=20) about what white mental health professionals need to understand about whiteness. The panel endorsed 162 items that included what white mental health professionals need to understand about historical and contemporary whiteness within the mental health fields and larger social systems, self of the therapist work for white therapists, as well as challenges to understanding whiteness in clinical training and practice. More specifically, the panel provided guidance on the cognitive and emotional transformations necessary for white mental health professionals to address whiteness, as well as the challenges to those transformations. The researchers provide clinical training implications for marriage and family therapists (MFTs) and other clinicians based on the results.     

Direct What? The Untapped Potential of Direct Payments to Mental Health Service Users

This article describes research carried out for the Central Research Unit of the Scottish Executive about Direct Payments to mental health service users including people with dementia. Previous research had found that Direct Payments were not often, if at all, offered to mental health service users. Using focus groups, interviews and a telephone survey, Scottish Health Feedback explored the extent of implementation of Direct Payments across Scotland, and the views of mental health service users, carers and professionals about the idea of Direct Payments, the potential obstacles, and the support that would be needed. Awareness of Direct Payments was low, even among professionals. Many were hearing about this option for the first time through this research and a common reaction to the research questions was 'Direct what?' The study found that in order to make Direct Payments work for mental health service users, what was needed was 'person-centred' assessment, access to proper support, advice and training, and Direct Payment schemes that were flexible to allow for different arrangements and for transitions.     

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.     

Social work has a problem: A psychosocial study

This paper explores the reasons for the inferior status of social work in relation to the other major mental health professions. The problem stems primarily from most social workers' difficulty in perceiving themselves as competent mental health professionals, a perception which then causes them to behave as though they are in fact subservient to psychiatrists and psychologists. They thus ensure their treatment as second-class psychotherapists. This subservient behavior was originally adaptive and helped the profession to survive; however, it has become unnecessary and self-destructive. The time has arrived for social workers to take themselves seriously and to make a conscious effort to communicate their worth actively. Recommendations for improvement of social work's image are offered.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Needed sociological research on the de-escalation of wars

This paper raises a series of questions regarding the de-escalation of wars. It distinguishes between three types of groups that engage in wars: (a) states, (b) insurgents, and (c) peoples, and suggests that wars between different combinations of these three groups follow different patterns of de-escalation. It raises questions regarding the dynamics of de-escalation processes, the roles of different participants, and various types of de-escalation formulae. It concludes with a discussion of special data-gathering problems involved in studying the de-escalation of wars.     

Mental health professionals in children's advocacy centers: is there role conflict?

Two recent chapters in professional books have criticized children's advocacy centers for creating role conflict for mental health professionals because of their work with criminal justice and child protection professionals in children's advocacy centers as part of a coordinated response to child abuse. This article argues that these critiques misunderstand children's advocacy center practice and overestimate the risk of role conflict. Children's advocacy center standards set a boundary between forensic interviewing and therapy, which in most children's advocacy centers are done by separate professionals and never by the same professional for a given child. Many mental health professionals serve children's advocacy centers as consultants with no treatment role. Children's advocacy center therapists are rarely involved in investigation, and their participation in multidisciplinary teams focuses on children's interests and well-being.     

The role of theory in the assessment of sex offenders

No generally accepted theory of sex offender behavior exists at this point. As clinical experience and research findings interact within an evolving theoretical framework, the picture of what is important, as well as what is possible to know about a sex offender, is rapidly changing. It is vital that mental health professionals, the legal system, social service agencies, and other consumers and providers of sex offender assessments be aware of both what is possible to learn about an offender as well as the limitations on that knowledge and its application. Prominent theories that influence the assessment of offenders in North America and Europe are presented and examined. Uses and limitations of each theory are discussed. Several trends emerge which could influence the future of sex offender assessment, treatment, management, and policy.     

Social theory and the de-escalation of international conflict*

Are we like the mothers and fathers at Jonestown, with the cyanide in place, rehearsing for suicide-murder? Daniel Ellsberg (1981) observes that the marchers protesting nuclear weapons are doing what the mothers and fathers in Jonestown waited too long to say ‘No! Not our children! This is craziness; we won't be part of it.’ He writes that ‘It is none too soon to be saying this to the President/Prime Minister/Chairman Jim Jones's of the world; nor is it, yet, too late.’ How did we get into a place that even resembles Jonestown: And more importantly, how do we get out of it? Social theory should help provide answers to such questions, but does not obviously do so. In the first part of this paper I discuss an emerging theoretical paradigm that has particular relevance for understanding how international conflicts increase and decrease in intensity. Then I apply that paradigm to instances of international conflict de-escalation, focusing on declines in tension and hostility between the Soviet and American governments and the Israeli and Egyptian governments. Finally, I will point to some implications of the discussion for social theory and for international policy.     

Disaster and response:science, systems and realities

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether "indicated" interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process.     

The production of understanding

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the contextual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us"/"them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power. The production of understanding serves as an important counterbalance to this tendency. Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides understanding about why health and mental health are mal-distributed among people from different social circumstances.     

Assessing the Level of Elder Abuse Knowledge Preprofessionals Possess: Implications for the Further Development of University Curriculum

Elder abuse is a multifaceted problemthat requires interdisciplinary prevention and intervention strategies. An important question that arises is whether professionals are adequately prepared to address elder abuse in this collaborative network. Unfortunately, no studies have been conducted to assess the varying levels of knowledge that preprofessionals enrolled in university courses possess with regard to elder abuse. To fill this void, this study assesses the levels of elder abuse awareness among social work, nursing, health professions, and criminal justice students. Specific attention is given to determining whether there are differences in the amount of exposure to elder abuse literature across the disciplines. The study involves the analysis of survey data collected from 202 students enrolled in health and human sciences classes at a large university. Results show that none of the preprofessional groups, on average, reported knowing enough about elder abuse. Implications for future practice and research are provided.     

The Role of Theory in the Assessment of Sex Offenders

SUMMARY

No generally accepted theory of sex offender behavior exists at this point. As clinical experience and research findings interact within an evolving theoretical framework, the picture of what is important, as well as what is possible to know about a sex offender, is rapidly changing. It is vital that mental health professionals, the legal system, social service agencies, and other consumers and providers of sex offender assessments be aware of both what is possible to learn about an offender as well as the limitations on that knowledge and its application. Prominent theories that influence the assessment of offenders in North America and Europe are presented and examined. Uses and limitations of each theory are discussed. Several trends emerge which could influence the future of sex offender assessment, treatment, management, and policy.     

Disaster and Response

Abstract

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether “indicated” interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process.     

Are universities left-wing bastions? The political orientation of professors,professionals, and managers in Europe

Universities are accused of being left-wing bastions, unwelcoming to conservative and right-wing professors. However, we know little about the political orientation of professors in comparison to other professionals, which would be the right comparison group if we want to know whether universities are potentially hostile environments to conservatives. Examining culturally and economically oriented political orientations in Europe, it is demonstrated that professors are more liberal and left-leaning than other professionals. However, there is no greater homogeneity of political orientations among the professoriate relative to other specific professions, suggesting that there is a diversity of opinions which is similar to what professionals would find in other occupations. One exception concerns attitudes towards immigration, on which professors have more liberal orientations and comparatively low residual variance around that more liberal mean. Importantly, the difference between professors and other professionals is not so clear within graduates from the social sciences, but emerges more clearly among graduates with a medical, STEM, economics or law degree. An important political cleavage exists between professionals and managers, a group of similar social standing.     

An Integral Approach to Mental Health Recovery: Implications for Social Work

The term recovery has become increasingly popular in the area of mental health care. Recently, it has been described by policy makers as the guiding vision for transforming the mental health system. Problematic, however, is that a lack of clarity continues to exist regarding how recovery is to be defined. Definitional attempts often appear to have competing opinions about what the concept exactly stands for. This causes confusion for both professionals and consumers desiring to adopt a recovery approach. Ken Wilber's integral theory is presented as a framework for organizing and connecting various viewpoints related to the “recovery” concept. Implications for social work are discussed.     

Interprofessional education for community mental health: Attitudes to community care and professional stereotypes

Social workers are considered key members of community mental health teams, yet difficulties in interprofessional collaboration between social workers and health care professionals, particularly psychiatrists and nurses, have been reported. This paper examines some sources of these difficulties in terms of perceived differences in models of mental illness, attitudes and values, including stereotyping, professional identification and role clarity. Interprofessional education (IPE) may diminish negative stereotypes and promote multidisciplinary teamwork. A theoretical framework is described and findings from the evaluation of a 1-year programme of interprofessional education for community mental health are presented. These findings suggest that attitudes and values concerning community care for people with mental health problems are largely shared by different professions, but they do confirm the existence of interprofessional stereotypes and of perceived status differences. In contrast to previous research, there was no evidence of changes in stereotypes. These findings are discussed in terms of the theoretical framework and the design of the programme.