“Is This How I'll Be for the Rest of My Life?”

Abstract

Obsessive-compulsive disorder (OCD) is an anxiety disorder affecting 2% to 3% of populations throughout the world. This paper provides an overview of symptoms (obsessional thoughts and compulsive behaviours) and current treatment options (medication and cognitive-behaviour therapy). A case study involving data obtained from an OCD sufferer and her mother is presented. Analysis of the data within the context of past literature highlights the economic and emotional costs of OCD which include years of psychiatric treatment, therapy, and medication, loss of productivity due to long-term unemployment, and individual and family stress. A framework for mental health social work practice assumes three key foci: (1) the family system as a whole; (2) individual family members; (3) a broader perspective that takes into account the need for adequate resources, community education and further research.     

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

This article aims to present the lived experiences of psychiatric service users/survivors who have experienced the transition from institutional care in the 1970s and 1980s to community care services in the 1990s and post-2000s. By using a biographical narrative approach the study compares service users’ historical experiences with their contemporary experiences of community and residential care. Sixteen biographical narratives were analysed to explore how mental health services have changed over time, from the perspective of service users/survivors, their families and mental health practitioners. The study examines how the closure of NHS mental hospitals in the 1980s, which were replaced in the 1990s with new types of community and residential care services, has changed the lives of service users/survivors. Thus, the article presents these lived biographical experiences which, for the majority of service users/survivors, were defined by the process of trans-institutionalisation rather than de-institutionalisation, within a neoliberal context.     

“We don't want to talk about that”: Overcoming barriers to rural aging research and interventions on sensitive topics

Geographical, economic, social and cultural barriers to accessing services in rural areas are widely reported. Less widely discussed are dilemmas posed by individual and community reluctance to address sensitive health issues. This article, focusing on the highly sensitive area of mental health, and employing a participatory action approach, describes the natural history of a project, the Mental Health and Aging Initiative (MHAI) to enhance awareness of mental health issues in rural Kentucky-Appalachian communities and overcome the reluctance of individuals in these communities to seek assistance. Funded by the United States Department of Agriculture (USDA), MHAI involved an educational intervention to improve knowledge about mental health and aging in rural Appalachian counties. The need to overcome significant community reluctance to engage in discussion of mental health resulted in significant modification of the protocol. The intervention was grounded in recognition of four key aspects of the local situation: (1) the need to understand the sensitivity of mental health as an element of rural culture; (2) the critical role of local community leaders as points of entry, acceptance, and action; (3) the need to overcome social stigma and reframe the topic of mental health in a more positive light; and (4) the need for methodological innovation in developing an empowering educational action plan oriented toward community-wide long-term impact. The intervention model that emerged from these considerations was based on engaging community leaders, providing educational and technical resources, and nurturing the acceptance by individual rural residents of responsibility for monitoring community mental health. This motif became a central theme in a strategy designed to facilitate culture change and acceptance of mental health as a community concern. It involved active engagement of community representatives in defining and implementing an intervention consistent with participatory action research as a means of empowering rural residents in monitoring and addressing sensitive health care issues. Given that many issues in rural health are difficult to address because of such sensitivity, the approach described is considered to have application in other contexts.     

The new mentality: Youth–adult partnerships in community mental health promotion

Youth–adult partnerships (Y-APs) engage young people in meaningful community activity and in the institutions and decisions that affect their lives. The current study is an examination of the process of The New Mentality, a multi-site pilot program intended to mobilize Y-APs to raise community awareness of child and youth mental health, reduce the stigma surrounding mental illness, and advocate for a mental health service system that is more responsive to the needs of children and youth. Data were gathered through individual interviews, focus groups, observations, and questionnaires with youth and adult stakeholders at various levels of the project. A number of themes emerged from the data. These included the critical nature of relationships youth experienced, the cultural differences and advocacy opportunities presented in the child and youth mental health system, the program's level of structure, and individual learning and knowledge sharing.     

Mental Health Workers Negotiating Risk on the Frontline

Abstract

Following deinstitutionalisation and the shift to models of community care, mental health practice has become increasingly focused on managing the risks posed by service users. However, the effects of risk management on workers’ professional identities have not been investigated empirically in Australia. Drawing on in-depth interviews with mental health workers from Victoria, Australia, this paper explores the diverse ways in which these workers adapted the formal technologies of risk management (e.g., the completion of risk assessment screens) to their professional identities. Some workers experienced risk management technologies as constraining their interventions with clients, while others saw these technologies as providing opportunities to strengthen and enhance their professional skills. Pondering these differences, the author speculates on the emergence of a new form of professional identity in the broader context of contemporary community mental health care.     

Shared decision making from the service users’ perspective: A narrative study from community mental health centers in northern Norway

This article aims to contribute to the understanding of shared decision making as an important aspect of user involvement in mental health care from the perspectives of service users. A thematic analysis of interviews with 25 individual service users in three different community mental health centers in Norway identified different understandings of shared decision making. Shared decision making was identified as essential in four contexts: 1) during admission, 2) in individualized treatment, 3) in different treatment contexts, and 4) in user-professional relationships. We consider shared decision making to be intertwined with treatment from the service user perspective.     

Using an action research approach to involving service users in the assessment of professional competence

This paper reports on a piece of action research that has involved people who use mental health services in systematically providing feedback from a user perspective on participants’ assessed work completed for one module of a masters’ training programme in mental health. In an attempt to improve professional practice and include people who were accessing mental health services in so doing, it outlines how users were trained to provide feedback and the training methods employed. The findings summarise the kind of issues users raised in their feedback to participants about the evidence professionals provided to demonstrate their learning from the training programme. A focus group interview with professionals provides a contrasting insight into the participants’ experience of having their work commented upon from a user perspective. The paper draws on the experience of a five-year external evaluation of an interdisciplinary programme in community mental health at Birmingham University in the UK which has highlighted the involvement of people who use mental health services as a particular innovation in the design, delivery and evaluation of the curriculum.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

The Power of Peer Support: The Development of the Empowerment Center

ABSTRACT

This article discusses the events and influences that led to the author’s contribution to the development of a mental health consumer-run organization, The Empowerment Center in Mount Vernon, NY. The author traces some events that influenced him personally and the evolution of the Empowerment Center from an organization that provided advocacy services (to those with mental health problems who were hospitalized) and community-based support services to people in mental health recovery, to an organization focusing on economic empowerment and economic development for the community of those in recovery. The transition of the Empowerment Center into an organization focused on economic empowerment underscores the importance of economic independence for people in recovery and the consumer-run organizations that support them. The Empowerment Center endeavors to demonstrate that mental health consumer-survivors can take control of their economic health as well as their physical and mental health.     

A Multilevel Analysis of Gender Differences in Psychological Distress Over Time

Females have higher rates of depression than males, a disparity that emerges in adolescence and persists into adulthood. This study uses hierarchical linear modeling to assess the effects of school context on gender differences in depressive symptoms among adolescents based on two waves of data from the National Longitudinal Study of Adolescent Health (N=9,709 teens, 127 schools). Analysis indicates significant school‐level variation in both overall symptom levels and the average gender gap in depression net of prior symptoms and individual‐level covariates. Aggregate levels of depressive symptomatology were positively associated with contextual‐level socioeconomic status (SES) disadvantage. A cross‐level contingency emerged for the relationship between gender and depressive symptoms with school SES and aggregate perceived community safety such that the gender “gap” was most apparent in contexts characterized by low SES disadvantage and high levels of perceived safety. These results highlight the importance of context to understanding the development of mental health disparities.     

Race-Ethnicity and Health Trajectories: Tests of Three Hypotheses across Multiple Groups and Health Outcomes

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.     

Multiple roles and mental health in cross-cultural perspective: the elderly in the United States and Japan

This paper examines how multiple roles affect the mental health of the elderly in Japan and the United States, two countries with vastly different cultures. Hypotheses were drawn based on the cultural differences in role experiences, and these hypotheses are tested by analyzing nationally representative samples of the elderly in these countries. The results show that Americans are more likely to be involved in roles related to family, work, and community, while the Japanese are more likely to be involved in only those roles related to family and work. Multiple roles are also found to be less beneficialfor the mental health of Japanese elderly compared to American counterparts. National differences in the effects of individual roles and role configurations on mental health are also documented. Overall, the results show the importance of broad cultural contexts for understanding the relationship between roles and mental health.     

Are case management services associated with increased utilization of adolescent mental health treatment?

Retention in treatment is one of the strongest predictors of positive mental health outcomes. Adolescents, however, are particularly challenging to retain in mental health treatment. Concurrent case management services may offer one strategy for retaining youth in mental health treatment as it aims to reduce barriers to services, coordinate multiple services, and establish a consistent relationship between each client and a single contact person. This study combines three extant data sources from the state of Kansas to examine whether youths' participation in case management is associated with increased utilization of individual and group mental health treatment, controlling for client satisfaction, severity of mental health symptoms, and demographic factors. Linear regression results indicate that participation in case management services predicts increased utilization of both individual and group mental health treatment. Case management may be a useful tool for retaining adolescent clients in mental health services. Practical implications for community mental health service delivery are discussed.     

Closing the Loophole: A Case Study of Organizing for More Equitable and Affordable Access to Health Care in San Francisco

This paper presents in-depth case study of a successful hybrid political and community organizing campaign to ensure equitable access to health care through the perspective of a grassroots San Francisco community-based organization, the Chinese Progressive Association (CPA), which has been organizing low-income Chinese immigrants for over four decades. First, it outlines the Health Care Security Ordinance (HCSO), which, since its passage in 2006, has established a near-universal health care access program, helping to make health care accessible and affordable to individuals living and working in San Francisco. Then it presents the campaign to save the HCSO, focusing on CPA’s participation in the HCSO coalition. Finally, it discusses health care as it relates to the San Francisco’s affordability crisis and the political economic context in which it is taking place. Despite the limitations inherent in small case studies like this one, it nevertheless provides a valuable opportunity to better understand how one politically progressive city attempted to address the problem of grossly inequitable health care access through the lens of community organizing, advocacy, and coalition building. San Francisco, like many major American cities today, is being confronted with rapid gentrification and growing economic inequality—the backdrop to the HCSO. Through innovative experiments in social responsibility like the HCSO, however, the city has made leaps in health care access. It concludes with lessons learned from local organizing and advocacy to save the HCSO as these may inform other local efforts to promote health care for all.     

Socioeconomic Status and Mental Illness in Japan*

Abstract Since the pioneering work of Faris and Dunham (1938), a number of studies in the United States have documented an inverse association between socioeconomic status (SES) and mental illness both at the aggregate and the individual levels, and both for the treated and the general population. However, there are few studies of whether this relationship holds in other countries. This study examines socioeconomic characteristics and mental illness in Japan, which has a very different social stratification system from that of the United States. It was found that, at the aggregate level, the “inverse” association between socioeconomic characteristics and the rate of treated mental illness does not hold in Japan. Instead, the relationship is curvilinear: mental illness is higher in districts with large numbers of blue collar and upper white collar workers than in districts with large numbers of lower white collar workers. The effect of SES on mental illness operates through economic stress embedded in the macro social context. Because different social structures lead to different patterns of economic stress, the inverse relationship between socioeconomic status and mental health cannot be assumed to hold in all countries.     

Developing a framework for anti-discriminatory practice teaching on social work courses

This article suggests that recognition of mental health issues in social work is a generic requirement. It considers the parameters of a mental health perspective in social work, examines the obstacles to its integration into practice, and outlines the contribution that social work training can make to the competence of individual workers. It recognises, however, the tension between individual and structural solutions, and locates mental health awareness within its organisational context.     

SOS—Satisfied or Stuck,Why Older Rural Residents Stay Put: Aging in Place or Stuck in Place in Rural Utah*

As rural communities undergo substantial demographic and economic changes, understanding the migration intentions and their antecedents of rural elderly persons becomes increasingly important. Using data drawn from a survey of adults from 24 rural Utah communities conducted in 2008, we examine whether rural residents 60 years of age or older plan to remain in their present communities (N= 621). We use structural equation models (SEM) to estimate the relationships between a variety of individual and community-level background measures, including perceptions of local service quality, leaving one's community for health care, Internet use, attachment to and satisfaction with community, and plans to age in place. Results suggest that even as the rural context of economic decline, population loss, and distance to medical services may reduce the viability of staying in a community, a desire to remain in the community is primarily a function of perceptions of the quality of local services and community satisfaction. This research highlights the need to better understand the interplay between the availability of medical services and perceptions of distance as well as to understand the complex relationship between individual and community level characteristics for migration intentions.     

QUESTIONS AND HINDSIGHT: WORK WITH ZARA,AN ASYLUM SEEKING CARE LEAVER

Psychodynamic ideas are used to think about social work with an asylum‐seeking young woman with mental health problems. Questions are raised about her needs and our response to them in relation to her individual history, the organisation and the wider socio‐economic context. These lead to reflections on adolescence and the leaving care task, non‐dependence, loss of home and homelessness, fear of madness, attitudes to difference and asylum seekers and institutional racism. Failure and learning from it is also a theme.     

“My heart is very painful”: Physical, mental and social wellbeing of older women at the times of HIV/AIDS in rural South Africa

The meanings of health and illness as well as people's beliefs about the required response to illness vary widely according to time and place and represents the culture and society in which people live. A double burden of disease in rural South Africa - an emerging epidemic of non-communicable diseases alongside high HIV-prevalence - defines illness as a ‘normal’ part of older persons' everyday lives. Against this background we analyze qualitative interviews with 30 women over the age of 60 in a rural community to provide an in-depth portrait of older women's physical, mental and social wellbeing and how these women make sense of it all in a changing and challenging social and economic context. These women, while making the connections between the various dimensions, view their own physical, mental and social wellbeing as impaired, and make use of a variety of health and help-seeking behaviors in order to feel better. However, poverty and the unavailability of health resources shape older women's constructions of the meaning of their health and their control, or lack thereof, over how healthy or ill they are. This study demonstrates the usefulness of the broader psycho-socio-environmental model in explaining old-age and wellbeing by providing a context specific and nuanced understanding.