The return to the veil: Individual autonomy vs. social esteem

Social status is a multidimensional concept in which individual autonomy and societal esteem may exert contrary pulls. We apply this distinction between autonomy and esteem to studies of Egyptian women who have taken up the veil. Wearing the veil is seen as a coping strategy women use to gain or maintain societal esteemand a small measure of autonomy in a patriarchal society in which opportunities for autonomy are increasingly limited. As conservative movements gain strength in a range of social settings, this theoretical distinction and case analysis assume broader sociological significance.An earlier version of this paper was presented at the Eastern Sociological Society meetings, Boston, March 1990.     

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.     

Evaluation in a down-loaded mental health system.

Speculation that policy and funding shifts in the nation's mental health system would negatively impact program evaluation services in community mental health centers (CMHC) is substantiated. Performance of program evaluation activities was investigated in 71 CMHCs in 15 states over a two-year period. Twenty-five percent of the centers reported cutbacks, including staff attrition and diminished funding devoted to evaluation functions. The majority of centers reported no changes, but many directors representing these centers also indicated that they had never fully developed a capacity for performing evaluations and would cease to devote attention to these activities without available funding. In some centers evaluation functions are being transferred to clinical administrators; integrated into quality assurance activities; performed "as needed' by external consultants; or ignored altogether. Many centers are developing or enhancing a computerized information system to improve internal efficiency and to meet state accountability requirements. The professional issues raised to these trends as well as their implications for federal and state policy are discussed.     

Research in mental health: social etiology versus social consequences

This article differentiates a social etiology model focused on identifying the social antecedents of one particular mental disorder from a social consequences model concerned with the overall mental health consequences of various social arrangements. In the social etiology model, people with disorders other than the one particular disorder singled out for investigation are implicitly classified as "well." This disorder-specific model is inappropriate for the more general sociological task of identifying the consequences of various social arrangements, such as concentrated poverty, racial segregation, and gender stratification. It is problematic because these consequences are typically nonspecific, not limited to one particular disorder. From this perspective, persons classified as "well" in the disorder-specific model who have a different disorder are misclassified. Consequently, the impact of social arrangements is underestimated, and estimates of causal effects are biased. To address these problems, the full range of theoretically derived mental health outcomes needs to be simultaneously analyzed.     

The validity of assessing mental health needs with social indicators.

Selection of the appropriate number and types of social indicators for use in mental health planning has been a perennial problem. Social indicators have been associated with several concepts (quality of life, community disorganization, populations at risk) of varying relevance for planning mental health services, and abstracting social indicators from these conceptual domains poses a variety of validity issues. The issues are discussed, and the viability of social indicators in mental health planning is reexamined.     

The social capital and mental health of long-term social assistance recipients in Norway

Previous findings have generally demonstrated the positive mental health benefits of social capital. However, the mental health benefits of social capital for social assistance recipients have not been fully demonstrated. This study analyses the mental health benefits of individual-level bonding and individual-level bridging social capital for 551 Norwegian longer-term social assistance recipients. The findings demonstrate that bonding social capital, i.e. contacts with friends and access to social resources, are positively associated with mental health. Of the variables in the study that relate to bridging social capital, social trust and trust towards the social worker particularly show significant associations for mental health. Consequently, it is important that the mental health benefits of various forms of bonding and bridging social capital are acknowledged within social work practices and that social work practitioners actively aim to increase social trust in longer-term social assistance recipients.     

The role of social work in the field of mental health: dual diagnoses as a challenge for social workers

This paper provides a discussion about the relevance of medical terminology within the social work context. The authors use the example of dual diagnoses to argue for less stigmatised attitudes toward people who become, in the process of help, labelled as people with dual diagnoses. It sets out that using medical terminology in the field of social work is more often a strategy to exclude people from the system of help than as a moment of providing adequate help. It is concluded that social workers do not need the knowledge about diagnoses – knowing the diagnosis is important only as information that illustrates users’ specific experience and perception of reality, the available resources and obstacles that people face in their everyday life. The planning of a social work intervention should be based on an operational definition of everyday life, e.g. how people live through the day, what are the important and valued roles they play in life, what are their wishes and needs.     

The physical, mental, and social health status of older Chinese: a cross-national study

This article reports data on 16 indicators of the physical, mental, and social health status of older Chinese living in Beijing, Guangzhou, and Los Angeles. Both the frequency distributions of these indicators and their factor structures are different among the three cities. These differences may have implications for the planning of public health services. Either they are the result of differences in the way in which people in each of these cities think about illness or they are the result of differential experiences with disease. Although these data cannot resolve this issue, both the frequency distributions and the severity ratings for nine chronic diseases also differed markedly among the three cities.     

Mechanisms linking social ties and support to physical and mental health

Over the past 30 years investigators have called repeatedly for research on the mechanisms through which social relationships and social support improve physical and psychological well-being, both directly and as stress buffers. I describe seven possible mechanisms: social influence/social comparison, social control, role-based purpose and meaning (mattering), self-esteem, sense of control, belonging and companionship, and perceived support availability. Stress-buffering processes also involve these mechanisms. I argue that there are two broad types of support, emotional sustenance and active coping assistance, and two broad categories of supporters, significant others and experientially similar others, who specialize in supplying different types of support to distressed individuals. Emotionally sustaining behaviors and instrumental aid from significant others and empathy, active coping assistance, and role modeling from similar others should be most efficacious in alleviating the physical and emotional impacts of stressors.     

Ethnic and class factors affecting mental health clinic service

Service delivery by a mental health clinic to clients from an older suburban catchment area containing both lower and middle class blacks and whites was studied. The epidemiologic method was employed, relating service delivery to the characteristics of the various population groups within the catchment. The findings indicate that low service rates for blacks were not related to ethnicity alone, but to the combination of black ethnicity and low social status; however, middle class blacks and middle class whites who entered treatment received similar service. Poor blacks had higher admission rates than poor whites with similar need indicators. In continued treatment, poor blacks received lowest service rates while minority status poor whites living in a predominantly black area received highest service rates. Social class mediated black service utilization. Severity of illness, interacting with social class and minority status mediated white service utilization. Outreach is suggested not only for poor blacks but also for poor whites, especially those living in areas in which they represent an ethnic minority.     

Responding to student mental health concerns in social work education: reflective questions for social work educators

In this paper, we explore ways in which social work educators might respond to students who report that mental health issues underlie their difficulty in meeting core competencies, or otherwise use the language of mental health to describe their struggles to succeed in social work programs. We discuss various trends in policy responses in Canada, the US, the UK, and Ireland. While there are general policy trends, it is clear that responding to these kinds of issues requires the development of highly flexible and situated policy processes that can respond to student realities, concern for students’ rights and privacy, and an awareness of potential discrimination against students. These processes also need to meet the specificities of practicums, particular institutional policies, the mandates of relevant professional bodies, and the precise local legislative framework that shapes these situations. Given these varying contexts, in this conceptual paper, we used a framework on disability that is informed by critical theory to engage existing school policies and propose a set of reflective questions that can guide schools of social work to create an overall responsive environment. These reflective questions are designed to help social work educators balance the rights and needs of students with the professional and institutional demands that students meet core competencies in their education.     

Mexican immigration and health care: a political economy perspective.

This paper examines the case of Mexican immigrants in the United States and their access to medical services within a political economy of health framework. Such an approach stresses that the provision of health care is independent of health factors per se and that access to health care is not equally distributed throughout a population. The first section reviews the three major concepts influencing medical anthropologists working within a political economy framework: the social origins of illness; the allocation of health resources; and fieldwork in Third World countries. The analysis then focuses upon the reasons for limiting immigrants' access to health care, followed by an examination of the socioeconomic characteristics of Mexican immigrants, including an undocumented immigration status, which limit their access to health care. Finally, the consequences of limited access to health services are suggested, including a low utilization of preventive health services resulting from the high cost of care combined with the immigrants' generally low income, lack of medical insurance and fear of using U.S. health services.     

Legal capacity and the mental health social worker role: an international comparison

ABSTRACT

New capacity laws have been introduced to many jurisdictions over the last decade. These laws have substantially changed the way in which mental health social workers and other professionals approach decisions about, and for, clients. Most notably, there is now an expectation that mental health social workers engage more in supported decision-making to prevent the need for substitute decision-making. This article describes the legal and policy drivers that have led to these changes in practice, with a particular emphasis on the significance of the United Nations Convention on the Rights of Persons with Disabilities (the UNCRPD) and the importance of recovery approaches in mental health services. It then uses selected literature to explore the efficacy of the laws and decision-making in this area. The second part of the article identifies the role that mental health social workers can play in supporting legal capacity, drawing from the authors’ experience and knowledge of mental health social work and law in four jurisdictions: Victoria, Australia; Ontario, Canada; England and Wales; and Northern Ireland. It is concluded that mental health and other social workers need to refine skills, knowledge and values to accommodate this paradigm shift in law, policy and practice.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.     

Gender differences in mental health consequences of exposure to political violence among Israeli adolescents

This study examined the role played by gender differences in the relation between political violence exposure and mental health during adolescence. Understanding these differences is particularly pertinent during the period of adolescence characterized as it is by processes of identity formation and gender role consolidation. Participants were 154 high school students recruited from two high schools in central Israel (78 males, 76 females; average age 16.54), who completed the Political Life Events Scale for measurement of political violence exposure, the Brief Symptom Inventory-18 for assessment of psychological symptoms and disorders, a risk-taking behavior scale, and the Posttraumatic Stress Symptom Scale — Interview (PSS-I) for assessment of posttraumatic stress symptoms. Results reflected high levels on many psychological indicators. The dose–response hypothesis was partially confirmed with adolescents' higher reported political violence exposure related only to higher levels of somatization and greater severity of posttraumatic stress symptoms. Contrary to the literature, only a few gender differences emerged and these showed mixed patterns. Females showed higher levels of anxiety than males, and males showed higher levels of risk-taking behavior. Females exposed to low political violence exposure showed significantly less substance abuse than males but those with high exposure reported significantly higher levels of substance abuse, equivalent to those of males. Findings show a complex constellation of gender effects on relations between political violence exposure and different psychopathological outcomes. Findings of this study indicate the necessity for more refined examination of gender differences in psychological processes in reaction to living in conditions of protracted conflict and war.