Integration and Targeting of Community Care for People with Severe and Enduring Mental Health Problems: Users' Experiences of the Care Programme Approach and Care Management

Correspondence to Professor John Carpenter, Director, Centre for Applied Social Studies, University of Durham, Elvet Riverside II, Durham DH1 3JT, UK. E-mail: J.S.W.Carpenter{at}dur.ac.ukJ.S.W.Carpenter@dur.ac.uk Summary We report the experiences of different models of community careof random samples of 262 people with severe and enduring mentalhealth problems living in four districts in the north of England.The districts were characterized in terms of the extent of (1)integration between the health service-led Care Programme Approach(CPA) and social services Care Management, and (2) targetingof services on people with severe mental health problems. Themajority of service users felt involved in planning their owncare and considered that they had choice in their care and treatmentwhen in the community, but not in hospital. Although all theseusers were formally subject to the CPA, the proportions of usersin the districts believing they had a written care programmeranged between 37 per cent and 60 per cent. Of these, the greatmajority were very positive about their care programmes andfelt that they were being helped to become independent. Theseresults were replicated when 87 per cent of the original samplewas re-interviewed six months later. There were significantdifferences between the four districts and evidence that userspreferred an integrated health and social care service. In addition,a higher proportion of users in inclusive districts were satisfiedcompared to those in targeted districts. Notwithstanding thesepositive findings, there is still considerable room for improvementin relation to the involvement of family carers and the provisionof adequate information about prescribed medication and makingformal complaints.     

Coping with parental loss because of termination of parental rights

This article addresses the process by which children and adolescents cope with severe acute stress of parental loss from causes other than divorce or death. Participants were 60 children and adolescents from a residential treatment facility. Most had experienced neglect, physical abuse, and sexual abuse, and their parents had their parential rights terminated. Measures of symptomatology indicated that children reported low levels of depressive symptoms, whereas caregivers reported the children were experiencing significant psychological problems. Children used avoidant coping strategies more often than emotion-focused coping strategies, which, in turn, were used more than problem-focused coping strategies. Results are discussed in terms of helping children cope with parental loss.     

THE IMPACT OF DEREGULATION ON THE PRODUCTION STRUCTURE OF THE MOTOR CARRIER INDUSTRY

Empirical analysis of the motor carrier industry pre- and post-regulatory reform reveals that deregulation resulted in significant changes in firm production structure and lower real average costs. Translog cost functions for firms operating in 1977 and 1983 were estimated and compared for "other specialized commodity" carriers. Fitted average costs were computed from these functions. The results indicate significant differences in the cost functions and real costs that cannot be attributed to technological changes but rather suggest efficiency gains. The results also suggest that it is inappropriate to predict outcomes of deregulation using empirical analyses of firms in the regulated environment.     

The case of the “unfair” review: Ethical issues from an editor’s file

This narrative traces the life and fate of a paper submitted to the journalSocial Problems and ultimately rejected, with the author claiming that the review was “unfair.” It is an editor’s story and seeks to specify various “ethical” dilemmas that help to define such work. He currently is completing a three-year team as editor ofSocial Problems.     

Type of Status Inconsistency and Schizophrenia*

A number of previous studies have called attention (typically ex post facto) to the finding that schizophrenics tend to have backgrounds with a particular type of status imbalance—their occupational level is lower than their years of education would seem to merit. The data from this study substantiated this finding. Moreover, we found that the greater the magnitude of this type of inconsistency, the higher the proportion of schizophrenia. Since schizophrenics were especially downwardly mobile, however, we tentatively concluded that this type of status inconsistency is not a “cause” of schizophrenia but rather a consequence of that illness.     

The social condition of the New Zealand people: a pre-election review of social indicator information

ABSTRACT

Many social commentators have considered that alongside the fiscal transparency enjoined by contemporary New Zealand governments, there should be a complementary social responsibility reporting. This task is usually assigned to social indicator frameworks. However, at present (as the 2017 election looms) there is a faltering in the provision of social indicators which have been in place in New Zealand for almost two decades, with the exception of the recent 2016 survey data from Statistics New Zealand and Ministry of Social Development that were made available within a month of writing this article. Having commented on the current status of the New Zealand social indicator system, we present data from the General Social Survey and the Quality of Life survey to at least convey recent trends in subjective social well-being and reported behaviours and experiences. References are also made to the accumulating literature on social well-being in New Zealand, followed by suggestions for more systematic indicator development and underpinning research.