Recovery From Mental Health Problems: Scratching The Surface Without Ethnography

This article examines a central plank of mental health policy (‘recovery’) in societies which have attempted to reverse the long-term warehousing of those with a diagnosis of mental disorder (de-institutionalisation). The emergence of the concept is traced in relation to the shift from an institutional to a more dispersed and community-based form of service organisation. Different usages of the term ‘recovery’, each with distinct implications for practice are considered on the part of three main interest groups (traditional bio-medical psychiatrists; social psychiatrists emphasising social skills training; and dissenting service users). These different usages suggest that ‘recovery’ is a polyvalent concept that creates an uneasy consensus point to define the management philosophies of local services enacting mental health policy. Also mental health work is about more than the group of patients mainly considered in relation to recovery (those with ‘severe and enduring mental health problems’). Practice-near research strategies are now required to investigate the varied practical scenarios these contradictions generate and ethnographic research is therefore indicated. Without multiple ethnographies, we will be left with competing rhetoric about recovery and its meaning or meanings may be rendered worthless.     

Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma

ABSTRACT

LGBT (lesbian, gay, bisexual, and transgender) populations experience disparities in health outcomes, both physical and mental, compared to their heterosexual and cisgender peers. This commentary confronts the view held by some researchers that the disparate rates of mental health problems reported among LGBT populations are the consequences of pursuing a particular life trajectory, rather than resulting from the corrosive and persistent impact of stigma. Suggesting that mental health disparities among LGBT populations arise internally, de novo, when individuals express non-heterosexual and non-conforming gender identities ignores the vast body of evidence documenting the destructive impact of socially mediated stigma and systemic discrimination on health outcomes for a number of minorities, including sexual and gender minorities. Furthermore, such thinking is antithetical to widely accepted standards of health and wellbeing because it implies that LGBT persons should adopt and live out identities that contradict or deny their innermost feelings of self.     

Enhancing the Career Planning Self-Determination of Young Adults with Mental Health Challenges

The impact of an intervention on the self-determination and career planning engagement of young adults with mental health challenges was studied. Sixty-seven young adults, 20 to 30 years of age, with mental health diagnoses (e.g., depression, bipolar disorder) were randomly assigned to intervention and control groups. Statistically significant greater increases were made by the intervention group versus the control group for self-determination and career planning engagement, and self-determination at least partially mediated increases in career planning engagement. With career planning self-determination interventions, young adults with mental health challenges might be able to achieve better career and life outcomes than is typical for this population.     

多维视角下的老年人社会健康影响因素分析

采用全国老年人口健康状况调查项目2002年~2005年纵向数据作为研究样本,对中国老年人社会健康的影响因素进行多维分析。通过结构方程模型,在方法上解决了社会健康的多维性、抽象概念的定量分析和测量误差的问题。研究发现,经济社会因素是影响老年人社会健康的主要方面,其中老年人自身的经济条件是最重要的因素;心理健康是影响老年人社会健康的关键因素,其它因素通过心理健康对社会健康起间接作用;由于社会生活方式的改变,家庭因素对老年人社会健康的直接影响正在弱化,但是家庭因素对老年人社会健康的间接影响依然存在。     

Need,well‐being and outcomes: the development of policy‐thinking for children's services 1989–2004

This paper describes how government policy thinking about the well‐being of children and young people developed between the Children Act 1989 and the Children Act 2004. These two Acts are milestone statements about how services to children in England and Wales should be delivered. It is an account informed by the author's own experience as a government adviser on children's social care over much of this period and supporting documentation. It traces the strands of government policy thinking about how to deliver services for children from children in need to the articulation of the five Every Child Matters outcomes. It argues that attempts to achieve coordinated service planning for children and young people played a significant role in the formulation of shared objectives and the articulation of child outcomes. However, it argues that looking at real outcomes exposes how children in the UK do relatively badly compared with other rich nations. It questions whether we can realistically expect our services to deliver significantly improved outcomes given the impact of enduring inequality in our society. This paper is dedicated to the memory of David Lambert CBE, former Assistant Chief Inspector of the Social Services Inspectorate in London, who died suddenly on 7 October 2010. He lent me articles to assist me in writing this paper.     

Risk Assessment for Hospital-Acquired Diseases: A Risk-Theory Approach

We introduce a new approach to hospital-acquired disease risk assessment from public health databases. In a spirit similar to actuarial risk theory, we define an adjustment coefficient that can quantify the risk associated with a hospital department, allowing comparisons of similar departments. The adjustment coefficient characterizes the tail of the distribution of the total patient length of stay in a department before the first disease event occurs. We show that this coefficient is the solution of a Lundberg-like equation, and we provide a nonparametric estimation procedure for this measure, based on a Cramér-Lundberg approximation for the tail of the distribution. Using simulations, we provide evidence of the robustness of the approximation to various individual risk models. In addition, we illustrate the relevance of this approach by evaluating the risk associated with a standard patient safety indicator in 20 hospitals of southeastern France.     

Gaps in social protection for health care and long‐term care in Europe: Are the elderly faced with financial ruin?

While public expenditure on health care and long‐term care (LTC) has been monitored for many years in European countries, far less attention has been paid to the financial consequences for older people of private out‐of‐pocket (OOP) expenditure necessary to access such care. Employing representative cross‐sectional data on the elderly populations of 11 European countries in 2004 from the Survey of Health, Ageing and Retirement in Europe (SHARE), we find that OOP payments for health care and LTC are very common among the elderly across European countries and such expenditures impact significantly on disposable income: up to 95 per cent of the elderly make OOP payments for health care and 5 per cent for LTC, resulting in income reductions of between 5 and 10 per cent, respectively. Failure to prevent financial ruin, as a consequence of excessive OOP payments, is evident in 0.7 per cent of elderly households utilizing health care and 0.5 per cent of elderly households utilizing LTC. Those particularly concerned are the poor, women and the very old.     

农民工子女健康危险行为思考

农民工子女健康危险行为日益增多,影响到社会安定。进行青少年健康危险行为的有关理论、概念、影响因素、预防和干预策略的阐述和总结,并为今后农民工子女健康危险行为研究提出建议。     

From Destruction to Reconciliation

SUMMARY

Daniel Johnson discusses how the application of “restorative justice” in his own life and in the life of the victim of his criminal offense contributed to his personal regeneration and healing for his victim. Mr. Johnson challenges criminal justice policy-makers to create conditions where “restorative justice” can be employed in the broadest sense in order to do what contemporary, punitive, retributive criminal justice systems are largely incapable of doing, that is, facilitate lasting offender rehabilitation and healing for crime victims and communities, and to offer opportunities for victim-offender reconciliations.     

Client Personality,Working Alliance and Outcome

Abstract

The relationship of the five-factor model of personality to working alliance, symptoms and well-being was examined in a diverse community mental health sample (N = 103). Agreeableness, openness, extraversion and conscientiousness were associated with alliance. Neuroticism was strongly associated with symptoms, and negatively associated with well-being. Extraversion was moderately associated with well-being. Personality is deserving of further study as a potentially important influence on therapy process and outcome. Part of the much-replicated association of alliance with outcome may be accounted for by personality. Implications for social work practice and research are discussed.