Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

Implementing a college mental health program – an overview of the first twelve months

Objective: To evaluate the demographics and clinical utilization patterns among college students during the initial 12 months of a novel, multi-disciplinary, collaborative, college mental health program (CMHP). Participants: Undergraduate and graduate students receiving treatment at the CMHP from Jan-Dec 2015. Methods: De-identified data was obtained via electronic health records for all students receiving care through the CMHP. Results: 1.2 FTE clinical providers treated 278 undergraduate and graduate students during the year (65.1% < age 26, 53.6% female, 49.6% caucasian). There were 1822 CMHP outpatient visits, 318 other medical visits and 103 total emergency room (ER)/inpatient visits. Ten students were identified as high utilizers of ER/inpatient services, while charges to the CMHP totaled $470,157 and total charges to the Health System were $2,378,315. Conclusions: Students with complex psychiatric/medical co-morbidities received cost effective, convenient and integrative treatment. Over time, we hope to intervene earlier and decrease ER/inpatient visits.     

Deaths of people with serious mental disorder: An exploration of deaths in custody and fatal police contacts

People with serious mental disorders (PSMDs) are overrepresented both in prison deaths and during fatal encounters with the police in the community (deaths after police contact, DAPC). To identify common factors present across cases of who died during contact with the criminal justice system in Queensland, publicly available coroners reports were analysed (N = 38). The findings of the study indicated psychosis and mood disorders were the most common diagnosis in incarcerated PSMD deaths, and suicide was the most common cause of death for incarcerated PSMDs. Within incarcerated settings, access to healthcare records, medication compliance, risk assessment and monitoring, and safe housing of at‐risk prisoners may be potential areas to explore with regard to prevention. Similarly, PSMD DAPCs were more likely to be experiencing mood or psychosis disorders than other forms of mental disorder, and suicide and police shootings were the most common causes of death. In PSMD DAPC, inadequate mental health access, treatment noncompliance and comorbid substance use were included as potential areas that could direct research efforts toward prevention.     

Discrimination,mental health,and body image among transgender and gender-non-binary individuals: Constructing a multiple mediational path model

The purpose of the current study was to examine the relationships among discrimination, mental health, and body image in a national sample of transgender adults. Participants (N = 78) identified as transgender, genderqueer, or other gender-non-binary identities and were recruited via a national online survey. Harassment/rejection, work/school, and other discrimination explained 10.4% of the variance in body appreciation, while satisfaction with life, anxiety, self-esteem, and depression explained 60.7%. Within these models, harassment/rejection was inversely associated with body appreciation, while self-esteem and satisfaction with life were positively associated. A series of path models moving from a measurement model to a more parsimonious and excellent-fitting model found that the effect of harassment/rejection on body appreciation was fully mediated by self-esteem and satisfaction with life, resulting in a multiple mediation.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Mindful of the Intersession Break in Family Therapy: The Time to Think Experiment

The Time to Think Experiment researches the experience of clinicians, consumers, and families of an intersession break, which has been used historically in various models of family therapy training. This qualitative pilot study explores the experiences of 21 clinicians, 19 consumers, and six family members using this break for reflection, across the domains of family and couple therapy, individual therapy, group work, and supervision in a mental health service covering the whole age range. Using a phenomenological design, the analysis included narrative, thematic, content, and comparative techniques. The paper considers the impact of privileging reflection in the therapy process, in a climate where models, work cultures, and general lifestyles may not encourage it. Using the intersession break to create space to ‘be’ in the therapy process is one way to integrate mindful and family therapy practice. The emerging themes of an intersession break to promote a richer and deeper therapy experience, and the apparent shift of responsibility for change from clinicians to consumers is discussed.     

Discourses of service user involvement in meeting places in Norwegian community mental health care: a discourse analysis of staff accounts

In previous research, meeting places have been favourably addressed by service users, but they have also been contested as exclusionary. In this participatory explorative study, we sought to perform a contextual analysis of meeting places in Norway based on a discourse analysis of three focus group discussions with 15 staff members. We asked the following question: how do meeting-place employees discuss their concrete and abstract encounters with service users and their experiences? We focused on service user involvement, which was largely analysed as neoliberal consultation and responsibilisation. Service users were positioned as resisting responsibility trickling down and defending staffed meeting places. Social democratic discourse was identified in the gaps of neoliberal discourse, which is noteworthy given that Norway is a social democracy. This relates to global concerns about displacements of democracy. We suggest that meeting places appear to hold the potential for staff and service users to collaborate more democratically.     

Distress or disability? Could a theoretical framework drawn from disability studies be a way forward when trying to understand experiences of oppression on the grounds of mental distress?

This article explores whether it is possible to use a theoretical framework drawn from disability studies to understand experiences of social oppression on the grounds of mental distress. Thomas’ extended social relational theoretisation of disablism was used in a PhD project concerned with experiences of mental distress. The tentative conclusion was that Thomas’ conceptualisation of disablism and impairment could offer a way of improving understanding of mental distress and oppression on the grounds of mental distress. However, Thomas and Reeve’s theorisation of the different forms of disablism was not readily transferred to the field of mental distress. Thus, tentative definitions of the different forms of disablism in relation to the field of mental distress were created. Perceived impairment type and disablism appear to be interconnected, and one has to acknowledge what kind of perceived impairment type one is focusing on when theorising disability and the different types of disablism.     

The family caregiving context among adults with disabilities: A review of the research on developmental disabilities,serious mental illness,and traumatic brain injury

ABSTRACT

A majority of adults with serious disabilities are cared for in the home by family members. Guided by an ecological framework, this article presents the findings of a literature review of research on family caregiving and family support for adults with disabilities. This review included 33 research studies published between 2000 and 2015 focused on three disabilities: Developmental disabilities, serious mental illnesses, and traumatic brain injury. A synthesis of the findings underscores the critical role that family caregivers occupy in addressing the needs of their loved one with a disability; however, the needs of the caregiver are insufficiently met by existing service approaches. A better understanding of the unique needs and strengths of the family support context of caregivers and care recipients is needed, giving greater attention to ethnic, racial, and cultural considerations in future research.     

What does wellbeing do? An approach to defamiliarize keywords in youth studies

Wellbeing has become a keyword in youth and social policy, a construct deployed as a measure of a good life. Often associated with physical and mental health, wellbeing encompasses numerous indicators, from subjective experiences of happiness and satisfaction to markers of economic prosperity and basic human needs of security. This article examines wellbeing as an organizing concept in discourses on young people and argues for defamiliarizing its truth claims and cultural authority by investigating what wellbeing does. We begin by examining the rise of wellbeing, drawing attention to its conceptual muddiness and ambiguity. Framed by the Foucauldian notion of problematization, the analysis proceeds along two routes: first, through an historical consideration of wellbeing as a relational concept with antecedents, focusing on ‘self-esteem’; and second, through a reading of wellbeing in contemporary educational policy. Informed by Somers' historical sociology of concept formation and Bacchi's critical policy analysis, we illuminate the mixed dimensions of wellbeing's reach, placing it within longer traditions of youth studies and psy-knowledges and showing its transformative promise as well as its individualizing effects. In doing so, we elaborate a methodological approach that can be adapted to examine other keywords in youth studies and social policy discourse.