INTERVIEW TO TOBY WILLIAMSON BY ANA M VERNIA

Explore pastoral strategies for dealing with mental health problems! Mental health is increasingly being recognized as an important issue in later life. This valuable book will help you examine this dimension of aging in the context of pastoral, spiritual, and cultural issues. It explores the relationship between mental health, spirituality, and religion in later life, including the search for meaning, cultural issues, spiritual issues, depression, dementia, and issues of suicide in older people. The first part of Mental Health and Spirituality in Later Life focuses on theology, ethics, and cultural issues in mental health and aging. The second part addresses issues of multidisciplinary practice, including a challenging chapter written by a woman with early onset dementia (Alzheimer's) and other chapters that present perspectives on the uses and meanings of ritual and symbolism in mental health and pastoral approaches to care. Part one of Mental Health and Spirituality in Later Life deals with issues of theology, culture, and mental health in later life, focusing on: the importance of a richly textured understanding of personhood as a prerequisite for constructing a picture of late-life mental health in the context of theology the relationship between culture, spirituality, and meaning for older immigrants—and their effects on mental health the adverse effects of a mental health system that reflects only the dominant culture of a society, leaving minority cultures vulnerable to misdiagnosis and inappropriate treatments that can do more harm than good a wholistic picture of aging that moves beyond the biomedical paradigm and demonstrates the power and potential of the human spirit in adjusting to and moving beyond suffering Part two of this valuable book addresses issues of concern to practitioners in mental health and spirituality for the aging, including: disruptive behavior among nursing home residents and common practices that fail to identify its causes or address the problem how some staff/resident interactions can produce suffering for all concerned—with case study outlines that illustrate the point memory loss and its effect on spirituality, self-worth, and the faith community pastoral care for people suffering with dementia—with practical information on helping them to make use of the power of prayer and to deal with loneliness, fear, and disempowerment an insightful look at a recent major study of residents in aged care facilities in Australia that explores the link between depression and spirituality risk and protective factors associated with suicide in later life and the treatment of depression pastoral interventions for depression and dementia

Focusing on mental health rather than mental illness, this book adopts a life course approach to understanding mental health and wellbeing in later life. Drawing together material from the fields of sociology, psychology, critical social gerontology, the mental health field, and life course studies, it analyses the meaning and determinants of mental health amongst older populations and offers a critical review of existing discourse. The book explores the intersecting influences of lifecourse experiences, social and structural inequalities, socio-political context, history, gender and age-related factors and demands an approach to prevention and resolution that appreciates the embedded, complex and multi-faceted nature of threats to mental health and ways to protect it. It foregrounds engagement with the perspectives and lived experiences of older people, including people living with dementia, and makes the case for a paradigmatic shift in conceptualising, exploring and researching mental health issues and supporting older people with mental health problems. The book is essential reading for policy makers, health and social care professionals and students, third sector agencies, researchers and all of those concerned to more effectively and collaboratively address mental health issues in later life.

Challenges in Aging, Dementia, and Mental Health: New Knowledge and Energy to Inform Solutions.

Purpose The purpose of this paper is to describe service user involvement, explain some of the key issues that define, affect or protect mental health in later life and show how involvement may contribute to better mental health in later life. Design/methodology/approach The paper reviews existing definitions of involvement and mental health in later life; provides a more detailed review of some examples of involvement at a range of levels and illustrates how these could have a positive impact on mental health. Findings Active involvement and engagement at all levels offers significant opportunities for older people to protect and improve their own mental health and the mental health of society as a whole. Research limitations/implications This research does not set out to promote any particular intervention or involvement technique. The examples given have been evaluated in a variety of ways. Practical implications Service user involvement should be considered as an important potential contributor to mental health in later life. Social implications The paper encourages people in later life to be considered as a community resource rather than a problem that needs to be solved. Originality/value This paper brings together existing research with a focus on the relationship between involvement and individual and collective mental health.

Curing Psychiatry's SchizophreniaA Commentary in Values-Based PHD Mental Health Practice K.W.M. (Bill) Fulford (bio) From the perspective of values-based practice (VBP), there is much of interest in Lorenzo Gilardi and Giovanni Stanghellini's "I am a Schizophrenic." Their dialogue exhibits many of the key elements of VBP, it exemplifies the particular challenges presented by VBP in mental health, it illustrates the power of phenomenology in meeting these challenges, and it points by extension to an insight into contemporary psychiatry's professional identity as a medical profession. VBP is a resource for working with values—with what matters or is important to those concerned—in healthcare (Fulford, Peile, & Carroll, 2012). Avoiding preset answers, it offers instead a process that supports those concerned in a given situation finding answers for themselves. Developed first in mental health as a practical offshoot of analytic philosophy and psychiatry (Fulford, 1989; Fulford & van Staden, 2013), VBP is now being extended to other areas of health and social care: the Director of the VBP Centre in Oxford is the vascular surgeon and Oxford's Tutor for Surgery, Ashok Handa (Handa et al., 2016; see also: www.//valuesbasedpractice.org). That "I am a schizophrenic" should be transparently values-based is unsurprising given Giovanni Stanghellini's important contributions to the field (more on this below). Evident in the dialogue between LG and GS are many of the key skills of VBP (notably, awareness of values and listening skills); the approach is dialogic (it is a conversation not a medical monologue); and the dialogue is patient-values-centered (it focuses on what matters or is important to LG). Evident, too, is the importance of narrative. Relegated to the bottom of the evidence hierarchy, narrative comes at the top of the corresponding values hierarchy (Fulford, 2020): and the LG/GS dialogue convincingly illustrates why this should be so. Then again, coming to VBP in mental health, the LG/GS dialogue is co-productive (it is a dialogue between equals); it is positive (it is concerned as much with LG's strengths as with his needs and difficulties (National Institute for Mental Health in England and the Care Services Improvement Partnership, 2008); and it is recovery oriented (it is aimed not at symptom control but rather at rebuilding a good quality of life as defined by what matters to LG as an individual (Slade, 2009). Importantly, there is nothing in the LG/GS dialogue that from the perspective of VBP is peculiar to psychiatry. True, it would be surprising, even [End Page 15] in Oxford, if Schopenhauer, Blankenburg and Nietzsche were all to come up within minutes of each other in a values-based consultation in Ashok Handa's aortic surgery outpatient clinic. But this is a difference only of content. In a consultation about aortic surgery the material values (the things that matter or are important) involve such (conceptually) straightforward issues as side effects (including death), length of stay in hospital, and the likelihood of relapse. The corresponding values in the LG/GS dialogue, by contrast, involve the (conceptually) far-from-straightforward nature of personal identity. Hence, then, the resort in the LG/GS dialogue to Schopenhauer, Blankenburg, and Nietzsche. Hence, too, the more challenging nature of VBP as a whole in mental health as compared with areas of bodily medicine such as surgery. Which is where Giovanni Stanghellini has been early in the field in adding to the originating analytic philosophical resources of VBP, the resources of phenomenology. There is, of course, a long tradition of phenomenological research in psychiatry (Stanghellini & Fuchs, 2013). There have been other initiatives, too, in phenomenological VBP (e.g., in addictive disorders; Messas and Soares, forthcoming, 2020). Stanghellini has given us what he calls a "PHD" model of therapy (Stanghellini, 2019). The LG/GS dialogue nicely illustrates how the PHD model combines the life-world insights of phenomenology with the heuristic methods of the hermeneutic circle in a dialogical form of person-centered phenomenological-dynamic psychotherapy. LG, it is true, is a particularly well-read and philosophically insightful patient. This is perhaps why as their dialogue nicely illustrates, GS and LG speak the same language. But this, again...

Purpose. This article examines the role of family context in shaping the influence of childhood maltreatment on later life psychological well-being in the cultural context of Chinese society. Method. Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) baseline. Maltreatment was measured by corporal punishment by either mother or father in childhood. We used family violence, parents’ family socioeconomic status (SES) and mental health to represent family context. Result. Our ordinary least square regression analysis shows that corporal punishment administered by a mother was associated with higher depressive symptoms (b=0.308, p<0.05) in later life while being hit by father did not result in higher depressive symptoms. Family contexts had residual (“long arm”) influence on respondents’ mental health: violence in the family, including being hit by siblings (b=0.657, p<0.001) and witnessing violence between parents (b=0.658, p<0.001) contributed significantly to higher depressive symptoms. Conclusion. Corporal punishment by parents had long term effects on mental health of their children in later life. Cultural values, such as filial piety did not eliminate the negative impacts of being hit in childhood on mental health in later life. Family contexts including violence between parents also played important roles in shaping the relationship between child maltreatment and mental health in later life. Implication. Our study offers important insights about the complex matrix of cultural traditions, social circumstances and diversity in dealing with child rearing stress and their consequences for later life mental health.

This chapter begins with the historical developments that put mental health and capacity law into context, then moves on to the relationship to other areas of law. It describes the principles, and the roles of professionals and relatives. It goes on to explain the procedures for using civil powers, and civil admission for treatment. Consent to treatment, leave from hospital, civil community treatment, and after-care. The chapter then details police powers under mental health law, court-ordered pre-sentence assessment and sentence of treatment, alongside other court orders. Transfer from prison to treatment is included, with restriction orders, then appeals against treatment and detention is outlined. The subsequent section outlines human rights law, the European Convention of Human Rights, misuse of mental health law, and finishes with mental capacity laws.

The increasingly complex interface between the Mental Health Act 1983 and the Mental Capacity Act 2005 has been discussed in this column over the last three months. The boundaries between the two statutes is becoming increasingly blurred with the Court of Protection, a specialist court that considers cases about people lacking decision-making capacity, commonly being asked to make decisions on mental health law as well. Northern Ireland is proposing to resolve the interface problem by repealing its mental health laws and replacing them with a single statutory framework for mental capacity law. If passed, it will give all adults with capacity the right to consent to or refuse any form of treatment. Physical and mental conditions will be on an equal footing and there would be no compulsory detention or treatment of adults with capacity. For those whose lack capacity, treatment will be available in their best interests with arrangements in place to authorise situations where the care arrangements amount to a deprivation of liberty. In this article Richard Griffith considers the new proposals for Northern Ireland and wonders where these proposals point the way for the other devolved nations to develop their mental health and mental capacity law for a 21st century Britain.

Mind the glass ceiling: The gender gap in how depressive symptoms after age 55 relate to earlier career mobility in CONSTANCES

The island of Ireland is partitioned into Northern Ireland and the Republic of Ireland. In both jurisdictions, there have been important developments in mental health and mental capacity law, and associated policies and services. This includes an emphasis on developing more comprehensive approaches to collecting data on outcomes and so there is an opportunity to align these processes to enable comparison and shared learning across the border. This article explores: legal and policy developments; international approaches to mental health outcomes; and the type of data that would be helpful to collect to better understand the use of mental health and mental capacity laws. It is argued that an inclusive strategy to developing a comprehensive, integrated and aligned approach to collecting and analysing data would benefit citizens, policy makers and professionals.

ABSTRACTAnxiety and insomnia are correlated in older adults and their caregivers, yet the moderating role of mental health literacy (MHL) is unclear. This study aimed to explore dyadic effects of anxiety on insomnia among Chinese chronically ill older adults and family caregivers across age groups and whether MHL moderates these effects. Data came from 1033 dyads of older adults and their family caregivers in China through the Guangdong Mental Health Survey. Anxiety was assessed with the Generalized Anxiety Disorder‐7, insomnia with the Insomnia Severity Index, and MHL with the Chinese National Mental Health Literacy Scale (consisting of mental health knowledge, attitudes, and capacity). The Actor‐Partner Interdependence Moderation Model was applied for analysis. Young caregivers' mental health attitudes, β = −0.558, p = 0.002, mitigated the effect of their anxiety on their insomnia, while older adults' mental health knowledge, β = 0.428, p = 0.019, enhanced this relationship. Older adults' mental health attitudes, β = −0.731, p = 0.004, reduced the impact of middle‐aged caregivers' anxiety on the latter's insomnia. Middle‐aged caregivers' mental health capacity, β = −0.367, p = 0.004, attenuated the effect of older adults' anxiety on caregivers' insomnia. No significant moderating effects were observed in the dyad group of older adults and older caregivers. Within caregiving dyads, enhancing MHL can potentially reduce the impact of anxiety on insomnia. Interventions aimed at improving the mental health attitudes of older adults and caregivers are more likely to alleviate anxiety and insomnia than mental health knowledge and capacity.

Understanding of the mechanisms by which meditation imparts beneficial effects on later-life mental health is limited. The current study assessed the role of compassionate love in mediating the relationship between meditation and mental health in later life. Using data from a nationwide web-based survey (N = 1,861), we examined the indirect effects of meditation on depressive symptoms and anxiety via compassionate love. Participants who practiced meditation (compared to those who did not) had significantly higher feelings of being loved (b = 0.11, p < 0.05); those who experienced more love had lower depressive symptoms (b = -2.10, p < 0.001) and anxiety (b = -0.99, p < 0.001). Meditation also had significant indirect effects (via compassionate love) on depressive symptoms (b = -0.23, p < 0.05) and anxiety (b = -0.11, p < 0.05). This study underscores the need for contemplative interventions that foster compassionate love to improve mental health in later life. [Journal of Gerontological Nursing, 50(3), 40-50.].

This article is a ‘taster’, and summarises the issues identified in the UK Inquiry report on Mental Health in Later Life. It looks at how the Inquiry undertook its work, how older people with mental health problems are often overlooked and what their views and experiences are of accessing services, what actions are proposed for the housing, health and care sectors, and key issues and recommendations. Age Concern is committed to auditing the response to the recommendations and will report progress in 2009.

3 - Culture and Mental Health in Later Life Revisited

Cross-sectional and longitudinal associations of outdoor walking with overall mental health in later life