Community Mental Health Workers Research Articles

Task shifting – Ghana's community mental health workers’ experiences and perceptions of their roles and scope of practice

BackgroundBecause of the absence of adequate numbers of psychiatrists, the bulk of mental health care at the community level in Ghana is provided by community mental health workers (CMHWs).ObjectiveTo examine the role and scope of practice of CMHWs in Ghana from their own perspectives and to make recommendations to improve the care they provide.DesignWe conducted a cross-sectional survey of 164 CMHWs from all the 10 administrative regions of Ghana, comprising 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs), and 74 (45.1%) community mental health officers (CMHOs).ResultsOverall, only 39 (23.8%) CMHWs worked closely with psychiatrists, 64 (39%) worked closely with social workers, 46 (28%) worked closely with psychologists and 13 (7.9%) worked closely with occupational therapists. A lower proportion of CMHOs worked closely with psychiatrists, psychologists, and social workers compared with CPOs and CPNs. There was no significant difference in the proportion of the different CMHW types who expressed confidence in their ability to diagnose any of the commonly named mental health conditions except personality disorders. However, a lower proportion of CMHOs than CPOs and CPNs expressed confidence in their ability to treat all the disorders. The CMHWs ranked schizophrenia as the most frequently treated mental health condition and there was no statistically significant difference in the reported frequency with which the three groups of CMHWs treated any of the mental health conditions.ConclusionsMental health policy makers and coordinators need to thoroughly review the training curriculum and also evaluate the job descriptions of all CMHWs in Ghana to ensure that they are consistent with the demands and health-care needs of patients they care for in their communities. For example, as CMHOs and CPNs prescribe medication even though they are not expected to do so, it may be worth exploring the merits of including the prescription of common psychotropic medication in their training curriculum and job descriptions.

Using Mental Health Outreach Teams in the Emergency Department to Improve Engagement in Treatment.

Engagement in treatment for a person having a behavioral health crisis is critical to fully address the concerns of the individual as well as to prevent future crises. This study explored the benefits of establishing outreach visits from a local community mental health provider to psychiatric patients in an emergency department. Using retrospective analysis of data collected by a local mental health agency, the effect of receiving face to face contact in the emergency room with a community mental health worker (and/or telephone follow up) was compared to no outreach interaction. The effect of this intervention was a significant increase in initial appointment attendance at the local mental health clinic in the aftermath of a psychiatric crisis. Community mental health services provided in partnership with community emergency departments may improve patient engagement in aftercare and consequently help alleviate future behavioral health crises as well as return visits to the emergency department.

Task shifting of mental health care services in Ghana: ease of referral, perception and concerns of stakeholders about quality of care.

To examine the perceptions of stakeholders about the ease of referral of patients from community mental health workers (CMHWs) to psychiatrists in Ghana and the level of stakeholder concerns about the quality of care provided to these community health cadres. A cross-sectional survey. Eleven psychiatrists, 26 health policy directors and 164 community mental health workers, including 71 (43.3%) community psychiatric nurses, 19 (11.6%) clinical psychiatric officers and 74 (45.1%) community mental health officers. We administered three separate, self-administered, semi-structured questionnaires to the study participants. Although many respondents including almost all CMHWs perceive that it is easy for them to refer difficult cases to a psychiatrist who will usually see such patients in a timely manner, less than a quarter of these health cadres reported that they always or often refer patients to see a psychiatrist. The majority of CMHWs were of the opinion that patients, psychiatrists and other healthcare workers have concerns about the quality of care they provide, sentiments that were echoed by all psychiatrists and over half of all the health policy directors. There is also a need for policy directors to educate CMHWs about their roles and to clarify referral pathways so that cases that are difficult to manage will be appropriately referred to psychiatrists or appropriately trained and incentivized district medical doctors for further management.

A Review of Taiwan's Community Mental Health Policies: Current Developments and Future Prospect

Community mental health is an important area of public health. This study initially elaborates from the perspective of community psychology the concept and basis of the practice of community mental health work, including the importance of prevention over treatment, of valuing personal advantages and capabilities, and of adopting an ecological perspective, a respect for diversity, empowerment, and scientific cooperation and integration. Subsequently, this paper reviews the history of the development of community mental health work in Taiwan and of the operations, developmental issues, and difficulties currently faced by community mental health centers. Finally, this paper addresses the future prospects for community mental health work in Taiwan in hopes that the government will attach greater importance to related policies and implementation plans, optimize the service and delivery systems of community mental health organizations, reinforce community mental health education, develop effective community mental health promotion strategies, provide accessible and continuous direct services, integrate community mental health resources, and support the families of mental health patients in order to consolidate and better promote community-based mental health work.

Factors influencing the career choice and retention of community mental health workers in Ghana.

BackgroundWhilst there have been several studies exploring retention in health workers, little is known about health workers engaged in the provision of mental health services and the factors that affect their recruitment and retention.AimsThe objective of this research was to examine the views of stakeholders about the factors which influence career choices and retention of community mental health workers (CMHWs) in Ghana.MethodsWe administered three separate, self-administered, semi-structured questionnaires to 11 psychiatrists, 29 health policy directors and 164 CMHWs across Ghana, including 71 (43.3%) community psychiatric nurses (CPNs), 19 (11.6%) clinical psychiatric officers (CPOs) and 74 (45.1%) community mental health officers (CMHOs).ResultsOverall, 34 (20.7%) of all CMHWs chose to work in mental health because of the job prospects in mental healthcare. Overall, 12 (16.2%) CMHOs, 1 (5.3%) CPO and 20 (28.2%) CPNs reported they had considered leaving the mental health profession because of the stigma, with 4 (36.4%) psychiatrists and 12 (41.4%) health policy coordinators also reporting that they knew some CMHWs who had considered leaving the mental health profession because of stigma. Similarly, 16 (21.6%) CMHOs, 4 (22.1%) CPOs and 38 (53.5%) CPNs said they had considered leaving the mental health profession because of concerns about risk. Furthermore, 6 (54.5%) psychiatrists and 3 (10.3%) health policy directors said they knew some CMHWs who had considered leaving the mental health profession because of concerns about risk. Overall, 61 (37.2%) of CMHWs reported that they have considered leaving the mental health profession for other reasons other than stigma and risk including the following: the lack of support, respect and recognition from healthcare managers, lack of opportunities for professional development and poor conditions of service including low salaries, lack of office and personal accommodation and lack of risk allowance and transportation as well as poor inter-professional relationships.ConclusionsSeveral factors affect the recruitment and retention of CMHWs in Ghana, including the prospects of easy employment, stigma, risk, lack of opportunities for career progression and low salaries.

Perception of Stake Holders About Adequacy of Training and Supervision for Community Mental Health Workers in Ghana

Background There is growing interest in the effectiveness of task shifting as a strategy for addressing expanding health care challenges. Aim To examine the perception of stakeholders about the adequacy of the training, supervision and support offered to community mental health workers in Ghana. Methods We administered three separate self-administered semi-structured questionnaires to 11 psychiatrists and 29 health policy coordinators and 164 Community Mental Health Workers (CMHWs), across Ghana including, 71 (43.3%) Community Psychiatric Nurses (CPNs), 19 (11.6%) Clinical Psychiatric Officers (CPOs) and 74 (45.1%) Community Mental Health Officers (CMHOs). Results Almost all the stakeholders believed CMHWs in Ghana receive adequate training for the role they are expected to play but not the role they actually play within the health delivery system. There were statistically significant differences between the different CMHW groups and the types of in-service training they said they had attended, the frequency with which their work was supervised and the frequency with which they receive feedback from supervisors. CPOs were more likely attend all the different kinds of inservice training than CMHOs and CPNs while CMHOs were more likely than CPOs and CPNs to report that their work is never supervised or that they rarely or never receive feedback from supervisors. There was disparity between what CMHWs said were their experiences and the perception of policy makers. Conclusion There is a need to review the curriculum of the training institution for CMHWs and also to offer them regular in-service training and formal supervision.

Canadian community mental health workers' perceived priorities for supportive housing services in northern and rural contexts.

A relationship between mental health and supportive housing has been established, yet there exist enduring challenges in meeting the supportive housing needs of people with severe mental health problems. Furthermore, not all stakeholder viewpoints of supportive housing services are well documented in the research literature, and research has tended to focus on supportive housing provision in large, urban centres. Potentially, distinct challenges and opportunities associated with the provision of supportive housing services in smaller urban and rural communities that define the greater geographical terrain of Canada and other jurisdictions are less developed. This study describes community mental health service workers' priorities for supportive housing services. Using Q methodology, 39 statements about supportive housing services, developed from a mixed-methods parent study, were sorted by 58 service providers working in four communities in northern Ontario, Canada. Data used in this study were collected in 2010. Q analysis was used to identify correlations between service workers who held similar and different viewpoints concerning service priorities. The results yielded four discrete viewpoints about priorities for delivery of supportive housing services including: a functional system, service efficiency, individualised services and promotion of social inclusion. Common across these viewpoints was the need for concrete deliverables inclusive of financial supports and timely access to adequate housing. These findings have the potential to inform the development of housing policy in regions of low population density which address both system and individual variables.

Psychology Without Psy Professionals: Exploring an Unemployed Centre Families Project as a Mental Health Resource

ABSTRACTThe activities and technologies of the psychology (Psy) disciplines, in the process of privileging professional understandings of distress, could be seen to be potentially facilitating corrosion in the capacity of the lay public to understand and ameliorate their distress. This paper draws on the experiences of people who use an Unemployed Centre Families Project in the South of England to provide an example of community mental health work that does not draw on the dominant discourses, institutions or practitioners of the Psy sciences. Through interviews with centre users, staff and volunteers, a picture emerges of a community space that provides a variety of services, projects and opportunities that have a very considerable positive impact on the mental well‐being of the centre users. This picture highlights non‐medical intersubjective processes that offer possibilities for recoveries from mental distress but that are often neglected and subordinated in the professional worlds of Psy and psychiatry. Such centres facilitate social networks and practical help, and transitions in identity can be beneficial for those experiencing mental distress. In so doing, they make prominent some of the key limitations of biomedical approaches to recovery. Copyright © 2015 John Wiley & Sons, Ltd.

A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq.

BackgroundExperiencing systematic violence and trauma increases the risk of poor mental health outcomes; few interventions for these types of exposures have been evaluated in low resource contexts. The objective of this randomized controlled trial was to assess the effectiveness of two psychotherapeutic interventions, Behavioral Activation Treatment for Depression (BATD) and Cognitive Processing Therapy (CPT), in reducing depression symptoms using a locally adapted and validated version of the Hopkins Symptom Checklist and dysfunction measured with a locally developed scale. Secondary outcomes included posttraumatic stress, anxiety, and traumatic grief symptoms.MethodsTwenty community mental health workers, working in rural health clinics, were randomly assigned to training in one of the two interventions. The community mental health workers conducted baseline assessments, enrolled survivors of systematic violence based on severity of depression symptoms, and randomly assigned them to treatment or waitlist-control. Blinded community mental health workers conducted post-intervention assessments on average five months later.ResultsAdult survivors of systematic violence were screened (N = 732) with 281 enrolled in the trial; 215 randomized to an intervention (114 to BATD; 101 to CPT) and 66 to waitlist-control (33 to BATD; 33 to CPT). Nearly 70% (n = 149) of the intervention participants completed treatment and post-intervention assessments; 53 (80%) waitlist-controls completed post-intervention assessments. Estimated effect sizes for depression and dysfunction were 0.60 and 0.55 respectively, comparing BATD participants to all controls and 0.84 and 0.79 respectively, compared to BATD controls only. Estimated effect sizes for depression and dysfunction were 0.70 and 0.90 respectively comparing CPT participants to all controls and 0.44 and 0.63 respectively compared to CPT controls only. Using a permutation-based hypothesis test that is robust to the model assumptions implicit in regression models, BATD had significant effects on depression (p = .003) and dysfunction (p = .007), while CPT had a significant effect on dysfunction only (p = .004).ConclusionsBoth interventions showed moderate to strong effects on most outcomes. This study demonstrates effectiveness of these interventions in low resource environments by mental health workers with limited prior experience.Trial RegistrationClinicalTrials.Gov NCT00925262. Registered June 3, 2009.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0360-2) contains supplementary material, which is available to authorized users.

Stigma as an organizing framework for understanding the early history of community mental health and psychiatric social work

ABSTRACTThe authors argue that stigma—both the forces that combat it and perpetuate it—can be viewed as an organizing framework for understanding the history of mental health care. This early history also provides a foundation for appreciating the roots of psychiatric social work and the uniqueness of our professional domain and identity. While hoping to build disciplinary pride, the article also points to work that remains to more deliberately oppose practices that perpetuate stigma, both subtle and overt, and instead embrace practices that humanize care for people with mental illness.

Burnout and self-reported quality of care in community mental health.

Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-rated Quality of Care, over and above background variables.

Atenção básica e saúde mental: experiência e práticas do Centro de Saúde Escola Samuel B. Pessoa

This paper presents and analyzes findings from an ethnographic study conducted inside the Health Center School Samuel B. Pessoa, focusing on the relationship between mental health and primary health care. It is divided intothree main sections covering the history of these relations in that institution, current aspects of public health policies related to this area and the practice of supervision for community mental health workers as a privileged space for training and dialogue on the designing of care practices. The study showed that the experience and practices of CSEB, linking mental health and primary care and basic health, preserve the historical memory of this relationship in Sao Paulo, trying at the same time, the new proposals for the area, from a critical perspective.

An Answer to the Lack of Psychiatric Services in Developing Countries

How can psychiatric services be delivered in a country possessing only one psychiatrist? The civil war in Liberia had left thousands suffering from post-traumatic stress disorder and depression; 50 to 70 percent of girls and women were sexually assaulted during the war. Yet less than one percent of the population had access to any mental health treatment. This was the dire situation prompting the government in Liberia to ask the Carter Center in Atlanta for assistance. In a television interview on CNN, former U.S. President Jimmy Carter talked about what he and his wife Rosalynn Carter had initiated in Liberia (CNN, February 21, 2013). The answer to the above question?Establishingtrainingprogramsinexistingnursing schools. The new mental health training programs will prepare 150 psychiatric nurses and physician assistants and 300 community mental health workers (The Carter Center, n.d.) Course materials were developed in conjunction with Liberian nurses and other health professionals to ensure cultural relevance. The students pay no fees for instruction or textbooks. The nurses and physician assistants who complete the training will be licensed as specialists in mental health and deliver their services within the Liberian primary health care system. I was excited to learn of this Carter Center initiative in Liberia. It seems to me that such programs could be widely replicatedinotherdevelopingcountries,includingotherAfrican countries ravaged by wars. Psychiatric nursing is ready to welcome our new colleagues, and I would welcome manuscripts about similar initiatives in developing countries, especially during this year of the journal’s special focus on global mental health.

Mental health and aging initiative: intervention component effects

The objective of this investigation is to evaluate the Mental Healthiness and Aging Initiative (MHAI) intervention. The MHAI was created to promote awareness and knowledge about mental health/substance (MH/SA) use and aging issues in rural Kentucky, USA, due to limitations in formal and informal mental health care and treatment resources as a result of multilevel barriers in rural regions and effects on health, wellbeing and quality of life. This investigation took place between 2010 and 2011 in two rural counties in Kentucky. Participants from two counties were recruited through an email solicitation sent to Kentucky cooperative extension agents (university-affiliated community liaisons). Individuals participated in a two-hour intervention session covering facts and information, application exercises, and community tools for addressing late-life mental health and substance abuse. Effectiveness was evaluated by examining changes in attitudes and knowledge about MH/SA and aging from pre-test to post-test and again 3 months and 6 months later. The evaluation survey examined mental health and substance abuse awareness (six questions) and knowledge (13 questions) and was previously piloted and designed for the current study ensuring face validity. Seven individual linear mixed models were analyzed using each of the six awareness questions and an additional model using an aggregate score across the knowledge questions representing the total percent correct for knowledge questions. The participating sample (n=55) was 65.35 years of age on average, with the majority being female (85%), white (100%), married (69%), living with a spouse/partner only (68%), high school educated (57%) and having a total household income averaging US$44,199. The findings indicated sustained improvement in awareness and knowledge about MH/SA and aging. Results also indicated that there is a need to improve maintenance of knowledge regarding older adult alcohol consumption risk, clinical provider communication about mental health, identifying/recognizing mental health problems, and older adult retention of their mental abilities based on long-term retention rates. These indicators had below 90% correctness at 6 months, despite having 90%+ accuracy at post-assessment, immediately after the intervention administration. This study demonstrates that community interventions for MH/SA awareness and knowledge are effective within majority rural regions. As currently designed, implementing the MHAI intervention program is feasible. Evidence from the current study indicates that community residents (including rural individuals) can be recruited to participate in a program about MH/SA and aging, and as an outcome have increased awareness and knowledge about MH/SA and aging. Future research will need to explore how to utilize MHAI-type intervention programs to a point where the mental health of rural adults can be improved. Specifically, further investigation is needed to examine whether community mental health awareness interventions, such as the MHAI intervention program, can lead to earlier detection of MH/SA issues among older adults and increase treatment rates. If so, community mental health workers and facilities can expect such interventions to increase local residents' awareness of their services and likelihood of utilizing mental health services. Future research needs to enhance generalizability and ensure that improved knowledge and awareness translates into improved mental health in rural regions.

Status of Stigma, 2012

Back to table of contents Previous article Next article Taking IssueFull AccessStatus of Stigma, 2012Steven S. Sharfstein, M.D., M.P.A.Steven S. SharfsteinSearch for more papers by this author, M.D., M.P.A.Published Online:1 Oct 2012https://doi.org/10.1176/appi.ps.631011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The word “stigma,” stemming from the Greek, means a sign or a branding mark. Erving Goffman is best known for his classic work on asylums and on stigma. In 1963, he defined stigma as “the process by which the reaction of others spoils normal identity.”Goffman addressed both “public stigma,” the reaction of others in the community at large toward people with symptoms of mental illness, and “self-stigma,” the self-blame and self-derogatory attitudes that people with mental illness may harbor about themselves. Two articles in this issue of Psychiatric Services examine strategies to reduce stigma and suggest agendas for future research and action. Corrigan and colleagues review efforts to challenge public stigma, and Mittal and colleagues summarize findings on self-stigma reduction. Both groups emphasize that stigma is essentially a public health problem and one of the main obstacles to access to care. Historically, stigma is a cause of insurance discrimination against treatment for mental illness, and the fight for parity has been a fight against stigma. The 2008 Kennedy-Wellstone legislation improved on the 1996 Domenici-Wellstone parity bill by establishing the principle of equal insurance coverage for psychiatric treatment with the rest of medicine.Stigma is also present at all levels of medical education. Physicians in training are actively discouraged from pursuing psychiatry as a career. I remember medical school faculty saying, “Psychiatry? Why would you want to do that?” Some of the most overt signs of public stigma are the obstacles encountered by community mental health workers in finding suitable housing, employment, and rehabilitation opportunities for their clients. Self-stigma is one reason that we, as providers of care, have such a difficult time engaging individuals in treatment, which leads to high no-show rates in community clinics. Stigma explains why some individuals who are disabled by serious mental illness—and families who are distressed by an ill family member—do not seek care. Peer support services are an effective way to address self-stigma.Will we ever see an end to the stigma that is associated with mental illness? No, not as long as there are untreated, delusional, disheveled, threatening, homeless individuals on our streets and in high-profile media examples of violence. The elimination of stigma is unlikely despite the best efforts to educate the public and to empower individuals in their recovery process. Great progress can be made to counter stigma by expanding access to effective care and by improving our own attitudes—that is, the attitudes of mental health professionals—as we encounter our patients, in our use of language about individuals with mental illness and mental illness itself, and in communications among ourselves and with our patients and at all levels in the treatment system.Sheppard Pratt Health System, Baltimore FiguresReferencesCited byDetailsCited bySpecial IssueCommunication Strategies to Counter Stigma and Improve Mental Illness and Substance Use Disorder PolicyEmma McGinty, Ph.D., M.S., Bernice Pescosolido, Ph.D., Alene Kennedy-Hendricks, Ph.D., Colleen L. Barry, Ph.D., M.P.P.2 October 2017 | Psychiatric Services, Vol. 69, No. 2Criminal Activity or Treatable Health Condition? News Media Framing of Opioid Analgesic Abuse in the United States, 1998–2012Emma E. McGinty, Ph.D., M.S., , Alene Kennedy-Hendricks, Ph.D., Julia Baller, Ph.D., Jeff Niederdeppe, Ph.D., Sarah Gollust, Ph.D., Colleen L. Barry, Ph.D., M.P.P.1 December 2015 | Psychiatric Services, Vol. 67, No. 4The Stigma ComplexAnnual Review of Sociology, Vol. 41, No. 1News Media Framing of Serious Mental Illness and Gun Violence in the United States, 1997-2012American Journal of Public Health, Vol. 104, No. 3Nurse Education Today, Vol. 34, No. 3Effects of News Media Messages About Mass Shootings on Attitudes Toward Persons With Serious Mental Illness and Public Support for Gun Control PoliciesEmma E. McGinty, M.S., Daniel W. Webster, Sc.D., M.P.H., and Colleen L. Barry, Ph.D., M.P.P.1 May 2013 | American Journal of Psychiatry, Vol. 170, No. 5 Volume 63Issue 10 October 2012Pages 953-953 Metrics PDF download History Published online 1 October 2012 Published in print 1 October 2012

Training practice nurses to improve the physical health of patients with severe mental illness: Effects on beliefs and attitudes

Annual health checks are recommended for patients with severe mental illness (SMI) as they are at high risk of cardiovascular disease. Ideally, these health checks should be carried out in primary care. Practice nurses are already competent in carrying out physical health checks, but might have misconceptions about mental illness, which is a barrier to offering the service. We used a mirror imaging study to establish the effectiveness of a training package for practice nurses that aims to address common misconceptions about the physical health of people with SMI. This 2-hour training package (Northampton Physical Health and Wellbeing Project) was delivered to eight practice nurses. Their misconceptions and beliefs were assessed before and after training. Motivation to work with community mental health workers was assessed after training. The practice nurses involved in the study rejected commonly held misconceptions about the physical health of people with SMI after training. Their attitudes towards their role in providing health checks appeared to be modified in a positive direction. Their motivation to work with community mental health workers also seemed to be enhanced. The Northampton Physical Health and Wellbeing Project training was effective in modifying practice nurses' misconceptions about physical health in people with SMI.

The stigma of mental illness in Sri Lanka: the perspectives of community mental health workers

Objective: To gain an understanding of how stigma associated with mental illness exists in Sri Lanka from the perspectives of community mental health workers and to explore their views on how stigma may be tackled in the future. Methods: Purposive and snowball sampling methods were used to recruit community mental health workers for this small qualitative study. Nine semi-structured interviews were conducted using an interview guide. The data were analyzed using the ‘thematic framework’ approach. Results: Stigma is associated with the family unit; there is strong faith in traditional beliefs and healers; and negative attitudes and behaviours exist regarding mental illness. Community mental health workers are influenced by poor health seeking behaviours and low prioritization of mental health services in the country. Conclusions: This study provides insight into how stigma exists in Sri Lankan communities and influences the work of community mental health workers. Findings reinforce existing international health literature and thus convey that stigma is an important issue that must be tackled globally. Implications: Community mental health workers can contribute to reducing stigma by increasing awareness of mental illness in various ways but increasing the availability of services within Sri Lanka is also a key to reducing stigma.

Transcultural issues in the dynamics of a Balint clinical reflection group for community mental health workers

The author presents transcultural issues in the content, process, and group dynamics of consecutive meetings of a Balint clinical reflection group for community mental health workers at Inala, Australia. Balint work and the context and evolution of the group process are briefly described, as is the consultative research methodology. The process of a Balint group meeting is reported in detail, following the author's consultation with group members. The collaborative work of a culturally diverse team of mental health professionals is examined in the context of discussion of a practitioner-patient relationship in which transcultural, gender, and family conflicts were the focus of affective and cognitive dissonance. For mental health workers engaging with communities of cultural diversity, Balint reflection groups can facilitate insight into cultural countertransferences that adversely affect clinical work. The group served to support the caseworkers' engagement with patients of different cultures, and provided a safe environment for the creative consideration and exploration in fantasy of the emotional pressures and complex ethical dilemmas related to boundaries in transcultural client-practitioner relationships, including those in which open discussion would otherwise be avoided.

Introducing peer support work in Latin American mental health services

In the course of implementing a recently funded network of hubs for building capacities in mental health service development, training, and research (RedeAmericas), the peer support workers are being introduced into the mental health workforce in three Latin American countries for the very first time. They will be part of a team, along with community mental health workers, that provides a modified Critical Time Intervention to individuals with severe psychiatric disorders living in the community. This article reviewed the background of this increasingly widespread development, and discussed its merits, as well as potential obstacles within local contexts.

Identifying Spirituality in Workers: A Strategy for Retention of Community Mental Health Professionals

ABSTRACT This study examines the relationship between workplace spirituality and intention to leave employment among community mental health workers. The study uses a cross-sectional self-administered survey of 403 direct service workers at the 20 participating community mental health centers in the state of Kansas. Results support the effect of perceived workplace spirituality on intention to leave and how intention to leave is moderated by degree of spirituality. Study results highlight how workplace spirituality can be viewed as a crucial factor that human service organizations can use to empower their workers. A recommendation for future research is to identify workplace spirituality as a factor for organizational transformation.