Contemporary Mental Health Research Articles

Clinical assessment and treatment of suicidal risk: A critique of contemporary care and CAMS as a possible remedy.

There is a significant need to improve clinical practices related to suicidal patients within contemporary mental health practice. It is argued that there is a general over-reliance on psychotropic medications and the use of inpatient psychiatric hospitalizations for suicidal risk. This reliance is

Contemporary mental health care and the role of psychiatrists.

Contemporary mental health care and the role of psychiatrists.

Doing what we can, but knowing our place: Being an ally to promote consumer leadership in mental health.

Consumer participation in all aspects of mental health services is clearly articulated as an expectation of contemporary mental health policy. Consumer leadership has been demonstrated to be beneficial to mental health services. Barriers to implementation have limited the realization of this goal. In this discursive paper, we argue that non-consumers who support consumer partnerships and leadership (known as 'allies') have an important role to play in facilitating and supporting consumers in leadership roles. Allies currently have more potential to influence resource allocation, and might be viewed more credibly by their peers than consumer leaders themselves. We call for allies to ensure their role is one of support and facilitation (doing what they can), rather than directing the content or speaking on behalf of the consumer movement (knowing their place). In the present study, we address the importance of allies for the consumer movement. It proposes some 'rules of engagement' to ensure that allies do not intentionally or otherwise encroach on consumer knowledge and expertise, so that they maintain the important position of supporting consumers and facilitating the valuing and use of consumer knowledge, expertise, and ultimately, leadership.

Mental health support workers: Profession and professionalization

ABSTRACTThe mental health services in Aotearoa New Zealand, have changed significantly since the late 1990s. Community services have expanded, and the role of the mental health support worker has developed and grown to be a significant presence in the mental health and disability workforce. Despite this, the role is minimally discussed, both in Aotearoa New Zealand, and internationally. In December 2014, Auckland University of Technology (AUT) hosted a panel presentation and discussion at the then Department of Psychotherapy & Counselling Forum. This article coalesces the contributions of the presenters at this panel discussion. Consideration is given to the development of the role and education of support workers, the environment in which they work, and the contemporary mental health support work workforce. Two examples of professionalization, with regard to different forms of registration, contribute to the discussion. A tentative conclusion is made that support workers, their employers, and the people they support would all benefit through some form of professionalization, standardization, and recognition.

Mental Health Act Assessments – Professional Narratives on Alternatives to Hospital Admission

This article draws on themes derived from research conducted as part of a doctoral study, using Framework Analysis, in which fifteen mental health professionals were involved in nine Mental Health Act assessments in the UK. In this work, risk is explored in terms of the social context, using a social constructionist perspective, in which concepts of ‘social crisis/mental illness’, professional negotiations and social capital are explored. The key findings highlighted: the social constructions of service users’ worlds, as presented by the Approved Social Workers (ASWs) and Home Treatment Professionals (HTPs), were notably different; the negotiations between the ASWs and HTPs provided the ASWs with a number of roles including negotiator, deal-maker and decision-maker; and the service user’s social network and the provision of home treatment showed that the ‘treatments’ provided can be seen as a shared role. Finally, the implications for contemporary mental health social work practice are presented.

Neural Substrate of Group Mental Health: Insights from Multi-Brain Reference Frame in Functional Neuroimaging.

Contemporary mental health practice primarily centers around the neurobiological and psychological processes at the individual level. However, a more careful consideration of interpersonal and other group-level attributes (e.g., interpersonal relationship, mutual trust/hostility, interdependence, and cooperation) and a better grasp of their pathology can add a crucial dimension to our understanding of mental health problems. A few recent studies have delved into the interpersonal behavioral processes in the context of different psychiatric abnormalities. Neuroimaging can supplement these approaches by providing insight into the neurobiology of interpersonal functioning. Keeping this view in mind, we discuss a recently developed approach in functional neuroimaging that calls for a shift from a focus on neural information contained within brain space to a multi-brain framework exploring degree of similarity/dissimilarity of neural signals between multiple interacting brains. We hypothesize novel applications of quantitative neuroimaging markers like inter-subject correlation that might be able to evaluate the role of interpersonal attributes affecting an individual or a group. Empirical evidences of the usage of these markers in understanding the neurobiology of social interactions are provided to argue for their application in future mental health research.

Reimagining the Cuckoo's Nest.

One Flew Over the Cuckoo's Nest (1962) by Ken Kesey and The Devil in Silver (2012) by Victor LaValle are two novels that focus on mental hospitalization as a medical and social practice. Published fifty years apart, however, the books possess important differences in setting, method, and message reflecting the times that spawned them. The purpose of this paper is to examine the changing documentary and metaphorical uses of the asylum novel by comparing an iconic work in the genre with a respectful, but divergent, successor. What emerges from this comparison is an appreciation of the literary conventions shared by Kesey and LaValle but also the ingredients that separate their work. Whereas Kesey produced an enduring tribute to the virtue of nonconformity, LaValle's social criticism expresses itself as a disturbing portrayal of class-based disparities and administrative dysfunction inside the contemporary American mental health system.

Therapeutic Social Control of People with Serious Mental Illness: An Empirical Verification and Extension of Theory

Mental health services and psychiatric professional values have shifted in the past several decades toward a model of client autonomy and informed consent, at least in principle. However, it is unclear how much has changed in practice, particularly in cases where client behavior poses ethical challenges for clinicians. Drawing on the case of clients’ sexual behavior and contraception use, we examine whether sociological theories of “soft” coercion remain relevant (e.g., therapeutic social control; Horwitz 1982) in contemporary mental health treatment settings. Using structured interview data from 98 men and women with serious mental illness (SMI), we explore client experiences of choice, coercion, and the spaces that lie in between. Patterns in our data confirm Horwitz’s (1982) theory of therapeutic social control but also suggest directions for updating and extending it. Specifically, we identify four strategies used to influence client behavior: coercion, enabling, education, and conciliation. We find that most clients’ experiences reflect elements of ambiguous or limited autonomy, wherein compliance is achieved by invoking therapeutic goals. However, women with SMI disproportionately report experiencing intense persuasion and direct use or threat of force. We argue that it is critical to consider how ostensibly noncoercive and value-free interventions nonetheless reflect the goals and norms of dominant groups.

Family inclusion in mental health services: Reality or rhetoric?

Contemporary mental health policies require family inclusion in the design, implementation and evaluation of services. This scoping review considers the factors in mental health practice which either mediate or promote family inclusion. A wide range of factors are reported to obstruct family inclusion, while a smaller number of studies report that meaningful family inclusion rests on a partnership approach which values the input of families and services users. When it comes to family inclusion, there is a gap between policy and service delivery practice. Changes in service delivery attitudes, values and culture are necessary to meaningfully and systematically include families and service users.

Factors predicting recovery from suicide in attempted suicide patients.

The aim of this study was to explore the factors predicting suicide recovery and to provide guidance for healthcare professionals when caring for individuals who have attempted suicide. The high rate of suicide is a global health problem. Suicide prevention has become an important issue in contemporary mental health. Most suicide research has focused on suicidal prevention and care. There is a lack of research on the factors predicting suicidal recovery. A cross-sectional design was adopted. A correlational study with a purposive sample of 160 individuals from a suicide prevention centre in southern Taiwan was conducted. The questionnaires included the Brief Symptom Rating Scale-5, Suicidal Recovery Assessment Scale and Beck Hopelessness Scale. Descriptive statistics and linear regressions were used for the analysis. The mean age of the participants was 40.2years. Many participants were striving to make changes to create a more stable and fulfilling life, had an improved recovery from suicide and had a good ability to adapt or solve problems. The linear regression showed that the Beck Hopelessness Scale scores (ß=-.551, p<.001) and Brief Symptom Rating Scale-5 (ß=-.218, p=.003) and past suicidal behaviour (ß=-.145, p=.008) were significant predictors of individuals' recovery from suicide. They accounted for 57.1% of the variance. Suicidal individuals who have a lower level of hopelessness, a better ability to cope with their mental condition and fewer past suicidal behaviours may better recover from suicide attempts. The nurses could use the results of this study to predict recovery from suicide in patients with attempted suicide.

'Your experiences were your tools'. How personal experience of mental health problems informs mental health nursing practice.

Introduction 'Expertise by experience' is a highly valued element of service delivery in recovery-oriented mental health care, but is unacknowledged within the mental health nursing literature. Aim To explore the extent and influence of mental health professionals' personal experience of mental ill health on clinical practice. Method Twenty-seven mental health nurses with their own personal experience of mental ill health were interviewed about how their personal experience informed their mental health nursing practice, as part of a sequential mixed methods study. Results The influence of personal experience in nursing work was threefold: first, through overt disclosure; second, through the 'use of the self as a tool'; and third, through the formation of professional nursing identity. Discussion Mental health nurses' experience of mental illness was contextualized by other life experiences and by particular therapeutic relationships and clinical settings. In previous empirical studies, nurses have cited personal experience of mental illness as a motivator and an aspect of their identity. In this study, there was also an association between personal experience and enhanced nursing expertise. Implications for practice If drawing on personal experience is commonplace, then we must address the taboo of disclosure and debate the extent to which personal and professional boundaries are negotiated during clinical encounters.

The current European status

In the last two decades, both early detection (ED) and early intervention (EI) programs and services have gradually become important and innovative components of contemporary mental health care. However, it is unclear whether ED/EI programs have consistently been implemented throughout Europe.Here, we report results of the EPA Survey on ED/EI Programs in Europe in 2016.A 16 item questionnaire was sent to representatives (presidents and secretariats) of 40 EPA National Societies/Associations (NPAs), representing 37 countries. The representatives were also invited to recommend a person for additional information about ED/EI services/programs in the country.The response rate was 59.4% (22 NPAs). Fifteen out of 28 NPAs were from developed, and 7 out of 8 from economies in transition. ED/EI services have been implemented in 54.5% of the included countries, mean duration 10.0 ± 4.9 yrs. Mostly, neither ED were separated from EI, not the adults from adolescents. National plans to develop ED/EI were reported in four countries. Although national guidelines for schizophrenia exist in most of the countries (73.9%), specific chapters focusing on ED/EI and/or at-risk mental states were not included in the majority of them. Duration of untreated psychosis was unknown in 63.6%. In those who gave the estimation it was 12–100 weeks (median in weeks: 33 developed economies; 44 economies in transition).The fields of ED/EI have been unequally developed across Europe. Still, many NPAs are without the development plans. EPA and its Sections should address the identified gaps and suggest how to harmonize services for the full range of assessments and interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Family-focused practice within a recovery framework: practitioners\u2019 qualitative perspectives

BackgroundFamily-focused practice (FFP) is an effective approach to supporting individuals with mental illness. ‘Recovery’ is also central to contemporary mental health care. However, there is a dearth of evidence about how the two concepts are related and subsequently implemented in practice. The aim of this study was to explore practitioners’ understandings and practices of FFP within a recovery framework.MethodsPurposive/snowball sampling was used to recruit and conduct qualitative interviews with 11 mental health practitioners in rural Australia. Concurrent sampling and data collection were informed by thematic analysis and continued until data saturation was reached.ResultsParticipants found it difficult to articulate their understandings of FFP within a recovery framework. Nonetheless they were able to describe practices that embodied family-focused recovery. Barriers to such practices included medical models of care, where there are often a shortage of skilled staff and high demands for care. Stigma (self and from others) and confidentiality were also identified as barriers to involving family members in recovery focused care.ConclusionsFamily-focused recovery care is a priority in many high-income countries. A family-focused recovery framework is needed to assist service planners, practitioners, family members and those with mental health needs and ensure such care is embedded within practice guidelines.

Psychoeducation for bipolar disorder: A discourse analysis.

Psychoeducation has become a common intervention within mental health settings. It aims to increase people's ability to manage a life with a long-term illness. For people with bipolar disorder, psychoeducation is one of a range of psychosocial interventions now considered part of contemporary mental health practice. It has taken on a 'common sense' status that results in little critique of psychoeducation practices. Using a published manual on psychoeducation and bipolar disorder as its data, Foucauldian discourse analysis was used in the present study for a critical perspective on psychoeducation in order to explore the taken-for-granted assumptions on which it is based. It identifies that the text produces three key subject positions for people with bipolar disorder. To practice self-management, a person must: (i) accept and recognize the authority of psychiatry to know them; (ii) come to see that they can moderate themselves; and (iii)see themselves as able to undertake a reflexive process of self-examination and change. These findings highlight the circular and discursive quality to the construct of insight that is central to how psychoeducation is practiced. Using Foucault's construct of pastoral power, it also draws attention to the asymmetrical nature of power relations between the clinician and the person with bipolar disorder. An effect of the use of medical discourse in psychoeducation is to limit its ability to work with ambivalence and contradiction. A critical approach to psychotherapy and education offers an alternate paradigm on which to basis psychoeducation practices.

Promoting recovery-oriented mental health nursing practice through consumer participation in mental health nursing education

Background: Developing recovery-oriented services, and ensuring genuine consumer participation in all aspects of services are central components of contemporary Australian mental health policy. However, attitudes of mental health professionals present a significant barrier. Given the positive impact of education on health professionals’ attitudes, particularly when consumers are involved, further exploration of consumer involvement in education is required.Aims: To enhance understanding of the role consumers can play within mental health nursing education.Method: A qualitative exploratory project was undertaken involving individual interviews with mental health nurse academics and consumer educators.Results: Two main themes emerged from nurse participants: Recovery in action, consumer educators were able to demonstrate and describe their own recovery journey; and not representative, some participants believed consumer educators did not necessary reflect views and opinions of consumers more broadly. Two main themes for consumers were: the truth about recovery, consumer educators demonstrated recovery as an achievable goal; and not a real consumer, where health professionals to dismiss the consumer experience as unrepresentative and therefore not credible.Conclusions: Consumer participation can contribute positively to nurse education, however representativeness presents a major barrier, potentially enabling nurses to dismiss experiences of consumer academics and educators as exceptional rather than typical.

Moving Beyond Routines in Teaching and Learning: Releasing the Educative Potential of Published Eating Disorder Memoirs

ABSTRACTLearning from the lived experience of disordered eating is vital for contemporary mental health practitioners. While mental health practitioners need to understand the psycho-biological issues that impact the person and family with an eating disorder, there is much about this complex condition that eludes and escapes a bio-medical perspective. Use of an aesthetic lens on the issue can illuminate various challenges, tensions and insights that people with disordered eating experience along the journey of their ill-health and on to their recovery, but which often remain unstated in the clinical context. Scholars within the creative arts discipline are experts in making judgements about the quality of artworks they encounter and have highly developed aesthetic knowing. Yet, the central skills and knowledges embodied in creative arts activity are not widely utilized outside that sphere. This article reports on how aesthetics can be applied to sensitize mental health practitioners to appreciate the lived experience of a mental health challenge such as an eating disorder. Such mental health practitioners play an important role in the health service, yet the widespread diffusion of the bio-medical model into mental health, once characterized for its equal emphasis on the psycho-social-cultural, has led to criticisms of an over-focus on illness identification, at the expense of accommodating the meanings of subjective and unique experiences of mental health, struggle and recovery. Using Kate Grenville's typology of the elements of effective creative writing, we show how these elements contribute to the aesthetic power and impact of particular eating disorder memoirs.

Improving exchange with consumers within mental health organizations: Recognizing mental ill health experience as a 'sneaky, special degree'.

Stigmatizing views towards consumers may be held even by those working within mental health organizations. Contemporary mental health policies require organizations to work collaboratively with consumers in producing and delivering services. Using social exchange theory, which emphasises mutual exchange to maximise benefits in partnership, the current study explores the perspectives of those working within organizations that have some level of consumer leadership. Interviews were conducted with 14 participants from a range of mental health organizations. Data were transcribed, and analyzed using thematic analytic and discursive psychological techniques. Findings suggest stigma is still prevalent even in organizations that have consumers in leadership positions, and consumers are often perceived as less able to work in mental health organizations than non-consumers. Several discourses challenged such a view - showing how consumers bring value to mental health organizations through their expertise in the mental health system, and their ability to provide safety and support to other consumers. Through a social exchange theory lens, the authors call for organizations to challenge stigma and promote the value that consumers can bring to maximize mutual benefits.

Unheard voices: researching participation in social work

ABSTRACTThe article draws attention to the loss of contract power of people, especially those with mental disabilities. It shows a gap between policies and ideology of participation on the one hand and lived experiences of participation practices in the care proceedings’ systems on the other. Users’ participation seems to be a trademark of contemporary EU social policy or mental health policy, while children’s participation is the most emphasised part of child-friendly justice discourse, but the question arises whether they really are in place. The national and European research projects conducted by the author and her colleagues in the last years are used to emphasise the most problematic points, but also innovative social work and advocacy practices. The central focus of the article is therefore the author’s recent EU research project ‘Access to Justice for Children with Mental Disabilities’, which has addressed the participation of children with mental disabilities in all stages of the legal processes. In the case of Slovenia, these are mainly taking the place at centres of social work. The findings showed that in spite of the progress towards participation of children in general in social care decisions, children with mental disabilities remain virtually invisible.

Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency by Neely Laurenzo Myers

Neely Laurenzo Myers, Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville: Vanderbilt University Press, 2015. 208 pp.Recovery has been a dominant paradigm shaping mental health policy in United States since turn of millennium. A treatment philosophy that emerged from disaster of deinstitutionalization and disappointment of psychopharmaceutical revolution, it draws on sources eclectic as antipsychiatry, psychiatric survivors and consumer rights movements, and psychosocial rehabilitation (Braslow 2013). Recovery advocates envision a new system of care that produces citizens no longer doomed by hopelessness of biological reductionism, nor dependent on social services. The central precepts of have been summarized as: renewing a sense of possibility, regaining competencies, reconnecting and finding a place in society, and repairing disruptions in self and career (Hopper 2007). The role of people with lived experience of mental illness, or peers is central to this approach at every level, from research, policy-making, and advocacy to frontline care provision. The movement's ostensibly radical core concepts of empowerment, self-determination, and freedom of (Myers 2015:7) were enshrined in George W. Bush's Presidential New Freedom Commission of 2003, an unfunded set of recommendations that many states have subsequently tried to implement. Critics see this embrace of by neoliberal reformers as a move to withdraw care and services from chronically mentally ill by declaring them recovered and substituting care with choice (Braslow 2013, Myers 2015:8).This is point of departure of Neely Myers's powerful book, in which she ethnographically documents how one community mental health agency in urban US, called Horizons, navigated shift from mental health services to recovery-oriented care through creation of a peer-led treatment program. Myers documents her own intimate journey as she developed relationships with staff and clients, or members, of agency. She provides a contextualized account of stark realities of living with severe, chronic mental illness and poverty in urban US, revealing promises, pitfalls, complexities, and contradictions of contemporary mental health reform and social abandonment members and staff worked against. Her detailed observations, poignant reflections, and incisive critique create a compelling account and an important contribution to medical anthropology and community psychiatry. Recovery's Edge is a story of relationships, therapeutic and traumatic, personal and professional, ruptured and repaired, lost and longed for, and often tragically unattainable.Myers's central thesis is that moral agency, the ability to be recognized as a 'good' person in a way that makes possible intimate connections with others, is oft-overlooked driver of recovery (13). Mental health crisis results in an initial loss of moral agency. This loss is perpetuated by ways people with mental illness are treated, both by society in general and by traditional mental health programs in particular. As a result, those with chronic, severe mental illness remain isolated and marginalized.Chapter 2, No Direction Home, establishes context with an account of history of deinstitutionalization and never-delivered promise of community-based care. A major theme introduced here is contradictions and double binds members faced as they sought to rebuild their lives despite recurring mental health crisis. One classic trap they faced was a dependence on Social Security insurance and Medicaid to pay for their high healthcare costs, yet full time, competitive employment would disqualify them of these benefits without providing a viable alternative. Members cycled through institutional circuit, including hospitals, jails, prisons, shelters, nursing homes, outpatient day programs, and streets. …

The treatment of madness in the nineteenth and twentieth centuries: discourses about curability in Spanish mental health care, 1890-1917.

This article studies the discourses about curability constructed by Spanish mental health practitioners in the transition from the nineteenth to the twentieth century. While in the 1870s and 1880s the predominant discourse promoted by doctors attached to private institutions was extremely optimistic, it subsequently changed and became more pessimistic regarding treatment outcomes. However, given phrenopathists' professional needs, they continued to profess more or less unshakeable confidence in the therapeutic abilities of psychiatry. The reception of new nosologies, such as Kraepelin's, depended in part on contemporary mental health practitioners' stance on curability and was accompanied by ambivalence.