Mental Agencies Research Articles

Rehab rounds: Predicting readiness and responsiveness to skills training: the Micro-Module Learning Test.

Introduction by the column editors: In the current era of limited funding for mental health services, public and private agencies would benefit from a means of most cost-effectively deploying specialized resources and personnel. Schizophrenia expresses itself in disparate ways—with great variability in psychopathology, response to treatment, psychosocial functioning, course of illness, and neurocognition. Accordingly, better methods for individualizing treatment planning are required to match patients with appropriate services and effectively allocate scarce treatment resources. This month's column describes the Micro-Module Learning Test, an assessment instrument designed to determine readiness for rehabilitation among individuals with serious mental disorders. The authors demonstrate how this measure can help prescribe a balance of skills training and environmental manipulation that maximizes the probability of improving the individual's level of functioning.

Predictors of Hope Among Members of Mental Health Self-Help Agencies

Hope is a key construct for successful community adjustment among those with severe mental illnesses, particularly given the strengths-based recovery model increasingly prevalent in mental health services and in social work. Consumer-run mental health self-help agencies (SHAs) are well suited to fostering hope via their supportive program environments. This study examines factors associated with hope among members of four self-help agencies via a two-stage least squares regression model (N =310). Findings provide evidence of both individual and program-level associations with hope. These findings mirror social work ethical values of focusing on consumer strengths and self-determination, which are primary goals of SHAs.

Guided reflection: a participatory evaluation and planning process to promote recovery in mental health services agencies.

This brief report describes a participatory evaluation and planning process--a "guided reflection"--that mental health services agencies can use to examine the state of recovery awareness and implementation in their organizations. The process revolves around structured small group discussions, identification of agency strengths and weaknesses, and the formation of an agency "recovery action team" to set priorities and plan for change.

Client Initiated Violence Directed Toward Staff: An Exploratory Comparison Between a Rural & an Urban Mental Health Social Service Agency

This is an exploratory comparative study investigating differences in the incidence of workplace client initiated violence between an urban and similar rural mental health service agency. The urban centre is located within 20 minutes of the centre of a metropolitan area whose population exceeds three million. The rural centre is on the outskirts of the largest city (population near 45,000) in a rural county. Findings point to significant differences between rural and urban mental health practice environments where rural practitioners report significantly higher than expected levels of knowledge of other professionals working in threatening conditions, of others who have experienced violence, and of others who have required medical attention for injuries resulting from violence directed toward them by clients. Data points to high rural and urban practitioner levels of experience of threats to themselves and other professionals, experience of risky working conditions, personal experience of violence, and concern about violence. On all variables, with the exception of threatening personal working conditions, rural practitioners report higher percentages of knowledge of, experience with, and concern about client initiated violence than their urban counterparts. Some possible explanations for the findings are put forward to encourage further research.

Psychotropic Medication Prescriptions: An Analysis of the Reasons People with Mental Retardation Are Prescribed Psychotropic Medication

A descriptive analysis was undertaken to determine the reasons people with mental retardation are prescribed psychotropic medication. The psychotropic medications and the reasons for which they were prescribed to 71 adults with mental retardation receiving services from a community mental health and mental retardation agency were recorded. There were a total of 145 psychotropic medications prescribed. Of the 145, 85 medications (59%) were prescribed to treat diagnoses or disorders (or both) for which the medications were intended. Twenty-nine of the 145 medications (20%) were prescribed for reasons that did not match the accepted uses of the medications. Results suggest that prescribing practices for people with mental retardation may not always be valid.

Fitness to drive: The Driver and Vehicle Licensing Agency and the College

Following a few high profile cases involving driving by people with both physical and mental disorders, the Driver and Vehicle Licensing Agency (DVLA) was asked by the Government of the time to review the procedures and standards to define fitness to drive. The new set of standards, as a result, was

EVALUATING THE DEPLOYMENT OF FIPA STANDARDS WHEN DEVELOPING APPLICATION SERVICES

We draw upon various practical experiences of designing and implementing complex systems through a multiagent approach which supports engineering of dynamic open distributed services. The general scope of multiagent system software engineering is reviewed with focus on the analysis and evaluation of certain aspects of the current specification standards provided by FIPA (Foundation of Intelligent Physical Agents). The benefits and drawbacks of a multiagent approach, using the FIPA standards as a benchmark, are evaluated and further illustrated through the deployment of an audio–video entertainment broadcasting (AVEB) system. The development and testing of the AVEB application was part of an EU project called FACTS (acts AC317). A main result of using agent engineering paradigm for complex distributed development, especially apparent in FIPA standards, has been the identification of the usefulness and power of its protocols. The reason for the importance of the protocols in developing multiagent systems (MAS) is it provides a degree of expressing cooperation within MAS architecture. As the protocols stand currently they are not sufficient to capture a complete explicit model of the cooperative requirements in multiagent systems. However, they provide a basis from which to start. We examine this feature of FIPA further in order to evaluate its role as a bridge between the mental agency and social agency requirements in the development of cooperation in multiagent systems.

Theistic Percepts in Other Species: Can Chimpanzees Represent the Minds of Non-Natural Agents?

AbstractThe present theoretical article addresses the empirical question of whether other species, particularly chimpanzees, have the cognitive substrate necessary for experiencing theistic and otherwise non-natural (i.e., non-physical) percepts. The primary representational device presumed to underlie religious cognition was viewed as, in general, the capacity to attribute unobservable causal mechanisms to ostensible output and, in particular, a theory of mind. Drawing from a catalogue of behaviors that may be considered diagnostic of the secondary representations involved in theory of mind (or at least theory of mind precursors), important dissimilarities between humans and other species in the realms of the animate-inanimate distinction (self-propelledness versus mental agency of animate beings), imaginative play (feature-dependent make-believe versus true symbolic play), and the death concept (biological death conceptualization versus psychological death conceptualization) were shown. Differences in these domains support the claim that humans alone possess the foundational and functional representations inherent in religious experiences.

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

The delivery of mental health services in the 21st century: bringing the community back in.

The community mental health movement of the 1960s enjoyed widespread public support but poorly served its intended target population of seriously mentally ill individuals because: (1) its professional values and technology were, at least initially, not well-oriented toward serving people with severe mental illness; (2) organizational structures linking Community Mental Health Centers with State Mental Health Agencies, State Hospitals, and other relevant service agencies were lacking; (3) ideologically driven aspirations diverted energies and resources into diffuse goals related to the achievement of social justice; and (4) performance objectives were not operationally defined or monitored. Since that time professional technologies and organizational linkages have substantially improved, but there has been a loss of public support for safety net services for the least well off, in part due to a general ascendence of individualist market values, declining civic engagement and reduced support for specialized services for the disadvantaged. A new community mental health movement would be less oriented towards stimulating broad community change, and more narrowly focused on building support among decision makers and the public at large to expand the availability of costly but effective and improved services for people with severe and persistent mental illness.

Concerns about the children of psychiatric in-patients – what the parents say

There is an increasing body of research literature investigating the effects of parental mental illness on children. This study investigates the views of psychiatric in-patients on consequences of their admission to hospital and their mental illness for their children. The results suggest that the parents do not readily acknowledge that their children have problems, and that interventional approaches require good liaison between adult mental health services and child-focused agencies.

Negative views of the mother after childhood sexual abuse

In childhood sexual abuse cases, the non-abusing parent (usually the mother) is often seen as colluder, helpless bystander or victim. These negative views may be based on misconceptions about incestuous families and can lead to treatment bias and neglect of the other ‘victims' of abuse. Mental health professionals and support agencies should ensure that the needs of the non-abusing parent are met as well as those of the victim and perpetrator.

Services for offenders with mental impairments: A Texas model

The Texas Council on Offenders with Mental Impairments stands as a model for envisioning and implementing the resolutions to problems of service development and delivery to offenders with mental impairments. Acting upon an uncommon sensitivity to the range of problems experienced by persons incarcerated with mental impairments, consumer groups, elected officials, and agency administrators moved to create the Council. The Council's coalition membership cuts across disciplines and agencies to promote close, effective coordination and collaboration. Most importantly, the Council was conceived, organized, mobilized, and continues to operate with advocacy as its primary guiding principle.

Stepfamily Assessment

The increase in the number of stepfamilies in our soci- ety is reflected in the high number of stepfamilies requesting help in mental health facilities and social agencies. The rationale for developing a model for assessing remarried fam- ilies comes from an awareness of the complexities of remarried fam- ilies and of b e difficulty therapists have in assessing and organizing all relevant information. We do not imply any particular method to assess the families; we are simply suggesting a format which needs to be in the mind of the therapist when interviewing the family or a family member. Our model emphasizes particular aspects of remarried family life that play a crucial role in the successful adjustment of the remarried family, such as the resolution of the previous relationship, the influ- ence of the outside parent, the co-parental relationship, the mobility of the children between households, and the integration of the new partner.

ECONOMIC DEVELOPMENT VS. SUSTAINABLE SOCIETIES: Reflections on the Players in a Crucial Contest

ness and romanticism than do many social scientists and humanists. The most exciting students of Earth's biophysical status learn from one another. Biologists (particularly ecologists), atmospheric specialists, and experts in public health should make their knowledge accessible and useful in local and state forums. Scientists must cease hiding behind walls of objectivity and become advocates of policies that remain consistent with their scientific knowl­ edge. Some (e.g. Ehrlich and Wilson) have been involved for decades, but mostly in national and international arenas. Communities, counties, and states-·perhaps less alluring stages-urgently need good applied science to defend their environments. The science departments of major state universities REFLECTIONS ON SUSTAINABLE DEVELOPMENT 237 could fonn ad hoc oversight teams to scrutinize actions of state environ­ mental agencies and to offer constructive criticism. For decades, ecologists such as Holdgate, Kassas & White (69) have pre­ sented scholarly warnings of intensifying global environmental deterioration. . Malone (97), in 1976, described scientists as linking humanity to natural biosphere. Scientists, well aware of steady contamination of air, water, and soils, must become sophisticated about such critical social issues as population, food security, and access to natural resources. Malone urged scientists to illuminate issues relevant to environmental policy. He praised scientists who preferred the advocacy (97, p. 87). Slobodkin (130) warned that ecology will lose its relevance unless its research is driven by practical questions. Frustrated by failure of politicians to act with common sense on basis . of best available data, Myers (102) asserted that biologists were as com­ petent as economists to engage in policy making. But nonnal science, conducted by thoroughly institutionalized practitioners in laboratories of government, corporations, and universities, emphasizes uncertainty and, therefore, need for more research money. Two decades ago, Dasman (46, p. vii) suggested that need for effective application of ecological principles exceeded need for more research. The values and strategies enunciated by two recent and influential statements on role of science in protecting planet diverge dramatically from arguments of scientists (12, 13, 46, 100-102) who assert that current knowledge is capable of retarding, if not reversing, further deterioration of soils, water, and forests. The Ecological Society of America (ESA) (49) and US National Re­ search Council ( 140) both fashioned powerful cases for massive infusions of research money. ESA's Sustainable Biosphere initiative, launched in 1988, accepted as articles of faith reliance on investigator-initiated research and retention of disciplinary integrity, each of which confonns to research structure of universities. Complexities and uncertainties, rather than avail­ ability of data useful now in defending biosphere, were stressed to justify funding aimed at global change, biological diversity, and sustainable ecological systems (49). Congruent with ESA message were urgent calls by Wilson (150, 151), Holloway (71, p. 12), Resser, Lubchenko & Levin (120), and US National Research Council (140, pp. 37-40) for emergency recruitment of systema­ tists to conduct national inventories of species, especially in remaining tropical rain forests. Ludwig and coauthors (90, pp. 17-18) objected to simplistic assumptions that ignorance is problem (19, pp. 640-42) and that more of such research would yield remedies to resource exploitation. The wild species of Brazil's Pantanal and Atlantic rain forests are plundered and destroyed by squatters and poachers who seek survival and by ranchers, resort developers,

Mourning and mental retardation

Abstract Too often, the grieving needs of the mentally retarded are misunderstood and disenfranchised by both family members and treatment staff. I outline a training program to equip the staff of mental retardation agencies to respond to the special needs of their clientele, as well as a program for the family members of retarded individuals. Interventions with the client themselves are illustrated through a series of case studies illustrating the unique difficulties in the grieving process that can arise from the convergence of ambivalnce, depends, and guilt that complicates the relationships between mentally retarded individuals and many of the people in their lives. In spite of their intellectual limitations, the majority of retarded individuals experience the death and loss as charged with emotional significance and provide a challenge to those who would support them in their grieving.

Breaking New Ground: Shared Supported Housing for People with Mental Health Related Difficulties

This paper describes the establishment by a government mental health support agency of a network of rented houses in which assistance was available to tenants at key times seven days a week during its first two years of functioning. This was the first project in the mental health area in South Australia to involve ‘direct care workers’ in the provision of on-site assistance. They have proved to be an invaluable resource. For tenants it has provided an opportunity to maintain family ties while becoming independent, with some help in resolving day-to-day difficulties available as required. Areas within the scheme which need further discussion and change have been noted and are being addressed systematically by workers and tenants. Similarly, key achievements to be preserved and enhanced are outlined.

Setting up a Client Database1

Database technology is becoming an essential aspect of planning the provision of a quality service. This paper describes the stages involved in establishing a client database in one large mental handicap agency. The critical features for successful operation of a database are outlined and suggestions made for further applications of data managements systems. The impact of an effective information system on the capacity of clinicians to monitor quality of service is discussed. The relevance of this approach to managing information is emphasised in relation to speech and language therapists, psychologists and other Health Care professionals.

Group psychotherapy with mentally retarded adults: Issues related to design, implementation, and evaluation

Although the mental health needs of mentally retarded persons are becoming increasingly acknowledged by service providers, psychotherapy is still neglected as a treatment modality. This paper provides a framework for considering issues related to the design, implementation, and evaluation of group psychotherapeutic endeavors to benefit dually diagnosed clients. A social systems approach to psychopathology is described to illustrate how a variety of potentially treatable aspects of dysfunctioning can be identified and selected as treatment goals for group psychotherapy with mentally retarded individuals. Treatment models are presented to assist in the pragmatic blending of behavioral and psychodynamic interventions that are relevant for conducting group psychotherapy with this population. Administrators and clinicians are provided with a prototype of how to establish and maintain cost-effective linkages between mental health and mental retardation agencies, so that dually diagnosed clients are not excluded from receiving services they need. Finally, process and outcome evaluation strategies are considered which might provide an empirical basis for documenting the effectiveness of group psychotherapy as a viable, nondrug approach to treating psychopathology in mentally retarded individuals.

Policy Development and Public Expenditures in Supported Employment: Current Strategies to Promote Statewide Systems Change

Supported employment for persons with developmental and other severe disabilities has moved rapidly from university-based demonstration projects to the development of comprehensive statewide services delivery systems. This article reports the results of a survey of 27 states that received major systems change grants from the Rehabilitation Services Administration (RSA) to convert traditional day activity programs to supported employment. The results indicate that although mechanisms have been developed to establish a large number of supported employment programs, states are taking a very cautious approach toward converting existing segregated employment settings, funding for ongoing support services is often unavailable, and specific procedures for including individuals with the most severe disabilities are poorly defined. Expenditures for supported employment have risen dramatically. During Fiscal Years 86–88, RSA expenditures approached $75 million, obligations from mental health and mental retardation agencies have increased 460%, and collectively over $214 million has been obligated by federal and state agencies for supported employment.