Building a bridge of trust: collaborative assessment with a person with serious mental illness

Collaborative assessment utilizes psychological testing to help people make positive changes in their lives. Limited research has evaluated the utility of collaborative assessment for persons with serious mental illness. This case example uses the Personality Assessment Inventory to illustrate the usefulness of collaborative assessment with a person with serious mental illness. This approach informed not only diagnostic considerations but also revealed the client's current level of distress, contributed to enhanced therapeutic alliance, and directly pointed to psychiatric rehabilitation strategies.     

The physical activity experiences of men with serious mental illness: Three short stories

ObjectivesAlthough a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users’ voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI).MethodsAn interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants’ voices.ResultsWe present three short stories in an effort to communicate participants’ personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness.ConclusionsFor us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions.     

Emotional Intelligence and resilience in mental health professionals caring for patients with serious mental illness

Emotional Intelligence (EI) and resilience may be considered as prerequisites for mental health professionals caring for patients with serious mental illness (SMI), since they are often exposed to severe emotional stress during daily work. Accordingly, this cross-sectional study assessed both EI and resilience and their interrelationship in 61 individuals belonging to an assertive outreach team for patients suffering from SMI compared 61 control subjects without healthcare-related working conditions. EI was assessed by means of the German version of the Mayer-Salovey-Caruso-Emotional-Intelligence Test (MSCEIT), resilience was assessed using the German version of the Resilience Scale. Both groups showed an average level of EI in all categories of the MSCEIT and indicated high levels of resilience. They did not differ significantly from each other, neither in terms of EI nor resilience. Correlation analysis revealed a positive association between EI and resilience, albeit small in magnitude. Our results suggest that mental health professionals are not more resilient and therefore not more ‘protected’ from stressors than the general population. Though this finding warrants cautious interpretation, the positive correlation between EI and resilience suggests that EI may be a potential target for education and training in order to strengthen resilience even in healthy individuals and vice versa.     

Pre-arrest diversion of people with mental illness: Literature review and international survey

Mental health diversion is a process where alternatives to criminal sanctions are made available to persons with mental illness (PMI) who have come into contact with the law. One form of mental health diversion is pre-arrest, in which the police use their discretion in laying charges. Concomitant with the growth of pre-arrest diversion programs is a growing body of research devoted to the phenomenon. The purpose of this paper is to review the existing literature of pre-arrest diversion, and to report the results of an international survey of pre-arrest diversion programs we conducted to identify evidence-based practices. On the basis of our review and survey, we note that successful pre-trial programs appear to integrate relevant mental health, substance abuse and criminal justice agencies by having regular meetings between key personnel from the various agencies. Often, a liaison person with a mandate to effect strong leadership plays a key role in the coordination of various agencies. Streamlining services through the creation of an emergency drop-off center with a no-refusal policy for police cases is seen as crucial. While there is some indication that mentally ill offenders benefit from their participation in this form of diversion, the evaluative literature has not yet achieved the "critical mass" necessary to create generalizable, evidence-based knowledge. The absence of generally agreed-upon outcomes could lead to the inequitable application of basic principles of diversion. We suggest that indicators, benchmarks, and outcomes must be agreed upon if a comprehensive understanding of pre-arrest programs is to emerge.     

Understanding successful community living by individuals with serious and persistent mental illness.

34 volunteers diagnosed as chronically mentally ill were administered a questionnaire to evaluate what factors were important in preventing rehospitalization. The volunteers were divided into two groups based on their relapse history. Analysis showed the nonrelapse group were more likely to attribute factors such as in-home therapy, taking medication, and having fun with friends than did the group who had experienced at least one relapse in the past 24 months.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

ObjectivesIt has been suggested that mental illness threatens identity and sense of self when one's personal story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy, therefore, is to allow individuals to re-story their life in a more positive way which facilitates the reconstruction of a meaningful identity and sense of self. This research explores the ways in which involvement in sport and exercise may play a part in this process.DesignQualitative analysis of narrative.MethodWe used an interpretive approach which included semi-structured interviews and participant observation with 11 men with serious mental illness to gather stories of participants’ sport and exercise experiences. We conducted an analysis of narrative to explore the more general narrative types which were evident in participants’ accounts.FindingsWe identified three narrative types underlying participants’ talk about sport and exercise: (a) an action narrative about “going places and doing stuff”; (b) an achievement narrative about accomplishment through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined with opportunities to talk about those experiences. We note that these narrative types differ significantly from—and may be considered alternatives to—dominant illness narratives.ConclusionThis study provides an alternative perspective on how sport and exercise can help men with serious mental illness by providing the narrative resources which enabled participants to re-story aspects of their lives through creating and sharing personal stories through which they rebuilt or maintained a positive sense of self and identity.     

Microaggressions: The experience of individuals with mental illness

The main objective of the study was to investigate the types of microaggressions experienced by individuals with mental illness (MI) based on this marginalized group status. This study included 4 focus groups, comprised of 18 individuals diagnosed with MI(es). The researchers qualitatively identified four themes (a) conveying stereotypes against individuals with MI (i.e. assumptions of inferiority, seeking attention or being dramatic, assumptions of coldness, bringing MI upon themselves, and using MI as an excuse), (b) invalidating the experience of having a MI (i.e. doubting existence, doubting severity, and avoiding acknowledgment of the MI), (c) defining a person by their disorder, and (d) misuse of terminology. Participants revealed the main perpetrators (i.e. family, friends, and professionals) of the microaggressions. The researchers discuss: how the identified themes compare to the three categories of microaggressions (i.e. microinsults, microinvalidations, and microassaults); similarities and differences between the current results and previously identified racial, gender, and sexual orientation microaggressions perpetrated in daily interactions and in therapeutic settings; and the perpetrators of microaggressions as they relate to prejudicial attitudes and social distance. Finally, the authors make recommendations for practitioners and researchers.     

Disruption and reconstruction: narrative insights into the experience of family members caring for a relative diagnosed with serious mental illness.

The findings of a study investigating carers' accounts about serious mental illness occurring in their family are presented. The narrative form is a primary means of ordering, structuring, and communicating illness experiences, reflecting some of the processes that carers intend to master and understand. Psychotic episodes entail a frightening disruption that forces carers to face fundamental existential, moral, and psychological issues because they call into question the continuity of lives and life-projects. This study has explored how carers articulate the consequences of a devastating experience and turn it into a meaningful event that can in some way be incorporated into the course of their life. Two types of narrative structure were identified. In stories of restitution or reparation, the experience of the event is transformed into phenomena having meaning, occupying a place in carers' lives. In chaotic and frozen narratives, the illness remains a series of random events. The effects on coping of these two narrative types were explored, as well as gender-related themes and beliefs about mastery and control. Therapeutic implications are discussed and also possible connections to other research constructs (for example, Expressed Emotion). It is argued that the concept of illness must be approached from a systemic, multidetermined perspective that includes our narrative constructions.     

Managing a stigmatized identity—evidence from a longitudinal analysis about people with mental illness

Previous research about coping with the stigma of mental illness mostly relied on cross‐sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross‐lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two‐wave panel of people with mental illness (n = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.     

Familiarity with and social distance from people with mental illness: Testing the mediating effects of prejudiced attitudes

The purpose of this study was to examine prejudiced attitudes as a factor associated with social distance from people with mental illness. A total of 289 university students from Greece completed written measures assessing social distance from, prejudiced attitudes about, and familiarity with mental illness. A structural equation model with manifest variables was tested. Participants who reported to be more familiar with mental illness held stronger social care and weaker prejudiced beliefs, and consequently expressed a less strong desire for social distance. Implications of the results and suggestions for future research are outlined. Copyright © 2011 John Wiley & Sons, Ltd.     

Healthcare's greatest challenge: providing services for people with severe mental illness in managed care

The delivery of services for people with severe mental illness (SMI) is described as healthcare's most difficult challenge because SMI patients suffer from the combined effects of conditions that have 1) a chronic course, 2) disabling consequences, and 3) a high risk of poverty. The fundamental advantages of managed care for persons with chronic, disabling conditions are discussed along with an examination of how well these assumptions hold in actual practice for persons with SMI. The legal risks assumed by clinicians in managed care are reviewed, including the inherent risk of discriminating against high cost enrollees, such as patients with SMI. Finally, recommendations are made regarding the measures that might be taken to increase the "match" between the principles of managed care and the specialized needs of people with severe mental illness.     

Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co-occurring substance use disorders

In recent years, jail diversion programs for people with serious mental illness and co-occurring substance use disorders have received increasing attention and have rapidly grown in number. Previous studies suggest that jail diversion programs have the potential to achieve positive outcomes. The present study reports findings from 6 jail diversion programs (3 pre-booking and 3 post-booking) participating in a federally-funded research initiative to assess the effectiveness of jail diversion programs for people with co-occurring disorders. Diverted and non-diverted groups were compared on self-reported outcomes at 12 months following diversion. The findings suggest that jail diversion reduces time spent in jail without increasing the public safety risk, while linking participants to community-based services. Jail diversion costs and the implications of these results for jail diversion programs and future research are discussed.     

The politics of mental illness

What is needed today is a biologically grounded explanation of behavior, one that moves beyond the so‐called mind‐body problem. Yet no solution will be found by philosophers who refuse to learn about how brains and bodies work, or by neuroscientists pursuing experimental research based on outmoded or blatantly anti‐biological theories. Churchland's book proposes a solution: to come by a unified theory of the mind‐brain philosophers have to work together with neuroscientists. Yet Churchland's vision of a unified theory is based on an assumption that, while widely held, may not adequately reflect brain functioning in the production of behavior, namely, the assumption that brain processes represent. The present paper proposes an alternative view, suggesting that patterns of neural activity do not ‘represent’ anything, that brains do not ‘read’ or ‘transform’ representations, and that brains do not require representations to produce goal‐directed behavior. Representations are replaced by self‐organizing neural processes that achieve a certain end‐state of interaction between the organism and its environment in a flexible and adaptive manner. Some of the implications of this view for neuroscientific research and the philosophy of mind are outlined.     

Explanatory models of mental illness: a qualitative study with Emirati future mental health practitioners

Cultural traits have an influence on the person's interpretation of mental illness, the expression of distress and help-seeking attitudes. UAE has a unique sociological context where Eastern and Western traditions coexist. Given that there is a scarcity of mental health studies and no study on the explanatory models (EM) of mental illness, it is important to examine the connections between Western biomedical approaches and traditional Emirati illness explanations and how those affect the Emirati EM. In order to explore the influence of those connections on Emirati future clinicians, the present study focuses on young Emirati psychology students in a Western-oriented university. In-depth interviews were performed regarding their EM. The results highlighted the influence of cultural traits on the EM formulation, the importance of family in the Emirati society and the impact of the UAE socio-economic and religious reality in forming the participants’ beliefs on mental illness.