A review of: “Quality of life and mental health services”

Joseph Oliver, Peter Huxley, Keith Bridges and Hadi Mohamad (1996) Quality of Life and Mental Health Services, London: Routledge, $16.99 (pb)     

The “religiosity gap” in a clinical setting: experiences of mental health care consumers and professionals

ABSTRACT

In Western countries, professionals in mental health care (“professionals”) tend to be less religious than “consumers”. This qualitative study explores the meaning of this “religiosity gap” for professionals and consumers in mental health care. Both a regular, secular and a Christian clinic in the Netherlands participated in this study. Content analysis was applied to 35 consumer interviews and 18 interviews with professionals. Consumers reported negative experiences (e.g., perceived disrespect and a lack of confidence) and/or negative expectations (e.g., misunderstanding and misinterpretation) related to a religiosity gap. They also mentioned advantages of a “religiosity match”, like safety and confidence and appreciated professionals’ religious/spiritual self-disclosure. Professionals in secular care setting tended to avoid religion and spirituality. In both clinics, they tended to neutralise religious/spiritual differences and be reticent in self-disclosure. Professionals are recommended to recognise the relevance of a religiosity gap and to consider different strategies in approaching religion/spirituality.     

“We Are Still Here”: Learning From Native American Perspectives

Counselors’ multicultural competence is often cultivated through 1 graduate-level diversity course. Therefore, it is important to regularly assess multicultural counseling textbook content to ensure accurate representation of the perspectives of members of diverse populations. To this end, the authors interviewed 14 Native Americans to explore their perspectives on subjects related to counseling to inform clinical practice and training. Using consensual qualitative research, the authors identified 10 domains in the data. Cross analysis of the domains revealed 1 general and 29 typical categories. The identified categories have implications for the development of culturally competent clinicians. Implications, limitations, and suggestions for future research are discussed.     

“You have to be mental to jump off a board any way”: Elite divers' conceptualizations and perceptions of mental health

ObjectivesMental health research in elite sport focuses predominantly on mental illness prevalence rates and help-seeking behaviours. Diving has been identified as a sport that generates particular challenges for maintaining mental health, yet has received scant attention from researchers. Therefore, purpose this paper explores what mental health and mental health related behaviours mean for a group of young, elite athletes as conditioned by their peculiar social context as elite athletes.MethodSemi-structured interviews were conducted with purposely sampled eight elite divers aged between 14 and 24 years with between 5 and 16 years of diving experience who have competed in international level diving competitions including Olympic, Common Wealth and World Cup competitions. Interviews were recorded, transcribed verbatim, and analyzed using inductive thematic analysis.ResultsAnalysis identified mental health literacy, experiences of mental health, risk factors, and opportunities for support as themes. Mental health generated negative connotations for participants attributable to knowledge development occurring through personal and vicarious experience of mental illness. Limited knowledge of symptoms of mental illnesses was evident. Participants identified a range of risk-factors inherent in their sport performance and culture revealing a performative and gendered dimension to mental health.ConclusionsOur results indicate the need to recognize the performative nature of mental health for elite divers and therefore social and cultural influences alongside biophysical. Greater efforts need to be made to help improve the overall mental health literacy of elite divers so they may be able to seek the support and treatment they need.     

Detecting “cracks” in mental health service systems: Application of network analytic techniques

This paper argued that problems of coordination and integration of community mental health systems are best approached from a network perspective in which all linkages between agencies are considered simultaneously. Structural coordination and integration can be assessed through the analysis of these linkages. The utility of this approach was demonstrated by deriving a typology of system "cracks" from network analytic constructs. A network analysis of a community mental health service network was then generated to illustrate how these cracks can be empirically identified. It is suggested that mental health planners will find both the network analytic approach and the typology of cracks useful for addressing problems of coordination and integration.     

Joining and leaving a new religious movement: A study of ex-members’ mental health

The impact of membership in new, often socially contested, religious movements (NRMs) on mental health of members and ex-members is still a controversial question in the psychological literature. In the present study, we interviewed 20 ex-members of various NRMs who also completed questionnaires measuring several cognitive (need for closure, world assumptions) and affective-emotional (parental and adult attachment, social relationships, depression) constructs. Ex-members were then compared with current NRM members and with individuals not involved in NRMs. It appeared that NRM membership compensated for some previously existing vulnerabilities reported by members (insecure attachment in childhood, few social relationships, negative life events). However, this supportive effect did not persist after the destabilizing experience of disaffiliation. Yet, ex-members remained strong believers and were very inclined to spirituality.     

Does fear of coercion keep people away from mental health treatment? Evidence from a survey of persons with schizophrenia and mental health professionals

Mental health consumer advocates have long argued that involuntary treatment frightens persons with mental disorder and thus deters them from voluntarily seeking help. We surveyed 85 mental health professionals and 104 individuals with schizophrenia spectrum conditions to assess their experience with and perceptions of involuntary treatment and other treatment mandates. Of the clinicians, 78% reported that overall they thought legal pressures made their patients with schizophrenia more likely to stay in treatment. Regarding involuntary outpatient commitment, 81% of clinicians disagreed with the premise that mandated community treatment deters persons with schizophrenia from seeking voluntary treatment in the future. Of the consumer sample, 63% reported a lifetime history of involuntary hospitalization, while 36% reported fear of coerced treatment as a barrier to seeking help for a mental health problem-termed here "mandated treatment-related barriers to care." In bivariate analyses, reluctance to seek outpatient treatment associated with fear of coerced treatment (mandated treatment-related barriers to care) was significantly more likely in subjects with a lifetime history of involuntary hospitalization, criminal court mandates to seek treatment, and representative payeeship. However, experience with involuntary outpatient commitment was not associated with barriers to seeking treatment. Recent reminders or warnings about potential consequences of treatment nonadherence, recent hospitalization, and high levels of perceived coercion generally were also associated with mandated treatment-related barriers to care. In multivariable analyses, only involuntary hospitalization and recent warnings about treatment nonadherence were found to be significantly associated with these barriers. These results suggest that mandated treatment may serve as a barrier to treatment, but that ongoing informal pressures to adhere to treatment may also be important barriers to treatment.     

The illusion of mental health: in the mind of which beholder?

We reference self-ratings and clinician ratings of childhood anxious symptoms to a third data source well delineated with regard to the pathophysiology of anxiety. A total of 36 children with anxiety disorders and other children were administered yohimbine, an alpha-sub-2-adrenoreceptor antagonist, in response to which anxiety-prone children have blunted output of growth hormone. We assessed neuroendocrine reactions. In general, participants who claimed anxiety that was unconfirmed by clinicians displayed anxiotypic neuroendocrine profiles, whereas those who denied anxiety detected by clinicians did not, suggesting self-report may have had the advantage over clinician ratings in some instances. Nuanced and contextualized conclusions in this area of work are needed. In response to the question "the illusion of mental health: in the mind of which beholder?," we answer "it depends on the sample and the syndrome under study."     

An “issue-focused” model for mental health consultation with groups of teachers

This paper presents and evaluates a model for group mental health consultation with teachers in which sessions are organized around mental health issues rather than cases. The rationale and advantages of the model are explicated and compared with other models of group consultation and group work with teachers. The model incorporates a heavy emphasis on educational preventive measures and is designed to simultaneously satisfy a wide range of consultee needs and to reduce anxiety and defensiveness. Consultant's preparations for the group sessions are highlighted so as to maximize their contribution to the participants' level of involvement, knowledge, skills, confidence, and objectivity. The different roles of the consultant during the session and the variety of techniques employed are described as they relate to group processes and consultation needs. Specific guidelines for the organization of consultation groups and training of group consultants are offered. Evaluation data based on feedback from participants in ten groups are included.     

The rate of “mental rotation” of images: A test of a holistic analogue hypothesis

This paper discusses the analogue-propositional distinction and argues that, given an appropriate understanding of this issue, the question of whether a particular cognitive function is analogue or not is an empirical one. As an example of how the question can be empirically investigated, the proposed analogue operation for mental rotation of images is considered. It is argued that the view that images are rotated in a holistic analogue manner should predict that rotation rate is independent of such factors as the conceptual complexity of the stimulus or of the comparison task. Two experiments are described that investigated the effects of several stimulus and task variables on the apparent rate of “mental rotation” of images in a Shepard-type task. Instead of comparing a stimulus and misoriented probe figure to determine whether they are identical (except for orientation) or mirror images, as was the case in most of previous studies, the present experiments required subjects to judge whether the misoriented probe was a subfigure of the target stimulus. The results showed that the “rotation rate” (i.e., the slope of the RT vs. angle of misorientation function) was influenced by practice, stimulus attributes, and the nature of the comparison task. In particular, when the probe was a “good” subfigure of the reference stimulus, apparent rotation rate was greater. These results are interpreted as indicating that the linear RT vs. angle relation is not due to a holistic analogue rotation of images, as had been supposed, but arises from a more articulated and piecemeal process in which analysis of the stimulus figure interacts with the comparison task.     

Computer technology in mental health care: “Toys” or tools?

An argument is made that applications of on-line computer technology which are truly relevant to decision making constitute the new “tools of the trade” in mental health care delivery.     

Spirituality and mental health among children and youth – a Swedish point of view

There is growing evidence that spirituality and spiritual development are important for the health and mental well-being of children and youth. In individualistic and secularised countries, resources and language adequate for securing this right to spirituality is shrinking. Sweden is regarded as one of the most secularised and individualised countries in the world, and the article argues that Sweden could be described as ‘spiritual illiterate’. Increasing mental ill-health among youth is discussed in relation to a heightened privatisation of religion, ‘state individualism’, and a growing performance culture. It is argued that strong cultural ideals like independence and self-realisation repress children’s and youth’s spirituality and spiritual development. Further research is called for in order to explore the complex interplay between individualisation, spirituality and mental ill-health among children and youth in today’s Sweden.     

Exploring families’ experiences of health: contributions to a model of family health

Child health and developmental outcomes are influenced by the health of the family and the context created. Research suggests symptoms of poor family health (e.g. suboptimal family interactions, parenting stress) yet there is limited understanding of the factors which contribute to robust family health which may unveil opportunities for targeted intervention and family health promotion. The present study examined families’ experiences of family health and factors contributing to family health. We performed a qualitative study using constructivist grounded theory methods to guide our understanding of family health for families with typically developing children aged 5–18. Interviews were conducted in family homes and all members were invited to participate. Data from interviews were transcribed, coded, thematically analyzed, and verified with select families. Ten families, including 10 mothers, 8 fathers, and 15 children participated in the study. Participants described family health as a process of balance, living purposefully, and sharing experiences together in alignment with family identity. Mediating family health were processes of awareness and reflection, and adapting, adjusting, and changing in response to family life including external stress factors. Results highlight the possibility for healthcare practitioners to facilitate families’ self-reflection and awareness about their health in order to mediate family health development.     

Surveys of community attitudes toward mental health facilities: Reflections or provocations?

This paper points out how political motives behind community research may affect the outcome. The case of public opposition to psychiatric halfway houses in Hong Kong is used as an illustration. These mass surveys related to the issue are reviewed to show how the different public opinions expressed may be affected by the objectives, context, sample, and content of the surveys.     

“Sacred Moments”: Social anxiety in a larger perspective

A treatment protocol was developed and piloted to examine whether perception of the sacred dimensions of their lives can be enhanced for people with social anxiety, and if so, whether that has therapeutic benefit. A 10-session manualized group treatment was developed to increase perception of sacredness in various domains of daily life. The treatment is described, as are preliminary results from two pilot groups. The small sample size limits quantitative analysis, but qualitative follow-up interviews, single-case analysis, and case material indicate decreased anxiety over time. Enhanced sense of sacredness appeared useful in broadening attentional focus, interrupting dysfunctional thought patterns, and generating behaviors incompatible with social anxiety. Focusing on sacredness instead of symptoms allowed participants to form supportive interpersonal relationships within the group, providing a corrective experience of social interaction. Although health professionals rarely discuss religion and spirituality with their clients, participants in these pilot groups welcomed the opportunity to do so.     

Special perspective: An immodest proposal: should treating mental health professionals be barred from testifying about their patients?

Notwithstanding ethical rules that address therapeutic and forensic role conflicts for psychologists and psychiatrists, overzealous patient advocacy by therapists, tightened reimbursement for therapy, and a growth market for forensic psychology and psychiatry, have led many therapists to appear willingly as forensic experts on behalf of their patients. Existing ethical rules, as well as other proposed approaches to address this problem, assume that it can be resolved by modest changes in existing practice that permit therapists to testify as long as their testimony avoids psycholegal opinions. This essay questions whether these modest changes can adequately address this problem and advances consideration of a more radical proposal to address this problem, prohibiting therapists from testifying about their patients. © 1998 John Wiley & Sons, Ltd.     

Locus of control as a mediator of the association between attachment and children’s mental health

Locus of control—the expectation that one is in control of one’s outcomes in life—is linked to well-being. The authors explored one of the possible antecedents of locus of control such as secure children’s attachment. The hypothesis was that locus of control acts as a mediator of the association between children’s attachment and their mental health, in terms of depression, anxiety (internalizing problems), and aggression (externalizing problems). Participants were 206 children with ages ranging from 8 to 14 years. The authors obtained data from teachers as well as by self-report. Structural equations modelling yielded significant results for both a direct path from insecure attachment to internalizing problems and an indirect pathway in which locus of control functions as a mediating variable between children’s attachment and internalizing problems. Although the data were consistent with the mediated pathway with regard to internalizing problems, different findings emerged for aggression. Insecure attachment was a significant predictor of aggressive behavior, while locus of control was not a mediator between attachment and aggressive behavior. The authors’ findings confirm the mediating role of the locus of control between attachment and internalizing problems, but not between attachment and externalizing ones.