Infant mental health: A new frontier

This overview is an adaptation of the keynote speech given at the First Annual Conference of the Michigan Association for Infant Mental Health, held in Ann Arbor, Michigan on March 24, 1977. A review of situations found by infant specialists and the statistical evidences of risk for infants suggests some of the components of a community-based support system.     

Correspondence: Mental health care in South Africa

Shame has been an insufficiently studied emotion in psycho-analytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.     

Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

Infant day care: A social and psychological perspective on mental health implications

A review of infant group daycare programs abroad and in the USA leads to the conclusion that the degree of industrial and technological development is a major determinant of infant daycare practices. In the USA a culture gap exists between the middle class providers and the predominantly poor and non-caucasion recipients of the service. Difficulties in implementing programs, especially in transmitting child development information to parents stem from these basically different orientations. Some suggestions are made that may lead to more effective communication and collaboration between families using daycare personnel.     

Socialization within day care: A brief review

Studies examining the effects of day care are reviewed. Little evidence was found indicating a negative impact on child development. A number of weaknesses in the day care literature were pointed out, including problems of ecological validity and failure to examine for differential effects. Suggestions for future research are made, among them a “natural history” of day care and studies of children who have experienced trauma.     

A school-based mental health consultation curriculum

Many articles have been written about mental health consultation and school-based consultation, but little has been written about how consultants are to be prepared for their role. Other authors focus on the theory or process aspects of the approach but do not take the next step in specifying what neophite consultants need to learn. The following paper presents one position on consultation that integrates a theoretical model, a process model, and a curriculum for training school-based mental health consultants. Elements of the proposed curriculum include: ethics, relationship building, maintaining rapport, defining problems, gathering data on what has already transpired, gathering data on the client, sharing information, generating interventions, supporting interventions, and following up and disengaging.     

Mental health care for Hispanic Americans: a current perspective

In this article, the authors review patterns and challenges in the conceptualization, implementation, and academic support of the mental health services of Hispanic Americans. A critical analysis was conducted on information obtained through manual and computerized searches of published literature and conference reports. New clinical care approaches include the DSM-IV's cultural formulation with its complement of standardized multiaxial diagnosis, integration of services across clinical disorders or conditions and across sources of care, as well as pluralistic criteria and judges for service outcome appraisal. Emerging clinical approaches offer an opportunity to enhance the mental health care of Hispanic Americans within an increasingly multicultural U.S. society.     

Intervention and prevention in swedish child health care

A strong public reaction to the low birth rate in the early 1930s became the starting point for many socioeconomic, social, and educational reforms in the decades that followed. Alva and Gunnar Myrdal regarded the low birthrate as a symptom of a badly organized society and not as something that was desirable from an economic point of view. In order to gain more than illusionary improvements, the whole society had to change direction. Society was to be responsible for equal rights for all children regardless of the socioeconomic and mental premises of their parents. This was to be and still is the main objective of most child-welfare and child-care programs. The influence of different psychological theories that concern the needs of young children may be observed from the sixties onward. The more active role of the fathers in the daily lives of young children is a special kind of intervention. The law against physical punishment in child rearing is another example of the influence of knowledge and research on the field of child psychology. The emphasis on parent education in new forms is discussed as an example of a change in perspective with regard to the methods of information to parents over the years.     

Mental health care and the politics of inclusion: A social systems account of psychiatric deinstitutionalization

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.     

A comparison of the environments of day care centers and group day care homes for 3 year olds

Caregiver-child interaction and social participation were compared in community-based day care centers and group day care homes for three year olds. Use of group day care homes made it possible to control for group size and adult-child ratio. Day care homes were found to be more structured in terms of curriculum, and more flexible in terms of overall schedule and social-emotional climate. Adult child interaction was of higher quality during structured periods in day care homes. Social participation was of higher quality in day care homes. The adult-child interaction in both types of day care was impersonal and neutral in affective tone.