Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.     

Age-related cognitive decline as a function of daytime testing

The current study investigates the effects of age, cognitive load, optimal time-of-day testing, and irrelevant background noise suppression on mental processing. One hundred and seventy-eight young (M = 22.97 years) and 114 old adults (M = 56.38 years) were assessed for implicit learning and speed of information processing under irrelevant sound interference early during daytime (7AM–2.30PM) or in the afternoons (3PM–midnight). No direct effect of irrelevant speech effect was found on implicit learning. An optimal time of testing per age group was identified according to the ability to suppress irrelevant auditory information. If no semantic meaning was derived from the sound conditions, irrelevant sound was easily inhibited leaving no room for declined cognitive performance. This suggests an intact phonological inhibition in older adults and a further circumvention of the phonological loop. However, when difficulty was increased, a widened performance gap between young and old people could be observed. Education modulated difficult performance irrespective of age. With increasing age, task demand fulfillment becomes a function of a limited time mechanism. If extraneous time is not adapted to cognitive skills and performance, higher order processing cannot be reached, rendering older adults slower than their younger counterparts.     

Culture as a resource for mental health

This article is based on the author's address at the National Multicultural Conference and Summit III in Los Angeles, California, in January 2003. The author focuses on culture as a resource--a resource for theories that can inform one's understanding of human behavior; a resource for healing, self-help, and positive emotions; a resource for clinical practice; and a resource for mental health and wellness. The author uses a healing story from native culture to describe the essence of his relational worldview and to reframe the professional thinking about culture as one of the greatest assets for healing and mental wellness rather than as a problem to solve.     

Effects of the community mental health centers program on the growth of mental health facilities in nonmetropolitan areas

Using a quasi-experimental design, changes in the numbers of mental health facilities between 1964 and 1974 were examined for a sample of 50 nonmetropolitan catchment areas that established a Community Mental Health Center (CMHC) before January 1973 and a sample that did not. Compared to non-CMHC areas, CMHC areas had a slightly greater number of general hospital psychiatric units in 1974. Nevertheless, the rate of increase in such units over the 10-year period was not significantly different between the two types of areas. Other findings supported the conclusion that the number of outpatient and day/night facilities continued to increase in areas not participating in the CMHC program, but that the program produced even greater numbers of such facilities in areas that did participate. This growth, though, occurred both through introducing additional facilities and supplanting existing ones.     

Challenges and opportunities in moving toward a public health approach in school mental health

These three outstanding papers are important for the discipline of school psychology, the field of school-based mental health, and more generally for systems of education and mental health for children and adolescents. As the authors emphasize, there is an unprecedented focus on improving programs that remove barriers to learning and enhance development, health, and mental health in youth, in the most universal natural setting—the schools. The authors also correctly highlight that school psychology is uniquely positioned to play a leading role in this reform and change effort. Two interconnected themes of the public health approach—applying the evidence base and moving toward preventive and population-focused interventions—are emphasized in these papers, and while they focus on school psychology, the issues discussed are generalizable to the many disciplines that operate within educational and mental health systems. In the following discussion, I react to the papers' two major themes, discuss realities that should be addressed for progress to be made, and comment on their implications for school psychology.     

Bilateral transfer as a function of mental imagery

Three experiments are reported which investigate the role of mental imagery in the bilateral transfer from right to Ie ft hand of rotary pursuit skill. In Experiment 1 both mental imagery and physical rehearsal showed significant positive transfer relative to a control condition. However, work decrement may have accumulated and transferred in the physical rehearsal group thereby depressing this group's left-hand performance. Experiment 2 was conducted under conditions designed to allow work decrement to dissipate prior to transfer to the contralateral limb. The data still showed no difference between physical rehearsal and mental imagery. One interpretation of these data is that work decrement was present under both the physical rehearsal and mental imagery manipulations in Experiment 1. The data from Experiment 3 confirmed this interpretation as well as replicated the positive transfer effects found for mental imagery in Experiments 1 and 2. The data are discussed in terms of central versus peripheral explanatory mechanisms.     

Self-help research and the public mental health system

Discusses views of self-help leaders, researchers, and policy makers from the public mental health system about collaborative research with self-help groups. Topics include assumptions underlying collaborative research, barriers to collaborative research, and the potential benefits of collaborative research. Special attention is given to the rationale and methods for including minorities in self-help research. Initial discussions were held at a meeting convened by the NIMH-funded Center for Self-Help Research and Knowledge Dissemination at the University of Michigan.     

The parish clergy as a mental health resource

Summary This paper presents observations on the assets and liabilities of the parish clergy as a mental health resource within the community. These observations are drawn from a ten-year program of continuing education for cleargy in mental health, which focuses on daily pastoral experience. The parish setting is similar in many respects to the service area of a community mental health center. The clergy's assets often include availability, experience, tradition, and the special significance of the religious leader. Inadequate training in mental health skills and the complex demands of parish life are among the problems confronting the clergy in this area. On the whole, the pastoral role offers a unique and highly useful opportunity for positive psychological intervention.The work described in this paper has been supported in part by National Institute of Mental Health grant no. MH-11929-01 and by grants from the Cleveland Foundation and the Grant Foundation, Inc., and the Cuyahoga County Board of Mental Health and Mental Retardation.     

Factors contributing to the utilization of mental health services in a rural setting

The purpose of this study was to examine if age, attitudes toward help-seeking, education, and sex were related to previous or intended future mental health utilization in a rural population. Data were collected via a mail survey from 438 adults. Regression analyses suggested that positive attitudes toward help-seeking, being female, and being younger were significantly related to both previous and intended future mental health service utilization. In addition, prior mental health use was significantly related to whether one would seek out mental health services in the future, Implications for mental health practitioners in rural settings are addressed, and limitations of the study discussed.     

Developing coordination of services between a mental health center and a public school system

A child-and-family oriented community mental health center of necessity is concerned with the manner in which the school system in its community is providing for the psychological, social, and emotional development of children. Fortunately, over the last decade, the number of school systems that are aware of their responsibility in this regard has greatly increased, and many affluent and enlightened school systems have moved to develop extensive pupil personnel services, functioning in many ways as in-house mental health programs. Where there are mental health providers both within the community and within the school system, however, problems may develop such as professional competition, overlapping functions, and differences with regard to how mental health problems are best dealt with. This paper will examine the relationship of a town-supported mental health program and the town's public school system. Highlighted will be the variety of problems which develop, including those mentioned above, and strategies adopted to resolve the problems.     

Cost-effective use of Rational Emotive Behavior Therapy in a public mental health service

With the advanced deinstitutionalization of the treatment of the mentally ill, the public mental health services in many parts of Australia are facing serious difficulties in providing adequate community-based treatment to the large numbers of individuals in need. Overreliance on medication and a diminishing supply of suitably trained therapists may result in an increasing proportion of patients being denied the benefit of optimal treatment and care which should include evidence-based psychological and behavioral approaches. In this communication we describe a day program, designed and implemented in Perth, Western Australia, which combines individual and group therapy provision, and is closely integrated with both primary care and the specialist mental health services. The program provides an alternative to in-patient admission and is cost-effective by reducing the demand for acute hospital beds. It is acceptable to patients and produces measurable improvements in symptoms, functioning and subjective well-being. Address correspondence to Anthony Mander, ENHANCE, Inner City Mental Health Service, Royal Perth Hospital, Box X2213, Perth 6000, Western Australia.     

Economic indicators of mental health service utilization in rural Appalachia

This exploratory study examined the relative predictive strengths of selected economic factors (welfare cases, banking activity, unemployment, retail sales, motor vehicle sales) for utilization of mental health services (hotline calls, intake at community mental health centers and admissions at mental hospitals) over a 78-month period in rural Appalachia. Monthly data were tested for autocorrelation and adjusted for seasonality and inflation. Regression analyses indicated that (a) economic factors did account for a considerable portion of variance in mental health factors; (b) these factors predicted mental hospital admissions and hotline calls; (c) strengths of these relationships were quite consistent across the areas sampled, but the directions sometimes were different; (d) welfare factors were the best predictors of utilization; (e) Aid to Families with Dependent Children was generally the best single predictor of utilization, especially when mental health factors were lagged by 3 months. A causative model describing the decision-making process involved in the utilization of mental health services was presented. This research was supported by grant number 1R01 MH34382 01 from the National Institute of Mental Health, Division of Biometry and Epidemiology, 1980–1981. The empirical data were collected with the help of the Shawnee Mental Health Services of Marietta, Ohio, Western District Guidance Center of Parkersburg, West Virginia, the Ohio Department, the Administrative Office of the U.S. Court, the Federal Reserve Banks of Public Welfare, the West Virginia Department of Health, the West Virginia Tax DEpartment, the Administrative Office of the U.S. Court, the Federal Reserve Banks of Cleveland and of Richmond, and Parkersburg National Bank. Robert Kirkbride of Marietta College and Robert Evans of People's Bank of Marietta, Ohio, provided economic advice. The computer facilities of Marietta College were used to store and analyze data. Barrie Gardner and Lucinda Pyatt, as research assistants, collected and analyzed much of the data.     

Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health

This article summarizes the conception and diagnosis of the mental health continuum, the findings supporting the two continua model of mental health and illness, and the benefits of flourishing to individuals and society. Completely mentally healthy adults--individuals free of a 12-month mental disorder and flourishing--reported the fewest missed days of work, the fewest half-day or greater work cutbacks, the healthiest psychosocial functioning (i.e., low helplessness, clear goals in life, high resilience, and high intimacy), the lowest risk of cardiovascular disease, the lowest number of chronic physical diseases with age, the fewest health limitations of activities of daily living, and lower health care utilization. However, the prevalence of flourishing is barely 20% in the adult population, indicating the need for a national program on mental health promotion to complement ongoing efforts to prevent and treat mental illness. Findings reveal a Black advantage in mental health as flourishing and no gender disparity in flourishing among Whites.     

Linguistic encoding in short-term memory as a function of stimulus type

In this study, we investigated bases for encoding linguistic stimuli in short-term memory. Past research has provided evidence for both phonological (sound-based) and cherological (sign-based) encoding, the former typically found with hearing subjects and the latter with deaf users of sign language. In the present experiment, encoding capabilities were delineated from encoding preferences, using 58 subjects comprising six groups differing in hearing ability and linguistic experience. Phonologically related, cherologically related, and control lists were presented orally, manually, or through both modalities simultaneously. Recall performance indicated that individuals encode flexibly, the code actually used being biased by incoming stimulus characteristics. Subjects with both sign and speech experience recalled simultaneous presentations better than ones presented orally or manually alone, which reveals the occurrence of enhanced encoding as a function of linguistic experience. Total linguistic experience appeared to determine recall accuracy following different types of encoding, rather than determining the encoding basis used.     

Undergraduates as campus mental health workers

This study evaluated, first, the effectiveness of group experiences in improving the interpersonal functioning of college freshmen and, second, the difference in effectiveness of group discussions led by undergraduate dormitory advisers (with consultation) and by psychology graduate students. A variety of measures of interpersonal behavior was used. Results show that freshmen in group discussions improved in their interpersonal relationships, especially as measured by a sociometric form. Members of groups led by graduate students showed slightly more improvement than those in groups led by dormitory advisers. Differences in group process were also found. Results suggest that indigenous subprofessionals can promote growth on the campus.     

Economic predictors of mental health service utilization: A time-series analysis

This research was designed to understand the relationships between economic indicators and mental health service utilization. Six monthly and three quarterly time-series analyses were done to assess the time-dependent association between three state-level economic indices and two measures of mental health service utilization. Consistent with the existing literature, increases in manufacturing employment were inversely related to both first admissions in state hospitals and case openings in community outpatient facilities. Labor force participation was also inversely related to first admissions to state hospitals. No relationship was found between service employment and either of the mental health service use indices. The specific findings suggest that two processes may be operating in the relationship of labor force participation and manufacturing employment with mental health service utilization. Some of the findings suggest a "crisis" process, in which service use increases rapidly following an economic stressor, whereas other findings suggest a more insidious process, in which economic stressors slowly weaken the mental health of the community and eventually lead to increased mental health service use. These results can be used to better inform social policy and preventive interventions by highlighting the human costs of changes in economic well-being. The need for more ecological research is discussed.     

Adaptive aspirations and contributions to a public good: Generic advertising as a response to decline

Generic advertising, the promotion of an entire product or service category, is a common form of inter-firm cooperation. Voluntary participation in such a campaign represents contribution to a public good. Based on the pattern of recent campaigns, we argue that this cooperation is dependent on adaptive aspirations and an increased willingness to consider alternative courses of action in light of declining sales within an industry. Three experiments are reported that tested these ideas. In each study, subjects assigned to four person groups chose how many resources to contribute to a generic advertising campaign the effectiveness of which depended on total funding levels. Each group member represented a different “store” in the same mall. The instructions framed the problem by presenting varying sales trends for the stores—Positive, Negative, or Neutral. The first two experiments were one-shot games with a dominant strategy of non-contribution and free riding. The results showed that subjects confronting the declining trend contributed significantly more than those in either of the other two conditions. A declining sales trend also positively influenced their expectations that others would contribute as well. The third experiment demonstrated that a decline-induced equilibrium persisted over trials of a finitely repeated game with a known stopping point. Contributions remained high even in the final round. Surprisingly, the specific identification of a competitor mall as the cause of the decline in sales actually resulted in lower levels of contribution. The implications for research and practice are discussed.