Overview: forging research priorities for women's mental health

After a decade of reports underscoring the inadequacy of existing scientific knowledge for understanding gender differences in mental disorder and its treatment, the National Institute of Mental Health has developed a women's mental health research agenda with five priority areas for research: diagnosis and treatment of mental disorder, mental health issues for older women, violence against women, multiple roles, and poverty. This overview highlights some of the major findings in each of these five areas and introduces the more in-depth treatment given in this Psychology in the Public Form section to the areas of violence, poverty, and multiple roles. It also underscores the importance of identifying sources of gender bias in all mental health research. Women's mental health issues have become officially recognized as part of the NIMH research agenda. Only time and continued monitoring will determine how these official policy priorities will become translated into actual funding and research initiatives.     

An examination of the assumptions of specialization, mental disorder, and dangerousness in sex offenders

Sex offenders have been singled out for differential treatment by the legal and mental health systems. This article attempts to inform law reform efforts and criminal justice mental health policy by examining the assumptions underlying differential legal and mental health treatment of sex offenders. These assumptions include the theories that sex offenders are mentally disordered and in need of treatment, specialists in sex crimes, and more dangerous than other criminal offenders. Empirical findings demonstrate that sex offenders are not specialists in sex crimes and are not mentally disordered. Examination of past research suggests that sex offenders are not at more risk than other criminal offenders to commit future sex crimes. Implications of research findings for selective prosecution of sex crime cases, mental health policy, sex offender legislation, and predictions of future dangerousness are discussed. Proposals for future research needs and law reform are presented.     

A philosophical examination of coercion for mental health issues

This article considers two philosophical questions about coercion and mental disorders: (1) an analytical question, i.e., what is meant by the concept of coercion? (2) a normative question, i.e., what justifies the use of coercion? The article distinguishes between coercion from other forms of power such as inducement, persuasion, and authority. It then considers a range of arguments for the paternalistic use of coercion for the benefit of mentally disordered persons and the use of coercion to restrain mentally disordered dangerous persons. This article rests on the assumption that there is something to be said for an academic division of labour, that empirical research in mental health and the law can benefit from conceptual clarification and the analysis of normative arguments. In this article I distinguish between two importantly different sorts of questions that we can ask about coercion and then offer some answers to those questions in broad strokes.     

Sexual coercion among women living with a severe and persistent mental illness: Review of the literature and recommendations for mental health providers

Women with severe and persistent mental illness (e.g., schizophrenia, bipolar disorder) are at enhanced risk for sexual coercion and several resulting sexual health complications. We examine the prevalence and types of sexual coercion encountered by women with severe and persistent mental illness and provide recommendations for interventions to reduce the prevalence of sexual coercion. Mental health professionals working with this population need to provide increased attention to the problem of sexual coercion and can take measures to intervene safely and effectively.     

Front-line services,complexity, research and policy

The evidence-based culture of modern mental health policy and service delivery is being extended through funded efforts to accelerate implementation of research findings in practice settings. In this paper, we argue that this linear model of research and policy-making is profoundly ill adapted to the nature of practice realities and real-world policy-making processes. Both need to be re-conceptualised using the theoretical and practical resources deriving from modern complexity theory. A short case study illustrates the nature of ‘complexity’, the reframing of the notion of ‘evidence’ it implies and the different relationship between research, practice and policy that flows from this more attuned model of mental health and therapeutic processes.     

Religiosity,spirituality, mental health,and mental health treatment outcomes in Australia: a systematic literature review

The relationship between religiosity and mental health is a relatively well-researched field within North America, covering numerous domains of religiosity, including: religion, spirituality, prayer, church attendance, church affiliation and belief in God or a higher power. Considering the Australian literature, there are few papers that explore these dimensions of religiosity and their relationship with health, and in particular, very little research into the field of religiosity and mental health. Using systematic literature review methods, this study explores the Australian research into relationships between religiosity, mental health, and treatment outcomes for psychiatric illness and suicidal behaviour.     

Coercion and ‘voluntary’ admission: An examination of psychiatric patient views

This article examines coercion in voluntary psychiatric patients. Three main themes are highlighted using qualitative and quantitative data from a sample of 412 psychiatric patients surveyed in 1990 who had experienced at least one period of hospitalisation. The themes are: the extent to which the label of ‘voluntary’ was an indicator of the patients' experience of being in hospital of their own volition; aspects of admission which patients considered to be coercive; and the impact that coercion might have on patients' views about their problem, professionals and treatment. The findings suggest that a substantial number of nominally voluntary patients reported coercive aspects of their hospitalisation. The impact of feeling coerced was found to produce a more rejecting attitude towards psychiatric services. The findings are discussed in relation to British mental health legislation and care. I particularly want to thank David Pilgrim for his collaboration with the research which made this article possible and for his useful and supportive comments. I am also indebted to John Monahan for his helpful comments on an earlier draft of this paper.     

No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished

This article argues that psychiatric diagnoses are not valid or useful. The use of psychiatric diagnosis increases stigma, does not aid treatment decisions, is associated with worsening long-term prognosis for mental health problems, and imposes Western beliefs about mental distress on other cultures. This article reviews the evidence base focusing in particular on empirical findings in relation to the topics of: aetiology, validity, reliability, treatment and outcome, prognosis, colonialism, and cultural and public policy impact. This evidence points toward diagnostic based frameworks for understanding and intervening in mental health difficulties being unable to either improve our scientific knowledge or improve outcomes in clinical practice and suggests that we need to move away from reliance on diagnostic based approaches for organising research and service delivery. Alternative evidence-based models for organising effective mental health care are available. Therefore formal psychiatric diagnostic systems such as the mental health section of the International Classification of Diseases Tenth Edition (ICD-10) and Diagnostic Statistical Manual Fifth Edition (DSM 5) should be abolished.     

Mental health and well-being of black women: Toward strategies of empowerment

This review of the literature on Black women's mental health has three goals: 1) to describe the mental health issues, needs, and adaptive behaviors of Black women; 2) to discuss the research, intervention, and public policy efforts of mental health professionals and Black women's groups to address the multiple needs of this population; and 3) to identify effective strategies by which community psychologists can improve the mental health status of Black women through efforts to reduce their environmental stressors, to increase their resources and access to services, and to facilitate their empowerment in American society. The authors propose a number of recommendations to improve Black women's mental health, including changes in research paradigms, changes in education and training programs, and the development of culturally competent service delivery systems.     

Putting Values into Practice: Public Policy and the Future of Mental Health Consumer-run Organizations

The purpose of the paper is to reflect on value dilemmas in mental health consumer-run organizations and to discuss implications for research, policy, and practice. We review the roots of consumer-run organizations in the self-help movement and the psychiatric survivor liberation movement, focusing on the distinctive values espoused by consumer-run organizations. We also discuss evidence-based and value-based approaches to mental health policy formulation and mental health reform, noting the particular importance of value-based approaches and the role that consumer-run organizations can play in mental health reform. Based on our experiences conducting a participatory action research study of four mental health consumer-run organizations, we identify and examine several value dilemmas, discuss the lessons that we learned about these value dilemmas, and note their implications for future directions in research, policy, and practice.     

Latino Family Participation in Youth Mental Health Services: Treatment Retention,Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.     

U.S. mental health policy. Doomed to fail.

Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, U.S. health policy in the 20th century has been inherently flawed. The short-term general hospital--the "doctors' workshop"--emphasizing acute care and surgery, has been the cornerstone of U.S. health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure.     

Prejudice,social stress,and mental health in lesbian,gay, and bisexual populations: conceptual issues and research evidence

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.     

Religion,Evolution, and Mental Health: Attachment Theory and ETAS Theory

This article reviews the historical origins of Attachment Theory and Evolutionary Threat Assessment Systems Theory (ETAS Theory), their evolutionary basis and their application in research on religion and mental health. Attachment Theory has been most commonly applied to religion and mental health in research on God as an attachment figure, which has shown that secure attachment to God is positively associated with psychological well-being. Its broader application to religion and mental health is comprehensively discussed by Kirkpatrick (2005). ETAS Theory explains why certain religious beliefs—including beliefs about God and life-after-death—should have an adverse association, an advantageous association, or no association at all with mental health. Moreover, it makes specific predictions to this effect, which have been confirmed, in part. The authors advocate the application of ETAS Theory in research on religion and mental health because it explains how religious and other beliefs related to the dangerousness of the world can directly affect psychiatric symptoms through their affects on specific brain structures.     

Linking Family-of-Origin Experiences and Perpetration of Sexual Coercion: College Males’ Sense of Entitlement

Sexual coercion on college campuses has become of major concern in recent decades. In recent years, researchers and policy makers have called for greater attention to this topic in order to reduce the sexual violence on college campuses. Recent research has examined the impact of family-of-origin experiences on the perpetration of sexual coercion. The current study examines the association between family-of-origin experiences, such as warmth and hostility between parents, inconsistent parenting, and overparenting during childhood, and the perpetration of sexual coercion among emerging adult males while examining feelings of entitlement as a possible mediator. Data from 326 male undergraduate students were analyzed using structural equation modeling. Results show that warmth and hostility between parents has a significant association with parenting behaviors (i.e., overparenting and inconsistent parenting) and that hostility between parents is associated with the perpetration of sexual coercion by the offspring in young adulthood for males. Also, findings suggest that while overparenting and inconsistent parenting during childhood are not directly associated with the perpetration of sexual coercion during emerging adulthood, they are strongly related to feelings of entitlement, which in turn was found to be associated with the perpetration of sexual coercion for males. These results have important implications for family life education, including relationship and parenting education, and for future research.     

Health consequences of intimate partner violence against married women: a population-based study in northern Iran

The effects of different types of intimate partner violence (IPV) on mental health are understudied. The aim of this study was to analyse the association between women’s mental health and physical, psychological and sexual IPV. We invited subjects of a population-based survey conducted in 2015 in Rasht, Iran, on IPV against women to complete the General Health Questionnaire (GHQ-28). The present research study is a secondary study based on these data and archival data from the 2015 study. For analysis, multivariate analysis of covariance was used. Additionally, predictors of IPV were evaluated using linear regression. A total of 2091 married women were surveyed. The participants were divided into abused women (n = 512, 24.5%) and non-abused women (n = 1579, 75.5%). The pattern of IPV among our patients showed more instances of psychological aggression than physical assault, sexual coercion or injury. Our results show that the non-psychotic psychiatric disorders of the victims were significantly impaired in all aspects, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression. Except social dysfunction, the psychological and sexual abuse were significant predictors of other aspects of mental health. Our findings suggest that risk of IPV is high in this population. They also indicate that various forms of abuse are different from each other in terms of predicting a victim’s mental health. Different strategies may be required to reduce and prevent this violence. Additional research is needed to confirm and expand upon our findings.     

Waking Rip van Winkle: why developments in the last 20 years should teach the mental health system not to use housing as a tool of coercion

Many housing programs for people with mental illnesses rely on models that require the person to adhere to treatment as a condition of continuing access to housing. These models that 'bundle' housing and treatment are relics of a past in which persons with mental illnesses were afforded little real choice in treatment, housing and other social supports. Conditioning access to housing in this manner is coercive and at odds with current thinking regarding treatment, as well as legal principles that shape the environment in which treatment is provided. This article summarizes the reasons why housing for people with mental illnesses should be provided free of the use of coercion.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

CBT in the British NHS: Vague imposition or imposition of vagueness?

The multi-faceted controversy created by the ascendance of cognitive behaviour therapy (CBT) in the British mental health industry is outlined. The historical and philosophical nature of this controversy is traced, by looking at CBT as a psychiatric form of treatment and eclectic form of applied psychology. CBT has become a policy battleground, which can be understood by putting its modernist credentials and its appeal to rationalism, pragmatism and techno-centric optimism into a mixed pre-modern and post-modern context. Given that there are diverse representatives of these realms of belief alive today in our society, the current singular policy emphasis on CBT is anti-democratic and insensitive to diversity. The paradox of this restrictive policy is that CBT itself is now a very diverse set of practices held together mainly by a faith in evidence-based practice. Consequently, a version of pluralism is being tolerated on the supply side of mental health services but a full offer of true choice is not being made on the demand side.