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)     

Getting “SMART” about implementing multi-tiered systems of support to promote school mental health

With the growing adoption and implementation of multi-tiered systems of support (MTSS) in school settings, there is increasing need for rigorous evaluations of adaptive-sequential interventions. That is, MTSS specify universal, selected, and indicated interventions to be delivered at each tier of support, yet few investigations have empirically examined the continuum of supports that are provided to students both within and across tiers. This need is compounded by a variety of prevention approaches that have been developed with distinct theoretical foundations (e.g., Positive Behavioral Interventions and Supports, Social-Emotional Learning) that are available within and across tiers. As evidence-based interventions continue to flourish, school-based practitioners greatly need evaluations regarding optimal treatment sequencing. To this end, we describe adaptive treatment strategies as a natural fit within the MTSS framework. Specifically, sequential multiple assignment randomized trials (SMART) offer a promising empirical approach to rigorously develop and compare adaptive treatment regimens within this framework.     

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."     

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.     

“Chaotic soup of politics:” a Native American Indian mental health perspective

Through a grounded theory process, tribal politics emerged as a core theme from interviews with mental health providers (MHPs) and Native American Indian people experiencing persistent mental illness (PMI). Interviews were conducted over a four-year period with 13 Indian MHPs and administrators, and 18 persons experiencing PMI. Symbolic Interactionism was the informing framework. Findings indicate that reservation life promotes a high immersion in Eurocentric politics, which negatively affects the person with PMI in their maintenance of a healthy spirit balance. To be effective, MHPs need immersion in; the oneness of culture, spirituality, and politics of the community; knowledge of the tribal history; and communication with elders/spiritual leaders. This personal growth could facilitate provision of culturally responsive care needed for a client's navigation of intergovernmental regulations. MHPs should work for adequate funding policies of human service centers while supporting the establishment of indigenous governing practices through tribal sovereignty.     

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.     

Service users’ perceptions of shared agency in mental health services

Objective: The concept of shared agency is used in examining the collaboration between the service user and the professionals. The study aims to find out what kind of experiences on shared agency mental health service users have.

Method: The study was based on interviews of 19 service users. The data set was formed of those parts of the interviews that dealt with shared aims, being heard, collaboration and joint planning and decision-making. Typical methods of inductive content analysis were applied.

Results: Three domains of shared agency were found: emotional, communicative and supportive ones. The emotional domain included elements of becoming heard and building confidence. In the communicative one, the main features were mutual information sharing, finding words to describe the chaos and reconstructing harmony. The supportive domain included encouragement and giving support. Experiences on non-shared agency were also found.

Conclusion: Many experiences on shared agency were found. Joint planning and working with life goals were, however, seldom reported. This result, together with experiences of non-shared agency, sets a challenge for mental health services.     

Families in China: an undervalued resource for mental health?

This article is based on 37 interviews with patients and family members in a psychiatric hospital in Hubei, the People's Republic of China. The main goal was to investigate the explanatory models that families used in understanding the causes of mental illness. Case material is provided to illustrate some of the issues concerning family dynamics and problems. Families use a holistic framework for understanding psychiatric disturbance. Doctors' explanatory framework is largely medical and they show no interest in family relationships. Equally, families make it clear that they need more information and support from medical practitioners, which is not forthcoming.     

Team approach in mental health services: generalists or specialists?

Psychiatrists, psychologists, and social workers were compared on their assessments of pathology, treatment techniques, and theoretical orientation for a typical hospitalized psychiatric patient. The purpose was to determine the relationship between treatment-team members' professional discipline and their clinical approach to a patient. Clinical discipline was significantly related to assessment, treatment, and theory. Psychiatrists favored medication, hospitalization, support, and brief, infrequent structured treatment focused on the present and external factors with an aim of social adaptation. Social workers were similar, but added types of treatment and longer, more frequent treatment. Psychologists were unique with an emphasis on psychoanalytically oriented psychotherapy aimed at personality change.     

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.     

“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.     

“Active faith” in Christian marriage: The challenge of family systems

The purpose of this paper is to examine the possibilities for creating an environment which nurtures active faith in marriage. I intend to do this by examining historical tradition on Christian marriage, and exploring behavioral science for its contribution to the subject. In particular, I will suggest some ways that family systems theory, with its understanding of healthy marriage and family life, can be a transforming element for the study of marriage today.Presented at The Future of the American Church Conference, Washington, D.C., September 22, 1991.     

Mothers’ self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers’ physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants’ behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.     

Interpretive flexibility: why doesn't insight incite controversy in mental health law?

This research investigates how the term "insight" was employed in 25 decisions from mental health review proceedings in Victoria, Australia. The application of insight appears problematic in these decisions. First, there is little clarification of its meaning. Second, the logic applied when insight is related to compliance is often unclear. Third, there are frequent allusions to an implicit and undefined scale of insight, offering the appearance of objectivity. We have analysed insight as an 'interpretive resource', focusing on its various functions in the complex social context of commitment hearings and with a view to its therapeutic jurisprudence implications. The variable application of insight-its interpretive flexibility-appears useful in addressing complex problems faced by review boards. Hence, a key function of insight is to bridge between legal and clinical discourses. Insight is also a convenient means to avoid complicated debates regarding the person's credibility. By analysing insight in Victoria, we hope to contribute to better theoretical understanding of decision-making patterns in mental health law in general.     

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.     

On the nature of international sales and sales management research: a social network–analytic perspective

This research uses a combination of text mining, co-word analysis, and social network analysis (SNA) to review 132 international sales and sales management (ISSM) articles published between 1980 and 2017. The study provides a unique view of the past and future of ISSM research and provides three principal contributions. First, from a social network–analytic perspective, it offers a unique examination of the ways ISSM research topics are interconnected, as reflected by keyword network structure. Second, by conducting SNA across two periods (1980–1999 and 2000–2017) and examining the changes in network centrality measures, the study offers initial insights into the evolving nature of the ISSM literature. Third, the study reports keyword network disconnections (i.e., structural holes) to propose a fruitful agenda for future ISSM research. Taken together, this research offers a current perspective of the ISSM research domain's evolving nature.