Prevalence of suicide programs in schools and roadblocks to implementation

We surveyed all school districts in Washington State for information on the prevalence of suicide programs and on major roadblocks to implementing programs. With 163 districts responding (62%), we found that the majority did not have suicide programs or policies and procedures. The largest perceived roadblock was insufficient staff and the greatest perceived need was more information. Although establishing policies and procedures is considered by many as a necessary first step to establishing suicide programs, we did not find schools choosing this option as often as others. This raises questions as to what are effective ways to have schools start suicide programs. We analyzed the data by school district size and by the title of the staff member making the report. We discuss the implications of these findings as well as the need for further efforts to develop appropriate programs for schools.     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.     

Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

Children with AIDS in the public schools: The ethical issues

The question of whether to allow children with AIDS to attend public school generates explosive emotions and has wide-reaching consequences. This paper focuses on the perspective of parents of well children who may be asked to attend school with children who have AIDS. These parents are poised at the heart of the dilemma: they are the ethical “bottom line,” and an argument that fails to satisfy them ought not to satisfy anyone. The conflicting commitments these parents face are first to the parentchild covenant which requires them to act in their child's best interests, and second, to the principles of beneficence and justice, which require them not to further burden a sick child with ostracism and isolation. Almost exact parallels exist between this issue and that of proxy consent by parents for children's participation in low-risk, non-therapeutic research. The lengthy and important debate between Paul Ramsey and Richard McCormick on this question is analyzed, concluding that McCormick's position in favor of thoughtful proxy consent is the more compelling. Returning to the question of allowing children with AIDS to attend school, the essay shows why the parallels are persuasive. On the ethical level, the apparent conflict of obligations is almost exactly the same; on the pragmatic level, the essay shows why sharing a classroom with a child who has AIDS is comparable to the “low-risk” category that the National Commission for the Protection of Human Subjects found acceptable in its 1978 guidelines. The essay concludes that parents of healthy childrenmay and ought to accept the presence of children with AIDS in the public school.     

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.     

Values and religious issues in psychotherapy and mental health

A decade of work by Bergin and others is reviewed and synthesized concerning two broad issues: (a) the role of values in psychotherapy and (b) the relation of religion to mental health. Trends have changed and there is now more professional support for addressing values issues in treatment. There is also more openness to the healthy potentialities of religious involvement, and therapists themselves manifest a new level of personal interest in such matters. Cautions and guidelines for dealing with such issues are considered in both empirical and clinical terms. The multifactorial nature of religion is documented, and healthy and unhealthy ways of being religious are described. Suggestions are given for including education in values and religious issues in the training of clinicians so that the vast population of religious clientele may be better served.     

Religion,mental health,and clinical issues

This article reviews a number of studies investigating the relationship between religion and the variables of mental health and social behavior. Characteristics of religious health and pathology are examined, and a framework for clinical assessment and treatment of religious pathology is described. Tentative conclusions concerning the subject matter are drawn and limitations of the number and type of studies are outlined.     

Infants' meaning-making and the development of mental health problems

We argue that infant meaning-making processes are a central mechanism governing both typical and pathological outcomes. Infants, as open dynamic systems, must constantly garner information to increase their complexity and coherence. They fulfill this demand by making nonverbal "meaning"-affects, movements, representations-about themselves in relation to the world and themselves into a "biopsychosocial state of consciousness," which shapes their ongoing engagement with the world. We focus on the operation of the infant-adult communication system, a dyadic, mutually regulated system that scaffolds infants' engagement with the world of people, things, and themselves, and consequently their meaning-making. We argue that infant mental health problems emerge when the meanings infants make in the moment, which increase their complexity and coherence and may be adaptive in the short run, selectively limit their subsequent engagement with the world and, in turn, the growth of their state of consciousness in the long run. When chronic and iterative, these altered meanings can interfere with infants' successful development and heighten their vulnerability to pathological outcomes. Cultural variations in meaning-making and implications for clinical practice are discussed.     

Some qualifying notes on the development and implementation of behavior modification programs

Value judgements are inherent in the development and implementation of any behavior modification program. However, there is concern that techniques will become the prime originator of values and that a broader new of the child and his terms will be lost.

This article has reviewed three aspects of program planning in terms of the value issues involved. These include the manipulation of both abtecedent and consequent events to the behavior, the inclusion of the child in program planning, and teacher resistance to the program.     

Change technology and the implementation of automation in mental health care settings

The problem of clinician resistance to automated systems in mental health care delivery settings is discussed. It is argued that this resistance is a natural part of the change process, an indicator of an inadequate change strategy. The theory of change is briefly reviewed. Previous efforts to install automated systems in mental health care delivery settings are discussed in terms of change theory. Suggestions for incorporating the technology of change into the implementation process are proposed.     

Treatment approaches and offending behavior programs: Some critical issues

This paper discusses what is known about effective methods of program delivery in offender rehabilitation programs and how this impacts on the integrity of correctional programs. Drawing on literature from both psychotherapy and adult education, it is concluded that collaborative and client-centred approaches are likely to be associated with the highest levels of effectiveness, and that there is a need to support these methods of delivery through the development of practice guidelines that can be used by both program providers and supervisors.     

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross‐sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.