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)     

Who uses community mental health centres? A study of one health district

A caseload analysis was undertaken to investigate those clients seen by five community mental health centre teams within one healthcare district. The 985 clients are described in terms of demographic and clinical features and questions relating to service provision are discussed.     

“Hello,can you hear me?”: Narratives of online mental health counselling among Filipino adults during the pandemic

Filipinos are often reluctant to seek professional mental health (MH) help. However, literature reveals that online counselling is preferable to face-to-face (F2F) MH services, with the pandemic possibly magnifying technology's anonymity and disinhibiting benefits. To further explore facilitators of online MH help-seeking, this study tapped into the lived stories of Filipino adults who experienced at least one counselling session from March 2020 to March 2022. Among 83 screened respondents, 11 semistructured interviews were transcribed and analysed following Crossley's (2000) method. Findings reveal an overarching online MH counselling narrative composed of three phases and their respective events: (a) Precounselling (Resiliency Narrative versus MH Awareness, Turning Point, and Linking versus Searching); (b) Counselling (Two-way Introduction, Unloading and Untangling, and Decision to Maintain or Terminate); and (c) Postcounselling (Relapse and Journey towards Growth and Advocacy). Three all-encompassing facilitators were embedded throughout the process: Autonomy, Financial Capability, and MH Institutions. Notably, participants attributed their MH help-seeking to autonomy, despite culture and stigma, because of enabling environments that entail heightened MH literacy, positive past experiences with professional MH help, social support and encouragement, and a sense of shared reality. Benefits unique to online counselling were also apparent among participants' narratives, including alleviating geographical boundaries and added financial and personal pressures. Overall, findings posit that Filipino adults consider online counselling as a preferable alternative to F2F counselling, thus necessitating further development and institutional support.     

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.     

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."     

Client or patient? Contrasts between medical and counselling models of confidentiality

Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability.     

Antecedents of employees' mental health—The role of career and work satisfaction

It was hypothesized that individual and situational variables, as a whole, will show stronger relationships with work-related attitudes than with mental health indices. Work-related attitudes, on the other hand, were expected to contribute more strongly to mental health than the individual and situational variables. Results obtained from two groups of staff professionals and retail store managers, using primarily questionnaire data, supported these hypotheses. Career and work satisfaction emerged as the strongest contributors to mental health. Situational variables such as job characteristics, supervisory style, and pay related more strongly to the attitudinal variables than to mental health. This pattern suggests that career and work satisfaction may serve as intervening variables in the relationship between situational variables and mental health.     

Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness

Young people’s perspectives about mental health concepts shape both their interactions with sufferers of mental illness and their actions related to their own mental health. The current study employed a cross-sectional qualitative design to explore how adolescents (aged 12–18 years) speak about mental health and illness in order to gain insight into young people’s perceptions and experiences and contribute to shaping approaches to policy and practice. When discussing mental health concepts and appropriate behaviours toward sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental health problems. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed, with students expressing difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents interviewed commonly conveyed the notion that young people may exaggerate or “fake” a mental illness for personal gain. Adolescent perceptions of mental health and illness hold practical implications for policy and school-based programs aimed at improving mental health knowledge, attitudes and behaviours among youth.     

Managing the university third strand innovation process? Developing innovation support services in regionally engaged universities

Universities increasingly provide assistance to innovating firms, particularly in less successful regions lacking other support providers. Universities have to develop such support, just as consultancies learn to work with clients. In this paper, we use an innovation framework to explore how universities learn about developing such services, and the barriers they have to address to improve the development of such services.     

Does coping help? A reexamination of the relation between coping and mental health

In a longitudinal community survey of 291 adults, we explored the relation between coping strategies and psychological symptoms. Respondents completed the revised Ways of Coping Scale (Folkman & Lazarus, 1985) for a self-named stressful episode. Factor analysis produced eight coping factors: three problem focused, four emotion focused, and one (support mobilization) that contained elements of both. Multiple regression analyses indicated bidirectionality in the relation between coping and psychological symptoms. Those in poorer mental health and under greater stress used less adaptive coping strategies, such as escapism, but coping efforts still affected mental health independent of prior symptom levels and degree of stress. We compared main versus interactive effects models of stress buffering. Main effects were confined primarily to the emotion-focused coping scales and showed little or negative impacts of coping on mental health; interactive effects, though small, were found with the problem-focused scales. The direction of the relation between problem-focused scales and symptoms may depend in part on perceived efficacy, or how the respondent thought he or she handled the problem. Implications for the measurement of adaptive coping mechanisms and their contextual appropriateness are discussed.     

Outpatient benefits for mental health services in Medicare. Alignment with the private sector?

Revision of Medicare's benefit for outpatient mental health care is long overdue. The Omnibus Reconciliation Act of 1987 expands the covered limit to $2,200 (from the $500 set in 1966) but retains the 50% coinsurance requirement for beneficiaries. There are several strong arguments supporting further changes in the benefit to reduce the coinsurance and include psychologists as covered providers. These are need among the elderly, changes in Medicare's inpatient reimbursement system, and innovations in treatment. Outpatient mental health care is a very small portion of Medicare expenditures, amounting to less than .1% of total costs. Using data from the Bureau of Data Management and Strategy at the Health Care Financing Administration (HCFA), it was estimated that $41.8 million was paid by HCFA for outpatient mental health care in fiscal year 1984. This article estimates the costs to Medicare and beneficiaries of reducing the coinsurance to 20% and including psychologists as eligible providers.     

Principlism, medical individualism, and health promotion in resource-poor countries: can autonomy-based bioethics promote social justice and population health?

Through its adoption of the biomedical model of disease which promotes medical individualism and its reliance on the individual-based anthropology, mainstream bioethics has predominantly focused on respect for autonomy in the clinical setting and respect for person in the research site, emphasizing self-determination and freedom of choice. However, the emphasis on the individual has often led to moral vacuum, exaggeration of human agency, and a thin (liberal?) conception of justice. Applied to resource-poor countries and communities within developed countries, autonomy-based bioethics fails to address the root causes of diseases and public health crises with which individuals or communities are confronted. A sociological explanation of disease causation is needed to broaden principles of biomedical ethics and provides a renewed understanding of disease, freedom, medical practice, patient-physician relationship, risk and benefit of research and treatment, research priorities, and health policy.     

What do we owe co-nationals and non-nationals? why the liberal nationalist account fails and how we can do better

Liberal nationalists have been trying to argue that a suitably sanitized version of nationalism—namely, one that respects and embodies liberal values—is not only morally defensible, but also of great moral value, especially on grounds liberals should find very appealing. Although there are plausible aspects to the idea and some compelling arguments are offered in defense of this position, one area still proves to be a point of considerable vulnerability for this project and that is the issue of what, according to the liberal nationalists, we owe both members of our nation, our co-nationals, and what we owe those who are not members of our nation. It is here that we see the project still has some distance to go if a version of liberal nationalism is, indeed, to be morally defensible. In this paper I examine leading liberal nationalist accounts of our obligations to co-nationals and non-nationals. I argue that liberal nationalists have not yet given us an adequate account of our obligations to non-nationals for a number of reasons. For instance, on the issue of the priority we may give co-nationals' interests over non-nationals', the theorists' view show significant tension, they seem to be confused about what their positions entail, the views are unhelpful, ad hoc, or the positions are quite unclear. Liberal nationalists also have a misleading impression that their positions better capture the relation between personal identity and duty, but this turns out to be false. Other defects with their specific projects are highlighted. I go on to offer a more promising method for determining our obligations to non-nationals. Rather than this alternative precluding any scope for nationalism, it actually makes clearer to us how there might be some defensible space for nationalism once our obligations to put in place appropriate institutions and sets of rules have been fulfilled.     

Research and the organization of knowledge: where do psychotherapy and counselling fit in?

In order to clarify the place of research in psychotherapy and counselling, I look at the interrelationship of two ‘organizations of knowledge’. Organization can represent a process or an institution. My thesis is that there are particular characteristics of psychotherapy and counselling, considered as an intellectual discipline, that mean it organizes knowledge in peculiar ways that are reflected in the difficulty of reconciling them within the organization of the modern university. I shall propose that a different conception of research, based upon a third ‘organization of knowledge’, is necessary to resolve these tensions. Once psychotherapy/counselling finds more cohesion as a discipline, it is more likely to establish an independent niche within the university.