Cultural Lens on Mental Illness: Four Clients Share Their Perspectives

People served by mental health providers represent diverse cultural groups. In-depth qualitative interviews were used to collect data to examine: “How do people, diagnosed with a mental illness, perceive their experience in a partial care mental health program from the perspective of their cultural context?” Four participants described cultural identities that included ethnic, health status, and sexual orientation identities. The participants' way of participating in the world was often in conflict with cultural values and expectations of the family and counselors. Cultural competence must include understanding how complex, multiple cultural contexts interact and influence a person's participation in the therapeutic process.     

International Counseling Introduction

The growth of counseling around the world is one of the major and most exciting emerging trends in the counseling profession. Although it was once thought to be primarily a U.S. phenomenon, other countries located on virtually every continent are developing counseling services to meet their unique mental health needs. The globalization of communication technology, transportation systems, and business has stimulated the initiation and growth of governmentally and privately sponsored mental health programs. Many nations throughout the world recognize that positive mental health is a valuable social/economic asset regardless of a country's political orientation.     

The admissibility of expert testimony regarding malingering and deception

This article discusses the legal admissibility of expert testimony and the ability of mental health professionals to detect malingering and deception among defendants. A legal analysis of the admissibility of expert testimony regarding malingering and deception in formal legal proceedings is presented. Some guidelines are provided to help mental health professionals and attorneys determine the admissibility of evidence they intend to introduce. Although psychologists and psychiatrists currently have a limited ability to identify accurately malingering and deception, expert testimony about the genuineness of a defendant's mental illness is likely to be held admissible for both practical and evidentiary reasons. In contrast, evidence about a witness' credibility is rarely admissible. In addition, psychologists are ethically obliged to recognize their limitations in making representations about their skills.     

Living in Alternative and Inner Worlds: Early Signs of Acting Talent

In an exploratory, qualitative study, 11 professional actors were interviewed about their childhoods to investigate the early predictors of acting talent. To control for verbal talent, scientists-turned-lawyers were selected as a comparison group. Participants were asked about their families, schooling, and training, as well as about their early propensities for play and imagination, their orientation towards fiction, and their emotionality and attunement to others' mental states. Actors' childhood memories differed from those of the lawyers in the following respects. The actors recalled greater engagement in alternative worlds (imaginary and fictional worlds) and in inner worlds (emotional and other mental states). Not surprisingly, then, they were also more likely to recall feeling different from others and unable to engage fully in school. Unlike the lawyers, the actors recalled practicing for their adult roles as early as age 4—by inventing and directing plays in their backyards. Unlike lawyers, actors chose their careers despite parental discouragement: although their parents valued the arts, they discouraged the choice of acting as a career. Taken together, the results suggest that an early interest in alternative and inner worlds and an identification of oneself as different from others are predictive of early and steady involvement in theater—a choice of career in which one can live daily in another world of imagined lives and in the other world of others' mental lives.     

Coparental communication,relational satisfaction,and mental health in stepfamilies

This study tested a series of actor–partner interdependence models of coparental communication, relational satisfaction, and mental health in stepfamilies. Participants included 127 couples (N = 254). Results revealed 2 actor‐oriented models whereby parents' and stepparents' coparental communication quality positively predicted their own (but not their partners') satisfaction and mental health. A final model revealed that parents' relational satisfaction mediated the effect of coparental communication on their own mental health. A similar pattern emerged for stepparents, although coparental communication continued to have a direct, positive effect on stepparents' mental health. Importantly, parents' coparental communication produced an inverse partner effect on stepparents' mental health, highlighting the potential stress stepparents may experience as they are called upon to help raise their spouse's offspring.     

Male callers to an Australian perinatal depression and anxiety help line—Understanding issues and concerns

There is increasing recognition of the issues facing men in the perinatal period. Vulnerability factors and issues in the partner relationship contribute to mental health risk and can impact the quality of the father–infant relationship. Yet, there is limited understanding of fathers’ help-seeking when they or their partner are experiencing mental health issues in the context of caring for a new baby. The present study examines fathers’ contacts with the Perinatal Anxiety and Depression Australia (PANDA) National Helpline. The study reviewed contacts from fathers and their identified needs for assistance, relationship issues, and support needs; 70% of male callers (N = 129) reported concerns about the mother's mental health, and 57% were concerned about relationship breakdown. Significant numbers of men raised issues about their own mental health (43%) and many were concerned about the impact of maternal mental state on the relationship with the infant. When compared to community data, there were elevated rates of concerns about depression and anxiety. Men also described difficulties with the fathering role and with regulating their own feelings of guilt and frustration. These findings highlight the needs of men for support when a mother experiences perinatal problems and also the risk for distress in fathers.     

African American Pastors on Mental Health,Coping, and Help Seeking

Within the Black Church, there remains much that is unknown about pastoral motivations, beliefs, and attitudes about mental health. The purpose of this study was to investigate pastors' responses to parishioners dealing with mental health issues, including perspectives on counseling services and coping strategies. According to this study's findings, African American pastors often are the first line of support for parishioners' mental health and recognizing adaptive and maladaptive forms of coping.     

Attorney- client decision- making in criminal cases: Client competence and participation as perceived by their attorneys

The authors employed a structured interview to ascertain public defenders' perceptions of their clients' competence and the degree of their participation in the defense. In a sample of 122 randomly selected, non-dismissed felony cases, attorneys had doubts about the competence of 14.8% (n = 18) of their clients. Attorneys reported that clients whose competence was doubted were less involved in decision-making and, overall, were passive participants in their cases. Nearly one-half of these clients were not referred for assessment by a mental health professional. The authors compare the practices of attorneys faced with clients of suspected competence with those of mental health clinicians treating patients with impairments in decision-making capacity.     

Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children’s Mental Health

Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.     

Psychological Functioning of Partners of Australian Combat Veterans: Contribution of Veterans' PTSD Symptoms and Partners' Caregiving Distress

Previous research has found posttraumatic stress disorder (PTSD) symptoms in combat veterans to be associated with impaired psychological functioning in their partners. However, little is known about possible mediators of this association. The present study investigated the mediational properties of six dimensions of the revised Partners of Veterans' Distress Scale (MacDonell, Marsh, Hine, & Bhullar, 2010). Participants were 181 female partners of Australian combat veterans, age ranging from 43 and 83 years (M = 60.47, SD = 4.96), who completed measures assessing their caregiving distress levels, dyadic adjustment, mental health, and satisfaction with life. The combat veterans also completed a scale measuring their PTSD symptoms. Our results indicated that higher scores of veterans' PTSD were associated with lower levels of dyadic adjustment, mental health, and satisfaction with life in their partners. Partners reported that distress related to exhaustion and intimacy problems significantly mediated the relationship between veterans' PTSD symptoms and their partners' satisfaction with life, whereas partners' distress associated with intimacy problems was the sole significant mediator for their dyadic adjustment, and exhaustion was the only significant mediator for partners' mental health. Implications for programmes designed to address the significant needs of the partners of combat veterans are discussed.     

Leadership in community mutual support groups for mental health: A qualitative case study from the leaders' perspective

This study explores the experience of leadership of member‐led community‐based mental health mutual support groups. Recent research has documented factors that affect these groups, including leader well‐being, but little is known about the experience of leadership at the individual level. We aimed to understand more about the experience of leadership and how leading members conceptualise their roles. Individual semi‐structured interviews were conducted with 14 leaders of a community mental health mutual support group in England and thematically analysed. Three themes were identified through which leading members conceptualised their roles and group dynamics: (a) “It's a family”; (b) professional values; and (c) working as a team. These knowledge frameworks appeared to influence leaders' well‐being and conceptualisations of their role. The potential impact of this on group stability is discussed. Recommendations are made that group and individual‐level processes be considered together in future research in mental health mutual support contexts due to their interconnected nature.     

Brain Fag: A Case Study Showing the Diagnosis and Therapy in Nigeria

The co-occurrence of somatic complaints along with other forms of mental illness such as depression, anxiety and brain fag is well documented in mental health literature. In Africa, the notion that somatic complaints are a variant of depression is popular. However objective empirical efforts to prove this notion are inconclusive. The common co-occurrence of somatic complaints along with depression, anxiety and brain fag complaints in Nigeria may put clinicians in a dilemma in making diagnostic and therapeutic decisions for their clients. In this paper the authors applied the Harmony Restoration Therapy (HRT) in the management of somatic, depressive, anxiety and brain fag symptoms of a client. The HRT is a psychotherapeutic framework based on the Africa world view of health and illness where health is harmony and illness is disharmony in one’s world of relationships. The case was used to illustrate the co-morbidity of depression, anxiety, somatization and Brain Fag and tries to contribute to how Brain Fag can be treated.     

Training Soviet immigrant therapists in the field of group psychotherapy

Between 1970 and 1990 about one-half million Jews immigrated to Israel, most of them from the former Soviet Union, including many mental health therapists who had trained and worked in the Soviet Union. This article addresses the special characteristics of this population, in general, and of the mental health therapists, in particular. It relates these characteristics to training for group psychotherapy. Key issues include their unique experience of the inner world as a source of danger, the specific defensive modes connected with this experience, their perception of authority as an agent of ideology, and their representation of the group as a persecutory entity and as a vehicle of indoctrination.     

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.     

Managing a stigmatized identity—evidence from a longitudinal analysis about people with mental illness

Previous research about coping with the stigma of mental illness mostly relied on cross‐sectional or qualitative research designs. In the present study, the consequences of ten identity management strategies for mental illness stigma were observed in a longitudinal design. Cross‐lagged analyses were used to describe the influence of the strategies on the frequency of stigma experiences and on mental health in a two‐wave panel of people with mental illness (n = 367, 79% repeated response rate). Selective disclosure and information seeking emerged as adaptive identity management strategies, whereas overcompensation and withdrawal led to lower mental health. Results were mostly unaffected by demographic and psychiatric variables. The results support an empowerment model of stigma resilience that portrays stigmatized people as active constructors of their social world.     

In the Wake of the Great Recession: Economic Uncertainty,Communication, and Biological Stress Responses in Families

The impact of spouses' communication about economic uncertainty on biological stress responses was examined. The sample included 82 Latino and Caucasian couples and one of their adolescents. Wives with low economic uncertainty experienced the greatest cortisol increase to a stressful discussion with their spouse, while wives with high economic uncertainty experienced a blunted cortisol response. Husbands with high economic uncertainty exhibited a low, unresponsive cortisol pattern. Wives who experienced elevated cortisol used more corumination and had low community support. The amount parents talked about their financial worries to their adolescent was not associated with the adolescent's mental health or biosocial markers, but the parents' economic uncertainty and corumination with each other were negatively associated with their own mental health.     

BUDDHISM,COMPARATIVE NEUROPHILOSOPHY,AND HUMAN FLOURISHING

Owen Flanagan's The Bodhisattva's Brain represents an ambitious foray into cross‐cultural neurophilosophy, making a compelling, though not entirely unproblematic, case for naturalizing Buddhist philosophy. While the naturalist account of mental causation challenges certain Buddhist views about the mind, the Buddhist analysis of mind and mental phenomena is far more complex than the book suggests. Flanagan is right to criticize the Buddhist claim that there could be mental states that are not reducible to their neural correlates; however, when the mental states in question reflect the embodied patterns of moral conduct that characterize the Buddhist way of being‐in‐the‐world, an account of their intentional and normative status becomes indispensable. It is precisely this synthesis of normativity and causal explanation that makes Buddhism special, and opens new avenues for enhancing, refining, and expanding the range of arguments and possibilities that comparative neurophilosophy can entertain.     

Canadian athletes' perspectives of mental health care and the importance of clinicians' sport knowledge: A multi-method investigation

The purpose of this inquiry was to explore Canadian competitive athletes' perspectives on their mental health care experiences using a sequential multi-method design. The overarching aims of the study were to explore athletes' self-reported reasons for seeking mental health care, their awareness of their clinician's knowledge of sport, and the importance they placed on their clinician having knowledge of the sport context. A sequential mixed methods design was employed in which two studies were conducted to address these aims. In study one, 70 current and former Canadian athletes completed a short survey assessing basic demographics, athletes' reasons for seeking treatment, and the importance they placed on their clinician having sport knowledge for effective care. In study two, ten athletes participated in individual semi-structured interviews in which similar topics were explored. Fifty-six percent of surveyed athletes reported that their clinicians' knowledge of sport did not impact their treatment experience, however only 29% reported being aware of their clinician having such knowledge. Thematic analysis of the interview data suggested that the connectedness of athletes' mental health issues and sport participation played a role in the importance they placed on their clinician having sport knowledge. Key components of a successful therapeutic alliance included the clinician validating the importance of sport, normalizing athlete mental health challenges, and understanding the demands of the competitive sport culture. Conclusions of this inquiry include that assessing how inter-related an athlete perceives their mental health challenges and sport participation to be, and demonstrating an understanding of the importance of sport in competitive athletes' lives, are likely helpful strategies in working clinically with this population even if a clinician does not have specific experience with the sport context.     

Are mental health awareness efforts contributing to the rise in reported mental health problems? A call to test the prevalence inflation hypothesis

In the past decade, there have been extensive efforts in the Western world to raise public awareness about mental health problems, with the goal of reducing or preventing these symptoms across the population. Despite these efforts, reported rates of mental health problems have increased in these countries over the same period. In this paper, we present the hypothesis that, paradoxically, awareness efforts are contributing to this reported increase in mental health problems. We term this the prevalence inflation hypothesis. First, we argue that mental health awareness efforts are leading to more accurate reporting of previously under-recognised symptoms, a beneficial outcome. Second, and more problematically, we propose that awareness efforts are leading some individuals to interpret and report milder forms of distress as mental health problems. We propose that this then leads some individuals to experience a genuine increase in symptoms, because labelling distress as a mental health problem can affect an individual's self-concept and behaviour in a way that is ultimately self-fulfilling. For example, interpreting low levels of anxiety as symptomatic of an anxiety disorder might lead to behavioural avoidance, which can further exacerbate anxiety symptoms. We propose that the increase in reported symptoms then drives further awareness efforts: the two processes influence each other in a cyclical, intensifying manner. We end by suggesting ways to test this hypothesis and argue that future awareness efforts need to mitigate the issues we present.     

General practitioners' perceptions of psychologists: A response to the Medicare changes in Australia

General practitioners (GPs) have historically been at the centre of primary health‐care delivery in Australia, including delivery of mental health‐care services. Recent changes, however, by the Australian Federal government have led to the creation of a number of mental health‐care items provided by psychologists that are now available on the Medicare Benefits Schedule. The aim of the present study was to examine GPs' perceptions of psychologists and the ways in which GPs have responded to these policy changes in making referrals for mental health patients. Nine GPs were interviewed regarding the provision of mental health‐care services. Analysis of the interviews indicated a number of themes including the benefits of the new Medicare policy in increasing accessibility of psychologists, GPs' frustrations with the bureaucracy surrounding the use of this policy, GPs' knowledge about the specific skills and training of psychologists, and the importance of GPs' matching patients and clinicians. Recommendations are made to facilitate the professional and clinical relationship between GPs and psychologists.