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.     

How People Can Benefit from Mental Health Consumer-Run Organizations

The goal of this study is to develop a more comprehensive theoretical understanding of the processes by which people can benefit from mental health consumer-run organizations (CROs). To accomplish this goal, the concept of roles is used to create a preliminary framework that draws connections between several established theoretical explanations. To ground theory development in empirical data, 194 CRO members from 20 CROs answered open-ended questions about what personal changes occurred as a result of their CRO involvement and what CRO participation experiences enabled personal change. Data analysis led to the identification of 18 personal change categories and 7 experiences that led to change. These categories were integrated into the preliminary theoretical framework, which needed to be extended to accommodate all categories. While inevitably tentative, the final conceptualization provides a more comprehensive understanding of the processes by which people can benefit from CRO participation.     

Community Participation Needs of Families With Children With Behavioral Disorders: A Systems of Care Approach

The purpose of the current study was to convey findings regarding the community participation needs of families who have children with behavioral disorders. The changing focus of community-based service provision to the systems of care approach for children with mental health needs requires family input to identify and better address their needs. This study identified characteristics of community participation in families of children with mental health needs through a survey, using mixed methods design and purposeful sampling. Evolved themes supported challenges for policymakers to make changes in professional, school, and community supports. Occupational therapists have a strong skill set to offer these families and must work collaboratively with family organizations, provide support for successful engagement in desired social activities, and build adaptive behaviors in children with mental health needs.     

Prohibiting Versus Discouraging: Exploring Mental Health Organizations Varied Stances on Sexual Orientation Change Efforts (SOCE)

Research has shown that sexual orientation change efforts results in more mental health damages than positive outcomes; yet a recent study found that 19.4% of mental health practitioners believe it is ethical to practice sexual orientation change efforts. The purpose of this paper is to highlight existing literature on sexual orientation change efforts, showcase mental health professional organization's stances on ethically prohibiting versus discouraging sexual orientation change efforts, and propose suggestions and learning objectives to mental health organizations. By doing so, we hope all mental health professional organizations enforce a clear ethical code against the practice of sexual orientation change efforts.     

Effects of resource-building group intervention on career management and mental health in work organizations: randomized controlled field trial

A resource-building group intervention was developed to enhance career management, mental health, and job retention in work organizations. The in-company training program provided employees with better preparedness to manage their own careers. The program activities were universally implemented using an organization-level, 2-trainer model with trainers from the human resources management and occupational health services. The study was a within-organizations, randomly assigned field experimental study; it investigated the impacts of the intervention on immediate career management preparedness and later mental health and intentions to retire early. A total of 718 eligible individuals returned a questionnaire in 17 organizations and became voluntary participants. The respondents were randomly assigned to either an intervention (N = 369) or a comparison group (N = 349). Those in the intervention group were invited to group intervention workshops, whereas those in the comparison group received printed information about career and health-related issues. The 7-month follow-up results showed that the program significantly decreased depressive symptoms and intentions to retire early and increased mental resources among the group participants compared to the others. The mediation analyses demonstrated that the increase in career management preparedness as a proximal impact of the intervention mediated the longer term mental health effects. Those who benefited most from the intervention as regards their mental health were employees with elevated levels of depression or exhaustion and younger employees, implying additional benefits of a more targeted use of the intervention. The results demonstrated the benefits of the enhancement of individual-level career management and resilience resources as career and health promotion practice in work organizations.     

Capturing Dynamic Processes of Change in GROW Mutual Help Groups for Mental Health

The need for a model that can portray dynamic processes of change in mutual help groups for mental health (MHGMHs) is emphasized. A dynamic process model has the potential to capture a more comprehensive understanding of how MHGMHs may assist their members. An investigation into GROW, a mutual help organization for mental health, employed ethnographic, phenomenological and collaborative research methods. The study examined how GROW impacts on psychological well being. Study outcomes aligned with the social ecological paradigm (Maton in Understanding the self-help organization: frameworks and findings. Sage, Thousand Oaks 1994) indicating multifactorial processes of change at and across three levels of analysis: group level, GROW program/community level and individual level. Outcome themes related to life skills acquisition and a change in self-perception in terms of belonging within community and an increased sense of personal value. The GROW findings are used to assist development of a dynamic multi-dimensional process model to explain how MHGMHs may promote positive change.     

Microlevel Structuration in Computer-Supported Group Decision Making

The theory of Structuration focuses on how actions by members of social collectives create the structures that enable and constrain future action. Most previous research on Structuration in groups and organizations used qualitative case studies because Structuration is quite complex. This study introduces a method for the study of Structuration in larger samples of groups or organizations. A category system for the identification of structuring moves is described, along with several methods for characterizing short- and long-term trends in Structuration processes. The method is used to study how groups incorporate a computerized group decision support system (GDSS) into their decision processes. GDSSs are part of a class of new computer and communication technologies designed to help groups improve their meetings and make better decisions. Because GDSSs must be used by a group rather than an individual, social processes are critical in determining their effects on group outcomes. GDSSs influence groups by structuring their activities, and structurational processes are critical mediators of the impacts of GDSSs on group decision making. The study focused on the effects of restrictiveness of GDSS technology on Structuration processes and, in turn, on the relation of Structuration to a key group outcome, consensus change. The results suggest that two major types of structuring processes occur in computer-supported groups and that the nature of structuration is related to degree of consensus change.     

Introduction to the Special Issue on Mental Health Self-Help

Since the 1950s, people with mental illness and their families have been organizing a wide range of self-directed, mutual support oriented initiatives, including self-help groups, nonprofit organizations, and businesses. These initiatives have become increasingly widespread over the years and today mental health self-help initiatives outnumber traditional mental health organizations in the United States (Goldstrom et al., Admin Policy Mental Health Mental Health Serv Res 33:92-103, 2006). Mental health self-help embodies much of what community psychologists promote, including the self-directed organization of people to create social change and facilitate personal transformation. This special issue provides new insight into several prominent areas of inquiry surrounding these low-cost interventions including: (1) their evidence base; (2) the processes by which people benefit; (3) how they interface with the mental health system; and (4) the value dilemmas they face.     

Community-based services and resources: The significance of choice and diversity

Conclusions We are reminded by the growth of consumer-run approaches of the value of diversity and individual choice in community support of persons with severe mental illness. These ideas are evident in the alternative approaches that have been developed to serve persons who have not been reached by more traditional services. The ACT program, described by Bond et al. (1990), is an example of a service approach designed to be responsive to individuals' day-to-day needs as they define them. Continued development of this type of alternative service should be encouraged.Persons coping with severe mental illness benefit from a variety of community supports and resources. Strategies that encourage consumer involvement, ownership, and control help to provide diversity of services and to empower the consumer. Our efforts, as professionals, to provide community services can be enhanced by (a) supporting diversity of service and resource options, both inside and outside of the professional mental health system; (b) developing services that are responsive to individuals needs as they define them; and (c) facilitating the process of consumer choice in selecting resources options.The author expresses thanks to Marc A. Zimmerman and Richard H. Price for comments on earlier drafts of this paper.     

Applying a longitudinal tracer methodology to evaluate complex interventions in complex settings

Long-running multi-faceted intervention studies are particularly problematic in large complex organizations where traditional methods prove too resource intensive and can yield inaccurate and incomplete findings. This paper describes the first use of, longitudinal tracer methodology (LTM), a realist approach to evaluation, to examine the links between multiple complex intervention activities (processes) and their outcomes on a construction megaproject. LTM is especially useful when the researcher has little control over intervention delivery but has evidence drawn from multiple sources to evaluate the intervention activities effects over time. This methodology has rarely been deployed in complex organizational settings and not on a construction megaproject. This paper presents a case study of its use over a period of three years, on 24 construction sites forming London’s Thames Tideway Tunnel (Tideway) megaproject. The study examines the “transformational” power of occupational safety and health (OSH) interventions across the multiple organizations and supply chains in the megaproject. The study shows how the method can be adapted in-flight to accommodate shifting lines of inquiry as the intervention activities progress and change. This feature along with its resource-efficient operation, make it an attractive option where interventions are likely to have differential effects across multiple sites of enactment.     

Governance Processes and Change Within Organizational Participants of Multi-sectoral Community Health Care Alliances: The Mediating Role of Vision,Mission, Strategy Agreement and Perceived Alliance Value

Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their ‘home’ organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.     

关于中国心理健康服务体系建设的若干问题

从我国心理健康服务的基本模式、技术体系、服务主体、教育培训、管理监督等五个方面回顾了我国心理健康服务体系的现状。近二、三十年来,我国心理健康服务体系从无到有,发展迅速,但也存在若干亟待解决的问题:服务的技术体系不完善,心理服务的从业机构和个人良莠不齐、总体水平偏低,从业人员的教育培训、从业人员和机构的资质认证缺乏有效的监督管理机制等。目前我国的心理健康服务体系难以适应社会对心理健康服务的需求。需要立足国情,借鉴外国的成功经验并结合我国传统文化,以扎实的研究和细致的工作来完善我国的心理健康服务体系。     

Lernen im Team

The recent rapid changes of the economic conditions in the health care system have lead to a sense af crisis especially in mental health care organisations. The goal of high quality health care is in conflict with the economic necessity of cost cutting and profitability. The demand for rapid change processes collides with a special need for stability in mental health care organisations. In treating this dilemma, we can observe a marked inclination for splitting as a defence, which is acted out especially between leadership and work force, as well as between the management and the therapeutic part of the institutions. This danger of splitting can be counteracted with an attitude of integrating and balancing the different needs and by orientating the organisation at the principles of a ?learning organisation“ (Senge 1990). Such an organization can use the capacity of self-management in treating the above mentioned dilemma. In addition, the capacity of ?learning from experience“ (Bion 1962) proves as an essential asset in the survival of mental health care organizations. In such organizations, work and learning is primarily organized in the structure of teams — this article will therefore discuss how teams organize learning and how they treat the dynamics of stability and change.     

Mental Health in Information Work

Abstract

The attention paid to problems related to mental health of employees in organizations is growing. Although the stress literature is huge and varied, most of the empirical studies are done in traditional work environments in which information technology and computers are of little importance. The recent increasing use of information technology has created a growing number of information processing work environments. The work in those work environments is typically done with data and can be characterized as “mental” work. The general hypothesis in this paper is that people doing mental work relate the perception of their work to mental health. More specifically, this paper describes the relationship between work-related factors and mental health among employees in a typical information processing environment: an insurance company. First, we discuss the concept of mental health. Next, we summarize the results of a number of studies on the determinants of mental health in information work. The results of our study indicate that work and health perception has a greater impact on mental health than work characteristics, personality, and activities outside work. Work perception, health perception, and mental health can be considered as one factor, although there are minor differences between subgroups in the population. In the discussion we try to integrate the findings into a general model of mental health related to work.     

Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization

The authors suggest that the mental health system of the nation could benefit by more fully embracing the idea of mutual-help (i.e., self-help), and this collaboration could be facilitated by the utilization of a well-established clinical theory to elucidate the psychological processes at work within mutual-help organizations. The processes of change of the transtheoretical model is offered as one potential framework. This well-established model has been used to help psychologists better understand clinical and professional phenemonena, but, to date, has been used less frequently with non-professional interventions. This article applies the ten processes of change of the transtheoretical model to mutual-help organizations, focusing on four groups, including Alcoholics Anonymous (AA), Oxford House, GROW, and Schizophrenics Anonymous. The advantages of the transtheoretical model and its potential ability to act as a common language across clinical professionals and mutual-help organizations are discussed. In addition, advantages of bolstering the present mental health system using combinations of both forms of care along the recovery continuum are described.     

Community Data Collection with Children of Mothers Living with HIV: Boundaries of the Researcher Role

The TRACK‐II program is a multi‐site, community‐based randomized controlled trial evaluating an intervention to assist mothers living with HIV (MLH) in disclosing their HIV status to their young children. Many participants—both mothers and children—reported significant depression and/or suicidal ideation, a phenomenon that presented ethical challenges. This article focuses on participants at one site (Atlanta). Through the vignette of “Jordan,” we describe ethical challenges that may arise when faced with the responsibility of maximizing participants’ safety while maintaining the boundaries of the researcher role. Guided by community psychology values, our team has taken measures within our role as researchers to empower and protect children and mothers endorsing suicidal ideation. For example, we have relied on relationships with community‐based organizations and AIDS service organizations to connect HIV‐affected families to mental health services. Furthermore, we have expanded our system of documentation to follow‐up adequately with families at risk, and we track family resources to promote a strengths‐based framework. We have solicited families’ feedback about their supports and needs to understand how we may best serve them by connecting them to the resources they report needing most and empowering them to care for themselves.     

青少年心理健康与心理素质培养的整合研究

青少年心理健康与心理素质培养的整合研究是重庆市人文社会科学重点研究基地西南大学心理健康教育研究中心十多年来确立的研究主题。围绕该主题我们不仅从理论到实证进行了较为系统的探讨,取得了一批有本土特色的研究成果,受到国内外学术界关注,而且重视把研究成果及时转化运用于教育实践,开发了系统测量工具,编写了系列教材,开展了青少年心理素质教育的实验探索,推动了学校心理健康教育积极有效的开展。文章主要从青少年心理健康与心理素质培养整合研究的理论依据、方法论思考、研究主题等方面,概括总结心理健康与心理素质培养整合研究的概况,以期进一步促进该领域的深化研究。     

Housing First and Photovoice: Transforming Lives,Communities, and Systems

This article presents findings from a community‐based participatory evaluation of a Housing First program on the Island of O'ahu. In this study, clients in a Housing First program used Photovoice to evaluate the program and to advocate for progressive housing policies. Written together by members of the Housing First Photovoice group, this collaborative article describes the outcomes from both the Housing First program and the Photovoice project and demonstrates the ways in which participatory program evaluations can interact with client‐driven programs like Housing First to produce a cumulative, transformative impact. Findings suggest that community psychologists hoping to re‐engage with community mental health systems through enacting transformative change should consider taking a community‐based participatory approach to program evaluation because increased client voice in community mental health programs and their evaluations can have far‐reaching, transformative impacts for research, practice, and policy.     

Mental Health Services in Juvenile Correctional Facilities: A National Survey of Clinical Staff

This study determined the use of best practices in providing mental health services to youth within juvenile correctional facilities. A national sample of 94 (49.7 %) lead clinical staff from all available and qualifying facilities responded to a mail and on-line survey. There were no statistically significant differences across respondents versus nonrespondents for security level, gender served, or census region of facilities. Specifically, we examined the provision of facility-wide mental health programming, individual, group, and family counseling, and case management services. Examination of these services included the use of evidence-based interventions provided through an established curriculum and methods used to evaluate the effectiveness of the interventions. We also examined staff involvement, and the perceived quality of services and barriers to providing interventions. Participants reported using a variety of evidence-based interventions; however, participants also acknowledged using other approaches that may not have empirical support. Additionally, although at least half of the participants reported mandatory individual and group counseling, less than a third of the participants reported that their facilities required family counseling. Clinical staff also reported a variety of methods used for evaluating the effectiveness of mental health services. Additional findings, as well as implications for research and practice, are discussed.     

Assessing quality of care and observance of human rights in residential mental health facilities in Greece through the WHO QualityRights tool kit

In this paper, we present and reflect upon the process of evaluating two residential mental health facilities in Thessaloniki, Greece, through the WHO QualityRights tool kit. The QualityRights tool kit is a structured process for assessing quality of care and human rights in mental health and social care facilities, in accordance with the United Nations Convention on the Rights of Persons with Disabilities (CRPD), introduced by the World Health Organization in 2012. We have piloted the use of the Toolkit in two supported accommodation facilities, a hostel and a service supervising independent living in apartments, for individuals with long-term severe mental health problems in the region of Thessaloniki. In this paper, we present the methodology and process of evaluating the facilities, including the challenges posed to the evaluation process by restrictions due to the Covid-19 pandemic. We showcase the outcome of this evaluation through presenting a summary of the results and the ensuing recommendations for improvement. Finally, we reflect on the usefulness, appropriateness and relevance of the Toolkit for evaluating mental health care facilities in the particular context of contemporary Greece.