Challenges and opportunities in moving toward a public health approach in school mental health

These three outstanding papers are important for the discipline of school psychology, the field of school-based mental health, and more generally for systems of education and mental health for children and adolescents. As the authors emphasize, there is an unprecedented focus on improving programs that remove barriers to learning and enhance development, health, and mental health in youth, in the most universal natural setting—the schools. The authors also correctly highlight that school psychology is uniquely positioned to play a leading role in this reform and change effort. Two interconnected themes of the public health approach—applying the evidence base and moving toward preventive and population-focused interventions—are emphasized in these papers, and while they focus on school psychology, the issues discussed are generalizable to the many disciplines that operate within educational and mental health systems. In the following discussion, I react to the papers' two major themes, discuss realities that should be addressed for progress to be made, and comment on their implications for school psychology.     

The development of a mental health coalition: A case study

Described the development of a local-level mental health coalition to advocate for housing and community support programs for psychiatric consumer/survivors. Resource mobilization theory was used as a framework from which to view and understand the origins, goals, tactics, and outcomes of the coalition. Data were presented indicating that the coalition played a role in obtaining increased funding for housing and community support programs. Also, there was an emphasis on consumer/survivor and family participation in the change process. Benefits and limitations of the coalition after 6 years of operation were reviewed and compared with other advocacy coalitions in mental health. Thanks to Wendy Czarny, Peter Dunn, Mary Earls, John Lord, Ken Parsons, Isaac Prilleltensky, Harvey Simmons, and the reviewers for their helpful suggestions on earlier drafts of this paper.     

Advocacy processes in mental health: a qualitative study

Advocates perform an important role in representing the rights of mental health consumers, especially since mental health consumers are often marginalized. Little is known about the processes advocates use to assist mental health consumers in navigating the health care system. This study details the manner in which advocates work together with mental health consumers and health professionals through presenting a qualitative synthesis of 60 case records. Four main themes emerged: negotiating on behalf of consumers during meetings with health professionals; liaising between consumers and health professionals outside of meetings; supporting consumer decision making without the involvement of health professionals; and involvement in legal processes. The findings of this study demonstrated that advocates were primarily oriented toward the protection of negative rights, but they also promoted positive rights.     

Health care practitioners' perceptions of public mental health care in the Eastern Cape,South Africa

This qualitative study explored the perceptions of health care practitioners (HCPs) concerning public mental health care in the Eastern Cape Province of South Africa. Data were collected from thirteen purposively selected HCPs using in-depth unstructured interviews (males?=?6, females?=?7). Data were transcribed verbatim and later thematically analysed. The findings suggest that mental health professionals perceive mental health services to be both inadequate and of suboptimal quality. Specifically, they perceived public mental health care to have lower priority, to be poorly resourced and lacking in patient-oriented care qualities.     

Forging partnerships for mental health: The case of a prefecture in crisis ravaged Greece

Public health and in particular mental health have been severely affected by the multitude of socioeconomic crises experienced by people in Greece. The severe austerity programmes, have reduced access to health services and increased demand for publically funded health care. This paper presents a case study focusing on the impact of these measures on the lives of mental health providers in one prefecture in Crete. Focus group methodology was applied and the data were analysed using thematic analysis. Analyses revealed three superordinate themes that converge at many levels and appear to be going counter to the circumstances: firstly, ‘forging partnerships for mental health’; secondly, ‘extending our reach’; and thirdly ‘transformations in professional identity through praxis’. These themes are discussed using the words of the participants and the relevant literature.     

The influence of culture on disaster mental health and psychosocial support interventions in Southeast Asia

Southeast Asia (SEA), which has borne the brunt of some of the most severe natural disasters in the past decade, has unfortunately, been largely under-represented in the world literature on disaster mental health. This article describes cultural factors that may inform the design and conduct of disaster-related mental health psychosocial support (MHPSS) interventions. Specifically, it discusses cultural nuances in emotional expression, shame, power distance, collectivism, and spiritual beliefs and their implications on providing post-disaster psychosocial interventions. It describes the MHPSS interventions implemented in the region using the Johns Hopkins Perspectives Model of Disaster Mental Health categories of resistance, resilience and recovery. Given the challenges on the delivery of MHPSS, there is a need for evidence-based interventions and to ensure that disaster responders in SEA understand the cultural factors that impact the delivery of MHPSS interventions.     

The influence of the media on practice in mental health: a bricolage of a single case study

This paper has its genesis in the convergence of two individuals’ interests – one with a long-standing interest in representations of mental health and one with an interest in the use of bricolage as a research approach. These interests converged around the ways in which mental health care practitioners might react to and subsequently reflect on images of mental health they came across in the media. A bricolage was developed relating to newspaper coverage of a homicide carried out by someone with a mental health problem. The bricolage draws on the assumption that practitioners will have immediate reactions to material they come across, take a more considered overview of this material, and subsequently attempt to contextualize this reflection in terms of academic literature. The bricolage as presented mirrors this process for an experienced practitioner. Suggestions are made concerning the use of newspaper reports on mental health, to enable both novice and experienced practitioners to gain vicarious experience through reflection on these reports.     

Resilience facilitates positive emotionality and integration of negative memories in need satisfying memory networks: An experimental study

Resilience has been associated with the capacity to experience positive emotions in the midst of negative life events or following the recall of such events. Apparently, resilient people are able to self-generate those positive emotions because they tend to integrate and associate such past negative life events with other positive past events in memory networks. However, study designs on resilience have remained either cross-sectional or longitudinal. The causal effect of resilience on these outcomes remains to be shown as a third variable or unknown factor could be at play. In this study, we used a resilience intervention from a self-help clinical program to induce resilience and compared this condition against Jacobson type relaxation and neutral music background. Results showed that the resilience intervention increased positive emotionality following the recall of a negative self-defining memory and facilitated the integration of that memory within more positive and need satisfying memory networks.     

Understanding public opinion relating to the establishment of community mental health facilities: implications of a discourse analytic approach

This paper demonstrates a novel approach to investigating the problem of public opposition to community mental health facilities. With the move towards community care, organizations setting up mental health facilities have encountered public opposition. It has been argued that this is due, in part, to the attitudes held by the public towards mentally ill people. A knowledge and understanding of attitudes towards this client group therefore has the potential to be of practical use to policy makers and practitioners who have a responsibility to consult on, and implement, community care for mentally ill people. The survey approaches and hypothetical situations used in previous British studies of community attitudes towards mentally ill people have, however, failed to take account of the rhetorical richness and complexity of the attitudes likely to be expressed in real‐life community care contexts. By contrast, the study reported in this paper used a discourse analytic approach to explore the views expressed about mentally ill people in a ‘hot situation’. Specifically, people's views were explored in the contexts of the arguments they used to challenge or advocate a supported accommodation project for mentally ill people in their community. This paper examines some of these arguments and discusses the theoretical implications for traditional approaches to attitude research. In conclusion, the potential practical utility of the findings is considered. Copyright © 1999 John Wiley & Sons, Ltd.     

Adolescent over-general memory,life events and mental health outcomes: Findings from a UK cohort study

Previous research suggesting that over-general memory (OGM) may moderate the effect of life events on depressive symptoms and suicidality has sampled older adolescents or adults, or younger adolescents in high-risk populations, and has been conducted over relatively short follow-up periods. The authors examined the relationship between OGM at age 13 and life events and mental health outcomes (depression, self-harm, suicidal ideation and planning) at age 16 years within a sample of 5792 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), approximately 3800 of whom had also provided data on depression and self-harm. There was no clear evidence of either direct or interactive effects of OGM at age 13 on levels of depression at age 16. Similarly there was no clear evidence of either direct or interactive effects of OGM on suicidal ideation and self-harm. Although there was some evidence that over-general autobiographical memory was associated with reduced risk of suicidal planning and increased risk of self-harm, these associations were absent when confounding variables were taken into account. The findings imply that although OGM is a marker of vulnerability to depression and related psychopathology in high-risk groups, this cannot be assumed to generalise to whole populations.     

Dose response effects of cognitive-behavioral therapy in a school mental health program

ABSTRACT

School mental health (SMH) programs have been shown to be effective in providing evidence-based interventions to underserved youth. However, limitations of SMH programs are that they can entail holiday breaks, typically do not operate through summer, and often require pulling students from class to receive therapy. These limitations suggest that treatment must be expeditious and potent. Although researchers have investigated dose response to treatment, no studies were located that addressed dose response to treatment in SMH programs. The present study addressed this gap by evaluating the dose response to SMH treatment in a sample of 133 adolescents. Adolescents were assessed at baseline, post-treatment, and at multiple time points throughout treatment. An average treatment response of a 26.81-point decrease in Youth Outcome Questionnaire (YOQ-30) score was found across 14 sessions of cognitive-behavioral therapy (CBT). Further, adolescents exhibited reliable change in YOQ-30 score within an average of 2.91 sessions. Finally, it was found that baseline scores on the Depression and Hyperactivity subscales of the Behavior Assessment System for Children, 2nd Edition, along with YOQ-30 score, predicted treatment response. These findings advance our understanding of dose response to CBT in SMH settings, and create opportunities to better inform effective treatment strategies in similar contexts.     

Religiosity,spirituality, mental health,and mental health treatment outcomes in Australia: a systematic literature review

The relationship between religiosity and mental health is a relatively well-researched field within North America, covering numerous domains of religiosity, including: religion, spirituality, prayer, church attendance, church affiliation and belief in God or a higher power. Considering the Australian literature, there are few papers that explore these dimensions of religiosity and their relationship with health, and in particular, very little research into the field of religiosity and mental health. Using systematic literature review methods, this study explores the Australian research into relationships between religiosity, mental health, and treatment outcomes for psychiatric illness and suicidal behaviour.     

Reminiscence bump in autobiographical memory: Unexplained by novelty,emotionality, valence,or importance of personal events

People tend to recall a disproportionately large number of personal events from their adolescence and early adulthood. This “reminiscence bump” has been examined extensively, but its causes remain unclear. In this Internet-based experiment, nearly 3,500 participants were given 10 cue words and were asked to describe the personal events that came to mind. Furthermore, they were asked to date each event and to indicate whether it was a first-time experience. Finally, the participants were asked to rate the strength of the emotional reaction to the event or the valence or the importance of the event. Surprisingly, the reminiscence bump consisted of relatively fewer novel, emotional, important positive or negative events. This result increases the likelihood of an alternative explanation—namely, that memory is generally enhanced in adolescence and early adulthood. However, this account has not been tested directly.     

Engagement with meditation as a positive health trajectory: Divergent narratives of progress in male meditators

Objective: Studying personal narratives can generate understanding of how people experience physical and mental illness. However, few studies have explored narratives of engagement in health positive behaviours, with none focusing on men specifically. Thus, we sought to examine men’s experiences of their efforts to engage in and maintain healthy behaviours, focusing on meditation as an example of such behaviour.

Design: We recruited 30 male meditators, using principles of maximum variation sampling, and conducted two in-depth interviews with each, separated by a year. Main outcome measures: We sought to elicit men’s narratives of their experiences of trying to maintain a meditation practice.

Results: We identified an overall theme of a ‘positive health trajectory,’ in particular, making ‘progress’ through meditation. Under this were six main accounts. Only two articulated a ‘positive’ message about progress: Climbing a hierarchy of practitioners, and progress catalysed in other areas of life. The other four reflected the difficulties around progress: Progress being undermined by illness; disappointment with progress; progress ‘forgotten’ (superseded by other concerns); and progress re-conceptualised due to other priorities.

Conclusion: Men’s narratives reveal the way they experience and construct their engagement with meditation – as an example of health behaviour – in terms of progress.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

Constructing autobiographical events within a spatial or temporal context: a comparison of two targeted episodic induction techniques

ABSTRACT

Recalling and imagining autobiographical experiences involves constructing event representations within spatiotemporal contexts. We tested whether generating autobiographical events within a primarily spatial (where the event occurred) or temporal (the sequence of actions that occurred) context affected how the associated mental representation was constructed. We leveraged the well-validated episodic specificity induction (ESI) technique, known to influence the use of episodic processes on subsequent tasks, to develop variants that selectively enhance spatial or temporal processing. We tested the effects of these inductions on the details used to describe past and future autobiographical events. We first replicated the standard ESI effect, showing that ESI enhances generating episodic details, particularly those that are perception-based, when describing autobiographical events (Experiment 1). We then directly compared the effects of the spatial and temporal inductions (Experiment 2 and 3). When describing autobiographical events, spatial induction enhanced generating episodic details, specifically perception-based details, compared to the control or temporal inductions. A greater proportion of the episodic details generated after the temporal induction were gist-based than after the spatial induction, but this proportion did not differ from a control induction. Thus, using a spatial or temporal framework for autobiographical event generation alters the associated details that are accessed.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Domestic violence and mental health in a Dutch community sample: The adverse role of loneliness

The present study explored whether the adverse mental health consequences of domestic violence victimization vary by type of loneliness (i.e., emotional and social loneliness). Participants were drawn from the Dutch city of Rotterdam (N = 7072). Domestic violence victimization, emotional loneliness and social loneliness were associated with self‐reported mental health. In addition, interaction effects were observed between domestic violence victimization and each type of loneliness. Implications for policy practice as well as strengths and limitations of the study were discussed. Copyright © 2010 John Wiley & Sons, Ltd.