Short versus longer term effectiveness of an outreach program for the homeless mentally Ill

Presents 12-month follow-up results from an outreach/linkage intervention with persons who are homeless and mentally ill, contrasting these with results obtained at 4 months. Both sets reflect the success of the program in placing individuals in independent housing. However, longer term data provide useful information regarding client movement patterns and increased tenure in nonhomeless living arrangements beyond the termination of specialized services. Analyses of 12-month residential outcomes identified four variables as significant predictors: recruitment source, project service duration, CMH service duration, and client age. In contrast to 4-month predictors, variables reflecting baseline client functioning were no longer significantly related to outcome, suggesting that the positive effects of the intervention may take longer to achieve with some clients. Discussion focuses on the implications of these effectiveness results for future research designs and measures as well as the utility and limitations of preexperimental approaches for evaluating innovative service models when implementation and efficacy experiences are lacking. This research was supported in part by a grant from the National Institute of Mental Health, #H87 MH44373, to the Michigan Department of Mental Health.     

病耻感对于精神病患者的影响以及文化对策

本文分析三种类型歧视所造成的患者及其家属的痛耻感,论述我们应当如何利用适当的文化应对策略来消除歧视、减少病耻感,从而有效地克服病耻感对于患者及其家属的负面影响。文化差异与病耻感的形成直接相关,文化作为一个重要变量,影响着精神卫生问题以及相应的服务政策,深入研究和认识儒家文化的核心价值有助于减少对于精神病患者的歧视,帮助他们克服病耻感。中国道家文化推崇道法自然,无为而治,可以发展出有效的心理疗法,对于精神疾病是一剂对症的良药。     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

Negative social interactions,distress, and depression among those caring for a seriously and persistently mentally III relative

Investigated both positive and negative social interactions and their effect on mental health for 106 individuals caring for a seriously mentally ill family member. Results from mixed-model (hierarchial and stepwise) multiple regression analyses in which caregiver age, socioeconomic status, caregiving demand, and severity of patient symptoms was controlled showed that negative social interaction accounted for a significant portion of variance in the caregivers' feelings of distress and depression. Moderated multiple regression analyses showed that under conditions of high negative interaction, the relationship between demand and distress was intensified. Implications of these findings for the conceptualization and measurement of negative social interaction as well as its clinical implications were discussed. The research for this paper was supported by funds from the Provost's office, University of Pittsburgh, School of Social Work. The authors thank the Pennsylvania Alliance for the Mentally Ill for their support of, and participation in, the study.     

Designated as Dangerous: Characteristics of Sex Offenders Subject to Post‐Sentence Orders in Australia

The earliest characterisation of Australian sex offenders subjected to post‐sentence legislation is presented. Demographic, developmental, clinical, and criminal characteristics were obtained for sex offenders under post‐sentence orders in Western Australia, New South Wales, and Victoria. Data on 50 offenders were recorded from psychological and psychiatric risk assessment reports statutorily required at the initiation of post‐sentence legal proceedings. The findings describe a group of demonstrably dangerous men who exhibited an early onset of sexual offending, high rates of mental disorder, sexual deviance, and antisociality. Their developmental histories are characterised by early deprivation, disadvantage, abuse, early exposure to substance abuse, and social and psychological dislocation. These offenders present a conundrum to criminal justice agencies. They are an objectively unfortunate group and have engaged in significantly harmful behaviours. However, the early onset of their offending suggests that early intervention services, such as those offered by mental health professionals, have a critically important role to play in any effort to alter offending trajectories such as those exhibited in this sample. A paradigm shift in public policy from a post hoc model to a well‐resourced preventative and public health approach to the problem of sexual violence is proposed. Broad treatment implications are also considered.     

INDUCING VARIABILITY IN COMMUNICATIVE GESTURES USED BY SEVERELY RETARDED INDIVIDUALS

Handicapped individuals who have been taught spontaneous gesture requests often use only a small part of their vocabulary. Procedures to recover the unused part of this vocabulary have not been documented. This study was designed to identify procedures for increasing the proportion of gestures used spontaneously. Six mentally handicapped individuals served as subjects. After a baseline phase during which spontaneous gesture requests were reinforced, consequences were withheld for high-rate gesture requests. This led to an increase in different gesture requests. Although gesture requests did not return to baseline levels during a reversal condition, functional control was demonstrated by way of a multiple baseline across subjects. The absence of a reversal effect suggests enduring effects of the procedure.