Unemployment and Health: Selection Effects

A large number of studies have shown that the unemployed are less healthy, both physically and psychologically, than the employed. The explanation may be that unemployment has negative health effects. An alternative, or additional, explanation is that healthy persons are less likely to become unemployed or more likely to find new employment if they become unemployed. Such effects of health on employment status are generally referred to as selection effects. The present paper analyses to what extent such selection effects are present in the Norwegian labour market. Panel data with observations made in 1989 and 1993 are used. The analyses show that people with psychological problems are more likely to be laid off, and there is also some evidence that psychological or physical health problems may reduce the chances of finding a new job if one has become unemployed. It is of particular interest that these selection effects can be documented for a country like Norway, which has strong legislation supporting worker rights and a quite high degree of unionization.     

Refusing to be Marginalized: Groupwork in Mental Health Services for Women Survivors of Childhood Sexual Abuse

Childhood sexual abuse is a major aetiological factor in the development of mental health difficulties experienced by women. Although this conclusion is supported by two decades of extensive research, it has had little impact on the provision of mainstream mental health services. It remains exceptional for there to be specialist therapy or counselling provision for women survivors of childhood sexual abuse within statutory mental health services. This represents a serious gap in service provision and, it is argued, results in extended and inappropriate treatment for women survivors using mental health services. In this article, the development of a multi-agency approach to the provision of groupwork for women survivors of childhood sexual abuse within mental health service is described. A women-centred model of groupwork is outlined. Evaluation and funding are discussed. It is argued that, as a time-limited and effective treatment option, groupwork for women survivors of childhood sexual abuse should form a central part of service provision within statutory adult mental health services.     

Developing Black Mental Health Provision: Challenging Inequalities in Partnership

This article describes and comments upon the process of developing the Sanctuary project in London, a project that will provide two community-based crisis support services for African and African-Caribbean women and men in mental crisis and distress. This initiative is informed by the extensive research documenting the ways in which mainstream, mental health services fail Black people, and by evidence suggesting that innovations in service provision for Black people are often vulnerable and limited in their impact. In an effort to avoid replicating these problems, considerable emphasis has been given to developing the project in partnership with the main stakeholders—in this instance statutory and Black voluntary sector agencies as well as Black users, carers and community members. Within this context, issues relating to inequalities can be proactively addressed, thereby reducing the risk that they undermine the effectiveness of service provision at a later stage. However, working in partnership can also hinder or delay service developments if discussions between stakeholders become protracted or conflicts unresolved. The author draws on experience gained from this project to identify the potential as well as the difficulties of using a partnership approach to developing effective Black mental health provision. The author's role in the development of these projects has been as representative of one of the partners, the King's Fund Centre for Development.     

Reconstructing Hymens or Constructing Sexual Inequality? Service Provision to Islamic Young Women Coping with the Demand to be a Virgin

In Islamic culture, there is an imperative demand that women should be virgins on their wedding night. Service providers in The Netherlands are increasingly confronted by Islamic young women who find themselves in serious difficulties because they are no longer virgins, and are about to enter a forced or arranged marriage. These young women report a diversity of problems such as loneliness, social isolation, depression, despair, suicidal feelings, identity problems and serious conflicts with parents. In this article we focus attention on the circumstances that can result in these types of difficulties, and also critically consider the kinds of help that young Islamic women are given. Attention is paid to the question of whether existing forms of service provision, especially surgical reconstruction of the hymen, take sexual and other inequalities into account.     

Mapping Men's Mental Health

The central theme of this paper is that men are at one and the same time both damaged and damage-doing. The process of being damaged through the agency of masculinity predisposes men to exploit, dominate and abuse—not only as boys, as partners and fathers, but as priests, teachers, therapists, lawyers, nurses, psychologists and psychiatrists. Mental health services need to see both aspects of this male equation: a focus on male abuse alone leads to punishment, containment and, very likely, the continuation of abuse; a focus on male damagedness alone preserves the ideology of male unaccountability. However, evidence reviewed here suggests that most traditional psychiatric services fail to acknowledge the impact of inequalities on men's mental health as comprehensively as they fail to acknowledge the impact of these inequalities on the mental health of women. This is a significant problem, and we suggest ways that a gendered analysis of masculinity can be used to help address this deficit. This analysis is used to develop a map of men's mental health that not only accommodates traditional categories of mental health difficulty, but other important consequences of the close association between masculinity and sexuality inequality, especially the use of violence and the capacity to do harm. This analytical framework also invites consideration of the invisibility of male distress, the disallowing and desensitizing of ‘vulnerability, and their submersion in a kind of psychology of entitlement. Finally, we consider the implications of this mapping exercise for mental health services and for working with men.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

Mental Health and Dangerousness: Characteristics and Outcomes of Children and Adolescents in Residential Placements

Violence has been identified as a significant risk behavior among children and adolescents. Dangerousness is a factor in psychiatric hospitalizations and out-of-community placements. However, there is only a small amount of research that has investigated the mental health co-morbidities and treatment outcomes of violent children and adolescents. A random sample of children and adolescents in residential placements through the State of Florida's child welfare system were studied. Cases were classified into three levels of dangerousness. Results indicated that dangerousness was associated with much elevated mental health co-morbidity. Also, cases who were dangerous at the time of admission had less developed peer and moral/spiritual strengths than did other cases. Although dangerous cases had worse dispositional outcomes, there was strong evidence that these cases derived the most clinical benefit from residential treatment.     

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.     

Possession and Medicine in South Central India

Possession is a powerful and surprisingly prevalent belief system in many parts of the developing world. In India it is common for many reasons—isolation, illiteracy, polyglotism, lack of an adequate medical infrastructure, a need for hope. Possession, and the practice of exorcism, is more than just an explanatory system based on superstition and folk lore. It is also an important social structure and force that allows the integration of the sick into the community of the well, and facilitates a first albeit tentative step from the local community to the medical community. In many parts of India, health care delivery as well as social organization is through the practice of possession. Thus, the role and power of possession needs to be appreciated if one seeks to affect health care delivery in India, and further possession should be appreciated if one seeks to better understand how some of its forces might in fact be curative.