Citizen Advocacy Observed: Tool or Tokenism?

Citizen advocacy, where a volunteer works in partnership with a vulnerable person, compliments self- and legal advocacy. In the context of mental health services, citizen advocacy is a tool for enabling and empowering people who use these services, and is founded on the recognition that mental health service users are frequently socially oppressed and disadvantaged. This article describes the development of a Citizen Advocacy service for people with mental health difficulties, and also the problems they brought to this service. The problems encountered in sustaining the service are noted and lessons are drawn for the future.     

Poverty and Mental Health: Underclaiming of Welfare Benefits

The study undertaken by a local MIND welfare benefits service found that 51% of people attending a local mental health resource centre were not receiving the welfare benefits to which they were entitled. Being in receipt of correct benefit entitlement was found to be unaffected by: whether a person had a long history of using mental health services; whether they had a care manager; or whether they had previously been given benefits advice. Women were less likely to be receiving their correct benefit entitlement than men. It is argued that the only way to guarantee that people receive their full benefit entitlement is to ensure that highly trained and experienced welfare benefits advisers are readily accessible to all people who use mental health services.     

Training Counsellors to Work with People who Live with Cancer: A Needs-led Approach to Planning

This paper traces the development of a cancer counselling service within a voluntary helping agency. The steps of recognizing the needs of people with cancer, identifying multi-faceted desired outcomes and the implementation of one specific goal, that of provision of a counselling service, are outlined. Significant events, stages and decisions made during this process are described and discussed. The emphasis throughout is on the importance of needs analysis and client group consultation in order that the planned service is best placed to meet such needs.     

The Nature of Client Agency Prior to Therapy: A Qualitative Study on Clients’ Narratives

Client agency is considered a crucial contributor to good treatment outcome. Recent studies, however, differ strongly in how they conceptualise and investigate agency. The current study explores the nature of client agency in ten clients’ pre-treatment interviews. Applying Consensual Qualitative Research, we constructed three overarching categories, subdivided into 14 sub-categories capturing both between- and within-person differences in agency before therapy. We found that all participants oscillated between the experience of a lack of grip on problems on the one hand and noticing their involvement in the problem and taking action on the other. These results present a dynamic conceptualisation of client agency. This allows us to ask pertinent questions for both future research and clinical practice.     

A multi-objective mathematical programming problem with fuzzy relation constraints

In this study we discuss the problem of multi-objective mathematical programming with constraints defined by ‘max-min’ composite fuzzy relation equations. Since the feasible region is normally non-convex, the properties of the efficient points of a non-convex feasible region under multi-objectives are investigated and illustrated by examples. The necessary and sufficient conditions are proposed and proved. To facilitate decisions, a procedure that transforms these efficient points of an interval-valued decision space into a constant-valued decision space is proposed when the level of confidence is given by a decision maker. Then the transformed problem becomes a multi-attribute decision problem that can be evaluated by Yager's method to find the optimal alternative.     

Targets of attack and defense in play-fighting of the Djungarian hamster Phodopus campbelli: Links to fighting and sex

Analysis of the body targets attacked and defended during play-fighting by juvenile Djungarian hamsters Phodopus campbelli revealed that about 70% of all attacks were directed at the mouth. If successfully contacted, the mouth was briefly licked and nuzzled. The remaining playful attacks were gentle bites directed at the rump, and to a lesser extent, the top of the head. During serious fighting the top of the head and the rump are targets of attack, whereas the mouth is not. Licking and nuzzling the mouth was found to be a behavior performed by adult males at the beginning of sexual encounters. Therefore, play-fighting in juvenile hamsters cannot be thought of merely as a form of “mock fighting” since the principal target is seemingly sexual, not agonistic. The data also show that of the sexual body targets contacted, adult females are more likely to defend the mouth. In this way it is suggested that targets attacked and defended during juvenile play-fighting are derived from adult contexts in which such targets are defended. This hypothesis accounts for the prevalence of agonistic targets in the play-fighting of many species, and may provide a rationale for classifying those amicable targets that are competed for during play-fighting.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

Hubert's multi-rater kappa revisited

There is a frequent need to measure the degree of agreement among R observers who independently classify n subjects within K nominal or ordinal categories. The most popular methods are usually kappa-type measurements. When R = 2, Cohen's kappa coefficient (weighted or not) is well known. When defined in the ordinal case while assuming quadratic weights, Cohen's kappa has the advantage of coinciding with the intraclass and concordance correlation coefficients. When R > 2, there are more discrepancies because the definition of the kappa coefficient depends on how the phrase ‘an agreement has occurred’ is interpreted. In this paper, Hubert's interpretation, that ‘an agreement occurs if and only if all raters agree on the categorization of an object’, is used, which leads to Hubert's (nominal) and Schuster and Smith's (ordinal) kappa coefficients. Formulae for the large-sample variances for the estimators of all these coefficients are given, allowing the latter to illustrate the different ways of carrying out inference and, with the use of simulation, to select the optimal procedure. In addition, it is shown that Schuster and Smith's kappa coefficient coincides with the intraclass and concordance correlation coefficients if the first coefficient is also defined assuming quadratic weights.     

The Liberating Awareness

The purpose of this article is to reflect on the search for racial justice as a call from God, using biblical readings and documents produced by the World Council of Churches (WCC). It is anchored in the increasingly intense challenges that emerge in this respect in Brazil, a country whose Indigenous peoples were annihilated in its colonization process, and which up until the 19th century received the largest flow of enslaved Africans in the world. The article combines the Latin American methodology “See, Judge, Act” with the theological methodology of the WCC's Pilgrimage of Justice and Peace and its three steps: “Celebrating Gifts,” “Visiting the Wounds,” and “Transforming Injustice.” The first part of the paper reflects the “See” and exposes the expressions of everyday racism in Brazil. The second part presents the “Judge,” seeking references to the challenge of racial justice in the Bible and in ecumenical reflection. The third and final section, “Act,” reflects on the possibility for transforming racial injustices, sharing experiences from Brazil as well as one of the Pilgrim Team Visits organized by the WCC in 2019.