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Oluwoye O, Nagendra A, Kriegel LS, Anglin DM, Santos MM, López SR. Reorienting the focus from an individual to a community-level lens to improve the pathways through care for early psychosis in the United States. SSM - MENTAL HEALTH 2023; 3:100209. [PMID: 37475775 PMCID: PMC10355221 DOI: 10.1016/j.ssmmh.2023.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
The implementation of coordinated specialty care in the U.S. over the past decade has led to the improvements of clinical and functional outcomes among individuals in the early stages of psychosis. While there have been advancements in the delivery of early intervention services for psychosis, it has almost exclusively focused on short-term change at the individual level. In light of these advancements, research has identified gaps in access to care and delivery of services that are driven by different levels of determinants and have the biggest impact on historically excluded groups (e.g., ethnoracial minoritized communities). Interventions or efforts that place an emphasis on community level (structural or sociocultural) factors and how they may influence pathways to care and through care, specifically for those who have been historically excluded, have largely been missing from the design, dissemination and implementation of early psychosis services. The present paper uses a structural violence framework to review current evidence related to pathways to care for early psychosis and the physical/built environment and conditions (e.g., urbanicity, residential instability) and formal and informal community resources. Suggestions on future directions are also provided, that focus on enriching communities and creating sustainable change that spans from pathways leading to care to 'recovery.' In all, this lays the groundwork for a proposed paradigm shift in research and practice that encompasses the need for an emphasis on structural competency and community-driven approaches.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Arundati Nagendra
- Center of Excellence in Psychosocial and Systemic Research, Massachusetts General Hospital/Harvard Medical School, 151 Merrimac Street, Floor 6, Boston, MA, 02114, USA
| | - Liat S. Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA
| | - Deidre M. Anglin
- City University of New York, Department of Psychology, 160 Convent Ave, NAC Building, Room 7/120, New York, NY, 10031, USA
| | - Maria M. Santos
- Department of Psychology, California State University, San Bernardino, 5500 University Parkway, San Bernardino, CA, 92407, USA
| | - Steven R. López
- Department of Psychology, University of Southern California, Seeley G. Mudd Room 501, 3620 S. McClintock, Los Angeles, CA, 90089, USA
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Volpe VV, Hope EC, Mosley DV, Javidi H, Sosoo EE, Benson GP. How We Get Free: Graduate Training as an Opportunity for Equitable Participation and Liberation. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:428-444. [PMID: 36037403 DOI: 10.1177/17456916221096086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this conceptual article, we assert that psychology should be transformed to adopt the explicit goal of working toward the liberation of people oppressed by society rather than striving for mere equality. To achieve such a transformation, it is necessary to reenvision graduate training in psychology. Graduate training in psychology is an important vehicle by which psychologists can become prepared to use research and practice to eradicate inequities in society. Therefore, we propose six pillars for liberation-focused graduate training in psychology: critical unlearning/unknowing, cooperative modes of production, prioritizing indigenous knowledge, embedded interdependence, systems-level action, and prioritizing members of oppressed groups. Although this conceptualization may engender resistance, we argue that there are many potential pathways by which graduate training may use liberation psychology to work equitably with oppressed groups to seek justice.
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Affiliation(s)
| | - Elan C Hope
- Department of Psychology, North Carolina State University
| | | | - Hannah Javidi
- Department of Psychology, North Carolina State University
| | - Effua E Sosoo
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
Background For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare. Methods We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals. Results The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships. Conclusion We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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MacIntyre G, Cogan N, Stewart A, Quinn N, O'Connell M, Rowe M. Citizens defining citizenship: A model grounded in lived experience and its implications for research, policy and practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e695-e705. [PMID: 34155710 DOI: 10.1111/hsc.13440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
Citizenship is gaining currency in health and social care internationally as a way of making sense of the lived experiences of people with major life disruptions who face exclusion, marginalisation and discrimination, but the concept is often contested, poorly defined and understood. This paper charts the development of an empirical model of citizenship within Scotland, UK. A mixed-method, community-based participatory research approach using 10 focus groups (n = 77), concept-mapping exercises (n = 45) and statement clarity and relevant ratings (n = 242) was used to develop a model of citizenship that is grounded in the lived experience of participants, which is absent from current conceptualisations of citizenship. Multidimensional scaling and hierarchical cluster analysis revealed five core domains emerging from our work: 'building relationships', 'autonomy and acceptance', 'access to services and supports', 'shared values and social roles' and 'civic rights and responsibilities' representing the personal meanings of citizenship for participants. We argue that the value of this model is that it is draws upon the personal understandings and experiences of participants who emphasised the 'banal ordinariness' of its core elements. We suggest that the model makes an original contribution by clearly illustrating the practical applicability of citizenship as a concept; thus, enhancing existing theories of citizenship. Our model highlights the interplay between the relational and structural aspects of citizenship and acknowledges the barriers that marginalised groups face in claiming their citizenship rights. It offers a call to action for policy makers and practitioners to set goals that contribute to the social inclusion of those who have experienced major life disruptions.
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Affiliation(s)
- Gillian MacIntyre
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Nicola Cogan
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Ailsa Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Neil Quinn
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
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Ramey HL, Lawford HL, Pancer SM, Matsuba MK, Pratt MW. Trajectories of Youth's Helping From Adolescence into Adulthood: The Importance of Social Relations and Values. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 69:134-144. [PMID: 34409607 DOI: 10.1002/ajcp.12551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
Helping behaviors (e.g., helping a sick friend, volunteering) are important forms of community involvement and likely change with age and life context. Yet, trajectories of community helping from adolescence through early adulthood have rarely been examined. It is also unclear how the roles of family, friends, and social attitudes might foster the development of helping behaviors across these years. We report on a study of community helping in a Canadian youth sample, across five intervals over a 15-year span, beginning at age 17 (N = 416). Helping displayed a quadratic trend, decreasing into the mid-20s, and then rebounding somewhat by 32. Social responsibility and salience of friends' prosocial moral values positively predicted age 17 community helping, whereas parents' moral values predicted less decrease in helping over this timeline. These findings add to an understanding of moral influences and social responsibility, in the potential shaping of youths' community helping behaviors.
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Affiliation(s)
- Heather L Ramey
- Department of Child & Youth Studies, Brock University, Sherbrooke, QC, Canada
- Centre of Excellence for Youth Engagement at the Students Commission of Canada, Toronto, ON, Canada
- School of Social and Community Services, Humber Institute of Technology & Advanced Learning, Toronto, ON, Canada
| | - Heather L Lawford
- Centre of Excellence for Youth Engagement at the Students Commission of Canada, Toronto, ON, Canada
- Department of Psychology, Bishop's University, Sherbrooke, QC, Canada
| | - S Mark Pancer
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - M Kyle Matsuba
- Psychology, Kwantlen Polytechnic University, Surrey, BC, Canada
| | - Michael W Pratt
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
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Pérez-Corrales J, Huertas-Hoyas E, García-Bravo C, Güeita-Rodríguez J, Palacios-Ceña D. Volunteering as a Meaningful Occupation in the Process of Recovery From Serious Mental Illness: A Qualitative Study. Am J Occup Ther 2022; 76:23213. [PMID: 35201298 DOI: 10.5014/ajot.2022.045104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community. OBJECTIVE To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work. DESIGN Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis. SETTING Several mental health community centers in Madrid and Catalonia, Spain. PARTICIPANTS People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data. RESULTS Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering). CONCLUSIONS AND RELEVANCE Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process.
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Affiliation(s)
- Jorge Pérez-Corrales
- Jorge Pérez-Corrales, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Elisabet Huertas-Hoyas
- Elisabet Huertas-Hoyas, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain;
| | - Cristina García-Bravo
- Cristina García-Bravo, MSc, OTR, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Javier Güeita-Rodríguez, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Domingo Palacios-Ceña, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
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Supporting Mental Health Recovery, Citizenship, and Social Justice. Community Ment Health J 2022; 58:11-19. [PMID: 34716831 DOI: 10.1007/s10597-021-00900-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/25/2021] [Indexed: 10/19/2022]
Abstract
Individuals with serious mental illness (SMI) have historically experienced stigma and marginalization. Mental health providers are well positioned to engage in social justice agendas geared at supporting the civil rights of those with SMI, and ultimately helping open doors to the full rights of participation in the community. By engaging and partnering in a mental health recovery and strengths-based orientation, leaders in these settings have the capacity to influence micro-, meso, and macro-systems. This can shed light on mechanisms to build on the strengths, capabilities, and hopes of individuals to live lives of meaning as they so define, with equal access to resources and rights, within communities of their choice. The article articulates an integrated application of these concepts for embracing and utilizing the concepts of mental health recovery, citizenship, and social justice in public mental health. Additionally, specific examples and practical applications are offered within the context of an inpatient setting and a community setting.
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O’Keeffe D, Sheridan A, Kelly A, Doyle R, Madigan K, Lawlor E, Clarke M. A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2022; 57:473-483. [PMID: 34143247 PMCID: PMC8934321 DOI: 10.1007/s00127-021-02121-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery). METHODS Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full 'functional recovery criteria' (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups. RESULTS Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group. CONCLUSION Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.
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Affiliation(s)
- Donal O’Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland ,School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Ann Sheridan
- School of Nursing, Midwifery, and Health Systems, University College Dublin, Dublin, Ireland
| | - Aine Kelly
- Saint John of God Hospitaller Services, Dublin, Ireland
| | - Roisin Doyle
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
| | - Kevin Madigan
- Saint John of God Community Services, Dublin, Ireland ,School of Postgraduate Studies, Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland ,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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"It's More Than Just Exercise": Tailored Exercise at a Community-Based Activity Center as a Liminal Space along the Road to Mental Health Recovery and Citizenship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910516. [PMID: 34639815 PMCID: PMC8507912 DOI: 10.3390/ijerph181910516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 11/29/2022]
Abstract
Mental health care policies call for health-promoting and recovery-oriented interventions, as well as community-based programs supporting healthier habits. The purpose of this study was to explore how individuals facing mental health challenges experienced participating in tailored exercise at a community-based activity center, and what role tailored exercise could play in supporting an individual’s process of recovery. Data were collected through in-depth interviews with nine adults experiencing poor mental health who engaged in exercise at the activity center. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Participants spoke about the community-based program being a safe space where they could “come as they are” (Theme 1). Taking part in the program was “more than just exercise” and allowed them to connect with others (Theme 2). The experiences they gained from exercise also helped with other areas in life and provided them with a safe space to build their confidence towards the “transition back to the outside” (Theme 3). We summarized the findings into one overall theme: “inside vs. outside”. In conclusion, a community-based activity center acted as a liminal space that aided mental health recovery by allowing participants to feel safe, accepted and supported, as well as experience citizenship. The findings highlight the need to treat mental health challenges as a contextual phenomenon and creating arenas for community and citizenship in society.
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Brekke E, Clausen HK, Brodahl M, Lexén A, Keet R, Mulder CL, Landheim AS. Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study. Front Psychol 2021; 12:727013. [PMID: 34566813 PMCID: PMC8457351 DOI: 10.3389/fpsyg.2021.727013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
| | - Hanne K. Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
| | - Annika Lexén
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
| | - Rene Keet
- Flexible, Innovative Top-ambulatory Academy of Community Mental Health Service, Geestelijke Gezondheidszorg Noord-Holland-Noord, Heerhugowaard, Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anne S. Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Brumunddal, Norway
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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Cogan NA, MacIntyre G, Stewart A, Tofts A, Quinn N, Johnston G, Hamill L, Robinson J, Igoe M, Easton D, McFadden AM, Rowe M. "The biggest barrier is to inclusion itself": the experience of citizenship for adults with mental health problems. J Ment Health 2020; 30:358-365. [PMID: 32762384 DOI: 10.1080/09638237.2020.1803491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Citizenship has been promoted within mental health for several decades however, its application in the field of mental health policy and practice is relatively novel. The voices of people who experience mental health problems (MHPs) are often absent in ongoing discourses about citizenship. AIMS To explore how adults with experience of MHPs and other life disruptions identify potential barriers to citizenship. METHOD A community based participatory research approach was adopted with peer researchers. Six focus groups (N = 40) using semi-structured interviews were conducted, consisting of participants who had experience of MHPs and other life disruption(s) within the last 5 years. The focus groups were audio recorded, transcribed verbatim and analysed in NVIVO using a thematic approach. RESULTS Three major themes associated with participants lived experiences of barriers to citizenship were identified: 'stigmatisation (internal & external) creates further divide'; 'being socially excluded leads to isolation'; and 'a sense of difference (as perceived by the self and others)'. CONCLUSIONS Those who have experienced major life disruption(s) face multi-level barriers to citizenship. An awareness of such barriers has important implications for mental health research, policy and practice. Citizenship-oriented implementation strategies that aim to address multi-level barriers merit further investigation.
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Affiliation(s)
| | - Gillian MacIntyre
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Ailsa Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Abigail Tofts
- School of Psychological Science and Health, Glasgow, UK
| | - Neil Quinn
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Gordon Johnston
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Linda Hamill
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - John Robinson
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Michael Igoe
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Duncan Easton
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Anne Marie McFadden
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Michael Rowe
- Department of Psychiatry, Yale University, New Haven, CT, USA
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12
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Sundet R, Kim HS, Karlsson BE, Borg M, Sælør KT, Ness O. A heuristic model for collaborative practice-part 2: development of the collaborative, dialogue-based clinical practice model for community mental health and substance abuse care. Int J Ment Health Syst 2020; 14:43. [PMID: 32528554 PMCID: PMC7285597 DOI: 10.1186/s13033-020-00377-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care. METHODS A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas' theory of communicative action, Bakhtin's dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration. RESULTS "The collaborative, dialogue-based clinical practice model" (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given. CONCLUSIONS The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.
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Affiliation(s)
- Rolf Sundet
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
| | - Hesook Suzie Kim
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
| | - Bengt Eirik Karlsson
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
| | - Marit Borg
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
| | - Knut Tore Sælør
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
| | - Ottar Ness
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, PO Box 235, 3603 Kongsberg, Norway
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Structural Barriers to Citizenship: A Mental Health Provider Perspective. Community Ment Health J 2020; 56:32-41. [PMID: 31659550 DOI: 10.1007/s10597-019-00490-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
This study employed a citizenship measure to explore mental health providers' views of citizenship to support the societal participation of people with mental illnesses, with citizenship defined as a person's (or people's) strong connection to the 5Rs of rights, responsibilities, roles, resources and relationships and a sense of belonging that is validated by others. Providers identified key structural barriers to full citizenship for clients. Their comments reflect openness to citizenship as a framework for understanding their clients and the need for greater access to normative community life, but also skepticism regarding providers' and public mental health centers' abilities to incorporate citizenship approaches in current care models. Findings suggest there are challenges to implementing "citizenship-oriented care" in public mental health settings, but efforts to address these challenges can support the goal of "a life in the community."
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Bjornestad J, Svendsen TS, Slyngstad TE, Erga AH, McKay JR, Nesvåg S, Skaalevik AW, Veseth M, Moltu C. "A Life More Ordinary" Processes of 5-Year Recovery From Substance Abuse. Experiences of 30 Recovered Service Users. Front Psychiatry 2019; 10:689. [PMID: 31620036 PMCID: PMC6759477 DOI: 10.3389/fpsyt.2019.00689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/27/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Studies investigating the subjective experiences of long-term recovery from substance use disorder are scarce. Particularly, functional and social factors have received little attention. Objectives: To investigate what long-term recovered service users found to build recovery from substance use disorder. Material and Methods: The study was designed as a phenomenological investigation subjected to thematic analysis. We interviewed 30 long-term recovered adult service users. Results: Our thematic analysis resulted in five themes and several subthemes: 1) paranoia, ambivalence and drug cravings: extreme barriers to ending use; 2) submitting to treatment: a struggle to balance rigid treatment structures with a need for autonomy; 3) surrendering to trust and love: building a whole person; 4) a life more ordinary: surrendering to mainstream social responsibilities; and 5) taking on personal responsibility and gaining autonomy: it has to be me, it cannot be you. Conclusions: Our study sample described long-term recovery as a developmental process from dependency and reactivity to personal autonomy and self-agency. The flux of surrendering to and differentiating from authority appeared to be a driving force in recovery progression. Participants called for treatment to focus on early social readjustment.
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Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | | | | | - Aleksander H. Erga
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - James R. McKay
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Philadelphia VA Medical Center, Philadelphia, PA, United States
| | - Sverre Nesvåg
- Centre for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of Førde, Førde, Norway
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Emerson A, Allison M, Ramaswamy M. Voter Registration and Jail-Incarcerated Women: Are Justice-Involved Women Civically Engaged? WOMEN & CRIMINAL JUSTICE 2019; 30:172-187. [PMID: 32742078 PMCID: PMC7394465 DOI: 10.1080/08974454.2019.1586620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 06/11/2023]
Abstract
Civic engagement, like the broader phenomenon of social engagement, seems out of keeping with the alienating ethos of incarceration. We sought to learn which demographic and contextual factors predicted one form of civic engagement, voter registration, in a jail-incarcerated female population. A 158-item survey was administered to 261 adult women incarcerated in three Midwestern jails, September 2014 to March 2016, as part of a parent intervention study for cervical cancer prevention. Chi-square comparisons between a voter registered and a non-registered group yielded significant differences in five demographic and social context indicators, and a model for voter registration was estimated using multiple logistic regression. Total time incarcerated, having personal health insurance, being stably housed, and identifying as a Black woman contributed significantly to voter registration. We suggest that in a justice-involved group the community's facilitation of access to basic resources may trigger a reciprocal engagement in civic life, and we speculate that Black women may find belonging and motivation for engagement in resilient, long-standing sources outside official institutions. Our findings support the notion that meeting the basic needs of individuals post-incarceration can create healthier, more engaged communities.
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Affiliation(s)
- Amanda Emerson
- School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Molly Allison
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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Townley G, Brown M, Sylvestre J. Community Psychology and Community Mental Health: A Call for Reengagement. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:3-9. [PMID: 29315707 DOI: 10.1002/ajcp.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well-being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross-cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under-examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.
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Affiliation(s)
- Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Molly Brown
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - John Sylvestre
- Center for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
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