Community mental health services for the underserved: a culturally specific model

Cultural considerations in forensic psychiatry: The issue of forced medication

There has been an ongoing debate regarding the forced use of antipsychotic medications and both the psychiatric and legal professions have reacted strongly to the growing debate. Within the penological context, cases such as Washington v. Harper, Riggins v. Nevada, and Sell v. United States established the framework for determining when antipsychotic medication may be forcibly administered. Medication decisions under the Sell and Riggins cases are to be approved at judicial hearings; whereas, administrative hearings are sufficient for Harper cases. Forensic psychiatrists are also given responsibility in making the legal decision of whether or not to forcibly treat a patient with psychotropic medication against his will. In making this critical decision, a significant factor that is often minimized is the cultural background of the patient. The purpose of this paper is to present cultural factors to be considered in forced medication. Focusing on the culture defense argument, a review of how the legal system has dealt with cultural implications of a case will be presented. This paper will then discuss cultural issues embedded in the assessment, diagnosis, and treatment of psychiatric patients by forensic psychiatrists who are called upon to make the decision of whether or not to force medicate a patient against his will. Lastly, recommendations and a framework for providing a culturally sensitive assessment during the decision to forcibly medicate a patient with psychotropic medication will be offered.

Clinical Psychology and Diversity: Progress and Continuing Challenges

The diversity of the clinical psychology workforce is an important contributing factor in ensuring that clients are able to access services that can reflect their own particular culture and personal identities, and also to allow the possibility of choice surrounding diversity across therapists and psychologists. Unfortunately the make up of clinical psychology trainees frequently does not reflect the population demographics of the communities within which training courses are located or serve. This mismatch has been recognised for many years both within clinical psychology and other healthcare professions. Despite various attempts at promoting diversity and equality within the profession, there is a widespread recognition that insufficient progress has been made, and the British Psychological Society (BPS) and the Division of Clinical Psychology (DCP) in particular, promoted a series of projects looking at selection and widening access across professional psychology training courses, culminating in a Professional Practice Board (PPB) Report that was published in 2004. In addition, through initiatives supported by the Group of Trainers in Clinical Psychology, various research and other practical projects were established. The purpose of this paper is to review the PPB Report and associated projects and to informally assess their impact. Finally, there is recognition that not only should the workforce be representative but psychologists and therapists ought to be culturally aware and trained to work with difference despite their own particular identities as individuals and therapists. Accordingly, we will also review initiatives to promote cultural awareness and sensitivity within clinical psychology training.

Mutual biases underlying the problematic relationship between older adults and mental health providers: any solution in sight?

As the size and diversity of the older population increases, mental health providers will be called upon to deliver high-quality services to the elderly. However, many of these professionals hold negative attitudes toward the elderly; psychotherapy conducted with older adults by clinicians with such biases could represent a waste of time and energy, as well as money, for these clients. This article reviews studies conducted within the past three decades on the biases held by mental health professionals (primarily psychiatrists and psychologists) toward older patients and vice versa. It also discusses possible solutions to the conflicts within the elderly-mental health provider relationship, based on the contributions made by professionals from various health care disciplines on this topic. Moreover, this article takes into account various ethnicity-related issues that are often at play in the relationship in question, and provides research and clinical recommendations for the enhancement of the quality of this relationship. It is time to find successful and interdisciplinary ways to improve how older adults and mental health professionals deal with one another. These efforts should creatively enhance the quality of the mental health services offered to older patients, in addition to dispelling age-related myths and corresponding obstacles to the utilization of these needed services by older adults.

Chronically mentally ill patients with and without substance use disorders: a pilot study

The study was designed to assess characteristics of chronic mentally ill patients with and without a substance use disorder. Study patients (n=48) had either psychiatric illness alone (they received conventional psychiatric rehabilitation) or dual diagnoses (they received mental illness and substance abuse services). All patients were administered the Brief Symptom Inventory (BSI), the Client Satisfaction Questionnaire, the Perceived Social Support Scales, and the Composite International Diagnostic Interview. Higher proportions of dually diagnosed patients had schizophrenia, had higher scores on the BSI, and were less satisfied with treatment.

Mental health nursing and cultural diversity

The focus of this article is on ethnic cultural difference. The establishment of a bi-cultural model of health care delivery has been a recent priority in New Zealand. Bi-culturalism has become an important concept for Maori and Pakeha (Europeans), working in partnership in the planning and implementation of mental health services in New Zealand. Adoption of the principles of respect and recognition of the uniqueness of different cultural identities, by nurses, has meant that clients who use mental health services in New Zealand are beginning to benefit from nursing care that is culturally competent.

Southcentral Foundation--Dena A Coy: a model program for the treatment of pregnant substance-abusing women

This article discusses the societal implications of substance abuse by pregnant women and women of child-bearing age and reviews their treatment needs as documented in the literature. It then provides a treatment model for pregnant women, using the Southcentral Foundation-Dena A Coy Residential Treatment Program as a model program. It outlines a number of components that are critical to successful substance abuse treatment of these women; specifically, medical interventions, social service provision, educational/vocational services, psychoeducational programs, psychotherapy, substance abuse interventions, and family preservation and involvement. These components are superimposed on a therapeutic community model that stresses gender and cultural relevance, as well as supportive structure and direction.

A school-based mental health clinic for adolescent mothers

TOPIC

The Department of Mental Health Nursing at Oregon Health Sciences University mental health program at an alternative high school for teenage mothers and their children.

PURPOSE

To provide direct mental health services to approximately 50% of the student population. Mental health concerns apparent with this population of young mothers and their children include issues of violence and abuse, depression, developmental delay, and conduct disorder. This paper describes the successes and failures of this mental health program in hopes of helping other schools of nursing establish similar school-based mental health programs in their communities.

CONCLUSIONS

Teenage mothers need a safe haven where they can experience trust and acceptance. In the therapeutic atmosphere of this school-based program, young women were able to explore their feelings regarding past violence, learned to nurture their children, and gained an increased sense of self-efficacy.

Geropsychiatric nursing: a clinical knowledge base in community and institutional settings

1. The term clinical knowledge base refers to the foundations and areas of knowledge that are integral to an independent and interdependent clinical discipline. 2. The clinical content essential to establish a research base in geropsychiatric nursing includes normal and abnormal aging, nature and magnitude of geriatric mental health problems, diagnostic categories, caregiver and family roles, and cultural determinants of mental health problems and care. 3. The clinical knowledge base for geropsychiatric nursing care in both community and institutional settings consists of the components identified above and the logical integration of each. Integration can be achieved by including these themes in the theoretical and clinical training of nurses.