Problems with managed mental health care for multicultural populations

Managed mental health care has developed a system of care-giving that does not recognize that acceptable and effective services must acknowledge individual differences and cultural or racial identities. This approach is unacceptable in an era when a psychology of differences is necessary to provide services for nearly one-third of the population. This paper suggests that the adequacy of contemporary psychoparmacological and psychological interventions for multicultural populations is either unknown or unsatisfactory. Historically, interventions in the United States were designed primarily for Euro-Americans and thus were culture-specific in derivation. Managed care has reduced the availability and quality of these interventions for all patients and further limited the range of possible options. Culturally competent mental health services are described and related to quality of care. A societal agenda for implementing cultural competence is suggested.     

Attitudes toward mental health professionals.

Attitudes of 85 undergraduates toward various mental health professional roles were evaluated using a semantic differential assessment instrument. Expressed attitudes were most positive toward those roles identified with physical medicine (i.e., physician and nurse) and least positive toward those professions traditionally identified with mental illness (i.e., psychiatrist and psychoanalyst). However, the public appears to be making increasing differentiations in attitudes expressed toward the various professional groups identified with the "psyche" prefix. For example, counseling psychologist was rated consistently as one of the most positive professional role categories, whereas psychoanalyst was rated consistently as one of the most negative role designations. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Law and mental health professionals: The limits of expertise.

Explores the structure and assumptions of mental health law to elucidate the proper role of mental health professionals when they provide information to the legal system. Most of the questions asked of professionals by law are argued to be primarily social, moral, and legal rather than scientific. It is claimed that in light of present knowledge, experts have less to offer to the law than is commonly supposed. They can, however, make a limited, reasonable contribution to legal decision making by providing scientific information that is not otherwise available to the law. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for mental health professionals in critical law enforcement incidents: An overview.

Law enforcement personnel routinely face various critical incidents in the course of their workday including confrontations with irate, violent, and/or mentally challenged individuals. While less frequent, law enforcement personnel also are called in response to hostage incidents, barricaded subject incidents, and attempted suicide/suicide by cop incidents. Over the past 30 years, response strategies utilized by law enforcement personnel have been evolving and have been influenced by mental health professionals. This article briefly reviews the histories of Critical Incident Teams (CITs) and Crisis Negotiation Teams (CNTs), discusses the roles of mental health professionals in the development and continuing evolution of CITs and CNTs, presents some of the obstacles to mental health involvement with law enforcement, and highlights areas in need of more empirical research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Concepts of schizophrenia among mental health professionals: A factor-analytic study.

Factor analyzed the questionnaire responses of 183 mental health professionals to identify relevant dimensions of beliefs about the phenomenology, etiology, and prognosis of schizophrenia. 8 factors were chosen for interpretation: interpersonal etiology, Bleulerian phenomenology, disease concept of schizophrenia, poor prognosis, poor understanding of schizophrenia, schizophrenia as thinking disorder, adaptive symptomatology, and irreversibility. In relating factor scores to S variables, it was found that professional discipline accounted for a significant proportion of variance in both etiological factors. Theoretical orientation was significantly related to opinions about the purposeful nature of schizophrenic symptoms and about prognosis, and place of employment was significantly related to various opinions about etiology and phenomenology. Findings are interpreted as casting doubt on the remaining usefulness of the term "schizophrenia." (26 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing the violent patient: A guide for psychologists and other mental health professionals.

Being threatened, harassed, attacked, or confronted by a patient with a weapon is becoming more common and is likely to occur at some point in a mental health professional's career. Effective violence management programs can reduce the incidence of violence. Yet, few resources have been provided to assist psychologists and other mental health professionals to deal with aggressive patients. The authors offer strategies for the management of aggressive behavior that can be implemented to empower practitioners to take precautions when necessary in a quick and efficient manner when dealing with violent and potentially violent patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of sex role stereotyping among mental health professionals.

85 male and 40 female psychologists (mean age 47.9 yrs) and psychiatrists (mean age 54.8 yrs) were administered the Attitudes Toward Women Scale and the short form of the Bem Sex-Role Inventory to assess the effects of sex, sex role attitudes, professional affiliation, and therapeutic orientation on sex-role attitudes and sex-role stereotyping. In general, Ss demonstrated relatively liberal sex role attitudes. However, more liberal attitudes were endorsed by psychologists than by psychiatrists and, within disciplines, by younger Ss and those with fewer years of experience. Regarding sex role stereotyping, Ss with less liberal sex role attitudes exhibited stereotyping to a significantly greater extent than did those with more liberal attitudes. Female Ss endorsed as great a double standard of mental health as did males. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.     

Toward reflective practice: A multicultural competence training model from a community mental health center.

Despite the importance of multicultural competence in clinical practice and training, there is a surprising dearth of innovative training models from fieldwork sites that would be replicable in other practicum settings. The authors illustrate a multicultural competence training model from a community mental health center that highlights the Guidelines on Multicultural Education, Training, Research, Practice, and Organization Change for Psychologists (American Psychological Association, 2003). The model focuses on providing multicultural training through two separate but linked training teams for the dual purposes of internal reflection and reflective practice. The authors conclude with a discussion of the implications of this training model for practice, research, and organizational change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Strategies for building multicultural competence in mental health and educational settings.

Reviews the book, Stategies for building multicultural competence in mental health and educational settings edited by M. G. Constantine and D. W. Sue (2005). Strategies for Building Multicultural Competence in Mental Health and Educational Settings is an excellent resource designed for mental health professionals who may lack knowledge and expertise in working with diverse clients. It provides hands-on strategies and suggestions in a variety of contexts, using the Multicultural Guidelines as a framework. This book is strongly recommended for clinicians working with culturally diverse populations. The Surgeon General's report Mental Health: Culture, Race and Ethnicity (U.S. Department of Health & Human Services, 2001) clearly demonstrates the disparity in the mental health care of racial and ethnic minorities as compared with Whites. This book is useful not only to novices exploring diversity but also to those who are already cross-culturally competent. The authors successfully apply the APA Multicultural Guidelines in clinical practice and educational, training, and organizational settings while providing specific strategies for clinicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The public's knowledge about psychologists and other mental health professionals.

A random sample of New London County, Connecticut, residents received a questionnaire about 9 mental health professions or professionals (MHPs): clergyperson, marriage and family counselor, nonpsychiatric physician, psychiatrist, psychiatric nurse, psychologist, psychotherapist, social worker, and telephone crisis counselor. Respondents defined each MHP and reported their satisfaction with treatment, which MHP they would recommend, their referral source(s), licensure requirements, and fees. A mixed-design ANOVA was computed, with comfortableness as the dependent variable; age, sex, saw an MHP, and education, the between-Ss variables; and the 9 MHPs, the within-Ss variable. A significant MHP effect showed that physicians were perceived as slightly more comfortable than were psychologists (nonsignificant), who, nevertheless, were perceived as exceeding all other trained MHPs in the comfortableness experienced by their clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The family, the courts, and mental health professionals.

Discusses the different facets of the role of mental health professionals (MHPs) in the legal system. The MHP's role in the family court is compared with that in the criminal court. In the family court, MHPs generally deal in crisis intervention, evaluation, and referral for treatment. Involuntary civil commitment and child abuse are also major issues. MHPs are called on to intervene in divorce and child custody proceedings. Some state legislatures have mandated the employment of MHPs in mental health clinics attached to the courts. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using positive psychology with special mental health populations.

In our clinical practice, we have attempted to use a positive psychology approach in working with people with schizophrenia and youths with behavioral disorders. We present three clinical applications that use a positive psychology approach with these populations: group treatment with persons with schizophrenia; individual cognitive stimulation therapy with persons with schizophrenia; and computer-facilitated dialogue and therapy with persons with schizophrenia and adolescents with behavioral disorders. These three clinical applications using positive psychology are consistent with those traditional treatment goals that aim to increase clients' functioning and improve their quality of life. Given that many people with long-standing emotional "problems" have difficulties initiating change or internalizing feedback regarding their behavioral deficits, the therapeutic environment and clinical interactions need to focus equally on clients' strengths and skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Salient attributes of two types of helpers: Friends and mental health professionals.

Asked 211 undergraduates to rate the importance of expertness, attractiveness, and trustworthiness for a friend and a mental health professional from whom they might seek help. Three levels of perceived attributes and 2 levels of type of helper were manipulated. Results indicate the salient attributes of a professional were perceived expertness and trustworthiness, whereas the salient attributes of a friend were perceived attractiveness and trustworthiness. The findings are discussed in terms of help-seeking behavior and the perceived credibility of helpers. It is suggested that the perceived credibility of helpers may be dependent upon the perception of trustworthiness in conjunction with the perception of either expertness or attractiveness. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdivorce family therapy: Suggestions for professionals.

Reviews the literature describing the stress experienced by family members (the ex-spouse, mother–child, and father–child relationships) in the postdivorce transition. Findings indicate that the postdivorce transition period may be abbreviated and/or more successfully negotiated by professional interventions designed to (1) increase ex-spouse cooperation and support in both parents' continuing participation in raising their children, (2) improve the quality and effectiveness of parent–child communication, and (3) train both mothers and fathers in behavioral management techniques useful in their single-parent roles. Suggestions are made for postdivorce family therapy oriented toward helping both ex-spouses continue meaningful involvement with their children. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The myth of mental illness:" continuing controversies and their implications for mental health professionals

Since the publication of "The Myth of Mental Illness" in 1960, there has been an ongoing debate about Thomas Szasz's ideas concerning mental illness. In this paper, Szasz's views are summarized, as are the views of Szasz's critics. Specifically, the following areas are addressed: Szasz's definition of disease, his notions regarding the unconscious and rationality, his beliefs regarding culpability, his proposed differences between psychiatry and other branches of medicine, the uses of the term "mental illness," and the possibility of implicating physical lesions in some mental illnesses. With this discussion as a backdrop, the importance of these issues to mental health practitioners is addressed.     

A comparison of espoused theories of self- and mutual help: Implications for mental health professionals.

Nonprofessional helping organizations, known as self- or mutual-help groups, are viewed as homogeneous, varying primarily in the problem addressed. However, there is great diversity in their methods, even among groups addressing similar problems, which has important implications for referring clinicians. Results of this study, which is a content analysis of the literature of 2 internationally known organizations for the mentally ill, suggest nonprofessional helping organizations are not homogeneous. Techniques of self-help based on authority, as opposed to mutual-help based on interpersonal and spiritual growth, characterize some of the differences. Groups also differ in problems addressed and help strategies offered. Implications of these differences for mental health professionals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapists' self-perceived multicultural competence and adequacy of training.

Explored the self-perceived multicultural competencies and adequacy of multicultural training of play therapists across the United States. Registered play therapists belonging to the Association for Play Therapy (N=134) completed the Multicultural Counseling Survey (MMCTS) (C. C. Holcomb-McCoy & J. E. Myers, 1999). Results indicate that play therapists perceive themselves as competent on Multicultural counseling competence. The results also suggest that play therapists perceived their multicultural training as less than adequate. Although results indicate no difference between play therapists' competence and training based on years of experience, there was a difference in multicultural competence and training based on coursework in multicultural counseling. Implications for practice and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)