Associative stigma among mental health professionals: implications for professional and service user well-being

In contrast with growing attention given to the stigma experiences of mental health service users, the stigma literature has paid almost no attention to mental health professionals. This study focuses on experiences of associative stigma among these professionals. We investigate the link between associative stigma and three dimensions of burnout as well as job satisfaction among mental health professionals, and the link of associative stigma with self-stigma and client satisfaction among service users. Survey data from 543 professionals and 707 service users from diverse mental health services are analyzed using multilevel techniques. The results reveal that among mental health professionals associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction. In addition, in units in which professionals report more associative stigma, service users experience more self-stigma and less client satisfaction. The results reveal that associative stigma is related to more depersonalization, more emotional exhaustion, and less job satisfaction among mental health professionals.     

Give your child and adolescent mental health service a health economics makeover

Specialist child and adolescent mental health services (CAMHS) must make decisions about what treatments to provide to whom, when, where and how, within limited budgets. This raises questions about how services make such decisions, to best meet the mental health needs of their catchment. The methods and practices of Health Economics, a field with considerable expertise in measuring performance in health systems, can help CAMHS make better informed decisions regarding service provision. This paper identifies a process through a set of focused questions to help CAMHS examine and improve their performance. The aspects covered are service profile, costs, conceptualisation of outcomes and identification of value for money. The recommended approach should help CAMHS redirect resources to maximise benefits for their catchment population.     

Working across borders to promote positive mental health and well‐being

World health reports highlight the increasing prevalence of mental health problems and the need to recognize that mental well‐being is a fundamental aspect of any health policy. The scale and cost of mental health problems mean that appropriate policies and strategies must be developed and implemented. In Ireland this is a period of substantial review and reflection on mental health policy and practice, but to date little consideration has been given to the development of a cross‐border strategy. Cooperation and collaboration has been largely dependent on the leadership of a number of individuals supported by short‐term European Union funding. This paper is informed by a study which was concerned with examining the issues associated with promoting mental health across the Irish border. Insights were provided by 38 individuals who were involved in the delivery of cross‐border mental health services in the North West region. The article argues that there is substantial support for working across borders and developing sustainable cross‐border health strategies. In the absence of a statutory all‐Ireland coordinated policy overseeing the development of mental health promotion, the sustainability of projects emerged as a key issue. The results suggest that whilst much innovative and creative work has been undertaken by committed individuals, what is now required is a strategic response from both the British and Irish governments which will ensure the needs of service users in these deprived border regions can be effectively addressed. Also, at a policy level this strategic development would be seen as a reflection of the value placed on promoting mental health and well‐being.     

Discourses of service user involvement in meeting places in Norwegian community mental health care: a discourse analysis of staff accounts

In previous research, meeting places have been favourably addressed by service users, but they have also been contested as exclusionary. In this participatory explorative study, we sought to perform a contextual analysis of meeting places in Norway based on a discourse analysis of three focus group discussions with 15 staff members. We asked the following question: how do meeting-place employees discuss their concrete and abstract encounters with service users and their experiences? We focused on service user involvement, which was largely analysed as neoliberal consultation and responsibilisation. Service users were positioned as resisting responsibility trickling down and defending staffed meeting places. Social democratic discourse was identified in the gaps of neoliberal discourse, which is noteworthy given that Norway is a social democracy. This relates to global concerns about displacements of democracy. We suggest that meeting places appear to hold the potential for staff and service users to collaborate more democratically.     

Experiences of volunteering: A partnership between service users and a mental health service in the UK

The aim of the study was to investigate how people with serious mental illness perceived the experience of volunteering for the health care organisation in which they had received a service. The study took a qualitative approach and in phase one, eleven service user volunteers were purposefully sampled and interviewed. In depth interviews were analysed using grounded theory. This paper describes the findings from phase one, and highlights the following themes to represent the volunteering experience: 1) rehearsing for a new direction; 2) treading carefully at first; 3) discovering my new self; and, 4) using my experience and extending relationships. These themes further support a tentative theoretical framework that considers supported volunteering to enhance recovery because it fosters positive risk taking and gives individuals a valued identity that integrates their mental health experience. In phase two, this framework will be tested with service users in more diverse volunteer positions. The findings of my study suggest that mental health services are in a unique position to build partnerships with service users to support their recovery and journeys toward employment by providing opportunities for volunteering.     

Keeley's journey: From service user to service provider

Background: This paper presents the vocational journey of a young British woman, Keeley, who changed her career aspirations to become a mental health worker following an episode of significant mental health difficulties. Keeley's story illustrates the application of the locally developed WORKS framework in conceptualising and supporting Keeley's vocational recovery. Approach: A narrative approach highlights the partnerships that developed between Keeley, the Occupational Therapist, Sally, and the User Support and Employment Service. Findings: The WORKS framework supported Keeley and Sally to collaboratively develop a successful employment pathway. Strategies, including attention to Keeley's view of her capabilities and aspirations, volunteer placements, support of peers, employer engagement and planning for sustainable employment, assisted Keeley to establish her chosen career. Keeley's journey highlights the leadership role that mental health services can assume by providing paid work for people with experience of mental health difficulties.     

Service user/survivor-led research in mental health: epistemological possibilities

This paper considers possible epistemologies for user-led and survivor research by drawing on four discourses: the mainstream English tradition, Canadian Mad Studies, critical theory more generally and feminist standpoint epistemology. It discusses general, universalising epistemologies, the extent to which these characterise the discourses at stake and the problems with knowledge claims that rest on such singular conceptualisations. The institutional and political concomitants are considered. The paper has an additional double aim: to engage with survivor scholarship around critical theory and to insert that scholarship into the field of critical theory itself in a novel manner.     

Training consumers to collect data in mental health service system evaluation research

Consumer satisfaction with services is an outcome measure. This report describes The Consumer Satisfaction Research Associate Training Program, which was designed for the education and supervision of recovered consumers who collected data during four studies at three psychiatric hospitals. The educational program had didactic and laboratory components. Consumer research associates collected quantitative and qualitative data using a survey tool for face-to-face interviews. Participant recruitment and management of confidential records were included in the role. Data collected by research associates from consumers who are in treatment can enhance the validity and trustworthiness of satisfaction surveys. Nurses can play an important role in the research process by serving as staff resources for consumers who collect data in various service system settings.     

Ethnic and class factors affecting mental health clinic service

Service delivery by a mental health clinic to clients from an older suburban catchment area containing both lower and middle class blacks and whites was studied. The epidemiologic method was employed, relating service delivery to the characteristics of the various population groups within the catchment. The findings indicate that low service rates for blacks were not related to ethnicity alone, but to the combination of black ethnicity and low social status; however, middle class blacks and middle class whites who entered treatment received similar service. Poor blacks had higher admission rates than poor whites with similar need indicators. In continued treatment, poor blacks received lowest service rates while minority status poor whites living in a predominantly black area received highest service rates. Social class mediated black service utilization. Severity of illness, interacting with social class and minority status mediated white service utilization. Outreach is suggested not only for poor blacks but also for poor whites, especially those living in areas in which they represent an ethnic minority.     

Physical and mental health effects of being stalked for men and women

Stalking is relatively common yet little is known of the longer-term health effects of stalking. Using the National Violence Against Women survey, we estimated lifetime stalking victimization among women and men, ages 18 to 65, identified correlates of being stalked, and explored the association between being stalked and mental and physical health status. With a criterion of being stalked on more than one occasion and being at least "somewhat afraid," 14.2% of women and 4.3% of men were victims. Among those stalked, 41% of women and 28% of men were stalked by an intimate partner. Women were more than 13 times as likely to be "very afraid" of their stalker than men. Negative health consequences of being stalked were similar for men and women; those stalked were significantly more likely to report poor current health, depression, injury, and substance use. Implications for victims, service providers, and the criminal justice system were reviewed.     

Differences in white-nonwhite community mental health center service utilization patterns

Routinely collected computerized data were used to study the process of service delivery in terms of admission patterns, type and quantity of services rendered, and status at termination for whites and nonwhites in two community mental health centers. Social area analysis techniques were employed to control for socio-economic status, ethnicity and life style variables, and an epidemiologic model was used to analyze admission and service delivery rate differences. It was found that nonwhite admission rates were at least twice as great as white rates. Service delivery rates to the population at large were considerably greater for nonwhites than for whites. Delivery of direct services within the centers differed for whites and nonwhites, but no consistent trends emerged when types and amounts of services rendered were analyzed, controlling for sex, ethnicity, age, diagnosis and social area. Disruption of care indices were greater for nonwhites than for whites. Highlighted were some of the complexities involved in interpreting results of utilization studies.     

Qualitative examination of rural service provision to persons with concurrent developmental and mental health challenges

Although there has been an international trend away from institutionalization to community-based care, this has not always been successful, particularly for the unique and vulnerable population diagnosed with both mental health and developmental disabilities. The challenge of meeting the needs of this population is increased in rural and remote areas. As a part of a larger study, this paper reports on the voices of service providers for people dually diagnosed as they maneuver through the considerable challenges of meeting complex needs while located in remote northern communities. The complexities of rural service provision for those with a dual diagnosis of mental illness and developmental disability is also highlighted and includes challenges of northern living, difficulties in diagnosis, and system level issues. This paper confronts the inequities in provision of effective community-based services to this population and draws attention to the need to support and develop local, integrated services in order to build inclusive communities for all.     

A nurse's guide to mental health assessment reference sources

1. As the research base on psychological testing has proliferated across various disciplines, a comprehensive review of the testing literature is recommended. 2. In researching literature on psychological tests, nurses need to rely on traditional print as well as electronic databases and Internet sites. 3. In reviewing test items or in using a test, nurses need to be aware of test-user qualifications and publisher copyright restrictions.     

A gender-informed model to train community health workers in maternal mental health

The New Haven Mental Health Outreach for MotherS (MOMS) Partnership is a community-academic partnership that works to develop public health approaches to ensure that pregnant and parenting women living in the City of New Haven achieve the highest possible level of mental health. The MOMS Partnership developed a training model for community health workers specializing in maternal mental health. Six community health workers (termed Community Mental Health Ambassadors or CMHAs) were trained on key topics in this gender-informed maternal mental health curriculum. Pre- and post-test questionnaires assessed changes in attitudes, perceived self-efficacy and control using standardized scales. The results indicated preliminary acceptability of the training curriculum in transforming knowledge and attitudes about maternal mental health among community health workers.