Reimagining sexual and reproductive healthcare for LGBTQ communities.

Qualitative interviews were conducted with nine individuals identifying as LGBTQ to identify recommendations for improving sexual and reproductive healthcare at a local clinic on the California Central Coast. Interviewees were recruited at local Pride events. Grounded theory methodology revealed several themes related to participants' desires for a LGBTQ-affirmative sexual and reproductive healthcare setting. Themes identified included: Beyond Enacted Inclusivity (avoiding a performative demonstration of LGBTQ-affirming care); Anti-Institutional Care (a political and visual challenge to what the healthcare setting should look like), a One-Stop-Shop (encompassing several types of care under one roof); Constrained Visibility (where LGBTQ identities are reflected but not exposed); and Community and Social Wellness (to be in community with other LGBTQ-serving organisations and one another in mutual support and celebration). Research implications and clinical recommendations are described at the local and system levels.

"Invisible in the Most Tragic of Ways": Exploring Internalized Transphobia and Coping Through Photovoice.

Transgender and gender diverse (TGD) individuals experience minority stress that includes internalizing the negative attitudes that exist in society about those whose identities rest outside of the gender binary. The purpose of this study was to gain a better understanding of the experience of internalized stigma and associated coping methods among six TGD adults utilizing photovoice. Thematic and iconographic analysis of 35 works produced by the participants revealed themes involving metaphors for internalized transphobia, internalized social messages, the psychological debt or emotional cost of internalized transphobia, and a range of coping strategies. Specifically, invisibility was a common metaphor used to suggest that a TGD person's experience may be associated with actively hiding, masking their identity, or failing to be seen as their true self. Participants expressed concern with being accepted by others and noted anxiety about outward expressions of their gender and personal characteristics. The results also revealed that participants experienced loneliness, fear of rejection, and low self-esteem related to internalized transphobia and their TGD identities. Participants reported receiving messages that TGD individuals are often viewed negatively and generally lack support from society and close relations. Coping strategies utilized by participants included withdrawing from others, hiding their TGD identity to avoid rejection or violence, self-exploration, accepting self and others, and connecting to a community of TGD persons and/or allies. Focus group feedback revealed benefits to participants, including an enhanced sense of community and self-esteem, as well as recommendations for future group structure. Implications and future research directions are discussed.

Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults.

Discrimination has been shown to disproportionately burden transgender people; however, there has been a lack of clinical attention to the mental health sequelae of discrimination, including posttraumatic stress disorder (PTSD) symptoms. Additionally, few studies contextualize discrimination alongside other traumatic stressors in predicting PTSD symptomatology. The current study sought to fill these gaps. A community-based sample of 412 transgender adults (mean age 33, SD = 13; 63% female-to-male spectrum; 19% people of color; 88% sampled online) completed a cross-sectional self-report survey of everyday discrimination experiences and PTSD symptoms. Multivariable linear regression models examined the association between self-reported everyday discrimination experiences, number of attributed domains of discrimination, and PTSD symptoms, adjusting for prior trauma, sociodemographics, and psychosocial comorbidity. The mean number of discrimination attributions endorsed was 4.8 (SD = 2.4) and the 5 most frequently reported reasons for discrimination were: gender identity and/or expression (83%), masculine and feminine appearance (79%), sexual orientation (68%), sex (57%), and age (44%). Higher everyday discrimination scores (ß = 0.25; 95% CL [0.21, 0.30]) and greater number of attributed reasons for discrimination experiences (ß = 0.05; 95% CL [0.01, 0.10]) were independently associated with PTSD symptoms, even after adjusting for prior trauma experiences. Everyday discrimination experiences from multiple sources necessitate clinical consideration in treatment for PTSD symptoms in transgender people. (PsycINFO Database Record

New roads paved on losses: photovoice perspectives about recovery from mental illness.

People with serious mental illness face stigma that interferes with recovery. Photovoice is a method that integrates photography and writing, providing a valuable means for capturing the narratives of people with mental illness whose voices are often marginalized. The purpose of the present article is to explore the meaning of recovery for individuals with serious mental illness based on a qualitative analysis of a new photovoice-based intervention, Recovery Narrative Photovoice. This intervention focuses on promoting the process of recovery and sense of identity through the creation of empowering visual images and narratives of recovery for individuals with serious mental illness. In this article, we present iconographic and thematic analysis for the 23 photovoice works from two pilots of the Recovery Narrative Photovoice intervention. Results reveal several themes, including metaphors for mental illness, associated losses, recovery strategies, and recovery outcomes. A final theme pertains to recovery messages learned from the recovery process.

Barriers to and facilitators of the acceptance process for individuals with serious mental illness.

The process of acceptance of mental illness is a central component of recovery and has been linked to functioning, illness management, and quality of life. A number of barriers and facilitators have been theorized as impacting this process. This study was conducted with 30 participants with serious mental illness (a major psychiatric disorder with impairment in multiple areas of functioning) to elicit the barriers to and facilitators of the acceptance of mental illness. Grounded theory methodology was utilized to analyze the 30 semistructured interviews. Results revealed barriers to and facilitators of acceptance of mental illness at the micro level (cognitive, emotional, behavioral, identity-related), meso level (relational), and macro level (cultural, systemic). Clinical and research implications are discussed with regard to facilitating acceptance of mental illness.

Development and evaluation of a webinar to reduce stigma toward people with serious mental illness.

OBJECTIVE: This study involved the development, dissemination, and pre- and postassessment of a mental illness awareness webinar. The goal of the webinar is to educate the general public about serious mental illness (SMI) and reduce stigmatizing attitudes. METHOD: The study included 203 participants (n = 101 treatment group; n = 102 control group). Each completed a pretest and posttest measure of a mental illness stigma scale and a transphobia scale in this randomized control trial research design, along with a demographic form and participant feedback questionnaire. RESULTS: Results revealed that stigma was significantly reduced from pretest to posttest depending on group condition. Participant feedback reflected generally positive responses to the benefits of participating in the webinar in terms of feeling more knowledgeable about SMI in particular (75.5%). Furthermore, while prior contact with people with-and prior education about-SMI alone did not appear to significantly impact stigma scores from pre- to posttest, these variables did appear to have a significant interaction in their combined impact on stigma scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings suggest that the mental illness awareness training holds promise as an effective tool or reducing stigma among members of the general public. The electronic nature of the webinar allows for widespread and cost-effective dissemination and can also be tailored to meet the needs of specific populations such as law enforcement, first responders, and veterans to destigmatize SMI and improve treatment seeking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The double stigma of obesity and serious mental illnesses: promoting health and recovery.

UNLABELLED: This article contrasts the traditional medical approach and size acceptance perspectives on obesity among people with serious mental illnesses. PURPOSE: Higher incidences of obesity among populations with serious mental illnesses have been identified. In response, a recent initiative in mental health has urged providers to address the obesity rates among populations with mental illnesses by monitoring weight, prescribing weight loss medication, and recommending bariatric surgery. However, literature is emerging with regards to the double stigma experienced by individuals with obesity and a mental illness. Therefore, the traditional focus on weight loss can benefit from a size acceptance approach to focus on health promotion and avoid stigmatizing size. SOURCES USED: Citations of theoretical and behavioral health literature on the experiences of individuals with mental illnesses and obesity are presented. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Recommendations for interventions, training, and future research related to obesity and mental illnesses are provided. Implications are suggested for a size acceptance approach to interventions for individuals in recovery from mental illnesses to promote health at every size within mental health and medical settings.

Preferred terminology of people with serious mental illness.

People with serious mental illnesses (SMIs) have argued for name changes for their conditions given problems with oversimplification, stigma, and social exclusion. There is a need to better understand the terminology preferences of people with SMI. The present two-part qualitative study analyzed data regarding participant preferences and evaluations of different labels for SMIs using qualitative data analysis methodologies of grounded theory and content analysis. The range of names identified by people with SMI in the present qualitative interviews and the positive and negative evaluations of the different labels are presented. Results were integrated across Study 1 and Study 2 to identify the following preferred and nonpreferred terms for these mental health problems; mental illness, diagnosis, disorder, psychiatric disability, person in recovery, person with lived experience, mental health challenges/issues, chemical imbalance, symptom names, and self-constructed labels. These results suggest the need to identify and reflect the terminology preferences of each individual with mental health problems when seeking psychological services and recognize the varying benefits of different terms depending on time and context. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The barriers and facilitators to serious mental illness: Recovery postincarceration.

Although there are effective treatments that promote recovery and improve quality of life for serious mental illness in nonincarcerated populations, more research is needed to understand the recovery process for individuals with a history of incarceration. A qualitative, grounded theory study was conducted with 17 men and women who have serious mental illness (SMI) and a history of incarceration. Findings revealed barriers and facilitators to the recovery process in the areas of identity, treatment, relationships, community, and institutions. The findings suggested that incarceration had harmful effects on the recovery process for individuals with SMI, although these individuals, at times, found ways to turn this challenging experience into an opportunity for personal growth. The clinical implications of these findings include the importance of the prevention of incarceration for people with SMI, as well as the provision of multidisciplinary care, such as medical, mental health, and substance use treatment, during and after incarceration, to reduce barriers and increase recovery outcomes. Additionally, factors related specifically to incarceration should be addressed during delivery of treatment and accessibility of community resources. Advocacy and policy change for prison reform will also be discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Treatment experiences with gender and discrimination among women with serious mental illness.

The unique experiences of women with serious mental illness (SMI) are often overlooked in the literature in mental health and rehabilitation services. This population faces increased risk of violence, sexual abuse, treatment bias, and a number of health problems when compared with their male counterparts. Further research is needed to identify these differences and suggest clinical implications for working with women with SMI. The present qualitative research includes data from a grounded theory study analyzing interviews with 20 women with SMI to explore their treatment experiences with mental health providers. The following themes pertaining to treatment experiences of women with SMI were generated from qualitative analysis: diminishing dismissals (questions as to the legitimacy of the symptoms and concerns of women with SMI in their mental health treatment), symptom misattribution (erroneous ascriptions of their mental health symptoms), male mistrust (wariness toward, and avoidance of, male providers), psychiatric insults (perceptions that mental health providers tend to make stigmatizing diagnoses), doomsday predictions (experience of providers' negative prognoses of their future), and diagnostic reordering (tendency of mental health providers to revise prior diagnoses of women with SMI in ways that reduce stigma and build trust). Clinical implications of these findings will be discussed, including the need for enhanced awareness of providers as to the perceptions and expectations of gender bias in treatment among women with SMI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development of a gender-sensitive and recovery-oriented intervention for women with serious mental illness.

OBJECTIVE: A pilot study was conducted to develop and provide a formative evaluation of a group intervention for women with serious mental illness, Women's Empowerment and Recovery-Oriented Care (WE-ROC). METHOD: Ten women with serious mental illness were recruited from a mental health center to take part in the pilot study. Several measures were utilized to assess prepost changes in recovery and empowerment and to elicit participant feedback. RESULTS: Results reflected a significant increase in recovery scores as well as empowerment scores. High attendance rates as well as satisfaction and effectiveness scores provided potential support for feasibility and acceptability of the study, respectively. Content analysis of qualitative feedback suggests positive impacts of group, particularly with regard to peer support and self-esteem. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Future implementation, refinement, and evaluation of the intervention can include a waitlist control group, additional postintervention assessment, and larger sample size. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Motherhood reimagined: Experiences of women with SMI surrounding parenting.

OBJECTIVE: Much of the extant literature on women with serious mental illness (SMI) has focused on the risks associated with motherhood, including violence, custody loss, poverty, and homelessness. The present study was conducted to characterize women's broader experiences surrounding the parenting role. METHOD: Twenty women with SMI, both those with and without children, were interviewed. Qualitative data were analyzed using grounded theory approach. RESULTS: Five themes pertaining to the topic of motherhood emerged from the data: motherhood declined, motherhood derailed, motherhood disabled, motherhood reimagined, and mattering through motherhood. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women with SMI face a number of challenges in their relationship to the role of mother. Clinicians can support women with SMI in their decision-making process with regard to having children or not, emphasizing self-determination and evaluation of the resources that might be needed to manifest this goal. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transgender and Gender Diverse Clients with Mental Disorders: Treatment Issues and Challenges.

A number of transgender and gender diverse individuals face risks of mental health problems and suicidality, often as a result of transphobia and gender minority stress. There are many resilience and protective factors that transgender individuals use to cope with mental distress and thrive. In this article, a review of the literature on transgender and gender diverse individuals with mental health problems is provided, as well as a discussion of the protective factors that enhance resilience.

Recovery narrative photovoice: Feasibility of a writing and photography intervention for serious mental illnesses.

OBJECTIVE: The primary purpose of this article is to describe the development and feasibility of the Recovery Narrative Photovoice intervention. The nature of this intervention will be discussed, including facilitating empowerment and a positive sense of identity among people with serious mental illnesses. We will also describe the integration of Photovoice methodology with psychoeducational components, informed by principles of the recovery movement and narrative therapy. METHODS: Sixteen participants with serious mental illnesses from a psychosocial rehabilitation and education center in the Northeast participated in a pilot study evaluating this new 10-week intervention with a pre-post test design. To assess feasibility, descriptive statistical analyses were conducted of attendance data and number of works produced. The pilot study was implemented in 2 consecutive waves with 8 participants each. RESULTS: High rates of attendance (69%) and production of photovoice works (82%) were demonstrated over the course of the 2 waves of the pilot. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings support the feasibility and acceptability of the Recovery Narrative Photovoice for individuals with serious mental illnesses. These results reflect the potential for using this intervention in psychiatric rehabilitation settings to facilitate recovery-related outcomes, including empowerment, positive identity, and community integration. Future research will require a replication of pre-post assessment of this intervention to further establish the efficacy of this program.

Acceptance of mental illness: core components of a multifaceted construct.

The recovery movement has identified acceptance of mental illness as critical to quality of life and illness management. However, there is a general lack of research on the acceptance of mental illness. The present qualitative study was conducted with 30 participants with mental illness to clarify the construct of acceptance. Grounded theory methodology is utilized to analyze the 30 semistructured interviews. Results in the present study reveal acceptance to be a multifaceted construct composed of several core characteristics, including the: (1) identity component, (2) cognitive component, (3) emotional component, (4) behavioral component, and (5) relational component. In addition, when asked to define acceptance of mental illness, some participants noted negative connotations to acceptance. Implications for psychological services and future research will be discussed to guide additional study and practice in this area.