Simplifying phrases in depression screens: Interpreters' views on usefulness in six languages.

Assessments and treatments of mental health conditions such as depression use language that may be difficult to understand or translate. Here, we studied how interpreters assessed the usefulness of simplifying the language of a depression screen. Two alternative versions of the PRIME-MD PHQ depression screen were generated, with increasing linguistic simplicity. All the versions (standard, moderately simplified and most simplified) were translated from Finnish into Arabic, English, Farsi, Russian, and Swedish. Ten professional interpreters then assessed the different usefulness aspects of the three versions. The interpreters' perceptions of usefulness of the different language versions for clients varied, and both simplified versions of the depression screen were commonly considered useful for interpreting contexts. The usefulness of the simplified language versions was seen as especially important for clients with multiple linguistic challenges, caused by, for example, dementia and immigration backgrounds. The language of depression screens can be greatly simplified. Simplified versions may significantly improve the accessibility of questionnaires for the wide range of individuals with compromised language competence. Simplified versions may also be helpful for inter-language interpreting in health care, and importantly, they may facilitate the transparency and cross-cultural calibration needed in evidence-based medicine.

Discussing physical restrictions in care plan meetings between family members of residents with dementia and nursing home staff.

In long-term dementia care, caregivers face a dilemma. On the one hand, they need to respect the residents' right to self-determination, but on the other hand, they sometimes rely on physical restraints to deal with potential violence and self-destructive behavior. The issue of self determination is further complicated by residents often depending on family members as advocates in decision-making. In this article, we examine 15 care plan meetings to identify the professional practices of discussing the physical restrictions posed to residents with severe dementia. Our method is conversation analysis. Our analysis demonstrates that staff members' practices involve informing, accounting, and agreeing on the goals rather than on the methods of physical restraining. Staff members tend to first inform family members about the principles of restraining and then account for the use of restraints. Accounts highlight the problems that can be avoided and the benefits that can be achieved by limiting residents' actions. Consequently, the family members' role in the discussion is to accept the decision that has already been approved by authorities. As the staff members highlight the aim of protecting the well-being of the resident, the family members tend to respond with overt agreement and even promote the use of restraints. Current negotiation practices provide insufficient opportunities for family members to advocate for residents. Therefore, we recommend involving family members in decision-making about restraining at an earlier stage, adjusting the protocol in care plan meetings, and engaging the family in minimizing and preventing restraints. In general, staff members should pay more attention to the residents' experiences and the family members' lifeworld knowledge of the residents.

Mental health rehabilitees' agency construction and promotion in community-based transitional work programme.

PURPOSE: The integration of mental health rehabilitees into the labour market is an important policy objective everywhere in the world. The international Clubhouse organization is a third-sector actor that offers community-based psychosocial rehabilitation and supports and promotes rehabilitees' state of acting and exerting power over their lives, including their (re)employment. In this article, we adopt the perspective of discursive psychology and ask how mental health rehabilitees' agency is constructed and ideally also promoted in the Clubhouse-based Transitional Employment (TE) programme. METHODS: The data consisted of 26 video-recorded TE meetings in which staff and rehabilitees of one Finnish Clubhouse discussed ways to further their contacts with potential employers. The analysis was informed by discursive psychology, which has been heavily influenced by conversation analysis. RESULTS: The analysis demonstrated how rehabilitees adopt agentic positions in respect to TE-related future activities, and how Clubhouse staff promote and encourage but also discourage and invalidate these agentic positionings. The analysis demonstrated the multifaceted nature of agency and agency promotion in the TE programme. CONCLUSIONS: Although ideally, Clubhouse activities are based on equal opportunities, in everyday interaction practices, the staff exercise significant power over the question whose agency is promoted and validated in the TE programme.

Self-Disclosure and Non-Communication: Stigma Management in Third-Sector Transitional Employment.

People who are recovering from a mental illness often have difficulties finding and maintaining employment. One of the main reasons for these difficulties is the negative label, or stigma, attached to mental illnesses. People who possess stigmatizing characteristics may use compensatory stigma management strategies to reduce discrimination. Due to mental illnesses' invisible characteristics, information control is an important stigma management strategy. People can often choose whether they disclose or non-communicate their illness. Nevertheless, it might be difficult to decide when and to whom to disclose or non-communicate the stigma. Since stigma management is a dilemmatic process, workers in mental health services play an important role in informing their clients of when it is best to disclose or non-communicate their illness. In this article, we adopt the perspective of discursive social psychology to investigate how workers of one mental health service programme evaluate and construct self-disclosure and non-communication as stigma management strategies. We demonstrate how these workers recommend non-communication and formulate strict stipulations for self-disclosure. At the same time, they differentiate non-communication from lying or providing false information. The study contributes to an improved understanding of stigma management in contemporary mental health services.

Discussing mental health difficulties in a "diagnosis free zone".

Being identified as "mentally ill" is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the "diagnosis-free zone", which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the "diagnosis free zone" programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members' explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.

Tensions and Paradoxes of Stigma: Discussing Stigma in Mental Health Rehabilitation.

Mental illness remains as one of the most stigmatizing conditions in contemporary western societies. This study sheds light on how mental health professionals and rehabilitants perceive stigmatization. The qualitative study is based on stimulated focus group interviews conducted in five Finnish mental health rehabilitation centers that follow the Clubhouse model. The findings were analyzed through inductive content analysis. Both the mental health rehabilitants and the professionals perceived stigmatization as a phenomenon that concerns the majority of rehabilitants. However, whereas the professionals viewed stigma as something that is inflicted upon the mentally ill from the outside, the rehabilitants perceived stigma as something that the mentally ill themselves can influence by advancing their own confidence, shame management, and recovery. Improvements in treatment, along with media coverage, were seen as the factors that reduce stigmatization, but the same conceptualization did not hold for serious mental illnesses. As the average Clubhouse client was thought to be a person with serious mental illness, the rehabilitation context designed to normalize attitudes toward mental health problems was paradoxically perceived to enforce the concept of inevitable stigma. Therefore, it is important for professionals in rehabilitation communities to be reflexively aware of these tensions when supporting the rehabilitants.

Self-directed speech and dialogue in dementia care: the potential of co-participants' contributions.

PURPOSE: Dementia is associated with an ongoing decline in language function, involving both language production and comprehension. Maintaining a conversation with persons with dementia may be challenging. In this study, we investigate how the contributions of professional caregivers affect the linguistic contributions of the speaker with dementia. METHODS: This is a conversation analytic case study of one individual with dementia. The data are drawn from a five-hour video corpus collected at a Swedish speaking care facility in Finland. RESULTS: In comparing self-directed speech and dialogue, the results show how professional caregivers can induce change in the linguistic and interactional behaviors of a person with dementia. CONCLUSIONS: Introducing an interactional perspective to self-directed speech and dialogue, this study provides new insights into the notion of a "good conversation" in dementia care.

Boundaries of participation in care home settings: Use of the Swedish token jaså by a person with dementia.

This article is a conversation analytic study of how one elderly person with dementia and her interlocutors interact in a care home setting. Participation is studied in the form of responsive action of the person with dementia, focusing on the Swedish response token 'jaså,' which has not previously been analysed in detail. The central claim is that even though the sequential placement of the response token indicates interactional competence, other factors reveal limited competence and communication impairment. First, the person with dementia's use of gaze is reduced, and she seems to rely on the auditory but not on the visual channel. Second, the interlocutors do not in all situations treat her as a ratified participant in spite of her attempts to contribute to the interaction. This study contributes both to the study of participation in the context of communication impairment and to the study of response tokens in Swedish.

Laughter, communication problems and dementia.

This article investigates how the elderly with dementia and their professional caregivers use laughter as a device to deal with problems related to language production and comprehension. The data consist of two game-playing situations, used to engage the elderly people in memory work. The article shows how the elderly patients recurrently laugh to acknowledge communication difficulties and to show awareness of their potential non-competency. The professional caregivers are shown to use slightly different strategies for responding to laughter segments initiated by the patients, either making the shortcomings part of the conversation or avoiding referring to the lapse explicitly. The laughter strategies used by the patients are compared to those reported in the CA-literature on laughter. It is well known that laughter is used in sequences of trouble and delicacy in both ordinary and institutional contexts, but my study shows that speakers with dementia laugh when they encounter problems related to language production and comprehension. This functional expansion in relation to premorbid occurrence is evidence that laughter fits the definition of compensatory behaviour utilized to overcome communication barriers. Certain conversational skills are preserved in individuals with dementia, but due to their cognitive impairment these resources are utilized in a slightly different way than by healthy speakers.