Impact of statutory revisions to family-petitioned civil commitment in South Korea.

INTRODUCTION: This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period. METHODS: Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group. RESULTS: In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness. CONCLUSION: The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emergencies arise.

Lack of continuity of care experienced by people diagnosed with schizophrenia in South Korea.

People diagnosed with schizophrenia (PDS) will find seamlessly coordinated services and care in their communities if they are delivered with a high level of continuity of care (COC). Most studies of COC were conducted in Western countries that initiated deinstitutionalisation several decades ago. Limited studies highlight experiences of COC among PDS who live in societies still heavily relying on institutionalised care, such as prolonged hospitalisation, like South Korea where PDS stay in psychiatric hospitals over 100 days on average. This qualitative study explored COC that PDS experienced in South Korea. We focused on cross-boundary COC, which refers to service coordination at a given moment, and longitudinal COC, which refers to care over a period of time. Twenty-one PDS completed in-depth interviews from June to August 2017. Fifteen participants were male (71.4%), and ages ranged from 26 to 71. We used grounded theory techniques for data analysis, including initial open coding, in vivo coding, constant comparison and axial coding. Findings include that PDS experienced poor longitudinal COC when discharge planning during hospitalisation was absent, which undermined their ability to live independently. Poor employment support effectively undermined recovery even if PDS worked hard to attain economic self-sufficiency. As for cross-boundary COC, poor communication between psychiatrists and providers offering psychiatric rehabilitation services was a barrier. PDS in general had difficulties locating needed psychiatric rehabilitation services in the community. The lack of COC appeared to arise from particular sociocultural contexts, including poor self-determination in consumer-provider relationships, families' lack of knowledge and support, and discrimination and prejudice. Despite experiences with discrimination, no participants appeared to have internalised messages that they are 'less than' those without mental illnesses. Findings highlight the significance of multi-pronged approaches to increase COC, which can effectively link PDS, families, psychiatrists and psychiatric rehabilitation service providers.

Mental illness discrimination and support experienced by people who are of color and/or LGB: Considering intersecting identities.

Little is known about mental illness discrimination toward and supports for people with mental health conditions (MHCs) who are of color and/or lesbian, gay, or bisexual (LGB). Informed by an intersectionality framework that facilitates an understanding of intragroup dynamics, this exploratory qualitative study used in-depth interviews to ask 20 people with MHCs and family members of people with MHCs who also identified as of color and/or LGB about their experiences (a) with mental illness discrimination and supports within their identity communities and (b) in peer- and family-run programs. Participants of color reported that their racial-ethnic communities commonly deny that MHCs exist and shame people with MHCs, and LGB participants said that LGB communities often exclude and stereotype them. Interactions with others with MHCs and affirmation of lesbian and gay identities serve as recovery supports within identity communities. Peer- and family-run programs provide a sense of humanization and education, respectively but are sites of heterosexism and may not address the needs of people of color; identity-specific programs are therefore desired. We describe variations in experiences related to race, ethnicity, and sexuality intersections; no differences in descriptions of mental illness discrimination in the focal identity communities emerged between people with MHCs versus family members. Implications include that efforts are needed to address discrimination in identity communities and peer- and family-run programs, and service providers need to recognize that identity intersections affect experiences with discrimination and supports. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mental Illness Discrimination in Mental Health Treatment Programs: Intersections of Race, Ethnicity, and Sexual Orientation.

People with mental illnesses (PWMI) who are of color and/or lesbian, gay, or bisexual (LGB) experience mental health disparities, including within mental health treatment programs (MHTPs). Informed by a critical framework with attention to intersectionality and microaggressions, this qualitative study asked 20 PWMI and family members who also are of color and/or LGB whether they had experienced mental illness discrimination in MHTPs, a possible factor in disparities. We also asked participants about aspects of MHTPs that supported recovery. Participants reported that they were ignored/not listened to, not viewed as complex individuals, experienced condescension/lack of respect and violations of privacy or other rights, and were presumed to lack intelligence. In addition, identifying mental illness discrimination was complex due to intersections of identities. Despite these perceptions of discrimination, participants described supportive aspects of MHTPs. Implications for practice and research are offered.

Peer employees' and clinicians' perceptions of public mental illness stigma and discrimination.

OBJECTIVE: Stigma and discrimination against people with mental illnesses are serious problems that can lead to many negative effects. This study examined providers' awareness of consumers' daily lived experience of discrimination. METHOD: We surveyed 51 peer employees and 52 licensed clinicians to learn how they viewed the extent of public stigma and discrimination. RESULTS: Clinicians, women, and those who had observed a friend with a mental illness treated unfairly perceived significantly higher levels of public discrimination than did their counterparts (adjusted R² = .399, p < .001). Men's perceptions of public discrimination were more strongly affected by personal contact. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Mental health providers are uniquely situated to help consumers deal with the effects of discrimination and should incorporate this issue into their clinical practice. Further research should examine the reasons for differences in perception and how these differences relate to provider behavior and consumer outcomes.

Stigma in the mental health workplace: perceptions of peer employees and clinicians.

Informed by a structural theory of workplace discrimination, mental health system employees' perceptions of mental health workplace stigma and discrimination against service recipients and peer employees were investigated. Fifty-one peer employees and 52 licensed behavioral health clinicians participated in an online survey. Independent variables were employee status (peer or clinician), gender, ethnicity, years of mental health employment, age, and workplace social inclusion of peer employees. Analysis of covariance on workplace discrimination against service recipients revealed that peer employees perceived more discrimination than clinicians and whites perceived more discrimination than employees of color (corrected model F = 9.743 [16, 87], P = .000, partial ŋ (2) = .644). Analysis of covariance on workplace discrimination against peer employees revealed that peer employees perceived more discrimination than clinicians (F = 4.593, [6, 97], P = .000, partial ŋ (2) = .223).

Youths of Mexican Descent of the Southwest: Exploring Differences in Ethnic Labels.

Knowledge of the factors that influence youths' choice of racial or ethnic labels will help us understand intragroup diversity, suggest ways in which school social workers can support youth's ethnic identity development, and learn if youth who choose different combinations of labels may be grouped together for research purposes. This study of 2,857 Mexican-origin youth in the U.S. Southwest found that linguistic acculturation, socioeconomic status, and educational aspirations are related to choice of ethnic labels. Implications for social work interventions in schools and for future research are offered.

Parents with co-occurring mental health and substance abuse conditions involved in Child Protection Services: clinical profile and treatment needs.

This article reports findings of an exploratory study of 71 parents with substance abuse conditions involved in a child dependency court. Over half (59%) of the parents had a co-occurring mental health condition. Parents with co-occurring conditions (PWCC) differed in several important ways from those with only substance abuse conditions. PWCC were also more likely than their case managers were to report a need for mental health treatment. Implications for child welfare practice and research are offered.

The animal-human bond and ethnic diversity.

Affectionate relationships with animal companions have health-enhancing effects on people and enrich their quality of life, and the majority of families with companion animals regard their animals as family members. Research has also suggested that these relationships are complicated and vary depending on a number of factors, yet there has been almost no exploration of ethnic diversity in relationships with companion animals. This descriptive study explores the relationships among race and ethnicity, beliefs about companion animals, and ownership practices. Findings indicate that in many instances there were no statistical differences by ethnicity. Nonetheless, describing oneself as white, American Indian, or both was associated with being more likely to have companion animals. Those identifying themselves as of Hispanic or Spanish origin were less likely to have cats and to have their cat or dog spayed or neutered and more likely to say they get a sense of personal safety from their dog or cat. The implications of these findings are discussed, and suggestions for research and practice are offered.