Strategies to destigmatize mental illness in South Africa: Social work perspective.

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.

Becoming an Approved Mental Health Professional: an analysis of the factors that influence individuals to become Approved Mental Health Professionals.

BACKGROUND: In England and Wales, the Approved Mental Health Professional (AMHP) has final responsibility for applying under the Mental Health Act 1983 to admit an individual compulsorily and convey them to psychiatric hospital. The AMHP role is challenging and legally accountable and unique to the UK context. AIMS: To analyse the motivation of individuals to become AMHPs, and identify factors which may affect motivation. METHOD: Semi-structured interviews were conducted with 12 AMHPs from local authorities across Southern England. Ten participants were social workers, one was qualified as both a nurse and social worker, and one was a mental health nurse. RESULTS: Participants identify career progression and professional development as significant as well as the status and independence of the role and enhanced job security. Social work participants value the Mental Health Act assessment as a contained piece of work, with a high degree of professional discretion. CONCLUSIONS: AMHPs are motivated by an increase in professional status and job security, but also exercising independent judgment and authority in a time-limited intervention is emotionally and professionally rewarding.

Training in the implementation of prolonged exposure therapy: provider correlates of treatment outcome.

The authors examined the degree to which provider characteristics, such as profession, treatment orientation, prior experience in treating posttraumatic stress disorder (PTSD), prior experience with prolonged exposure (PE) therapy, and attitudes about PE, were related to the clinical outcomes of veterans receiving care from clinicians participating in the national Department of Veterans Affairs (VA) PE Training Program. Positive patient outcomes were achieved by providers of every profession, theoretical orientation, level of clinical experience treating PTSD, and prior PE training experience. With 1,105 providers and 32 predictors (13 provider variables), power was at least 90% power to detect an effect of ß = .15. Profession was the only provider characteristic significantly related to outcomes, but the mean effect (a 2 point difference on the PTSD Checklist) was too small to be clinically meaningful. The results support the intensive training model used in the VA PE training program and demonstrate that clinicians of varying backgrounds can be trained using interactive training workshops followed by case consultation to deliver PE effectively.

Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers.

OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

[Mental health promotion in school with school coaches: evaluation of a pilot project]. / Die Förderung psychischer Gesundheit in der Schule durch Schulcoaches: Evaluation eines Modellprojekts in Sachsen.

OBJECTIVE: How did the work of four school coaches in five Saxonian schools influence children's and adolescents' psychosocial development? METHODS: At three points in time, students at intervention (N = 292) and control schools (N = 300) were evaluated concerning their social distance towards mentally ill people and their help-seeking behavior in case of crisis. The survey also included teachers (N = 323) and parents (N = 370). Data analysis was done descriptively and with random effects models. RESULTS: The social distance of the intervention schools declined significantly compared to the control schools. Having heard or read about mental illnesses, or personally knowing somebody affected by mental illness, led to less social distance and more empathy. Information increased the confidence to receive help from a professional consultant. Friends and family were the main reference groups. The school coaches were accepted as confidential persons and helped with school and private issues. CONCLUSION: The school coaches' work showed positive influence on all members of the school system.

Teaching psychiatry and establishing psychosocial services--lessons from Afghanistan.

We describe the extremely limited psychiatric resources of war-torn countries like Afghanistan. In such countries, we suggest to apply experience from training medical students in industrialized countries to teach a very basic and simplified understanding of psychiatric classifications and core diagnostic symptoms to medical students (who will later serve in various medical disciplines in regional and district hospitals) and to medical staff including nurses and psychosocial counsellors working in health posts and district hospitals. We describe such a brief but clinically relevant list of symptoms and classifications based on experiences with medical student and practitioner training.

Understanding the differential impact of outcome monitoring: therapist variables that moderate feedback effects in a randomized clinical trial.

Providing outcome monitoring feedback to therapists seems to be a promising approach to improve outcomes in clinical practice. This study aims to examine the effect of feedback and investigate whether it is moderated by therapist characteristics. Patients (n=413) were randomly assigned to either a feedback or a no-feedback control condition. There was no significant effect of feedback in the full sample, but feedback was effective for not-on-track cases for therapists who used the feedback. Internal feedback propensity, self-efficacy, and commitment to use the feedback moderated the effects of feedback. The results demonstrate that feedback is not effective under all circumstances and therapist factors are important when implementing feedback in clinical practice.

Novel unsupported and empirically supported therapies: patterns of usage among licensed clinical social workers.

BACKGROUND: While considerable attention has been focused in recent years on evidence-based practice, less attention has been placed on clinical social workers' choice to use ineffective or harmful interventions, referred to in the present paper as Novel Unsupported Therapies (NUSTs). METHOD: The present study surveyed 400 Licensed Clinical Social Workers (LCSWs) across the United States in order to determine the extent of their usage of NUSTs, as well as their usage of conventional therapies that lacked support and empirically supported therapies (ESTs). Reasons for selecting interventions were also assessed. RESULTS: While the vast majority (97.5%) reported using some form of EST, 75% of our sample also reported using at least one NUST. Logistic regression analysis revealed that NUST usage was related to female gender and trauma specialization. A split plot ANOVA revealed that respondents rated positive clinical experience higher than published research as a reason for selecting an intervention. LCSWs with a CBT theoretical orientation rated research evidence more highly than those of other theoretical orientations. However, even within the group of LCSWs with a CBT orientation, clinical experience was rated more highly than research evidence. CONCLUSIONS: Implications for practice are discussed.

Perceptions of the relationship between mental health professionals and family caregivers: has there been any change?

A number of international studies have highlighted family caregivers' (FCGs') dissatisfaction with their relationship with mental health professionals (MHPs) when providing care for mentally ill family members. However, few studies have explored the mental health professionals' perspective of this relationship. This study explored both FCGs' and MHPs' perspectives. Semi-structured interviews were conducted with seven FCGs and seven MHPs from two different geographical areas of New Zealand. Thematic analysis of these interviews revealed four distinct MHP themes and five FCG themes. The themes illuminate incongruence between MHPs' intentions to form a positive working relationship with families and the FCGs' mainly negative experiences of this relationship.

Mental health social work and nursing in the USA and the UK: divergent paths coming together?

BACKGROUND: When the mental health systems of the UK and the USA are compared, one of the most striking differences is that social workers are the largest professional group in the USA and community nurses the largest in the UK. AIM AND METHOD: This paper examines the history of the development of both professional groups in both countries, and their education and training. RESULTS: Demand, supply and economic factors are important influences and reasons for these differences. CONCLUSIONS: Both professions have critical future workforce roles, but further consideration needs to be given to the extent to which their skills and values overlap in order to inform future workforce planning, and to reduce the extent to which the workforce pattern in both countries risks being over-determined by supply issues.

Psychosocial care for women survivors of the tsunami disaster in India.

OBJECTIVES: I investigated the effectiveness of Psychosocial Care, a community-based mental health initiative for survivors of the 2004 tsunami disaster in India. METHODS: Mental health teams from the National Institute of Mental Health and Neurosciences (NIMHANS) in India implemented a train-the-trainer model of psychosocial care in one of the worst tsunami-affected areas of south India. Three months of psychosocial care was provided for an intervention group of women, but not for a control group recruited from an exposed neighboring village. Impact of Event Scale (IES) scores--both total scores and scores for subscales on hypervigilance, avoidance, and intrusion--were compiled for both the intervention and control groups and used as outcome measures. RESULTS: For the intervention group, posttest total IES and subscale scores were significantly lower than pretest scores (P < .001), indicating improvement in symptoms. Posttest total IES and subscale scores were significantly lower for the intervention group than for the control group (P < .001). CONCLUSIONS: Psychosocial care is an effective mental health strategy for women survivors of disasters and should be an integral component of disaster response in resource-poor countries.

Educational collaboration in psychiatric disability, rehabilitation, and recovery: developing transformative solutions.

This article describes an innovative statewide collaboration between schools of social work and public mental health departments to transform social work curriculum and address the workforce crisis in public mental health service systems. The collaborative partnership has fostered the development of a Mental Health Initiative that has developed a set of mental health competencies offered in each of the participating master's in social work (MSW) programs in California. These competencies identify critical skills and knowledge necessary to support recovery, resiliency, evidence-based practice, and psychosocial rehabilitation principles. A statewide stipend program to support final-year MSW students in their graduate study and a requirement for a year of employment payback in the public mental health system is also presented, as well as a brief discussion of the organizational and structural principles supporting the collaborative organization. Current successes, future challenges, and strategies for the partnership collaborative in their task of developing a workforce are addressed.

Beyond stigma and discrimination: challenges for social work practice in psychiatric rehabilitation and recovery.

The recovery process and social work education share theoretical and practice roots that facilitate a goodness-of-fit between the profession and the empowerment orientation of recovery. This article examines the linkages between the recovery process and social work education, including areas where curricular renewal will assure that master's in social work (MSW) students and graduates embrace the recovery-oriented values that facilitate consumer-driven services. Curricular innovation is also proposed that addresses the need for MSW programs to develop supported education programs that will enable more consumers to pursue and complete graduate social work education.

Mental health of farmers in Southern Queensland: issues and support.

OBJECTIVE: To inform the development of an initiative designed to support the mental well-being of farmers in Queensland. DESIGN: Interactive focus groups. SETTING: Rural and remote Queensland. PARTICIPANTS: Health professionals, farmers and representatives of organisations and agencies working with farmers. MAIN OUTCOME MEASURES: Determination of factors contributing to the declining mental health of rural landholders. Content material for inclusion into mental health first aid programs held for field officers. RESULTS: Key areas identified to contribute to the decline in mental health of farmers were: increasing isolation in its varying forms, the ongoing drought, increased government regulations and widening of the schism between urban and rural Australians. The issues that affect farmers are recognised to have a 'knock-on' effect on the people who interact with them. In particular, rural support organisations are concerned for the well-being of their staff, prompting some to begin to put protocols in place to address their staff need for mental health support. Additional mental health training of field officers that involves awareness, recognition, communication skills, understanding and empathy was recognised by participants to be beneficial. CONCLUSION: Training of field officers was considered to be of benefit to the support of farmers. An understanding of the various and diverse issues that rural landholders face should be a fundamental component of that training.