Adaptation of a Hearing Voices Group Facilitation Training for VA Stakeholders.

The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visions, which mental health professionals commonly refer to as 'auditory hallucinations,' 'schizophrenia,' or 'psychosis.' Central to this movement are peer support groups through which attendees connect with others who have similar experiences. This paper describes an adaptation of a Hearing Voices group facilitation training at VA Greater Los Angeles (VAGLA) and discusses training modifications, along with trainee perceptions and implementation and intervention outcomes. This is a first step towards adapting HV-inspired groups to VA systems of care. Data collection involved surveys of trainees (n = 18) and field notes throughout the 24 h online training. Findings indicate high acceptability and appropriateness of the training and high feasibility in implementation, suggesting the training was well-adapted to VAGLA. This research contributes to global efforts to integrate the Hearing Voices approach in diverse settings and increase awareness about its benefits among providers.

Policy Statement: Mental Well-being among Anthropologists at Universities: A Call for System Transformation.

The Anthropology of Mental Health Interest Group affirms that the state of mental health in Academic Anthropology needs serious attention and transformation. We respond to structural inequities in academia that exacerbate mental distress among graduate students and other anthropologists who experience oppression, by putting forward a policy statement with recommendations to create more equitable learning and working environments.

"Boundary Formation" Within Mutual Aid Assemblages.

As grassroots user/survivor movements gained traction across the Global North, mental health activists have provided mutual aid for those who consider themselves to be negatively affected by their psychiatrization experiences and for those in search of alternative (non-biopsychiatric) frameworks for understanding mental diversity. In addition to in-person support groups, digital communication has become an integral organizing mechanism for mutual aid actions to support those in mental distress. However, activists have often found both digital and face-to-face communication to be quite taxing to their own well-being-as they negotiate personal capacity to respond to collective needs and practice self-care through limiting their engagements in radical mental health communities. While engaging in an ethnography with a mutual aid community in the United States, I explored the use of "boundary formation" to set parameters for social engagement within digital support and face-to-face encounters. Semi-structured interviews with 14 participants, focus group discussions, participatory observation, and an analysis of digital communication revealed that group members often discussed setting personal boundaries as an act of self-care, a recognition of the pitfalls associated with engaging in group dynamics during times of mental distress, and as a practice to ensure communal longevity. The ways that participants discussed and enacted boundary formation are analyzed in this paper as a way of blocking, redirecting, and restructuring digital and in-person engagements within mutual aid assemblages.

Stakeholder perspectives on sustainment of Housing First in a VA permanent supportive housing program.

OBJECTIVE: To evaluate the sustainment of Housing First (HF) implementation in a permanent supportive housing program for homeless-experienced veterans, 5 years after practice implementation. STUDY SETTING: From 2016 to 2017, primary data were collected from providers and veterans in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program at Los Angeles. STUDY DESIGN: Guided by the integrated sustainability framework, we performed a mixed-methods study to evaluate the sustainment of HF, an evidence-based practice implemented to improve housing outcomes. To assess sustainment, we measured fidelity to HF in six of seven HUD-VASH teams. These data were integrated with qualitative interviews with providers and veterans who described perceived sustainment to HF and contextual factors that supported or impeded sustainment. DATA COLLECTION: Fidelity to HF at 5 years after practice implementation, as a proxy for sustainment, was quantified via surveys with HUD-VASH teams. HUD-VASH providers (n = 51) and 31 veterans participated in semi-structured interviews. Team-based template analyses were used to develop an emergent understanding of stakeholder perspectives on HF sustainment. PRINCIPAL FINDINGS: Overall, HUD-VASH teams reported HF sustainment. The lowest fidelity scores were found in the domains of client-to-staff ratios, frequency of client-provider contact, and time to housing. Qualitative findings indicated that outer contextual factors (e.g., housing scarcity) and organizational factors (e.g., staff turnover) impacted HF sustainment. Providers identified changes in leadership and unmet resource needs as impediments to practice sustainment. All stakeholders identified positively with the HF practice and believed that the approach benefited veterans. CONCLUSIONS: This snapshot of HF sustainment demonstrates that this practice can be sustained over time. However, strong leadership, organizational resources, and community partnerships are needed. Adaptations to HF in response to outer contextual factors and organizational capacity may result in practice sustainment while allowing for flexibility in service provision.

Uncivilizing "Mental Illness": Contextualizing Diverse Mental States and Posthuman Emotional Ecologies within The Icarus Project.

This article argues humans should not be defined strictly at their physical boundaries with clear distinctions between anatomical bodies, mental states, and the rest of the world. Rather, diverse mental states, which are often diagnosed as "mental illness," take shape within greater environmental forces and flows, including those that are constructed online. Drawing from a multi-sited ethnography of The Icarus Project, a radical mental health community, the author situates online narratives written by two of its members within posthuman emotional ecologies in which the exchange of ideas online affects mental states in a profound way. These narratives can be seen as a new type of psychiatric resistance based in new technologies, one that "uncivilizes" mental illness by searching for alternative frameworks and metaphors to understand lived experiences with mental distress. This ethnographic perspective differs significantly from traditional bio-psychiatric models and interventions and can offer both patients and mental healthcare providers with an alternative language to frame mental health.

Navigating the Paradoxes of Neoliberalism: Quiet Subversion in Mentored Service-Learning for the Pre-Health Humanities.

In describing the foundations of our pedagogical approaches to service-learning, we seek to go beyond the navel-gazing-at times, paralyzing-paradoxes of neoliberal forces, which can do "good" for students and their communities, yet which also call students into further calculative frameworks for understanding the "value" of pre-health humanities education and social engagement. We discuss methods to create quiet forms of subversion that call for a moral imagination in extending an ethics of care to students as well as to the communities with which they engage. While we recognize the partiality and limitations of our attempts, framing mentored service-learning in unexpected ways can help students and practitioners to understand their role within broader social, historical, cultural, and emotional contexts and encourage them to act intentionally toward the communities they seek to serve in response to this new self-knowledge. To that end, we outline an academically rigorous service-learning intervention at one of our universities.

Dis/Assembling Schizophrenia on YouTube: Theorizing an Analog Body in a Virtual Sphere.

As visual technologies become increasingly networked online, websites like YouTube provide a space to share vlogs (video blogs) online, suggest related content for viewers, and help in/form virtual communities, including those of mental illness. Within this space, vlogs of schizophrenia and comments generated about them by other users can represent transitional, dialogical states of illness that speak back to the analog body and affect a body's way of being in the world. Moreover, as vlogs create resistance against static definitions of schizophrenia, they may foster a creativity, experimentation, and inventiveness that transforms understandings of schizophrenia within the sciences and humanities.