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A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

Long-term care (LTC) homes are highly regulated settings that provide care to people living with complex health conditions who are often at the end of their lives. Mental health and quality of life are important concepts in LTC given the inherent poor health and diminished autonomy of residents living in this setting. The COVID-19 pandemic had the potential to further compound these issues through lockdowns limiting movement within and outside of LTC homes, increased fear of severe COVID-19 infections, staff shortages, and impaired communication through personal protective equipment. However, the evidence describing the effect of the pandemic on mental health and quality of life is mixed, with some studies describing increased rates of mental health concerns and others presenting modest increases or decreases. Creative strategies to mitigate negative mental health consequences of lockdown included technology supported and window or outdoor visits, increased access to volunteers, and supports for families. However, the evidence in this area continues to evolve as subsequent waves of the pandemic progress. Future research may present new evidence about other strategies that became important in different stages of the pandemic.

Purpose – This chapter describes the “Teen Alliance for Prepared Parenting–SPIN” (TAPP-SPIN) unwanted pregnancy prevention intervention for pregnant/parenting adolescents and their adult parent(s) in primarily African American and Latino communities in the District of Columbia (DC).

Methodology/approach – We augment TAPP services with SPIN Video Home Training (VHT)11Called Video Interaction Guidance in the United Kingdom., an intervention to build Parent–Child Connectedness (PCC). SPIN VHT aims to (1) improve adult–teen interaction to strengthen the supports teen parents need to continue to progress toward life success and (2) build the teen's ability to engage in warm, attuned, and skillful parenting of her child.

SPIN VHT uses a guided, strengths-based analysis of videotaped parent–child interactions to identify examples of the parent's competencies that support the child's well-being and optimal development. Collaborative review of an edited collection of video helps guide participants to integrate what has been effective into their daily patterns of interaction and communication.

Findings – The randomized experiment compares TAPP to TAPP-SPIN with a sample of 400 15- to 18-year-olds and their parents (dyads). After a baseline survey, we collect follow-up data at 6, 12, 18, and 24 months post-baseline. We collect outcome data on health information-seeking, pregnancy prevention communication, cognitions related to parenting and subsequent pregnancy, improved parenting, and clinical outcomes including subsequent pregnancy.

Social implications – The TAPP-SPIN intervention aims to advance the state of pregnancy prevention research in a population facing multiple health disparities.

Originality/value of chapter – This chapter describes the first ever randomized controlled trial of the SPIN approach to improving PCC.

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

Since the demise of Delivering Race Equality strategy in 2010 under the last Labour government and with the Coalition (2010–2015), and now the Conservative government at times have adopted a “color blind” approach to race and health. This raises the fundamental question why is race equality off the political agenda and how black mental health issues can be part of a future strategy. The 2015 Care Quality Commission (CQC) annual monitoring report of the Mental Health Act (MHA; which has also incorporated the learning since the inception of the Act in 1985) further highlighted the overrepresentation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order (CTO) in the psychiatric system over the last 30 years. The CQC have revised the code of practice which recognizes issues around race equality as part of wider perspectives and principles of human rights.

In October 2017, the government established an independent review of the 2007 MHA as a way of providing more safeguards for patients and service users. The review, under the leadership of Sir Simon Wessely which is reported in 2018, provided an opportunity for an informed public debate on the historical and contemporary roles of psychiatry and the experiences of mental health in Britain’s African and Caribbean communities. The review did examine community anxieties about the proportionally larger numbers of black ethnic minorities receiving inpatient care and CTOs, or in the criminal justice system. However, after 30 years of Black History Month in the UK, we still need to ask the question: Are those of African descent overrepresented in these systems? If so, is serious mental illness over diagnosed among these groups due to the persistence of stereotypes rooted in the experiences of slavery, or do they in fact experience distinctive patterns of mental health and illness, perhaps due to the wider fallout of historical enslavem