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1 – 10 of over 20000In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for…
Abstract
Purpose
In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.
Approach
I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.
Research implications
Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.
Social implications
Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.
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Niki Kyriakidou and Sofia Triliva
The purpose of this paper is to focus on how mental health professionals involved in the therapeutic treatment of children in public mental health facilities in Greece experience…
Abstract
Purpose
The purpose of this paper is to focus on how mental health professionals involved in the therapeutic treatment of children in public mental health facilities in Greece experience and talk about the impact of the socioeconomic crises on the psychotherapeutic process.
Design/methodology/approach
In all, 21 semi-structured interviews were conducted and phenomenologically informed thematic analysis was used in analysing the data.
Findings
The results coalesced into two all-encompassing thematic structures articulating the following: first, the socioeconomic crises have permeated society and therapeutic praxis like a torrential and chronic rain storm. This has resulted in a deluge in demand for therapeutic services within the public mental health sector; second, mental health professionals describe their positioning and work as “a constant tug-of-war” where they are inundated and often overwhelmed with work, find themselves identifying with service users and taking on several roles simultaneously, and being challenged to find solutions often in dire and complex situations. They describe how creativity and flexibility are in demand in their day-to-day interactions and if they are to intervene in place of a health and welfare system that is faltering. Doing therapeutic work under such circumstances appears to be both emotionally onerous and stimulating with regard to conceptualising new ways of intervening in such complex psychosocial situations.
Research limitations/implications
The study is limited in that only mental health professionals presented their experiences and service users were not included. The findings do highlight how severe austerity policies impact mental health services and peoples’ lives.
Practical implications
The study has implications for policy regarding the provision and organisation of mental health services in contexts where crises and economic turmoil prevail.
Social implications
The results associate severe austerity with major changes in family and community life.
Originality/value
The paper provides insights and implications on how mental health services are impacted by socioeconomic conditions.
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Catherine Cosgrave, Myfanwy Maple and Rafat Hussain
Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff…
Abstract
Purpose
Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff turnover of this workforce has been limited. The purpose of this paper is to identify work factors negatively affecting the job satisfaction of early career health professionals working in rural Australia’s public sector CMH services.
Design/methodology/approach
In total, 25 health professionals working in rural and remote CMH services in New South Wales (NSW), Australia, for NSW Health participated in in-depth, semi-structured interviews.
Findings
The study identified five work-related challenges negatively affecting job satisfaction: developing a profession-specific identity; providing quality multidisciplinary care; working in a resource-constrained service environment; working with a demanding client group; and managing personal and professional boundaries.
Practical implications
These findings highlight the need to provide time-critical supports to address the challenges facing rural-based CMH professionals in their early career years in order to maximise job satisfaction and reduce avoidable turnover.
Originality/value
Overall, the study found that the factors negatively affecting the job satisfaction of early career rural-based CMH professionals affects all professionals working in rural CMH, and these negative effects increase with service remoteness. For those in early career, having to simultaneously deal with significant rural health and sector-specific constraints and professional challenges has a negative multiplier effect on their job satisfaction. It is this phenomenon that likely explains the high levels of job dissatisfaction and turnover found among Australia’s rural-based early career CMH professionals. By understanding these multiple and simultaneous pressures on rural-based early career CMH professionals, public health services and governments involved in addressing rural mental health workforce issues will be better able to identify and implement time-critical supports for this cohort of workers. These findings and proposed strategies potentially have relevance beyond Australia’s rural CMH workforce to Australia’s broader early career nursing and allied health rural workforce as well as internationally for other countries that have a similar physical geography and health system.
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Public consultation and engagement in public services has become increasingly important to UK governments. This has taken on greater significance for the Labour government as it…
Abstract
Public consultation and engagement in public services has become increasingly important to UK governments. This has taken on greater significance for the Labour government as it releases increased funding into the public services. This paper provides a case study in stakeholder involvement in the development of the vision, values and goals of a new National Health Service Mental Health Trust. It does so within the context of the relationship model of public relations and the deontological ethical tradition. The case demonstrates how active stakeholder involvement can help formulate an effective mission and organisational structure which determine management priorities and organisational behaviour. It argues that the ethical motivation for such involvement is driven by a strong sense of duty and community rather than organisational advantage.
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Marta Ortega Vega, Chris Attoe, Hannah Iannelli, Aleks Saunders and Sean Cross
Public mental health training can effectively support well-being at a population level. The application of this type of training is increasingly prevalent, however, training…
Abstract
Purpose
Public mental health training can effectively support well-being at a population level. The application of this type of training is increasingly prevalent, however, training evaluation is currently limited and inconsistent. This paper aims to summarise the characteristics of public mental health training available in England, presents key quality criteria for this training and identifies gaps in training provision.
Design/methodology/approach
This paper uses a pragmatic mixed-methods approach including database and Google Searches, focus groups and survey methods. The data analysis included a structured data extraction template for the training availability scoping and thematic analysis of the survey and focus groups.
Findings
This paper identifies a total of 74 training courses targeting workplace employees, young people and the general population. Most courses were delivered face-to-face (54), followed by e-learning (16) and blended modalities (4). This paper derives four core quality principles, focussing on the training approach, key features of training, trainer attributes and evaluation. There were no significant gaps in training provision, although areas for future development included consistency in public mental health terminology, systems and populations requiring additional training and the logistics of training delivery, etc.
Originality/value
The results contribute to the evidence base of interventions that are currently available, supporting the efforts to evaluate the impact of training provision in this area. This paper provides a novel approach to assessing training quality and discuss areas for development and innovation in this field.
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Christian Guest and Tom A.C Chrisp
The purpose of this paper is to describe the delivery of a mainstreaming model within a public sector, mental health (National Health Service (NHS)) organisation. The model…
Abstract
Purpose
The purpose of this paper is to describe the delivery of a mainstreaming model within a public sector, mental health (National Health Service (NHS)) organisation. The model promotes the inclusivity of a spectrum of presentations from co-existing moderate anxiety and depression to severe mental disorder (psychosis) and problematic substance and alcohol use.
Design/methodology/approach
This paper introduces the delivery of three collective approaches, termed the “three essential elements” to support a mainstreaming treatment model, facilitated by a “Dual Diagnosis Lead”. The model encompasses; a “direct access” referral pathway, joint collaboration with practitioners and the delivery of a “Dual Diagnosis” training programme. An independent evaluation was commissioned to explore eight mental health and substance misuse practitioners’ views and experiences in relation to the impact of the mainstreaming model. This paper also considers feedback from 230 course participants attending a one day “Dual Diagnosis” training programme.
Findings
This paper suggests that practitioners may benefit from the implementation of the mainstreaming approach and the delivery of this approach could be moving “Dual Diagnosis” interventions closer to mainstream practice.
Research limitations/implications
The limitations of the mainstreaming model are acknowledged in relation to the generalisation of practitioners’ views and reported experiences.
Originality/value
This paper offers a description of the delivery of a mainstreaming model involving the “three essential elements”. The model provides a useful insight and demonstrates the possibilities which may be achieved when attempting to implement a mainstreaming treatment approach within mainstream mental health and drug and alcohol services.
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Chronic illnesses require long term, ongoing medical care as well as the provision of a variety of social support services. These diverse systems of care need to be integrated…
Abstract
Chronic illnesses require long term, ongoing medical care as well as the provision of a variety of social support services. These diverse systems of care need to be integrated. However, under managed care, health care systems adhere to a disease model where emphasis is placed upon cure rather than care. While managed care can increase system coordination, the logic of cost containment favors acute services over the long term supportive services needed by chronic care clients. In this paper I describe efforts in one community which has received funding to integrate services for individuals with chronic mental illness as well as a planning grant to integrate multiple chronic care systems (HIV, mental health, and substance abuse) for minority clients. I describe various models of system integration and how diverse systems can be coordinated. In the conclusion I examine the barriers to system integration and argue that sociologists need to play a stronger role in understanding systems of care.
Margaret Tobin, Luxin Chen, Julie L. Edwards and Stella Chan
An urban mental health service undertook a quality improvement programme to involve staff in the identification and resolution of cross‐cultural issues. The programme involved…
Abstract
An urban mental health service undertook a quality improvement programme to involve staff in the identification and resolution of cross‐cultural issues. The programme involved clinical file audits, staff survey and workshops, and a focus group for consumers and their carers. It was found that non‐English speaking patients received a different spectrum of services from English speaking patients. Non‐English speaking patients were found to receive more pharmacological treatments and less cognitive behavioural therapy. In seeking to address these issues and improve their service delivery to all patients, the mental health service is now in the process of developing cross‐cultural training; revising policies and procedures; and engaging bilingual mental health counsellors in a revision of their roles, particularly to increase their availability to staff as cultural consultants.
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Geoff Dickens, Philip Sugarman, Marco Picchioni and Clive Long
In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness…
Abstract
In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness and men with learning disability in a secure care pathway. Total and individual HoNOS‐secure item ratings made by multi‐disciplinary teams across the course of a period of admission (mean 15 months) for 180 men were examined. There was significant positive change on the clinical and risk‐related scales of HoNOS‐secure for patients in the learning disability care pathway (N = 48) between initial and final ratings. In the mental health care pathway (N = 132 patients) an apparent lack of change masked a more complex picture, where initial decline in HoNOS‐secure ratings was succeeded by significant improvement. Results suggest that it is challenging to measure clinical and risk‐related medium‐term clinical outcomes objectively for these patients, particularly in relation to core issues of treatment of mental disorder, and reduction of both problem behaviour and risk to others. However, it is important that practitioners continue to strive to demonstrate the benefits of care and treatment through appropriate outcomes measures.
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