Navigating rocky terrain: a thematic analysis of mental health clinician experiences of family-focused practice

2020 ◽  
Vol 15 (2) ◽  
pp. 71-83
Author(s):  
Genevieve Leenman ◽  
Karen Arblaster
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Thematic Analysis ◽  
Approaches To Learning ◽  
Mental Health Clinicians ◽  
Content Type ◽  
Positive Effects ◽  
Multiple Strategies ◽  
Clinician Experiences ◽  
Family Focused Practice

Purpose Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians’ experiences of FFP and associated workplace factors. Design/methodology/approach In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings A global theme of “navigating rocky terrain” captured clinicians’ experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature.

The impact of inequality on mental illness: thematic analysis on clinical notes

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kristina Brenisin ◽  
Elizabeth Akinwande ◽  
Aile Trumm ◽  
Kieran Breen
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Thematic Analysis ◽  
Well Being ◽  
Qualitative Approach ◽  
Living Environment ◽  
Early Years ◽  
Content Type ◽  
Clinical Notes ◽  
The Impact

Purpose The concept of inequality can be described as not being treated equally to everyone else in society. While previous studies have explored the concept of inequality and its impact on mental illness, these have been primarily quantitative. The details of experiences and potential impacts of inequalities by patients prior to admission into secure care have not been investigated comprehensively using a qualitative approach, which will identify individualised factors that may contribute to the development of mental ill-health. This study aims to explore whether those with multiple disadvantages are at greater risk of developing mental illness. Design/methodology/approach A qualitative study of patients’ clinical notes upon admission to a secure in-patient facility was conducted using a thematic analytical approach to investigate the key inequalities reported by patients with mental health problems. The topic of inequality was examined by assessing the clinical notes of 21 patients who were under treatment at the time of the study. Findings The majority of patients experienced multiple inequalities which impacted negatively on their mental health status. Three main themes that were identified were – a disrupted living environment, disturbed childhood and the importance of support. The thematic analysis has shown that the majority of the patients were exposed to numerous societal disadvantages in association with challenging life events in their early years and these have impacted significantly on their subsequent well-being. Practical implications When assessing the background to mental illness, it is important to gain a deep understanding of many inequalities that patients have faced prior to them developing their condition and, in particular, how these have combined to initiate the clinical manifestation. The study highlights the importance of raising awareness of how being treated unfairly, whether based on protected or non-protected characteristics, can contribute towards people becoming disadvantaged in society and ultimately making them more vulnerable to the development of mental health difficulties. Results of the study may inform the future use of inequalities as an integral component in the development of trauma-informed care. Originality/value This is the first study, to the authors’ knowledge, to consider intersectionality and admission to mental health units by adopting qualitative approach, specifically by reviewing patients’ clinical notes.

Learning disability and the Scottish Mental Health Act

2017 ◽  
Vol 11 (2) ◽  
pp. 74-82
Author(s):  
Heather Welsh ◽  
Gary Morrison
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Learning Disabilities ◽  
Mental Disorder ◽  
Learning Disability ◽  
Psychotic Disorders ◽  
Content Type ◽  
Mental Health Legislation ◽  
Scottish Government ◽  
Health Legislation

Purpose The purpose of this paper is to investigate the use of the Mental Health (Care and Treatment) (Scotland) Act 2003 for people with learning disabilities in Scotland, in the context of the recent commitment by the Scottish Government to review the place of learning disability (LD) within the Act. Design/methodology/approach All current compulsory treatment orders (CTO) including LD as a type of mental disorder were identified and reviewed. Data was collected on duration and type of detention (hospital or community based) for all orders. For those with additional mental illness and/or personality disorder, diagnoses were recorded. For those with LD only, symptoms, severity of LD and treatment were recorded. Findings In total, 11 per cent of CTOs included LD as a type of mental disorder. The majority of these also included mental illness. The duration of detention for people with LD only was almost double that for those without LD. A variety of mental illness diagnoses were represented, psychotic disorders being the most common (54 per cent). Treatment was broad and multidisciplinary. In all, 87 per cent of people with LD only were prescribed psychotropic medication authorised by CTO. Originality/value There has been limited research on the use of mental health legislation for people with learning disabilities. This project aids understanding of current practice and will be of interest to readers both in Scotland and further afield. It will inform the review of LD as a type of mental disorder under Scottish mental health law, including consideration of the need for specific legislation.

Recovery college features and context: advancing a recovery and well-being policy agenda

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Amadene Woolsey ◽  
Gillian Mulvale
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health System ◽  
Mental Health System ◽  
Well Being ◽  
System Reform ◽  
Educational Approach ◽  
Content Type ◽  
Policy Objectives ◽  
Mental Health Association

Purpose Internationally, there has been a move towards more recovery-oriented mental health policies for people living with mental illness, and some countries have included well-being as a population-level objective. In practice, these policy objectives can be difficult to achieve because of deeply rooted policy legacies, including a biomedical approach to care and the stigma associated with mental illness. The purpose of this paper is to investigate how interventions that operate outside the formal mental health system, such as recovery colleges (RCs), may advance these policy objectives more easily than efforts at broader system reform. Design/methodology/approach This study conducted a scoping review to explore the features and context of RCs that make the model an attractive and feasible opportunity to advance a recovery and well-being agenda. Our research is motivated by the initial and growing adoption of RCs by the Canadian Mental Health Association. This paper applies the consolidated framework for implementation research to analyse features of the model and the context of its implementation in Canada. Findings The RC’s educational approach, adaptability, coproduced nature and positioning outside the formal mental health system are key features that facilitate implementation without disrupting deeply entrenched policy legacies. Other facilitators in the Canadian context include the implementing organisation’s independence from government, its federated structure and the model’s alignment with national policy objectives. Originality/value This paper highlights how interventions outside the formal mental healthcare system can promote stated recovery and well-being policy goals.

Resisting stigma and evaluating realism in a direct-to-consumer advertisement for psychiatric drugs

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Tara Walker
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
General Population ◽  
Online Survey ◽  
Bipolar Depression ◽  
Online Advertising ◽  
Sample Population ◽  
Content Type ◽  
Direct To Consumer ◽  
Psychiatric Drugs

Purpose This study aims to examine how experience with mental illness influences perceptions of stigma and realism in a specific direct-to-consumer advertisement (DTCA) for bipolar depression. Design/methodology/approach An online survey had participants watch a 90 s advertisement for a prescription bipolar depression drug and then answer 24 questions about stigma, mental illness experience and the realism of the portrayals in the advertisement. Findings Findings show that people who identify as having experience with mental illness tend to see the ad as more stigmatizing and less realistic. Additionally, people who expressed more stigmatizing beliefs also tended to see more stigma present in the ad. Finally, the study reconfirms conclusions of previous research that people who have experience with mental health conditions possess fewer stigmatizing beliefs overall regarding mental illness. Research limitations/implications The sample population, while diverse in age and somewhat diverse in location, were highly educated, suggesting that they were not representative of the general population. Future studies may want to use more representative samples. A more nuanced approach to understanding experience is needed. While the sample in this study was purposively derived from communities with a higher rate of mental illness, a comprehensive experience scale to measure degrees of experience with mental illness would enhance understanding of this construct. Researchers may also want to look more deeply into the emotional responses of consumers who view these ads. To develop a greater understanding of the trajectory of DTCA, studies of online advertising for psychiatric drugs are needed. Practical implications The results of the study suggest that respondents with experience with mental illness may find ads that sell psychiatric medications unrealistic. This study presents the topic of realism in DTCA as an important construct for determining how consumers may perceive portrayals of disorders. Social implications The fact that people who have experience with mental illness found the Latuda ad to be generally unrealistic suggests that DTCA may be failing to represent mental illness in a way that demonstrates care for patients. Additionally, this research confirms that people who have had exposure to and experience with mental illness tend to hold less stigmatizing beliefs, (Link and Cullen, 1986; Corrigan et al., 2001; Angermeyer et al., 2004) a finding which supports the continuing project of increasing mental health literacy and awareness in the general population. Originality/value This study investigates the reactions of people who identify as having some experience with mental illness to see if they accept the portrayals of mental illness in DTCA or resist them by challenging their realism or identifying stigmatizing elements.

‘It’s Not Really a Part of Standard Practice’: Institutional Silencing of Sexuality Within Australian Mental Health Settings

2021 ◽  
pp. 104973232110613
Author(s):  
Kristi Urry ◽  
Anna Chur-Hansen ◽  
Carole Khaw
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Thematic Analysis ◽  
Professional Education ◽  
Institutional Context ◽  
Social Constructionist ◽  
Mental Health Clinicians ◽  
Making Sense ◽  
Mental Health Settings ◽  
Workplace Cultures

Research seeking to understand and improve sexuality-related practice in mental health settings has paid little attention to the institutional context in which clinicians’ practice is embedded. Through a social constructionist lens, we used thematic analysis to examine how 22 Australian mental health clinicians implicated the wider institutional context when discussing and making sense of sexuality-related silence within their work. Interviews were part of a study exploring participants’ perceptions of sexuality and sexual health in their work more generally. Broader silences that shaped and reinforced participants’ perceptions and practice choices were situated in professional education; workplace cultures; and the tools, procedures and policies that directed clinical practice. We argue that sexuality-related silence in mental health settings is located in the institutional context in which clinicians learn and work, and discuss how orienting to this broader context will benefit research and interventions to improve sexuality-related practice across health settings.

Stigma on mental illness in the Arab world: beyond the socio-cultural barriers

2019 ◽  
Vol 12 (4) ◽  
pp. 285-298 ◽  
Author(s):  
Rita Merhej
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Health Care ◽  
Arab World ◽  
Arab Countries ◽  
Cultural Barriers ◽  
Mental Illness Stigma ◽  
Content Type

Purpose Research on mental illness stigma in the Arab world has traditionally focused on socio-cultural barriers that deprive persons with mental illness from their fundamental human right for privacy and informed consent. The purpose of this paper is to address the question whether or not mental health legislations in a number of Arab countries effectively safeguard the human rights of people with mental illness and protect them from stigmatizing and discriminatory practices. Design/methodology/approach A qualitative review of literature was performed over two rounds of search, targeting published research on mental illness stigma in the Arab world from year 2000 until now and existing national mental health legislations in the Arab world, using English and Arabic databases. Findings The review reveals that beyond society and culture, persistence of mental illness stigma in the Arab world may be explained by absent or inefficient monitoring mechanisms of mental health legislations and policies within the health-care setting. Although integration of mental health services into the primary health care system is being gradually implemented as a step toward de-stigmatization of mental illness, more remains to be done to change the stigmatizing behavior of the health personnel toward mental illness. Originality/value Mental health authorities in the Arab world need to be more aware of the public perceptions explaining people’s fear and reluctance to seek mental health care, so as to ensure that the control and monitoring mechanisms at both the primary and mental health care levels foster a human rights, culturally competent, patient-friendly and non-stigmatizing model of mental health care.

scholarly journals Referring to psychological therapy services in secondary NHS mental health services – how do mental health care professionals decide?

2020 ◽  
Vol 25 (2) ◽  
pp. 185-196
Author(s):  
Lucy Fiddick ◽  
Emily Neale ◽  
Falguni Nathwani ◽  
Kristina Bennert ◽  
James Gregory
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Thematic Analysis ◽  
Secondary Care ◽  
Service User ◽  
Mental Health Problems ◽  
Psychological Therapy ◽  
Content Type ◽  
Psychological Therapies ◽  
Therapy Services

Purpose Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in community mental health teams (CMHTs) can act as gatekeepers for access to psychological therapies for those in secondary care, but little is known about how they make referral decisions. This paper aims to understand how CMHT practitioners make decisions about who to refer or not, to secondary care psychological therapy services (PTS). Design/methodology/approach A total of 11 CMHT practitioners were interviewed to understand the decision making processes underpinning their referrals or otherwise, to a PTS within NHS England. The data were analysed qualitatively using thematic analysis. Findings Thematic analysis resulted in 11 sub-themes under three main themes of the self, the organisation and wider structure and the service user. Results indicated that some participants were referred automatically for psychological therapy if a service user asked or if there was external pressure to refer, while others’ decisions were informed by contextual information such as the service user’s ability to engage or change, risk status and limited organisational resources. Originality/value This study explores the decision making of multi-disciplinary professionals referring to PTS. The findings have important implications for understanding some of the factors that can influence patient access to psychological treatment in secondary care.

Managers’ perceptions of mental illness in Barbadian workplaces: an exploratory study

2017 ◽  
Vol 12 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Dwayne Devonish
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Public Sector ◽  
Small Sample ◽  
Content Type ◽  
Mental Health And Illness ◽  
Health And Illness ◽  
Private And Public ◽  
The Caribbean ◽  
Public Sector Managers

Purpose The purpose of this paper is to examine the perceptions of private and public sector managers in Barbados regarding the concepts of mental health and illness at work. It also explored their interactions and experiences with persons with mental illness at work and various forms of support and resources needed to improve the overall management of these persons within the organisational setting. Design/methodology/approach This qualitative study used an exploratory research design based on two focus groups of private and public sector managers. Findings The findings revealed that both private and public sector managers understood the distinction between the concepts of mental health and mental illness. However, managers believed that high levels of stigma and discrimination exist in both private and public sector workplaces due to a lack of understanding of mental illness, cultural norms, and socialisation in Barbados regarding mental illness and negative stereotypes. However, workplace education and promotion, associated workplace policies, and employee assistance programmes (EAPs) were identified as key strategies for effectively addressing issues of mental health stigma and the management of persons with mental illness at work. Research limitations/implications Due to the qualitative approach used and small sample selected based on non-probability sampling, generalising the findings to larger populations is heavily cautioned. Practical implications Organisations in both private and public sectors should emphasise workplace mental health interventions such as mental health education and awareness, the development and implementation of supportive and flexible policies, and EAPs. These strategies are likely to help destigmatisation efforts and enhance managers’ understanding of mental health and the management of persons with mental illness. Originality/value This study provided a rich and in-depth understanding of mental health and illness from the perspective of private and public sector managers in a small developing country in the Caribbean. The Caribbean region possesses a dearth of empirical research concerning issues of mental health and illness at work.

The development and results of the European Mental Health Integration Index (2014)

2015 ◽  
Vol 14 (4) ◽  
pp. 205-210
Author(s):  
Peter John Huxley
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Best Practice ◽  
Mental Health Problems ◽  
Community Mental Health Services ◽  
Health Problems ◽  
Community Services ◽  
Content Type ◽  
People With Mental Illness ◽  
Mental Health Integration

Purpose – The purpose of this paper is to report on the development and results of the Mental Health Inclusion Index. Design/methodology/approach – Data gathering and interviews with key policy makers in 30 countries in Europe (the EU28 plus Switzerland and Norway). Data gathered enabled the production of an 18 indicator benchmarking index ranking the 30 countries based on their commitment to integrating people with mental illness. Findings – The main findings were: mental illness exacts a substantial human and economic toll on Europe, and there is a substantial treatment gap, especially for people with common mental health problems. Germany’s generous social provision and strong healthcare system put it number one in the Mental Health Integration Index. The UK and Scandinavian states come next. The lowest-scoring countries in the index are from Europe’s south-east, where there is a long history of neglect of mental illness and poorly developed community services. One needs to understand that the leading countries are not the only ones providing examples of best practice in integrating those with mental illness. Employment is the field of greatest concern for people with mental illness, but employment is also the area with the most inconsistent policies across Europe. A distinction can be made between countries whose policies are aspirational and those where implantation is support by substantial and most importantly sustained, resource investment. Europe as a whole is only in the early stages of the journey from institution- to community-based care. Lack of data makes greater understanding of this field difficult, and improvement can only be demonstrated by repeated surveys of this kind, based on more substantial, comprehensive and coherent information. Research limitations/implications – Usual caveats about the use of surveys. Missing data due to non-response and poverty of mental health inclusion data in many European countries. Practical implications – The author reflects on the findings and considers areas for future action. The main implications are: better services result from substantial, but most importantly, sustained investment; and that employment is most important to people with mental health problems, but is one of the most inconsistent policy areas across Europe. Social implications – Supports the need for consistent investment in community mental health services and more consistent employment policies in Europe. Originality/value – This survey is the first of its kind in Europe, and was conducted by the Economist Intelligence Unit in London, and sponsored by Janssen.

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