scholarly journals The lonely legacy: loss and testimonial injustice in the narratives of people diagnosed with personality disorder

2020 ◽  
Vol 24 (4) ◽  
pp. 241-255
Author(s):  
Olivia Sagan
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Personality Disorder ◽  
Mental Health Policy ◽  
Well Being ◽  
Phenomenological Approach ◽  
Complex Nature ◽  
Epistemic Injustice ◽  
Content Type ◽  
Testimonial Injustice

Purpose This study aims to explore the lived experience of loneliness among a group of people diagnosed with the contested diagnosis of borderline personality disorder (BPD). In so doing, it contributes to works offering dimensional conceptualisations of personality disorders and contributes to loneliness study more broadly which has seen a rise in interest since the Covid-19 epidemic and the subsequent enforced isolation and the resultant new phenomenon of sudden loneliness. Design/methodology/approach Participants with diagnoses of BPD were recruited through a combination of calls through online fora and announcements at self-help groups. A total of 25 people made contact, with interviews eventually being carried out with 14 of these. They were invited to take part in unstructured, recorded one-to-one interviews. Thematic analysis was used in this study, which used a narrative phenomenological approach using an Arendtian lens. Findings Through attending to the interwoven themes in the narratives of trauma, loss and loneliness, it emerged that the enduring loneliness experienced was compounded by repeated instances of testimonial injustice. Research limitations/implications This study supports the need for a further deepening of our understanding of the complexity of experience at the interface of loneliness and mental ill health. Practical implications This study critiques the reductive assumptions behind websites, simplistic tool kits and training within the mental health arena dictating “what works” for loneliness. The paper argues for health professionals to develop a more nuanced listening to reported loneliness and that part of what may compound this complex experience among people diagnosed with personality disorder is epistemic injustice, rife within a climate of neoliberalism. Social implications Neoliberalism has been identified as a key driver of distinct shifts in mental health policy and the commodification of mental health. Its fixation with medicalisation and its drive to treat “mental illness” as a problem within the individual positions people as self-contained agents and downplays, or worse, ignores the social, cultural and economic dimensions that contribute to the person’s distress. Neoliberalism’s discourse of “responsibilization” for example, urges individuals that families, communities and workplaces rather than publicly funded services become the main resources to respond to in times of mental distress. This, however, assumes a concreteness to these institutions which may be illusory and leaves those in difficulty dependent on presumed immediate social circles. These circles, however, if they exist, may contain the very people who have failed individuals or subjected them to the testimonial injustices so often cited in the narratives of this research. Originality/value The Arendtian account of loneliness rests on the premise that the human being of contemporary society is afflicted with a sense of isolation and homelessness, further exacerbated in today’s neoliberal context. By drawing on this account, the enmeshed and complex nature of mental illness, loneliness and dislocation from society and the ways in which continued epistemic injustice negatively impact on mental well-being are laid bare. Phenomenology of loneliness goes some way to helping people without the devastating life experiences common to those diagnosed, rightly or not, with a personality disorder gain a sense of the experience, and this research argues for psychological practice to be more mindful of this literature and the value of closely heard first-person narratives.

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.

Mind Matters: a psychoeducation programme for individuals with intellectual disabilities and co-morbid diagnoses of mental disorder

2017 ◽  
Vol 8 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Sarah Ashworth ◽  
Krista Jansen ◽  
Lydia Bullock ◽  
Paul Mooney
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Intellectual Disability ◽  
Personality Disorder ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Intellectual Disabilities ◽  
Psychological Intervention ◽  
Content Type ◽  
Group Members

Purpose The purpose of this paper is to describe a feasibility study into the development and pilot of a psychoeducational group for people with intellectual disability and co-morbid mental disorder (including mental illness and personality disorder) within forensic settings. Design/methodology/approach “Mind Matters”, a psychoeducational programme for people with an intellectual disability and co-morbid mental disorders is a group based programme in a medium secure hospital, adapted and developed to be suitable for people with intellectual disability therapist multidisciplinary approach was key to its development. An open group on a 16-bedded ward for individuals with mild to moderate intellectual disability and co-morbid mental illness was delivered over a six-week period. Findings The group was positively received in pilot by participants and members of the clinical teams. Attendance and engagement of participants were key measures of the success of the programme. In addition to the apparent increased social skills and motivation to engage with future psychological intervention. Practical implications The authors believe that this approach benefitted both the group members and staff on ward, reinforcing strategies for maintaining positive mental health. It also stimulated engagement, discussion about mental disorders including mental illness, personality disorder and intellectual disabilities. Originality/value This paper shows how a psychoeducational approach to mental disorder and mental health in individuals with an intellectual disability is possible, beneficial and well received.

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, autism and the Criminal Procedure (Scotland) Act

2020 ◽  
Vol 14 (5) ◽  
pp. 149-167
Author(s):  
Fionnuala Williams ◽  
Mike Warwick ◽  
Colin McKay ◽  
Callum Macleod ◽  
Moira Connolly
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Personality Disorder ◽  
Learning Disability ◽  
Design Methodology ◽  
Medication Use ◽  
Criminal Procedure ◽  
Content Type ◽  
Scottish Government

Purpose This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA. Design/methodology/approach All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use. Findings Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%). Originality/value The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland.

Evaluation of two community outreach forensic psychological services

2014 ◽  
Vol 16 (4) ◽  
pp. 312-326 ◽  
Author(s):  
Max Ward ◽  
Pamela Attwell
Keyword(s):  
Mental Illness ◽  
Personality Disorder ◽  
Serious Mental Illness ◽  
Rating Scale ◽  
Community Outreach ◽  
Well Being ◽  
Small Sample ◽  
The Body ◽  
Psychological Services ◽  
Content Type

Purpose – The purpose of this paper is to gauge service user’ perspectives on the effectiveness of two community outreach forensic psychological services in London for people with personality disorder and serious mental illness who pose a risk of sexual and violent offending. Both services are guided by principles of the Good Lives Model and circles of support and accountability. Design/methodology/approach – The research design was mixed qualitative and quantitative, incorporating thematic evaluation of semi-structured interviews with service users and a rating-scale constructed specifically for this purpose. Findings – Outcomes suggest both services are broadly successful in achieving their aims to: first, enhance psychological well-being and general quality of life; second, promote links with other agencies and broader social inclusion; and third, monitor and manage risk of re-offending. Research limitations/implications – However, there are limitations. Cause and effect cannot be inferred and outcomes are not generalizable to other contexts partly as a result of the small sample size. Another possible issue is that participants spoke favorably about their care through fear of being evaluated negatively or through fear of compromising the support they receive. To control for these and other possible confounding variables, further more rigorous research is required. Practical implications – The current findings can be used as a guide to help services engage and manage people with personality disorder and serious mental illness who are at risk of further serious offending. Originality/value – It is suggested here that the current findings contribute to the body of evidence supporting initiatives that aim to address recidivism by enabling offenders to develop a more positive identity through social and community inclusion and integration.

Policy challenges

2018 ◽  
pp. 131-140 ◽  
Author(s):  
Felicia A. Huppert ◽  
Kai Ruggeri
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Policy ◽  
Mental Health Policy ◽  
Public Mental Health ◽  
Well Being ◽  
Diverse Populations ◽  
Widespread Agreement ◽  
Uniform Definition ◽  
Mental Well Being

Taking a whole-population perspective, the chapter argues that improved well-being is the most important outcome of policy. Despite growing awareness of its importance, accepting the primacy of well-being has been a challenge within public mental health because there has been no uniform definition or measure, nor consensus on how to apply such a subjective concept across diverse populations. Confusion created by using terms such as happiness, or the continuing tendency to equate mental well-being with lack of mental illness, have created barriers to gaining widespread agreement on the importance of well-being in policy. In this chapter, historical approaches to defining well-being, issues of measurement, and evidence underpinning well-being interventions are explored. The chapter closes with a proposal on how best to consider well-being as an outcome, making use of the evidence in driving public mental health policy.

How employers can better support people with mental health issues

2018 ◽  
Vol 17 (4) ◽  
pp. 204-208
Author(s):  
John Dean
Keyword(s):  
Mental Health ◽  
Negative Impact ◽  
Mental Health Policy ◽  
Well Being ◽  
Research Report ◽  
Health Issues ◽  
Content Type ◽  
Working Environments ◽  
Employee Wellbeing ◽  
Current Trends

Purpose Mental health is a growing concern amongst UK employers, yet eight in ten employers currently have no mental health policy. This paper aims to highlight why employers should implement such a policy and gives advice on implementing an effective well-being policy. Design/methodology/approach Punter Southall Health and Protection recently released “Employee Wellbeing Research 2018”, carried out in association with Reward & Employee Benefits Association. This research report looks at the current trends in workplace well-being. Findings The Employee Wellbeing Research 2018 report revealed that 73 per cent of respondents said high pressure working environments are now the biggest threat to well-being and are worried about the negative impact on their employees. But one striking issue the research revealed is that programmes are not being driven by the Board. Less than one in ten (8 per cent) said that their Board actively drives the organisation’s well-being agenda and one in 20 (5 per cent) reported that their Board has little or no interest in employee well-being. Originality/value This paper is aimed at HR professionals, senior management, CEOs and board members.

scholarly journals Older Adults’ Subjective Well-being Following an Exergame Intervention “Bandit the Dolphin”: Focus Group Findings

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 169-170
Author(s):  
Brittany Drazich ◽  
Breanna Crane ◽  
Kyle Moored ◽  
Karl Shieh ◽  
Janiece Taylor ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Illness ◽  
Focus Groups ◽  
Well Being ◽  
Community Dwelling ◽  
Mental Illness Stigma ◽  
Subjective Well Being ◽  
Future Health ◽  
Adult Participants

Abstract Due to generational mental illness stigma and under diagnosis of mental illness, older adults do not always receive the mental health help that they need. One unique technology that has the potential to improve mood in older adults is exergames, or exercise video games. The objective of this sub-study (main study: Stimulation With Intricate Movements “SWIM” Study) was to explore older adults’ mood following an exergame intervention called “Bandit the Dolphin,” created by the Johns Hopkins KATA Studio. Researchers conducted three focus groups with 14 community-dwelling older adult participants who took part in the SWIM Study exergame intervention. The semi-structured focus groups were transcribed, coded, and analyzed using deductive and inductive techniques described by Ray Maietta’s “sort and sift, think and shift” method. Three themes related to playing “Bandit the Dolphin” and mood emerged. First, participants described their perceived association between activity and mood. Participants felt that both active and passive activities, “Bandit the Dolphin” and otherwise, improved their mood through the “fun” factor, and through feelings of achievement. Second, the participants described that the competition and frustration of playing “Bandit the Dolphin” increased eventual feelings of achievement. Third, participants described how feelings of immersion, or being absorbed in the game, helped them forget their other life concerns. These findings provide a better understanding of older adults’ perceived relationship between an exergame intervention, “Bandit the Dolphin,” and short-term improved mood. Future health and engineering researchers should explore exergames as a potential tool to improve the mental health of older adults.

scholarly journals Mental health policy issues and development in Lithuania

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I R Rubikas
Keyword(s):  
Mental Health ◽  
Alcohol Consumption ◽  
Mental Health Policy ◽  
Well Being ◽  
Health Impact ◽  
Health Policies ◽  
Social And Emotional ◽  
Suicide Rates ◽  
Mental Health Policies ◽  
The Eu

Abstract Background Lithuanian has experienced rapid and relatively successful transition to capitalism and transatlantic-Western values and practices in recent decades. Suicide and legal alcohol consumption rates remain the highest in the EU and OECD, and Lithuania's Positive emotions index score has been consistently amongst the 10 lowest in the world in recent years. Emigration rate is the highest in the EU and OECD, social inequality is amongst the highest in the same groups. Despite a relatively strong economy these changes are not automatically transferred to better social and emotional well-being. Methods This unconventional situation calls for strong and unconventional policy responses in the area of mental health, amongst others. Health impact assessment using theory-based approach and desk research. Results Recent attempts include strategic reorientation towards social and emotional well-being, stronger focus on prevention and promotion and primary care, intensifying efforts to reduce suicide rates, and implementation of strong regulatory measures to reduce alcohol use. Suicide rates have been declining since 2013 but remain high. Effort is made to implement best practices in media reporting, recognition and providing appropriate help for those in suicide crisis, expanding prevention efforts. Conclusions Finally, WHOs “best buys” in alcohol control were implemented since 2017, including steep increases in excise taxes, ban on alcohol advertisement, increase of allowed age, reducing alcohol trading hours and others. This resulted in the steepest decline of legal alcohol consumption in decades. The chosen policy route may be called iterative policy-making, whereby improvements are made along the way, which allows for quicker policy decisions and results. Key messages Mental health policies need to be based on the socio-political context of the specific country. Smaller countries such as Lithuania might benefit form flexible approaches to mental health policies.

scholarly journals Food for thought: the importance of nutritional well-being during COVID-19

2021 ◽  
pp. 1-6
Author(s):  
L. Burke-Furey ◽  
F. McNicholas
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Life Expectancy ◽  
Nutritional Status ◽  
Crucial Role ◽  
Well Being ◽  
Physical And Mental Health ◽  
Balanced Diet ◽  
Current Experience ◽  
Roll Out

Individuals with mental illness have poorer physical health, nutritional status, and lowered life expectancy. Optimising their physical and nutritional status has become an increasingly important therapeutic goal. Current experience with COVID-19 has further emphasised the susceptibility to physical illness and poorer outcomes amongst individuals with mental illness and those who are nutritionally compromised. Although life as we knew it has been suspended until the widespread roll-out of a vaccine, individuals can take immediate action to improve physical and mental health by attending to and optimising their nutritional well-being. Clinicians within mental health services have a crucial role to play in assisting such change, and reminding their patients of the importance of pursuing a healthy and balanced diet.

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