When Non-Compliance Carries the Day: Evaluating the Effectiveness of an Employment Program for the Severely Mentally Ill

Background: Mental disease is increasing worldwide and people who suffer from it show lower employment rates and lower earnings. Various approaches have been tried to increase the employment rate of people with mental disease. In the US, empirical studies show that individual placement and support(IPS)—a rapid transition to the job market, with some external assistance—is effective in increasing the employment rate of the mentally ill. Europe lacks such evidence. Purpose: The study assesses the impact of an IPS-like program undertaken in Italy on the employment rate of people with severe mental illness. Methods: The analysis is based on a RCT that tests whether offering people with severe mental illness the support of a “job coach” increases their chances of being employed. Moreover, using a battery of tests—one of which is made available by the RCT itself—we show that the large non-compliance with the protocol showed by the RCT is ignorable. This motivates estimating the impact of carrying out a traineeship during the experimental period on employment using non-experimental methods. Results and Conclusions: The study finds that the availability of a coach boosts the patients’ chances of finding a traineeship during the experimental period; moreover, undertaking a traineeship almost doubles the likelihood of being at work one year later. JEL CODES: J78, J48, J38

Using a Transdiagnostic Perspective to Disrupt White Supremacist Applications of the DSM

White supremacist applications of the Diagnostic and Statistical Manual of Mental Disorders (DSM) result in the disproportionate labeling of Black, Indigenous, and People of Color as violent or severely mentally ill. Racial diagnostic disparities and misdiagnoses are endemic in social work practice, in part because of the DSM’s categorical classification system, which encourages reductive thinking and reinforces implicit racial biases. While courses on psychopathology are common requirements for clinical field placements, the mental health field’s reliance on the DSM often contradicts antiracist curricula. In an effort to address this paradox, we utilize pedagogical approaches that seek to critique and deconstruct White Supremacist applications of the DSM while simultaneously preparing students to enter a field that relies so heavily on diagnostic labels. This is done in part by teaching students to shirk the DSM’s categorical perspective in favor of a transdiagnostic perspective—identifying symptoms or traits underlying human suffering that occur across diagnostic categories and are informed by macro systems of privilege and oppression. Teaching students to adopt a transdiagnostic perspective may disrupt White Supremacist practices in diagnostics by encouraging an acknowledgement of multisystem factors underlying human suffering without relying on discrete diagnostic categories that are prone to racial interpretations.

Experiences of Family Burden in Caring for the Severely Mentally Ill in a Foreign Land: A Qualitative Study of Chinese Immigrant Families in Toronto, Canada

There is a relative dearth of qualitative studies on the actual experiences of families caring for members suffering from serious mental illness, and even less is known about disadvantaged ethnic minority immigrant families. This explorative qualitative study examines the burden experienced by 15 family members of Chinese immigrant background in Toronto, Canada. Six common themes emerged from the study: 1) significant worries about not being able to take care of ill members in the future; 2) on-going strain and changed family life; 3) pervasive social stigma, discrimination and lack of resources; 4) general appreciation of Canadian health and welfare systems and opportunities; 5) cultural factors and beliefs uniquely shape families’ support and caring commitment; and 6) families find various ways to cope and help themselves. Opportunities for improved care delivery based on these understandings are discussed.

The Association between Patient Activation and Outcomes among Severely Mentally Ill Patients

Little is known about the association between patient activation, health, service utilization, and cost among mental health (MH) patients. Patients aged 18 to 64 with schizophrenia (Sz, n = 43), bipolar disorder (BD, n = 59), or major depressive disorder (MDD, n = 34) completed the Patient Activation Measure for Mental Health (PAM-MH), the Colorado Symptom Index, demographic, socioeconomic, treatment, and social support questionnaire items. Average PAM-MH score indicated BD patients the most activated (66.6 ± 17.5), Sz (57.4 ± 10.4) less activated, and MDD the least activated (55.4 ± 14.6). The MDD cohort had the highest ($27,616 ± 26,229) and the BD had the lowest total annual healthcare cost ($18,312 ± 25,091). PAM-MH score was inversely correlated with healthcare costs and regression analysis showed a PAM-MH score × gender interaction. The strongest negative relationship between PAM and cost was for males. These analyses support the inverse association between PAM-MH and healthcare service utilization and cost.

Analisis Pelayanan Home Visite Orang Dengan Gangguan Jiwa Di RSJ Kalawa Atei Provinsi Kalimantan Tengah

This study aims to analyze the home visite services of people with mental disorders in Kalawa Atei General Hospital in Central Kalimantan Province. Given the implementation of the program for people with mental disorders to access health services whose handling is different from other health services. This study uses a qualitative approach that aims to describe the complexity and dynamics of handling people with mental disorders. The primary data in this study were sourced from several informants, namely Home Visite Officers from Kalawa Atei General Hospital, Social Service and Povinsi / Regency Health Service, local Puskesmas, and Family of Ganguan Mental Panderita. Meanwhile, Secondary Sources in this study include the Implementation of Home Visite Regulation, Home Visite Service Profile, Home Visite Patient Ratio and other related documents. The results of the study show the conclusions of the study that the implementation of home visite services organized by the Central Kalimantan Atei Central Hospital along with other cross sectors has been running quite well. This is seen in terms of the facilities and infrastructure that have been provided in providing home visite services for ODGJs that have been prepared and are maximally sought. Home visite services are in accordance with SOPs, competencies and disciplines of each service officer. Home visite services provide guarantees to each patient with a special schedule by officers to come to the regions to provide these services. In this case, home visite services in terms of empathy by service personnel are good enough. Considering that home viste activities are shown to severely mentally ill patients, who cannot access Kalawa Atei General Hospital for various reasons, such as financial incapacity, no family support, family ignorance, and the existence of savings. However, there are several inhibiting factors in the implementation of the Home Visite Service at Atawa Kalawa Hospital, namely: 1) equipment completeness, 2) field conditions, 3) communication.