Recommendations of mental health professionals and the general population on how to treat mental disorders

Objective The objectives of the study are (1) to assess the mental health literacy of mental health professionals, (2) to determine whether there is agreement between different professional groups with respect to different psychopathological conditions and (3) to compare the professionals' knowledge with that of the general population. Methods Two representative samples of mental health professionals and laypersons were presented with a vignette depicting either a person with schizophrenia, major depression or without any psychiatric symptoms (‘non-case’). Out of 18 treatment proposals, the respondents were asked to indicate the proposals regarded as helpful and those considered as being harmful, respectively, for the person depicted. Results Mental health professionals view their profession and less often their treatment methods as helpful. Dealing with the situation alone, electroconvulsive therapy, hypnotics and sedatives are consistently regarded as harmful. For the individual with schizophrenia, mental health professionals agree about helpful treatments. Regarding depression, a lack of consensus is found about treatment proposals such as psychiatric hospitalisation, antidepressants and complementary and alternative medicine. An important part of mental health professionals suggests medical help (psychologists and general practitioners) for the non-case vignette. Fewer nurses, social workers, vocational workers and occupational therapists (‘other therapists’) as compared to psychiatrists and psychologists recommend standard treatment methods. Professionals and the general population significantly differ in their attitudes towards the treatment suggestions, especially regarding medication and alternative medicine. Conclusions To improve the treatment of mental disorders, various strategies must be considered. These include permanent education of all mental health professionals, especially nurses and other therapists. A special focus must be given to affective disorders and a potential (over-) treatment of normal behaviour.     

Assessing morale in community mental health professionals

Background While there is a need to assess morale in community mental health professionals, it still remains to be determined how to obtain and interpret data in a sound and meaningful way. The aims of the present study were to assess the extent to which levels of morale are sensitive to differences between professional groups and health care systems, and identify factors influencing morale across groups and settings. Methods A literature search of electronic databases was undertaken to identify studies measuring morale in different groups of community mental health professionals. Data was subjected to a pooled analysis. Differences between groups and sites were tested using factorial ANOVA and respective effect sizes were estimated based on Cohen’s [1] work. Results Data of four studies and a total of 723 professionals (from Austria, Germany, Italy and United Kingdom) were combined in a pooled analysis. Significant differences of morale levels were found between professional groups and study sites, and differences between professional groups varied significantly by study site. Effect sizes estimated for differences between particular groups of different health care systems ranged from small to large. Age was found to be a factor independently associated with morale. Conclusions Staff in community mental health care show substantial differences in morale levels depending on the professional group and context. These differences can often be identified even if in sample sizes of only 30 participants per group. Levels of morale need to be established specifically for different professional groups and context, and age should be controlled as an influential factor. The findings show a discriminant validity of assessment instruments for staff morale in community mental health care, and underline the rationale for such assessments in research and routine care.     

Morale and job perception of community mental health professionals in Berlin and London

Abstract Introduction Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs. Methods In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories. Results Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both. Conclusions Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.     

The current state of adult mental health care in France

Since the 1960s, French public mental health services are organised in “sectors”, each sector catering for a mean population of 54,000 inhabitants. Although this organisation was aimed at insuring equal access to care whatever the place of residence, there are still huge disparities in number of staff and bed resources from one sector to another. The reduction in the number of hospital beds started later in France than in most other European countries, and was really effective in the 1990s. In 2000, there were 9.4 beds for 10,000 inhabitants aged over 20 years. Hospital-based care has still an overwhelming importance, and is associated with a marked under-development of community services and lack of sheltered housing for the most disabled patients. With more than 13,000 registered psychiatrists in France, the density of psychiatrists is one of the highest in the world. However, French psychiatry has currently to face a structural crisis due to the reduction in public health budgets, as well as to the reduction of 30% in the number of French psychiatrists over the next two decades. The numerous national programmes aimed at renovating French mental health services, published over the last decade, have not yet kept their promises.     

Stigma and mental health professionals: A review of the evidence on an intricate relationship

In the past decade, mental health professionals have initiated a number of national and international efforts against the stigma of mental illness. While largely successful in beating stigma and discrimination, these programmes have, in part, been criticized to be largely uninformed by the lived realities of people with mental illness and their families. Some critics claimed that anti-stigma efforts led by mental health professionals were in fact a concealed attempt at de-stigmatizing psychiatry itself as a profession. This paper will attempt to throw light on the various ways in which mental health professionals are ‘entangled’ in anti-stigma activities. It will outline the complex relationships between stigma and the psychiatric profession, presenting evidence on how its members can simultaneously be stigmatizers, stigma recipients and powerful agents of de-stigmatization. In exploring the role of mental health professionals as targets of stigma, new findings will be presented on the role of stigma as a professional stressor in psychiatry. Conclusions will be drawn on how the pursuit of professional self-interest can be a legitimate goal of anti-stigma programmes. Further, ways in which acknowledging psychiatry's own agenda can contribute to both credibility and success of fighting stigma from within psychiatry will be discussed.     

广东地区精神专科医院从业人员精神疾病相关病耻感水平和影响因素分析

目的探究精神卫生从业人员精神疾病相关病耻感水平及其影响因素,以期为制定减轻病耻感的干预策略提供参考。方法本研究为横断面研究,选取广东地区9家精神专科医院从业人员1 600名为研究对象。采用中文版精神卫生工作人员相关病耻感量表(CASS-C)评估其病耻感水平。采用线性回归方法分析其病耻感水平的影响因素。结果最终纳入研究对象1 453例,CASS-C总评分为(39. 71±12. 04)分,不同受教育程度(F=2. 719,P=0. 02)、职业(F=11. 993,P0. 01)、工作部门(F=17. 868,P0. 01)的精神专科医院从业人员CASS-C评分差异均有统计学意义。线性回归分析显示,在住院部工作、受教育程度为大专、护士职业是相关病耻感的影响因素(β=0. 097、0. 092、-0. 097,P均0. 05)。结论精神专科医院从业人员精神疾病相关病耻感水平较高,不同工作部门、受教育程度以及职业是相关病耻感的影响因素。     

Job satisfaction among mental health professionals in Rome,Italy

Although various surveys on job satisfaction have been performed in mental health care settings, no studies have investigated in-depth the level of satisfaction with the various aspects of work in Italian mental health services. In the present study, all clinical mental health staff working in a large psychiatric catchment area in Rome were invited to anonymously complete a previously validated questionnaire designed to measure job satisfaction among mental health professionals. Of the total 236 health professionals, 196 (83%) agreed to participate. Most participants were not completely satisfied with many aspects of their job, and many were not even moderately satisfied. The level of satisfaction increased with age, and it was significantly lower among hospital-ward staff compared to the staff of outpatient clinics or residential facilities, even after adjusting for age, gender, profession, work setting, and time in current job, using a multiple logistic regression model. Our findings suggest that interventions aimed at increasing job satisfaction among Italian mental health professionals might be warranted, particularly among hospital-ward staff.     

Consultation of mental health professionals by French adolescents with probable psychiatric problems

A national sample of school-attending adolescents aged 12-20 years (n = 8435) filled out an anonymous self-administered questionnaire. We considered a group of 868 adolescents with probable psychiatric problems (PPP) in order to identify personal, psychological and environmental factors as well as help-seeking behaviour associated with consultation of mental health professionals (MHP). Among the adolescents with PPP, 13.7% consulted MHP at least once during the year. Logistic regression analysis showed that consultation with MHP was more frequent for adolescents with multiple problems (OR = 2.3), functional physical disorders (OR = 1.9), family problems (OR = 2), separated parents (OR = 4.4) or multiple contacts with other doctors (GP, school doctor and other specialists, OR = 2.2, 3.6 and 2.6, respectively), and among those who confided in teachers or youth group advisors (OR = 2.2). Those who confided in peers consulted MHP less often (OR = 0.5). However, consultation with MHP was not associated with other sociodemographic or educational characteristics, with type of problem (internalized or externalized), or with confiding in one's parents.     

Determinants of self-reported mental health and utilization of mental health services in Canada

Research evidence suggests that the prevalence of mental health conditions in Canada has increased while a considerable percentage of people with a mental health issue do not seek professional mental health services. Weighted logistic regression models were used to determine whether age, sex, income, and education predict the self-reported mental health status of Canadians and their odds of utilizing mental health services. This study found clear disparities in reporting mental health and utilization of mental health services. Young adults (aged 25 to 44) have 1.4 times (95% CI: 1.3 to 1.6 times) higher odds of reporting poorer mental health status than seniors (aged 65 or older). Females are 2.7 times (95% CI: 2.3 to 3.1 times) more likely to utilize mental services than males. The lowest income group (<$15,000) has 2.2 times (95% CI: 1.9 to 2.4 times) higher odds of rating poorer mental health status than the highest income group (>$80,000). The least educated group (<high school education) has 1.5 times (95% CI: 1.3 to 1.6 times) higher odds of reporting poorer mental health status than the highest educated group (post-secondary education). However, the highest educated group is 1.6 times (95% CI: 1.3 to 2.0 times) more likely to utilize mental health services than the least educated group. Even in a country that has a universal health insurance system such as Canada, disparities and inequities associated with mental health burden and health care utilization persist, specifically among groups with lower education, lower income, and males.     

Social networks and mental health among a farming population

Aims  The study investigated the associations between mental health and measures of community support, social support networks, sense of place, adversity, and perceived problems in a rural Australian population. There was a specific focus on farming communities due to previous qualitative research by the authors indicating distress by farmers in response to drought (Sartore et al. Aust Fam Phys 36(12), 990–993, 2007). Method  A survey was mailed to adults randomly selected from the Australian Electoral Roll and residing within four local government areas (LGAs) of varying remoteness in rural New South Wales (NSW). Survey measures included: support networks and community attachment; recent stressors (including drought-related stress); and measures of health and related functioning. The Kessler-10 provided an index of current psychological distress. Results  The sample (n = 449; response rate 24%) was predominantly female (58.4%) and 18.9% were farmers or farm workers. Moderate to very high psychological distress was reported for 20.7% of the sample. Half (56.1%) of all respondents, and specifically 71.8% of farmers or farm workers, reported high levels of perceived stress due to drought. Psychological distress was associated with recent adverse life events, increased alcohol use and functional impairment. Hierarchical regression analysis demonstrated an independent effect of the number of stressful life events including drought related stress, perceived social support (community and individual), alcohol use and physical functioning ability on levels of psychological distress. This model accounted for 43% of the variance in current levels of distress. Lower community support had a more marked impact on distress levels for non-farming than farming participants. Conclusions  This study has highlighted the association between unique rural community characteristics and rural stressors (such as drought) and measures of mental health, suggesting the important mediating role of social factors and community characteristics. The results illustrate the importance of addressing subgroup differences in the role of social capital in mental health.     

Person-centered versus disease-centered narratives among mental health providers in Kuwait: A critical and qualitative analysis of iatrogenesis and .global medical discourse in action

This article uses bioethical and cross-cultural lenses to examine the narratives of 11 mental health professionals (psychiatrists, psychologists, and counselors) regarding their perceptions of, and experiences in providing mental health services in Kuwait. Given that there is no legal ethical body governing mental health service delivery in Kuwait, and that there have been recent reports of negative personal experiences with mental health professionals, this study sought to understand the types of narratives and treatment approaches that may contribute to inadequate service delivery. This study drew on interpretive phenomenological analysis (IPA) and critical discourse analysis in its analysis. The analyses indicated that ideology (either patient-centered or disease-centered) can be shaped by educational background and professional experiences, which can, in turn, shape how mental health professionals deliver mental health services to the Kuwaiti community. Findings also indicate that mainstream western medical discourses are actively transforming the landscape of mental health care in Kuwait; while this western transformation is welcomed (and even imposed) by some clinicians, it is critiqued by others who feel that: a) indigenous forms of healing are beginning to wane; and b) local clinicians can be pressured to assimilate to North American standards of mental health care. Research limitations and directions for clinical education and practice are also discussed.     

Attitudes of health care professionals towards care of the elderly

The effect of a short psychogeriatrics training course for primary health care physicians, nurses and social workers on their attitudes towards care of the elderly was explored using the Snape Attitude Scale before and after the training. Participants' attitudes were not altered significantly. The most positive attitudes were found in a reference group formed by nurses specializing in psychiatry. The groups regarded physicians as having the least interest in geriatric care while social workers were felt to have the greatest willingness to care for the elderly.     

The impact of mental health literacy,stigma, and social support on attitudes toward mental health help-seeking

Guided by the theory of reasoned action, this study built a model to examine the ways in which mental health literacy (MHL), personal stigma, self-stigma, and social support collectively influence attitudes toward mental health help-seeking. A sample of 211 participants (age range 22–64; 67.62% females) from a cross-sectional survey that examined MHL of local public housing staffs in Texas were included in a structural equation modeling analysis. MHL directly influenced attitudes. Personal and self-stigma did not mediate the relationship between MHL and attitudes. Yet, self-stigma was significantly associated with attitudes. Social support positively predicted attitudes. Findings suggest the need for improving MHL and strengthening social support to promote positive attitudes toward mental health help-seeking. Mental health education to those who are at risk for mental illness and to families who are likely to influence help-seeking attitudes of those with mental illness could be useful.     

Reflections on the use of mental health resilience concepts in migration and global mental health

Abstract

With the concept of resilience increasingly deployed across a range of issues in development studies—from conflict resilience to climate resilience—this paper considers the relevance of resilience concepts to current issues and concerns in global mental health. Resilience discourses can be seen as one response to the need for more holistic accounts of mental health that focus, not only on stressors and risk factors for mental ill health, but also recognize the sometimes overlooked capacities of people and communities to manage and coproduce their own mental wellbeing. For example, migration forms the backdrop to global mental health for a significant proportion of the world’s populace. And yet, thus far, most literature on migrant mental health has tended to focus on risk factors and stressors with comparatively little consideration given to potential sources or resources for positive mental health and coping with adversity. Nevertheless, while concepts of “resilience” are increasingly advocated in development studies and global mental health contexts, such concepts also have their critics. For example, resilience rhetorics can “depoliticize” by appearing to normalize otherwise unacceptable circumstances which might—from post-development and other alternative critical perspectives—be viewed as politically constituted through-and-through.     

Teachers' role breadth and perceived efficacy in supporting student mental health

Teachers are considered well placed to identify issues concerning students' mental health and well-being and can play a critical role in the helping process for their concerns. However, little is known about the views of teachers regarding their role in supporting student mental health and how well-equipped they feel to fulfil it. The aim of this study was to investigate teachers' perceived role breadth and perceived self-efficacy in supporting students' mental health. Interviews were conducted with 21 teachers from Canberra, Australia. Teachers viewed supporting student mental health as part of their role, though perceived a lack of knowledge and skills in mental health-related areas. They clearly emphasized the need to work within a well-coordinated pastoral care system. Additional training in mental health and clear role delineation within the school may assist teachers to feel better prepared to effectively and appropriately support student mental health.