Choice of health insurance by families of the mentally ill

This paper investigates whether choice of health insurance is influenced by the perceived mental and physical health of family members among a sample of policy-holders with private health insurance. A multinomial probit model of the choice among major medical coverage only, traditional full coverage, and coverage through a health maintenance organization is estimated. Results indicate that the presence of at least one family member who rates his or her general health as poor does not affect the policy-holder's choice of health insurance. However, the presence of at least one family member considered at risk of mental illness does in some instances affect the policy-holder's choice of health insurance: We observe significant effects for policy-holders who are female, black, have some college education, work for a large firm, and live in an urban area. These findings suggest that adverse selection may arise when individuals are able to choose between health insurance policies with different degrees of coverage for mental health care and that such effects are far more pronounced for those people who consider themselves at risk for mental illness than physical illness.     

Narratives of illness and offending: mentally disordered offenders’ views on their offending

Narratives have been used in both the sociology of health and illness and in criminology to examine how groups of people present themselves in moral terms. This article focuses on the narratives of offenders with mental health problems in England subject to section 37/41 of the Mental Health Act 1983 to examine how they justified offending prior to admission. Participants presented illness in a variety of different ways indicating a range of moral positions towards offending. In line with previous research a first group used mental illness to excuse offending and saw themselves as achieving moral reform through treatment. A second group also used illness to excuse offending, but did so inconsistently, seeking to mitigate responsibility whilst distancing themselves from treatment obligations. A third group portrayed themselves as dishonourable both due to their category of offence and the type of illness experienced. A final group rejected both labels of illness and offending, seeking to portray themselves as consistently moral.     

Mapping HIV community viral load: space,power and the government of bodies

HIV plasma viral load testing has become more than just a clinical tool to monitor treatment response at the individual level. Increasingly, individual HIV plasma viral load testing is being reported to public health agencies and is used to inform epidemiological surveillance and monitor the presence of the virus collectively using techniques to measure ‘community viral load’. This article seeks to formulate a critique and propose a novel way of theorizing community viral load. Based on the salient work of Michel Foucault, especially the governmentality literature, this article critically examines the use of community viral load as a new strategy of government. Drawing also on the work of Miller and Rose, this article explores the deployment of ‘community’ through the re-configuration of space, the problematization of viral concentrations in specific micro-locales, and the government (in the Foucauldian sense) of specific bodies which are seen as ‘risky’, dangerous and therefore, in need of attention. It also examines community viral load as a necessary precondition – forming the ‘conditions of possibility’ – for the recent shift to high impact prevention tactics that are being scaled up across North America.     

Treatment,deterrence or labelling: mentally disordered offenders’ perspectives on social control

Mentally disordered offenders are a group of service users who experience substantial amounts of control and supervision. This article uses theories of social control to analyse the way in which mechanisms of control are understood by this group. Semi‐structured interviews with mentally disordered offenders in England who were subject to a restriction order under the Mental Health Act 1983 (as amended by the Mental Health Act 2007) provided the empirical basis for this study. The offenders had a number of perspectives on the restriction order. Firstly, it was seen as a mechanism for identifying those suffering from a mental disorder and for providing appropriate treatment. Secondly, the restriction order was viewed as a form of disciplinary control through which societal norms might be internalised. Thirdly, it was seen as labelling offenders in a manner that was experienced as limiting and oppressive. A number of research participants were aware that the order acted to limit staff actions. These participants saw the order as a means by which they might shape the support that they received in order to further their own aims.A video abstract of this article can be found at: https://www.youtube.com/watch?v=qwIwDI2sOTY&feature=youtu.be     

Preserving rural school health during the COVID-19 pandemic: Indigenous citizen scientist perspectives from a qualitative study

This qualitative study is part of Smart Indigenous Youth, a digital health community trial involving rural schools in Saskatchewan, Canada. Secondary school administrators and educators were engaged as citizen scientists in rural Indigenous communities to understand rapid decision-making processes for preserving school health during the COVID-19 pandemic, and to inform evidence-based safe school policies and practices. After COVID-19 restrictions were implemented, key informant interviews and focus groups were conducted with school administrators and educators, respectively, to understand the impact of school responses and decision-making processes. Two independent reviewers conducted thematic analyses and compared themes to reach consensus on a final shortlist. Four main themes emerged from the administrator interviews, and six main themes were identified from the educator focus group discussions which revealed a pressing need for mental health supports for students and educators. The study findings highlight the challenges faced by schools in rural and remote areas during the COVID-19 pandemic, including school closures, students'' reactions to closures, measures taken by schools to preserve health during the pandemic, and different approaches to implement for future closures. Citizen scientists developed a set of recommendations, including the need for structured communication, reflection meetings, adequate funding, and external monitoring and evaluation to guide evidence-based safe school policies and practices during the pandemic.     

Refining quality of life: validating a multidimensional factor measure in the severe mentally ill

Quality of life measurement has historically been characterized by a focus on physical functionality, great variability in definitions and insufficient attention to psychometric properties of measures. The present study examined four core subscales of the Quality of Life Enjoyment Scale (Q-LES-Q) designed to assess subjective quality of life (i.e. physical health, subjective feelings, leisure activities and social relationships) administered to 151 male and female subjects with severe mental illness admitted to a residential community treatment center or a university psychiatric hospital. The use of factor analysis is a common approach to examining construct validity of instruments through the examination of correlated clusters of item responses. Those sets of highly correlated item responses should identify a construct or dimension of related items (i.e. a factor). Two factor approaches, exploratory (i.e. the maximum number of possible factors is unspecified) and restricted (i.e. the maximum number of factors allowed is specified), were employed to examine construct validity of the four Q-LES-Q subscales. In addition, both orthogonal (i.e. independence between factors is maximized) and oblique (i.e. correlated factors are allowed) rotations (arrangements) of factor structure were also investigated to define subscale validity further. Results supported good construct validity for each subscale with either factor approach, i.e. the four proposed subscales were clearly identifiable in the factors (groupings) of correlated item responses from the sample. In both cases, the orthogonal (independent) rotation produced the simplest structure, i.e. the clearest groupings of items. These results indicate that the Q-LES-Q does appear to measure valid dimensions matching those proposed by the subscales and, thus, may be a useful and reliable tool for clinical applications.     

The micro-fascism of Plato's good citizen: producing (dis)order through the construction of risk

Abstract  The human body has come to be seen as forever susceptible to both external and internal hazards, which in many circumstances require immediate, heroic, and expensive intervention. In response to this, there has been a shift from a treatment-based healthcare model to one of prevention wherein nurses play an integral role by identifying and assessing risks for individuals, communities, and populations. This paper uses Deborah Lupton's outline of the spectrum of risk and applies the theoretical works of Foucault and Plato to demonstrate the means by which nurses maintain social order by identifying and counselling risk takers. It also utilizes the work of Deleuze and Guattari to illustrate how Plato's framework for creating social order through the creation of the good citizen can be viewed as a micro-fascist system, which has been adopted wholeheartedly by preventative health professionals. The goal of this paper is to present an alternate understanding of risk to provide nurses and other healthcare professionals with a non-traditional appreciation of certain aspects of their practice as researchers and clinicians.     

History of arrest, incarceration and victimization in community-based severely mentally ill

This study examined history of arrest and victimization in an urban community sample of severely mentally ill adults. Adults (n = 308) were consented and interviewed in one of four short-term residential treatment facilities in San Francisco. Nearly three quarters (71.4%) had been arrested at some time in their lives, 28.2% of whom had been arrested in the past 6 months. Substance use and homelessness were associated with history of arrest, while gender and ethnicity were not, although African Americans were more likely to have spent longer time in jail or prison. One quarter (25.6%) reported victimization. Being female (OR 2.02, 95% CI 1.2–3.5, p = 0.032) and homeless (OR 2.1, 95% CI 1.2–3.8, p = 0.013) were associated with reporting victimization. Severe mental illness, in particular in combination with substance abuse and homelessness, is associated with higher prevalence of both arrest and victimization history. Healthcare providers should solicit histories to include these events in order to understand and provide optimal care and case management services.Mary Castle White is Professor, Linda Chafetz, Professor, and Gerri Collins-Bride, Clinical Professor, all at the University of California, San Francisco School of Nursing, Department of Community Health Systems; and John Nickens is Clinical Director of the San Francisco Progress Foundation, San Francisco, California, USA.This work was supported by the National Institutes of Health, National Institute for Nursing Research (RO1-NR05350).     

Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push

Background/aim: Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method: Thirty‐eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results: Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ‘bored’ or ‘stale’, organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions: The results supported the development of a ‘push and pull’ conceptualisation of recruitment and retention issues, including job‐related (intrinsic) and non‐job‐related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.     

Case management for the mentally ill: a comparative evaluation of client satisfaction

This paper reports on client satisfaction with community mental health services. A Client Satisfaction Interview was used as one outcome measure in a randomized controlled study of clinical case management vs. standard community care. The Interview had high internal consistency reliability (Cronbach's alpha = 0.89) with very high inter-rater reliability for overall scores (r= 0.99) and good inter-rater reliability for individual items (kappa over 0.9 for 18 of 22 items). Case management clients had significantly higher total satisfaction scores than control group clients who received standard community care at 9 months (t= 2.02 P= 0.05) but not at baseline (t= 0.59, P= 0.55) or 18 months (t= 1.76, P= 0.09). In addition to a quantitative measure of satisfaction, clients were asked to provide more qualitative accounts of their experience with services. The findings are discussed in relation to the team's model of case management and the differences between case management and control services. The limitations of this study are considered in the context of methodological issues surrounding measurement of client satisfaction and the study's own methodological shortcomings.     

突发公共卫生事件中城市居民健康教育需求调查、影响因素及对策研究

目的了解城市居民在SARS突发事件中对健康教育的需求情况及影响因素。方法对北京、太原和哈尔滨市的城市居民进行个人问卷调查。对相关人员进行访谈。结果公众愿意接受的健康教育方式排在前3位的是：电视专家讲座（80．7％）、报纸专栏（57．1％）、广播（31．0％）。人们普遍偏好传统的三大媒体作为健康教育知识的获取渠道;受教育程度、收入与健康教育满意度呈负相关。结论建立并完善突发事件健康教育与健康促进的健康传播模式;专业机构应密切关注受众的信息选择,以需求为导向;加强危机心理支持.     

Gender,citizenship and dementia care: a scoping review of studies to inform policy and future research

Gender is a neglected dimension in public discourse related to people with dementia. Those living with this condition are typically portrayed in policies and strategies in gender neutral terms as ‘people with dementia’ and ‘family carers’ as if gender does not matter, when clearly it does. The purpose of this scoping review was to take stock of knowledge about gender differences in relation to dementia care to inform policy and future research. The work is grounded in a feminist perspective to citizenship, as this provide a lens with which to expose and examine gendered assumptions within dementia studies. A search of four databases, including CINAHL, Web of Science, Medline and Cochrane was conducted using systematic techniques between May and July 2014. A repeat search was conducted in February 2015. We found a significant amount of valuable research concerned with gender differences in relation to dementia care published from 1990 to 2014; the majority of which lacks a feminist citizenship perspective. Moreover, a disproportionate number of studies focused solely on caregivers rather than citizens with dementia. As such, questions about gender equality are not being raised and the voices of men and women with dementia are silent. Thus we argue for increased gender‐sensitivity in policy making and recommend that social scientists inject a feminist citizenship perspective into their work.     

Status of Practice in Mental Health: Assessment and Frames of Reference

Educational orientation and clinical practices for Australian mental health occupational therapists were surveyed to determine theoretical approaches and assessment procedures used. Questionnaires were sent to clinicians and educators to estimate current differences and similarities between educational content and clinical practice. Combined results indicate the need for increased effectiveness in teaching conceptual theories of occupational therapy, more structured classroom and fieldwork learning experiences, and improved instruction in and application of assessments by clinicians.     

Producing (potentially) pregnant teen bodies: biopower and adolescent pregnancy in the USA

Although the rate of adolescent childbearing in the USA continues to decline, and its consequences increasingly found to be equivocal, a persistent discourse of teen pregnancy as pathology structures public health responses. Foucault’s concepts of biopower and governmentality are useful to understand and critically analyze the operation of power in discourses related to adolescent childbearing; specifically, how power over life is simultaneously exercised at the level of the body and the population through self-governance. By conducting a situational analysis using health promotion materials and policy documents from a national, non-governmental teen pregnancy prevention organization, I identify two strategies through which the management of bodies and populations emerges in relation to teen pregnancy: the production of risky bodies and subjectivities and the deployment of a regulatory regime of heterosexuality. While the pregnant teenage subject is produced through public health discourses of normalizing judgment, risk, and deference to experts, the pregnant teen body is regulated through abjection and rites of redemption. At the same time, the expansive scope of the teen pregnancy ‘problem’ requires increasing forms of self-governance and rational behaviors from across diverse populations. This analysis enables us to challenge deeply entrenched assumptions guiding teen pregnancy prevention efforts and explore the possibility that the stigmatization and regulation of young women’s reproduction reinforce and reproduce existing health and social inequalities.     

Families in a state of flux: the experience of grandparents in autism spectrum disorder

Background The experience of being a grandparent of a grandchild with autism spectrum disorder (ASD) is a previously under‐researched area. This study sets out to examine the grandparents’ own perspective in an exploratory way using a qualitative approach to answer the question, ‘What is the experience like?’ Method A qualitative research project, using a purposive sampling technique and semi‐structured interviews to examine the experiences of six grandparents of children with ASD diagnosed by a specialist team in a second opinion Tier 4 Child and Adolescent Mental Health Service. Results The experiences of the grandparents were characterized by three Key Themes which emerged from the interviews: (1) The Parental Bond (protective bonding towards grandchild and adult child); (2) Striving for Answers (searching for meaning); (3) Keeping Intact (holding the family together). Conclusion The study suggests some interesting insights and confirms the need for more attention to this area. A key question raised by the study is how a child‐focused multidisciplinary team can embrace its role in delivering a family‐centred service. The clinical implications of this project have led to a change of practice in the specialist team. Further research would be appropriate to investigate the therapeutic effectiveness and cost effectiveness of involving grandparents as part of the assessment process.     

Living with the mentally ill: Effects on the health and functioning of other household members

Based on data from the National Health Interview Survey Mental Health Supplement, 1989 (NCHS, 1991), this article compares health outcomes for respondents living with someone who is mentally ill (N = 776) with a randomly selected subsample of respondents not living with someone identified as mentally ill (N = 716). When other predictors of health are controlled, sharing a household with a mentally ill person is associated with poorer self-reported physical health, increased risk of reporting some activity limitation, and increased service utilization—both greater risk of hospitalization or visiting a physician, and a greater number of days hospitalized and number of physician visits among those utilizing these services. The severity and duration of mental illness have little effect across health outcome measures. Impaired health and increased utilization of medical care among persons living with someone who is mentally ill suggest hidden costs to individuals, to families of the mentally ill, and to the service system.     

Infant mental health promotion and the discourse of risk

The field of infant mental health promotion has rapidly developed in academia, health policy and practice. Although there are roots in earlier childhood health and welfare movements, recent developments in infant mental health promotion are distinct and different. This article examines the development and practice of infant mental health promotion in South Australia. A regional, intersectoral forum with a focus on families and young children was used as a case study. In‐depth interviews with forum members were analysed using a governmentality lens. Participants identified a range of risks to the healthy development of the infant. The study suggests that the construction of risk acts as a technique of governing, providing the rationale for intervention for the child, the mother and the public's good. It places responsibility on parents to self‐govern. Although the influence of broader social contexts is acknowledged, the problematisation of mothering as risk shifts the focus to individual capacity, rather than encompassing the systems and social conditions that support healthy relationships. This research suggests that the representations of risk are a pervasive and potent influence that can act to undermine health promotion efforts that seek to empower and enable people to have more control over their own health.     

Navigating HIV citizenship: identities,risks and biological citizenship in the treatment as prevention era

The use of HIV Treatment as Prevention (TasP) has radically changed our understandings of HIV risk and revolutionised global HIV prevention policy to focus on the use of pharmaceuticals. Yet, there has been little engagement with the very people expected to comply with a daily pharmaceutical regime. We employ the concept of HIV citizenship to explore responses by people living with HIV in the UK to TasP. We consider how a treatment-based public health strategy has the potential to reshape identities, self-governance and forms of citizenship, domains which play a critical role not only in compliance with new TasP policies, but in how HIV prevention, serodiscordant relationships and (sexual) health are negotiated and enacted. Our findings disrupt the biomedical narrative which claims an end to HIV through scaling up access to treatment. Responses to TasP were framed through shifting negotiations of identity, linked to biomarkers, cure and managing treatment. Toxicity of drugs – and bodies – were seen as something to manage and linked to the shifting possibilities in serodiscordant environments. Finally, a sense of being healthy and responsible, including appropriate use of resources, meant conflicting relationships with if and when to start treatment. Our research highlights how HIV citizenship in the TasP era is negotiated and influenced by intersectional experiences of community, health systems, illness and treatment. Our findings show that the complexities of HIV citizenship and ongoing inequalities, and their biopolitical implications, will intimately shape the implementation and sustainability of TasP.