Risk and liminality in mental health social work

From a socio-cultural standpoint, the concept of otherness is central to explaining the way risk is associated with certain social groups rather than others. In the mental health field, writers have frequently employed the concept of otherness to describe the ways in which mental health service users have been perceived, especially since the implementation of community care policies in the UK in the 1990s. Despite its popularity, few empirical studies have explored the concept of otherness and its use in explaining the risks associated with being mentally ill in any depth, and fewer still have done so in relation to professional practice. The present paper draws upon data from semi-structured interviews with 39 mental health social workers in order to explore the relevance of this concept in risk assessment. The paper employs the concept of liminal otherness as an analytic tool to explain how social workers assessed the risk of clients who were 'difficult to place' because of uncertainty about whether their behaviour was the result of their personality or their mental illness. It is concluded that liminality is relevant to understanding the following: the way in which some service users are found 'in-between' places in terms of service provision; the allocation of responsibility for the management of the risks they represent to social work as a liminal profession; and the symbolic importance of 'the street' as a liminal space within which forms of 'racial otherness' have become central to contemporary constructions of community care.     

Salient characteristics of child welfare articles in selected social work journals

The articles in refereed journals comprise a major resource for social workers for improving their practice with children. This study examines the characteristics of four selected social work journals in terms of their child welfare content. The author analyzed journals representing social work education, scholarship, research, and general practice.1 The article identifies and discusses insights about the journals, authors, and content.     

Getting the complete picture: combining parental and child data to identify the barriers to social inclusion for children living in low socio-economic areas

Background Childhood mental health problems are prevalent in Australian children (14–20%). Social exclusion is a risk factor for mental health problems, whereas being socially included can have protective effects. This study aims to identify the barriers to social inclusion for children aged 9–12 years living in low socio‐economic status (SES) areas, using both child‐report and parent‐report interviews. Methods Australian‐born English‐speaking parents and children aged 9–12 years were sampled from a low SES area to participate in semi‐structured interviews. Parents and children were asked questions around three prominent themes of social exclusion; exclusion from school, social activities and social networks. Results Many children experienced social exclusion at school, from social activities or within social networks. Overall, nine key barriers to social inclusion were identified through parent and child interviews, such as inability to attend school camps and participate in school activities, bullying and being left out, time and transport constraints, financial constraints and safety and traffic concerns. Parents and children often identified different barriers. Discussion There are several barriers to social inclusion for children living in low SES communities, many of which can be used to facilitate mental health promotion programmes. Given that parents and children may report different barriers, it is important to seek both perspectives. Conclusion This study strengthens the evidence base for the investments and action required to bring about the conditions for social inclusion for children living in low SES communities.     

Forensic social work in a mental health setting

In forensic social work, a relatively new field of practice, significant contact between social work and the law is prominent. A statewide program of services to forensic psychiatric patients in Maryland demonstrates the principles and issues involved in forensic work and the widespread applicability of social work concerns in the criminal justice and mental health systems.     

The influence of parental education on child mental health in Spain

Purpose

To analyze the association between parental education and offspring’s mental health in a nationally representative Spanish sample, and assess the contribution of other socioeconomic factors to the association.

Methods

We conducted a secondary analysis of data on 4- to 15-year-olds participating in the 2006 Spanish National Health Survey. Mental health was assessed using the parent-reported Strengths & Difficulties Questionnaire. Parents’ respective educational levels were summarized in a single variable. Univariate and multivariate analyses, controlling for family-, child- and parent-related characteristics, were used to study the association.

Results

The final sample comprised 5,635 children. A strong association between parental education and parent-reported child mental health was observed among 4- to 11-year-olds, with odds ratios (ORs) increasing as parental educational level decreased. Where both parents had a sub-university level, maternal education showed a stronger association than did paternal education. Following adjustment for covariates, parental education continued to be the strongest risk factor for parent-reported child mental health problems, OR = 3.7 (95% CI 2.4–5.8) for the lowest educational level, but no association was found among 12- to 15-year-olds. Male sex, immigrant status, activity limitation, parent’s poor mental health, low social support, poor family function, single-parent families, low family income and social class were associated with parent-reported child mental health problems in both age groups.

Conclusions

Our results show that there is a strong association between parental education and parent-reported child mental health, and that this is indeed stronger than that for income and social class. Among adolescents, however, the effect of parental education would appear to be outweighed by other factors.     

Drug courts and mental health courts: implications for social work

In recent years communities across the United States have instituted specialized criminal courts for defendants with substance abuse disorders and mental illness. These specialized courts seek to prevent incarceration and facilitate community-based treatment for offenders, while at the same time protecting public safety. The authors describe two types of specialized courts: drug courts and mental health courts. They critically examine the strengths and weaknesses of these courts and conclude with implications for social work education, practice, research, and advocacy.     

Culturally sensitive social work practice with Arab clients in mental health settings

Several culturally specific practical considerations should inform social work interventions with ethnic Arab peoples in Arab countries or in Western nations. These include taking into account gender relations, individuals' places in their families and communities, patterns of mental health services use, and, for practice in Western nations, the client's level of acculturation. Such aspects provide the basis for specific guidelines in working with ethnic Arab mental health clients. These include an emphasis on short-term, directive treatment; communication patterns that are passive and informal; patients' understanding of external loci of control and their use of ethnospecific idioms of distress; and, where appropriate, the integration of modern and traditional healing systems.     

Maternal custody status and living arrangements of children of women with severe mental illness

The authors report results of a pilot study on the custody status of 20 women with severe mental illnesses who were parents of a total of 76 children. The mothers had some of their children living with them and others dispersed among kinship and nonkinship arrangements. Qualitative findings illustrate how bewildered these women were about the status of children placed outside the home and their ability to obtain custody or maintain contact with their children. The authors suggest that social workers working with women with severe mental illness inquire about and "map" the whereabouts of women's children, help mothers mediate legal and social services delivery systems, and help mothers exercise their rights when there is risk of termination of parental rights.     

Experiences of social work intervention among mothers with perinatal mental health needs

Perinatal mental health difficulties are prevalent among women, and the vulnerability of young infants makes this a time when families experiencing multiple adversities may be particularly likely to attract state intervention. However, very little is known about how mothers experience social work intervention during the perinatal period. This study explored experiences of social work intervention among women with perinatal mental health difficulties. Qualitative semi‐structured interviews were carried out with 18 women with 6‐ to 9‐month‐old babies, who had been treated in England for a perinatal mental health difficulty and also had social services intervention. Interviews were analysed using thematic analysis. Findings suggested that mothers had a predominantly negative view of children's social services, especially when social workers had significant child protection concerns. The fear of being judged an unfit mother and having their babies taken away overshadowed their encounters. Mothers felt that social workers would not accept they could be good mothers in spite of their difficulties and set them up to fail. Some felt that social workers focused exclusively on the risks to the baby and did not acknowledge the mother's own needs or understand perinatal mental health. In some cases, social work intervention was described as intensifying pressure on mothers’ mental health, leading to escalating difficulties and increased likelihood of care proceedings. At the same time, our study also included examples of mothers forming positive relationships with social workers, and of ‘turning points’ where initially negative interactions stabilised and child protection concerns lessened. Women's accounts highlighted the importance of feeling ‘known’ by social workers who understood and respected them. The findings also suggested there may be value in improving collaboration between social workers and mental health professionals to create more space for representation of women's needs as well as those of their babies.     

Vulnerable children in families affected by parental mental illness: The role of theory in programme development

Abstract

People who experience mental illness frequently undertake parenting duties. While this group of parents can parent well, they often experience challenges that are associated with adverse impacts upon their children's mental health. A robust body of evidence does not currently exist to indicate interventions for this group that are most effective in promoting positive outcomes. We argue that, in this context, theory and the use of theoretical models are advantageous for practitioners to increase the effectiveness of interventions. This paper presents an analysis of the explicitly stated theoretical models used to guide published evaluations targeting this vulnerable group of children and young people. Almost half (46%) of the published evaluations examined failed to state explicitly or describe a theoretical underpinning for the intervention programme. Of those programmes that did use theory there was an emphasis on individual-focused theories drawn from psychology, psychiatry and social work rather than mainstream health promotion theories.     

Strategies to destigmatize mental illness in South Africa: Social work perspective

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers’ perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.     

Viewing and engaging in an art therapy exhibit by people living with mental illness: implications for empathy and social change

Objective

To determine how healthcare professionals, family members and community members responded to an art exhibit created by people living with mental illness.

Study design

Phenomenological study with qualitative analysis.

Methods

Forty-six participants with various relationships with people living with mental illness attended an art therapy exhibit and art making workshop. Surveys, response art, reflective writing and discussion groups were used in this qualitative research study.

Results

Responses were categorized into four cluster themes: empathic, self-oriented, other-oriented and world-oriented.

Conclusions

Each response category has strengths and weaknesses, indicating implications for increasing awareness and understanding of the artists and mental illness. They also inform educational interventions that can be utilized when using art exhibits for the purpose of confronting bias and stigma towards people living with mental illness.     

Assessing the social class of children from parental information to study possible social inequalities in health outcomes

PURPOSE: When the subjects are children, the assessment of social class must be made indirectly from parental data. We propose correspondence analysis as a method for combining parental information. METHODS: Four assessment methods were used: father's occupation, mother's occupation, dominant occupation of both, and both combined by means of a correspondence analysis. The results were used to explore social inequalities in dental health. We used data from a survey performed on school children (12- and 15-16-year olds) in the Comunitat Valenciana (Spain). Dental health was measured through prevalence of caries, number of teeth with caries, number of caries in permanent teeth, decayed, missing, and filled teeth score (DMF-T), decayed, missing, and filled surface score (DMF-S), prevalence of DMF>0, community periodontal index of treatment needs (CPITN) and prevalence of CPITN>0. RESULTS: Correspondence analysis methods reflect the impact of social class on health indicators. They were able to assign a social group to all individuals. The association between social class and oral health was found to be sensitive to the method used. CONCLUSIONS: Pooling information from both parents is important. Evidence of social inequalities in oral health may or may not be obtained depending on the method used.