The denial of adolescence for people with mental handicaps: AN UNWITTING CONSPIRACY?

This article addresses the issues concerning the experience of adolescence for young people with mental handicaps. A developmental model is presented, which states that various tasks need to be accomplished if they are to attain adult status. Evidence is put forward which suggests that, for the great majority of adolescents with mental handicaps, these tasks are never accomplished. It is hypothesised that there is an unwitting conspiracy on the part of carers, both parents and professionals, to thwart the accomplishment of these tasks: unwitting in as much as there is no conscious conspiracy, but a communication through postures, attitudes, and styles of interaction. It is suggested that reform of service provision is the first step towards a more developmentally appropriate adolescence for people with mental handicaps and greater opportunities for the attainment of adult status.     

Daily living: Does this matter for people with mental illness?

Structuring their daily life is an important problem for many individuals with chronic mental disorder. Therefore day structuring services are considered as constituent parts of modern mental healthcare systems. In this paper the theoretical and empirical basis for the implementation and evaluation of day structuring services will be discussed from a social science perspective. Recent work in the field of cultural sociology shows that the social framework of everyday behaviour in modern societies provides a great variety of opportunities to create and practice individual lifestyles. The potential to take advantage of these opportunities is related to individual competencies and resources. The few existing qualitative studies on the everyday behaviour of individuals with chronic mental disorders in the community reveal that increased freedom of choice is often combined with an objective or subjective lack of resources and competencies to make use of this variety of opportunities. Therefore, beyond providing a structure for daily life, day structuring services should help empower individuals with chronic mental disorder to make their choices among behavioural alternatives bearing in mind both illness-related limitations and their strengths and resources.     

Is antipsychotic medication stigmatizing for people with mental illness?

Antipsychotic medications are clearly identified as important in the treatment of individuals with schizophrenia and with bipolar disorder. However, negative societal reaction related to having a serious mental illness and the socially undesirable side effects associated with antipsychotic medication treatment may combine to worsen stigma associated with treatment for mental illness. Specific stigmatizing effects of antipsychotic therapy may be difficult to evaluate independently from factors such as symptoms, insight into illness and side effects. Attitudes towards antipsychotic medication may be positive in individuals who recognize therapeutic drug effects, however other individuals may view medications negatively due to a sense of stigma. Stigma among individuals with bipolar disorder in relation to treatment with antipsychotic medication has not been well addressed in the literature. An additional concern among individuals with bipolar disorder who receive antipsychotic medications may be the notion that antipsychotics are 'schizophrenia drugs', and thus an inappropriate treatment for their condition. Antipsychotic medications can be stigmatizing for patients with serious mental illness, however the roots of stigma are extensive, and efforts to minimize stigma can only be successful when addressed by the individual with illness, their families and loved ones, treatment providers and society at large.     

E-mail: a new technique for forming a therapeutic alliance with high-risk young people failing to engage with mental health services? A case study

This article describes e-mail therapy with a teenager whom professionals found difficult to communicate with and understand. Anne had a 4-year history of low mood and unpredictable self-harming behaviour that in the past had led to admission to a secure unit. Therapy involved weekly e-mails over a 3-month period and ended when she was transferred to adult services. The article focuses on how e-mail enabled engagement to occur. The therapeutic relationship allowed Anne to explore and understand past experiences, and start resolving present problems. Diagnosis also became clearer.     

Where do people with mental disorders are looking for help?

This article presents and discusses the concept of "pathway to psychiatric care". According to literature review, only few people, who meet criteria for mental disorders, reach psychiatrists. Therefore it is important to identify institutions where people with mental disorders look for help. On the basis of World Health Organization programme "Pathway study" authors present institutions in different countries all over the world, which are involved in helping people with mental disorders. In all European centers taken part in the "Pathway study" most of the people who reached psychiatrists had been consulted in primary healthcare first. Project "Pathway study" has been the first research programme related with this topic. It has initiated similar studies in different centers all over the world. Results of those studies show, where outside psychiatric institutions, it is possible to diagnose and treat mentally ill people.     

Improved investment in mental health services: value for money?

BACKGROUND: This paper examines what has been achieved in the specialist mental health services by the vastly increased health expenditures that the National Health Service (NHS) has enjoyed in the past 5 years. AIMS: To describe the way money has been spent in specialist mental health services and examine why problems remain after such admirable changes to already available resources. METHOD: Changes in staff employed by mental health services, where the extra staff are deployed, and patterns of expenditure within the whole service and within community mental health teams are examined. RESULTS: Some of the new expenditure has been well spent, and has produced improvements in the service. However, one must also take account of the costs of the greatly increased numbers of managers, who impose two sorts of costs: that of their own salaries, and the opportunity costs of front-line staff having to attend meetings and write reports rather than seeing patients. Throughout the rest of the NHS, money has been wasted on needless reorganisations, on consultant and general practitioner contracts, and on information technology that has so far failed to deliver tangible advantages. CONCLUSIONS: The emphasis on central control undermines local initiatives and wastes resources. Some central control is inevitable, but policies need to be developed in collaboration with clinicians. At local level, expenditure by primary care trusts and mental health trusts also needs to be scrutinised by committees that should include representatives of front-line mental health staff.     

Best practices: recovery centers for people with a mental illness: an emerging best practice?

The authors report a process evaluation that used rigorous qualitative methods consistent with best practice to assess the development and impact of a nascent recovery center in the New York City area. The center successfully delivered services that focused on helping increasing numbers of consumers achieve educational and functional improvements. Consumers perceived the center as providing a strong sense of community while also serving as a "stepping stone" to wider opportunities. Because they offer a feasible and popular means to help individuals with mental illness acquire skills, recovery centers may be an emerging best practice. Further research is necessary to test their efficacy.     

What do children and young people want from mental health services?

PURPOSE OF REVIEW: The purpose of this paper is to review the literature reporting on children and young people's views on child and adolescent mental health services. RECENT FINDINGS: The review demonstrates that there is limited research exploring the views of children and young people regarding mental health services. Despite its limitations, the research available shows that young people, their parents and healthcare providers often have different expectations of services. Young people want accessible services staffed by those they are able to trust and who demonstrate an ability to listen; above all, young people want to be involved in the decisions made about them. SUMMARY: To date, children and young people have not been actively engaged or involved in service development. This is an evolving field and we need to ensure that existing evidence is taken into account as well as investigating further the views of young people. Child and adolescent mental health services need to consider how we serve young people, particularly children, whose perspectives may differ from those of their parents.     

Debate: Child and adolescent mental health services in Pakistan; Do we need in-patient mental health facilities for children and young people?

Depression and anxiety are leading causes of morbidity in children and adolescents worldwide. In Pakistan, young people are exposed to many chronic adversities including violence, social and economic inequalities, and are at greater risk of developing mental health problems. Yet there is a lack of trained human resources, in-patient child and adolescent mental healthcare facilities, and training opportunities in child and adolescent psychiatry and mental health in Pakistan. Given the poor economic condition of the country, which has been made even worse by the COVID-19 pandemic, it is very unlikely that dedicated resources will be made available in near future to develop specialist child and adolescent mental health services in Pakistan. To bridge this treatment gap, we propose a multitiered, transdiagnostic, task-shifting strategy-based model for child and adolescent mental health services in Pakistan.     

Does the HoNOS 65+ meet the criteria for a clinical outcome indicator for mental health services for older people?

BACKGROUND: A clinical indicator should demonstrate clinically meaningful change, be relevant, allow comparisons between services, be acceptable to clinicians, and have acceptable validity, reliability and sensitivity to change. The HoNOS 65+ has been suggested as a clinical outcome indicator. The sensitivity to change of the HoNOS 65+ is not known. METHODS: This is a prospective study using routine clinical data. A pilot cohort (n = 42) was used to measure the concurrent validity of the HoNOS 65+ with the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and Brief Agitation Rating Scale (BARS). The main cohort of 245 consecutive referrals to a community mental health service for older adults was used to assess sensitivity to change against the CIBIC+. RESULTS: The HoNOS 65+ was acceptable to case managers, most HoNOS 65+ items had excellent interrater reliability and the HoNOS 65+ had good concurrent validity. Changes in the HoNOS 65+ scores between assessment and discharge had a moderate, but significant correlation with CIBIC+ scores. CONCLUSION: The HoNOS 65+ meets the criteria for a clinical outcome indicator for community mental health services for older people. The HoNOS 65+ is sensitive to change.     

Domiciliary and day care services: Why do people with dementia refuse?

Objective: To explore the reasons given for refusal of day services, and to examine the relationship between willingness to accept day services and clinical variables.

Method: Fifty people with dementia who lived alone and had refused day services were interviewed.

Results: The most common reasons for reluctance to attend day services were the belief that they did not need day services, that they liked being on their own, and the belief that they would not enjoy it. People who persistently refused day services tended to have additional worries about meeting new people, losing their independence and being institutionalised. Fifty-four per cent of people with dementia who lived alone and had refused day services scored six or more on the Cornell Scale for Depression in Dementia, suggesting possible presence of major depression.

Conclusion: In patients with dementia who live alone and refuse day services, their misconceptions about day services and possibility of undiagnosed depression need further exploration.     

Participation and service access rights for people with intellectual disability: A role for law?

Abstract

Background Supported decision-making and personal budgets for services are the new paradigms.

Method Supported decision-making proposals from the Australian State of Victoria are analysed against international trends to determine the viability of laws reflecting new international norms of the United Nations Convention on the Rights of Persons with Disabilities 2006 (CRPD).

Results/Conclusions The article concludes that it is desirable to pursue supported decision-making and allied legal reforms, but the contribution of the law is small and the new supported decision-making paradigms have similarities to old paternalist guardianship, as well as possible unintended consequences. It is suggested that realising the equality, support, protection, and socioeconomic service aspirations of the CRPD raise important practical challenges for governments, for service providers, for families, and—centrally—for people with intellectual disability (ID).This article examines the limited contribution law can make to this enterprise.     

Patients as parents and young people approaching adulthood: how should we manage the interface between mental health services for young people and adults?

PURPOSE OF REVIEW: The present review discusses critically recent research findings (published during the period 2003-2004) on the mental health needs of young people in transition (old adolescents and young adults), including those of young parents. Also, the evidence on effective interventions and service models is considered. RECENT FINDINGS: Emerging evidence indicates that young people have high rates of mental health needs (in addition to high prevalence of psychiatric disorders) that may be related to life transitions. These needs often fall between the remit of adolescent/adult and mental health/social care services, and therefore are not adequately met. With the exception of mental health interventions for early psychosis and psychosocial programmes for teenage parents, there is very limited knowledge on how best to meet the mental health needs of young people in transition. SUMMARY: It is widely recognized that young people in transition require services and interventions tailored to their characteristics, rather than a mere extension to either child/adolescent or adult services. Recent policies and research findings have led to the development of early psychosis interventions, with initial encouraging messages. Similar initiatives are required for young people with nonpsychotic disorders.     

Comprehensive mental health services: who needs them?

In 1980 the agency "Psychosocial Services" was founded in Vienna, Austria to set up and to operate comprehensive outpatient services, with responsibility to the total population of the city of 1.53 millions. Vienna has been divided into eight catchment areas. 11.076 patients have been in contact with the eight outpatient departments until the end of 1984 (0.72% of the total population). Data show high numbers of alcoholic, neurotic and schizophrenic patients. Number of patients indicates a need of some minimum equipment of the city with regionalized outpatient services. 50% of all the patients have never been under inpatient precare when they contact the outpatient departments.     

Adolescents with mental health problems: what do they say about health services?

This study explored the health-related views and experiences of adolescent users of mental health services through semi-structured interviews with 32 14-20-year olds who had been diagnosed with a mental illness. The majority of respondents had both negative and positive things to say about their contact with health services. These relate to: the doctor-patient relationship, treatment received, the health-care system, and the environs of the hospital or clinic. The views and experiences of young people with regard to their health care must be taken into account in efforts to boost help-seeking, attendance and compliance rates and, generally, to improve child and adolescent mental health services. In particular, further attention needs to be given to the development of empathic communication skills by health professionals working with adolescents with mental health problems. Work on the health-related views and experiences of representative samples of young people with mental health problems should be prioritized.