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An Overview of Homelessness and Mental Health

Published on by Andrew Marshall5 Comments

Introduction

In a study in Western societies, homeless people have a higher prevalence of mental illness when compared to the general population.

They also are more likely to suffer from alcoholism and drug dependency. It is estimated that 20-25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. Others estimate that up to one-third of the homeless have a mental illness. In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the US. Depending on the age group in question and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% of the homeless – 250,000 individuals – had any mental illness. More would be labelled homeless if these were annual counts rather than point-in-time counts. Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalisation within the criminal justice system. Majority of the homeless population do not have a mental illness. Although there is no correlation between homelessness and mental health, those who are dealing with homelessness are struggling with psychological and emotional distress. The Substance Abuse and Mental Health Services Administration conducted a study and found that in 2010, 26.2% of sheltered homeless people had a severe mental illness.

Studies have found that there is a correlation between homelessness and incarceration. Those with mental illness or substance abuse problems were found to be incarcerated at a higher frequency than the general population. Fischer and Breakey have identified the chronically mentally ill as one of the four main subtypes of homeless persons; the others being the street people, chronic alcoholics, and the situationally distressed.

The first documented case of a psychiatrist addressing the issue of homelessness and mental health was in 1906 by Karl Wilmanns.

Historical Context

United States

In the United States, there are broad patterns of reform within the history of psychiatric care for persons with mental illness.  These patterns are currently categorised into three major cycles of reform. The first recognised cycle was the emergence of moral treatment and asylums, the second consists of the mental hygiene movement and the psychopathic (state) hospital, and most recent cycle includes deinstitutionalisation and community mental health.  In an article addressing the historical developments and reforms of treatment for the mentally ill, Joseph Morrissey and Howard Goldman acknowledge the current regression of public social welfare for mentally ill populations. They specifically state that the:

“historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies”.

Asylums

Refer to Greyhound Therapy.

Within the context of transforming schemas of moral treatment during the early nineteenth century, the humanitarian focus of public intervention was linked with the establishment of asylums or snake pits for treatment of the mentally ill.  The ideology that emerged in Europe disseminated to America, in the form of a social reformation based on the belief that new cases of insanity could be treated by isolating the ill into “small, pastoral asylums” for humane treatment. These asylums were meant to combine medical attention, occupational therapy, socialisation activities and religious support, all in a warm environment.

In America, Friends Asylum (1817) and the Hartford Retreat (1824) were among the first asylums within the private sector, yet public asylums were soon encouraged, with Dorothea Dix as one of its key lobbyists. The effectiveness of asylums was dependent on a collection of structural and external conditions, conditions that proponents began to recognise were unfeasible to maintain around the mid-nineteenth century. For example, with the proliferation of immigrants throughout industrialisation, the original purpose of asylums as small facilities transformed into their actualised use as “large, custodial institutions” throughout the late 1840s.  Overcrowding severely inhibited the therapeutic capacity, inciting a political reassessment period about alternatives to asylums around the 1870s. The legislative purpose of state asylums soon met the role society had funnelled them toward; they primarily became institutions for community protection, with treatment secondary.

Deinstitutionalisation

Toward the end of World War II, the influx of soldiers diagnosed with “war neurosis” incited a new public interest in community care. In addition to this, the view that asylums and state hospitals exacerbated symptoms of mental illness by being “inherently dehumanizing and antitherapeutic” spread through the public consciousness. When psychiatric drugs like neuroleptics stabilised behaviour and milieu therapy proved effective, state hospitals began discharging patients, with hope that federal programs and community support would counterbalance the effects of institutionalisation. Furthermore, economic responsibility for disabled people began to shift, as religious and non-profit organisation assumed the role of supplying basic needs.  The modern results of deinstitutionalisation show the dissonance between policy expectations and the actualized reality.

Community Mental Health Centres

In response to the flaws of deinstitutionalisation, a reform movement reframed the context of the chronically mentally ill within the lens of public health and social welfare problems. Policy makers intentionally circumvented state mental hospitals by allocating federal funds directly to local agencies. For example, the Community Mental Health Centres (CMHC) Act of 1963 became law:

“which funded the construction and staffing of hundreds of federal centers to provide a range of services including partial hospitalization, emergency care, consultation, and treatment.”

Despite efforts, newly founded community centres:

“failed to meet the needs of acute and chronic patients discharged in increasing numbers from public hospitals”.

With decreased state collaboration and federal funding for social welfare, community centres essentially proved unable “to provide many essential programs and benefits”, resulting in a growth of homelessness and indigency, or lack of access to basic necessities. It is argued that an over reliance on community health has “left thousands of former patients homeless or living in substandard housing, often without treatment, supervision or social support.”

State Mental Hospitals

As debates regarding the deteriorating role of US asylums and psychiatry amplified around the turn of the century, new reformation arose. With the founding of the National Committee for Mental Hygiene, acute treatment centres like psychopathic hospitals, psychiatric dispensaries and child guidance clinics were created. Beginning with the State Care Act in New York, states began assuming full financial control for the mentally ill, in an effort to compensate for the deprivations of asylums. Between 1903 and 1950, the number of patients in state mental hospitals went from 150,000 to 512,000. Morrissey recognises that despite persistent problem of chronic mental illness, these state mental hospitals were able to provide a minimal level of care. US president John F. Kennedy signed the Community Mental Health Act (1963) that was put in place to give funding for community-based facilities rather than having patients going to state hospitals. Decades later, once the Community Mental Health Act was implemented a lot of state hospitals suffered and were on the verge of forced to close which pushed patients to the community-based facilities. The closures of the state hospitals lead to an overcrowding in the community facilities and there was a lack of support, which lead to patients not having access to the medical help they needed.

Personal Factors

Neurobiological Determinants

The mental health of homeless populations is significantly worse than the general population, with the prevalence of mental disorders up to four times higher in the former.  It is also found that psychopathology and substance abuse often exist before the onset of homelessness, supporting the finding that mental disorders are a strong risk factor for homelessness.  Ongoing issues with mental disorders such as affective and anxiety disorders, substance abuse and schizophrenia are elevated for the homeless.  One explanation for homelessness states that “mental illness or alcohol and drug abuse render individuals unable to maintain permanent housing.”  One study further states that 10–20% of homeless populations have a dual diagnoses, or the co-existence of substance abuse and of another severe mental disorder. For example, in Germany there is a link between alcohol dependence and schizophrenia with homeless populations.

Trauma

There are patterns of biographical experience that are linked with subsequent mental health problems and pathways into homelessness.  Martens states that reported childhood experiences, described as “feeling unloved in childhood, adverse childhood experiences, and general unhappiness in childhood” seem to become “powerful risk factors” for adult homelessness. For example, Martens emphasizes the salient dimension of familial and residential instability, as he describes the prevalence of foster-care or group home placement for homeless adolescents. He notes that “58 percent of homeless adolescents had experienced some kind of out-of-home placement, running away, or early departure from home.”  Moreover, up to 50% of homeless adolescents report experience with physical abuse, and almost one-third report sexual abuse.  In addition to family conflict and abuse, early exposure to factors like poverty, housing instability, and alcohol and drug use all increase one’s vulnerability to homelessness. Once impoverished, the social dimension of homelessness manifests from “long exposure to demoralizing relationships and unequal opportunities.”

Trauma and Homeless Youth

Youth experiencing homelessness are more susceptible to developing post-traumatic stress disorder (PTSD). Common psychological traumas experienced by homeless youth include, sexual victimisation, neglect, experiences of violence, and abuse. In an article published by Homeless Policy Research Institute it notes that homeless youth are subjected to many different forms of trauma. A study was done and found that 80% of youth that experienced homelessness in Los Angeles suffered at least one traumatic experience. Another study was conducted in Canada that showed a more severe statistic that Canadian homeless youth have been through 11 to 12 traumatic experiences. While trauma is prevalent in homeless youth, it is not uncommon for an adolescent to experience an increase of trauma after they experience homelessness. The LGBTQ community represents 20% of the homeless youth population. The reason for this high percentage is due to the issues and/or rejection from their family due to the sexual orientation.

Societal Factors

Draine et al. emphasize the role of social disadvantage with manifestations of mental illness. He states that “research on mental illness in relation to social problems such as crime, unemployment, and homelessness often ignores the broader social context in which mental illness is embedded.”

Social Barriers

Stigma

Lee argues that societal conceptualizations of homelessness and poverty can be juxtaposed, leading to different manifestations of public stigma. In his work through national and local surveys, respondents tended to de-emphasize individual deficits over “structural forces and bad luck” for homeless individuals. In contrast, the respondents tended to associate personal failures more to the impoverished than homeless individuals. 

Nonetheless, homeless individuals are “well aware of the negative traits imputed to them – lazy, filthy, irresponsible dangerous – based on the homeless label.” In an effort to cope with the emotional threat of stigma, homeless individuals may rely on one another for “non-judgmental socializing”. However, his work continues to emphasize that the mentally ill homeless are often deprived of social networks like this.

Social Isolation

People who are homeless tend to be socially isolated, which contributes negatively to their mental health. Studies have correlated that those who are homeless and have a strong support group tend to be more physically and mentally healthy. Aside from the stigma received by the homeless population, another aspect that contributes to social isolation is the purposeful avoidance of social opportunity practiced by the homeless community out of shame of revealing their current homeless state. Social isolation ties directly to social stigma in that homeless socialisation outside of the homeless community will affect how the homeless are perceived. This is why homeless individuals talking with those who are not homeless is encouraged since it can combat the stigma that is often associated with homelessness.

Racial Inequality

One dimension of the American homeless is the skewed proportion of minorities. In a sample taken from Los Angeles, 68% of the homeless men were African American. In contrast, the Netherlands sample had 42% Dutch, with 58% of the homeless population from other nationalities.  Furthermore, Lee notes that minorities have a heightened risk of the “repeated exit-and-entry pattern”.

Institutional Barriers

Shinn and Gillespie (1994) argued that although substance abuse and mental illness is a contributing factor to homelessness, the primary cause is the lack of low-income housing. Elliot and Krivo emphasize the structural conditions that increase vulnerability to homelessness. Within their study, these factors are specifically categorized into “unavailable low-cost housing, high poverty, poor economic conditions, and insufficient community and institutional support for the mentally ill.”  Through their correlational analysis, they reinforce the finding that areas with more spending on mental health care have “notably lower levels of homelessness.”  Furthermore, their findings emphasize that among the analysed correlates, “per capita expenditures on mental health care, and the supply of low-rent housing are by far the strongest predictors of homelessness rates.” Along with economic hardship, patterns of academic underachievement also undermine an individual’s opportunity for reintegration into general society, which heightens their risk for homelessness.

On a psychological level, Lee notes that the “stressful nature of hard times (high unemployment, a tight housing market, etc.) helps generate personal vulnerabilities and magnifies their consequences.” For example, poverty is a key determinant of the relationship between debilitating mental illness and social maladjustment; it is associated with decreased self-efficacy and coping. Moreover, poverty is an important predictor of life outcomes, such as “quality of life, social and occupational functioning, general health and psychiatric symptoms”, all relevant aspects of societal stability.  Thus, systemic factors tend to compound mental instability for the homeless. Tackling homelessness involves focusing on the risk factors that contribute to homelessness as well as advocating for structural change.

Consequences

Incarceration

It is argued that persons with mental illness are more likely to be arrested, simply from a higher risk of other associated factors with incarceration, such as substance abuse, unemployment, and lack of formal education. Furthermore, when correctional facilities lack adequate coordination with community resources upon release, the chances of recidivism increase for persons who are both homeless and have a mental illness. Every state in the United States incarcerates more individuals with severe mental illness than it hospitalises. Incarcerations are due to lack of treatments such as psychiatric hospital beds.  Overall, according to Raphael and Stoll, over 60% of US jail inmates report mental health problems. Estimates from the Survey of Inmates in State and Federal Correctional Facilities (2004) and the Survey of Inmates in Local Jails (2002) report that the prevalence for severe mental illness (the psychoses and bipolar/manic-depressive disorders) is 3.1–6.5 times the rate observed for the general population.  In relation to homelessness, it is found that 17.3% of inmates with severe mental illness experienced a homeless state before their incarceration, compared to 6.5% of undiagnosed inmates.  The authors argue that a significant portion of deinstitutionalised mentally ill were transitioned into correctional facilities, by specifically stating that “transinstitutional effect estimates suggest that deinstitutionalization has played a relatively minor role in explaining the phenomenal growth in U.S. incarceration levels.”

Responses

Responses to mental health and homelessness include measures focused on housing and mental health services. Providers face challenges in the form of community adversity.

Housing

Modern efforts to reduce homelessness include “housing-first models”, where individuals and families are placed in permanent homes with optional wrap-around services. This effort is less expensive than the cost of institutions that serve the complex needs of people experiencing homeless, such as emergency shelters, mental hospitals and jails. The alternative approach of housing first has shown positive outcomes. One study reports an 88% housing retention rate for those in Housing First, compared to 47% using traditional programmes. Additionally, a review of permanent supportive housing and case management on health found that interventions using “housing-first models” can improve health outcomes among chronically homeless individuals, many of whom have substance use disorders and severe mental illness. Improvements include positive changes in self-reported mental health status, substance use, and overall well-being. These models can also help reduce hospital admissions, length of stay in inpatient psychiatric units, and emergency room visits. There is a new intervention called “Permanent Supportive Housing” that was designed help independent living and help with employment and health care. 407,966 individuals were homeless in shelters, transitional housing programmes, or on the streets. Those with mental illnesses have difficulty not only with their current housing issues, but have issues with housing if they get evicted. Youth can benefit from permanent housing, increases social activity, and improve mental health. Federally funded rental assistance are in place, but due to the high demand of the funds, the government is unable to keep up.

One study evaluating the efficacy of the Housing First model followed mentally ill homeless individuals with criminal records over a two-year period, and after being placed in the Housing First programme only 30% re-offended. Overall results of the study showed a large reduction in re-conviction, increased public safety, and a reduction in crime rates. A significant decline in drug use was also seen with the implementation of the Housing First model. The study showed a 50% increase in housing retention and a 30% increase in methadone treatment retention in programme participants.

Mental Health Services

Uninterrupted assistance greatly increases the chances of living independently and greatly reduces the chances of homelessness and incarceration. Through longitudinal comparisons of sheltered homeless families and impoverished domiciled families, there are a collection of social buffers that slow one’s trajectory toward homelessness. A number of these factors include “entitlement income, a housing subsidy, and contact with a social worker.” These social buffers can also be effective in supporting individuals exiting homelessness. One study utilising Maslow’s hierarchy of needs in assessing housing experiences of adults with mental illnesses found a complex relationship between basic needs, self-actualisation, goal setting, and mental health. Meeting self-actualisation needs are vital to mental health and treatment of mental illness. Housing, stable income, and social connectedness are basic needs, and when met can lead to fulfilment of higher needs and improved mental health. Those with a brief history of homelessness and managed disabilities may have better access to housing.

Research calls for evidence based remediation practices that transform mental health care into a recovery oriented system. The following list includes practices currently being utilised to address the mental health needs of homeless individuals:

  • Integrated service system, between and within agencies in policy making, funding, governance and service delivery.
  • Low barrier housing with support services.
  • Building Assertive Community Teams (ACT) and Forensic Assertive Community Teams (FACT).
  • Assisted Community Treatment (ACT).
  • Outreach services that identify and connect homeless to the social service system and help navigate the complex, fragmented web of services.

Challenges

Fear surrounds the introduction of mentally ill homeless housing and treatment centres into neighbourhoods, due to existing stereotypes that homeless individuals are often associated with increased drug use and criminal activity. The Housing First Model study, along with other studies, show that this is not necessarily the case. Proponents of the NIMBY (not-in-my-backyard) movement have played an active role in the challenges faced by housing and mental health service interventions for the homeless.

Summary

For some individuals, the pathways into homelessness may be upstream. E.g. issues such as housing, income level, or employment status. For others, the pathways may be more personal or individual, e.g. issues such as compromised mental health and well ‐ being, mental illness, and substance abuse. Many of these personal and upstream issues are interconnected.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Homelessness_and_mental_health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

How Mad Are You? (2008): Part 02

Published on by Andrew MarshallLeave a comment

Introduction

“How Mad Are You?” is a two-part 2008 BBC Horizon/Discovery Channel Co-Production produced and directed by Rob Liddell.

Part of the BBC’s Horizon documentary series.

The programme was recreated in 2018 by SBS for Australian TV.

UK Version (BBC)
Australian Version (SBS)

Outline (UK Version)

Ten Britons spend a week together. Five have a history of mental illness. Five do not. The question is – Who’s Who?

The programme explores the relationship between character traits and mental illness and considers the social implications of inaccurate diagnosis of the latter. Ten volunteers, five of whom have been previously diagnosed with psychiatric disorders, are observed and interviewed by a panel of three mental health experts who then venture their diagnoses. The experts include a psychiatrist, a professor of clinical psychology, and a psychiatric nurse. The volunteers and experts have no prior knowledge about one another, and were brought together for this one week study.

The program was inspired by the 1972 “Rosenhan Experiment,” in which the American psychologist David Rosenhan and several associates feigned auditory hallucinations in order to have themselves admitted to psychiatric hospitals. Eight of these “pseudopatients” were diagnosed with psychiatric disorders. Although they ceased displaying any symptoms once admitted to a hospital, they were detained for between 17 and 52 days. None were recognised by hospital staff. The experiment’s results, published in Science in 1973,1 raised questions about the validity of psychiatric diagnosis.

You can read an in-depth overview of the programme by Yusef Progler in the Journal of Research in Medical Sciences.

Part 02

Second part of the special documentary considering where the line between sanity and madness lies as ten volunteers come together for an extraordinary test.

With five ‘normal’ volunteers and five who have been officially diagnosed as mentally ill, Horizon asks if you can tell who is who.

Part 01 here.

Outline (Australian Version)

Recreates the BBC UK version.

New two-part SBS documentary series How ‘Mad’ Are You? addresses mental illness in a way never seen before on Australian television. Ten Australians, from all backgrounds and ages spend a week together. Five have a history of mental illness. Five do not. Who is who?

  • This ground breaking two-part series will address the issue of mental illness in a way never seen before on Australian television.
  • Around one in five Australians experience mental illness every year. Despite the scale of the problem – the stigma remains.
  • Ten Australians with diverse backgrounds and from right across the country, have all agreed to take part in a bold and daring study in the hope of breaking down this stigma.
  • Five of them have been diagnosed as being mentally unwell, five have not; the question is – Who’s Who?
  • Over the next week, they will take part in a series of specially designed tests.
  • The group will be under the gaze of experts who face the daunting task of working out who has been diagnosed as mentally ill and who has not.
  • The experts are putting their professional reputations on the line, and the ten risk being labelled with a mental illness they don’t have. It is all in the name of breaking down stigma and exploring where the fine line between being ‘well’ and ‘mentally ill’ lies.
  • Each episode delves into the relationship between character traits and mental illness, and considers the social implications arising from the diagnosis of mental illness.
  • The series will explore major disorders including Clinical Depression, Social Anxiety Disorder, Schizophrenia, Bipolar Disorder, Obsessive-Compulsive Disorder and Anorexia Nervosa.
  • The question of who is ‘mad’ and who is not goes to the core of how we see ourselves, and how we see others in Australia today.
  • Crucially the volunteers who take part are ultimately living proof that a history of mental illness does not have to define you or make you ‘other’ in today’s society.

Production & Filming Details

  • Narrator(s):
    • Judy Davis.
    • Paul McGann
  • Director(s):
    • Naomi Elkin-Jones … (2 episodes, 2018)
    • David Grusovin … (2 episodes, 2018)
    • Rob Liddell
  • Producer(s):
    • Darren Dale … producer (2 episodes, 2018)
    • Jacob Hickey … series producer (2 episodes, 2018)
    • Agnes Teek … story producer (2 episodes, 2018)
    • Rob Liddell
  • Writer(s):
    • Jacob Hickey … (2 episodes, 2018)
  • Music:
    • Angela Little … (2 episodes, 2018)
  • Cinematography:
    • Justin Brickle … (2 episodes, 2018)
    • Marden Dean … (2 episodes, 2018)
    • Daniel Gallagher … (2 episodes, 2018)
  • Editor(s):
    • Mark Atkin … (2 episodes, 2018)
  • Production:
    • Blackfella Films
  • Distributor(s):
    • BBC.
    • SBS.
  • Release Date:
    • UK: 11 and 18 November 2008.
    • Australia: 11 and 18 October 2018.
  • Running Time: 2 x 50 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

How Mad Are You? (2008): Part 01

Published on by Andrew Marshall1 Comment

Introduction

“How Mad Are You?” is a two-part 2008 BBC Horizon/Discovery Channel Co-Production produced and directed by Rob Liddell.

Part of the BBC’s Horizon documentary series.

The programme was recreated in 2018 by SBS for Australian TV.

UK Version (BBC)
Australian Version (SBS)

Outline (UK Version)

Ten Britons spend a week together. Five have a history of mental illness. Five do not. The question is – Who’s Who?

The programme explores the relationship between character traits and mental illness and considers the social implications of inaccurate diagnosis of the latter. Ten volunteers, five of whom have been previously diagnosed with psychiatric disorders, are observed and interviewed by a panel of three mental health experts who then venture their diagnoses. The experts include a psychiatrist, a professor of clinical psychology, and a psychiatric nurse. The volunteers and experts have no prior knowledge about one another, and were brought together for this one week study.

The program was inspired by the 1972 “Rosenhan Experiment,” in which the American psychologist David Rosenhan and several associates feigned auditory hallucinations in order to have themselves admitted to psychiatric hospitals. Eight of these “pseudopatients” were diagnosed with psychiatric disorders. Although they ceased displaying any symptoms once admitted to a hospital, they were detained for between 17 and 52 days. None were recognised by hospital staff. The experiment’s results, published in Science in 1973,1 raised questions about the validity of psychiatric diagnosis.

You can read an in-depth overview of the programme by Yusef Progler in the Journal of Research in Medical Sciences.

Part 01

First of a two-part special. Ten volunteers have come together for an extraordinary test. Five are ‘normal’ and the other five have been officially diagnosed as mentally ill. Horizon asks if you can tell who is who, and considers where the line between sanity and madness lies.

Part 02 here.

Outline (Australian Version)

Recreates the BBC UK version.

New two-part SBS documentary series How ‘Mad’ Are You? addresses mental illness in a way never seen before on Australian television. Ten Australians, from all backgrounds and ages spend a week together. Five have a history of mental illness. Five do not. Who is who?

  • This ground breaking two-part series will address the issue of mental illness in a way never seen before on Australian television.
  • Around one in five Australians experience mental illness every year. Despite the scale of the problem – the stigma remains.
  • Ten Australians with diverse backgrounds and from right across the country, have all agreed to take part in a bold and daring study in the hope of breaking down this stigma.
  • Five of them have been diagnosed as being mentally unwell, five have not; the question is – Who’s Who?
  • Over the next week, they will take part in a series of specially designed tests.
  • The group will be under the gaze of experts who face the daunting task of working out who has been diagnosed as mentally ill and who has not.
  • The experts are putting their professional reputations on the line, and the ten risk being labelled with a mental illness they don’t have. It is all in the name of breaking down stigma and exploring where the fine line between being ‘well’ and ‘mentally ill’ lies.
  • Each episode delves into the relationship between character traits and mental illness, and considers the social implications arising from the diagnosis of mental illness.
  • The series will explore major disorders including Clinical Depression, Social Anxiety Disorder, Schizophrenia, Bipolar Disorder, Obsessive-Compulsive Disorder and Anorexia Nervosa.
  • The question of who is ‘mad’ and who is not goes to the core of how we see ourselves, and how we see others in Australia today.
  • Crucially the volunteers who take part are ultimately living proof that a history of mental illness does not have to define you or make you ‘other’ in today’s society.

Production & Filming Details

  • Narrator(s):
    • Judy Davis.
    • Paul McGann
  • Director(s):
    • Naomi Elkin-Jones … (2 episodes, 2018)
    • David Grusovin … (2 episodes, 2018)
    • Rob Liddell
  • Producer(s):
    • Darren Dale … producer (2 episodes, 2018)
    • Jacob Hickey … series producer (2 episodes, 2018)
    • Agnes Teek … story producer (2 episodes, 2018)
    • Rob Liddell
  • Writer(s):
    • Jacob Hickey … (2 episodes, 2018)
  • Music:
    • Angela Little … (2 episodes, 2018)
  • Cinematography:
    • Justin Brickle … (2 episodes, 2018)
    • Marden Dean … (2 episodes, 2018)
    • Daniel Gallagher … (2 episodes, 2018)
  • Editor(s):
    • Mark Atkin … (2 episodes, 2018)
  • Production:
    • Blackfella Films
  • Distributor(s):
    • BBC.
    • SBS.
  • Release Date:
    • UK: 11 and 18 November 2008.
    • Australia: 11 and 18 October 2018.
  • Running Time: 2 x 50 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

Just Like You: Anxiety + Depression (2023)

Published on by Andrew MarshallLeave a comment

Introduction

Follows the stories of various people as they tackle the fear and stigma plaguing the mental health community.

Outline

10 brave kids, 2 Emmy award winning journalists, 1 clinical psychologist at Columbia University and 1 determined mother take on the fear and stigma plaguing the mental health community.

Production & Filming Details

  • Director(s):
    • Jennifer Greenstreet
  • Producer(s):
    • Karen Arkin … executive producer
    • Jennifer Greenstreet … executive producer
    • Mauria Stonestreet … producer
    • Chad Swenson … producer
  • Writer(s):
    • Jennifer Greenstreet
  • Music:
  • Cinematography:
  • Editor(s):
    • Hugh Ormond
  • Production:
    • Just Like You Films
  • Distributor(s):
    • Gravitas Ventures (world-wide)
  • Release Date: 08 March 2022 (internet).
  • Running Time: 77 minutes.
  • Rating: Not Rated.
  • Country: UK.
  • Language: English.

RTE Investigates: Ireland’s Unregulated Psychologists

Published on by Andrew MarshallLeave a comment

Introduction

RTÉ Investigates the lack of regulation of psychologists in the private sector where families of young children are forced to seek help because of long public waiting lists.

Outline

Reporter Barry O’Kelly shows how easy it is to call yourself a psychologist in Ireland today.

You can read comments made by the Psychological Society of Ireland (PSI) here (PDF, external link) regarding the programme.

Production & Filming Details

  • Director(s):
  • Producer(s):
  • Writer(s):
  • Music:
  • Cinematography:
  • Editor(s):
    • Hugh Ormond
  • Production:
    • RTE
  • Distributor(s):
    • RTE One
  • Release Date: 06 March 2023 (Ireland).
  • Running Time: 41 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

An Overview of Self-Help Groups for Mental Health

Published on by Andrew MarshallLeave a comment

Introduction

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.

Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

Types

Mutual Support and Self-Help

Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.

Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.

Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.

Behaviour Control or Stress Coping Groups

Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.

Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.

Member vs Professional Leadership

Member leadership. In Germany, a specific subset of Conversation Circles are categorized as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.

Professionally Led Group Psychotherapy

Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.

Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.

Professional Affiliation and Group Lifespan

If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.

Typology of Self-Help Groups

In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorisations for self-help groups.

Unaffiliated Groups

Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.

Federated Groups

Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.

Affiliated Groups

Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).

Managed Groups

Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.

Hybrid Groups

The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.

Group Processes

No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.

Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.

Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.

  • Social support: Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
  • Experiential knowledge: Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
  • Social learning theory: Members with experience become credible role models.
  • Social comparison theory: Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
  • Helper theory: Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalised learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.

A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.

Relationship with Mental Health Professionals

A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.

The 1987 Surgeon’s General Workshop marked a publicized call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.

A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.

Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”

Referrals

A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.

Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.

Effectiveness

Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.

While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.

Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.

Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.

List

Emotions Anonymous

Refer to Emotions Anonymous.

Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.

GROW

Refer to GROW (Support Group).

GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.

Neurotics Anonymous

Refer to Neurotics Anonymous.

Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favor with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.

Recovery International

Refer to Recovery International.

Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.

Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.

Criticism

There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.

Formulaic Approach

Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.

High Attrition Rates

There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.

Overgeneralisation

Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.

Panacea Complex

There is a risk that self-help group members may come to believe that group participation is a panacea—that the group’s processes can remedy any problem.

Sexual Predation and Opportunism

Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Self-help_groups_for_mental_health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of the American Association of Community Psychiatrists

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Introduction

The American Association of Community Psychiatrists (AACP) is a United States-based organisation of recovery-oriented and recovery focused psychiatrists, psychologists and social workers who primarily work in community-based settings.

Outline

It was founded in 1985 “to encourage, equip, and empower community and public psychiatrists to develop and implement policies and high-quality practices that promote individual, family and community resilience and recovery.”

The AACP has published a number of texts on community psychiatry.

Its most prominent publication is the peer-reviewed Community Mental Health Journal, published by Springer.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/American_Association_of_Community_Psychiatrists >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Structured Clinical Interview for DSM?

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Introduction

The Structured Clinical Interview for DSM (SCID) is a semi-structured interview guide for making diagnoses according to the diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The development of SCID has followed the evolution of the DSM and multiple versions are available for a single edition covering different categories of mental disorders. The first SCID (for DSM-III-R) was released in 1989, SCID-IV (for DSM-IV) was published in 1994 and the current version, SCID-5 (for DSM-5), is available since 2013.

It is administered by a clinician or trained mental health professional who is familiar with the DSM classification and diagnostic criteria. The interview subjects may be either psychiatric or general medical patients or individuals who do not identify themselves as patients, such as participants in a community survey of mental illness or family members of psychiatric patients. SCID users should have had sufficient clinical experience to be able to perform diagnostic evaluation, however, non-clinicians who have comprehensive diagnostic experience with a particular study population may be trained to administer the SCID. Generally additional training is required for individuals with less clinical experience.

DSM-III Editions of SCID

The SCID for the DSM-III-R helped determine Axis I (SCID-I) and Axis II disorders (SCID-II). Separate versions were used to assess psychiatric patients (SCID-P) and to study non-patient populations (SCID-NP). Another form of the SCID-P, SCID-P W/PSY SCREEN, was developed for patients in which psychotic disorders were expected to be rare and only included screening questions for these disorders but not the complex module. Special versions were also created for studying panic disorder, assessing PTSD and combat experience in Vietnam veterans and studying the social and psychiatric consequences of HIV infection.

The reliability and validity of the SCID for DSM-III-R has been reported in several published studies. With regard to reliability, the range in reliability is enormous, depending on the type of the sample and research methodology (i.e. joint vs. test-retest, multi-site vs. single site with raters who have worked together, etc.).

SCID-D

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) is used to diagnose dissociative disorders, especially in research settings. It was originally designed for the DSM-III-R but early access to DSM-IV criteria for dissociative disorders allowed them to be incorporated into the SCID-D.

For subjects with non-dissociative disorders administration takes between 30 minutes and 1.5 hours. Subjects with dissociative disorders usually require between 40 minutes to 2.5 hours. These subjects should be given enough time to describe their experiences fully.

The SCID-D has been translated into Dutch and Turkish and is used in the Netherlands and Turkey.

DSM-IV Editions of SCID

SCID for DSM-IV also follows the multi-axial system, SCID-I for Axis I disorders (major mental disorders) and SCID-II for Axis II disorders (personality disorders).

There are several variants of SCID-I addressed to different audiences. Similarly to the previous edition SCID-I is available for examining psychiatric patients (SCID-I/P) and studying non-patients (SCID-I/NP) and patient populations where psychotic disorders are not expected (SCID-I/P W/ PSY SCREEN). Specific version for clinicians (SCID-CV) and clinical trials (SCID-CT) were also developed. The SCID-II for DSM-IV comes in a single edition.

A variant of the tool (KID-SCID) was developed at York University for generating childhood DSM-IV diagnoses for clinical research studies. In 2015 a study evaluated the psychometric properties of the KID-SCID in a Dutch sample of children and adolescents which later led to the creation of SCID-5-Junior for the DSM-5 (see below).

An Axis I SCID assessment with a psychiatric patient usually takes between 1 and 2 hours, depending on the complexity of the subject’s psychiatric history and their ability to clearly describe episodes of current and past symptoms. A SCID with a non-psychiatric patient takes 1⁄2 hour to 1+1⁄2 hours. A SCID-II personality assessment takes about 1⁄2 to 1 hour.

There are at least 700 published studies in which the SCID was the diagnostic instrument used. Major parts of the SCID have been translated into other languages, including Danish, French, German, Greek, Hebrew, Italian, Portuguese, Spanish, Swedish, Turkish, and Zulu.

DSM-5 Editions of SCID

SCID-5-RV (Research Version) is the most comprehensive version of the SCID-5. It contains more disorders and includes all of the relevant subtypes and severity and course specifiers. An important feature is its customisability, allowing the instrument to be tailored to meet the requirements of a particular study. SCID-5-CV (Clinician Version) is a reformatted version of the SCID-5-RV for use by clinicians. It covers the most common diagnoses seen in clinical settings. Despite the “clinician” designation, it can be used in research as long as the disorders of interest are among those included in this version. SCID-5-CT (Clinical Trials version) is an adaptation of the SCID-5-RV that has been optimised for use in clinical trials.

SCID-5-PD (Personality Disorders version) is used to evaluate the 10 personality disorders. Its name reflects the elimination of the multiaxial system of the SCID-IV. The SCID-5-AMPD (Alternative Model for Personality Disorders) provides dimensional and categorical approaches to personality disorders. Designed for trained clinicians, the modular format allows the researcher or clinician to focus on those aspects of the Alternative Model of most interest.

Various versions of the SCID-5 have been translated to Chinese, Danish, Dutch, German, Greek, Hungarian, Italian, Japanese, Korean, Norwegian, Polish, Portuguese, Romanian, Spanish, Turkish.

As a result of earlier studies conducted on Dutch youth a variant of the tool, SCID-5-Junior, a revision of the KID-SCID, is available in Dutch. There are plans to create a more widely available version for children and adolescents.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Structured_Clinical_Interview_for_DSM >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Mental Health Inequity

Published on by Andrew MarshallLeave a comment

Introduction

Mental health inequality refers to the differences in the quality, access, and health care different communities and populations receive for mental health services.

Globally, the World Health Organisation (WHO) estimates that 350 million people are affected with depressive disorders. Mental health can be defined as an individual’s well-being and/or the absence of clinically defined mental illness. Inequalities that can occur in mental healthcare may include mental health status, access to and quality of care, and mental health outcomes, which may differ across populations of different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location. Social determinants of health, more specifically the social determinants of mental health, that can influence an individual’s susceptibility to developing mental disorders and illnesses include, but are not limited to, economic status, education level, demographics, geographic location and genetics.

Disparities in Accessing and Quality of Mental Health Care

There is a growing unmet need for mental health services and equity in the quality of these services. While these services often advertise themselves as being a support system and caregiver for any and all who need treatment or support, oftentimes certain aspects of an individual’s life, such as race, ethnicity, and sexual orientation, will determine the access and quality of care that they are given.

Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it. African Americans and Hispanics are more likely to be uninsured or have Medicaid, limiting the amount and type of access that they have mental health outpatient sources. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care).

In addition, mental illnesses are often under and over diagnosed among different minority groups for various reasons. For example, schizophrenia is often over diagnosed in African Americans, whereas mood disorders, depression, and anxiety are under diagnosed. This serves as an example of how minority groups in the United States, such as African Americans, are at risk of being diagnosed based on stereotype and not properly assessed or treated for other mental health conditions that they may or may not be at risk for.

The LGBTQ population, while still open to the same disparities as racial minority groups, is often confronted with the problem of being denied mental health treatment because of the gender they identify as or their sexual orientation. In a study conducted by The National Centre for Transgender Equality and the National Gay and Lesbian Task Force, 19% of the LGBTQ sample reported being denied the healthcare they needed. In addition, 28% of the sample reported being harassed or even physically assaulted during the health visit. While denial of treatment and harassment during treatment are large causes of the disparities among mental health care quality, the lack of knowledge is also of concern among the LGBTQ population. As it is such a newly developing field of study, there is very little knowledge or research conducted that relate specifically to LGBTQ health and healthcare. Because of this, about 50% of the LGBTQ population report having to teach aspects of their health and treatment to the health care providers.

Socioeconomic Status Disparities

Refer to Socioeconomic Status and Mental Health.

Lack of socioeconomic resources can lead to development of traumatic experiences that precipitate into mental health disorders. For example, not having employment or having limited access to resources can influence the course of developing some of the most common mental health disorders, such as depression, anxiety, bipolar disorder, and psychological stress. Living with a mental health disorder can also contribute to disparities in receiving mental health care. Living with a mental health disorder could affect an individual’s economic status, which can additionally lead into their mental health quality as well as life expectancy.

Another socioeconomic factor that can lead to barriers and inequalities in accessing mental health care services include financial restraints. There has been a rise in cost for uninsured individuals in accessing mental health care services compared to individuals who have private or public insurance.

Education Disparities

Educational disparities can be defined as unjust or unfair differences in educational outcomes that can be a result of difference in treatment of certain minority groups in schools, varying socioeconomic statuses, and varying educational needs. These disparities in education can ultimately lead to issues of mental health. When this happens, less privileged groups get looped into the cascading effects of inequality.

Disparities in education, contributory to socioeconomic status, immigrant status, and ethnic/racial status can be another contributing factor to mental health inequality. Socioeconomic status plays a large role in the difference in access to educational resources. School districts are split geographically. Because the current funding for public schools comes from local property taxes, there is more incentive for high-status individuals to narrow the boundaries to not include lower income families from their school districts. Because each school district is then only encompassing one socioeconomic group, the programmes and quality are affected. This is where we begin to see the dramatic differences between school districts. While some schools offer amazing guidance departments, advanced classes, and phenomenal facilities, other areas struggle to find qualified and motivated teachers to teach basic classes. Although public education is something that is supposed to be a right for all, an individual’s socioeconomic status can greatly affect the quality of that education.

An individual’s immigration status also affects the quality of education received. While there are some immigrant groups which do well after immigrating to the United States, many do not have the same level of success. There are many barriers that prevent the academic success of immigrant children. These barriers include but are not limited to the fact that most parents of immigrant children do not understand the United States educational system, inadequate English as a Second Language programmes, and segregation. There are also differences in outcomes across immigrant generation, with first-generation immigrants performing better than subsequent generations. This is termed the immigrant paradox. These issues along with the psychological effects of acculturation (e.g. adapting to a whole new country, language, and culture) amplify educational inequality.

Disparities in education are the insufficiency of resources that are included but limited. These disparities usually targets socially excluded communities with low income. Statistics are used when measuring grades, GPA, test scores, and dropout rates to determine the success of students. By creating a system in which a person could never succeed can perpetuate inequalities, especially those suffering from mental health.

Spatial Disparities (Geographic Location)

Spatial disparities include, but are not limited to, where one lives, spends most of their time, where they receive most of their resources, and where they receive education. For example, minority races who live in higher poverty neighbourhoods are at higher risk for additional stresses and mental health disorders. Yet this population has been shown to experience more difficulties in accessing mental health services. Considering this cycle of needing care but not being able to receive care, inequality due to spatial location will likely remain and continue to limit access to mental health care without additional intervention to increase access to mental health services.

Many minorities including African Americans, Hispanics, and Asian Americans inhabit these poverty filled neighbourhoods due to factors being not in their favour in certain aspects of society. These neighbourhoods lack resources such as offices with psychiatrists or health clinics with good doctors who are trained to help those in need of mental health care. It would also be beneficial to make specific services just for those in high-poverty neighbourhoods who lack the resources so we can encourage those in need to get the help that they deserve. With adjustments made to meet these circumstances, the spatial disparities can be lowered and allow those who need the help to get it.

Ethnic and Racial Disparities and Predictors

There is inequality in mental health care access for different races and ethnicities. Studies have shown that minorities with low-income have less access to mental health care than low-income non-Latino whites. In addition to lack of access, minorities in the United States were more likely to receive poorer quality in mental health care and treatment compared to non-Latino whites individuals, leading to many minorities delaying or failing treatment. Studies have shown the African Americans have decrease access to mental health services and mental health care compared non-Latino white Americans. Many minorities have difficulty in finding care for mental health services.

The historical events that took place in the United States against African Americans have resulted in a distrust in the healthcare system. The stigma of mental healthcare in the African American community has caused an increased prevalence of these disorders as surveys have found that 12 million women and 7 million men suffer from some kind of mental health illness. Besides being the most vulnerable race to contract the Covid-19 virus, they also presented a higher incidence of mental health disorders. Research has shown that this community reacts better to treatment when it is offered by healthcare professionals as an alternative to other treatments. When considering why African Americans are so at-risk for mental health issues, it is important to consider how their race impacts their daily lives. Black individuals in this country still face discrimination, which leads to negative emotions, and these emotions could include feelings of social isolation. Not only are they made to feel as though they are not fully a part of our society, but they may also feel as though their non-black family members and friends do not fully understand their struggles. This could definitely lead to subjective social isolation, or a lack of feeling close to other people. One study revealed that subjective social isolation in African Americans is correlated to having any 12-month disorder listed in the DSM and to having a higher number of 12-month disorders listed in the DSM. Based on this reasoning, subjective social isolation could be one of the reasons why African Americans are an at-risk group when it comes to mental health struggles, and it would definitely make sense for this subjective social isolation to be a result of racism that still exists today. It is also important to consider the intersectionality of race and gender when thinking about mental health. The same study as mentioned above states that African American men are more likely to experience social isolation than African American women, which could make black men in this country even more at-risk for psychiatric disorders. When thinking about the racism in this country, this somewhat makes sense, because black men experience certain aspects of discrimination that are specific to their group. For example, African American men are often perceived as dangerous and have high rates of being arrested. When all of these risk factors are then combined with the stigma that all men face in terms of discussing mental health issues, this puts African American men at a very high risk for both developing psychiatric disorders and not feeling empowered enough to talk about their struggles. When we are talking about racial disparities in mental health, not only do we need to acknowledge the lack of access that minority groups have to the proper health care, but we also need to understand that being in a minority racial group puts individuals at a higher risk for developing psychiatric disorders in the first place. Then, it is crucial to consider some of the possible reasons for this and begin to ask how we could decrease the disparities in this country. All minority groups are especially at-risk for mental health issues, including racial minority groups, and this is linked to systemic racism.

During the early 2010’s the Latino Community experienced an increase in cases of mental health disorders. Studies have shown that Latinos are more likely to present early symptoms of mental health disorders than non Latino-whites. Among Latinos, those without a legal status in the United States suffer a higher burden of being diagnose with a mental health disorders as their journey to the country has caused them to experience traumatizing events including sexual abuse, kidnapping, and the constant fear of deportation. Consequently, undocumented Latinos have a lower access to mental healthcare than US born Latinos because of the current political restrictions against this community.

After surveying individuals of different races, a study has shown that African Americans, Hispanics, and Asian Americans gain less access to the same type of mental services that non-minority whites get access to. A possible reason that the author stated:

“This theory postulates that Whites have a greater propensity to avoid living in poverty communities because they are more likely to enjoy social and economic advantages. Only seriously mentally ill Whites suffer from steep downward mobility and come to reside in high-poverty neighborhoods”.

Minorities have an absence of mental health support within their communities as a result of stigmas and stereotypes applied to those pursuing mental health guidance. Another barrier to the shortage of mental health support is the lack of this type of healthcare available because of the rural settings that contain a high population of minorities. External environmental factors, such as family, community, and work, can influence the inclination to reach out for mental health counselling.

This has been a problem for minority races that need the same services. It is an issue because African Americans, Hispanics, and Asian Americans need the services more in certain areas due to how biologically certain minority races are more likely to be diagnosed with a mental illness than whites.

Problems can extend to the point of racial beliefs of health professionals and researchers influencing the diagnoses and treatments developed for some communities. James Burgess Waldram wrote a 2004 text Revenge of the Windigo (the title referring to “Wendigo psychosis”, which he asserts is an artificial construction of anthropologists and psychologists) discussing the behavioural health industry’s difficulties successfully analysing and treating the needs of indigenous people in the United States and Canada.

Race is often difficult to acknowledge in mental health. Even when access to mental health therapies exists for minorities, oftentimes both the therapist and the patient can be reluctant to factor their own racial positioning into treatment or find it difficult to believe that some of their mental health stress is due to race. Both often favour explanations rooted in past experiences like family life, personal setbacks, and other potential barriers.

LGBTQ Disparities and Predictors

Sexuality plays a large role in the prediction of mental illnesses and overall mental health. Those who identify as lesbian, gay, bisexual, transgender, and/or queer have a higher risk of having mental health issues, most likely as a result of the continued discrimination and victimisation they receive at the hands of others. Members of this population are confronted with derogatory and hateful comments, whether through face-to-face communication or through social media, which affects their self-worth and confidence, leading to anxiety, depression, thoughts of suicide, suicide attempts, and suicide. These mental health effects are most commonly seen among adolescents, however, they are also prevalent among adults of all ages. The sources of discrimination and victimization that the LGBTQ population suffers from can be both external and internal. While parts of society today are not accepting of the LGBTQ community and make public statements to advertise their discontent, an identifying LGBTQ can also have low confidence and a lack of self-worth that furthers these negative mental health effects.

The most notable predictor of mental health illnesses among the LGBTQ population is family acceptance. Those of the LGBTQ population who receive little or no family support and acceptance are three times more likely to have thoughts of suicide than those who do have a strong family support system behind them. Oftentimes, the lack of familial support is more conducive of detrimental behaviours, such as drug and illegal substance abuse, which can cause further harm to the individual. Multiple aspects of lifestyles, including religion, can affect family support. Those who have strong family ties to religion may be less likely to seek support and help from family members due to fear of a lack of acceptance within the family, as well as within the religious community.

Although mental health awareness has increased for the LGBTQ+ community, the aging citizens of this community are still struggling to have their voices heard. Research has shown that compared to heterosexuals and other groups in the LGBTQ+ community, older people have a higher incidence of suffering from mental health disorder. One of the most common reasons why older citizens refrain from seeking mental health care is due to the past discrimination by medical professionals. In addition to the lack of knowledge, this group is marginalised due to the lack of funding as most of the funds go to campaigns for the younger LGBTQ+ population.

Sex and Gender Disparities and Predictors

While gender differences among those with mental health disorders are an underdeveloped field of study, there are gender specific aspects to life that cause disparities. Gender is often a determinant of the amount of power one has over factors in their life, such as socioeconomic status and social position, and the stressors that go along with these factors. The location of genders and sex within the social construct can be a great determinant of risks and predictors of mental health disorders. These disparities in gender can correlate to the disparities in the types of mental health disorders that individuals have. While all genders and sexes are at risk of a large variety of mental health illnesses, some illnesses and disorders are more common among one sex than another. Women are twice as likely as men to be diagnosed with forms of depression as depressive disorders account for close to 41.9% of the disability from neuropsychiatric disorders among women compared to 29.3% among men. On the other hand, men are three times more likely to be given a diagnosis of a social anxiety disorder than women.

Sex can also be a determinant of other aspects of mental health as well. The time of onset of symptoms can be different dependent on one’s sex. Women are more likely to show signs of mental illnesses, such as depression, earlier and at a younger age than men. Many believe this to be a correlation with the onset time of puberty. As a result of social stigmas and stereotypes within society, women are also more likely to be prescribed mood-altering medications, whereas men are more likely to be prescribed medications for addictions. Further research on the mental health disparities among sex and gender is needed in order to gain a deeper knowledge of the predictors of mental health and the possible differences in treatments.

Adult women are at a high risk of experiencing mental health disorders during their pregnancy, however, most physicians do not address this until the postpartum period. With anxiety and depression being the most common ones, these disorders can affect both the pregnant woman and the baby’s life. The most common reasons for mental health disorders in this community were domestic abuse, fear of loneliness and previous medical history of mental disorders. The Covid-19 pandemic was a difficult time for those who were pregnant as isolation, one of the main causes for anxiety and depression, was mandated. Studies showed that during the pandemic, while the mental health of middle class pregnant women living in New York City improved, pregnant women living under a low socioeconomic status were more vulnerable to suffer from psychological disorders.

Current Initiatives in Achieving Mental Health Equality

Because mental health inequality is largely due to disparities in health insurance, ways to improve mental health equity must come from changes in healthcare policies. Much of mental health disparity comes from a lack of access to healthcare in low socioeconomic communities and, often, underprivileged minorities. This lack of access can arise from geographic isolation, poor funding and incentive for health care providers, inefficient health care coverage or highly stigmatised and discriminatory community attitudes surrounding mental health. Also, changing the content of healthcare literature and education to include mental health is equally important. The United States has made strides to break down the stigmas surrounding mental health, but the rate of such stigma is currently still on the rise. Potentially linked to such high stigma and miseducation, mental health is also still not considered to be a significant part of basic health care plans. In order for individuals to receive the treatment necessary for mental illness, it must be first acknowledged as a real, treatable illness.

In May 2013, the World Health Assembly adopted a new action plan to address mental health over the following 8 years. This plan is called the Comprehensive Mental Health Action Plan 2013-2020. This plan is an indicator of the global importance of mental health and includes goals for global mental health improvement. This plan also addresses mental health inequalities by acknowledging the need for greater access in low and middle-income countries.

Global Mental Health Inequalities

There is major inequality in the mental health field on a global scale, especially in developing countries. The number of people with a mental health condition is substantial, while clinicians are underappreciated and under resourced.

Around 30% of people globally suffer from a mental disorder in any given year, and more than two thirds of those individuals do not receive the necessary care. The most common mental health disorders globally are depression, alcohol and substance abuse, and psychosis. The consequences of mental health inequalities include unneeded suffering and premature death, increased stigma and marginalisation, a lack of investment in mental health workforce and infrastructure and limited or no treatment for people suffering from these conditions.

The burden of unmet mental health needs perpetuates a cycle of inequalities that impact a person’s overall health and wellbeing. Many developing countries lack policies that address the basic needs and rights of people suffering from mental illnesses. According to research, patients in developing countries frequently leave hospitals without knowing their diagnosis or what medications they are taking, they wait too long for referrals, appointments, and treatment, and they are not respected or given adequate emotional support.

There is astounding disparity that exists between the prevalence of mental problems around the world and the resources available for mental health. Globally, only 2% of national budgets are devoted to mental health. Due to a lack of finances and the ability to adequately treat their patients, some nations merely have warehouses to serve as hospitals where patients are isolated from the rest of society. The few psychiatric hospitals that do exist in developing countries are frequently overcrowded, understaffed, and may not offer the necessary level of care. Most psychiatric hospitals are located in urban areas, away from family members, which increases social isolation and costs for families. Integrating mental health into primary health care could help solve these problems on a global scale.

Adolescents Mental Health

Mental health is as an ongoing issue for adolescents. Researchers claim that preventing mental health problems, which commonly start in adolescence, is both doable and necessary. Schools have emerged as an target for involvement due to the high number of young people who experience mental health issues and the low number of those who have access to expensive and time-consuming therapies. Studies have demonstrated that preventative programs that take place in clinics or other healthcare settings are more beneficial to teenagers, despite the possibility that they may be successful in schools. Social media may be a valuable resource for young people who are socially isolated and who are struggling with mental health issues. But, especially in girls and underrepresented groups, social media use has also been related to sadness, suicide, and self-harm.

By facilitating easier access to interventions and resources that have been scientifically proven effective as well as by simplifying some steps in the diagnostic, monitoring, and health indicators, digital technologies have the potential to revolutionise the way that services for young people with mental health issues are provided. There are many ways mental health can effects an adolescents directly and indirectly. Lower grades, conflicts with parents and a lack of social relationship are few of the indirect ways a child can be effects. Whereas, changes in mood states, is one sign of a direct affect of mental health on adolescents.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mental_health_inequality >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Socioeconomic Status and Mental Health

Published on by Andrew Marshall1 Comment

Introduction

Numerous studies around the world have found a relationship between socioeconomic status and mental health.

There are higher rates of mental illness in groups with lower socioeconomic status (SES), but there is no clear consensus on the exact causative factors. The two principal models that attempt to explain this relationship are the social causation theory, which posits that socioeconomic inequality causes stress that gives rise to mental illness, and the downward drift approach, which assumes that people predisposed to mental illness are reduced in socioeconomic status as a result of the illness. Most literature on these concepts dates back to the mid-1990s and leans heavily towards the social causation model.

Social Causation

The social causation theory is an older theory with more evidence and research behind it. This hypothesis states that one’s socioeconomic status (SES) is the cause of weakening mental functions. As Perry writes in The Journal of Primary Prevention, “members of the lower social classes experience excess psychological stress and relatively few societal rewards, the results of which are manifested in psychological disorder”. The excess stress that people with low SES experience could be inadequate health care, job insecurity, and poverty, which can bring about many other psycho-social and physical stressors like crowding, discrimination, crime, etc. Thus, lower SES predisposes individuals to the development of a mental illness.

Research

The Faris and Dunham (1939), Hollingshead and Redlich (1958), and Midtown Manhattan (1962) studies are three of the most influential in the debate between social causation and downward drift. They lend important evidence to the linear correlation between mental illness and SES, more specifically that a low SES produces a mental illness. The higher rates of mental illness in lower SES are likely due to the greater stress individuals experience. Issues that are not experienced in high SES, such as lack of housing, hunger, unemployment, etc., contribute to the psychological stress levels that can lead to the onset of mental illness. Additionally, while experiencing greater stress levels, there are fewer societal rewards and resources for those at the bottom of the socioeconomic ladder. The moderate economics assets available to those just one level above the lowest socioeconomic group allows them to take preventative action or treatment for psychoses. However, the hypothesis of the social causation model is disputed by the downward drift model.

Faris and Dunham (1939)

Faris and Dunham analysed the prevalence of mental disorders, including schizophrenia, in different areas of Chicago. The researchers plotted the homes of patients preceding their admission to hospitals. They found a remarkable increase of cases from the outskirts of the city moving inwards to the centre. This reflected other rates of distributions, such as unemployment, poverty and family desertion. They also found that cases of schizophrenia were most pervasive in public housing neighbourhoods as well as communities with higher numbers of immigrants. This was one of the first empirical, evidence-based studies supporting social causation theory.

Hollingshead and Redlich (1958)

Hollingshead and Redlich conducted a study in New Haven, Connecticut, that was considered a major breakthrough in this field of research. The authors identified anyone who was hospitalised or in treatment for mental illness by looking at files from clinics, hospitals, and the like. They were able to design a valid and reliable construct to relate these findings to social class using education and occupation as measures for five social class groups. Their results showed high disproportions of schizophrenia among the lowest social group. They also found that the lower people were on the scale of social class, the likelier they were to be admitted to a hospital for psychosis.

Midtown Manhattan Study (1962)

The study by Srole, Langer, Micheal, Opler, and Rennie, known as the Midtown Manhattan Study, has become a quintessential study in mental health. The main focus of the research was to “uncover [the] unknown portion of mental illness which is submerged in the community and thus hidden from sociological and psychiatric investigators alike”. The researchers managed to probe deep into the community to include subjects usually left out of such studies. The experimenters used both parental and personal SES to investigate the correlation between mental illness and social class. When basing their results on parental SES, approximately 33% of Midtown inhabitants in the lowest SES showed some signs of impairments in mental functioning while only 18% of the inhabitants in the highest SES showed these signs. When assessing the relationship based on personal SES, 47% of inhabitants in the lowest SES showed signs of weakening mental functions while only 13% of the highest SES demonstrated these symptoms. These findings remained the same for all ages and genders.

Downward Drift

In contrast to social causation, downward drift (also known as social selection) postulates that there is likely a genetic component that causes the onset of mental illness which may then lead to “a drift down into or fail to rise out of lower SES groups”. This means that a person’s SES level is a consequence rather than a cause of weakening mental functions. The downward drift theory shows promise specifically for individuals with a diagnosis of schizophrenia.

Research

Weich and Lewis (1998)

The Weich and Lewis study was conducted in the United Kingdom where researchers looked at 7,725 adults who had developed mental illnesses. They found that while low SES and unemployment may increase the length of psychiatric episodes they did not increase the likelihood of the initial psychotic break.

Isohanni et al. (2001)

In the Isohanni et al. longitudinal study in Finland, the researchers looked at patients treated in hospitals for mental disorders and who were aged between 16 and 29. The study followed the patients for 31 years and looked at how their illness affected their educational achievement. The study had a total of 80 patients and it compared patients who had been treated in the hospital for diagnoses of schizophrenia, and other psychotic or non-psychotic diagnoses, to those of the same 1966 birth cohort who had received no psychiatric treatment. They found that individuals who were hospitalised at 22 years or younger (early onset) were more likely to only complete a basic level of education and remain stagnant.

Some patients were able to complete secondary education, but none advanced to tertiary education. Those who had not been hospitalised had lower completion rates of basic education but much higher percentages of completing both secondary and tertiary education, 62% and 26%, respectively. This study suggests that mental disorders, especially schizophrenia, impede educational achievement. The inability to complete higher education may be one of the possible contributors to the downward drift in SES by individuals with mental illness.

Wiersma, Giel, De Jong and Slooff (1983)

The researchers in the Wiersma, Giel, De Jong and Slooff study looked at both educational and occupational attainment of patients with psychosis compared to their fathers. Researchers assessed both topic areas in the fathers as well as in the patients. In a two-year follow-up, the downward mobility in both education and occupation was greater than expected in the patients. Only a small percentage of patients were able to keep their job or find a new one after the onset of psychosis. Most of the individuals participating in the study had a lower SES than when they were born. This study also showed that the drift may begin with prodromal symptoms rather than at full onset.

Debate

Many researchers argue against the downward drift model, because unlike its counterpart, “it does not address the psychological stress of being impoverished and fails to validate that persistent economic stress can lead to psychological disturbance”. Mirowsky and Ross discuss in their book, Social Causes of Psychological Distress, that stress frequently stems from lack of control, or the feeling of lack of control, over one’s life. Those in lower SES have a minimal sense of control over the events that occur in their lives.

They argue that lack of control does not only stem from jobs with low income, but that “minority status also lowers the sense of control, partly because of lower education, income, and unemployment, and partly because any given level of achievement requires greater effort and provides fewer opportunities”. The arguments posed in their book support social causation since such high stress levels are involved. Although both models can be existing, they do not need to be mutually exclusive, researchers tend to agree that downward drift has more relevance to someone diagnosed with schizophrenia.

Implications for schizophrenia

Although social causation can explain some forms of mental illnesses, downward drift “has the greatest empirical support and is one of the cardinal features of schizophrenia”. The downward drift theory is more applicable to schizophrenia for a number of reasons. There are varying degrees of the disease, but once a psychotic break is experienced, the person often cannot function at the same level as before. This impairment affects all areas of life—education, occupation, social and family connections, etc. Due to the many challenges, patients will likely drift to a lower SES because they are unable to keep up with previous standards.

Another reason why the downward drift theory is preferred is that, unlike other mental illnesses such as depression, once someone is diagnosed with schizophrenia they have the diagnosis for life. While symptoms may not be constant, “individuals with this diagnosis often experience cycles of remission and relapse throughout their lives”.

This explains the large discrepancy between the incidence of schizophrenia and prevalence of the disease. There is a very low rate of new cases of schizophrenia in comparison to the number of total cases because “it often starts in early adult life and becomes chronic”. Patients will usually function at a lower level once the illness has manifested itself. Even with the help of antipsychotic medication and psycho-social support, most patients will still experience some symptoms making moving up out of a lower SES nearly impossible.

Another possible explanation discussed in literature regarding the relation between the downward drift theory and schizophrenia is the stigma associated with mental illness. Individuals with mental illness are often treated differently, usually negatively, by their community. Although great strides have been made, mental illness is often unfavourably stigmatised. As Livingston explains, “stigma can produce a negative spiraling effect on the life course of people with mental illnesses, which tends to create…a decline in social class”.

Individuals who develop schizophrenia cannot function at the level they are used to, and “are particularly likely to experience the effects of ostracism, being amongst the most stigmatized of all the mental illnesses.” The complete exclusion they experience helps to maintain their new lower status, preventing any upward mobility. The downward drift theory may be mainly applicable to schizophrenia; however, it may also apply to other mental illnesses since each is accompanied by a negative stigma.

While it can be hard to maintain status once the schizophrenia appears, some individuals are able to resist a downward drift, particularly if they start out at a higher SES. For example, if a person is from a high SES, they have the ability to access preventative resources and possible treatment for the disease which can help buffer the drift downwards and help maintain their status. It is also important for those with schizophrenia to have a strong network of friends and family because friends and family may notice signs of the illness before full onset. For example, individuals that are married show less of a drift downwards than those who are not. Individuals who do not have a support system may show early signs of psychotic symptoms that go unnoticed and untreated.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Socioeconomic_status_and_mental_health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.