Facing Suicide (2022)

Introduction

Explore the crisis of suicide, including risk factors and prevention strategies.

Outline

Facing Suicide combines the poignant personal stories of people impacted by suicide with profiles of scientists at the forefront of research to reveal new insights into one of America’s most pressing mental health crises. Shining a light on this difficult topic can destigmatise suicide while revealing that there is help as well as hope for those at risk and their loved ones.

988 Suicide & Crisis Lifeline

If you are considering suicide, or if you or someone you know is in emotional crisis, please call or text 988. The 988 Suicide & Crisis Lifeline is a national network of local crisis centres that provides free and confidential emotional support to people in suicidal crisis or emotional distress.

Production & Filming Details

  • Narrator(s):
    • Josh Charles
  • Director(s):
    • James Barrat
  • Producer(s):
  • Writer(s):
  • Music:
  • Cinematography:
  • Editor(s):
  • Production:
    • Twin Cities PBS
    • PBS Distribution
  • Distributor(s):
    • PBS Distribution.
  • Release Date: 25 October 2022.
  • Running Time: 60 minutes.
  • Rating: Unknown (but contains Mature content).
  • Country: US.
  • Language: English.

What is Quality of Life?

Introduction

Quality of life (QOL) is defined by the World Health Organisation (WHO) as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”.

Standard indicators of the quality of life include wealth, employment, the environment, physical and mental health, education, recreation and leisure time, social belonging, religious beliefs, safety, security and freedom. QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. Health related QOL (HRQOL) is an evaluation of QOL and its relationship with health.

Refer to Physical Quality of Life Index.

Engaged Theory

One approach, called engaged theory, outlined in the journal of Applied Research in the Quality of Life, posits four domains in assessing quality of life:

  1. Ecology;
  2. Economics;
  3. Politics; and
  4. Culture.

In the domain of culture, for example, it includes the following subdomains of quality of life:

  • Beliefs and ideas
  • Creativity and recreation
  • Enquiry and learning
  • Gender and generations
  • Identity and engagement
  • Memory and projection
  • Well-being and health

Under this conception, other frequently related concepts include freedom, human rights, and happiness. However, since happiness is subjective and difficult to measure, other measures are generally given priority. It has also been shown that happiness, as much as it can be measured, does not necessarily increase correspondingly with the comfort that results from increasing income. As a result, standard of living should not be taken to be a measure of happiness. Also sometimes considered related is the concept of human security, though the latter may be considered at a more basic level and for all people.

Quantitative Measurement

Unlike per capita GDP or standard of living, both of which can be measured in financial terms, it is harder to make objective or long-term measurements of the quality of life experienced by nations or other groups of people. Researchers have begun in recent times to distinguish two aspects of personal well-being: Emotional well-being, in which respondents are asked about the quality of their everyday emotional experiences – the frequency and intensity of their experiences of, for example, joy, stress, sadness, anger and affection – and life evaluation, in which respondents are asked to think about their life in general and evaluate it against a scale. Such and other systems and scales of measurement have been in use for some time. Research has attempted to examine the relationship between quality of life and productivity. There are many different methods of measuring quality of life in terms of health care, wealth, and materialistic goods. However, it is much more difficult to measure meaningful expression of one’s desires. One way to do so is to evaluate the scope of how individuals have fulfilled their own ideals. Quality of life can simply mean happiness, the subjective state of mind. By using that mentality, citizens of a developing country appreciate more since they are content with the basic necessities of health care, education and child protection.

According to ecological economist Robert Costanza:

While Quality of Life (QOL) has long been an explicit or implicit policy goal, adequate definition and measurement have been elusive. Diverse “objective” and “subjective” indicators across a range of disciplines and scales, and recent work on subjective well-being (SWB) surveys and the psychology of happiness have spurred renewed interest.

Human Development Index

Perhaps the most commonly used international measure of development is the Human Development Index (HDI), which combines measures of life expectancy, education, and standard of living, in an attempt to quantify the options available to individuals within a given society. The HDI is used by the United Nations (UN) Development Programme in their Human Development Report. However, since year 2010, The Human Development Report introduced an Inequality-adjusted Human Development Index (IHDI). While the original HDI remains useful, it stated that:

“the IHDI is the actual level of human development (accounting for inequality), while the original HDI can be viewed as an index of ‘potential’ human development (or the maximum level of HDI) that could be achieved if there was no inequality.”

World Happiness Report

The World Happiness Report is a landmark survey on the state of global happiness. It ranks 156 countries by their happiness levels, reflecting growing global interest in using happiness and substantial well-being as an indicator of the quality of human development. Its growing purpose has allowed governments, communities and organisations to use appropriate data to record happiness in order to enable policies to provide better lives. The reports review the state of happiness in the world today and show how the science of happiness explains personal and national variations in happiness.

Developed again by the UN and published recently along with the HDI, this report combines both objective and subjective measures to rank countries by happiness, which is deemed as the ultimate outcome of a high quality of life. It uses surveys from Gallup, real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, freedom from corruption, and generosity to derive the final score. Happiness is already recognised as an important concept in global public policy. The World Happiness Report indicates that some regions have in the past been experiencing progressive inequality of happiness.

Other Measures

The Physical Quality of Life Index (PQLI) is a measure developed by sociologist M.D. Morris in the 1970s, based on basic literacy, infant mortality, and life expectancy. Although not as complex as other measures, and now essentially replaced by the Human Development Index, the PQLI is notable for Morris’s attempt to show a “less fatalistic pessimistic picture” by focusing on three areas where global quality of life was generally improving at the time, while ignoring gross national product and other possible indicators that were not improving.

The Happy Planet Index, introduced in 2006, is unique among quality of life measures in that, in addition to standard determinants of well-being, it uses each country’s ecological footprint as an indicator. As a result, European and North American nations do not dominate this measure. The 2012 list is instead topped by Costa Rica, Vietnam and Colombia.

In 2010, Gallup researchers trying to find the world’s happiest countries found Denmark to be at the top of the list. For the period 2014-2016, Norway surpasses Denmark to be at the top of the list. uSwitch publishes an annual quality of life index for European countries. France topped the list from 2009 to 2011.

A 2010 study by two Princeton University professors looked at 1,000 randomly selected US residents over an extended period. It concludes that their life evaluations – that is, their considered evaluations of their life against a stated scale of one to ten – rise steadily with income. On the other hand, their reported quality of emotional daily experiences (their reported experiences of joy, affection, stress, sadness, or anger) levels off after a certain income level (approximately $75,000 per year in 2010); income above $75,000 does not lead to more experiences of happiness nor to further relief of unhappiness or stress. Below this income level, respondents reported decreasing happiness and increasing sadness and stress, implying the pain of life’s misfortunes, including disease, divorce, and being alone, is exacerbated by poverty.

Gross national happiness and other subjective measures of happiness are being used by the governments of Bhutan and the United Kingdom. The World Happiness report, issued by Columbia University is a meta-analysis of happiness globally and provides an overview of countries and grassroots activists using GNH. The OECD (Organisation for Economic Co-operation and Development) issued a guide for the use of subjective well-being metrics in 2013. In the US, cities and communities are using a GNH metric at a grassroots level.

The Social Progress Index measures the extent to which countries provide for the social and environmental needs of their citizens. Fifty-two indicators in the areas of basic human needs, foundations of wellbeing, and opportunity show the relative performance of nations. The index uses outcome measures when there is sufficient data available or the closest possible proxies.

Day-Reconstruction Method was another way of measuring happiness, in which researchers asked their subjects to recall various things they did on the previous day and describe their mood during each activity. Being simple and approachable, this method required memory and the experiments have confirmed that the answers that people give are similar to those who repeatedly recalled each subject. The method eventually declined as it called for more effort and thoughtful responses, which often included interpretations and outcomes that do not occur to people who are asked to record every action in their daily lives.

Liveability

The term quality of life is also used by politicians and economists to measure the liveability of a given city or nation. Two widely known measures of liveability are the Economist Intelligence Unit’s Where-to-be-born Index and Mercer’s Quality of Living Reports. These two measures calculate the liveability of countries and cities around the world, respectively, through a combination of subjective life-satisfaction surveys and objective determinants of quality of life such as divorce rates, safety, and infrastructure. Such measures relate more broadly to the population of a city, state, or country, not to individual quality of life. Liveability has a long history and tradition in urban design, and neighbourhoods design standards such as LEED-ND are often used in an attempt to influence liveability.

Crimes

Some crimes against property (e.g., graffiti and vandalism) and some “victimless crimes” have been referred to as “quality-of-life crimes.” American sociologist James Q. Wilson encapsulated this argument as the broken windows theory, which asserts that relatively minor problems left unattended (such as litter, graffiti, or public urination by homeless individuals) send a subliminal message that disorder, in general, is being tolerated, and as a result, more serious crimes will end up being committed (the analogy being that a broken window left broken shows an image of general dilapidation).

Wilson’s theories have been used to justify the implementation of zero tolerance policies by many prominent American mayors, most notably Oscar Goodman in Las Vegas, Richard Riordan in Los Angeles, Rudolph Giuliani in New York City and Gavin Newsom in San Francisco. Such policies refuse to tolerate even minor crimes; proponents argue that this will improve the quality of life of local residents. However, critics of zero tolerance policies believe that such policies neglect investigation on a case-by-case basis and may lead to unreasonably harsh penalties for crimes.

In Healthcare

Within the field of healthcare, quality of life is often regarded in terms of how a certain ailment affects a patient on an individual level. This may be a debilitating weakness that is not life-threatening; life-threatening illness that is not terminal; terminal illness; the predictable, natural decline in the health of an elder; an unforeseen mental/physical decline of a loved one; or chronic, end-stage disease processes. Researchers at the University of Toronto’s Quality of Life Research Unit define quality of life as “The degree to which a person enjoys the important possibilities of his or her life” (UofT). Their Quality of Life Model is based on the categories “being”, “belonging”, and “becoming”; respectively who one is, how one is connected to one’s environment, and whether one achieves one’s personal goals, hopes, and aspirations.

Experience sampling studies show substantial between-person variability in within-person associations between somatic symptoms and quality of life. Hecht and Shiel measure quality of life as “the patient’s ability to enjoy normal life activities” since life quality is strongly related to wellbeing without suffering from sickness and treatment. There are multiple assessments available that measure Health-Related Quality of Life, e.g. AQoL-8D, EQ5D – Euroqol, 15D, SF-36, SF-6D, HUI.

In International Development

Quality of life has been deemed an important concept in the field of international development because it allows development to be analysed on a measure that is generally accepted as more comprehensive than standard of living. Within development theory, however, there are varying ideas concerning what constitutes desirable change for a particular society. The different ways that quality of life is defined by institutions, therefore, shape how these organisations work for its improvement as a whole.

Organisations such as the World Bank, for example, declare a goal of “working for a world free of poverty”, with poverty defined as a lack of basic human needs, such as food, water, shelter, freedom, access to education, healthcare, or employment. In other words, poverty is defined as a low quality of life. Using this definition, the World Bank works towards improving quality of life through the stated goal of lowering poverty and helping people afford a better quality of life.

Other organisations, however, may also work towards improved global quality of life using a slightly different definition and substantially different methods. Many non-governmental organisations (NGOs) do not focus at all on reducing poverty on a national or international scale, but rather attempt to improve the quality of life for individuals or communities. One example would be sponsorship programmes that provide material aid for specific individuals. Although many organisations of this type may still talk about fighting poverty, the methods are significantly different.

Improving quality of life involves action not only by NGOs but also by governments. Global health has the potential to achieve greater political presence if governments were to incorporate aspects of human security into foreign policy. Stressing individuals’ basic rights to health, food, shelter, and freedom addresses prominent inter-sectoral problems negatively impacting today’s society and may lead to greater action and resources. Integration of global health concerns into foreign policy may be hampered by approaches that are shaped by the overarching roles of defence and diplomacy.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Quality_of_life >; 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.

Matt Willis: Fighting Addiction (2023)

Introduction

This raw documentary sees Busted’s Matt Willis open up about his struggles with addiction and the pressure it puts on his family, as well as looking into what helps him and others stay clean.

Outline

Musician, actor and dad of three Matt Willis may seem to have it all. He’s part of the hugely successful noughties pop band, Busted, has a flourishing acting career and is happily married to TV presenter Emma Willis, with whom he has three kids. But behind the success, there is one thing that often dominates his thoughts – his addictions. In this raw and honest documentary, Matt opens up about his past and takes an extensive look into his battle with drugs and alcohol, how it has pushed him to the edge, and his daily struggle to keep himself clean and sober. Matt talks about how he constantly lives with the fear of relapse and the pressure that puts on himself and his family.

The film looks back at some of Matt’s darkest days as he begins to explore what could be behind his addiction. Through meeting and talking with others, he tries to understand why he and fellow addicts become dependent on drugs and alcohol, what help is available, and what the latest developments in treatment are. Matt and his brother revisit their childhood home to see if the roots of his addictions can be found in their past.

He visits the rehab unit on the south coast that made a real difference to his recovery and where he spent four weeks in 2008 before his marriage to Emma Willis, coming out the day before his wedding, clean and sober. He joins a meeting at the centre, talking with current clients about their addiction and recovery experiences. Matt also travels to Imperial College London to meet a research team who are studying the differences between the brains of people in addiction and those of people who aren’t, and looks at treatments to help people in the long and often difficult road to recovery.

As well as his personal journey, the film captures the unwavering support Matt has from his bandmates, friends and family, in particular his wife Emma. Together, he and Emma travel to a leading charity in Glasgow that supports the relatives of addicts. Here, they meet the children, parents and spouses of people struggling with addictions.

Matt’s exploration of his addictions in this film comes at a time when he and Busted are preparing for their reunion tour, an environment that in the past has put him at risk of relapse. Can he get himself to a place where he feels comfortable and confident going on tour, and remain clean and sober? And through looking into the various possible reasons for his addictions, as well as some of the methods available to help ease them, can he help himself and others find peace in their daily battle with addiction?

Production & Filming Details

  • Narrator(s):
  • Director(s):
  • Producer(s):
  • Writer(s):
  • Music:
  • Cinematography:
  • Editor(s):
  • Production:
  • Distributor(s):
    • BBC One and BBC iPlayer
  • Release Date: 17 May 2023.
  • Running Time: 59 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

The Consultant (2022)

Introduction

The Consultant is a thriller TV series by director Ignacio Maiso.

Outline

A psychiatrist relives all of his past fears with the arrival of three new patients.

Cast

  • John-Christian Bateman … David
  • Rebecca Calienda … Sharon
  • Katie Dalton … Kate
  • Gareth Lawrence … Mike
  • Alex Reece … John
  • David Stock … John
  • Sindri Swan … Delivery guy

Production & Filming Details

  • Director(s):
    • Ignacio Maiso
  • Producer(s):
    • Agustin Maiso … executive producer
    • Ignacio Maiso … executive producer
    • Danny Mounsey … producer
    • David Stock … associate producer
  • Writer(s):
    • Ignacio Maiso
  • Music:
    • Ben Cook
  • Cinematography:
    • Milos Moore
  • Editor(s):
    • Chiraag Patel
  • Production:
    • Tractorni Productions
  • Distributor(s):
  • Release Date: 26 October 2022 (Internet).
  • Running Time: 97 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

Currently unavailable.

What is Meant by a Mental Environment?

Introduction

The mental environment refers to the sum of all societal influences upon mental health.

Refer to An Overview of Environmental Psychology, Healing Environments, and Healthy Building.

Outline

The term is often used in a context critical of the mental environment in industrialised societies. It is argued that just as industrial societies produce physical toxins and pollutants which harm humans physical health, they also produce psychological toxins (e.g. television, excessive noise, violent marketing tactics, Internet addiction, social media) that cause psychological damage.

This poor mental environment may help explain why rates of mental illness are reportedly higher in industrial societies which might also have its roots in poor educational environment and mechanical routinised life present. Magico-religious beliefs are an important contribution of such communal settings. Delusions such as these rooted from childhood are often hard to completely regulate from a person’s life.

The idea has its roots in evolutionary psychology, as the deleterious consequences of a poor mental environment can be explained by the mismatch between the mental environment humans evolved to exist within and the one they exist within today.

“We live in both a mental and physical environment. We can influence the mental environment around us, but to a far greater extent we are influenced by the mental environment. The mental environment contains forces that affect our thinking and emotions and that can dominate our personal minds.” Marshall Vian Summers

Further Reading

Gebelein, B. (2007). The Mental Environment (Mostly about Mind Pollution). 1st Ed. Omdega Press. ISBN 978-0-9614611-2-6.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Mental_environment >; 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 Greyhound Therapy?

Introduction

Greyhound therapy is a pejorative term used in the US health care system since the mid-1960s to refer to mental health authorities’ buying a ticket on a Greyhound Lines bus to get rid of possible “troublemaker” patients.

The practice is still in use in certain mental-health circles.

Diesel therapy or motorcoach therapy are similar terms for the practice and are usually used pejoratively.

Refer to Homelessness and Mental Health.

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.

An Overview of Homelessness and Mental Health

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

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.

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

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.

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)

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.