Structural Disadvantage and Culture, Race, and Ethnicity in Early Psychosis Services: International Provider Survey.

OBJECTIVE: Little is known about provider perspectives on programmatic responses to structural disadvantage and cultural differences within early intervention in psychosis (EIP) services, programs, and models. The primary objective of this study was to investigate providers' perspectives on the impacts of disadvantage and minority race, ethnicity, and culture and to describe current practices and perceived gaps and concerns. METHODS: An online survey of specialized EIP providers was disseminated in the United Kingdom, United States, Canada, Australia, and Chile. A total of 164 providers, representing 110 unique sites, completed the survey. Closed-ended questions gathered demographic and program data, including information on formal assessment of trauma or adversity, integration of trauma-informed care, integration of formal cultural assessment tools, training focused on culture, programmatic changes to address culture-related issues, and consultation with cultural insiders. Open-ended questions addressed the demographic mix of the program's client population; the perceived role and influence of trauma, structural disadvantage, and cultural differences; and concerns and needs related to these topics. Frequencies were examined for closed-ended items; open-ended responses were systematically coded. RESULTS: Overall, survey findings suggested low levels of implementation of a variety of assessment and support practices related to cultural diversity in EIP programs. Coding of open-ended responses revealed numerous concerns regarding the impacts of disadvantage and cultural difference on clients and perceived gaps in policy and implementation. CONCLUSIONS: An expansion of research and service development aimed at better meeting the disadvantage- and culture-related needs of young people with early psychosis and their families should be a priority for the field.

Voting rights for persons with serious mental illnesses in the U.S.

OBJECTIVE: Voting is a fundamental right in democratic societies. Despite this fact, persons with serious mental illnesses (SMIs) frequently encounter barriers to exercising this right. The purposes of this Brief Report are to emphasize the importance of electoral participation in this population, to describe common barriers, and to outline relevant federal and state laws. METHOD: We conducted a review of the relevant psychological and legal literature. FINDINGS: Due to the structural barriers that they encounter, individuals with SMIs are less likely to vote than the general population. Federal laws that protect voting rights for persons with disabilities are the Equal Protection Clause of the Fourteenth Amendment, the Americans With Disabilities Act, Section 504 of the Rehabilitation Act, the Help America Vote Act, the Voting Rights Act, and the National Voter Registration Act. State laws concerning voter competence, photo IDs, voter challenges, and incarceration practices can affect the electoral participation of persons with SMIs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: We offer recommendations for mental health professionals and other stakeholders who are interested in addressing barriers and engaging in advocacy efforts that might increase voting opportunities among persons diagnosed with SMIs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Home Groups: Integrating Peer Support and Clinical Care in a Community Mental Health Center.

With peer supporters now comprising one of the most rapidly growing components of the mental health workforce, group interventions that combine their expertise with those of more traditional mental health providers are needed. An example of one such intervention, developed and implemented at a large community mental health center for individuals with serious mental illnesses, is presented. Called a "Home Group" and co-led by peers and clinical psychology interns, this intervention provides unique learning opportunities for peers and trainees and many potential benefits to group members. Vignettes to illustrate the model are presented and the potential therapeutic and empowering aspects of this innovative and promising approach are identified and discussed.

The Duration of Untreated Psychosis: A Phenomenological Study.

Mounting evidence has indicated that early intervention leads to improved clinical and functional outcomes for young persons experiencing recent onset psychosis. As part of a large early detection campaign, the present study aimed to investigate subjective experiences during the duration of untreated psychosis (DUP), or time between psychosis onset and treatment contact. Participants were 10 young adults participating in early intervention services for psychosis. After DUP was estimated during standardized baseline assessment, participants engaged in qualitative interviews focused on their life experiences prior to treatment and leading up to the present. Mixed methods data analyses compared standardized DUP estimates with participants' subjective narratives. Findings revealed that participants experienced and conceptualized a longer trajectory of subjective difficulties (TSD) beginning before and extending beyond standardized DUP estimates. Participants emphasized striving for independence and social belonging. The majority of participants reported benefiting from their current services and believed that earlier support of some kind would have been beneficial. These findings support previous research on subjective barriers to early detection and treatment seeking in young adults experiencing psychosis. Implications and future research directions include further efforts to differentiate the struggles unique to early psychosis from psychosocial risk factors and other challenges of young adulthood.

A clinical study of the intergenerational transmission of eating disorders from mothers to daughters.

Clinicians and researchers have long recognized the existence of eating disorders in very young children, including infants whose mothers have eating disorders. This paper combines reviews of the literature relevant to the study of eating disorders from the perspectives of both research and psychoanalytic theory in order to explore the psychodynamics of the intergenerational transmission of eating-disordered pathology from mother to child. A developmental pathway as well as several mechanisms that illuminate the pathogenesis of the intergenerational transmission of eating disorders are proposed and described. Clinical-observational data from a therapeutic play nursery for mothers with eating disorders and their children are presented, and this material is examined in relation to the proposed psychodynamic pathways of transmission.

Stock-still behavior: a potential developmental marker.

During the course of a pilot study of toddlers' behavior and play, the experimenters observed a previously undocumented behavior. This behavior now labeled "stock-still" behavior, was noted at the age of 17.5 months and consisted of the toddlers' standing motionless at or near the doorway of a nursery when previously they had marched, seemingly intrepid, into the room on their own. A prospective study of eight children was undertaken to test the hypothesis that this behavior reliably occurs at a set time during the child's development. Analysis of videotape footage determined that the behavior did not occur as an isolated event but instead was part of a series of one to six individual events within a window spanning two to eight weeks, during a discrete period of time from ages 15.5 months to 18.5 months. It was hypothesized that this behavior may be a developmental marker of the moment when a toddler cognitively and affectively registers the differences between "inside" and "outside," self and other and inner space and outer space. This developmental step is manifested behaviorally as the child's ability to inhibit her responses to previously compelling external stimuli. This hypothesis, as well as its limitations, is herein discussed, and additional clarifying observations are suggested.