Homelessness, behavioral health disorders and intimate partner violence: barriers to services for women.

Homeless women comprise a significant portion of the homeless population and may encounter multiple life stressors including mental illness, substance abuse, and trauma. Women who are homeless may experience difficulty gaining access to resources such as shelter and health care. In addition, the interaction of behavioral health problems with intimate partner violence (IPV) may create extraordinary barriers to their engagement in services. This paper explores the co-occurrence of homelessness, behavioral health problems, and IPV and lessons learned through a gender-specific homeless services program designed to reach women who are unengaged in traditional services. Recommendations for providing gender-responsive services are discussed.

Becoming expert and understanding mental illness.

In the process of becoming an expert in the mental health field the newcomer, through reading, lectures, and supervision, is taught what to notice and how to structure and conceptualize that information. A less recognized part of this learning process is that the newcomer is also taught, explicitly or implicitly, what not to notice, what not to pay attention to. Much of the subjectivity of the newcomer and of the patients and clients he or she sees is pushed, purposely or not, out of the way and is then lost to view. Although these experiences may help the newcomer survive and manage in a complex and difficult world, they also lead to ignoring potentially crucial information. Given how difficult it is at best to know another human being, ignoring available information is particularly unfortunate. In what often appears to be the learning of an important scientific--and objective approach, much data become ignored, potentially leading to a very unscientific "expertise." In this report by making use of first person reports and creative writings, we will describe instances to illustrate how this process takes place and what can be lost or ignored in the effort to be objective and scientific and the implications of this problem for the eventual practice, teaching, or research carried out by the person becoming an expert.

Play, pleasure, and other positive life events: "non-specific" factors in recovery from mental illness?

As part of the emerging recovery paradigm, there is an increasing need for psychiatric treatment and rehabilitation to be strengths-based and to be driven by the desires and preferences of the person with mental illness. Yet if mental illness is a brain disease, it is not at all clear how these characteristics contribute to improvement in the person's condition or influence the course and outcome of the disorder. To avoid these aspects being relegated to the role of nonspecific factors, the field must develop an understanding of the role of strengths and interests in recovery. To contribute to this effort, we review the existing empirical research on the protective and stress-buffering effects of positive life events and qualitative data on the importance of play and pleasure in the lives of people with mental illness. We conclude by considering briefly the implications of this research for clinical practice.