Mental Illness Discrimination in Mental Health Treatment Programs: Intersections of Race, Ethnicity, and Sexual Orientation.

People with mental illnesses (PWMI) who are of color and/or lesbian, gay, or bisexual (LGB) experience mental health disparities, including within mental health treatment programs (MHTPs). Informed by a critical framework with attention to intersectionality and microaggressions, this qualitative study asked 20 PWMI and family members who also are of color and/or LGB whether they had experienced mental illness discrimination in MHTPs, a possible factor in disparities. We also asked participants about aspects of MHTPs that supported recovery. Participants reported that they were ignored/not listened to, not viewed as complex individuals, experienced condescension/lack of respect and violations of privacy or other rights, and were presumed to lack intelligence. In addition, identifying mental illness discrimination was complex due to intersections of identities. Despite these perceptions of discrimination, participants described supportive aspects of MHTPs. Implications for practice and research are offered.

Mental health issues in recently returning women veterans: implications for practice.

Increasing numbers of women are found in the military, and they are now performing roles very similar to those of male service members. More returning servicewomen and veterans have been exposed to stressful and traumatic experiences, such as combat and difficult living circumstances, and military sexual trauma is common. These experiences have been found to be associated with adverse mental health outcomes, posttraumatic stress disorder, depression, and substance abuse in particular. Comorbidity rates are also high. In addition, more veterans are returning with injuries, including traumatic brain injuries. Although more women veterans of Operation Enduring Freedom and Operation Iraqi Freedom are seeking health services at Veterans Administration facilities, many are not. Thus, community-based social workers need to be familiar with the needs of this growing population to serve them effectively. Use of empirically supported assessment instruments and screening for military sexual trauma are recommended. Recommended interventions include the use of evidence-supported practices, such as cognitive-behavioral treatment, and offering assistance to enhance social support among women veterans.

Peer employees' and clinicians' perceptions of public mental illness stigma and discrimination.

OBJECTIVE: Stigma and discrimination against people with mental illnesses are serious problems that can lead to many negative effects. This study examined providers' awareness of consumers' daily lived experience of discrimination. METHOD: We surveyed 51 peer employees and 52 licensed clinicians to learn how they viewed the extent of public stigma and discrimination. RESULTS: Clinicians, women, and those who had observed a friend with a mental illness treated unfairly perceived significantly higher levels of public discrimination than did their counterparts (adjusted R² = .399, p < .001). Men's perceptions of public discrimination were more strongly affected by personal contact. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Mental health providers are uniquely situated to help consumers deal with the effects of discrimination and should incorporate this issue into their clinical practice. Further research should examine the reasons for differences in perception and how these differences relate to provider behavior and consumer outcomes.

Stigma in the mental health workplace: perceptions of peer employees and clinicians.

Informed by a structural theory of workplace discrimination, mental health system employees' perceptions of mental health workplace stigma and discrimination against service recipients and peer employees were investigated. Fifty-one peer employees and 52 licensed behavioral health clinicians participated in an online survey. Independent variables were employee status (peer or clinician), gender, ethnicity, years of mental health employment, age, and workplace social inclusion of peer employees. Analysis of covariance on workplace discrimination against service recipients revealed that peer employees perceived more discrimination than clinicians and whites perceived more discrimination than employees of color (corrected model F = 9.743 [16, 87], P = .000, partial ŋ (2) = .644). Analysis of covariance on workplace discrimination against peer employees revealed that peer employees perceived more discrimination than clinicians (F = 4.593, [6, 97], P = .000, partial ŋ (2) = .223).

Conation: a missing link in the strengths perspective.

Conation is action derived from instinct, purposeful mode of striving, volition. It is a conscious effort to carry out self-determined acts and, as such, may result in the same goal being approached by different individuals through the use of different actions. It is a critical, yet neglected aspect of the "tripartite" human mind, which is composed of cognitive, affective, and conative elements. Because most social workers are not familiar with the concept, client behavior that represents action toward a goal might not be understood or might be misunderstood. A true strengths-based approach to social work requires this understanding. The authors use case studies to describe conation and to demonstrate its applicability. They present examples of how clients' and social workers' conative ability are important to the assessment and intervention process and describe implications for research.

Parents with co-occurring mental health and substance abuse conditions involved in Child Protection Services: clinical profile and treatment needs.

This article reports findings of an exploratory study of 71 parents with substance abuse conditions involved in a child dependency court. Over half (59%) of the parents had a co-occurring mental health condition. Parents with co-occurring conditions (PWCC) differed in several important ways from those with only substance abuse conditions. PWCC were also more likely than their case managers were to report a need for mental health treatment. Implications for child welfare practice and research are offered.

Promoting reduced and discontinued substance use among adolescent substance users: effectiveness of a universal prevention program.

Efforts to address youth substance use have focused on prevention among non-users and treatment among severe users with less attention given to youth occupying the middle ground who have used substances but not yet progressed to serious abuse or addiction. Using a sample from 35 middle schools of 1,364 youth who reported using substances, this study examined the effectiveness of a universal youth substance use prevention program, the SAMHSA Model Program keepin' it REAL, in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. Discrete-time event history methods modeled the rates of reduced and recently discontinued use across four waves of data. Each substance (alcohol, cigarettes, and marijuana) was modeled separately. Beginning at the second wave, participants who reported use at wave 1 were considered at risk of reducing or discontinuing use. Since the data sampled students in schools, multi-level models accounted for the nesting of data at the school level. Results indicated that prevention program participation influenced the rates of reduced and recently discontinued use only for alcohol, controlling for baseline use severity, age, grades, socioeconomic status, ethnicity and gender. Among youth who reported use of alcohol in wave 1 (N=1,028), the rate of reducing use for program participants was 72% higher than the rate for control students. The rate of discontinuing use was 66% higher than the rate for control students. Among youth who reported use of one or more of the three substances in wave 1 (N=1,364), the rate of discontinuing all use was 61% higher for program participants than for control students. Limitations and implications of these findings and plans for further research are discussed.

Psychiatric rehabilitation: an empowerment-based approach to mental health services.

Psychiatric rehabilitation is a framework for providing services to people with mental illness that encourages adaptive community functioning in all life domains. Despite its well-established inclusion in community mental health treatment programs, psychiatric rehabilitation has received little attention in the discipline-specific social work literature. The philosophical base of psychiatric rehabilitation is built around the principles of empowerment, competence, and recovery. Its goal of promoting adaptive community functioning is consistent with social work values and contemporary social work practice models. This article provides an overview of the history, philosophy, and services components of psychiatric rehabilitation and analyzes its compatibility with social work. Further integration of psychiatric rehabilitation and social work services is suggested.

Is social work's door open to people recovering from psychiatric disabilities?

Social workers are the major providers of mental health services in the United States, yet the profession has been reluctant to include recovering consumers in its ranks. This article contrasts social work's historic focus on the deficits believed to be inherent in colleagues' history of psychiatric disorder with an empowerment perspective. The article describes perceived risks and benefits to clients when the social worker has a history of a psychiatric disorder. It reviews recovering consumers' successful roles as paraprofessionals in mental health services delivery as a demonstration of the strengths consumers bring to the mental health field. Finally, it identifies barriers to social work employment faced by the social worker who has a history of a psychiatric disability.