Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20084

Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems

A new evidence base is emerging, which focuses on well-being. This makes it possible for health services to orientate around promoting well-being as well as treating illness, and so to make a reality of the long-standing rhetoric that health is more than the absence of illness. The aim of this paper is to support the re-orientation of health services around promoting well-being. Mental health services are used as an example to illustrate the new knowledge skills which will be needed by health professionals. New forms of evidence give a triangulated understanding about the promotion of well-being in mental health services. The academic discipline of positive psychology is developing evidence-based interventions to improve well-being. This complements the results emerging from synthesising narratives about recovery from mental illness, which provide ecologically valid insights into the processes by which people experiencing mental illness can develop a purposeful and meaningful life. The implications for health professionals are explored. In relation to working with individuals, more emphasis on the person's own goals and strengths will be needed, with integration of interventions which promote well-being into routine clinical practice. In addition, a more societally-focussed role for professionals is envisaged, in which a central part of the job is to influence local and national policies and practices that impact on well-being. If health services are to give primacy to increasing well-being, rather than to treating illness, then health workers need new approaches to working with individuals. For mental health services, this will involve the incorporation of emerging knowledge from recovery and from positive psychology into education and training for all mental health professionals, and changes to some long-established working practices.

/pdf/mental-illness-and-well-being-the-central-importance-of-3id2thyzct.pdf

Mental illness and well-being: the central importance of positive psychology and recovery approaches

Patient-Centered Medicine: Transforming the Clinical Method

1. History, Critique, and Useful Conceptions: Toward a Strengths Paradigm 2. A Beginning Theory of Strengths 3. The Purpose, Principles, and Research Results of the Strengths Model 4. Engagement and Relationship: A New Partnership 5. Strengths Assessment: Amplifying the Well Part of the Individual 6. Personal Planning: Creating the Achievement Agenda 7. Resource Acquisition: Putting Community Back into Community Mental Health 8. Supportive Case Management Context: Creating the Conditions for Effectiveness 9. Strenghts Model Epilogue: Commonly Asked Questions (Objections) and Managed Care

The Strengths Model: Case Management with People with Psychiatric Disabilities

Foreword, Patricia Deegan Preface 1. History, Critique, and Useful Conceptions: Toward a Strengths Paradigm 2. A Beginning Theory of Strengths 3. The Purpose, Principles, and Research Results of the Strengths Model 4. Engagement and Relationship: A New Partnership 5. Strengths Assessment: Amplifying the Well Part of the Individual 6. Personal Planning: Creating the Achievement Agenda 7. Resource Acquisition: Putting Community Back into Community Mental Health 8. Supportive Case Management Context: Creating the Conditions for Effectiveness 9. Strengths Model Epilogue: Commonly Asked Questions (Objections) Appendix I. Spirit-Breaking Behaviors Appendix II. Hope-Inducing Behaviors Appendix III. Areas to Explore Through the Strengths Assessment Appendix IV. Quality Review of Strengths Assessment Appendix V. Strengths Model Core Competencies Evaluation Tool Appendix VI. Strengths Model Case Management Fidelity Scale References Index

The Strengths Model: A Recovery-Oriented Approach to Mental Health Services

This paper identifies ten principles or active ingredients of case management that are common to interventions that produced statistically significant positive outcomes for people with serious psychiatric disabilities. Twenty-two studies employing experimental or quasi-experimental designs were selected for inclusion in this review. The use of the principles for systems design is briefly discussed. The term case management is used throughout this article because it is the term that is used in the studies reviewed. We acknowledge that this term is considered pejorative to many people with psychiatric disabilities. People with psychiatric disabilities are not "cases" and they do not need to be "managed." A more accurate reflection of what this service entails is that it is the services or resources that are managed in order to help people reach their goals. Until a more appropriate title becomes globally recognized, the term should be used with sensitivity to the negative connotations it carries.

The principles of effective case management of mental health services.

Over the last 8 years, Kansas has been successful in the implementation of evidence-based practices. This paper describes the strategies used at multiple levels of the mental health system including: state policy, provider agency management, fidelity and outcome monitoring, supervisor training and support, and practitioner training. The challenges going forth are described.

Evidence-based practice implementation in Kansas.

For nearly 50 years, case management has been the keystone of community mental health care for people with serious mental illnesses, essential for optimal treatment and support. Specific models of case management have emerged and evolved in response to inadequacies in systems of care at any particular time. Many of these models have been further refined as part of the evidence-based practices movement in an attempt to bind together an array of effective services called evidence-based practices. But much has changed in the past few years that will challenge the future development and effectiveness of case management. Basic social supports have eroded. People with mental illnesses have been shunted into the criminal justice system. Psychiatrists in community mental health centers have been marginalized. Medical comorbidities and early mortality have become salient and have probably increased. Insurance payments to the pharmaceutical industry and to managed care companies have increased while payments for psychosocial supports have decreased. And at the same time that services have deteriorated, expectations have increased!

Richard J. Goscha

Papers

The Strengths Model: Case Management with People with Psychiatric Disabilities

The Strengths Model: A Recovery-Oriented Approach to Mental Health Services

The principles of effective case management of mental health services.

Evidence-based practice implementation in Kansas.

Case Management and Assertive Community Treatment