Showing papers by "Rob Whitley published in 2010"
TL;DR: Five superordinate dimensions of recovery are proposed: clinical recovery, experiencing improvements in symptoms; existential recovery, having a sense of hope, empowerment, agency, and spiritual well-being; functional recovery, obtaining and maintaining valued societal roles and responsibilities; physical recovery, pursuing better health and a healthy lifestyle; and social recovery, experience enhanced and meaningful relationships and integration with family, friends, and the wider community.
Abstract: Various definitions, dimensions, and components of recovery have been posited. Building on existing work, the authors propose five superordinate dimensions of recovery: clinical recovery, experiencing improvements in symptoms; existential recovery, having a sense of hope, empowerment, agency, and spiritual well-being; functional recovery, obtaining and maintaining valued societal roles and responsibilities, including employment, education, and stable housing; physical recovery, pursuing better health and a healthy lifestyle; and social recovery, experiencing enhanced and meaningful relationships and integration with family, friends, and the wider community. The model also identifies lay, professional, and systemic resources that promote each recovery dimension.
222 citations
TL;DR: It is found that 80% of sites sustained their practices for 2 years post-implementation, that sustainers differed from non-sustainers in several domains: financing, training, fidelity and agency leadership, and that most sites adapted practices moderately to meet state and local needs.
Abstract: The research presented here reports on sustainability of the practices within the National Implementing Evidence Based Practices Project for people with serious mental illness. Forty-nine sites completed the initial 2-year implementation phase and were the focus of our study. Our aims were to discern the number of sites that sustained practices 2 years after implementation, the reasons for sustaining or not sustaining, differences in characteristics between the two groups, and the extent and nature of practice adaptations. We used a mixed-methods approach, based on a telephone survey that gathered qualitative and quantitative data from site representatives and others familiar with the sites and practices during the follow-up period. We found that 80% of sites sustained their practices for 2 years post-implementation, that sustainers differed from non-sustainers in several domains: financing, training, fidelity and agency leadership, and that most sites adapted practices moderately to meet state and local needs.
157 citations
TL;DR: This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health, finding that mental health consumers may have a different view of decision making than the literature on shared decision making suggests.
Abstract: Objective Most theoretical and empirical work regarding decision making in mental health suggests that mental health consumers have better outcomes when their preferences are integrated into quality of life decisions. A wealth of research, however, indicates that providers have difficulty predicting what their clients' priorities are. This study investigates consumer decision-making preferences and understanding of construction of decisions in community mental health. Methods People living with severe mental illness being treated in the public mental health care system (N=16) participated in qualitative interviews regarding case management decision making as a part of a larger study investigating a decision support system to facilitate shared decision making. Interviews were transcribed, coded, and cross-case thematic analyses were conducted. Results Mental health consumers generally endorse a "shared" style of decision making. When asked what "shared" means, however, consumers describe a two-step process which first prioritizes autonomy, and if that is not possible, defers to case managers' judgment. Consumers also primarily focused on the relationship and affective components of decision making, rather than information-gathering or deliberating on options. Finally, when disagreements arose, consumers primarily indicated they handled them. Conclusions Mental health consumers may have a different view of decision making than the literature on shared decision making suggests. Mental health consumers may consciously decide to at least verbally defer to their case managers, and remain silent about their preferences or wishes.
78 citations
TL;DR: In this article, a litterature scientifique pertinente sur la sante mentale et les services de sante- mentale in Haiti is presented, where the authors decribe les principales donnees historiques, economiques, sociologiques and anthropologiques.
Abstract: Cet article passe en revue et resume l’ensemble de la litterature sur la sante mentale et les services de sante mentale en Haiti. Ce compte rendu a ete redige a la suite du tremblement de terre qui a frappe Haiti en janvier 2010. Nous avons effectue des recherches dans Medline, Google Scholar et d’autres bases de donnees disponibles en vue de recueillir la litterature scientifique pertinente sur la sante mentale en Haiti. La consultation d’ouvrages de reference et de la litterature grise sur Haiti a complete les recherches. La premiere partie decrit les principales donnees historiques, economiques, sociologiques et anthropologiques qui permettent de comprendre sommairement Haiti et sa population. La demographie, la structure familiale, l’economie haitienne et la religion y sont abordees. La deuxieme partie est axee sur la sante mentale et les services de sante mentale. L’epidemiologie elementaire des maladies mentales, les croyances au sujet des maladies mentales, les modeles explicatifs, les idiomes de detresse, les comportements de recherche d’aide, la configuration des services de sante mentale et l’etude des relations entre la religion et la sante mentale y sont examines.
54 citations
TL;DR: Worry about forthcoming delivery and fears for the woman’s survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity, and the notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced.
Abstract: The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman’s survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.
50 citations
TL;DR: Mental illness stigma in Jamaica is explored by conducting focus groups with 16 community samples and four overarching conceptual themes are discussed, including a distinction between “madness” and “mental illness.”
Abstract: Stigma may be an important factor in mental health service seeking and utilization. However, little work on stigma has been conducted in developing nations in the Caribbean, including Jamaica. We explored mental illness stigma in Jamaica by conducting focus groups with 16 community samples. Four overarching conceptual themes are discussed: (1) community members' definitions of stigma; (2) emotional responses towards those with mental illness, such as fear and love; (3) behavioral responses towards those with mental illness, including avoidance and cautious approach; and (4) perceptions of and beliefs about mental illness, including a distinction between "madness" and "mental illness."
49 citations
TL;DR: Characteristics and competencies self-reported by specialists as influential to proficient performance in the field are documented to redresses this deficit by documenting characteristics and competency self- reported by specialists by determining the importance of eight factors.
Abstract: The Individual Placement and Support model of supported employment is one of the most robust interventions available for people with severe mental illness. Supported employment specialists deliver this intervention. There has been little research on what influences specialists’ performance in the field. This paper redresses this deficit by documenting characteristics and competencies self-reported by specialists as influential to proficient performance in the field. Twenty-two qualitative interviews were conducted with specialists and their supervisors. Content analysis suggested the importance of eight factors: (1) initiative; (2) outreach; (3) persistence; (4) hardiness; (5) empathy; (6) passion; (7) team orientation (8) professionalism.
47 citations
TL;DR: Content analysis of interviews suggested that the heart was perceived as a receptacle that contained an accumulation of life's ordeals, negative emotions and family traumas resulting in perceived heart strain, which was considered a direct cause of the MI.
42 citations
TL;DR: It is argued that atheism should be treated as a meaningful sociocultural variable in the study of mental health and is an appropriate domain of study for social and cultural psychiatrists interested in exploring socio‐environmental stressors and buffers relating to mental health.
Abstract: The exploration of the impact of religiosity on mental health is an enduring, if somewhat quiet, tradition. There has been virtually no exploration, however, of the influence of atheism on mental health. Though not a "religion," atheism can be an orienting worldview that is often consciously chosen by its adherents, who firmly believe in the "truth" of atheism-a phenomenon known as "positive atheism." Atheism, especially positive atheism, is currently enjoying something of a renaissance in the Western liberal democracies-a trend often referred to as the "new atheism." I argue that atheism, especially positive atheism, should be treated as a meaningful sociocultural variable in the study of mental health. I argue that atheism (just like theism) is an appropriate domain of study for social and cultural psychiatrists (and allied social scientists) interested in exploring socio-environmental stressors and buffers relating to mental health. Specifically, I argue that (1) atheism needs to be accurately measured as an individual-level exposure variable, with the aim of relating that variable to psychiatric outcomes, (2) there needs to be greater systematic investigation into the influence of atheism on psychiatry as an institution, and (3) the relation of atheism to mental health needs to be explored by examining atheistic theory and its practical application, especially as it relates to the human condition, suffering, and concepts of personhood.
42 citations
TL;DR: It takes consumers with CJI substantially longer to engage in Supported Employment services, and both programmatic and policy level interventions and modifications may ameliorate this problem.
Abstract: Objective This paper aims to provide further understanding of the influence of severe mental illness (SMI) and criminal justice involvement (CJI) on access to Supported Employment (SE) services. The authors investigate differences between consumers with and without CJI regarding access to SE and explore reasons for group differences. Method This study employs a mixed-methods design. The quantitative portion compares employment service utilization of consumers with CJI to consumers without CJI to examine hypothesized differences in frequency of access and time to receipt of SE services. The qualitative portion includes in-depth, individual interviews with consumers with CJI and service providers to gain various perspectives on consumers' with CJI entry to SE. Results Consumers with CJI take longer to access SE services. Consumers with CJI and service providers identify the following as barriers or facilitators to access to SE: competing challenges for consumers with CJI such as mental health probation, the adverse impact of CJI on consumers' psychosocial functioning, social networks, consumers' relationships with practitioners, and practitioners' relationship with SE. Conclusions Consumers with CJI do receive SE services at the same rate as those without CJI, but it takes them substantially longer to engage in SE services. Both programmatic and policy level interventions and modifications may ameliorate this problem.
22 citations
TL;DR: The need for focused training among employment specialists to better understand and negotiate clients' wishes is suggested, along with more integration and communication between members of the treatment team, and spreading awareness of the IPS model across resource-sharing agencies.
Abstract: Aims. This article examines the notion of client-centeredness from the perspective of supported employment specialists and supervisors, identifying barriers and facilitators to implementation in the field. Though by definition client-centered practices give precedence to clients' wishes, in a realistic setting client-centeredness is adapted to account for negotiations among clients, specialists, employers, and mental health service agencies.Method. Qualitative interviews (n = 22) were conducted with employment specialists and supervisors to elicit facilitators and barriers to successful supported employment outcomes. Data were analyzed inductively using ATLAS.ti 5.0 software.Results. Principal factors influencing implementation of client-centeredness include (1) clients' anxieties about their interests and abilities, (2) difficulties interpreting and negotiating clients' preferences in realistic contexts, (3) quality of supervision and guidance in implementing client-centered practices and upholding moral...
TL;DR: To be successful, interventions must simultaneously target three levels: macro, provider, and patient, and five domains are posited that cut across these levels: cross-cultural communication, discrimination, explanatory models, stigma, and family involvement.
Abstract: 508 African Americans make up approximately 12% of the U.S. population, a total of around 36 million people. Evidence suggests that African Americans suffer from significant and persistent disparities within the mental health system. African Americans with severe mental illness are less likely than Euro-Americans to access mental health services, more likely to drop out of treatment, more likely to receive poor-quality care, and more likely to be dissatisfied with care. Dominant patterns of treatment for African Americans with psychiatric disabilities are often least suited to long-term rehabilitation. To be successful, interventions must simultaneously target three levels: macro, provider, and patient. Five domains are posited that cut across these levels. These are cross-cultural communication, discrimination, explanatory models, stigma, and family involvement. These need appropriate research and action to enhance the psychiatric rehabilitation of African Americans. Potential solutions to overcome barriers raised within these domains are suggested. (Psychiatric Services 61:508–511, 2010)
TL;DR: Perceptions of smoking risk and ways of thinking about risk for 31 persons with a Severe Mental Illness are described, indicating that many current smokers interpret and frame perceptions of health risks from smoking in rel...
Abstract: Background: This qualitative paper describes perceptions of smoking risk and ways of thinking about risk for 31 persons with a Severe Mental Illness (SMI). Research has shown that many people with SMI want to quit smoking, and, like many other disadvantaged groups, make many quit attempts. Aim: The authors undertook a qualitative study to explore views and experiences about smoking and quitting, within a general context of what it means to them to live a healthy lifestyle. Method: A purposive sample of former smokers, current smokers, and individuals who had never smoked was chosen to participate in a semi-structured interview. Questions targeted various lifestyle domains, narrowing to focus more specifically on smoking habits, attempts to quit, and thoughts about the future in relation to health and smoking. Techniques of grounded theory were used to categorize and interpret themes. Results: The results indicate that many current smokers interpret and frame perceptions of health risks from smoking in rel...
TL;DR: In contemporary Bollywood film, hopeful endings often focus on reveries of an idyllic rural life as mentioned in this paper, and one often sees cinema goers leaving a film before its ending if the resolution appears to be heading away from hope and triumph.
Abstract: case during nation-building after the 1947 catastrophies of Partition. In contemporary Bollywood film, hopeful endings often focus on reveries of an idyllic rural life. One often sees cinema goers leaving a film before its ending if the resolution appears to be heading away from hope and triumph. Hopefulness is underlined by Dr. Bhugra’s closing comments that Bollywood may increasingly play a role in making mental health care a more acceptable option in India.