1-20 of 79 Results

  • Keywords: mental health x
Clear all

Article

Wayne Lindstrom

Continuing a history of inequity, private insurers have placed restrictions and limitations on coverage for mental health conditions making access to treatment services increasingly more challenging. A state-by-state advocacy movement has led to the enactment of various state laws to require mental health parity. With the Clinton Administration’s attempt at health care reform, mental health parity became part of the health reform debate and led to the passage of the Mental Health Parity Act of 1996. The inadequacies of this law were partially corrected in the Mental Health Parity and Addiction Equity Act of 2008, which included mandated coverage for substance use conditions. The Obama Administration in 2011 included these provisions in the Patient Protection and Affordable Care Act, which does not require compliance monitoring nor does it provide a definition for “mental health,” which leaves insurers to define it and hence determine what coverage will actually be available.

Article

Susan Frauenholtz and Amy Mendenhall

Mental-health disorders are widely prevalent in children and adolescents, and social workers are the primary service providers for children and families experiencing these disorders. This entry provides an overview of some of the most commonly seen disorders in children and adolescents: attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, separation anxiety disorder, and specific learning disorders. The prevalence, course, diagnostic criteria, assessment guidelines, and treatment interventions are reviewed for each disorder. In addition, the key role of social workers in the identification and intervention of these disorders, as well as ways social workers can support the children and families experiencing these disorders, is discussed.

Article

Edward R. Canda and Sherry Warren

This entry provides an introduction to mindfulness as a therapeutic practice applied within social work, including in mental health and health settings. It describes and critiques mindfulness-based practices regarding definitions, history, current practices, best practices research, and ethical issues related to using evidence-based practices, acquiring competence, addressing social justice, and respecting diversity.

Article

Daniel Eisenberg and Ramesh Raghavan

One of the most important unanswered questions for any society is how best to invest in children’s mental health. Childhood is a sensitive and opportune period in which to invest in programs and services that can mitigate a range of downstream risks for health and mental health conditions. Investing in such programs and services will require a shift from focusing not only on reducing deficits but also enhancing the child’s skills and other assets. Economic evaluation is crucial for determining which programs and services represent optimal investments. Several registries curate lists of programs with high evidence of effectiveness; many of these programs also have evidence of positive benefit-cost differentials, although the economic evidence is typically limited and uncertain. Even the programs with the strongest evidence are currently reaching only a small fraction of young people who would potentially benefit. Thus, it is important to understand and address factors that impede or facilitate the implementation of best practices. One example of a program that represents a promising investment is home visiting, in which health workers visit the homes of new parents to advise on parenting skills, child needs, and the home environment. Another example is social emotional learning programs delivered in schools, where children are taught to regulate emotions, manage behaviors, and enhance relationships with peers. Investing in these and other programs with a strong evidence base, and assuring their faithful implementation in practice settings, can produce improvements on a range of mental health, academic, and social outcomes for children, extending into their lives as adults.

Article

Ruth Irelan Knee

Milton Wittman (1915–1994) was a social worker, writer, and leader in social work, public health, and mental health. He played a key role in the expansion of opportunities for social work education and for the involvement of social workers in the provision of mental health services.

Article

Kenneth R. Wedel

Ruth Irelan Knee (1920–2008) was a leading social worker in the formative years of public mental health programming and was a contributor to the “patients’ rights movement” for institutionalized persons.

Article

Marlys Staudt

The primary focus of the entry is service utilization. As background, the risks for and prevalence of childhood mental disorders are summarized. Then, the current children's mental health services system is described, including the role of nonspecialty sectors of care and informal support systems. Service use barriers and disparities, pathways to services, and strategies to increase service use are discussed. The conclusion notes other current issues in child mental health, including the need to implement evidence-based treatments.

Article

Mindfulness, adapted from ancient Buddhist thought and practice, was introduced into the West in a secularized and Westernized form during the 1980s. In subsequent decades, it spread around the world, into clinics, workplaces, and schools. The practice involves cultivating the ability to focus attention, and to notice any distracting thoughts and feelings without judgment or elaboration, in order to reduce stress and improve mental health. As such, it is a psychological phenomenon involving metacognition, or thinking about thinking, though this can be placed within a holistic framework that sees the mind as intricately linked with the body and the external world. In the early years of the 21st century, concerns grew about children’s mental health, and schools became seen as places to address this through universal programs; that is, mental health promotion programs that reach all students and that therefore do not stigmatize those who already have psychological difficulties, or are at risk of developing them. Evidence was also accruing that, with samples of healthy (non-clinical) adults, mindfulness had moderate effects on measures such as anxiety, and strong effects in reducing stress. Although research designs were generally not very strong, the positive results and public enthusiasm for mindfulness encouraged the introduction of universal programs into schools, and even preschools. However, the dissemination of school-based mindfulness programs ran well ahead of the scientific evidence examining their efficacy (under tightly controlled conditions) or their effectiveness in real-world school contexts. While studies were suggestive that mindfulness could affect many aspects of children’s and adolescents’ wellbeing and development, the body of research as a whole fell short in terms of scientific rigor. There were few well-designed randomized controlled trials that would enable firm conclusions to be drawn that any identified effects were due to the mindfulness program rather than to unknown factors. Moreover, little attention was paid to the presumed mechanisms of change or to the developmental appropriateness of programs. As more, and better-designed, studies began to emerge, accumulating results suggested that effects were generally small, but stronger for older than younger adolescents, and longer lasting for adolescents than for children. Issues that remained for further systematic attention included many matters of program design and implementation, the safety of the practice, its basis in developmental theory and research, and its ethical and political implications.

Article

Kim Van Orden, Caroline Silva, and Yeates Conwell

Suicide in later life is a significant public health problem around the world—a problem that will increase in magnitude in the coming years with the impact of population aging. Adults age 70 and older have higher suicide rates than younger groups worldwide in both lower-income and higher-income countries. While suicide rates tend to increase with age, suicide in later life is not an expected or normative response to stressors that accompany the aging process. Instead, a constellation of risk factors places an older adult at elevated risk for suicide. These factors can be remembered as the Five D’s: psychiatric illness (primarily depression); functional impairment (also called disability, often associated with dependency on others); physical illness (particularly multiple comorbid diseases); social disconnectedness (including social isolation, loneliness, family conflict, and feeling like a burden); and access to lethal (deadly) means. The greatest risk occurs when multiple domains of risk converge in a given individual. Approaches to prevention can address the Five D’s. Given that older adults are reluctant to seek out mental healthcare and that standard primary care practice cannot easily provide it, models of primary care-based integrated care management for mental disorders, including in older adulthood, have been developed, rigorously tested, and widely disseminated. These models play an important role in suicide prevention by integrating treatment for physical and mental illness. Upstream, selective prevention strategies that target disconnectedness—such as engaging older adults as volunteers—may serve to reduce disconnectedness and thereby reduce suicide risk. Universal prevention strategies that involve growing the geriatric workforce may address disability by increasing older adults’ access to medical and social service providers with expertise in improving physical, cognitive, and social functioning, as well as improving quality of life. Addressing ageism and building age-friendly communities that use strategies to integrate older adults into society and promote social participation hold promise as universal prevention strategies. Ultimately, effective suicide prevention strategies for older adults must focus on improving quality of life as well as preventing suicide: strategies such as psychotherapy and medication for psychiatric disorders must be supplemented by prevention strategies for older adults give at all ages in addition to treating psychiatric disorders and suicidal thoughts is needed to address the problem of suicide in later life.

Article

Spring Chenoa Cooper and P. Christopher Palmedo

Embarrassment, according to Fischer and Tangney, is an “aversive state of mortification, abashment, and chagrin that follows public social predicaments.” It is usually related to our perceptions of how others perceive us as well as their judgments of us, and it is associated with a loss of self-esteem when we perceive that others have judged us as inadequate or incompetent. However, even mere exposure or attention publicly placed on someone can elicit embarrassment (think of someone pointing at you and laughing). Embarrassment is considered a self-conscious emotion. Self-conscious emotions include those that are evoked by self-reflection and self-evaluation: embarrassment, shame, guilt, and pride. Shame, an intense form of embarrassment, also has structural and larger social contexts, while embarrassment is more individually experienced. Self-conscious emotions play an important role in regulating behavior; they assist us in behaving according to social standards and guide us in responding when those rules are broken. While these emotions provide feedback in social situations, they also provide feedback for anticipated outcomes. Embarrassment can play an important role in health, both in communication and behavior, and occurs through different forms. Primary embarrassment is the first rush of blood to the face and increased heart rate that usually lasts a few moments. Secondary embarrassment is the after-effect that shapes future behavior. Anticipatory embarrassment is the emotion surrounding the potential for embarrassment in an upcoming situation. Solitary embarrassment is the one that no one actually observes. Three stigmatized areas of health—mental health, healthcare, and sexual health—may be assessed as case studies through which to understand the literature around embarrassment, as both an affect and an emotion.

Article

Cristina Bellés-Obrero and Judit Vall Castelló

The impact of macroeconomic fluctuations on health and mortality rates has been a highly studied topic in the field of economics. Many studies, using fixed-effects models, find that mortality is procyclical in many countries, such as the United States, Germany, Spain, France, Pacific-Asian nations, Mexico, and Canada. On the other hand, a small number of studies find that mortality decreases during economic expansion. Differences in the social insurance systems and labor market institutions across countries may explain some of the disparities found in the literature. Studies examining the effects of more recent recessions are less conclusive, finding mortality to be less procyclical, or even countercyclical. This new finding could be explained by changes over time in the mechanisms behind the association between business cycle conditions and mortality. A related strand of the literature has focused on understanding the effect of economic fluctuations on infant health at birth and/or child mortality. While infant mortality is found to be procyclical in countries like the United States and Spain, the opposite is found in developing countries. Even though the association between business cycle conditions and mortality has been extensively documented, a much stronger effort is needed to understand the mechanisms behind the relationship between business cycle conditions and health. Many studies have examined the association between macroeconomic fluctuations and smoking, drinking, weight disorders, eating habits, and physical activity, although results are rather mixed. The only well-established finding is that mental health deteriorates during economic slowdowns. An important challenge is the fact that the comparison of the main results across studies proves to be complicated due to the variety of empirical methods and time spans used. Furthermore, estimates have been found to be sensitive to the use of different levels of geographic aggregation, model specifications, and proxies of macroeconomic fluctuations.

Article

Cecilia Ayón, Tanya Nieri, and Maria Gurrola

Latinx immigrants represent a large segment of the immigrant population in the United States. While immigrants tend to be healthier than native-born people, they experience a number of health disparities. Latinx immigrants experience many barriers to accessing health care, including immigration policy barriers related to undocumented or recent permanent resident status, lack of culturally and linguistically responsive services, challenges during the access verification process, discrimination by providers, and external resource constraints (e.g., cost). Many are uninsured or underinsured and experience limited access to care. Existing models to understand health are examined. A social determinants of health framework is used to understand immigrants’ health outcomes. Within this framework immigration is a social determinant of health. Substantial empirical evidence illustrates how the immigration policy context impacts on immigrants’ health through exposure to enforcement activity, threat of detainment and deportation, and actual deportation. Enforcement activity is racialized to effect all Latinxs regardless of status. Other domains including economic insecurity, education, and community and social support are other sources that may disadvantage immigrants and impact on their health. The search for economic opportunity is a primary motivation for Latinxs to migrate to the United States, yet many face economic challenges and live in poverty. Education has significant impact on immigrants across the development spectrum as they experience disparities in access. Social ties are critical to the wellbeing of Latinx, evidence suggests disparities in access to support by status. Immigrants contend with a number of challenges as they integrate into society. Social determinants of health, through multiple domains, affect immigrants’ health.

Article

Irina Grafova

One of the most fundamental results in health economics is that a greater socio-economic status is associated with better health outcomes. However, the experience of financial pressure and lack of resources transcends the notion of low income and poverty. Families of all income categories can experience financial pressure and lack of resources. This article reviews the literature examining the relationship between financial strain and various health outcomes. There are three main approaches to the measurement of financial strain found in the research literature, each one capturing a slightly different aspect: the family’s debt position, the availability of emergency funds, and inability to meet current financial obligations. There are two main hypotheses explaining how financial strain may affect health. First, financial strain indicates a lower amount of financial resources available to individuals and families. This may have a dual impact on health. On the one hand, lower financial resources may lead to a decrease in consumption of substances such as tobacco that are harmful to health. On the other hand, lower financial resources may also negatively affect healthcare access, healthcare utilization, and adherence to treatment, with each contributing to a decline in health. Second, financial strain may produce greater uncertainty with regard to the availability of financial resources at present as well as in the future, thereby resulting in elevated stress, which may, in turn, result in poorer health outcomes. Examining the relationship between financial strain and health is complicated because it appears to be bidirectional. It is not only the case that financial strain may impact health but that health may impact financial strain. The research literature consistently finds that financial strain has a detrimental impact on a variety of mental health outcomes. This relationship has been documented for a variety of financial strain indicators, including non-collateralized (unsecure) debt, mortgage debt, and the inability to meet current financial obligations. The research on the association between financial strain and health behavior outcomes is more ambiguous. As one example, there are mixed results concerning whether financial strain results in a higher likelihood of obesity. This research has considered various indicators of financial strain, including credit card debt and the inability to meet current financial obligations. It appears that both among adults and children there is no consistent evidence on the impact of financial strain on body weight. Similarly, the results on the impact of financial strain on alcohol use and substance abuse are mixed. A number of significant questions regarding the relationship between financial strain and health remain unresolved. The majority of the existing studies focus on health outcomes among adults. There is a lack of understanding regarding how family exposure to financial strain can affect children. Additionally, very little is known about the implications of long-term exposure to financial strain. There are also some very important methodological challenges in this area of research related to establishing causality. Establishing causality and learning more about the implications of the exposure to financial strain could have important policy implications for a variety of safety net programs.

Article

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Article

Sarah E. Bledsoe, Brianna M. Lombardi, Brittney Chesworth, and Samuel Lawrence

This article discusses interpersonal psychotherapy (IPT), a psychotherapeutic intervention developed by Gerald Klerman, Myrna Weissman, and colleagues in the 1970s as an outpatient treatment for major depression in adults. Based on the theories of Harry Stack Sullivan and Adolph Meyer, IPT is a manualized, time-limited intervention that addresses the underlying interpersonal antecedents and correlates of psychiatric illness. The goal of IPT as originally developed is to reduce depressive symptoms and improve interpersonal relationships. IPT has been widely tested in adults and adolescents and is an empirically supported treatment for major depression. IPT has been adapted for a variety of psychiatric illnesses and problems of living including perinatal depression, anxiety, and trauma-related disorders. Current evidence detailed below supports the use of IPT across cultures, illnesses, and populations.

Article

Catherine G. Greeno

Mental illnesses are very common; more than one-quarter of people will develop a mental illness during their lifetime. Mental illnesses are associated with substantial disability in work, relationships, and physical health, and have been clearly established as one of the leading causes of disability in the developing, as well as the industrialized world. Mental disorders are common in every service sector important to social workers, and affect outcomes in every service sector. Mental disorders are strongly associated with poverty worldwide, and are common and often unrecognized in the general health sector, child welfare, and criminal justice settings, among others. Basic information about mental health is thus important to all social workers. Information about classification systems and major categories of mental illnesses, including depression, anxiety, psychotic disorders, and substance abuse disorders, is presented. The service system for mental disorders is badly underdeveloped, and most people who need treatment do not receive it. There is an increasing body of evidence demonstrating effective treatments, and policy is moving toward requiring that treatments offered be evidence based. This is a period of a great explosion of knowledge about mental health, and we can expect considerable advances in the coming years.

Article

Jennifer Briar-Bonpane and Katharine Briar-Lawson

Scott Briar (1926–1998) was a practitioner, researcher, scholar, and leader who championed research-informed practice and helped shape modern casework. He was Dean of Washington School of Social Work, edited Social Work, and served as a reviewer for NIMH.

Article

Dorothy M. Pearson

Carl A. Scott (1928–1986) was assistant professor at the New York University School of Social Work. As a senior consultant on minority groups at the Council on Social Work Education he developed programs directed toward enhancing minority presence in curricula.

Article

Larraine M. Edwards

Julia Jessie Taft (1882–1960) founded the “functional” school of social casework practice. She was director of the Child Study Department of the Children's Aid Society in Pennsylvania and developed a psychologically oriented curriculum at the Pennsylvania School of Social Work.

Article

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.