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Article

Mental Health Disparities  

Rhonda Wells-Wilbon, Rhea Porter, Taylor Geyton, and Anthony Estreet

Millions of Americans are affected by a mental illness or disorder each year. Given the prevalence, it is unfortunate that significant disparities exist within mental health care. Some of the most common reasons mental health disparities exist include stigma, previous negative experiences, limited mental health literacy, lack of culturally aware providers and services, language access, and lack of financial resources. Additionally, members of racial and ethnic, gender, and sexual orientation minority groups, who already encounter higher levels of bias, experience poorer mental health outcomes due to disparities than their counterparts. Grounded in the values and ethics of the profession, it is no surprise that social workers play a vital role in reducing mental health disparities.

Article

Mental Health Parity  

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

Disaster Mental Health  

Leia Y. Saltzman, Regardt J. Ferreira, and Tonya C. Hansel

Disaster mental health refers to the provision of psychological and substance use services in environments coping with and recovering from disasters. In addition, disaster mental health refers to the study of the psychological and emotional impacts of disasters on individuals, families, and communities. Disasters—including climate-related, human-caused, biological, technological, and infrastructure failure—have documented impacts on the mental health of survivors. Disasters do not equitably impact individuals, families, and communities but rather may exacerbate existing disparities, worsening health and mental health outcomes and limiting access to mental health care. As societal and environmental factors continue to evolve, communities that previously were not impacted by disasters have begun to feel the effects. Simultaneously, communities that have previously been impacted by disasters are now facing recurring or compounding disaster experiences—for example, repeated wildfires, hurricanes, or flooding. The 2020 COVID-19 pandemic has also increased concerns about protracted and lengthy disaster experiences and the impact these events may have on new and/or worsening mental health symptoms. Social workers have a unique perspective that can contribute to the practice of disaster mental health with individuals, families and communities—from the provision of clinical services to policy and preparedness, to research. The system approach coupled with a strengthsbased perspective which is the hallmark of social work is imperative when working with individuals, families, and communities impacted by disasters and those who face mental health challenges in the wake of these experiences.

Article

Child and Adolescent Mental-Health Disorders  

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

Investments in Children’s Mental Health  

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

Mindfulness-Based Therapy  

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

Wittman, Milton  

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

Displacement, Natural Hazards, and Health Consequences  

Christelle Cazabat

When natural hazards lead to disasters, they can affect people in many ways, including damaging their housing and negatively impacting their livelihoods. Each year, millions of people are injured or killed as a result of disasters. They can also force people out of their homes: In 2020, 30.7 million new internal displacements linked with disasters, mostly storms or floods, were recorded throughout the world. Between 2010 and 2020, disaster displacements were recorded in 198 countries and territories, making the issue truly global. Such displacement can have severe and long-lasting consequences on physical and mental health, often similar to those of conflict-related displacement. Psychosocial trauma and the deterioration of living standards and housing conditions often alter displaced people’s well-being and their ability to maintain healthy lives or obtain treatment and care. People with disabilities or long-term illnesses are particularly vulnerable in displacement, as are children and older people. Depression and anxiety, malnutrition, communicable diseases, and lack of access to sexual and reproductive health are among the most frequent issues for internally displaced people. The health consequences of displacement linked with disasters vary depending on affected people’s pre-existing conditions and sociodemographic characteristics, the duration and severity of their displacement, and the type of support they are able to access. In cases of mass and protracted displacement, the health of people in communities of refuge and the health systems in the areas of origin and refuge can also be affected, with repercussions on the broader society. Although some of these impacts are relatively frequent and should be systematically considered by national and local governments, humanitarian organizations, and aid providers, each situation requires tailored approaches. Information on the health impacts of displacement remains limited, but the body of knowledge is growing as awareness increases on the scale of current and future displacement crises linked with disasters in a changing climate.

Article

Health Effects of Incarceration  

Justin Berk, Ann Ding, and Josiah Rich

Since 1976, incarcerated individuals in the United States have an established right to healthcare. This has created a national system charged with addressing the unique challenges of healthcare delivery in jails and prisons. As incarcerated populations are often excluded from large research studies, evidence-based practices must often be extrapolated from community data. There is a wide variation in care delivery across institutions nationwide. Challenges in correctional settings include a “dual loyalty” to patients’ health and facility security and the toxic effects of disciplinary practices including solitary confinement, violence, communicable disease control, an aging population, discharge planning for community reentry, and a high prevalence of substance use disorder and mental health disease. Although incarceration may offer a unique opportunity to address chronic health issues of a difficult-to-reach population, the net health effects in the United States seem to be mostly negative. Mass incarceration in the United States has led to significant health consequences at the individual, family, and community levels and has exacerbated health, socioeconomic, and racial disparities. As most incarcerated individuals return to the community, healthcare delivery during incarceration plays a substantial role in the health of communities at all levels.

Article

An Ecological Preventative Approach to Adolescent Psychology and Youth Mental Health Needs in China  

Xu Zhao, Zhiyan Chen, and Leiping Bao

Adolescent psychology and mental health needs in China are part of an interdisciplinary area of research. In this area of research, macro and micro processes are closely linked; biological, cultural, and socio-structural influences tightly intertwined; and patterns identified in other societies fall apart due to the impact of powerful societal forces on individual psychology. As a result, there has been a fundamental and long-lasting split between the idea that “Chinese adolescent psychology” should be a distinctive science within China, addressing issues specific to the circumstances of Chinese children and families, and the argument that it should contribute to a universal theory of human development by documenting its applications to Chinese societies. The problem of the first idea lies in its assumption of cultural relativism or the incommensurability of the human experience of growing up in particular sociocultural contexts. In contrast, the problem of the second argument lies in its failure to ask what is “universal,” when a universal theory is applicable to China, and when it may not be. Arguably, adolescents in all cultures carry vulnerabilities and strengths as they go through the process of major biological and psychological transitions. Certain psychosocial needs, such as the needs for self-exploration, quality peer relationship, and continuous guidance and support from adults, are shared by adolescents across the world, albeit through different forms. When their basic needs are neglected by ideology-driven policies and practices that are carried to an extreme extent, youth mental health is seriously threatened. It is important for researchers not only to go beyond the dichotomous view of the field by taking an ecological approach and multidisciplinary perspectives to investigate the salient issues in adolescent psychology and mental health needs in their specific sociocultural context, but also to consider their broader implications for understanding universally relevant questions about success and sacrifice in human and social development.

Article

Knee, Ruth Irelan  

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

School-Based Mindfulness Interventions  

Rosalyn H. Shute

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’ well-being 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

Mental Illness: Children  

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

Embarrassment and Health & Risk Messaging  

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

Suicide in Later Life  

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

The Business Cycle and Health  

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

Health and Gender in Adolescence in the United States  

Chris Barcelos

In the United States, gender and health in adolescence are sites of contestation and conflict marked by both hyperrepresentations and absences. Youth who are multiply marginalized by interlocking systems of racism, sexism, classism, heterosexism, cissexism, ableism, and so on are overrepresented in cultural and policy domains as “at risk” for negative health outcomes. At the same time, absences surrounding young people’s complex health needs and experiences abound in schools, healthcare settings, families, and the media. For instance, debates around sex education and teen pregnancy prevention have dominated the policy landscape for decades, with no signs of receding any time soon. Missing from these debates has been an analysis of how the intersections of race, class, gender, and sexuality structure the health outcomes and educational experiences of diverse youth. Likewise, queer, transgender, and gender-expansive youth are overrepresented in discussions about bullying to the detriment of the social structural factors that produce poor mental health outcomes. Understanding how gender and health play out in the lives of adolescents, as well as at the level of social institutions and structures, is central to teasing out the dynamics of gender, health, and social inequalities.

Article

Latinx Immigrant Health and Mental Health  

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

Financial Strain and Health  

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

Mental Health Policy Overview  

Christine M. Rine

Mental health practice is inextricably linked to how this concept has been understood in a historical context from which policies and systems of care develop. How mental health is perceived has shaped policy, as much as policy has influenced how mental health has been defined and subsequently treated. Early frameworks evolved, furthering the multidisciplinary nature of policies and services highlighting social and environmental contributions. Holistic approaches that appreciate social determinants are a comparatively new way to understand and advance mental health policy that underlies access to insurance, programs, and services based on qualifications and eligibility. A chronological and historical overview highlights interconnectedness and provides context to the development of mental health policies, initiatives, and systems of care. Content specific to roles of the social work profession should be included.