Anna Scheyett

Clinicians’ Attitudes Regarding Barriers to the Implementation of Psychiatric Advance Directives

ObjectivePsychiatric advance directives (PADs) may include documenting advance instructions (AIs) and/or designating health care agents (HCAs). Laws authorizing PADs have proliferated in the past decade, but there has been little research regarding perceptions of barriers to the implementation of PADs among groups of mental health professionals.MethodsA total of N=591 mental health professionals (psychiatrists, psychologists, and social workers) completed a survey regarding their perceptions of potential barriers to the effective implementation of PADs.ResultsAcross the three professional groups barriers related to operational features of the work environment (e.g., lack of communication between staff, lack of access to the document) were reported at a higher rate than clinical barriers (e.g., inappropriate treatment requests, consumers’ desire to change their mind about treatment during crises). However, psychiatrists were more likely to report clinical barriers to implementation than both psychologists and social workers. In multivariable analyses, legal defensiveness, employment in public sector mental health services, and a belief that treatment refusals will outweigh the benefits of PADs were associated with more perceived barriers, whereas age and endorsing positive perceptions of PADs were associated with fewer perceived barriers.ConclusionPsychiatrists, psychologists and social workers tend to perceive significant potential barriers to PADs, related to operational aspects of these professionals’ work environment as well as certain clinical features of PADs for persons with severe mental illness. Additionally, legal defensiveness and general endorsement of PADs appear to shape perceptions of barriers to the effective implementation of PADs.

The Mark of Madness : Stigma, Serious Mental Illnesses, and Social Work

Abstract Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.

Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry

BackgroundAlthough prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison.MethodsWe conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher’s Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures.ResultsMost participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care.ConclusionThese findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources.

Walking our talk in Social Work Education: partnering with consumers of Mental Health Services

Social work education emphasizes the importance of partnership and collaboration with clients, defining clients as experts in their lives and needs. However, academic departments of social work do not usually model this concept of partnership by fully collaborating with clients in the process of educating social work students. Clients are seldom partners with academic educators in curriculum development, information dissemination, or student evaluation. The authors developed and implemented a facilitated dialogue process between consumers of mental health services and social work students as a way to begin to address this issue. Areas of discussion included consumer views on helpful social worker actions and interventions, as well as ways consumers could be, and wished to be, included in social work education. This paper reports on the strategies and recommendations generated by consumers during the dialogue, and discusses implications for social work education.

Preparation of Social Workers to Support People with Developmental Disabilities

We examine how well schools of social work prepare students to work with people with developmental disabilities (DD). Using websites of 50 U.S. schools of social work, we examine their curricula to determine the number and nature of disability studies courses. We examine tenure-line faculty to identify potential for current staff to expand DD courses. We provide evidence of growing demand for DD services, and show minimal opportunities exist for students to obtain a concentration or certification in disability studies. Also, a large percentage of tenure-line faculty have research backgrounds in the DD field which are not reflected in current course offerings. Implications for social work education are discussed and recommendations given for future research.

HIV-Infected Prison Inmates: Depression and Implications for Release Back to Communities

High rates of both HIV and depression are seen in prison populations; depression has been linked to disease progression in HIV, risky behaviors, and medication non-adherence. Despite this, few studies have examined HIV-infected inmates with depression. We therefore conducted an exploratory study of a sample of HIV-infected inmates in North Carolina prisons (N = 101) to determine what proportion of this sample screened positive for depression and whether depression was associated with different pre-incarceration characteristics or post-release needs. A high proportion of HIV infected inmates (44.5%) screened positive for depression. Depressed inmates were significantly more likely have low coping self-efficacy scores (180 vs. 214), to report having had resource needs (OR = 2.91) prior to incarceration and to anticipate needing income (OR = 2.81), housing (OR = 4.07), transportation (OR = 9.15), and assistance with adherence (OR = 8.67) post-release. We conclude by discussion the implications of our findings for prison based care and effective prison release planning for HIV infected inmates.

Psychiatric advance directives: a tool for consumer empowerment and recovery.

Individuals with psychiatric disabilities identify choice and self-direction as central elements of recovery. During times of psychiatric crisis people may experience a frightening loss of choice and self-direction, which can be damaging and traumatic. Psychiatric advance directives (PADs) are legal documents created to address this loss of autonomy and choice during crises by allowing individuals to communicate in the present wishes for care during a future crisis. This paper examines the ways in which PADs support and can be a tool for recovery and discusses future recovery-oriented directions for PAD research and intervention.

Screening and Access to Services for Individuals with Serious Mental Illnesses in Jails

High rates of serious mental illnesses (SMI) among jail inmates pose challenges for the criminal justice system and risks for the individual with SMI. Research has identified actions to address these issues; it is unclear to what extent they have been operationalized. This study examines jails in one state, exploring how individuals with SMI are identified and treated, and comparing these with research-based recommendations. Results indicate that jails are not using evidence-based screenings, staff require training in SMI, access to services and medications for jailed individuals with SMI is often slow, and coordination between community providers and jails is limited.

Danger and Opportunity: Challenges in Teaching Evidence-Based Practice in the Social Work Curriculum.

Abstract Evidence-based practice has received increased emphasis within the social work field in the past decade and social work educational programs are including more evidence-based practice content in their curricula. This article examines some issues social work educators may wish to consider as they teach evidence-based practice to social work students, including encouraging student critical thinking, rather than simple acceptance of any practice guideline labeled “evidence-based,” enhancing student awareness of potential misuses of evidence-based practices, and facilitating exploration of evidence-based practices within the larger context of social work values. Recommendations for addressing these issues are provided.

Silence and Surveillance: Mental Illness, Evidence-Based Practice, and a Foucaultian Lens

Abstract Evidence-based practice (EBP) has had a significant impact on aspects of social work practice in mental health. It is important for social work to consider EBPs and their implications, particularly around the dynamics of power and potential for coercion and oppression. This paper uses a post-modern lens to examine EBPs and explore the dominant discourses of science and mental illness that are its foundation. Specifically, it uses the work of Michel Foucault to explore three major thematic fields: silenced voice; moral fault; and power and knowledge; and concludes with a discussion of the implications for social work research and practice.