Beth Angell

A cross-cultural study of employers' concerns about hiring people with psychotic disorder: implications for recovery

IntroductionEmployment discrimination is considered as a major impediment to community integration for people with serious mental illness, yet little is known about how the problem manifests differently across western and non-western societies. We developed a lay model based on Chinese beliefs and values in terms of Confucianism, Taoism, Buddhism, and folk religions which may be used to explain cross-cultural variation in mental illness stigma, particularly in the arena of employment discrimination. In this study, we tested this lay approach by comparing employers’ concerns about hiring people with psychotic disorder for entry-level jobs in US and China.MethodOne hundred employers (40 from Chicago, 30 from Hong Kong, and 30 from Beijing) were randomly recruited from small size firms and interviewed by certified interviewers using a semi-structured interview guide designed for this study. Content analysis was used to derive themes, which in turn were compared across the three sites using chi-square tests.ResultsAnalyses reveal that employers express a range of concerns about hiring an employee with mental illness. Although some concerns were raised with equal frequency across sites, comparisons showed that, relative to US employers, Chinese employers were significantly more likely to perceive that people with mental illness would exhibit a weaker work ethic and less loyalty to the company. Comparison of themes also suggests that employers in China were more people-oriented while employers in US were more task-oriented.ConclusionCultural differences existed among employers which supported the lay theory of mental illness.

From adherence to self-determination: evolution of a treatment paradigm for people with serious mental illnesses.

Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.

Crisis Intervention Teams and People With Mental Illness Exploring the Factors That Influence the Use of Force

The Crisis Intervention Team (CIT) program was first developed to reduce violence in encounters between the police and people with mental illness as well as provide improved access to mental health services. Although there is overwhelming popular support for this intervention, scant empirical evidence of its effectiveness is available—particularly whether the program can reduce the use of force. This investigation seeks to fill this gap in the literature by exploring the factors that influence use of force in encounters involving people with mental illness and evaluating whether CIT can reduce the likelihood of its use.

Reconceptualizing the Case Management Relationship in Intensive Treatment: A Study of Staff Perceptions and Experiences

The helping relationship or alliance is theorized to be an important process variable in case management services for people with serious mental illness. Previous studies of the case management relationship borrow concepts and measures from psychotherapy research and therefore may overlook important differences in tasks, settings, and clinical roles across settings. A study of client–provider relationships as perceived by case managers, based on a qualitative study of two intensive case management (ICM) teams, is presented. The findings, which delineate positive and negative experiential elements, may be used to improve measurement of the case management relationship in future research.

Defying Negative Expectations: Dimensions of Fair and Respectful Treatment by Police Officers as Perceived by People with Mental Illness

Programs to improve police interactions with persons with mental illness are being initiated across the country. In order to assess the impact of such interventions with this population, we must first understand the dimensions of how police encounters are experienced by consumers themselves. Using procedural justice theory as a sensitizing framework, we used in-depth semi-structured interviews to explore the experiences of twenty persons with mental illness in 67 encounters with police. While participants came into contact with police in a variety of ways, two main themes emerged. First, they feel vulnerable and fearful of police, and second, the way police treated them mattered. Findings elaborate on dimensions of procedural justice theory and are informative for police practice and mental health services.

Promoting Treatment Adherence in Assertive Community Treatment

Treatment adherence is a fundamental challenge for programs that serve people with serious mental illness. Assertive community treatment (ACT) is a comprehensive treatment approach that is designed to mitigate adherence barriers. Although ACT is recognized as an evidence‐based practice, the model has been criticized as paternalistic and coercive in its approach to promoting adherence. This article examines the ways that service providers in two ACT programs promote treatment adherence in standard practice. The study conceptualizes the adherence‐promoting behaviors of ACT providers as social influence strategies. It uses qualitative methods and a grounded dimensional analysis approach to examine the ways in which ACT providers grapple with and manage nonadherence.

Measuring Strategies Used by Mental Health Providers to Encourage Medication Adherence

Mental health clinicians rely on a range of legal mandates and interpersonal strategies of encouragement and pressure to address nonadherence to treatment. This paper describes the development and testing of a scale to assess formal and informal strategies used by clinicians to encourage adherence to medication. The 16-item measure was administered to 271 clinicians and analyzed using Rasch measurement modeling. Subsequently, items were revised and readministered to a second sample of 44 clinicians in an urban mental health clinic. Rasch analysis of the items yielded a coherent and internally consistent unidimensional measure of strategies used to promote adherence that vary on a continuum of pressure or social control. Criterion-related validity was assessed by observing the association of the measure with clinician ratings of client adherence. The resulting measure may be employed in future studies to examine the ways in which clinician behavior relates to medication adherence and to consumer perceptions of treatment alliance, quality of care, and perceived coercion.

Crisis Intervention Teams in Chicago: Successes on the Ground

Police officers encounter a sizable number of calls involving individuals who have mental illness. In response to the challenges that officers face with mental health calls, police departments nationally are implementing specialized response programs. In this article, we present findings from qualitative interviews with police regarding the implementation of a well-known specialized response model, Crisis Intervention Teams (CIT). Researchers employed a grounded dimensional analysis to examine how CIT is utilized in four Chicago police districts. Results indicate that police, irrespective of whether they received CIT training, perceive an array of benefits of CIT implementation in their district. Implications for practice and policy are discussed.

Engagement processes in model programs for community reentry from prison for people with serious mental illness

Linking prisoners with mental illness with treatment following release is critical to preventing recidivism, but little research exists to inform efforts to engage them effectively. This presentation compares the engagement process in two model programs, each representing an evidence-based practice for mental health which has been adapted to the context of prison reentry. One model, Forensic Assertive Community Treatment (FACT), emphasizes a long-term wrap-around approach that seeks to maximize continuity of care by concentrating all services within one interdisciplinary team; the other, Critical Time Intervention (CTI), is a time-limited intervention that promotes linkages to outside services and bolsters natural support systems. To compare engagement practices, we analyze data from two qualitative studies, each conducted in a newly developed treatment program serving prisoners with mental illness being discharged from prisons to urban communities. Findings show that the working relationship in reentry services exhibits unique features and is furthered in both programs by the use of practitioner strategies of engagement, including tangible assistance, methods of interacting with consumers, and encouragement of service use via third parties such as families and parole officers. Nevertheless, each program exhibited distinct cultures and rituals of reentry that were associated with fundamental differences in philosophy and differences in resources available to each program.

Intervening at the Entry Point: Differences in How CIT Trained and Non-CIT Trained Officers Describe Responding to Mental Health-Related Calls

In response to challenges officers face with mental health-related calls, police departments are implementing specialized response programs like Crisis Intervention Teams (CIT). CIT is gaining support for its promise to promote safe, respectful interactions with police and individuals with mental illnesses. This paper outlines the results of a qualitative study investigating the impact of CIT. We found difference in CIT and non-CIT officers’ response tactics to mental health-related calls and assessments of danger. CIT officers described a broader understanding of exhibited behaviors and considered more options when deciding the outcomes of calls. Implications and directions for future research are discussed.