David C. Kondrat

AN ANTI‐STIGMA APPROACH TO WORKING WITH PERSONS WITH SEVERE MENTAL DISABILITY: SEEKING REAL CHANGE THROUGH NARRATIVE CHANGE

Self‐stigma is the process whereby individuals expect to be discriminated against by society and in turn hold prejudicial beliefs about themselves. Self‐stigma is particularly difficult for persons with severe mental disability (SMD) as they often experience stigma from the public and, thus, allow the public stigma to foster self‐stigma. Public and self‐stigma are theorised to be comprised of stereotypes, prejudice and discrimination. This paper proposes that in order to decrease self‐stigma among persons with SMD, social work and mental health practitioners need to intervene on an individual and/or societal level to dispute stereotypes, prevent prejudices and combat discrimination. We propose an individual‐level, anti‐stigma approach utilising social constructivism, adaptive systems theory and narrative therapy to empower persons with SMD to reconstruct their sense of self that is free from stigma.

Factors Associated with Mental Health Court Nonparticipation and Negative Termination

Mental health court outcomes research shows moderate success in reducing criminal recidivism. Far less research concentrates on defendants who do not choose to participate or are negatively terminated. Eight years of data from a suburban Midwestern mental health court indicate that substance abuse history and having multiple psychiatric diagnoses increased the odds of nonparticipation, while a bipolar diagnosis, the other category of diagnosis, and referral source, decreased the odds. For those negatively terminated, being male, racial minority status, having multiple diagnoses, a charge of stealing, and committing a new crime while under Municipal Mental Health Court supervision increased the odds of negative termination. A substance abuse history, increased mental health court attendance, receiving disability income, and psychiatric medication prescription decreased the odds of negative termination. Implications for policy, practice, and future research are discussed, including better engagement strategies for participation and treatment.

Battling in the Trenches: Case Managers’ Ability to Combat the Effects of Mental Illness Stigma on Consumers’ Perceived Quality of Life

Intervention effectiveness research requires that investigators include “real world” variables in the design of studies to develop an understanding of how interventions perform in the “real world.” Two areas that have been neglected in effectiveness research on mental health case management are mental illness self-stigma and the effects of different case managers. Self-stigma is a reality for many consumers that negatively impacts their lives. Case managers, themselves, are a potential source of autocorrelation and likely provide services differently. This study explores the relationship between self-stigma and quality of life for consumers receiving services from different case managers. Cross-sectional data were collected from 160 consumers of an urban case management agency. Self-stigma was negatively associated with quality of life. Case managers did not account for a significant amount of variance in quality of life scores. However, the interaction between case manager and self-stigma was significant. Some case managers were able to mitigate the negative effects of self-stigma on quality of life. Future effectiveness research in community mental health case management needs to account for the effects of self-stigma, case managers, and the interaction between the two in the research design.

A Solution-Focused Approach to Case Management and Recovery With Consumers Who Have a Severe Mental Disability

Community mental health systems have been increasingly emphasizing providing services and using interventions that support mental health consumers recovering from severe mental disability. It has been noted in the literature that the strengths approach to case management is supportive of mental health consumers experiencing recovery. Although strengths-based case management has been operationalzed by six principles and five functions, it has not been very well operationalized at the micro level of direct interactions between case managers and mental health service recipients. This article describes how the perspective of and techniques from solution-focused therapy can be used to further operationalize the strengths perspective for these direct, one-on-one interactions to facilitate mental health consumer recovery.

Solution-focused therapy in an Emergency Room setting: Increasing hope in persons presenting with suicidal ideation

• Summary: One-third or more of persons presenting to Emergency Rooms (ER)/Accident and Emergency departments in psychiatric emergencies report experiencing suicidal ideations. A critical task for hospital-based practitioners is to assess the lethality of the situation to determine whether the person should be hospitalized. Practitioners often employ standardized assessment instruments to assist in determining the suicidal risk factors, yet such measures often fail to recognize or consider the following: 1) the relative importance of the therapeutic process in creating meaningful therapeutic change; 2) the quality of the therapeutic encounter in the ER; and 3) follow-through with the community referral process. • Findings: This article proposes the use of the actual ER encounter between client and practitioner to work with suicidal risk factors that are amenable to immediate therapeutic change. Using a therapy approach that can positively impact a clients level of hopelessness and allow for the assessment of suicide risk can work to ensure that an appropriate hospitalization disposition is reached. • Application: This article details how the use of solution-focused therapy provides one avenue for assessing suicide risk and how the therapeutic intervention, which has not been subjected to the scrutiny of empirical research, can serve as an opportunity for increasing hope.

The Looking-Glass Self: Looking at Relationship as the Mechanism of Change in Case Management of Persons With Severe Mental Illness

Community mental health case management has been an important source of support for persons living with a severe mental illness (SMI) since the shift from hospital-based to community-based services, and it is considered to be a central component of the recovery-based model of care. Fostering a strong and positive relationship between case managers and consumers is important to good case management practice. The ascendance of recovery in the mental health paradigm has invigorated the need for collaborative relationships that open up space for consumers to move toward recovery. Using Cooleys metaphor of the looking-glass self, we examine the consumer-case manager relationship and how it helps create a new, recovery-oriented self in SMI consumers. Understanding this relationship as an important mechanism of change provides a useful model for understanding the impact of case managers on the lives of SMI consumers.

Tough on Crime or Beating the System: An Evaluation of Missouri Department of Mental Health’s Not Guilty by Reason of Insanity Murder Acquittees

Homicide defendants asserting the insanity defense make a volatile combination. Numerous studies review inmates with murder convictions, yet the literature is not rich regarding defendants found not guilty by reason of insanity (NGRI) for murder. This study analyzes 27 years of insanity acquittals in Missouri, finding significant differences between those defendants found NGRI for murder and those found NGRI for other crimes. The get-tough-on-crime initiatives found in the criminal justice system may have led to longer hospital stays post-1996 for NGRI murder acquittees, yet hospitalization lengths increased for all NGRI acquittees, a potential unintended consequence. Policy implications and future research directions are discussed.