Gideon de Jong

Beyond Care Avoidance and Care Paralysis: Theorizing Public Mental Health Care

Care avoidance refers to the condition wherein clients do not seek assistance and do not attend appointments although they are in need of help. Care avoidance is linked to another phenomenon, the inability to help clients with multiple and complex problems by social services and care facilities, in this article identified as care paralysis. The aim of this article is to understand the production and reduction of care avoidance and care paralysis. Care avoidance and care paralysis not only coincide, they reinforce and recall each other. Trust and initiative — the opposite of avoidance and paralysis — are affirmed under conditions as an experienced proximity between the local population and care facilities and the committed involvement of professionals to a bounded territory. Trust and initiative also coincide, reinforce and recall each other. The existence of a safety net like Public Mental Health Care is closely linked to the absence of this vitality.

Family Group Conferencing in public mental health and social capital theory

Summary Clients in public mental health care have limited social capital; they lack trusting and mutually supportive relations within bonded groups and do not have access to supportive external groups. Family Group Conferencing (FGC) is a promising decision-making model to restore social ties and mobilise informal support. From January 2011 to September 2013, 41 family group conferences were organised in a Dutch public mental health care setting and studied using a qualitative case study methodology. Twenty-three of the conferences were successful in meeting their goals. This article reports on findings from the other 18 family group conferences that apparently had failed as the preparations became stuck or because a plan was never reached or fully implemented. Semi-structured interviews with 118 out of a possible total of 215 FGC participants were conducted to examine the process and impact of the conferences. Findings The interviews indicate that conferences were often held as a last resort, in situations where professional care had already failed prior to the conference. The intended goals of the conferences were not achieved because support from the social network was insufficiently mobilised and clients themselves felt helpless that they could improve their conditions. Applications A single conference seems insufficient on its own to break through a sense of inadequacy and paralysis. Social capital theory points to the necessity of not only renewing informal networks (‘strong ties’) but of expanding networks through connecting public mental health care clients to paid and volunteer work (‘weak ties’). FGC plans can include such action steps. Instituting a ‘family manager’ to monitor these steps may support the bonding of ‘strong ties’ and the bridging to ‘weak ties’.

Family group conferences in public mental health care

Family group conferences are usually organized in youth care settings, especially in cases of (sexual) abuse of children and domestic violence. Studies on the application of family group conferences in mental health practices are scarce, let alone in a setting even more specific, such as public mental health care. The present study reports on an exploratory study on the applicability of family group conferencing in public mental health care. Findings suggest that there are six reasons to start family group conference pilots in public mental health care. First, care providers who work in public mental health care often need to deal with clients who are not motivated in seeking help. Family group conferences could yield support or provide a plan, even without the presence of the client. Second, conferences might complement the repertoire of treatment options between voluntary help and coercive treatment. Third, clients in public mental health care often have a limited network. Conferences promote involvement, as they expand and restore relationships, and generate support. Fourth, conferences could succeed both in a crisis and in other non-critical situations. Sometimes pressure is needed for clients to accept help from their network (such as in the case of an imminent eviction), while in other situations, it is required that clients are stabilized before a conference can be organized (such as in the case of a psychotic episode). Fifth, clients who have negative experiences with care agencies and their representatives might be inclined to accept a conference because these agencies act in another (modest) role. Finally, the social network could elevate the work of professionals.

The use of family group conferences in mental health: Barriers for implementation

Summary The number of compulsory admissions in Dutch psychiatry has increased in the past 25 years. The reduction of coercion with Family Group Conferences in youth care has been successful. How, when and under what conditions can Family Group Conferences reduce coercion in adult psychiatry, is subject of an extensive inquiry. This paper, however, focusses on the reverse question, namely, in what circumstances can Family Group Conferences not be deployed? An answer to this question provides insights regarding situations in which Family Group Conferences may (not) be useful. Barriers in 17 cases were examined using multiple case studies. Findings The following barriers emerged: (1) the acute danger in coercion situations, the limited time available, the fear of liability and the culture of control and risk aversion in mental health care; (2) the severity of the mental state of clients leading to difficulties in decision-making and communication; (3) considering an Family Group Conference and involving familial networks as an added value in crisis situation is not part of the thinking and acting of professionals in mental health care; (4) clients and their network (who) are not open to an Family Group Conference. Applications Awareness of the barriers for Family Group Conferences can help to keep an open mind for its capacity to strengthen the partnership between clients, familial networks and professionals. The application of Family Group Conferences can help to effectuate professional and ethical values of social workers in their quest for the least coercive care.

Regaining ownership and restoring belongingness: impact of family group conferences in coercive psychiatry

AIM This study examined the impact of family group conferences on coercive treatment in adult psychiatry. BACKGROUND Coercive treatment in psychiatry infringes the fundamental rights of clients, including the right to control their lives. A promising intervention is the family group conferences, which has the potential to prevent crises through the integration of the expertise of informal and professional networks. DESIGN A responsive evaluation, including qualitative and quantitative methods, was deployed to study the process leading up to the FGC, the proceedings and the impact of the conference. METHOD From 2013-2015, 41 family group conferences were studied in three regions in the Netherlands. The impact of every conference was examined with scales (ranging from 0-10) during interviews with attendees (clients, family members, friends, mental health professionals and family group conferences coordinators) who reflected on three outcome measures: belongingness, ownership and coercion. RESULTS After the family group conferences, respondents indicated a slight reduction in their experience of coercive treatment. They also mentioned an increase in ownership and belongingness. CONCLUSION Family group conferences seems a promising intervention to reduce coercion in psychiatry. It helps to regain ownership and restores belongingness. If mental health professionals take a more active role in the pursuit of a family group conferences and reinforce the plans with their expertise, they can strengthen the impact even further.

Enabling social support and resilience: outcomes of Family Group Conferencing in public mental health care

Family Group Conferencing (FGC) is a decision-making model where clients with their social network formulate their own plan. There is little experience with FGC in mental health care. We studied the outcomes of 41 conferences in a public mental health setting in the north of the Netherlands. We interviewed 312 respondents out of a total of 473 conference participants. In 33 cases, it was possible to obtain scores from 245 respondents on scales ranging from 0 to 10 about the situation prior and after the conference on three outcome measures, namely the quality of: (1) social support, (2) resilience and (3) living conditions. In the 33 cases, t-tests and multilevel analyses indicate on all of the three outcomes measures significant positive changes after the conferences. On average, the scores on the quality of social support (5.04–6.73), resilience (4.09–6.32) and the living conditions (3.73–6.64) had been increased since the conferences were organised. The results are modest but remarkable. That the impact of FGC is not more substantial can be explained. The clients referred to a conference in this particular study, mostly had a limited network and few recourses from whom little support could be expected.

Beyond silence and rumor

Purpose – This paper aims to explore the role of a small‐scale project around storytelling as a form of informal education in five health clinics in rural areas of the Limpopo Province in South Africa. The aim of the project is to decrease the stigma around HIV/AIDS and to start an open dialogue in local communities about the disease.Design/methodology/approach – This is an exploratory study using a qualitative approach, which was carried out in 2005/2006, that focused on perceptions of participants from the audience of the project and health practitioners.Findings – The research findings emphasize the importance of involvement of a storyteller who can play an influential role in local rural communities by breaking the stigma attached to HIV/AIDS and providing people with little or no education with simple but effective messages about the disease. Stories are embedded in local traditions and make use of metaphors, like dialogues between animals. Beside, stories are a form of “edutainment”: education enric...

The weakening of kin ties: Exploring the need for life-world led interventions

The protective features that families and wider social relationships can have are required to meet the demands of life in contemporary Western societies. Choice and detraditionalization, however; impede this source of solidarity. Family Group Conferencing (FGC) and other life-world led interventions have the potential to strengthen primary groups. This paper explores the need for such a social intervention, using insights from sociological and philosophical theories and empirical findings from a case study of the research project ‘FGC in mental health’. This need is understandable considering the weakening of kin ties, the poor qualities of state agencies to mobilise self-care and informal care, its capacity to produce a shift of power from public to private spheres and its capacity to mitigate the co-isolation of individuals, families and communities. A life-world led intervention like FGC with a specific and modest ambition contributes to small-scale solidarity. This ambition is not inclined to establish a broad social cohesion within society but to restore; in terms of the German philosopher Peter Sloterdijk; immunity (protection) and solidarity in primary groups, and consequently, resolve issues with those (family, neighbours, colleagues) who share a sphere (a situation, a process, a fate).

Reasons to temper enthusiasm about open access nursing journals

Background: Open access is a relatively new phenomenon within nursing science. Objectives: Several papers from various nursing journals have been published recently on the disadvantages of the traditional model of purchasing proprietary fee-based databases to access scholarly information. Just few nursing scholars are less optimistic about the possible benefits of open access nursing journals. Design and methods: A critical reflection on the merits and pitfalls of open access journals along insights from the literature and personal opinion. Two arguments are discussed, providing justification for tempering enthusiasm about open access journals. Results: First, only research groups with sufficient financial resources can publish in open access journals. Second, open access has conflicting incentives, where the aim is to expand production at the expense of publishing quality articles; a business model that fits well into a neoliberal discourse. Conclusion: There are valid reasons to criticise the traditional publishers for the excessive costs of a single article, therefore preventing the dissemination of scholarly nursing information. On the contrary, the business model of open access publishers is no less imbued with the neoliberal tendency of lining the pockets.Background: Open access is a relatively new phenomenon within nursing science. Objectives: Several papers from various nursing journals have been published recently on the disadvantages of the traditional model of purchasing proprietary fee-based databases to access scholarly information. Just few nursing scholars are less optimistic about the possible benefits of open access nursing journals. Design and methods: A critical reflection on the merits and pitfalls of open access journals along insights from the literature and personal opinion. Two arguments are discussed, providing justification for tempering enthusiasm about open access journals. Results: First, only research groups with sufficient financial resources can publish in open access journals. Second, open access has conflicting incentives, where the aim is to expand production at the expense of publishing quality articles; a business model that fits well into a neoliberal discourse. Conclusion: There are valid reasons to criticise the traditiona...

Nursing and the Emergence of Egoless Care: A Discussion on Social Engineering in Mental Health

ABSTRACT The narrowing of the diverse fields of psychiatry to just the single dimension of the biomedical model has resulted in a situation where professions with a focus on curing (psychiatrists and psychologists) are favoured over those with a focus on caring and encouraging near communities to care for each other (nurses). The social engineering of mental problems leads to a state of helplessness. This paper contributes to an understanding of the barriers to utilise the social resources of people with mental health problems and argues for forms of “indirect social engineering” and “egoless care,” and, ultimately, a rediscovery of nursing, using the mental health care in the Netherlands as a case study.