Thomas Styron

“Please Ask Me How I Am”: Experiences of Family Homelessness in the Context of Single Mothers' Lives

An increasing number of studies in recent years have examined the issue of family homelessness. The majority of this research has taken a quantitative approach, focusing primarily upon the demographics and characteristics of homeless mothers and children and the conditions of shelter facilities. The goal of this study was to examine the experience of family homelessness from an alternative perspective through interviews with formerly homeless mothers about their lives before and after leaving the shelter system. In-depth interviews with 24 formerly homeless single mothers in New York City were conducted and subsequently analyzed employing a qualitative-narrative approach. Major themes that emerged from the womens life stories are elucidated: poverty, neglect, abuse, troubled interpersonal relationships, and mental health concerns. Surprisingly, a majority of women spoke of their experience in the shelter system in positive terms. This and other findings are discussed in the context of the womens life experiences and support services provided by the New York City shelter system. Social policy issues and recommendations for future research and program development are presented.

Supported Parenting to Meet the Needs and Concerns of Mothers with Severe Mental Illness

Women with serious mental illness (SMI) often parent without adequate support from psychiatric and behavioral health providers. The lack of such services is significant, given that women with SMI have children at the same rate as or higher rates than women without psychiatric disabilities. In this call to action, we argue that the need to develop supported parenting initiatives for women with SMI is necessary and long overdue. First, we describe numerous social and systemic barriers in the United States that have hindered the development of parenting supports for women with SMI over the last century. We next describe recent qualitative and quantitative findings regarding the parenting needs and strengths of these mothers. Finally, we conclude with suggestions for future research, program development, and systems-level policy changes to support mothers with SMI in parenting most effectively.

Self-Efficacy and Self-Care: Missing Ingredients in Health and Healthcare among Adults with Serious Mental Illnesses

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.

Curriculum resources for training Direct care providers in public Sector mental health

Direct care personnel who do not have graduate-level professional degrees provide a substantial amount of client care in mental health organizations across the nation. Training for them is minimal in many settings. This shortcoming may negatively affect client care, staff recruitment and retention, and the effective use of scarce resources. In this paper, we identify and review curriculum resources available to mental health organizations interested in implementing or enhancing training programs for direct care personnel. These include two relevant competency sets and six portable training curricula, as well as information on how to access these resources.

Teaching an interdisciplinary approach to the treatment of chronic mental illness: challenges and rewards.

ObjectiveNational policy makers and psychiatric educators have established the goals of teaching and promoting interdisciplinary care as high priorities. This article describes the implementation of an interprofessional seminar for which the dual aims were to provide a knowledge base for treating individuals with serious mental illness and to teach how to work collaboratively with other disciplines.MethodA seminar, the “Treatment of chronic or recurrent mental illness: recovery, rehabilitation and interdisciplinary collaboration,” was developed in an academic community mental health center. Pre- and postseminar surveys were administered in order to test the hypothesis that the seminar would have a positive impact on trainees’ attitudes about working with the seriously mentally ill and within an interdisciplinary team. A combination of 5-point Likert scales and open-ended questions were used to gather the data. Paired samples t tests were conducted to test for significant differences between the pre- and postmeasures.ResultsThe seminar participants included 24 students from psychiatry, nursing, social work, and psychology with a wide range of experience. Complete pre- and postseminar data were obtained from 14 participants. Although participants valued the seminar experience, they reported that the actual interdisciplinary work with the seriously mentally ill was less gratifying than expected. They described several advantages and challenges of care-oriented collaboration and shared learning.ConclusionBringing together a diverse group of graduate and postgraduate trainees to learn together and to learn about each other’s disciplines appeared to be a successful venture, but the authors were not able to detect a positive impact on their actual work life during the course of the year. Further development of strategies to inspire professionals to engage in and promote interdisciplinary care of the seriously mentally ill is needed.

Principles for Recovery-Oriented Inpatient Care

This chapter defines and distinguishes between two related concepts of “recovery” in relation to serious mental illnesses and the provision of “recovery-oriented care.” With this distinction in place, the chapter then outlines four key principles for applying the principles of recovery-oriented care to inpatient psychiatry. This first principle is that it is the person’s own recovery, reframing the aim of inpatient care to preparing the person to manage his or her condition and life following discharge. The second principle that follows from this is that Recovery-oriented care needs to be person/family-centered and culturally responsive to be relevant to the person’s life. Given the high prevalence of trauma among persons with mental illness and the potentially traumatic nature of hospitalization itself, the third principle is that inpatient staff should anticipate, and welcome, trauma survivors through the provision of a safe, respectful, and collaborative environment. Finally, principle four is that the interdisciplinary team needs to be expanded to include the person him or herself, his or her identified family members, and the community-based providers who have worked with the person in the past and/or will work with the person following discharge. In closing, the respective role of each of these team members within the context of recovery-oriented inpatient care is described.

Perceived quality of early paternal relationships and mental health in adulthood.

Abstract We aimed to determine the association between perceived paternal relationships and mental health and social functioning among adults in the community. Data were drawn from the National Comorbidity Survey (N = 8098), a nationally representative sample of adults aged 15 to 54 years in the United States. Multiple logistic regression analyses were used to assess the relationships between quality of paternal relationship in childhood and current mental disorders, quality of current social relationships, and attachment style. Poor paternal relationship was associated with a significantly increased likelihood of mood and anxiety disorders. Poorer quality of paternal relationships was also associated with poorer current social functioning and avoidant and dependent attachment styles. Our findings suggest that quality of paternal relationships is associated with mental health and social functioning in adulthood and highlight a need for increased understanding of the role of paternal relationships in social/emotional development.

Utilization Management for Residential Programs

This paper reviews recent literature on utilization management (UM) in community-based supportive residential programs for people with behavioral disorders. Various approaches for facilitating placement and movement are discussed in the context of an effort to develop a residential UM process in New Haven, Connecticut. Recommendations are made for a residential UM process that may be applied to a range of service systems. It takes into account the methodological difficulties inherent in the development of generalizable decision tools.

New Forms of Outreach in Community Psychiatry: A Report from the Field

Alternatives to office-based practice, such vere mental illnesses in their own communities became apparent; and (2) in the 1980s, as assertive community treatment (Stein & Test, 1985; McGrew & Bond, 1995) and ashomelessness among persons with mental illness reached a crisis point. A form of outsertive outreach to homeless persons (Cohen & Marcos, 1992; Rowe, Hoge, & Fisk, reach in community psychiatry that is less often discussed and evaluated is outreach 1996) were implemented in some community mental health systems in response to to individuals living in poor neighborhoods who are at risk for a range of behavioral two developments: (1) In the 1970s, the difficulty of treating some individuals with sehealth disorders, rather than outreach to an identified sub-group of persons with serious and persistent mental illness (SPMI). Michael Rowe, Ph.D.; Paul Falzer, Ph.D.; Miriam The former individuals may find services Delphin, Ph.D.; Vangie Vargas, B.A.; Thomas more helpful when they are delivered withStyron, Ph.D.; and Larry Davidson, Ph.D., are in the physical and socioeconomic context affiliated with the Yale School of Medicine, Department of Psychiatry. Lynelle Thomas, M.D., of their daily lives, including poverty, stigma, is affiliated with the Yale School of Medicine, and lack of access to economic and social Child Study Center. Joseph Berryhill, Ph.D., is resources (Davidson et al., 2001; Timko & associated with the University of North CaroMoos, 1998). In this report, we use our work lina at Asheville. This paper was written, in part, with the supwith a federally funded service demonstraport of a grant from the federal Substance Abuse tion project that aims to increase access to and Mental Health Services Administration for behavioral healthcare among residents of improving access to mental health services for public housing as a case example of this less persons residing in public and assisted housing, discussed form of behavioral health outCMHS GFA No. SM00–12. Address for correspondence: Michael Rowe, reach. After the case history of this workPh.D., Yale University School of Medicine, Dein-progress, we discuss the challenges that partment of Psychiatry, Program on Poverty, have emerged in our work, and we offer Disability, and Urban Health, 205 Whitney Aveexamples of how we have tried to address nue, New Haven, CT 06511. E-mail: michael.rowe @yale.edu. them.

The 2012 sandy hook elementary school shooting: Connecticut’s department of mental health crisis response

ABSTRACT This article reports on the role, activities, and lessons learned of a state mental health authority—the Connecticut Department of Mental Health and Addiction Services—in responding to the mental health needs of families and community members following the 2012 Sandy Hook Elementary School shooting. Following the introduction, we provide a brief case study of Department of Mental Health and Addiction Services’ role in the aftermath of the Sandy Hook shooting. This role included use of the Incident Command System (ICS) to deploy a standing statewide network of clinicians who provided direct care for surviving children and school personnel, victims’ family members, and others, and coordination of its mental health response with the activities of other state, private, and individual players. We then discuss key themes and lessons learned and offer recommendations to mental health authorities for planning and implementing their own responses to possible like incidents in the future.