Addressing psychosocial factors is essential in promoting health and supporting patients’ salutogenic development. Internationally, the theoretical and methodological foundations of social work in healthcare remain ambiguous. As Swedish Health Social Workers (HSWs) now receive specialist education, it is increasingly important to clarify the expectations placed on licensed HSWs. Focus group discussions explored how HSWs apply theories and methods in everyday practice. Participants highlighted the value of trust-building, active listening, and involving patients in defining goals. Greater consensus on working methods could strengthen professional identity, clarify roles, and ensure adequate, high-quality care while maintaining individualised approaches.
Abstract: As the British population ages, along with those of other advanced economic societies, there will be a greater need for health and social care for this group. Successive British governments have to some extent failed to tackle this demographic issue. All health and social care professions will have to devote more of their staffing resources to working with older adults and social work is no exception. A recent research study (Carson et al., 2020), looked at how British people in the North and the South of England (n = 1608), were functioning in the week of the first COVID-19 lockdown in England. While originally planned as a study of happiness, it was obvious that participants were very worried about the growing threat of the COVID-19 pandemic. In this paper we compare the findings from a group of Older participants (aged 60 to 87, n = 104), with a Younger cohort (aged 17 to 30, n = 673), on a range of measures. Older participants were seen to have significantly higher levels of Flourishing on three subscales from the PERMA Profiler. They had higher levels of Meaning and Personal Accomplishments, and lower levels of Negative Emotions. They were also found to have lower levels of Loneliness and less psychological distress. Age may have been an advantage going into the COVID-19 lockdown. We report on these findings and outline a new study of Older adults which aims to compare a large British and a Taiwanese sample. Do people in Britain have higher levels of Flourishing and less psychological distress than their Taiwanese counterparts? We also intend to look at the concept of anti-mattering. Do Older people in the UK feel they are listened to more and that their views matter to others more than their Taiwanese equivalents?
Young men have only recently been recognised as pivotal to promoting gender equality and strengthening family wellbeing in South Africa. This study documents the experiences of fifteen young men from low-income, urban communities who became fathers through unprotected sex. All were aware of the negative consequences of such behaviour but felt that it was not their responsibility to practice safe sex. They were over-burdened with the responsibility of being fathers, especially in the absence of family support. They highlighted a lack of social support services for men and fathers. Although there have been efforts to expand family planning efforts and promote safer sexual practices in resource poor settings, it remains a challenge. This study emphasises the importance of targeted, gender-inclusive, social services aimed at men to promote safer sexual practices and a greater commitment to their fathering role.
Background: The global prevalence of diabetes mellitus is rising, with a significant comorbidity of depression, a condition called “diapression”. Acceptance and Commitment Therapy (ACT) is a transdiagnostic approach that may benefit this population, and online delivery can improve accessibility. However, qualitative insights into the experiences of patients with diapression undergoing online ACT are lacking. Objective: This exploratory qualitative study aimed to investigate the perspectives of Chinese patients with type 2 diabetes and comorbid depression on an online, self-help ACT intervention, focusing on its acceptability and potential improvements. Methods: Semi-structured interviews were conducted with eight participants one month after they completed an 8-week online ACT program delivered via WhatsApp/WeChat. Data were analyzed using inductive thematic analysis. Results: Five key themes were identified: (1) the perceived usefulness of ACT techniques for improving self-management and reducing distress; (2) difficulties in understanding certain abstract ACT concepts; (3) a preference for brief, succinct intervention components; (4) the benefits of online delivery for flexibility and accessibility; and (5) need for more personalized interaction and prompt feedback Conclusion: Online ACT was generally acceptable to patients with diapression. The intervention was valued for its practical skills and flexible format but could be enhanced by incorporating more real-life examples, culturally adapting concepts, and integrating methods for increased interaction, such as AI chatbots. These findings provide crucial insights for refining online self-help psychotherapies for this population before conducting larger-scale trials.
The CHIME Model has become the dominant model of mental health recovery. The model has been grounded in the lived experience literature of people recovering from mental health problems. Four of the components were first articulated by Australian researchers. These were Hope, Identity, Meaning and Empowerment. English researchers added Connection, thus forming the acronym CHIME. In this paper we show how we have added to this basic model. Robert and Jerome were the first to describe C-CHIME, with the C reflecting Creativity. This was also Jerome’s experience in mental health services, that often those people who recovered most, had creative talents, such as photography, artistic skills, filmmaking, or poetry. Lisa and Jerome discovered that a critical element in recovering from addiction was the concept of Growth. For someone to give up an all-consuming addiction, something needs to replace this in their lives. This could be education or developing a new career. Ije found that there were additional critical elements in her recovery from lupus. She felt that Pain, Acceptance, Adaptation and again Growth, were key in addition to the core elements of CHIME. Andrew Voyce briefly describes his own long journey of recovery that took place over a 20-year period. He illustrates how CHIME can be harnessed to explain his own recovery. Finally, we look at how practitioners might apply the CHIME model and its variants in their clinical practice. We note the lack of an assessment that might just guide this process, but which could also serve as an outcome measure.
Grounded in the holistic health theory of body-mind-spirit, this study uses a horticultural group intervention approach to examine the effectiveness of promoting holistic child development in social work practice. It aims to provide innovative perspectives and methodologies for social work practitioners and to support the creation and growth of child-friendly communities in mainland China. The study was conducted in the Z Child-Friendly Community of N City and involved 160 children who were divided into an intervention and control group for practical implementation. Evaluation was carried out using both quantitative and qualitative techniques. The results indicate that the Body-Mind-Spirit Horticulture group intervention is effective in promoting holistic health development in children by reducing stress, optimising emotional state, and promoting harmonious coexistence with nature. These findings have significant practical relevance. The study also discusses the challenges and limitations of implementing the holistic health group counselling programme in child-friendly communities.
One of the most frustrating groups of people to work with for social workers, can be people with addictions. In this paper the authors introduce a new approach to addiction recovery, which they call recovery protection. They argue that it is more empowering than the dominant relapse prevention model. All five authors of this paper as in recovery from addiction themselves. After presenting their new model of recovery protection, three of them describe their own recovery journeys and how a model of recovery protection has been a better model for them to have pursued. All five have benefitted from engaging in higher education. Each has a mission to try and make things better for people in addiction or recovering from addiction. The recovery protection model they advocate represents a paradigm shift in the field. Recovery is a gift. Let’s protect it.
Social workers work with many disadvantaged and stigmatised groups. People with mental health problems have been stigmatised for centuries. In the last few decades attempts have been made to reduce levels of stigma in the general population, such as with the Time to Change program in the United Kingdom. Yet, there is so much about stigma we still do not understand, which has been referred to by Smith as stigma’s ‘dark matter.’ For instance, how do levels of stigma vary among different cultures? In this paper we consider what affects stigma in South Asian populations. After a short review of the literature in Sri Lanka, Pakistan, and India, we describe three studies we have conducted in this area. The first was a quantitative online survey, that used a previously published vignette to assess elements of stigma in 425 participants. The second comprised interviews with 15 people of South Asian heritage. The third was a community engagement event which brought together 99 mental health professionals and community activists for a hybrid educational event. The three studies are presented and discussed. Some tentative conclusions are offered
This study investigates the mechanisms through which neighborhood disorder exert adverse influence on child psychological well-being through chain effects of maternal emotional distress and hostile parenting. Cross-sectional data from mother–child dyads within urban communities surrounding transport-parks in one of Nigeria’s largest cities was analyzed using structural equation modeling. Results revealed a significant indirect effect of neighborhood disorder on child emotional distress via maternal emotional distress (β = 0.045, p < 0.05). A serial mediation model further revealed that neighborhood disorder elevated maternal emotional distress, which in turn intensified hostile parenting and exacerbates poor child psychological well-being (β = 0.024, p < 0.05). Maternal age moderated the direct paths, buffering the impact of neighborhood disorder and hostile parenting on child outcomes. Gender-specific patterns also emerged in this study. These findings highlight the imperative for interventions targeting maternal mental health and parenting practices to alleviate adverse psychological well-being of children in neighborhood surrounding transportation parks in Nigeria.
Drawing on findings from a larger project with children whose parents have mental illness in Ghana, involving 30 interviews and 19 diaries completed, we provide a snapshot into the maltreatment experience of these children. Epidemiological studies have found that these children may develop mental health issues and ample evidence has been reported on their poor social and behavioural outcomes. However, the children’s voices and experiences of their own living situation has been limited. Notwithstanding, services have not always met their needs. Their needs and problems are often unnoticed and ‘invisible’. In this article, we focus on information from their diaries. Overall, the article reports specific events in the children’s lives that represent physical, verbal, and emotional abuse. The children also understand that their life contains good and bad days, representing the unpredictability of mental illness. We conclude that services should be preventative to address the impact of parental mental illness on children. This could be achieved through inter-agency collaboration, where mental health and child welfare services work together. The starting point for any professionals who work with the child or the family, to collect information and assess the parental roles and functions and what it means for the child. before a more formal platform for inter-agency work is established for the different disciplines (i.e., medical doctor, medical social worker, family worker and child welfare officers).
This paper explores the impact Peter Huxley had on one of his PhD students who went on to forge a career in mental health social work research. It provides a personal reflection on the stimulus and inspiration Peter provided through his research interests and his concern for methodological rigour. The paper relates a sequence of events through the author’s research career and their origins in Peter’s work. This began with a piece of practice research which provided a gateway to a Fellowship. Alongside PhD research, they collaborated on mental health social work workforce research and the development of social outcome measures in mental health services. This provided the foundation for the author’s subsequent focus on intervention research, through which Peter’s legacy is evident.
The paper describes a part of the work on assessment of quality of life that Peter Huxley has been involved in. It first describes the background for the development of Manchester Short Assessment of Quality of Life (MANSA), the content and form of MANSA, some preliminary results and psychometric properties of MANASA that has been found, that it has been recommended for use as an outcome measure for quality of life, and that there has not yet been done a systematic review of MANSA and the use of MANSA. The author then discussed how she became involved in a systematic review of MANSA led by Peter Huxley, parts of the work with the systematic review that is in progress, and her personal and positive experience of Peter as a supervisor and person.
This paper describes a project to facilitate mental health reform in one Russian oblast (region) using systematic approaches to policy design and implementation. The author led a multidisciplinary team which undertook a three-year action-research programme across three pilot sites, comprising a multifaceted set of interventions combining situation appraisal to inform planning, sustained policy dialogue at federal and regional levels to catalyse change, introduction of multidisciplinary and intersectoral-working at all levels, skills-based training for professionals, and support for nongovernmental organizations (NGOs) to develop new care models. Training programmes developed in this process have been adopted into routine curricula with measurable changes in staff skills. Approaches to care improved through multidisciplinary and multisectoral service delivery, with an increase in NGO activities, user involvement in care planning and delivery in all pilot sites. Hospital admissions at start and end of the study fell in two pilot sites, while the rate of readmissions in all three pilot sites by 2006 was below that for the region as a whole. Lessons learned have informed the development of regional and federal mental health policies. It is concluded that a multifaceted and comprehensive programme can be effective in overcoming organizational barriers to the introduction of evidence-based multisectoral interventions in one Russian region. This can help facilitate significant and sustainable changes in policy and reduce institutionalization.
Drawing on Professor Emeritus Terry Smith’s work on Aftermath Architecture, we reflect on how the world’s purportedly ‘eternal’ architectural icons can be transformed in the public consciousness, by terrorism and political intrigue, into impermanent ‘soft targets’. In parallel we explore the grandiose ‘Iconomy’ of Psychiatry, and the decay of its grandiose institutional icons into stigmatizing stereotypes of dysfunctional mental health services. Professor Smith also invoked a related concept: the ‘Lattermath’, a late 15th century term for the new shoots of grass growing after harvest, to make the case that a renewal of hope is possible for architecture, prioritizing domestic and communal living. To achieve an enduring ‘Lattermath’ in psychiatry requires us to shift the centre of gravity of mental health services from being so hospital-centric towards community living. It also entails rebuilding mental health-care eco-systems which integrate clinical, lived experience, and carer expertise, while optimizing mental health and wellbeing outcomes., It also entails heeding First Nations caring for nature and community, their climate change activism and their resilience, and operationalizing human rights and an ‘invisible village’ or a co-designed local community of ongoing mental health care and support for individuals and families while ever they need it.
Contact and collaboration with Peter over more than two decades has led to the use of MANSA as a measure of quality of life of several thousand patients in some Norwegian studies: a study of service users of community mental health centres, a national survey of outpatients in mental health services, and a study of service users of Assertive Community Treatment teams. Research in Norway has shown that MANSA has adequate measurement properties, that quality of life varies among subgroups of service users, that quality of life is associated with aspects of service delivery, and that quality of life in specific life domains are related to specific types of practical and social functioning.
Abstract: Mental health interventions matter most where they result in improvements in the social lives of patients. Those resettled from the asylum preferred living in the community and experienced few adverse outcomes. Resettlement was undoubtedly institutional in nature, patients having little or no choice over where, when or with whom they moved. The underlying ‘train then place’ rehabilitation model persists to this day, with step-down towards independence contingent on the (re-)acquisition of daily living skills. Subsequent recognition of the importance of choice and person-centred care has led to interesting questions about this model. Emerging evidence suggests instead a ‘place then train’ approach, involving a rapid move to independent accommodation or to open job placement with support following as necessary. The relationship between service user and the professional providing care is critical for these optimistic person-centred interventions. It is therefore disquieting to observe declining continuity of care and care models that promote fragmentation of the care team.
Restraint is used in around 5% of psychiatric inpatients in the UK. Patients experience different types of restraints in widely different ways. This article argues that the UK restricts its services and psychiatric patients from making preferred choices about the types of restraint used by restricting the available restraint to seclusion and physical restraint.
This brief paper reflects on the measurement of an important aspect of social inclusion - active citizenship through participation in voting. It highlights some of the challenges of understanding voting and its implications for the measurement of citizenship for people with mental illness. Given the challenges, it concludes by acknowledging that the work undertaken by Peter Huxley makes a significant contribution to the measurement of an important aspect of social inclusion.
The article emphasizes the importance of policies and practices contrasting social exclusion and promoting social integration in a new ‘ecological’ approach to mental healthcare. The relationship between the subjectivity of the person, their social capital, the services and institutions of our societies, the role of the social determinants of mental health are described. Inequities and inequalities arise from a number of parameters encompassed for instance by the Mental Health Integration Index developed by Peter Huxley and colleagues. At the same time, these parameters impact on individuals and their capabilities to use resources and opportunities, that is crucial in the field of mental health. The overall concept of citizenship is key for social integration. Citizenship rights are related to the power of individuals in the social domain and are regulated in psychiatry by the existing institutions and the level of social sanction they establish for ‘deviant behaviors’, condemning them to social exclusion. Thus, the need for a work of de-institutionalization and the shift of people and otherwise wasted resources to new community services. The example of Trieste, Italy is proposed for a possible action encompassing a set of levels that are required for this action. Merely ‘clinical’ services seem not to address the complex issue of comprehensive care. The main elements of a whole person, whole life and whole system approach, needed to enable individuals to be active member of their community, are finally summarized and outlined.
In this paper the authors introduce readers to the field of autoethnography (AE). They provide an overview of the field, then describe several different forms of AE. These include positive autoethnography, collaborative AE, duoethnography, and digital autoethnographical psychobiography, in both national and international formats (DCAP and IDCAP). They point out how AE is distinguished from autobiography. They stress the application of AE as a way for social work academics, their students, and their service users to capture elements of their professional practice, and the nature of their working relationships and experiences. This approach enables social workers and their clients to participate as equal partners in a process which can be cathartic as well as being respectful of each other’s position.
