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Mental Disorder And Suicide Research Paper Essay Help Site:edu

Mental Disorder


Suicide- Mental Disorder


Beginning with a historical analysis of suicide, the psychopathology of suicide is analyzed. Empirical findings are also presented to address probable causes of suicide. This paper addresses the psychopathology of suicide starting with its historical backdrop. It additionally contemplates the probable reasons leading to this pathology founded on latest empirical results. Control of suicidal behaviors and ideation are addressed, along with prevention and treatment strategies. Finally, the religious and cultural purviews with respect to suicide are considered based upon current research in the field.


Globally, suicide is one of the major causes of death. As many as 36,000 commit suicide in the United States annually and estimates suggest that 1 million individuals commit suicide in the rest of the world. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify suicide as a mental disorder (DSM-IV-TR), practitioners recognize the correlation between psychological dysfunction and suicide, particularly with respect to perturbed orientation towards life, emotional confusion, and poor skills in ordinary coping with circumstances (Comer, 2013).


The precise definition of a suicide attempt is that it is an action which the individual has initiated with at least a partial goal of ending their own life. This act may or may not result in medical consequences and/or injury. Factors that impact the actual result of the suicide attempt include: low intentionality and/or ambivalence, chance intervention during the attempted act, incomplete knowledge about the method chosen for the suicide, and poor planning (American Psychiatric Association, 2013).


The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) states that suicidal behavior includes at least one suicide attempt by the individual. An attempt made at suicide by an individual, even if they changed their mind and/or there was a timely intervention, is considered suicidal behavior. As an example, some suicide attempts include the use of poison and/or medications. The individual may begin taking these substances but then might be stopped by another person, or may choose to stop themselves. However, should the individual not actually initiate the suicidal behavior, whether due to stopping themselves and/or an intervention, it is recommended that this person not be diagnosed as suicidal (American Psychiatric Association, 2013).


Historical Perspective


In 1642, Sir Thomas Browne first used the word suicide in his book ‘Religio Medici’. This word comes from the Latin sui and cida ‘one who kills oneself’. While suicidal numbers are high at present, the act itself seems to have been recorded throughout history. Prior to the introduction of word ‘Suicide’, other terms used included self-destruction, self-killing and self-murder. Beck and colleagues defined suicide as a willful self-infliction of an act that is life-threatening (Pooja & Kochar, n.d.).


Historically, the societal view of suicide has varied with the culture. For example, the traditions of the feudal Japanese held suicide to be an honorable act by which a family or clan were protected from dishonor by the acts of one family member. The view of many in the ancient Roman Empire was that the act of committing suicide was an act of glory, and a demonstration of superior wisdom. Indeed, often in former historical periods it appears that the deliberate choice of death before one was enfeebled was ‘dying with dignity’ (Barnes, 2010). To some extent then, and particularly prior to the 1600’s when the actual term ‘suicide’ entered into conversational use, this act was considered to be merely a different form of death.


An early stigmatization of suicide as an unforgivable sin came from Saint Augustine, and his followers, and much of Western Christianity, viewed suicide as a sinful act. Suicide was considered to be an act of murder, and thus direct violation of one of the Ten Commandments. Accordingly, individuals who committed suicide were not permitted a church burial. Furthermore, in some cases other acts expressing the societal and moral disapproval included the dragging of the bodies of suicides through town to impress the wrongness of the act upon the community, and possibly also to punish and/or humiliate the family of the individual (Barnes, 2010).


While there were often penalties and disgrace for families of suicides, classification of an individual as mentally disturbed began, during the 1800s, to change the societal purview of suicide. The societal status of a family was of significant importance in that time period, and both reputation and family dignity were considered priorities; thus having a suicide in the family was considered disgraceful. Having a family member who was mentally ill was also considered disgraceful, and the stigma attached led to the development of a taboo against suicide in Western culture. In contrast, suicide is today spoken of almost openly, and disgrace is not necessarily concomitant with the sorrow of a lost loved one to suicide. Along with the disappearance of the need for secrecy, the view of the individual who has committed suicide has changed from being a ‘sinner’ to being a ‘victim’ (Barnes, 2010).


Causes of suicide


Different purviews as to the causes of suicide come from the biological, psychodynamic, and socio-cultural perspectives.


The Biological View


Analysis of the families, close relatives and parents, of individuals who commit suicide, has shown that there is a higher rate of suicide in many cases. These data have indicated the possibility of biological and/or genetic factors in the ideation that leads to suicide. Indeed, twin studies also support these data as well (Comer, 2013).


Over the last thirty years, there have been increasing laboratory and clinical studies into suicide. For example, the neurotransmitter serotonin has been studied. For individuals with low levels of serotonin, impulsive behavior and aggressive activity are observed. As well, for individuals diagnosed as clinically depressed, there is evidence that aggressive tendencies may be, in part, a consequence of low serotonin activity. The result is that such individuals may be at particular risk to consideration and action upon suicidal thoughts (Comer, 2013).


The Psychodynamic View


In terms of psychodynamic theory, it has been suggested that suicidal behavior is derived from unresolved anger at other people as well as from depressed mental states, where the individual redirects the external anger inwards. One theory considers that individuals ‘introject’ the persona of a lost loved one, whether that loss has been real, as in a death, or merely consists of a dysfunctional relationship and lost personal contact. This act of introjection occurs as an unconscious incorporation of the other person into the self-identity, along with feelings towards oneself akin to those formerly held towards the other person. These feelings can include anger towards the other person, now experienced as self-hatred. This anger at the other person can then be expressed as extreme anger towards oneself as well as significant depression. The extreme expression of this self-punishment and self-hatred is then acted out as suicide.


The Socio-cultural Perspective


One analysis of the probability and origins of suicide, that of Durkheim (Comer, 2103), focuses on the integration of the individual into societal groups, including the community, the family, and religious institutions. This perspective suggests that lack of integration is more often a factor in suicidal ideation, whereas more-closely integrated individuals have an inherently decreased risk of suicide. The socio-cultural perspective includes at least three categories of suicidal individual: altruistic, anomic, and egoistic suicide (Comer, 2013).


The category of altruistic suicides includes those individuals who are apparently well-integrated into society, and actually consider that the sacrifice of their lives is a contribution to the well-being of society. Anomic suicides, based on the definition of the word anomie (a lack of normal ethical and societal standards) is a category of suicidal individuals whom Durkheim proposes lack meaning in life. Their individual circumstances, whether through family, religion, or friends, does not provide sufficient stability to provide ‘meaning to life’. The category of egoistic suicides includes individuals who are iconoclastic in general, and are neither well-integrated into the social fabric, nor responsive to societal mores and norms (Comer, 2013).


Other factors


Early life factors


There are a variety of factors that can lead to suicidal risks and behaviors. Among these, traumatic life experiences, abuse (whether physical, mental, or sexual), childhood adversity, and parental neglect (inadequate care, death, separation, divorce) are all factors that can contribute to the development of suicidal risk behaviors as well as mental disorders, regardless of age of the individual. Furthermore, it appears that physiological factors, genetically derived, may also contribute to suicidal ideation, as certain individuals are thus more prone to neuro-cognitive deficits, neuroticism, and impulsive aggression (Draper, 2014).


Personality traits


There are specific personality traits that have been linked to an increased risk of suicide. Of these, neuroticism is dominant, although this trait is less common in suicidal attempts among middle-aged individuals. There are some suggestions that neurotic behavior is associated with, or a proxy for, undetected depression. Indeed, a clinical study found that once older individuals who had attempted suicide were treated for major depression their neurotic behavior also decreased (Draper, 2014).


Suicide and Age


Evidence exists that suicide-likelihood has an age-dependent factor. Generally, suicide is not observed for children, although unfortunately there is an increase in suicide for this group. In contrast, for adolescents, suicide is a far more common occurrence, although in this group there has been a decade-long decrease in ‘successful’ suicides. For adolescents, the act of suicide is linked not only to adolescent life, but also to major stress, impulsiveness, clinical depression and to anger. Indeed, suicide attempts by adolescents are numerous, and many factors concerning this observation are being considered. For example, the population of adolescents and young adults is increasing, psycho-active drug usage and drug availability have been increasing, family ties are generally recognized to be severely weakened, and as well, there is considerable media coverage of suicidal behaviors and acts by adolescents. Presently in Western society, the prevalence of suicide is largest among the mature and/or elderly population. Factors related to these data include emotional feelings of loneliness, depression, hopelessness, and even inevitability of death itself. As well, other factors involved in aging such as the loss of control, loss of social status, loss of health, and loss of friends to death and age all contribute to a larger incidence of suicide in older populations (Comer, 2013).


Effective therapy approaches for treatment of suicide


For successful treatment of suicidal patients and/or clients, several new methodological approaches have proven effective. A brief analysis of treatment approaches for which a sound empirical basis exists is described below.


Cognitive therapy is an approach to treatment of suicidal individuals that was first developed by Aaron Beck and Gregory Brown. One unique aspect of Cognitive therapy is that it is open-ended, working with the client/patient until that individual is deemed able to handle distressing emotional issues on their own. While there are other Cognitive Behavioral treatment methods, many of these are time-limited. The technique focuses on the observation that suicidal individuals cannot always access emotional-management skills when they are facing a perceived crisis. The inability to use the newly acquired skills during a crisis potentially renders them inactive and useless. To address this weakness, the approach of Cognitive Therapy is to use sessions with the client/patient to evoke the crisis and train the client to test and apply newly developed coping skills while the therapist is present to offer support. Once a client/patient demonstrates that the skills can indeed be utilized in crisis, then the client can ‘graduate’ from treatment.


Dialectical behavior therapy (DBT) is an approach designed to address and treat suicidal behavior and difficulties of an individual with emotional regulation. DBT works, in part, via training of the individual and ‘skill-building’, with a focus on learning healthy approaches to affect regulation, development of tolerance to stress and distress, and improving the overall approach to emotional regulation. Healthy affect regulation is essential for the suicidal individual to use in place of formerly unhealthy emotional approaches.


Metalizing treatment is a therapeutic approach that focuses on expression and regulation of emotions. Assisting clients in observation, tolerance, and regulation of emotions occurs through training in the capability to metalize: to observe and seek to understand not only one’s own mind, but also the minds of others. Thus by observing what Firestone calls the mind behind the behavior, one develops a broader and deeper understanding of emotional affect and its power as well as developing the ability to regulate emotions instead of being at their mercy (Firestone, n.d.).


Prevention Strategies


Roascoat & Beck (2013) described three types of successful interventions preventing suicide. These include: [1] the implementation of emergency call centers; [2] limiting patient access to means of suicide; and [3] pro-active follow-up of patients who have been admitted to the hospital due to a suicide attempt. Evidence suggests that blocking access to lethal means may be one of the best approaches to suicide prevention. By reduction of consumer access to products that are dangerous, the risk of suicide is decreased. This can be done at local and national levels, as well as focusing on the individual level, securing the home environment of the person who has previously attempted suicide. For both adolescents and adults, follow-up contact after hospitalization has had a positive, protective effect against future suicide attempts.


Cross-culturally related variations


There are cultural variations in suicidal actions both with respect to its form, or method, and its frequency. In some cases, the availability of a method for suicide varies, such as use of guns in the southwestern United States, use of pesticides in third world countries, and even what appear to be psychological syndromes specific to a given culture. For example, the phrase ataques de nervios is expressed in Hispanic cultures, and is believed to correlate with suicidal attempts and/or activities that facilitate attempts at suicide (American Psychiatric Association, 2013).


Other societo-cultural mores may also contribute to inter-personal distress. For example, in Korea and China, certain couples are not permitted to marry. It is possible that these cultural traditions can be contributing factors in terms of the severity and nature of emotional distress, perhaps leading to suicidal behavior. The individual’s response to severe stress or distress may also be affected by their culture, such as the possibility of an individual considering suicide when bankruptcy appears imminent. This behavior is known as the pathoplastic effects of culture and their impact upon the act of suicide and upon suicidal behavior is well-known and has been observed in such cases that range from individual suicide to group suicide to family suicide and even mass suicide. Specific cultural examples include ‘suttee’, practiced in India and describing the ritual death of a female spouse when her husband has died, and the Japanese ‘seppuku’. Simultaneously with cultures that may have traditions that condone suicide or honor it, other cultures such as Muslims, see it as a crime or even an unforgivable sin. Many cultures do indeed have a negative purview of suicidal behavior, while others appear to be at least slightly sympathetic (Colucci, 2006).


Biblical Perspective of suicide


The sixth commandment states “Thou shalt not murder,” and this commandment is often interpreted as being strictly against suicide, as it is direct disobedience of God. The short-sighted thinking that may be a factor in the ideation of suicide, a focus on daily pain and suffering, is a failure to recognize the spiritual support that God offers. Realizing that, as a believer, one will stand before God to account for one’s life, brings one to a perspective that is perhaps more heavenly, an ‘eternal’ mindset. Filling one’s mind with the Word of God will provide support for the believer, and establish an inner foundation of faith enabling one to have the strength to handle life’s travails (In Touch Ministries, 2013).


Future Directions for research


Additional research is necessary in order to address a plethora of unanswered questions about suicide, as well as to provide clearer perspectives towards care for and assessment of patients having suicidal behaviors and ideas. At least three categories can be delineated for future research directions: determination of effective and appropriate interventions that can ameliorate the risk of suicide; determination of aspects influencing long- and short-term suicidal behaviors and risks; and a more in-depth determination of the physiological and precise neurobiological foundation for suicidal behaviors (Jacobs, et. al. 2003).


References


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.


Barnes, DH (2010). The truth about suicide. Retrieved from https://www.overdrive.com/media/322303/the-truth-about-suicide


Comer, R.J. (2013). Abnormal Psychology. New York, NY: Worth Publishers


Colucci, E. (2006). The cultural facet of suicidal behaviour: Its importance and neglect. Australian e-Journal for the Advancement of Mental Health, 5(3). Retrieved from http://www.livingisforeveryone.com.au/uploads/docs/Cultural%20facet%20of%20suicidal%20behaviour%20(2006).pdf


Draper, B.M. (2014). Suicidal behaviour and suicide prevention in later life. Maturitas, 79, 179-183. doi: 10.1016/j.maturitas.2014.04.003


Firestone, L. (n.d.). Suicide: what therapists need to know. Retrieved from


In Touch Ministries (n.d.). Suicide: The Impact on Believers. Retrieved from


Jacobs, et. al. (2003). Practice guidelines for assessment and treatment of patient with suicidal behaviors. American Psychiatric Association publications.


Pooja, R., & Kochar, S.R. (n.d.) Suicide in Youth: Shifting Paradigm. J Indian Acad Forensic Med, 32(1), 45-48. Retrieved from


Roscoat, E. & Beck, F. (2013). Efficient interventions on suicide prevention: A literature review, Epidemiology and Public Health, 61, 363-374. doi: 10.1016/j.respe.2013.01.099



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Psychiatric Patients and Mechanical Restraints professional essay help: professional essay help

Psychiatric Patients and Mechanical Restraints


Mechanical restraints are one of the most controversial aspects of psychiatric care. The aversion to using them no doubt dates back to the popularity of films like One Flew Over the Cuckoo’s Nest, which portrays the psychiatric institutions and medical authorities using restraints to constrain the free spirits of sane, but noncompliant patients. The reality of the use of restraints is far more complex and some defend the use of these devices to promote patient safety. According to the review article “Mechanical restraint — which interventions prevent episodes of mechanical restraint? — A systematic review” by Bak (2011), “in some countries, mechanical restraint is performed according to the law when psychiatric inpatients pose a risk to themselves or to others.” But other countries do not allow the use of mechanical restraints: for example, in the United Kingdom, only the use of seclusion and holding (physical restraint) is allowed (except in exceptional circumstances in special hospital environments)” (Bak 2011).


The consensus as to what constitutes the ethically-acceptable use of mechanical restraints is thus still in doubt. This article from Perspectives in Psychiatric Care attempts to establish greater clarity about how to avoid the use of this controversial technique whenever possible. The use of mechanical restraints can have grave physical as well as psychological consequences for an already vulnerable psychiatric population. Even when available to use as a method of last resort, it is desirable to find other means to treat the patient population and promote safety.


What were the author’s objective(s) for the systematic review?


The objectives of the authors were to provide greater clarity about how to avoid the use of mechanical restraints. “In order to provide a basis for choosing and developing nursing interventions, under which the number of mechanical restraint episodes are decreased, the following will be reviewed: Which conditions in nursing and which nursing interventions have been shown to reduce the frequency of mechanical restraint episodes?” (Bak 2011). The presumption of the authors is that not all uses of mechanical restraints are invalid, although some countries, such as the United Kingdom, have entirely banned their use. The presumption is that it is preferable not to use such a technique when another is available. A review of existing literature will enable clinicians to better understand why certain nursing interventions are more successful in doing so and others are not. The format of the review encompassed both qualitative and quantitative research.


Describe the author’s search process and the criteria used to include the studies in the review


The authors encountered major problems related to the paucity of research on the subject. It “was recognized very early during the process that only very few randomized clinical trials existed, and no meta-analyses were found (Muralidharan & Fenton, 2006). Therefore, searches were not limited to these study designs. Also, many of the areas under investigation could not be covered from quantitative papers solely. Therefore, we developed a way to combine quantitative and qualitative papers into ranked recommendations in order to deduce maximum information from the available papers” (Bak 2011).


On one hand, this technique has an advantage in terms of comprehensiveness. It also ensures that more personalized and experiential evidence that may give greater voice to nurses’ and even patient’s personal perspectives may be deployed in the form of qualitative analysis. The downside to this approach is that interventions that use different research techniques were compared in a manner that might be a form of ‘apples vs. oranges’ comparison. Comparing even similar quantitative studies even presents features of difficulty given that the patient populations may be different; as well as the clinical setting, experience level of nurses, etcetera. The authors were also forced to combine different elements of ethical standards and guides for the review process. “The combination of principles from the mentioned sources has been necessary because no one in itself covered both quantitative and qualitative research quantification” (Bak 2011). As chronicled in Table 1 in the article, one of these steps involved “Grading the recommendations for the quantitative and qualitative evidence separately” (Bak 2011).


However, despite the desire to include a wide variety of studies and patients, there were clear criteria in selecting the cases. Only “original peer-reviewed papers, covering the care of adult psychiatric inpatients who have been physically restrained, were included in the review” alone were included (Bak 2011). Children and patients not identified as psychiatric patients were omitted. The use of restraints in learning disability settings, nursing homes, and prisons were excluded, and no study was included more than once in the statistical tabulations. The emphasis was on current studies, only including papers published after 1998 and the review and selection process spanned August and November 2008 and was updated in April 2009 (Bak 2011).


The studies were written in English, Danish, Norwegian, and Swedish and all had available English abstracts. Key words were used in different combinations and included such words as restraint, active, adolescent, elder, music, talk-down, and various other terms associated with intervention therapies. The researchers used 32 different databases that housed peer-reviewed articles (Bak 2011).


The search technique included “an overarching strategy for conditions and interventions across selected databases;” a “search to identify guidance and reportsnot indexed in the major databases; followed by “a topic-specific search strategy on PubMed” (Bak 2011). Then, “for each condition or intervention, evidence of effectiveness or harm was sought” (Bak 2011). The authors also conducted manual searching for studies that were not electronically indexed and they used reference lists to find other relevant papers.


Once the papers were amassed, the quantitative studies were graded based upon the levels of evidence provided and the qualitative studies were graded based upon levels of complexity in the evidence. Finally, the researchers synthesized their finding to come to a consensus upon the quality of the work. The search process involved considerably whittling down of the original search findings of 2,885 papers. These were reduced to 358 based upon abstract and title review, and the full papers after being read were reduced in number to 268. Final quality checking yielded 59 papers (48 were quantitative and 11 were qualitative papers) (Bak 2011).


Describe the overall effectiveness of the interventions reviewed along with their statistical significance


Once the authors had found studies that satisfied their criteria, they listed the different interventions in the studies and rated them on an effect scale of 1 to 5, with one being the most effective and 5 being the least. The most effective intervention included “implementation of cognitive milieu therapy.through patient involvement and empowerment” (Bak 2011). In other words, encouraging patients to become involved participants in their treatment had the most salutary effect on behavior and was most effective in reducing the need for mechanical restraints. Almost as effective were “combined intervention programs” also using “patient participation, patient education, staff education, programmatic changes, high-level administrative endorsement, cultural changes, data analysis” and “implementation of patient-centered care with a higher degree of patients’ positive involvement in their own care” (Bak 2011).


Other forms of intervention were far less effective. Some of the least effective interventions were trying to change the nurses’ focus: “from considering the patient as deviant to being a resource in his/her own treatment;” using music interventions to soothe patients; separating patients in solitary confinement; early administration of evening medications; “debriefing, defusing, and crisis intervention minimize the number of mechanical restraint episodes” amongst the staff; improving the education or experience level of the staff; trying to explain the rationale for rules to patients; higher staff ratios; and better video surveillance systems (Bak 2011).


It should be noted that all of the studies did find that these improvements still had a positive effect. But by comparing all of the studies and the quality of the studies, the authors found that the studies which stressed patient empowerment and participation were more effective, relatively speaking, than those which tended to focus upon staff members exclusively or upon the physical aspects of the mental health facility. “The recommendation grade describes the intervention’s ability to exert an effect on reducing the number of mechanical restraints in the clinical setting, not the degree of how much it would reduce the number of mechanical restraints, but if it would” (Bak 2011). The most effective reduction was found in the use of cognitive milieu therapy (CMT) which involved an 87% reduction in the use of mechanical restraints through the implementation of an “active, structured, problem-orientated, psycho-educational, and dynamic treatment form” (Bak 2011). The second and third most effective interventions, statistically speaking, involved changing the culture of the organization to allow for more patient input along with better staff education and the third most effective intervention involved shifting the focus to more patient-centered care.


Discuss the similarities and differences of the effects the authors found between the studies


The authors noted that “no interventions reached the highest degree of recommendation combined with the highest effect, and to create strong evidence-based practice in this area” and stated that more high-quality research was needed to make further recommendations (Bak 2011). The three most effective forms of therapy involved some degree of patient empowerment, versus focusing on restraining patients or improving the security systems of the facilities, which tended to characterize the least effective treatments.


But the connecting thread between all of the studies was mainly their relatively small nature and the lack of high-quality research on the subject. And in the studies with the greatest reductions in the use of restraint, even the study designers did not make assertive recommendations as to the applicability of the research in widespread clinical settings. (This could also be due to the difficulty of making generalizations about how to treat psychiatric patients, given the profound individuation in terms of the types of treatment required to optimize care at different facilities amongst different patient populations).


PICO review and implications for clinical practice


P: Patient


In the review of the studies, there was no specific discussion about the different types of psychiatric populations under review, only the fact that mechanical restraints were used at the places where the research was being conducted. It is feasible to ask if different interventions designed to reduce the use of restraints might depend upon the functionality of the patients and the level of cognitive impairment. However, the findings of the research do suggest that using some form of patient empowerment and improving the dialogue between providers and patients can reduce the need for the use of restraints and promote a more healthy dialogue between patients and healthcare workers.


I: Intervention


The use of specific techniques such as cognitive milieu therapy (CMT) and Tidal Model (TM) therapy, both of which stress the patient’s role in helping him or herself get better and patient empowerment in treatment, seemed to be useful. Although more general cultural changes in patient and provider relationships were also found to be effective, the findings seem to indicate that structured programs can be useful to introduce a new culture to the organization in which patients have a more active role in determining policies and influencing their treatment. Vague and less empirically justified interventions may lack follow-through or clear guidelines of how to implement them in stressful situations.


C: Comparison


The main options under comparison can be summed up as follows: either doing nothing and continuing to use mechanical restraints without attempting to reduce them; creating a system of patient empowerment; or trying to focus upon improving the education, experience level, training, and standard operating procedures of the facility to make it more secure. As noted by the researchers, mechanical restraints are undesirable and should be avoided for a variety of reasons, including the physical damage they can cause to patients; the psychological breakdown of the patient and the psychological breakdown of caregiver-patient relationships; as well as legal questions which might arise. The weight of the evidence thus points to the use of patient empowerment to reduce the need to use mechanical restraints, versus more staff-focused interventions. Focusing on the patients and the patient’s roles, rather than on improving the staff alone seemed to be more effective in reducing the need to use the restraints. Still, the quality of evidence regarding this finding is still not substantial enough to make the recommendation for all facilities in a broad and sweeping fashion. The findings of the researchers are more in terms of emphasis than are conclusive in nature.


O: Outcome


Although the recommendations are cautious, it would behoove organizations to use patient empowerment and therapeutic programs that promote staff dialogue with patients to reduce the use of mechanical restraints. Improving patient care cannot be achieved in a ‘top-down’ fashion. Patients must feel as if they have a stake in how care is administered and develop a sense of responsibility for self-regulating to the maximum degree to which they are capable.


Reference


Bak, J., Brandt-Christensen, M., Sestoft, D., & Zoffmann, V. (2011). Mechanical restraint which interventions prevent episodes of mechanical restraint: A systematic review. Perspectives in Psychiatric Care, 48(2), 83-94. doi:10.1111/j.1744-6163.2011.00307.x



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Social Advocacy in Counseling Model Answer english essay help: english essay help

Social Advocacy in Counseling


Social advocacy has been described by some counseling theorists as a “fifth force” paradigm that should be considered to rival if not replace other major counseling psychology paradigms regarding behavior and mental illness (Ratts, 2009). This paper briefly discusses what social justice/advocacy is, the debate regarding its status as a paradigm in counseling psychology, and how social advocacy can enhance both the client’s experience and life and the professional counselor’s personal, professional, and ethical obligations to helping others.


Social Justice


Social justice is fairness or impartiality exercised in society, specifically as it is implemented by and within different levels of social classes of a society. A truly socially just populace would be based on the principles of solidarity and equality, would consider and maintain values, human rights, and the dignity of every person in the society (Bell, 1997). Social justice/advocacy theories have in recent years been presented as valid psychological paradigms for counseling psychology.


Social Advocacy as a “Fifth Force” in Counseling Psychology


According to Ratts, D’Andrea, and Arredondo (2004) the profession of counseling is being influenced by a growing movement directing professional counselors to incorporate a social justice perspective into counseling theories, paradigms, and practices. A counseling perspective incorporating social justice would consider issues surrounding the imbalance of power and oppression and would focus on activism and social advocacy as a method to speak to the inequitable conditions in a society that hinder the personal development, academic attainment, and career objectives of marginalized groups (Ratts, 2009). Ratts (2009) also claims that social advocacy as a means to address issues of societal inequity is in union with the American Counseling Association’s Code of Ethics (American Counseling Association [ACA], 2005). Ratts (2009) points out that in Section A.6.a. Of the code this mission is clearly stated: “when appropriate, counselors advocate at the individual, group, institutional, and societal levels to examine potential barriers and obstacles that inhibit access and/or the growth and development of clients” (ACA, 2005; p. 5).


The relationship of social justice/social advocacy to counseling should go beyond simple partisan political affiliations or beliefs according to Ratts and associates. For example, Ratts et al. (2004) make the case that social justice counseling as a “fifth force” in the field following the paradigms of the psychodynamic, cognitive behavioral, existential-humanistic, and multicultural counseling paradigms that have been the backbone of theory and intervention in counseling. Other theorists have followed suit (e.g., Fouad, Gerstein, & Toporek, 2006; Lee, 2007). In more recent pleas for the infusion of social advocacy/justice as a counseling psychology paradigm Ratts et al. (2009) claim that the intentions of the counseling field are not effectively drawing the connection between oppression in marginalized groups and issues surrounding mental health. The issue for social justice advocates is that they believe that the prominent counseling paradigms, whose focus tends to be on the individual without taking into account environmental factors, is limiting in its explanation of mental health. This notion has led Ratts and others to the request to expand the counselor role as to include the notion of social justice advocacy (Ratts, 2009). Indeed several other authors have followed this call with the justification that social justice counseling is a resurfacing paradigm that is consistent in understanding broader explanations of human behavior and the methods by which the practice of counseling is currently being shaped (e.g., Greenleaf & Williams, 2009; Lee, 2007). In essence, this is an ethical cry to adopt a political, social, or philosophical point-of-view as a psychological paradigm. Moreover, this “paradigm” has been rediscovered many times. The fundamental foundation of this ethical command is that long-established counseling paradigms in the form of individual, family or other psychotherapeutic interventions have at times not been able to assist therapeutic clients to maximize their wellness and personal development. So these researchers claim that newly discovered links between systemic oppression and mental health issues indicate that many of the clients’ problems and issues are environmentally-based (Greenleaf & Williams, 2009). This writer finds this last claim almost comical and wonders if these individuals ever read the works of Freud, Watson, Skinner, Lewin, Rogers, Allport, and a host of other classic psychological theorists who described environmentally-based factors that shape human behavior.


Nonetheless, the ACA created a taskforce to present a framework to address issues of oppression so that it could assist the counseling profession conceptualize how social justice and advocacy counseling appears in clinical practice (Lewis, Arnold, House, & Toporek, 2002). These Advocacy Competencies outlined a model for counselors to follow when engaging in social justice counseling at multiple levels including counseling with the client/student and the school/community. At the client/student level this would involve empowering these individuals to advocate for themselves and advocate on behalf of others when fitting. Advocacy at the school/community level emphasizes community involvement and entails collaboration with leaders in the community or in organizations to distinguish and reduce oppressive situations and structures. Advocating at the public level focuses on making the general public aware of macro-systemic issues as the relate to human dignity as well as acting as agents of change to get rid of barriers that obstruct the development of clients and students ( Lewis et al., 2002).


According to Ratts (2009) in spite of ACA’s ethical mandate for advocacy and the formation of Advocacy Competencies, there are still a large number of counselors that still fail to recognize the role of societal oppression in generating and perpetuating clients’ issues and the profession is stilled filled with practitioners who exclusively adhere to an intrapsychic viewpoint in order to explain and ease the client’s issues. In other words, social justice theory, according to Ratts and others trumps any other psychological explanation of a client’s difficulties (see also Greenleaf & Williams, 2009).


According to Dohrenwend (2000) support for a paradigm shift in counseling can be found in the empirical research on oppression and its effects on wellness and development. The evidence indicates that oppression leads to stress, and stress has dramatic physical and mental health consequences (Dohrenwend, 2000). Chronic stress in the form of oppression can cause (associated) physiological changes to the immune system and the brain that may result in psychological distress (Carlson, 2011), substance abuse (Carlson, 2001), increased rates of suicide (Dohrenwend, 2000), and increased risk for biological disease such as coronary and infectious diseases (Carlson, 2011).


Dohrenwend (2000) also looked at the rates of physical and psychological problems related to stress and determined that the increase of adversity inherent in racial prejudice there were higher rates of depression, anxiety and other psychological problems among disadvantaged groups. Turner and Avison (2003) found that African-Americans reported higher instances of chronic stress compared with Caucasians over their lifetimes. Zyromski (2007) reported that post-traumatic stress disorder (PTSD) occurs more frequently in Hispanic and African-American and Latino than in European-American youth due to the greater exposure to violence and oppression which these minorities’ experience.


Discrimination, which is a type of oppression, apparently may have consequences that can be related to depression. For example Gee (2002) discovered that there was an association with depressive symptoms in Asian-Americans and perceived discrimination as well an association of discrimination and overall poor mental health. Other researchers have found this same association of perceived discrimination is negatively associated with self-esteem, and positively associated with depressive symptoms and stress. Numerous other studies support these relationships (Ratts, 2009).


Ratts (2009) charges that the traditional intrapsychic-oriented approaches to mental health care as well as culturally biased diagnostic criteria work to propagate various forms of cultural oppressions and social injustice within the profession of counseling. Ratts (2009) further charges that other researchers have documented that that the various DSM-IV-TR diagnoses (e.g., anxiety, depression, etc.) are social indicators of the distress that is experienced by disenfranchised populations that lack power. Therefore counselors should anticipate that oppressed and underprivileged groups would demonstrate greater and more frequent symptoms of psychopathology and of stress in general. Ratts (2009) also charges that there is a correlation between marginalized populations and the misdiagnosing (under or over misdiagnoses) of psychopathology. Thus, the fifth force in counseling should be social justice advocacy counseling. Therefore, despite the acceptance of the medical model in conceptualizing mental health the intrapsychic framework it involves should conflict with legitimate counselors’ core values and beliefs according to some (Greenleaf & Williams, 2009; Ratts, 2009).


Opposition to the “Fifth Force” Concept


Despite the call for social advocacy as a counseling paradigm this call to arms has not been embraced by all. For example, Smith, Reynolds, & Rovnak (2009) traced the history of the social advocacy movement and offer several criticisms of the proposed social justice/advocacy paradigm. Social advocacy purports that mental illness is the result of a societal illness and that counselors have a responsibility to right this injustice. Smith et al. (2009) see three major issues here: First, Smith et al. suggest that the social advocacy movement in counseling lacks sufficient control over its doctrine and as a result attempts to promote certain agendas (e.g., political, personal, economic, etc.) labeled as being a “social action.” Indeed many of the tenets and precepts of current social justice advocates are aligned with the postmodernist philosophy, which has been associated with Marxist principles by many scholars (e.g., see Johnson, 2009; Nicholson & Seidman, 1995). This is not to suggest that social advocacy is a “communist plot” but instead is an attempt to understand how social justice advocates may instead attempt to promote certain political agendas in the name of science. There is no denying that upbringing, environment, and experience shape who we are (this has always been the fundamental psychological principle of human behavior), but social advocates may attempt to exploit this principle in terms of certain agendas. The issues of social change are tackled by political scientists, social researchers, and sociologists as opposed to counselors or counselor educators


Secondly, Smith et al. (2009) point out the social advocacy as a paradigm makes certain bold claims, such as being effective clinically, when there is little or no empirical evidence for these claims. The research for the effectiveness of social advocacy as a counseling paradigm that can add to positive treatment outcomes suffers from poorly designed studies with small effects. The notion that societal illness leads to mental illness places the counselor in a role of an agent of social change as opposed to treating clients or families with personal issues. Social advocacy theory and practice are expressed in professions such as political science, social work, and sociology. How would or why would a counselor add to these professions and still keep their separate identity? There has been a shift in some areas of counseling skill; however, these new competencies might present with good face validity, there is little empirical support with regards to their efficacy in counseling. This is a key issue.


Let us relook at some of the research cited previously. Dohrenwend (2000) notes the association with oppression, stress, and poor health both physical and mental health. There are so many issues with Dohrenwend’s conclusions it is almost tragic that a peer-reviewed journal would print them. First, it is STRESS and not oppression that is related to issues with health. This literature is vast and is not new by any means (e.g., see Carlson, 2011). Stress is the culprit in this paradigm. Now, if only oppression caused stress or if only stress lead to mental health issues then one could argue Dohrenwend’s conclusions have some basis and are sound. But in fact stress has many causes that include things like being oppressed by society, a harsh or ill spouse, a job, getting divorced or married, etc. Prolonged stress is associated with the increased risk of having poor health (Carslon, 2011), but stress is not causal as not everyone who experiences the same stressors develops health issues. Moreover, not everyone who belongs to a disenfranchised group of some type develops mental health problems either. These notions of cause and effect, association, and the definition of a risk factor are so elementary that a first-year undergraduate statistics student should know them, but apparently some researchers are not aware of “correlation does not imply causation” (as we should have all heard many times). A risk factor is some condition, practice, or entity that increases the probability of developing an illness or disorder, but it is not causal (Redelmeier, Koehler, Liberman, & Tversky, 1995). As it turns out, most of the research cited by Ratts and others that attempts to present societal oppression as a direct cause of mental illness is flawed in a like manner. If these theorists wish to define stress, and not social oppression as a culprit and make the study of stress-related illness a new paradigm they are a bit late, as that paradigm already exists and is called health psychology (Marks, Murray, Evans, & Estacio, 2011).


Third, Smith et al. (2009) make a good case that when one investigates the history of paradigms in psychology and counseling there is little support for the assertion that social advocacy is the “fifth force” in psychological thought. Instead these authors view this movement as a recurring wave on the social sciences and in counseling. They note that there have been several past instances (e.g., Dworkin & Dworkin, 1971; Goldman, 1971) where advocacy was encouraged as a response to social trends of those times. Social advocacy is a historical label for the birth of the counseling profession. Ratts (2009) states that the paradigm is not rediscovered but instead redefined as Kuhn (1970) outlined.


Other issues that Smith et al. (2009) discuss include the notion of disenfranchisement of those counselors who are not identified as part of the social advocacy movement. One can actually see hints of this in Ratts (2009) and in others discussion such as Greenleaf and Williams, (2009). Moreover, Ratts’ (2009) assertion that the DSM-IV-TR diagnostic scheme is created to foster social oppression has no basis in fact. The fact that there are both over-diagnoses and under-diagnoses of disorders in disenfranchised groups relates to inherent issues in the diagnostic classification system and those making the diagnosis and not an overarching plan by some ethnic group to exploit others. This assertion is so ridiculous it undermines what true social advocacy should encompass. In addition Ratts’ (2009) and others (e.g., Greenleaf & Williams, 2009) assertion that the counseling field and the ACA should give credence to social justice and social advocacy counseling theories over other long established paradigms is elitist and itself discriminatory. There is no evidence that social advocacy/justice counseling theory is the only legitimate explanation of psychological distress (in fact there is little evidence that it is a legitimate explanation). The ACA or any theorist do not have the right to dictate what paradigm a counselor will follow when treating a client, except perhaps in cases where a paradigm has been empirically demonstrated to be ineffective or harmful to the client.


Moreover, what forms of advocacy are to be mandated by the ACA? Are all forms of advocacy appropriate for every counseling professional or group? Smith et al. (2009) reports that certain counselors have reported a lack of ability to advocate in certain ways or situations due to their own cultural backgrounds. Should not these individuals have the right to abstain from advocating in ways that conflict with their values and beliefs? One example here might be the gay marriage issue or an issue with abortion. Possibly the worst form of disenfranchisement is an attack on the personal or professional character of someone. Interestingly, the drive to be tolerant of others and to be culturally competent often turns into intolerance for opposing views as can be seen publically recently with the issues involving the views of the upper management of the Chick-Fil — A Corporation. As Smith et al. (2009) state:


Rigid criticism of dogma creates the potential for the oppressed to become the oppressor, wherein the oppressed use the strategies of the oppressor, such as labeling, personalization, isolation, and rigid adherence to one particular stance against another, rather than engage in thoughtful counter dialogue. (p. 491).


A Paradigm?


Theories are comprised of a series of logical propositions presented systematically which describe and explain some aspect of the world or universe (e.g., behavior), whereas paradigms are broad theoretical formulations (Godfrey-Smith, 2003). Theories and paradigms are pretty much the same concept except that paradigms are often used to designate theoretical formulations that describe a philosophy of some action or practice. The terms “theory” and “hypothesis” are often used interchangeably (which is incorrect) and often in a lay sense are used to mean “an explanation” of some type. However, the notion of what constitutes a scientific theory has become a more complex issue.


What Constitutes a Theory or Paradigm?


Kuhn (1970) reports that in the twentieth century three influential views of what makes up theories were: (1) a theory is reducible to observables, (2) theories are used a tools or guides to do something, and (3) theories are statements about existing things (past, present, or future). However, a theory may not deal directly with observables. In any theory of intelligence the construct of “intelligence” is never directly observable and only the variables in the hypotheses been tested that are operationalized to represent intelligence are observable (e.g., IQ test results). The view of observables confuses a hypothesis with a theory. They are not the same. Theories are not reducible to direct observations, hypotheses are. The other two views that Kuhn discuses relevant, but do not distinguish a scientific theory from a lay theory or any other statement. Likewise oppression can only exist as an operationalized variable; we cannot look at oppression unless we define it in some specific context.


There has also been a prevailing notion made by many philosophers of science that almost any theory can be maintained in the face of almost any evidence if adjustments are made elsewhere in the theory (Godfrey-Smith, 2003). Thus, theories can perpetuate themselves indefinitely. This is simply not true. For instance the flat earth theory, the theory of phlogiston, theories that bad mothering leads to autistic children, and many modern theories in science have been or are routinely refuted. However, some theories are conditional and this is where the confusion originates from. Social justice theory can only be applied in light of a subjective definition of “justice” or advocacy. Social justice and advocacy in 1930s Nazi Germany would have a different conceptualization that the social justice Ratts and others discuss.


Research psychologists use the terms theory and hypothesis to explain the processes that explain the relationship between variables and events, particularly when one or more variables, events, or processes are not directly observable. So as to not confuse the two, hypotheses relate to an explanation of a specific relationship between two or more variables (e.g., as head size increases IQ increases), whereas theories are broader in context and relate to an explanation between constructs (e.g. neural connectivity and brain volume influence human intelligence). Hypotheses are tested to confirm or disconfirm theoretical assumptions. All of the pontification in the science of philosophy tends to occur because of over-thinking relatively straightforward ideas and concepts similar to what occurs in physics with bubble-universe theories and so forth. Because the nature of theories often deals with constructs (which are complex ideas formed from observations, but the ideas themselves are not directly observable) this leads to making a simple definition more complex than it needs to be or to developing theories that are not directly testable (like a bubble-universe theory).


In some of the physical sciences and math the word “theory” refers to a sex of axioms (assumptions), theorems (logical derivations from axioms), and other terms directly or implicitly defined by axioms. The axioms and theorems describe the relationships between the terms. So here a theory entails a set of statements that describe a relationship(s) among terms and permit the further derivation of further relationships between the terms (Wilder, 1985). Some psychologists like Clark Hull have attempted to explain psychological constructs in this manner in an attempt to be more “scientific.” Even here the use of constructs occurs. For instance numbers are abstract ideas. The number “four” is an idea (construct) that represents a quantity of something. You can observe four apples, four psychologists, or four of anything, but you can never observe just “four.” Without the idea of “four” there is no four; alone it is nonexistent. Likewise justice or social advocacy is not something that exists outside of subjective human explanations and interpretations. It does not exist in nature. This is consistent with the philosophy of postmodernism that social advocacy/justice theories are derived from (Johnson, 2009). Thus, social justice is not a form of “truth” outside the context in which it is defined, despite what advocates believe.


Scientific Theories vs. Lay Theories.


Scientific theories have several qualities compared to other personal or lay theories (Godfrey-Smith, 2003). First a scientific theory must explain some real-world phenomenon (descriptive and explanatory power). These ideas and precepts are stated clearly and precisely and thoroughly explain the relationships and constructs (hypothetical and factual) that it attempts to cover. This allows for the second general feature of a theory. Second, the theory must be testable (thus, many religious theories do not qualify as scientific). Being testable entails several things. A theory will place limits of what can be investigated. This includes the idea of parsimony, that a good theory does not try to explain too much (a good theory of everything would be too complicated and impossible to test). Good theories include the constructs, relations, and other concepts needed to explain the phenomenon of interest, nothing more. The method used to test the hypotheses that represent a theory must follow the scientific method (which is one point that distinguishes scientific theory from lay theories). Third, one must be able to repeat these tests to confirm the premises of a theory over different but related hypothetical situations using the scientific method (and using variables to represent constructs). By being testable and repeatable, theories are supported by a convergence of independent evidence and have heuristic value in that their observations and premises generate scientific research (theories make predictions). This leads to the last major feature of a scientific theory, that it must be falsifiable. In order to find support for a theory it must be vulnerable to disconfirmation, or they are not testable. By failing to disconfirm aspects of a theory the researchers gain support for it, as most theories of behavior outside of math and certain physical sciences cannot be proven to be true (due to the nature of their constructs not being directly observable).


Thus, many lay (or “common sense”) theories such as “Haste makes waste” and “A stitch in time saves nine” are the exact opposites of one another and not well developed, parsimonious, or therefore falsifiable. Many religious theories are not testable, falsifiable, or parsimonious. Even so-called scientific theories such as those of Freud are not testable (How can the notion of the id, ego, or superego be tested?) or falsifiable in that Freudians can offer numerous alternative explanations for the same behavior in different people or even different behaviors in the same person. Moreover, many of these theories are based on observation, but not on empirical scientific research.


Social justice/advocacy as a theory has attempted to explain psychological distress as a function of being in a disenfranchised group and as a result of inequitable distributions of resources such as power, economic variables, opportunities for career, education, and other commodities. Certainly, it can be purported as a theory than can explain some of the variance in mental health issues with those that belong to certain ethnic, cultural, religious, and other similar disenfranchised / marginalized groups in society. In this way it can be useful in helping understand, relate to, and treat clients from these groups. Thus, social advocacy embodies the notion of cultural competence. Cultural competence describes four components of proficiency: (1) being aware of one’s own worldview of other cultures/lifestyles/differences (2) understanding one’s attitudes towards these differences, (3) developing a knowledge of different views and different cultural practices, and (d) developing cross-cultural/interpersonal skills (Betancourt, Green, Carrillo & Park, 2005). Developing this type of competence results in an ability to communicate, understand, and efficiently interact with people across all types of diverse backgrounds. Some notion of cultural competence must be present for one to be a social advocate.


However, any good theory or paradigm should recognize its limitations. Social justice/advocacy as an explanatory paradigm has limitations as previously discussed. This is the notion of parsimony. Social advocacy may or may not be a fifth force in counseling, but it is not the only paradigm in psychology and it should never be proclaimed as the only paradigm that is of any consequence to professional counseling. This what authors like Ratts (2009), Greenleaf and Williams (2009) and others appear to be supporting. Social justice theory does not explain everything about mental illness, difficult periods in a person’s life, and the origin of stress despite what proponents of this theory state. Their conclusions do indicate that one’s status in society may be related to the magnitude of distress or mental illness that they experience, but it is not causal. For instance there are a great number of homeless people with severe mental illnesses such as schizophrenia, but does homelessness lead to schizophrenia or does schizophrenia lead to homelessness? As it turns out the relationship is bidirectional and influenced by numerous other factors (Cohen, 2003; Sadock & Sadock, 2007). As opposed to having proponents claim it is “the” paradigm for counseling practitioners it should be looked on as a paradigm that can enhance the efficacy of treatments used by other paradigms in counseling psychology.


What is the Place of Social Advocacy in Counseling Psychology?


Whether or not the theories of social justice counseling should be considered the “fifth force” in counseling psychology will most likely continued to be debated. However, it is clear that there is a mounting influence of social justice, social advocacy, and activism in counseling psychology. However, being a social advocate for marginalized groups and the paradigm of social justice theory that seems to claim that all of society’s woes stem from exploitation and inequality are not the same thing. Certainly a counselor can understand and empathize with a client or clients from any number of marginalized groups and advocate for fairness and equality without giving up other practices such a cognitive behavioral therapy and so forth. There have been a number of developments that are designed to spur counseling psychologists into action such as the group Counselors for Social Justice and ACA Advocacy Competencies (Lee, 2007). From an ethical standpoint psychologists in general should be interested in social advocacy and social change to empower marginalized/disenfranchised groups. However, the number of marginalized groups in society is increasing at breakneck speed. How can one advocate for minority ethnic groups, obesity, senior citizens, those with mental illness, those with developmental disabilities, those with developmental delays, hoarders, non-Christians, vertically challenged people, gay rights groups, etc. And still maintain a solid practice, a fulfilling family life, continue to keep current with the field of counseling psychology, and have time for oneself? What is the definition of fulfilling the role of an advocate?


This author believes that there are several important points to be made regarding advocacy in the counseling psychology prospective. First social justice theory in counseling is best utilized as an adjunctive theory to other major paradigms. Secondly, by understanding social justice theory counselors can understand how and if the client’s perception of their life stance in society affects their psychological well-being (see also Ratts, 2009). By understanding all related issues to the client’s subjective sense of reality as well as societal influences on their position in the world the counselor can be in a better position to assist the client with their goals. This writer suggests that all counselors should become very familiar at least with the theories of Lewin, Maslov, Fromm, Allport, and Bandura in this regard. Afterword one can move on to more contemporary theories of how the environment affects behavior.


Third, counselors can assist clients to become advocates for themselves. In essence, this is one of the main goals of counseling and certainly the counselor is in an excellent position to be able to assist the client to understand how their position in the world and how societal limitations placed on their growth, personal development, and potential can affect their functioning. By advocating for the client to advocate for oneself, the counselor is fulfilling one aspect of the ACA’s mandate regarding social justice. Certainly empowering all clients, regardless of their demographic background, is the goal of counseling.


Fourth, counselors can contribute time to instigating social change outside of assisting clients in counseling sessions. The ACA not should dictate to its members what groups or types of social advocacy causes counselors should support, and counselors should be guided, but not forced, by the ACA ethical guidelines and their own personal sense of where they believe they can make a substantial contribution as to what specific causes/groups/venues that they invest their time. This would result in the counselor maintaining and autonomous and yet action-oriented role in social change and would be consistent with the overall concept of social justice.


References


American Counseling Association. (2005). ACA code of ethics. Alexandria, VA: Author.


Bell, L. (1997). Theoretical foundations for social justice education. In M. Adams, L. Bell, & P. Griffin (Eds.), Teaching for diversity and social justice (pp. 3-16). New York: Routledge.


Betancourt, J.R., Green, A.R., Carrillo, J.E., & Park, E.R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24, 499 — 505.


Carlson, N. (2011). Foundations of behavioral neuroscience (8th ed.). Boston, MA: Pearson


Cohen, B. (2003). Theory and practice of psychiatry. New York: Oxford University Press.


Dohrenwend, B.P. (2000). The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research. Journal of Health and Social Behavior, 41, 1-19.


Dworkin, E.P., & Dworkin, A.L. (1971). The activist counselor. The Personnel and Guidance Journal, 49, 748-753.


Fouad, N.A., Gerstein, L.H., & Toporek, R.L. (2006). Social justice and counseling psychology in context. In R.L. Toporek, L.H. Gerstein, N.A. Fouad, G. Roysircar, & T. Israel (Eds.), Handbook for social justice in counseling psychology: Leadership, vision, and action (pp. 1-16). Thousand Oaks, CA: Sage.


Gee, G.C. (2002). A multilevel analysis of the relationship between institutional racial discrimination and health status. American Journal of Public Health, 5, 109-117.


Godfrey-Smith, P. (2003) Theory and Reality. Chicago: University of Chicago Press.


Goldman, L. (Ed.). (1971). Counseling and the social revolution [Special issue]. The Personnel and Guidance Journal, 49(9).


Greenleaf, A.T. & Williams, J. (2009). Supporting social justice advocacy: A paradigm shift towards an ecological perspective. Journal for Social Action in Counseling and Psychology, 2(1), 1-14.


Johnson, R.B. (2009). A twenty-first century approach to teaching social justice: Educating for both advocacy and action. New York: Lang.


Kuhn, T.S. (1970). The structure of scientific revolutions. Chicago: University of Chicago Press.


Lee, C.C. (Ed.). (2007). Counseling for social justice (2nd ed.). Alexandria, VA: American Counseling Association.


Lewis, J., Arnold, M.S., House, R. & Toporek, R. (2002). ACA Advocacy Competencies. Retrieved July 27, 2012 from http://www.counseling.org/Publications/


Marks, D.F., Murray, M., Evans, B., & Estacio, E.V. (2011). Health psychology. Theory- research-practice (3rd Ed.) New York: Sage.


Nicholson, L.J. & Seidman S. (1995). Social postmodernism: Beyond identity politics. New York: Cambridge University Press.


Ratts, M.J. (2009). Social justice counseling: Toward the development of a “fifth force” among counseling paradigms. Journal of Humanistic Counseling, Education, and Development, 48, 160-172.


Ratts, M., D’Andrea, M., & Arredondo, P. (2004). Social justice counseling: “Fifth force” in the field. Counseling Today, 47(1), 28-30.


Redelmeier, D.A., Koehler, D.J., Liberman, V., & Tversky, A. (1995). Probability judgment in medicine: discounting unspecified possibilities. Medical Decision Making, 15, 227-230.


Sadock, B.J., and Sadock, V.A., (2007). Kaplan and Sadock’s Synopsis of Psychiatry:


Behavioral Sciences/Clinical Psychiatry (10th ed.). Philadelphia: Lippincott Williams & Wilkins.


Smith, S.D., Reynolds, C.A. & Rovnak, A. (2009). A Critical Analysis of the Social Advocacy Movement in Counseling. Journal of Counseling & Development, 87, 483- 491.


Turner, R.J., & Avison, W.R. (2003). Status variations in stress exposure: Implications for the interpretation of research on race, socioeconomic status, and gender. Journal of Health and Social Behavior, 44, 488-505.


Wilder, R.L. (1965). Introduction to the foundations of mathematics (2nd ed.). New York: Wiley.


Zyromski, B. (2007). African-American and Latino youth and Post-Traumatic Stress Syndrome: Effects on school violence and interventions for school counselors. Journal of School Violence, 6, 121-137.



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Violence in people Suffering From Bipolar Disorder write my essay help: write my essay help

Risk of Committing Violence Among Individuals Suffering From Bipolar Disorder


Several studies argue that most psychiatric symptoms are closely correlated with criminality, since such symptoms impair judgment and violate societal norms. In this regard, several studies have been conducted regarding the risk of violence among individuals suffering from mental illnesses but few have highlighted the possibility of bipolar individuals engaging in criminal behavior. The common disorders known to be highly related to criminality include antisocial personality disorder, kleptomania, voyeurism and schizophrenia. Therefore, this study is meant to examine the possibility of bipolar individuals engaging in criminal behavior.


Research Topic


This paper aims at analyzing the likelihood of committing violence among individuals suffering from bipolar disorder as well as the factors that are likely to influence the degree to which these individuals are likely to commit violent acts.


Thesis Statement


Past studies have hinted that individuals suffering from bipolar disorder have a greater possibility of engaging in criminal activities than the general population and that this likelihood emanates from mood swings related to misconceptions of persecution (Link, Monahan, Ann, & Cullen, 1999). On the contrary, contradicting studies highlight that the likelihood of persons with bipolar disorder committing violent acts is not related to their medical conditions. In this regard, this thesis claims that genetics as well as environmental changes are some of the factors likely to encourage violent activities among people having bipolar disorder. Despite the fact that, bipolar individuals portray a greater likelihood of committing crime than non-bipolar individuals, the same factors propagating crime is the same even for the bipolar-free population.


Introduction


The general public believes that individuals having bipolar disorder are prone to committing violence than non-bipolar individuals a factor that several researches have disproved. In this regard, public surveys report that locals have a notion that crime and mental illnesses are closely interlinked. Though it is acknowledged that persons having psychiatric disorders commit violence, results have been varying regarding the extent to which mental disabilities and drug dependency contribute to such criminal acts. Bipolar disorder is a psychological illness in which individual experience constant mood swings with alternating states of depression (Taylor, 2008). There are two phases of bipolar disorder; mania whereby individuals are always alert and energetic; and a higher level where individuals become impulsive and restless, often making bad unrealistic decisions and are likely to display psychotic behavior such as violence.


Several medical studies have been conducted regarding bipolar disorder due to the increasing claims that bipolar individuals are not likely to engage in criminal activities. On the contrary, other researches as well as legal institutions argue that bipolar individuals are able to commit violence are not legally insane (Belfrage, 1998). These studies ascertain that there is expanding evidence that individuals suffering from bipolar disorder are aware of their actions and the penalties the actions attract. To clarify these contradictory findings, this study looks at past researches, theories as well as the role of environmental stimuli on the likelihood of bipolar individuals committing violent activities.


Hypotheses and Theoretical Conceptions


As highlighted in the preceding paragraphs, study findings have been contradictory regarding the extents to which individuals suffering from bipolar disorder are likely to engage in criminal behavior. However, it is widely acclaimed that bipolar individuals have an increased likelihood of committing violence compared to the general populations. On the other hand, several studies have concluded that bipolar symptoms such as restlessness and constant mood swings have impacts on the possibility of these individuals engaging in violence.


To prove these hypotheses, a joint study conducted by the Oxford University and Karolinska Institute of Sweden from 1998 through 2000 illustrated that individuals with bipolar disorder are likely to commit crime and these persons account for a greater percentage than the general population. Nevertheless, the study had mixed results; first, bipolar individuals engaged in more violence than non-bipolar people with the degree of violence increasing due to drug dependency. On the contrary, unaffected siblings of bipolar patients have elevated likelihood of engaging in crime, a factor that shows that genetics can increase violence among unaffected individuals in families with bipolar disorder (Fazel, Lichtenstein, Grann, Goodwin, & Langstrom, 2010). As a concern, there was no significant variations in the extent of violent acts by clinical subgroups; manic vs. depressive and psychotic vs. nonpsychotic. This study had its own share of limitations though the major constraint was the failure to discuss the impact of clinical phases of bipolar disorder on increasing the risks of violence and the role of meditation in curbing this likelihood as well. Therefore, it recommended that the research group should have conducted interview-based studies to assist in expounding such issues. Despite the limitation, the study’s strength emanates from the large sample of violence bipolar individuals studied which makes the findings more valid and reliable. To cap it all, the study highlights the risk of crime among bipolar individuals and though it is still far from being conclusive, it is a base for conducting further research. Thus, further studies should be initiated, better measures developed, and larger samples used to validate the link between bipolar disorder and crime. Notwithstanding the limitations, the research illustrates that performing various risk assessments among bipolar patients having drug tolerance is likely to give in-depth details on the link between bipolar disorder and violent crime.


In addition, to validate the theory that bipolar disorder is linked to violence; a study was conducted to ascertain the extent of crime in a sample of 261 male patients having affective disorders. In this regard, the patients were subdivided into three RDC groups and a comparison drawn out with the same number of control subjects picked from the non-affective disordered individuals (Modestin, Hugb, & Ammann, 1997). Additionally, the patients’ criminal records as well as convictions were used to gauge the degree to which their criminal activities varied. The study concluded that of the sample, approximately 42% of patients and 31% of non-patients had past criminal records. As a concern, there were higher percentages of violent activities committed by individuals suffering from bipolar disorder whereas unaffected patients recorded lower criminal behavior. The major strength of this study is that it compared the same number of bipolar individuals with their non-affected counterparts which makes the results reliable and valid; besides, the comparison shows the fluctuations in criminality of the individuals ranging from, bipolar to unipolar persons. However, the main limitation is that the research subjects were few thus; it does not represent the general idea that bipolar individuals are prone to engaging in violent activities. However, this research adds evidence to the notions that bipolar individuals are generally violent and can be used to conduct further research on the same topic in future.


On the same line, it was realized that mood disorders coupled with drug and alcohol dependency resulted in increased inmate violence as well as a study was a tendency to repeat their offenses over again (Vaeroy, 2011). Therefore, a study was conducted in this regard using various psychometric methods. To gauge the extent of the participants’ depressions, Clinical Anxiety, Hospital Anxiety and Depression as well as Montgomery Asberg Depression Rating scales were incorporated in the study. The findings illustrated the possibility of inmates undergoing preventive convictions developing higher degrees of depression and mood disorders which resulted into feeling of violence. Besides, the prisoners undergoing preventive corrections were confirmed to be the most violent which is closely linked to affective conditions are associated with high likelihood of prison violence and frequent as well as repeated crime. However, despite the correlation between mood disorders and prisoners’ violence, the prison environment plays a critical role elevating depressive symptoms among the inmates just like other factors such as drug dependency. Despite proving the link between violence and bipolar affective disorder, the study had some limitations; the main one being the low participants’ number which emanates from the small percentage of Norwegian inmates under preventive imprisonments. Therefore, it is recommended the study can be used a base for further research on the topic among inmates. The strength is that similar studies on inmates’ mood swings in relation to violence have not conducted thus making the findings from this study somehow reliable. In addition, the study also highlight the existing relationship between substance abuse and violence and recommends the initiation of preventive mechanisms concerning drug dependency which when fully incorporated in the prison system is likely to reduce the likelihood of committing violence thus reducing proneness of inmates to repeat their violence activities both in and out of imprisonment.


In the same scope, convicts suffering from mental illnesses ranging from schizophrenia, bipolar disorders, and psychotic symptoms which high levels of drug dependency are likely to be arrested over again for violent criminal activities several years after their release as opposed to prisoners without such disorders. In this regard, a study was conducted by Teplin and associates to prove this hypothesis 6 years after the acquittal of prisoners having psychological disorders and non-affected persons (Teplin, Abram, & McClelland, 1994). By using the National Institute of Mental Health Diagnostic Interview Schedule, to collect data, several interviewers randomly examined 728 and afterwards, they conducted follow-up six years after the convicts had been freed from prison. However, this study presented mixed results; first, it was realized that both mental illness and drug abuse portrayed increases in the likelihood of prisoners arrest several years after their release from prisons. On the contrary, the study upheld that individuals with symptoms of both hallucinations as well as misconceptions had elevated percentages of arrests following repletion of criminal activities long after prison acquittals, but to a lesser percentage. As a research concern, it was realized that findings were similar after excluding prior violence activities and age issues. Therefore, this study disproves the fact that mentally ill criminals have a tendency of engaging in criminal acts after they have been freed. The main study limitation was the random selection of detainees; this likely flawed the results since not all the participants from the study were mentally ill, drug dependent, the mentally unstable individuals could have been a representation of the real facts. Thus, for future research, the participants should be carefully selected while emphasizing on mental condition among other issues.


There are several studies that oppose the notion that mental disorders are interrelated with the possibility of committing violence. An example is Monahan who ascertains that there is insufficient evidence linking violence and the mentally ill. There have been ideas circulating that crime and mental disorders does not exist as was illustrated in a 1983 study by Monahan and Steadman. According to this notion, individuals having several mental conditions are not likely to engage in criminal behavior compared to the general population. In this regard, Monahan and his affiliate argue that violence among mentally unstable people is a factor of antisocial behavior which comes due to societal imbalances which both the mentally disadvantaged and the unaffected population both share. As highlighted in the article, mental disorders are not to blame for criminality but due to the changing public perception as well as growing body of research on the subject, Monahan to redact his opinions in his 1992 publication. In this regard, a study was conducted whose findings showed that there is a correlation between bipolar disorder and the risk of committing violence among these individuals (Monahan, 1992). In addition, for bipolar individuals having maniac episodes, they become aggressive and may turn to be violent towards other people; however, the degree of violence increases due to drug dependency as well as failure to use medications. Additionally, the study claims that mental disorder is a consistent though a low risk factor for the chances of violence among these individuals. Therefore, according to this study, disproving that mental disorders and crime are correlated is a misleading. As a result this study illustrates that though bipolar individuals are not prone to engaging in violence, and despite the positive link between bipolar disorder and violence, this is not a proper reason to conclude that the violence itself is the causal factor; there are other unrelated factors that are likely to increase chances of violence among these people.


Conclusions


The link between violence and bipolar disorder has attracted its own share of proponents and disbelievers. In this regard, there is considerable evidence for the negative and positive side of this relationship and it is not been possible to consider all the aspects in this document. As highlighted above, several studies as well as debates have alluded that violence among individuals suffering from bipolar disorder emanates from the patient’s illness (Feldmann, 2001). Nonetheless, several researches have also upheld that bipolar patients are not known to commit violence. Therefore, data on the possibility of violence among these individuals remains inconclusive whether violence is due to the disorder or, there other external factors that have a role in violence risk among these individuals. As a result, this paper presents other factors that are likely to impact the likelihood of committing violence among these individuals but are not highlighted in the main body of the article.


The first factor likely to increase the possibility of committing crime among bipolar individuals is a past history of violent activities. According to this hypothesis, persons who have been involved in past criminal acts and have been convicted for violence are prone to engage in violent behavior again. Present researches argue that this factor is the best predictor of the possibility of these individuals engaging in criminal activities in the future. However, the only limitation of this idea is that it is impossible to explain whether the past violent activities were due to bipolar disorder symptoms or other unrelated factors.


The next major issue is the effect of drug dependency. In this situation, studies argue that patients who have undergone dual diagnoses are more likely to become increasingly violent compared to other patients with other psychological disorders. To curb this situation, it is recommended that prior to making conclusions regarding the link between violence and bipolar disorder; patients should undergo rigorous assessments concerning drug dependency history as well as the symptoms of their disorder. This evaluation is supported since it helps understand the extent to which drug abuse impacts bipolar individuals since drugs are known to impair rationality as well as increase individual misconceptions. However, drug abuse may bring about symptoms such as paranoia as well as hostility and may be used to hide other risk factors for violence. As an example, a study of 1,410 participants having schizophrenia under the Clinical Antipsychotic Trials of Intervention Effectiveness study, reported that the risk of violence increased with elevated levels of drug abuse and dependency.


The last factor that should be considered when evaluating the extent of violence among these individuals is the nature of symptoms. In this scenario, there are some patients who may have occasions of fearful misbeliefs and unrealistic psychotic idea and are likely to become more violent as opposed to other patients; thus, all the patients should not be considered at risk of being violent just from observing a single individual. Therefore, for researchers, it is critical to understand the individual’s belief of their unrealistic thoughts since this can help in gauging the time a patient may become violent.


From the above paragraphs, it is clear that bipolar individuals have a tendency of engaging in criminal activities with the degree dependent of other external factors. Despite the contradictory statements as well as studies, there remains some evidence that the risk of people with bipolar disorder committing violent acts is unrelated to their medical conditions. In this regard, this thesis claims that disease severity and drug dependency are some factors likely to encourage violent activities among people having bipolar disorder. Notwithstanding the point that bipolar individuals show greater likelihood of violence crime than non-bipolar individuals, the factors spreading crime remains the same for these two groups of individuals.


References


Belfrage, H. (1998). A ten-year follow-up of criminality in Stockholm mental patients. British Journal of Criminology, 38, 145-155.


Fazel, S., Lichtenstein, P., Grann, M., Goodwin, G.M., & Langstrom, N. (2010). Bipolar Disorder and Violent CrimeNew Evidence From Population-Based Longitudinal Studies and Systematic Review. Archives of General Psychiatry, 67(9), 931-938.


Feldmann, T.B. (2001). Bipolar Disorder and Violence. Psychiatric Quarterly, 72(2), 119-129.


Link, B.G., Monahan, J., Ann, S., & Cullen, F.T. (1999). Real in Their Consequences: A Sociological Approach to Understanding the Association between Psychotic Symptoms and Violence. American Sociological Review, 64(2), 316-332.


Modestin, J., Hugb, A., & Ammann, R. (1997). Criminal Behavior in Males with Affective Disorders. Journal of Affective Disorders, 42(1), 29-38.


Monahan, J. (1992). Mental Disorder and Violent Behavior: Perceptions and Evidence. American Psychologist, 47(4), 511-521.


Taylor, P.J. (2008). Psychosis and violence: stories, fears, and reality. Canadian Journal of Psychiatry, 53, 647-659.


Teplin, L.A., Abram, K.M., & McClelland, G.M. (1994). Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study. American Psychologist, 49(4), 335-342.


Vaeroy, H. (2011). Depression, anxiety, and history of substance abuse among Norwegian inmates in preventive detention: Reasons to worry? BMC Psychiatry, 11, 40.



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The Attribution Theory Covered in the Readings essay help tips: essay help tips

Attribution Theory Covered in the Readings


Human beings are naturally an inquisitive set of species; they are always wondering how and why things occur. For this reason, they create sciences, philosophies and religions as approaches of answering their questions. For decades, this curiosity has influenced their personal, interpersonal, cultural and societal lives in intricate ways. Much of this is observed in our daily lives through our conversations and mindset interactions with other people. For example, human beings tend to question why some people look the way they do. Eventually, they develop answers according to different situations like why some people do not have jobs while others wonder why other people went overseas (Bains, 1983). The process of developing questions and answers to a series of questions are fundamental such that it figures out the underlying causes of things that happen. Researchers have characterized this tendency as a justified basic human activity. A battery of theories has been advanced to give light on how and why things happen as they do. This family of concepts, collectively known as attribution theory seeks to explain and describe the communication and mental processes that form our daily explanations. In this study, I critically discussed the issues in Attribution theory covered in the readings and their related associations. I have also provided a critique of the usefulness of the theory in explaining processes on interpersonal communication (Buss, 1978).


Introduction


The attribution concept argues that people are able to make sense of their vicinity and surroundings. This is based on what these people consider as the cause and the effect of a given phenomenon. Attribution theory suggests that people observe their own experiences and behavior. They then attempt to figure out what caused these experiences and behavior. Therefore, the causes make people shape their future differently. This review critically discusses the issues found in attribution theory covered in the readings.


History of attribution theory


Charles Antaki in his book talks about the history of attribution theory. The history of the attribution theory starts with studying someone’s perception. In the 1950s, individual perception theorists were greatly concerned with things that people think about one another. It is also based on how they would judge one another as well as how people are influenced by their desires and needs. The birth of the attribution theory started when theorists began directing more attention towards people’s ascription of qualities and causes. Heider was responsible for the change rationale (Antaki, 1982).


Attribution theory is social psychology’s core element. Over the past 40 years, a series of articles have been published in light of this theory. These include handbooks, journals and textbooks focusing on social psychology. According to Bernard Weiner the entire attribution theory as a body of research is easily distinguished into general approaches towards social psychological phenomena. Forming attributions are equal to giving explanations mainly on behavior. Heider further broke down ordinary explanations into two; these are environmental and personal causes. In his analysis, people explain actions by two means. One of them is through attributing the action and linking it with something that has to do with someone who performed it (Antaki, 1982). Another one is by attributing it to an external cause.


Analysis of Attribution theories


The readings have provided a set of examples of attribution theories including inference theories belonging to Jones and Davis. According to these readings, this theory enables people to understand the entire process of making internal attribution. This means that people tend to do other things as a correspondence between behavior and the motive. Dispositional internal attributions provide people with sufficient information from where to make predictions to do with someone’s future behavior. According to Davis, using the term correspondent inference only applies when referring to the occasion. For example, when a specific observes infers that someone’s behavior corresponds or matches with their personalities. This is another alternative to dispositional attribution (Weiner, 1980).


Kelley’s Co variation model is well-known under attribution theories. Kelley came up with a logical model used in judging whether a given action must be attributed to internal characteristics of the environment or a person. The person’s characteristics are internal while the environmental characteristics are external. According to him, three major types of causal information influence judgments. These include consistency, consensus and distinctiveness. People in their lives look back on their experiences and look into two main causes. The first one is multiple necessary causes. This includes high motivation in order to succeed. The second one is multiple sufficient causes. This involves looking into sufficient reasons for certain actions.


Weiner’s model explains achievement attributions. This refers to someone’s causal attributions that lead to achievement behaviors and subsequent achievement motivation and behaviors. These also include shame or pride felt due to failure or success, future achievement expectancies as well as persistence towards similar tasks (Buss, 1978).


Attribution theory of behavior


Bernard Weiner talks about attribution theory of behavior. According to him, performance outcomes are uncommon. This is because attributions include multiple causes. Therefore, whenever performance outcomes are common then attributions are blamed to be the only cause. After a performance of several tasks at the difficult level, Weiner’s results evidenced the fact that both effort and ability are necessary in order to attain success. This is because difficult task judgments are an indicator of a complementary causal factor. In order to attain success, all the components and causal factors need to be enhanced and worked on efficiently (Weiner 1985).


Causes and reasons in attribution theory


Allan Russ talks about causes and reasons in attribution theory. This conceptual critique argues that they have not been distinguished from one another adequately despite the fact that reason and cause have appeared in the literature of attribution theory. With the help of recent ideas taken from the philosophy of the mind, the conceptual critique helps in the explanation (Bohner, Bless, Schwarz, & Strack, 1988).


Russ has presented several arguments to show the causes and reasons of attribution theories. The causes as well as reasons are distinct categories that give explanations on various behavioral aspects. The causes always lead to changes. On the other hand, reasons also play a critical role in bringing change. In his reading, Russ has identified two distinct behaviors. One of them is the fact that when non-intentional behavior happens to someone, the person is likely to suffer. This is an occurrence, which is explained by both observers and actors with causes. A close examination of the readings demonstrates that attribution theorists tend to project exclusive causal frameworks. These frameworks lay down explanations of behaviors. It also lays down explanations that look into reasons for these behaviors. Progress in these areas is mainly dependent on the adequacy of the areas’ key concepts (Bohner, Bless, Schwarz, & Strack, 1988).


A causal attribution refers to a largely implicit assumption. This assumption serves to guide research in the area where a layperson gives an explanation of behavior mainly on causal terms. There are four main causes. The first one is the efficient cause. This one brings out small changes. The second is the final cause. This is the end or purpose of the resultant change. The third is a formal cause. This refers to the shape or pattern of the changed one. The fourth is the material cause where the change is finally realized.


Control and attribution theory


Bains in his book explaining the need for control tries to link attribution theory to control. The major concept when studying attribution theory is a control. It is referred as the locus of control. Here, one makes interpretations of events and states that they mainly caused by someone’s behavior. It can also be caused by outside or rather external circumstances. Someone with an internal control often believes that performance in a given work project is steered mainly by his or her ability and the amount of hard work exhibited. The external forces also attribute either failure or success by making different conclusions. From Bains perspective, it is evident that conclusions may be contributed by aspects like a hard project or the boss may have been extremely unhelpful in allowing one to finish the project. An internal locus of control in short is often associated with physical health as well as optimism toward achieving something. People who possess it are always successful (Bains, 1983). External or internal attribution is made with respect to several other people. This includes situations like is the person singly responsible for the event or is the event caused by things that are beyond the person’s control.


Issues in measuring attribution theories


Solomon S. wrote on how to measure dispositional and situational attributions. Disposition attribution mainly explains individual’s behaviors. This is mainly due to internal characteristics. These internal characteristics often reside within an individual. Dispositional optimism tends to apply across several situations. On the other hand, situational attribution mainly stems from the environment. It can also stem or arise from a culture that is tied to the individual. According to Solomon, four main problems arise with the measurement of dispositional and situational causality. The first one is the fact that both situational and dispositional causality are inversely linked. The diversity of these causes is considered to be within the dispositional and situational categories are another measurement problem (Solomon, 1978).


Another one is the fact that there are difficulties that arise with differentiating between the external and internal causes to the actor. There is also the low convergent validity. This validity is that of numerous closed ended attribution measures. Studies conducted reaffirm the deficiency of convergence among several close-ended measures as well as between open and closed measures. The second study looks into subject ratings. It involved looking into subject ratings belonging to closed ended attributions (Solomon, 1978). Oftentimes, they are considered indicators where a freely chosen dimension offers a limited representation for a subject’s attribution thought.


Craig Anderson and William Deuser in their book looked into the primacy of control in causal thinking as well as the attribution style. They also majorly focused on the attribution functionalism perspective. The functionalist perspective tries to give an explanation on social institutions. This explanation attempts to explain them as a collective means used in meeting individual as well as social needs (Brown & Siegel, 1988). Emile Durkheim is the sole foundation of functionalist theory in sociology.


The readings have put forward several predictions for attribution functionalism. These predictions suggest that the most significant dimension is controllability. This is what mainly guide’s someone’s future actions. Attribution functionalism links an action in a specified target behavior domain. There are other attribution dimensions. These include intentionally, and global stability. These play major roles. These roles include functional roles acting as primarily refinements. The dimension is often termed secondary in several situations. There is also the aspect of functionalism directed to the observer. This mainly focuses on giving responses to specific anticipated actions. People make attributions to their life events. People also make attributions about others. Functional analysis of attributions can target failure outcomes (Antaki, 1982).


Just as researchers, human beings are forced to choose whether to believe the verdict on the usefulness and validity of this theory. If we reject this theory, it only implies that we must go back to the drawing board to create ways of explaining how and why we make judgments on personality founded on behavior. On the other hand, if we believe that Heider’s principles of attribution are factual beyond reasonable doubts, then nothing other than human decency demands human beings to refrain from inbuilt biases tilting human perceptions.


Explanations as well as the need for control


In light of these readings, the main idea that motivates people can play a role in influencing as well as distorting the manner in which people perceive events in the world. However, the entire attribution theory has thrown aside and neglected this is view. Neglecting the motivational influences shows general tendencies that are evident mainly in social psychology. This was mainly in the 1960s. The main significant impacts of attribution are huge control of the whole environment (Bains, 1983). Whereas knowledge is power, it is always important to recognize that there are certain knowledge forms that mean greater power more than others do.


Importance of attribution


Attribution theory helps to provide important methods used in examining as well as understanding the motivation in several settings. Attribution theory is extremely significant since it examines someone’s beliefs on the reason as to why some events occur. It afterwards correlates the beliefs of someone to motivate subsequently. The major premise of the attribution theory is the fact that people need to understand their environments well. Understanding their environments and anything going on around them assists people to determine their behaviors (Bains, 1983). In a classroom setting, students develop causes for several of their experiences. Students also often tend to look into what influenced their past decisions as well as the ability that they might gain in order to control the future. An example is failing a test in class. The most definite cause will be to look into the probable attribute that led to the failure. These might narrow down to poor instruction, inability as well as lack of effort.


Conclusion


Although the attribution theory has been in existence for over 5o years now, it remains unclear how the findings of this theory support the specified conditions. This has generated major questions of falsifiability and verifiability of the attribution theory. Accumulating studies suggest that some researchers claim to have verified and supported the attribution theory. However, although reports indicate partial report and lack of support towards this theory, it is not easy to identify a scholar of merit claiming that this theory has fundamental flaws and that we need to replace some of its premises. Therefore, it is utmost importance that researchers examine this theory on a close criterion.


References


Anderson, C.A. & Deuser, W.E. (1993). The primacy of control in causal thinking and attributional style: an attributional functionalism perspective. In G. Weary, F. Gleicher & K.J. Marsh, Control motivation and social cognition. (pp. 94-121). New York: Springer-Verlag.


Antaki, C. (1982). A brief introduction to attribution and attributional theories. Attributions and psychological change: application of attributional theories to clinical and educational practice. London: Academic Press.


Bains, G. (1983). Explanations and the need for control. In M. Hewstone (ed) Attribution theory: social and functional extensions. (pp. 126-143). Oxford: Blackwell.


Bohner, G., Bless, H., Schwarz, N. & Strack, F. (1988). What triggers causal attributions? The impact of valence and subjective probability. European Journal of Social Psychology, 18, 335-345.


Brown, J.D. & Siegel, J.M. (1988) Attributions for negative life events and depression: he role of perceived control. Journal of Personality and Social Psychology, 54, 316-322.


Burns, M.O. And Seligman, M.E.P. (1989). Explanatory style across the life span: evidence for stability over 52 years. Journal of Personality and Social Psychology, 56, 471-477.


Buss, A.R. (1978). Causes and reasons in attribution theory: a conceptual critique. Journal of Personality and Social Psychology, 36, 1311-1321.


Cutrona, C.E., Russell, D. And Jones, R.D. (1984). Cross-situational consistency in causal attributions: Does attributional style exist? Journal of Personality and Social Psychology, 47, 1043-1058.


Nesdale, A.R. (1983). Effects of person and situation expectations on explanation seeking and causal attributions. British Journal of Social Psychology, 22, 93-99.


Solomon, S. (1978). Measuring dispositional and situational attributions. Personality and Social Psychology Bulletin, 4, 589-593.


Weiner, B. (1980). Human motivation. New York: Holt, Rinehart & Winston. Read only pp. 341-352.


Weiner, B. (1985). “Spontaneous” causal Thinking. Psychological Bulletin, 97, 74-84.



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Culture on Developmental Psychopathology


The objective of this work is to examine how conceptualization, assessment, diagnosis and treatment of childhood mental health disorders may vary by culture. Specific questions addressed in this research are the following: (1) How do psychologists define culture? How does our definition of culture guide us in our understanding of mental health problems? (2) What are critical components of our cultural experience that are important in how we assess and diagnose behavioral disorders? Finally this work will suggest ways that psychologists might better incorporate culture into their study and treatment of childhood behavioral disorders.


Impact of Culture: Assessment of Developmental Psychopathology of Children


Culture impacts the view of developmental psychopathology a great deal and that impact is differentiated by various cultural beliefs and customs and this includes religious beliefs and superstitions whether founded or unfounded according to factual evidence or science. The work of Hoagwood and Jensen (1997) states that it is hard to imagine a term that is “more slippery…than culture. One need not venture far into theories of culture to see the way sin which the use of this term has been vast, imprecise, and inconsistent.” (Hoagwood and Jensen, 1997) p.108


In fact, it is stated that the complications resulting from the “uses of the term culture have constituted a serious impediment to generating empirical knowledge and aligning cultural psychology with the study of developmental psychopathology.” (Hoagwood and Jensen, 1997)


These difficulties are stated to include:


(1) Ideological uses;


(2) Extreme relativism;


(3) Circularity; and (5) Overinclusiveness. (Hoagwood and Jensen, 1997)


B. Cultural Diversity and the Nuances of Behavioral Variation


Socio-linguistic studies examine socialization and its effect on development of identity. Study on language learning is stated to reveal a great deal about the “discursive practices that constitute the meaning of normal or abnormal behavior within defined communities.” (Hoagwood and Jensen, 1997) Research has approached and interpreted cultural diversity “as mere ethnic cookie-cutting, newer ways of thinking about culture suggest that those categories do not reflect the range of particularities that cultural studies most wanted to address: the meaningful variations in human social grouping that explain the nuances of behavioral variation.” (Hoagwood and Jensen, 1997)


The work of Parron (1997) states that cultural pluralism ‘has become a worldwide reality with the population of the United States and most Western nations now including large numbers of person, many of whom are recent immigrants, who trace their origins to non-Western societies.” (Parron, 1997) the entire world’s cultures have made an attempt to provide an explanation for illness and behavioral or developmental anomalies.” (Parron, 1997) Stated as the view that underlies the DSM-IV assessment system is that “psychiatric disorders are universal and antheoretical and hence ‘culture free’ categories.” (Parron, 1997)


III. Latino-Specific Study Reported


The work of Weiss, Goebel, Page, Wilson and Warda (1998) reports a study that “…examined the impact of financial, cultural, and family variables on the incidence of behavioral and emotional problems in a group of two- and three-year-old Latino children. Findings in this study stated that in terms of the children as a group “the mean score for total behavioral problems falls within the normal range, and well below the range suggestive of clinical concern.” (Weiss, Goebel, Page, Wilson and Warda, 1998)


However, it is stated that 7% of the children in the study “had scores indicating risk for mental health problems and 14$ showed enough symptoms to warrant substantial clinical concern.” (Weiss, Goebel, Page, Wilson and Warda, 1998) it is reported that the study was focused on the determination of the degree to which behavioral and emotional problems may be related to the family’s financial status, cultural heritage, degree of acculturation, and family functioning.” (Weiss, Goebel, Page, Wilson and Warda, 1998)


Results stated in the work of Weiss, Goebel, Page, Wilson and Warda (1998) are stated to suggest that “…as a group, Latino preschoolers are quite well adjusted, experiencing a range of emotional and behavioral problems typical for their age group. However, a small proportion of the sample demonstrated behaviors indicative of substantial mental health problems. Boys seem more likely to warrant clinical concern as a result of both their externalizing and internalizing problems.” (Weiss, Goebel, Page, Wilson and Warda, 1998)


IV. DSM-IV Cultural Formulation Guidelines


Parron states that the components of the DSM-IV Cultural Formulation Guidelines are:


(1) cultural identity of the individual;


(2) cultural explanations of the individual’s illness;


(3) Cultural factors related to psychosocial environment and functioning;


(4) Cultural elements of the relationship between the individual and the clinician; and (5) Overall cultural assessment for diagnosis and care. (Parron, 1997)


Analysis


Assessment of the behavioral and emotional state and factors of the individual is an initiative that requires that one understand the target culture or the culture of origination of the individual undergoing assessment. Different behavioral expectations exist among and between various cultures of the world and what might appear to be problem behavior in one culture may be viewed as normal behavior in another culture. Because of this assessment of certain behavioral and emotional aspects of the individual is characterized by a great deal of difficultly and challenge. That which is viewed as normal or expected behavior in the culture of North America individuals is viewed quite differently by other cultures who may be either more or less conservative in their approach or interactions with other cultures. Behavioral problems in the Latino community may not be viewed as behavioral problems in the traditional American household and vice-versa. Therefore, it is critically important that the psychological profile of an individual give consideration to the customs and culture of the individual undergoing assessment as there is not a generic umbrella assessment that can be used across all cultures and belief systems. Parron (1997) urges researchers in the next century to move beyond “superficial descriptive conclusions on their research efforts…and delve more deeply into understanding those factors that make ethnic and nonethnic children and adolescents so similar and yet so different.” (Parron, 1997)


Bibliography


Hoagwood, Kimberly and Jensen, Peter S. (1997) Developmental Psychopathology and the Notion of Culture; Introduction to the Special Section on ‘The Fusion of Cultural Horizons: Cultural Influences on the Assessment of Psychopathology in Children and Adolescents. Applied Development Science 1997. Vol. 1 No.3.


Parron, Delores L. (1997) the Fusion of Cultural Horizons; Cultural Influences on the Assessment of Psychopathology on Children. Applied Development Science 1997. Vol. 1 No.3.


Weiss, S.J., Goebel, P., Page, a., Wilson, P. And Warda, M. (1998) the Impact of Cultural and Familial Context on Behavioral and Emotional Problems of Preschool Latino Children. Child Psychiatry and Human Development Vol. 29.



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A Review of Psychological Literature free college essay help: free college essay help

Elderly Depression: A Review of Psychological Literature


When exploring the issues of aging there are important investigative studies available in the literature to aid the researcher in understanding key psychological aspects. This paper delves into several studies that embrace important components of the elderly experience — in particular the problems encountered that relate to depression. The four studies that will be reviewed in this paper are all based on sound empirical psychological strategies and will be presented in a format that is both instructive and interesting.


It is not a revelation to learn that as humans get up in years, they begin to lose the alertness and clarity of thought, memory, and perception. For those unfortunate individuals whose cognitive skills diminish to the point of dementia the likelihood of becoming depressed is greatly increased. Hence researchers are continually monitoring the elderly to attempt to discover possible markers early in life that may portend dementia and depression in the later years.


Literature Review: In the journal Gerontology the authors point out that due to the definition gap between normal dynamics of getting older (the transitional stage that includes memory loss) and dementia, a new phrase has become commonplace in the literature. Indeed, “mild cognitive impairment” (MCI) is now being used in that context, and while MCI is certainly not as serious a problem for aging individuals as dementia, it nevertheless is referred to as a “heterogeneous clinical syndrome” for which no DSM-IV criteria has yet been established (Dierckx, et al., 2007). One of the key themes in this research article is an attempt to come to terms with the relationship between MCI and depression in elderly people. Also, the piece stresses that a better understanding of when, how and why older people fall into the MCI category can help in terms of screening for possible beginnings of Alzheimer’s (AD).


Dierckx (p. 30) outlines the existing — though not necessarily fully accepted in the literature — criteria for determining if a person has moved into an MCI condition or not. One, if the individual has a “memory complaint” and that problem is collaborated by “an informant” then MCI may be present; two, if the person’s “episodic memory” abilities are fading this indicates there may be serious neuropsychological impairment; three, if the person’s cognitive functioning is “largely normal” there may not be a problem; four, if the “daily living” functions are “intact” MCI may not be in evidence; and five, use of the CAMCOG test should tell the clinician whether or not the individual is “more than 1.5 standard deviation below the mean for his (or her) age” (pp. 30-31).


Because about 25% of elderly people suffer from depression and cognitive impairment when they reach (and pass) 65 years of age, this research is important to the field of psychology and gerontology. Additionally, the authors believe that the “neuropsychological presentation of MCI and depression may be very similar” (p. 31). The association between depression and dementia can be broken down into four hypotheses, the authors explain. Those four are: a) depression is “an early stage of dementia”; b) depression is “a risk factor for dementia”; c) depression happens as a response to “the loss of function associated with the early cognitive decline of dementia”; and d) depression and dementia share “common risk factors such as cerebrovascular disease” (pp. 31-32).


At the conclusion of the piece the authors assert that further research might well be focused on tests and tools that can “predict conversion to dementia” and also researchers should attempt to make a “differentiation between progressive and non-progressive MCI” (p. 33).


Meanwhile a study in the journal Developmental Psychology looks into the issue of cognitive reserve, which is the generally accepted theory that those individuals who, earlier in life, achieved higher levels of education and training (and knowledge), would “exhibit higher levels of cognitive functioning” later in life (Tucker-Drob, et al., 2009). This research is pertinent because the degree of loss of cognitive function in elderly people — and the timing of that loss — offers helpful data for those in the fields of psychology and healthcare.


The authors of this research studied 690 individuals between the ages 65 and 89 over a five-year period. They called the survey the “Advanced Cognitive Training for Independent and Vital Elderly” study (ACTIVE) — and the results indicate that “cognitive reserve reflects the persistence of earlier differences in cognitive functioning” as opposed to the differential rates of “age-associated cognitive declines” (Tucker-Drob, p. 431). Moreover, the authors offer a pair of conclusions highly germane to elderly issues. One, formal education achieved during the formative years is not directly related to “rates of decline in cognitive functioning during later life” (p. 441). And two, getting a good education “casually influences cognitive abilities” during youthful years and “these benefits seem to persistuntil late adulthood.” Indeed the authors hypothesize that these benefits “may also serve to protect against functional impairment” and hence have “substantial implications for everyday functioning in later life” (p. 441).


An article in Southern Medical Journal discusses the “psychologic morbidity, particularly depressive symptoms” that can be brought on by the death of an elderly spouse (Williams, 2005). The negative and depressive experience of an elderly person who has lost a spouse can “exacerbate the health effects” that the surviving elderly person is already struggling with, Williams explains. Moreover, this “magnifier effect” tends to be “especially pernicious” due to the fact that “bereavement and depression both tend to increase cardiovascular mortality rates” (Williams, p. 90).


What a primary care physician should look for in an elderly person that has recently lost a loved one (in particular a spouse) is signs of “mood disorders”; in the event of a death of a spouse an elderly bereaved person should be encouraged to continue with any religious or spiritual observances, Williams adds. There may also be a need for psychotherapy and other psychosocial support, to help the bereaved person from falling too deeply into depression. Depression, in fact, is itself a killer; to wit, a group of Dutch investigators followed a “large cohort of [depressed] older persons” over a 4-year period and found that “major depression was associated with almost a twofold higher risk of death among men and women” (p. 93).


Meanwhile Dr. Joseph I. Sirven, Professor of Neurology at the University of Minnesota, along with researcher Barbara L. Malamut (PhD) write that in long-term care facilities, there is only one mental disorder that is more common among elderly people than depression, and that is dementia. In the book Clinical Neurology of the Older Adult (Sirven et al., 2005) the authors assert that the annual rate of new cases of “major depression” is as high as 9.4%. The risk factors associated with depression — and those are higher among females — include: a) lower levels of education (which collaborates material provided earlier in this paper); b) a history of poverty beginning with childhood; c) sexual assault; d) parental divorce or separation; e) lower level of occupational profession; f) widowhood “or other unmarried states”; g) lack of social support network; h) “chronic financial or medical stresses”; i) “acute provoking events”; and j) a history of heavy consumption of alcohol (Sirven, p. 544).


One problem healthcare professionals in nursing homes confront in determining depressive symptoms in the elderly is that “When cognitive impairment is prominent, mood symptoms are even less likely to be reported” (Sirven, p. 543). Clinicians often require observable behaviors vis-a-vis an elderly patient’s danger level, hence the conundrum.


References


Dierckx, E., Engelborghs, S., De Raedt, R., De Deyn, P.P., & Ponjaert-Kristoffersen, I.


(2007). Mild Cognitive Impairment: What’s in a Name? Gerontology, 53, 28-35.


Sirven, Joseph I., & Malamut, Barbara L. (2008). Clinical Neurology of the Older


Adult. Hagerstown, MD: Lippincott Williams & Wilkins.


Tucker-Brob, Elliot, Johnson, Kathy E. & Jones, Richard N. (2009). The Cognitive


Reserve Hypothesis: A Longitudinal Examination of Age-Associated Declines


in Reasoning and Processing Speed. Developmental Psychology, 45(2), 431-446.


Williams, Jonathan Richard. (2005). Depression as a Mediator Between Spousal Bereavement


and Mortality From Cardiovascular Disease: Appreciating and Managing the Adverse


Health Consequences of Depression in an Elderly Surviving Spouse. Southern Medical


Journal, 98(1), 90-96.



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Literature

Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Finance

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While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


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Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


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We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


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Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.


What discipline/subjects do you deal in?


We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.


Are your writers competent enough to handle my paper?


Our essay writers are graduates with bachelor’s, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.


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There is a very low likelihood that you won’t like the paper.


Reasons being:

When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
We will have a different writer write the paper from scratch.
Last resort, if the above does not work, we will refund your money.

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How Mentally Ill People Are Incorporated In Society homework essay help: homework essay help

Housing for the Mentally Ill: Psychological Effect and Sociological Factors That Determine How Mentally Ill People Are Incorporated Into Society


A primarily problem for many individuals who are mentally ill is coping with every day problems that are not directly related to their mental illness and one of these is the securing and maintenance of a residence. Facilities that are local to Tennessee residents attempt to secure patients with housing however obstacles including budget cuts, the rising costs of living and opposition from insurance companies are ever present.


This work intends to examine this phenomenon, expose redundancies and waste, and propose some ideas for solutions. This issue was specifically chosen since it involves both the areas of Psychology and Sociology as the writer of this work is giving consideration to entering this field of research therefore this study will result in a gain in the writers’ insight regarding the day-to-day reality of social work and the needs of mentally ill patients who require assistance.


Many aspects of providing Psychological treatment are realized through social involvement. Mental health providers help relieve some pressure by integrating patients into group homes, teaching them to interact accordingly, and building essential skill sets to meet the norms of our society. Social environments have a great impact on Psychological well-being.


Although less than five percent of the total population suffers from severe mental illness, twenty to forty percent of the homeless population is known to have a severe mental illness. (California Psychology Association, 2010) In addition, mentally ill individuals who are homeless are many times arrested for some type of nuisance crime “yet those who receive comprehensive community mental health treatment stay in such treatment, remain safely housed, and have an incarceration or homeless rate of less than 2%.” (California Psychology Association, 2010 )


It is reported by Steinberg (1999) that AB34 in the state of California funds community mental health programs that provide voluntary outreach, access to medicines and a variety of support services for the homeless who suffer from mental illness. An initial investment of $10 million produced millions in savings by reducing hospitalization and incarceration. Because of AB 34’s success, the program was expanded in 2000 to 34 cities and counties, helping 4,720 homeless mentally ill individuals. As a result, state and local governments are seeing a $23 million savings through an 81% reduction in jail days, a 66% reduction in hospital days and an 80% reduction in homelessness.” (California Psychology Association, 2010)


In a recent National Coalition of the Homeless Fact Sheet, specifically 3% published in June 2008, it is reported that findings in a survey conducted by the U.S. Conference of Mayors show that 7,.9% of the homeless population are individuals that a total of 29.9%. It is additionally stated that despite the large population of homeless individuals, “the growth in homeless individuals is not related to the release of seriously mentally ill people from institutions” although the “mass deinstitutionalization form mental health facilities occurred over forty yeas ago, yet the promise of community-based programs and outpatient services has not been kept especially toward the homeless and others living in poverty.” (NCH Fact Sheet, 2008, paraphrased) It is held that the new wave of deinstitutionalization due to managed care driven rate of unplanned discharge might very well be contributing to the population of individuals who are homeless at the present. (NCH Fact Sheet, 2008, paraphrased)


Mental disorders are such that prevention individuals from the carrying out of “essential aspects of daily life, such as self-care, household management and interpersonal relationships.” (NCH Fact Sheet, 2008) Those who are mentally ill and homeless are likely to be homeless for long periods of time and to have less familial contact as well as less contact with friends. Disorders such as schizophrenia are stated to “often misinterpret the guidance of others and react irrationally because of their condition. The mentally ill homeless population is further stated to encounter “more barriers to employment tend to be in poorer physical health, and have more contact with the legal system than homeless people who do not suffer from mental disorder. (NCH Fact Sheet, 2008, paraphrased)


The work of Breakey, et al. (1989) focused on homeless people in Baltimore, Maryland and specifically on their health characteristics. The first stage of the study involved “298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data.” The second stage involved a subsample of 203 subjects which were randomly chosen from the baseline survey respondents to have “systematic psychiatric and physical examinations.. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions are demonstrated and data are provided on the subjects’ needs for mental health and substance abuse services.” (Breakey, et al., 1989)


McNiel, Binder and Robinson (2005) report a study that assessed the relationships between homelessness mental disorder and incarceration.” Using archival databases that included all 12,934 individuals who entered the San Francisco County Jail system during the first six months of 2000, the authors assessed clinical and behavioral characteristics associated with homelessness and incarceration.” The study results report that sixteen percent of the incarcerations were of inmates who were homeless and in eighteen percent of cases the inmates were stated to have been diagnosed with a mental disorder and thirty percent of the inmates who were homeless had a diagnosis of mental disorder during one or more episodes.” (McNiel, Binder and Robinson. 2005) The study concludes by stating that individuals who were homeless “and who were identified as having mental disorders, although representing only a small proportion of the total population, accounted for a substantial proportion of persons who were incarcerated in the criminal justice system in this study’s urban setting. The increased duration of incarceration associated with homelessness and co-occurring severe mental disorders and substance-related disorders suggests that jails are de facto assuming responsibility for a population whose needs span multiple service delivery systems.” (McNiel, Binder and Robinson, 2005)


The work of Combaluzier, Gouvernet, and Bernoussi (2009) reports a study that states findings that the association of homelessness multiples the risk for development of personality disorders and it was also found that many homeless personality-disordered individuals were also affected by drug abuse.


The work of Gilmer, et al. (2010) entitled: “Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness” Reports that adults who are chronically homeless with severe mental illness are heavy users of costly inpatient and emergency psychiatric services.”


II. STATEMENT OF PROBLEM


Individuals with mental illness often have a great problem in gaining access to housing and require assistance in obtaining and maintaining a place of residence.


III. PURPOSE OF THE STUDY


The purpose of the study herein is to examine the issue of mental illness as it relates to homelessness among those with psychological disorders and the challenges they face in obtaining housing.


IV. SIGNIFICANCE OF THE STUDY


The significance of this study is the knowledge that it will add to the already existing base of knowledge in this area of research and study.


V. LITERATURE REVIEW


The work of Finnerty (2008) states that homelessness is a problem that affects most societies today. It does not discriminate by geographical location; it can occur in any city of town, in any country in the world. Homelessness is defined as being without a place to live, and therefore living on the streets; living in unstable conditions, such as a shelter, or substandard conditions such as boarding houses.” (Finnerty, 2008) Various problems impact homeless individuals and there is a great deal of uncertainty about how individuals without housing should be handled. Exacerbating this problem is that many homeless individuals are affected by mental illness and in fact a report of the National Coalition for the Homeless (2006) states that approximately 20 to 25% of homeless adults are known to suffer from some type of severe mental illness. This results in these individuals comprising the majority of the population of homeless and very vulnerable individuals.


Mental disorders affect the individual in a manner that prevents them from taking care of essential aspects of everyday life. Individuals who have mental disorders “are homeless for a longer period of time and have more problems involving employment, physical health and the legal system compared to homeless people who do not have a mental illness.” (Finnerty, 2008) The study of mental illness in those who are homeless is important “because the outcome could affect how to treat this population and what kind of support or aid they should be given.” (Finnerty, 2008)


Finnerty (2008) states that approximately 50% of those who are mentally ill and homeless also have “co-occurring substance abuse disorder.” (Finnerty, 2008) It is reported that those who suffer from co-occurring mental illness and substance abuse problems are also likely to be homeless. According to the Health Care for the Homeless Clinicians’ Network (2000) “Co-occurring mental illness and substance abuse makes it more likely that people will be chronically homeless.” (cited in Finnerty, 2008) Factors that are known to contribute to homelessness in those with co-occurring mental illness and substance abuse include factors such as: (1) Financial problems; (2) Loss of family support; (3) Severity of symptoms; and (4) Time spent in institutions such as jails or hospitals. (Brunette, Mueser and Drake, 2004 in: Finnerty, 2008) Padgett and Struening (1991) state that substance abuse and mental disorders “increase the health care needs of homeless persons, whose primary source of care is often the emergency room.


The work of Padgett et al. (2006) reports having interviewed a group of women who had been previously homeless. The interviews examine the women in terms of their history of mental illness, substance abuse and traumatic events. It was found that nine of the thirteen women in the study “reported traumatic events, including rape and childhood sexual abuse, violence, or betrayal of trust. A history of substance abuse was reported in nine of the thirteen women. Hawkins and Abrams (2007) conducted a study on mental illness and homeless persons and specifically 39 individuals with mental illness in New York City. These individuals had abused drugs or alcohol and who were homeless. The study found that the majority of these individuals “had few friends or relationships with others.” (Finnerty, 2008)


Rosenthal (2007) examined co-occurring disorders among young, recently homeless persons in Melbourne, Australia, and Los, Angeles, United States. The study was inclusive of 162 individuals in Melbourne and 259 individuals in Los Angeles. The individuals in this study were questioned concerning mental health and problems with alcohol and drugs both at the start of the study and six months and one year later. The results of the study state that there was a low rate of co-occurring mental illness and substance abuse among young homeless and “at all three points in time, the majority of the individuals had neither a mental illness, nor problems with drugs or alcohol. One problem with this study is that it only questioned individuals between ages 12-20 years old. Most serious mental illness does not develop until after the age of 20.” (Finnerty, 2008)


A report published by the Health Care for the Homeless Clinicians’ Network (2000) conducts an examination of “mental illness, substance abuse, and possible treatment policies. Treatment is necessary for those with a mental illness and the longer one goes without treatment, the worse their illness gets and they become more difficult to treat. Treatment is necessary for this group of homeless persons, but is extremely difficult without stable housing.” (Finnerty, 2008)


According to HCH Clinicians (2000) “Patients with severe mental illnesses who are housed have fewer complications, and are much less likely to have co-occurring disorders that exacerbate their illness”(p. 2). Homeless people have multiple needs and need individual care and long-term service if they hope to get better.” (Health Care for the Homeless Clinicians’ Network 2000 cited in Finnerty, 2008)


The work of Liebow (1993) states that life is more difficult for the population of women who are also affected by mental illness and substance abuse as these individuals are those with the greatest need for shelter and health care, however, this group rarely receives shelter or health care service. In fact, Liebow states that the stress of being homeless only serves to exacerbate the problems of mental illness and substance abuse. Finnerty states that studies have found that “mental illness makes homelessness even worse and increases the likeliness that one will remain homeless. Other studies have found that treatment is necessary to overcome homelessness.” (cited in Finnerty, 2008)


It is reported that The Criminal Justice Task Force Report on Mental Health and Criminal Justice in Tennessee made recommended through the Office of Housing and Homeless Services that TDMHDD “work toward increasing appropriate housing options for persons with serious mental illness who are engaged with the criminal justice system.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010) Findings of the THDA SJR 279 Housing Report (2000) states the following conclusions: (1) Approximately 15% of persons with severe and persistent mental illness receiving case management are housed inappropriately. One can assume that this percentage might be considerably higher among other segments not receiving services at all, such as homeless persons’ (2) In all areas of the state and among every subgroup of the population surveyed, the primary barrier to appropriate housing was insufficient income to pay for monthly expenses; (3) The type of housing most appropriate for the majority of the consumers surveyed is independent living units; (4) A large proportion of persons awaiting release from regional mental health institutes cannot be discharged because there are not enough spaces available in appropriate licensed facilities. (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


It was established by the National Technical Assistance Center for State Mental Health Planning’s Housing for Persons with Psychiatric Disabilities: Best Practices for a Changing Environment that there is a responsibility of the state and community mental health systems to focus on housing “as a necessary component of recovery and community support; (2) The focus of housing planning should be on “permanent housing that is affordable.” (3) Planning for housing and planning for support of people needing recovery should be closely linked. (4) The most effective method to the promotion of recovery and re-integration into society is a combination of professional services that are staffed both by individual with and without a history of psychiatric disabilities combined with peer support and consumer operated services and natural support systems in the community. (5) The leadership of the state mental health agency needs to view assistance for rental as an integral part the strategy of a design to increase access to integrated housing. (6) Rental assistance activities should be developed in the context of an overall housing policy that supports a variety of activities designed to increase the availability of integrated housing. This includes the development of state policy in regards to housing and residential services. (7) Housing discrimination against people with psychiatric disabilities is a major national problem that requires urgent attention. (8) Legal protections and tools, such as those found in the Fair Housing Amendments Act, Section 504 of the Rehabilitation Services Act, and in provisions of the Americans with Disabilities Act, are often overlooked within both mental health and housing systems and should be utilized as important tools for assisting people with psychiatric disabilities to meet their housing needs. (9) Education, information, and training in these protections are of critical importance to consumers and family members as well as to housing and mental health staff. (10) State and local mental health agencies should develop partnerships with housing finance and development agencies to increase housing access and supply. (11) State mental health agencies should support the development of knowledge and skills necessary for accessing mainstream housing resources. (12) Creative use of mainstream housing resources both new and existing (e.g., Community Development Block Grant, HOME funds), should be a priority of mental health and housing authorities. (13) The leadership of the state mental health agency must view rental assistance as part of a larger strategy designed to increase access to integrated housing. (14) Rental assistance activities should be developed in the context of an overall housing policy that supports a variety of activities designed to increase the availability of integrated housing. Helpful activities include assembling groups of stakeholders to assist in the development and oversight of state policy regarding housing and residential services. (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


A recent study conducted by Dennis Culhane and colleagues and published by the Fannie Mae Foundation states conclusions that supportive housing, described as “permanent housing with attendant social services” has always been considered to be “prohibitively expensive” however, it is stated that this type of housing “has emerged as a good investment because it is shown to substantially reduce the use of other publicly funded services.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010) It is stated that New York City “established a comprehensive supportive housing program for homeless people with severe mental illness. A major study of the program calculated that long-term homeless people with severe mental illness used an average of $40,500 a year in public shelter, corrections, and health care services. For those placed in the permanent supportive housing program, the reduced use of acute care services nearly offset the costs of the supportive housing.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010) In fact, evaluations of other programs similar to these have discovered that retention rates for supportive housing programs are 80% and that these lead to “significant reductions in hospitalizations and shelter use.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


Evaluations of similar programs nationally have found that most supportive housing programs for homeless people with mental illness boast retention rates of 80% up to one year following placement, while leading to significant reductions in hospitalizations and shelter use. Furthermore, there are non-financial benefits to the provision of supportive housing including “the benefit from residents of supportive housing being more likely to secure voluntary or paid employment and an improved quality of life.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


In addition it is noted that there is a “social value of reduced homelessness” as well as the provision of a greater level of social protection for those who are disabled. Individuals who are placed in housing are very likely to reduce their use of hospital services since they are in a much better position to take part in outpatient programs. Access to housing additionally has the potential to greatly reduce the length of stays in the hospital for these individuals. (Tennessee Department of Mental Health and Developmental Disabilities, 2010, paraphrased) It is reported as well that a study conducted by Rosenheck, Kasprow, Frisman and Liu-Mares in 2003 on the cost-effectiveness of supported housing for those who are homeless and have mental illness states findings that “Supported housing, integrating clinical and housing services, is a widely advocated intervention for homeless people with mental illness.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


Primary benefits of the U.S. Department of Housing and Urban Development and U.S. Department of Veterans Affairs HUD-VA Supported Housing program included outcomes of 35 to 36% fewer measures of psychiatric or substance abuse status or community adjustment.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010) Comparison data form the Lewin Group states that when comparing the difference in services the following findings are stated: (1) One day in a mental hospital costs $607.00; (2) One day in jail costs $90.00 per day; and (3) One day in supportive housing cost $30.00,


(Tennessee Department of Mental Health and Developmental Disabilities, 2010)


It is clear that the benefits to those who are homeless and suffer from mental illness through supportive housing will also serve to benefit the community and society at large in the reduction of costs needed to assist and support these individuals who are homeless and who suffer from mental illness. The Lewin Group states “While everyone who is homeless for the long-term obviously does not spend 365 days a year in jail — there is evidence that too many spend almost all their time bouncing among institutions without becoming stable. A recent study in New York City found 909 people who each spent on average 397 days out of two years in either shelter or jail.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010) It is additionally stated by the Lewin Group that the benefits of supportive housing are obvious “to the taxpayer, as a more humane solution, and to encourage people to be as independent and engaged in work and community as possible.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


It is reported that a separate study published by the Corporation for Supportive Housing states the following findings: (1) not only is supportive housing effective for ending cycles of homelessness it further serves to improve the “performance and impact of services provided by mainstream systems such as healthcare, child welfare, and criminal justice”; (2) because of the lack of integration in the present systems for health care, mental health, housing, criminal justice and child welfare along with addiction treatment, these are not effective in assisting those with complex health and social services needs. However, a supportive housing system has the potential to produce “far superior, long-term results with minimal addition costs to existing programs.” (Tennessee Department of Mental Health and Developmental Disabilities, 2010)


The U.S. Department of Housing and Urban Development Office of Policy Development and Research publication in 2007 and entitled “The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness” reports a study that included nine programs that incorporated the key features of the Housing First model. Those locations are stated to include locations in Columbus, Ohio; San Francisco, California, Seattle, Washington; Philadelphia, Pennsylvania; Los Angeles, California; New York City, New York; San Diego County, California; and Long Beach, California. Pathways to Housing, DESC and REACH were selected for this study since they are committed to provide service to homeless people with chronic mental illness and because they “emphasize placement into permanent housing without requirements for sobriety and treatment compliance. It is reported that the program elements that emerged as important in contributing to the success of the programs were those as follows: (1) Access to a substantial supply of permanent housing; (2) Making a provision of housing that clients like; (3) Wide array of supportive services to meet the multidimensional needs of clients; (4) Service delivery approach that emphasizes community-based, client-drive services; (5) Staffing structure that ensures responsive service delivery; (6) Diverse funding streams for housing and services. (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007)


The Housing First approach is stated to be theoretically different from approaches “that transition people with serious mental illness from the streets to permanent housing” as these programs involves the provider making the assumption that “homeless people with severe mental impairments require a period of structured stabilization prior to entering permanent housing, often involving stays in a series of housing settings along a continuum of increasingly independent living. Entering the continuum often requires that the homeless person commit to a service plan and agree to abstain from using drugs or alcohol.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007) The symptoms of the client that are related to mental disorder or substance abuse may become worse at times requiring increases in the level of service provision or institutional care, which may either halt temporarily or reverse the individuals’ progress toward living independently. There are two groups: (1) those unable to succeed in a more structured approach to services; and (2) those resistant to accepting services which are stated to be “the primary targets for the Housing First approach.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007)


Primary characteristics of the Housing First approach are stated to include the following: (1) The direct, or nearly direct, placement of targeted homeless people into permanent housing. Even though the initial housing placement may be transitional in nature, the program commits to ensuring that the client is housed permanently; (2) While supportive services may be offered and made readily available, the program does not require participation in these services to remain in the housing; (3) The use of assertive outreach to engage and offer housing to homeless people with mental illness who are reluctant to enter shelters or engage in services. Once in housing, a low demand approach accommodates client alcohol and substance use, so that “relapse” will not result in the client losing housing; and (4) The continued effort to provide case management and to hold housing for clients, even if they leave their program housing for short periods. (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007)


The Pathways to Housing approach is one that separates housing and treatment services in an arrangement where clients rent the apartments and the Pathways to Housing holds the lease and landlords have no direct relationship with the program. It is stated to be a “low demand approach” in that the program does not prohibit substance use as a condition for obtaining or retaining housing. The only requirement for the program is that the client spends thirty percent of their income for rent and this is generally done through a representative payee money management program. The second requirement is that the client participates in two home visits by their case manager each month. (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007, paraphrased)


Conclusions of the Housing First Program study states that “despite the history of homelessness and severe mental illness of the clients served in the three Housing First programs 84% (n=67) of the clients tracked for this study remained enrolled in the Housing First program at the 12th month. Forty three percent remained in the Housing First housing for the full 12 months, 41% were ‘intermittent stayers’ and left during the 12-month period but returned and 15% left the housing or died within the first 12 months.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007) It is stated that the differences among stayers, intermittent stayers, and leavers are modest, but some patterns emerge. Leavers and intermittent stayers more often entered the Housing First program from the streets and were more likely to experience temporary program departures. Furthermore, it is reported that leavers and intermittent stayers “experienced higher levels of impairment related to psychiatric symptoms during their last month in housing compared to month 12 for stayers.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007)


Findings in this study show that the Housing First approach is achieving “considerable positive housing outcomes with a population with high service needs.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007) The Housing First approach makes the assumption that upon clients achieving stability in housing that they are “better prepared to address their mental illness and substance-related issues.” (U.S. Department of Housing and Urban Development Office of Policy Development and Research, 2007) Additionally, program housing in combination with support services assists the client in stabilizing their financial situation and enables the client to become more self-sufficient. This program is one that offered mental health and substance abuse services to clients but did not require participation in these programs as a condition for receiving the provision of housing however, the program reports positive outcomes and overall success rates of approximately 90%.


The work entitled “The Criminalization of Homelessness: Illegal to Be Homeless” published in the Winter of 2002 by the National Coalition for the Homeless and the National Law Center on Homelessness and Poverty reports that those who experience being homeless are likely to have their very basic civil rights violated “through the unconstitutional application of laws, arbitrary police practices and discriminatory public regulations.” (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008) It is additionally reported that local governments, local business improvement districts, and police departments all across the United States are “diverting precious public resources and funding to penalize people for being homeless.” (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008) Homeless individuals who lack “private spaces in which to carry out life-sustaining activities such as sleeping, resting, storing personal belongings, or activities associated with personal hygiene, people experiencing homelessness face the further indignity of arrest.” (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008) The study notes that once having been arrested the individual has gained another barrier to obtaining housing and the fact is that these laws which are described as being “short-sighted “may make good sound but only serve to invest more tax dollars in jails than in housing, health care and services.” (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008) The National Coalition for the Homeless and the National Law Center on Homelessness and Poverty report states that presently the homeless are being removed from view but the root causes of homelessness are not being addressed. Specifically stated is that laws are being passed that effectively “target behaviors associated with the state of being homeless, such as sleeping, bathing, sitting, cooking, lying down, urinating, or storing personal belongings in public spaces” and that these laws are unconstitutional because “collectively, they target people based on their housing status, not for behaviors that, in and of themselves are criminal. These laws and practices are designed to criminalize homelessness without mentioning the words “homeless” or “housing” because they target behaviors most likely to be conducted by people experiencing homelessness.” (2008) The report also states findings that in 100% of communities surveyed there was a lack of “enough shelter beds to meet demand and housing costs are out of reach for many, including the working poor.” (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008) Recommendations stated in the National Coalition for the Homeless and the National Center on Homelessness and Poverty report include the following stated recommendations: (1) Educate people experiencing homelessness, and their allies, about their constitutional rights; (2) Provide immediate support for local monitoring projects and data collection activities to challenge local abuses, support local best practices, and building a national resource data bank; (3) Federal action is required to investigate patterns and practices of the civil rights violations of people experiencing homelessness; (4) Combine litigation with grassroots organizing and public education efforts; (5) All people experiencing homelessness who are arrested must be advised of their right to counsel and given the phone number of an advocacy organization to track and independently document the arrest; (6) Local police-watch projects should be fully funded so that people experiencing homelessness and their allies can independently document police intervention; and (7) Develop, document, disseminate and replicate successful organizing models. (National Coalition for the Homeless and the National Law Center on Homelessness and Poverty, 2008)


Gilmer TP, Stefancic A, Ettner SL, Manning WG, Tsemberis S. (2010) Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness.


rch Gen Psychiatry. 2010 Jun;67(6):645-52.


VI. FINDINGS


This study has conducted an extensive review of literature relating to homelessness and has found that there is an ongoing systematic abuse of the civil rights of individuals who are homeless. The absence of asses to health care both for mental and physical health and substance abuse treatment only serves to make homelessness more prevalent in those who have a mental disorder and those individuals are disproportionately affected by homelessness. Resources that could serve to assist the homeless in communities are instead being wasted on criminalization of the homeless. This study has also found that there are replicable models which have been and are in the midst of being developed that demonstrate positive outcomes and economic gains through reduction of expenses when homeless individuals with mental disorders are provided with housing.


VII. SUMMARY & CONCLUSION


Homelessness is a prevalent issue in the United States and one that has resulted in criminalization of a group of very vulnerable individuals. Individuals with a mental disorder are much more likely to become and remain homeless than are other individuals. Studies have demonstrated replicable models to address the issue of homelessness among those with mental disorder in models that include access to mental health care but that however do not make use of that care a requirement in receiving the provision of housing. Arising from this study is a recommendation that more research be applied in the area of such models toward the goal of addressing the ever expanding group of homeless individuals in the contemporary society.


BIBLIOGRAPHY


1. Brunette, Mary F., Kim T. Mueser, and Robert E. Drake. 2004. “A Review of Research on Residential Programs for People With Severe Mental Illness and Co-occurring Substance Abuse Disorders.” Drug and Alcohol Review 23:471-81.


2. Creating Homes Initiative. (2010). TN Department of Mental Health and Developmental


Disabilities. Retrieved on June 23, 2010 from http://www.tennessee.gov/mental/recovery/CHIpage.html


3. Finnerty, Jacqueline (2008) Homelessness and Mental Illness Literature Review. 30 Apr 2008. Sociological Analysis. Online available at: http://www.unh.edu/sociology/media/pdfs-journal2008/Finnerty2EDITED.pdf


4. Homelessness and Mental Health (2010) California Psychological Association. Online available at: http://www.calpsych.org/publications/access/homelessness.html


5. Housing and Health Services (2010) Tennessee Department of Mental Health and Developmental Disabilities. Online available at: http://state.tn.us/mental/recovery/housing2.html


6. Illegal to Be Homeless: The Criminalization of Homelessness (2002) National Coalition for the Homeless and the National Law Center on Homelessness and Poverty. Winter 2002. Online available at: http://www.housingforall.org/Criminalization.htm


7. Liebow, Elliot. 1993. Tell Them Who I Am. New York: Penguin Books.


8. Mental Illness and Homelessness (2008) National Collation for the Homeless. Fact Sheet #5. June 2008. Online available at: http://www.scribd.com/doc/25102558/Mental-Illness-and-Homelessness


9. Mental Illness, Chronic Homelessness: An American Disgrace (2000) Healing Hands. HCH Clinicians. Vol. 4 No. 5. October 2000. Online available at: http://www.nhchc.org/Network/HealingHands/2000/October2000HealingHands.pdf


10. Rosenthal, Doreen, Shelly Mallett, Lyle Gurrin, Norweeta Milburn, and Mary Jane Rotheram – Borus. 2007. “Changes Over Time Among Homeless Young People In Drug Dependency, Mental Illness, and Their Co-morbidity.” Psychology, Health, & Medicine 12:70-80.


11. The Applicability of Housing First Models to Homeless Persons with Serious Mental Illness (2007) U.S. Department of Housing and Urban Development, Office of Policy Development and Research. July 2007. Online available at: http://www.huduser.org/Publications/pdf/hsgfirst.pdf


12. Combaluzier S, Gouvernet B, Bernoussi A.(2010) Impact of personality disorders in a sample of 212 homeless drug users. Encephale. 2009 Oct;35(5):448-53. Epub 2008 Oct 1. PUBMED online available at: http://www.ncbi.nlm.nih.gov/sites/pubmed


13. Ingram G, Muirhead D, Harvey C.(2010) Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviors and social functioning. Aust NZJ Psychiatry. 2009 Nov;43(11):1077-83.


14. Kresky-Wolff M, Larson MJ, O’Brien RW, McGraw SA.(2010) Supportive housing approaches in the Collaborative Initiative to Help End Chronic Homelessness (CICH J. Behav Health Serv Res. 2010 Apr;37(2):213-25.


15. Padgett, Deborah K. And Struening, Elmer L. (1991) Influence of Issuance Abuse and Mental disorders on Emergency room Use by Homeless Adults. Psychiatric Services 24:834-838.


16. Kushel, Margot B. et al. (2005) Revolving Doors: Imprisonment Among the Homeless and Marginally Housed Population. October 2005, Vol 95, No. 10 | American Journal of Public Health 1747-17


17. Folsom, David P. (2005) Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System. October 2005, Vol 95, No. 10 | American Journal of Public Health 1747-1752. 2005 American Public Health Association.


18. Bucknre, John C. et al. (2010) Mental Health Issues Affecting Homeless Women: Implications for Intervention. American Journal of Orthopsychiatry. Volume 63 Issue 3, Pages 385 — 399. Published Online: 24 Mar 2010. American Orthopsychiatric Association


19. Bassuk, E.L., et al. (1986) Characteristics of Sheltered Homeless Families. American Journal of Public Health, Vol. 76, Issue 9, 1097-1101, Copyright 1986 by American Public Health Association.


20. Gonzalez, Gerardo (2002) Outcomes and Service Use Among Homeless Persons With Serious Mental Illness and Substance Abuse. Psychiatr Serv 53:437-446, April 2002.


21. Gilmer TP, Stefancic A, Ettner SL, Manning WG, Tsemberis S. (2010) Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Arch Gen Psychiatry. 2010 Jun;67(6):645-52.



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Theology and Spirituality in Counseling college essay help free: college essay help free

Theology and Spirituality in Counseling


Intervention Studies on Forgiveness


The article Intervention studies on forgiveness: A meta-analysis, addresses the idea of forgiveness from a counseling perspective. Three different types of categories were considered by the authors. These were decision-based interventions, along with two types of process-based interventions. One of those was individual and the other was with groups. There were nine published studies used to gather the data for the article, which equated to 330 participants’ information being collected and analyzed. Theories of forgiveness were also reviewed, in an effort to examine why people choose to forgive or not forgive, and how that forgiveness may or may not play into their faith and other types of beliefs. The groups that were studied also included a control group, in order to ensure that the information drawn from the study was truly applicable to more than just the study participants.


The study looked at forgiveness, as well as other measures of emotional health. It found that there was no effect seen from the interventions that were decision-based, but that process-based group interventions showed some effect. The largest effect was from the process-based individual interventions, which showed significantly large effects. That was very important to the study, because it provided the authors with the understanding that forgiveness in clinical settings through the use of process-based interventions could be highly valuable for a number of people. It also helped to indicate that forgiveness is truly a process, and that simply making a decision to forgive someone may not be enough to adequately do so. Some people need more than that decision to move past hurt that has been brought on by another person, and a clinical setting can help with that.


Reflection


When it comes to studies that have been done on forgiveness, the article provides a lot of good insight in compiling past information and analyzing it properly. The study is a good way to see that there are many different ways to work toward forgiving someone, and that not all of them are equally effective. While that is unfortunate for people who are trying to forgive and having trouble doing so, it is important to remember that forgiveness is different for each person. Some of them struggle to forgive even the smallest infraction, while others are capable of forgiving very serious crimes and related difficult behavior. It may be about the person and what he or she chooses to allow, but it can also be about how the idea of forgiveness is presented to that person. A decision-based option does not seem to be as effective as a process-based option. This would make sense, because deciding to forgive someone is a process, even though there is ultimately a decision at the end of that process.


The process is also very individualized, which would indicate why the individual process-based option worked better than the group-based option when it came to truly helping people forgive and move past any issues they were facing with another person. There are times when forgiving is very difficult, and it can help to see that others in the group are having similar experiences. However, that does not mean that the actual way a person forgives is going to be the same as other people in the group. That is where the individual process issue appears to be most significant, because it gives each person the opportunity to decide how they are going to forgive and focus on that so they are able to let go of the feelings of anger, disappointment, and related issues they have regarding another person. With forgiveness having so much value for the individual, it is important that each person who needs to forgive others — and themselves — find a way to do so adequately.


Application


The work in this article is particularly significant for counseling, and can easily be used to address spiritual issues, as well. When a person needs to forgive, there may be the need to seek counsel with other people and explore the value of forgiveness. Additionally, there may be ways in which the person feels he or she cannot forgive, and that has to be addressed in order to allow that person to get past those perceived “roadblocks” in order to find the necessary forgiveness. Because it is a process that culminates in a decision, more focus has to be put on the process of forgiveness and less on the actual decision that comes from it. Ultimately, if the process is correct and carried out, the decision will come from it naturally, and will not be so much an actual decision as a realization of the truth of the matter and the value of forgiving, letting go, and moving on. This is a vital part of counseling for nearly every person who struggles with forgiveness, as applying the process to those who must learn to let go can be very helpful for their present and future mental health.


Many people do not realize just how much a lack of forgiveness can affect their mental health, but it is something that a number of people struggle with. It can weigh them down for years, and eventually they may just get used to that weight. When it is lifted, they can feel very different about themselves, other people, and the world around them. That is the joy and value that forgiveness brings to them, and the main reason why they should be very focused on working through the process of forgiveness. During counseling, it is possible for them to see that there is more of a benefit for them than for the person they are forgiving, and that true forgiveness is about letting something go so it can no longer harm them. That is the overarching message that has been collected through the article analysis, and the overall takeaway from the article itself.


References


Baskin, T.W. & Enright, R.D. (2004). Intervention studies on forgiveness: A meta-analysis. Journal of Counseling and Development, 82: 79-90.



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