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Journal article

Research watch: the power of genetic and biological explanations to reduce social inclusion

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 16(3), 2012, pp.116-120.
Publisher:
Emerald

This review summarises two recent research papers relating to the use of biological explanations. The first paper highlights how unhelpful it can be to over-use genetic explanations for various human experiences, and the second paper discusses the unhelpfulness of exclusively biological explanations for mental health conditions. The first paper explores the many ways in which genetic explanations are over-used to understand race, ethnicity, the sexes, sexual orientation, crime, mental health and obesity. This over-use of genetic explanations leads to various negative consequences, among them social exclusion, but may be counteracted by better explanations of both the relatively weak nature of genetic influences and how people's genes and environment interact. The second paper examines evidence about whether it is really helpful to think of mental health conditions as illnesses “like any other”. The author points to the need for promoting a more holistic understanding of human experience, and against focusing too narrowly on only one kind of cause, namely biological, and mostly on one aspect of biology – genes.

Journal article

Hearing voices and befriending schemes

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 15(4), 2011, pp.160-164.
Publisher:
Emerald

This paper provides a summary of 2 recent research papers relating to mental health and social inclusion. The first (Beavan, J. Mental Health, 2011, 20, 281-92) considers the prevalence of voice hearing. Voice hearing is defined as when someone hears a voice that sounds real (rather than a thought) but that others cannot hear. Studies spanning more than 100 years are reviewed and suggest that hearing voices is more common than usually thought. The article argues the case for viewing hearing voices more positively than at present. The second article (Mitchell & Pistrang, Psychology and Psychotherapy, 2011, 84, 151-69) looks at befriending schemes for people with mental health problems. Interviews involving 8 people with mental health conditions and their befrienders suggest that demonstrating empathy and being non-judgmental helped people with mental health conditions to talk things through, with both parties learning from one another. Going out together helped befriendees gain greater confidence to participate in further activities and feel less isolated.

Journal article

How included are mental health service users in decisions about their medication?

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 20(3), 2016, pp.141-148.
Publisher:
Emerald

Purpose: The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services. Design/methodology/approach: One article describes conversations between a psychiatrist and service users about medication. The second paper describes a study in which young people were supported with the aim of developing their confidence to challenge medication decisions. The third paper reports on interviews with both professionals and service users about medication decisions. The fourth paper presents a theory of how the wider context can affect medication decision making in mental health. Findings: The first paper shows how a psychiatrist can persuade service users to accept medication decisions. The second paper shows how some young people can challenge medication decisions if they have the right support. The third paper illustrates how both professionals and service users may doubt service users’ ability to decide about medication, and pessimistically suggests that shared decision making may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are organised in order to enable service users to be more empowered about medication decisions. Originality/value: A model of shared decision making is being imported into mental health from physical health. These four papers illustrate problems with a simple transfer from physical to mental health. The present paper points to differences in apparent awareness of different clinical researchers of the need to tackle service users’ disempowerment in mental health care, showing how some researchers are tackling this. (Publisher abstract)

Journal article

Research watch: art therapy: a dose of treatment, an aid to social inclusion or an unnecessary indulgence?

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 17(2), 2013, pp.64-69.
Publisher:
Emerald

Purpose – This Research Watch aims to summarise two recent and very different research publications on art therapy and comments on their ability to shed light on the usefulness of art therapy to address mental distress and enhance social inclusion. Design/methodology/approach – The author discusses a recent edition of a UK art therapy journal in which research papers focus on art therapy with people who have been given a diagnosis of personality disorder. The main methodologies are qualitative describing participants’ and/or therapists’ experiences and the role of art therapy in addressing serious mental distress. The second publication is a recent report of a large randomised controlled trial of art therapy for people given a diagnosis of schizophrenia. The author assesses the value of both publications in informing us about the usefulness of art therapy in addressing mental distress and enhancing social inclusion. Findings – In the author's view, neither publication establishes definitively how or whether art therapy might address serious mental distress, whether labelled personality disorder or schizophrenia. However, the qualitative articles provide insight into possible helpful (and less helpful) aspects of therapy. The randomised trial should have been able to establish general principles about the effectiveness of art therapy for a specific group of people in specified contexts, but instead exemplifies many problems inherent in the pervasive research culture of putting numbers onto complex human interactions and calculating their value for money, sometimes at the expense of really understanding what is going on. Originality/value – The author draws upon these two very different examples of research to reflect a current dilemma in UK art therapy research, and tentatively looks at possible ways forward. (Publisher abstract)

Journal article

Poor quality employment is worse for mental health than no job at all and contributes to mental distress in new mothers

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 16(2), 2012, pp.66-71.
Publisher:
Emerald

Two recent research papers on employment and mental health, one relating to all sectors of the working age population and the other to women who had recently had a child, are reviewed and summarised in this article. Both studies involved large samples of people in Australia. In the first study, information from a longitudinal survey was used to follow people over time and assess whether the quality of employment was related to mental health. It found that mental health was significantly better for people who were in jobs compared to those who were not, but that a poor quality job was no better than unemployment in terms of mental health and that, when the effect of other predictors of mental ill health was taken into account, a poor quality job was worse than no job at all. The second study focused on employed women who had given birth in the previous 12 months and had returned to work. It assessed the effect of working conditions on mental health, and found that quality of employment predicted whether they experienced mental distress, with psychological distress significantly associated with poor employment conditions. The author reports that the papers add to understanding of the relationship between mental health and employment, and comments that social inclusion through employment may depend not only on being in work but on the quality of that work.

Journal article

Now I have a voice: service user and carer involvement in clinical psychology training

Authors:
HOLTTUM Sue, et al
Journal article citation:
Mental Health and Social Inclusion, 15(4), 2011, pp.190-197.
Publisher:
Emerald

UK universities have only recently begun to address the need for a partnership with service users in higher education. This paper describes the challenges and rewards of service user and carer involvement in clinical psychology training as experienced in Canterbury Christ Church University. The aim of involvement is to ensure that trainee clinical psychologists understand the experiences and perspectives of mental health service users and their carers. Members of the service user and carer advisory group Salomons Advisory Group of Experts by Experience (SAGE) regularly take part in a variety of clinical psychology training sessions. Three members of SAGE describe their contributions to the work. The challenges of inclusion and specific approaches that are used to work with these challenges are explored. They require that everyone involved should fully acknowledge the social and historical barriers in order to work together to overcome them.

Journal article

Research watch: is social inclusion for service users increased when mental health professionals "come out" as service users?

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 22(2), 2017, pp.73-79.
Publisher:
Emerald

This paper discusses two recent studies of mental health professionals who have experience of mental distress, one in the USA and one in Australia. The purpose of this paper is to highlight different experiences, first of largely concealing their experience, and second of disclosing and using it. Design/methodology/approach: The Australian study examined the barriers experienced by mental health professionals, including trainees, in relation to seeking help. The USA study reported on a sample of mental health professionals who were doing well, including leaders of services, despite current or past mental distress. Findings: Both studies included more psychologists than other mental health professionals. Australian mental health professionals reported similar fears and barriers to those found in other studies, in addition to concern about their colleagues’ duty to report impairment to the regulating body. Professionals in the USA-based study were described as potentially helpful in reducing stigma about mental distress because their achievements demonstrated that recovery is possible. However, many of them were also cautious about who they disclosed to, and wanted further reduction in stigma and discrimination. Originality/value: The Australian study highlighted specifically that the requirement to report impairment to the regulator deterred people from disclosing distress at work, making it less likely that they would get help. The USA-based study was ground-breaking in documenting achievements of a substantial sample of mental health professionals with experience of mental distress. Potentially more professionals being “out and proud” might help increase recovery and social inclusion for service users more generally.

Journal article

School inclusion for children with mental health difficulties

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 19(4), 2015, pp.161-168.
Publisher:
Emerald

Purpose: The purpose of this paper is to highlight research on the exclusion from school of children with disabilities, and especially those identified as experiencing emotional disturbance. Two studies of schools that are inclusive are then described in order to examine how they achieve good results. Design/methodology/approach: Three papers are summarised. The first examines things that predict children with disabilities being excluded from school, including characteristics of children and of schools. The second is a qualitative study of four English schools involved in a national programme aimed at improving children’s mental health. The third is a case study of one American school identified for its high inclusivity and excellent educational results. Findings: In the first study, children with emotional disturbance, and African-American children were most likely to be excluded from school. The study of four English schools suggested that implementation of the national programme was variable but leadership and planning seemed vital, as well as whole-school commitment. The high-performing inclusive American school had whole-school commitment, high quality planning alongside flexibility, on-going further training for teachers, and close pupil tracking. Originality/value: The study of school exclusion was the first to examine children and schools together, as well as different disabilities and ethnicity. The study of English schools highlights the experiences of those directly involved in implementing a national programme to promote children’s mental health. The study of a high-performing inclusive school in America discovered much in common with inclusive high-performing schools in England, suggesting that some practices can be identified across the two cultures that aid successful inclusion of children with disabilities including mental health difficulties. (Original abstract)

Journal article

Do clinicians and clinical researchers do enough to foster social inclusion?

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 19(1), 2015, pp.5-11.
Publisher:
Emerald

Purpose: The purpose of this paper is to raise questions about the social issues involved in mental and physical health. It highlights how, even where social issues are evident, clinicians and clinical researchers often focus mainly on individual people and what has gone wrong with them. This has the effect of making it less likely that social exclusion and adversity will be taken into account or that clinicians will help to change these. Design/methodology/approach: Three journal papers are summarised. The first one reports an attempt to test whether depression is a result of people feeling defeated and trapped. The second paper reports the results of analysing medical writing about domestic abuse. The third paper discusses the need for trainee clinicians to be made more aware of social conditions that affect people's lives. Findings: It does appear that people who feel defeated and trapped are more likely to become depressed. However, the life circumstances that lead to feeling trapped need more attention. Medical writing about domestic abuse may need to incorporate the broader context so that it is not just seen as a “women's problem”. It may be worth training clinicians about social conditions and how they might help to change them. Originality/value: These papers highlight important links between social exclusion and mental and physical health. There is a key role for clinicians and clinical researchers to be more part of the solution where they sometimes unwittingly help maintain the problems. (Publisher abstract)

Journal article

Mental health recovery is social

Author:
HOLTTUM Sue
Journal article citation:
Mental Health and Social Inclusion, 18(3), 2014, pp.110-115.
Publisher:
Emerald

Purpose: The purpose of this paper is to summarise two 2014 research papers that highlight the role of social interactions and the social world in recovery in the context of mental distress. Design/methodology/approach: The author summarise two papers: one is about two theories from social psychology that help us understand social identity – our sense of who we are. The other brings together and looks at the similarities and differences between ten different therapies that can be called resource-oriented – that is, they focus on people's strengths and resources rather than what is wrong with them. Findings: The paper on social identity gives a convincing case for incorporating teaching about social identity – and the social groups to which people belong – into the training of mental health professionals. The paper on resource-oriented therapies suggests that social relationships are a main component of all ten therapies examined. This second paper suggested a need for more research and theory relating to resource-oriented therapies. Social identity theory could help address this issue. Mental health services may be able to help people more by focusing on their established and desired social identities and group-belonging, and their strengths, than is usual. Originality/value: These two papers seem timely given the growing recognition of the role of social factors in the development and maintenance of mental distress. More attention to social factors in recovery could help make it more self-sustaining. (Publisher abstract)

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