Final Flashcards
1
Q
Who promoted the concept of recovery
A
consumer/survivor movement
2
Q
MHCC task
A
develop first MH strategy for Canada
3
Q
Example of person who wrote a book on personal experience with recovery
A
Pat Deegan
4
Q
What kind of movement is recovery (Direction)
A
Bottom-up
5
Q
Key themes of recovery
A
- Not the same as symptom remission
- It’s a process not an outcome
- recovery ‘in’ MI not ‘from’
- as a series of short steps
- it involves normative social roles and routines
- emphasis on employment housing, social relationships and community integration (ROUTINE)
- this model involves choice, empowerment and agency in the health system
- stigma as a massive barrier to recovery
6
Q
(recovery) Model that offers less agency is
A
paternalistic
7
Q
Collaborative care (recovery)
A
when the model is more collaborative, shared decision-making, reaching a consensus
8
Q
End goal in recovery?
A
Different definitions
but generally it’s seen as an ongoing process, you never stop
9
Q
Recovery stand in contrast to notions of
A
Chronicity Stabilization Paternalism Continuing care Segregation
10
Q
Chronicity (recovery)
A
belief that certain illnesses will never improve
11
Q
Stabilization (recovery)
A
focus on reducing symptoms
Goal - just to stop being from being a threat to themselves or others
12
Q
Continuing care (recovery)
A
CC unit people would visit you to make sure you were stabilized (chronicity idea)
13
Q
Segregation (recovery)
A
People with severe MI separated "sheltered workshops" Segregation for 1. Refuge - need refuge from society 2. containment - to stop them from being a threat to society
14
Q
Stats about recovery/stigma
A
80% unemployment among people with severe MI
20-50% homeless people have a MI
High hate crime rate
Most budget for MI doesn’t go to recovery (containment …)
15
Q
Clinician’s role? (recovery)
A
foster recovery
16
Q
What do clinicians need? (recovery)
A
Retraining- adopt respectful + hopeful attitudes
support choice
encourage autonomy
fight stigma around patient’s irrationality and decisional capacity
17
Q
Recovery oriented interventions
A
- Supported employment (specialists help make action plan)
- Supported housing
- Illness self-management course (u come up with ur own strategy)
- Psychiatric advance directive (like a will for when you have episodes)
- Peer support
- recovery centres (learn skills)
- Shared decision making as 2 experts (medical + physical/personal)
18
Q
Stigma etymology
A
Ancient greek word “mark” or “brand”
19
Q
According to goffman stigma is perpetuated by
A
fear, myth, misconception and prejudice
20
Q
2 types of stigma
A
External
Internal
21
Q
External stigma
A
held by the rest of society to subgroup
becomes problem if held by people of power
Manifests itself in unemployment rate
22
Q
Internal stigma
A
when you internalise stigma and start to question yourself
23
Q
External stigma manifests itself in
A
Housing (high rate of homelessness)
Education (high drop-out rate, low investment in facilitating needs)
Dating and relationships
Criminal and justice issues (3 strikes you’re out policy, pb for untreated schizophrenia –> “revolving doors”)
24
Q
in stigma -“revolving doors”
A
Police just arrest and then kick them out after a few days
25
what happens psychologically through internal stigma?
Self isolation
Self esteem and confidence drops
shame, guilt, self doubt
26
Result of internal stigma?
Embarrassed to utilize health services
Substance abuse - "self medication" to fill social/existential vacuum
Suicide and suicidality (thinking or attempting)
27
Change in stigma over time
Studies have shown no change
People think more and more that MI is chronic and biological
(BBB model)
28
Bottom-up ways to reduce stigma
Confrontation
Boycott
Media-Monitoring
Public rallies (more of emotional catharsis though)
29
Top down ways to reduce stigma
PSA (only short term tho, discouraged)
Legislation, courts, policy (prevent discrimination, MHCC)
Contact-based workshops (MOST EFFECTIVE)
30
Contact based workshops (stigma)
- Someone with MI will go to a target group of people and make a speech
- Collabo with an expert
- Have long term effect
31
Best way to reduce stigma? (combo)
Legislation (by making things illegal), complemented by targeted contact- based workshops
32
Ödegaard (immigration)
compared MH - people in noarway with norwegian immigrants with native minnesotans
33
Competing theories about the high rates of MI among immigrants
```
Social drift (people who emigrate because they're having problems)
Social causation (new country causes problems: racism, language barrier--> stress)
Misdiagnosis or social control (stigmatization of immigrants, seen as threats)
```
34
3 phases of immigrant mental health
Pre-migration
Migration journey
Post-migration
35
Pre migration
odegaard attributes elevated risks to this
| Many ppl came from war-struck countries, persecution, natural disasters --> risk factors for PTSD
36
Migration journey
Terrible journey affected mH
Vietnamese boat people
refugee camps - waiting for relocation (high rate of violence and sexual assault)
37
Post-migration
unemployment, underemployment, discrimination, language barriers
38
Ethnic density study
Faris and Dunham in the 1930s
Low ethnic density : higher racism, micro aggression
Higher ethnic density: more social support, more networks
culturally relevant community centres
places of worship --> all G for MH
39
Immigrant study - Cautor- Graae and Jelten
schizophrenia in immigrants 3:1
higher risk among 2nd gen
Adapting to new environment is hard (especially if it's not a great as you expected)
Use of cannabis - predictor for psychosis (controversial though)
cultural differences interpreted as psychosis- delusions (ex. religious references, talking close to face)
40
Why higher risk of MI in 2nd gen than first gen?
If you're first gen: more embedded in your own culture, but 2nd gen - foot in both camps, different norms and values (double bind)
first gen can engage in escapism not second gen
But also can have birth complications if pregnant during immigration
41
Healthy migrant effect?
- selection process chooses healthier people
- better networks among immigrants
- rely more on alternative mental health services (traditional, religious healing and spirituality)
42
Statistics about boys and education
40% of undergraduate degrees
77% of dropouts
Lower performance scores
43
Suicide in men
second leading cause of death (15-34)
44
Why is men's MH so bad?
```
Technology replacing them
Women more suited to economy
Demasculanization of schools
Devaluation of men
Internet porn (addiction + loss of drive)
Negative rep of young men in media
Less likely to get help
```
45
Contributing factors to men's MH
Men's behaviour
Limitations within healthcare system
Harmful social norms/political ideologies
46
Men's health behaviour
- downplay and avoid illness
- cowboy complex
- stigma: contradiction with masculine ideals
- Men's coping : self medication + isolation
47
Cowboy complex
- Idea of stoicism, self-reliance
| - Not appropriate to seek help (esp. For non-physical issues)
48
Limitations within healthcare system (men's)
Lack of MH programs for men
Limit of diagnostically tools
Male unfriendly places - hostile healthcare workers --> barriers to care
Lack of research on men's MH (gender bias)
49
Limit of diagnostical tools for men's MH
M and W have v different expression of emotional trouble
tool's pick up women's depression but not men's
Men's symptoms are miscategorised (alcoholism, personality disorder)
50
Media analysis - chivalry hypothesis
Media reflects social paradigms of gender
Women treated in chivalrous way (lighter sentences, etc)
Men with MI portrayed as villains and women with MI portrayed as victims
51
Men's double bind
Because they're advantaged in society - don't deserve help on the micro level
7% of men get custody of their children
52
Response to terrible MHS for men
Men's sheds (australia)- normalcy, integration, contribution, sense of purpose
Movember
Online support groups (sometimes are misogynistic)
53
Consequences to not addressing men's MH
```
Drain on health care system
Higher suicide rates
Higher drug/alcohol abuse
Weaker families and communities
Weaker societies
```
54
Kind of support given by peer support
emotional, social and practical
55
Why peer support (+who)
consumer survivor movement
Formed because of dissatisfaction with formality and distance
Experiential knowledge - know how to navigate complex system
56
what do PS do
support and guide - don't suggest
57
How is spirituality defined
person's relationship to the transcendent
| more of a personal activity
58
How is religiosity defined
The way that a person might be religious
| Devotion, holiness, piousness
59
What kind of factor if religiosity
a protective factor for onset of mental illness or disorder
60
Religious variables and mental health
Positive correlation with well-being
| Negative correlation with rates of alcohol/ substance abuse, delinquency and crime, depression and suicide, anxiety
61
Religious clinical interventions
Respecting and supporting spiritual beliefs
Challenging beliefs --> by bringing in spiritual expert
Praying with patients
Consultation with clergy
62
How does religiosity help with MI?
it provides meaning/structure
sense of belonging
explains hard things (ex. death)
63
Different definitions of homelessness
```
Narrow definition = strict
Sheltered homeless
Hidden homeless (in rural areas, cars or outhouses)
```
64
Risk factors for depression and MI (housing unit)
homelessness, housing instability, low quality
65
Interventions to solve homelessness among people with MI
shelters (short term)
transitional housing
congregate housing (short term)
(BEST) housing first (str8 from street to independent appt)
66
Luhrmann institutional circuit
--> streets --> homeless shelter --> prison --> mental hospital --> streets....
67
gender and racial inequalities in homelessness
Aboriginal people = 30 of the homeless
75% homeless people are men
1 shelter just for men vs 600 for women (bc of lobby groups, chivalry hypo..)
68
risk factors for MI in urban setting
Fear of crime/ actual crime
Lack of social support/social capital
Cost of living/ quality of life
Racism
69
National media and MI study stats
40% of articles talk about MI in terms of crime and violence
only 15% talk about recovery
70
Most effective way to reduce stigma in journalism
Contact-based educational workshops at journalism schools
Evidence-based guidelines for reporting into brochures
Online training
71
Gendered representations of MI in the media
Articles about men are more likely to be more stigmatizing
| Articles about women: quote experts, recovery, intervention + resources
72
Definition of suicidal planning
thinking about doing it
73
Definition of suicidal ideation
thinking about killing yourself
74
Definition of deliberate self harm
act of intentionally trying to harm yourself
75
Suicide stats in canada
```
4000 a year
Underestimation though
(stigma, insurance...)
75% men
Higher risk in homosexuals
Lower risk in immigrants/minorities
```
76
Slow motion suicide
Addictions
Continuous risky behaviour (sex, eating, driving..)
Personal neglect
Deliberate self harm
77
Rate of women attempting suicide
3:1
| interpreted more as a cry for help
78
How to reduce suicide rates?
national anti suicide strategies
| phone lines, anti suicde professional come into schools, reserved hospital beds
79
Predictors of suicide/self harm
```
Childhood experience
Mental health issues
Life transitions and consequences
Adult employment issues
Aboriginal people
Men
```
80
Childhood experience (as predictor S/SH)
```
Physical/sexual abuse
Separation from father
Pbs in school/delinquency
School drop out
Bullying
Childhood MD
Residential schools
```
81
Mental health issues (as predictor S/SH)
Depression
Substance abuse
Not utilizing services
82
Life transitions and consequences (as predictor S/SH)
```
Divorce/break up
Unemployment
Chronic illness and sick-leave
Retirement
Bereavement
```
83
Adult employment issues (as predictor S/SH)
Stress in workplace
PTSD (esp. if in army)
Decline in job security, manufacturing jobs
--> feeling of defeat
84
Aboriginal people (as predictor S/SH)
```
Residential schools
poverty
racism
lack of hope
land issue
```
85
Men (as predictor S/SH)
double standard in legal system
Men misrepresented in the media
Fatherless communities
Campus culture
86
Solutions to Suicide/self harm
```
National strategy
Specified support for life transitions
More choice in MH services
Peer and other support in workplace
Better training of professionals
Work with media
Diminish hostility towards high-risk groups
```
87
Individualisation thesis
Society evolving must faster than it was before - harder to adapt.
People are lonelier
More freedom, more choice but less security
Change in 5 domains : religious, familial, economic, , demographic, culture, media
88
Individualization in Religion
Less and less present
Much less influential in policy making
Less social support
89
Individualization in Family
```
Smaller families
Less sibling if not any
Have children later - don't know your grandparents
More isolation
High rates of divorce
```
90
Individualization in Economy
Unions have more power
Less social clubs
More hours
91
Individualization in Demography
Aging population
Married later
Isolating
92
Individualization in Culture
Birth control
Recreational sex
Internet
Television
93
Criticism of Individualization
People are moving away from outdated forms of groups and forming new ones - more choice
94
Individualization thesis relates to
Epidemic of loneliness
Constant comparison with others
Self-monitoring
Insecurity and low self esteem (don't know if you're doing the right thing anymore bc you don't have religion to tell you what to do)
Dialectic between conformity and difference (drive to be difference and unique but not too different)
95
MI linked to Individualization
Suicide (social isolation and divorce)
PTSD (esp. after Vietnam war- people hated them)
Depression
Anxiety (take away social support, you're lost)
96
Individualization affects more
Women
| they desire a lot more social contact
97
Social roles and self identity in individualization
Much more fluid
| Individuals faced with infinite choice
98
Maslow on individualization
Solid foundation for 'authentic self'
99
Downside of individualization
Choice can paralyze you
Very taxing on the mind for the future to be unpredictable
Cognitive dissonance (see people with better lives on social media)
RD Laing - 'false self syndrome'(link to internal/external validation)
100
Kierkegaard quote on individualization
“every actual moment of despair is traceable to possibility”
101
Important elements referring to appearance and behaviour in individualization thesis
self-presentation and self-monitoring
102
Background info about the MHCC
Est in 2007
MH strategy for canada
Anti stigma campaign
Opening minds
103
4 target groups of opening minds
Health care providers
Youth
News and media
Workplace
104
Opening minds approach
Bottom up
Evidence-based (finding successful ones- identifying active ingredients)
Create toolkits
105
Program evaluation (opening minds)
Pre-test
Post test
Focus on 2 areas (stereotypes, social acceptance)
106
What learning needs to healthcare providers have in relation to stigma
Pessimism about recovery
Lack of skills/confidence
Lack of awareness of own prejudices
See the illness before the person
107
Importance of MHCC in workplace
Diagnoses for MI happens much later than PI
Costs money
Absenteeism
Presenteeism/lost productivity
Help people identify MI in their coworkers
108
Using colours for MH
Reduces stigma - no longer labels
| Emphasis possibility of back and forth on this continuum
109
Participatory action research (PAR)
Collaborative process
Constant contact
‘systematic investigation, with the collaboration of those affected by the issue being studied, for purposes of education and taking action or effecting social change’.
110
Photovoice
group of marginalized people
Group given disposable cameras
Take pictures of barriers, challenges, triumphs..
Targeted photo-exhibits --> invite key people --> raise awareness
111
Participatory video
Same as photovoice but with cameras
Group activity
Work with pre-existing disempowered groups
Fogo process
112
Fogo process
- Raise 'critical consciousness' through discussion groups
- Members trained in video-scripting, filming and editing
- Production of informative video about issues
- Videos disseminated to chosen audience
- Research of outcome
113
Sub categories of eating disorder
```
Disordered eating
Anorexia
Bulimia
Binge ED
EDNO (eating disorder not otherwise specified)
(obesity)
```
114
Types of ED
Binge - purge
Restricting
Binge
115
Stats for ED
ED occur in 30% of the female population
10% mortality rate (highest of all MI)
2/3 of clients in ED therapy have a negative outcome
116
Explanation
Body dissatisfaction for women has doubles since the 1970s
Society values a certain body type - reflected through media (undermines women)
40 billion dollar/year diet industry
Culture of narcissism aided by social media (external validation essential to happiness)
117
ED and gender
10:1 ratio
Gendered response to deep psychological suffering
(men is drinking)
ED as a result of self-silencing and suppression of anger
118
Internalized anger theory (ED)
Silencing opinions or frustrations to maintain close RS and social harmony
Expressing anger seen as unacceptable in women
119
ED as symbiotic
ED as signal you're sending out to the world
You feel marginalized
You feel this is the only way to express yourself
Cry for help
120
Environment (and predictors of ED)
Family history of dieting (family systems theory)
Parenting process especially perfectionist parents
Divorce
Powerlessness and inadequacy
Perfectionism and personal standards
121
Perfectionism in ED
Personal standards
Self-criticism (self-monitoring)
Control and lack of control (ED as a way of gaining control)
122
Other side of ED
Women who don't see it as an illness but as a lifestyle choice
Online communities
Social support or illness consolidation?
123
Freud and civilization
MI as a consequence of civilization
Bourgeois form of not expressing anger, sexuality
MI doesn't exist in colonial countries
124
MI and racism
Drapetomania
Eugenics - frontal lobe
"happy savage"
125
Psychiatry in the colonial period
"tropical medecine"
Centralized mental hospital operated by colonial authorities
Used to contain opponents of regime
Voyeurism
126
Psychiatry in the post colonial period
'international health'
Epidemiological transition
Focus on chronic diseases
International aid departments created around the world
Mental health still seen as a low priority
127
Problem with global mental health
Treatment gap
Systems in place often scarce and unsatisfactory
Alternative healing methods used
Often condescending
128
Reactions to the problems with GMH
Raising awareness
Creating broad alliance to take action
top down movement
129
Solutions to problems with GMH
Finding cost effective intervention to tackle treatment gap
Scale up interventions
Task shifting to LHW
130
Task shifting to LHW (GMH)
Lay Health workers
People with rudimentary training that have been mentored
Shifting tasks from clinicians to one of those workers
131
Critiques of GMH
DSM and western concepts of MI are cultural construct
Top-down imposition of alien western models
Ridicule and marginalization of indigenous knowledge and local ideologies of healing
Recovery rates better in developing countries (less labeling, less segregation)
Trojan horse for mass medicalization and big pharma
Need to focus on social determinants of health
Act of cultural imperialism/neo colonialism
132
Upstream factor in Aboriginal MH
cultural loss, impact of residential schools, colonisation, unemployment, poverty and racism
133
Downstream factor in aboriginal MH
sense of hopelessness; as well as inadequate health care
