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Towards a Socioecological Framework to Support Mental Health Caregivers: Implications for Social Work Practice and Education
Abstract
In 2012, eight million Canadians provided care to family member or friends with a long-term mental or physical health condition. In the context of mental health, the largest groups of care-recipients are children and spouses due to mental illness such as mood, anxiety, personality or psychotic disorders. Although the social work practice literature emphasizes ecological interventions in mental health, little research has been done on social workers’ role in supporting family caregivers. Using a socioecological framework, the present theoretical article proposes multi-levelled social work interventions to support family caregivers in the context of mental health. Four levels of interventions will be highlighted: attachment and strengths-based approaches (micro system), community based interventions (meso system), national policies in the context of mental health caregiving in Canada (exo system), and lastly the role of ideologies in shaping attitudes towards family caregivers (macro system).
... Social workers in psychiatric hospitals in Israel can play an important role in supporting the hospitalized person and his/her family member. The traditional interest of social workers and their knowledge in the person, family, and environment, makes them ideal for responding to the needs of the hospitalized person with SMI and his/her family members' complex needs (Ahmed, Sheryl, & Tomas, 2018;Aviram, 2002). The social work profession in Israel has been influenced primarily by developments in American social work (Gal & Weiss, 2000). ...
... The rationale behind the choice of these two disorders is that they are some of the most studied disorders in mental health literacy research (e.g., Adu et al., 2021;Nersessova et al., 2019), and they are likely universal, having been documented in most populations around the world (Thapa et al., 2014). These disorders are found to make a significant contribution to the world's economic burden, caregiver demands, and disability (Ahmed et al., 2018;WHO, 2001). Also, both disorders are found to be associated with stigma (e.g., see Adu et al., 2021;Nersessova et al., 2019;Upthegrove et al., 2017). ...
Research on the beliefs and attitudes regarding specific mental disorders in Ghana is limited. A vignette study was conducted to examine the relationship between causal attributions, help-seeking, and stigma towards depression and schizophrenia using lay Ghanaians (N = 410). This adapted questionnaire presented two unlabelled vignettes about a hypothetical person with the above disorders for participants to provide their impressions. Next, participants answered questions on beliefs and attitudes regarding this person. The results showed that causal beliefs about mental disorders related to different treatment options, and stigma. Contrary to previous literature, religious belief did not negatively associate with professional help-seeking for the mental disorders. In conclusion, results suggest that integration of “idioms of distress' into mental health assessment and interventions may benefit Ghanaians. Our findings have implications for mental health literacy and anti-stigma campaigns in Ghana and other developing countries in the region.
... Social workers' traditional interest in and knowledge of person, family and environment makes them ideal for responding to the complex needs and quest for assistance of family members (Aviram, 2002). Ahmed et al. (2018) also note that theories implemented by social workers such as the eco-systemic theory could be useful to capture the complexity of the experience of family members of persons with SMI. Therefore, they are well situated to assess and respond to the multiple levels of barriers; the personal, the familial, and socio-cultural, that family members of persons with SMI may experience in their pathways to receive supportive and preventative services for themselves. ...
Research aimed at understanding the barriers that family members of persons with mental illness may encounter in seeking supportive and preventative services from social workers during the hospitalization of their family member is scarce. Therefore, a cross-sectional survey study was implemented among 120 family members of persons with mental illness in family-centered services in two psychiatric hospitals in Israel. The research instrument included structured questionnaires and open-ended questions examining the barriers to seek help and the experience of families caring for a person with mental illness. The findings indicate that having a person with mental illness in the family may have significant implications on the barriers experienced by family members to seek help for themselves. The extent of the barriers could be related to factors such as the stigma they may experience, overwhelming reactions, lack of knowledge about the mental illness and about the availability of services for families, and dilemmas about seeking help. Social workers are in a key position in psychiatric hospitals to identify and reduce the individual as well as the contextual barriers. To increase family members’ readiness to seek help and their access to early intervention, they should adopt a family-centered approach.
... Celui-ci stipule que les facteurs de risque psychosociaux ont une influence sur les stresseurs vécus par la famille et seraient atténués par ses ressources. Plus précisément, ce modèle écologique (Ahmed et al., 2018) soutient que le développement de certains comportements à risque, tels que la consommation de substance, serait influencé par le contexte environnemental (communauté, école, entourage, famille) qui lui-même évolue à travers les années. Mais en contrepartie, que le renforcement des liens familiaux, la cohésion, la communication et la supervision parentale et les valeurs familiales positives, de même que l'accès et l'utilisation des ressources de la communauté (Riesch et al., 2012) constituent des facteurs de protection essentiels. ...
Cet article présente les résultats d’une recherche dont l’objectif était de faire l’évaluation des retombées du Programme de Renforcement des Familles (PRF), implanté en 2011 dans deux quartiers défavorisés de la ville de Trois-Rivières. Cette recherche s’intéressait à savoir si l’expérience du PRF a permis aux familles y ayant participé de créer des liens entre elles et, plus globalement avec leur communauté. Les résultats découlant d’entretiens réalisés auprès de 20 parents et de 12 membres de la communauté donnent à réfléchir sur le pouvoir d’agir de ces familles de même que sur celui des intervenants qui les accompagnent.
... This preference may have to do with the universality of these two disorders, found in various cultural settings around the world (Heine, 2015). Both disorders are also highly researched and contribute significantly to disability, caregiver and economic burden and have been associated with stigma in various settings (e.g., see Ahmed, Bruce, & Jurcik, 2018;Nersessova, Jurcik, & Hulsey, 2019;Chong et al., 2016). Previous studies found that differences exist between disorders when it comes to their recognition, with correct identification rates for depression tending to be higher compared to schizophrenia in public surveys. ...
Research on Mental Health Literacy (MHL) has been growing internationally. However, the beliefs and knowledge of Ghanaians about specific mental disorders have yet to be explored. This vignette study was conducted to explore the relationships between religiosity, education, stigmatization and MHL among Ghanaians using a sample of laypeople (N = 409). The adapted questionnaire presented two vignettes (depression and schizophrenia) about a hypothetical person. The results revealed that more participants were able to recognize depression (47.4%) than schizophrenia (15.9%). Religiosity was not significantly associated with recognition of mental disorders but was positively associated with both social and personal stigma for depression, and negatively associated with personal and perceived stigma for schizophrenia. Moreover, education was found to be positively associated with disorder recognition, and negatively with perceived stigma. Finally, perceived stigma was positively associated with disorder recognition, whereas personal stigma for schizophrenia related negatively to recognition of mental disorders. In conclusion, education but not religiosity predicted identification accuracy, but both predictors were associated with various forms of stigma. Findings from this study have implications for MHL and anti-stigma campaigns in Ghana and other developing countries in the region.
... A tiered approach to mental health support that recognises the individual, the community and the wider societal systems and structures has been identified by several commentators. This type of model is also reflected in 'socioecological' frameworks and interventions that look at the macro, meso and micro level determinants of mental health (Ahmed et al., 2018, Wilson et al., 2015. ...
EXECUTIVE SUMMARY
Background
The purpose of this study was to assess a proof of concept around a novel way of meeting mental health service needs in a small rural town using existing workforce resources. Our underlying assumptions were:
• That rural towns have a disproportionally high burden of mental health needs, but are less able to access appropriate supports
• That traditional models of care tend to emphasise individual approaches to meeting those needs, rather than looking at the community and their needs as a whole
• That there are assets available within rural towns that can contribute to meeting the needs of those communities if they are appropriately identified and mobilised
• If community mental health needs (demand) can be appropriately identified and concomitantly, the available workforce assets (supply) can be discovered, then it may be possible to better meet the needs of small rural towns by deploying existing competencies, rather than using traditional workforce models that rely on employing a “whole professional” who, if available, may only meet a component of the community needs.
For the purpose of this study, “workforce” includes any person involved in the delivery of mental health support, including clinical, non-clinical, paid and unpaid workers, including carers and peer support workers.
The aim of the study was to develop a new model for providing mental health supports in small rural towns that aligns the mental health needs identified by the town with the available competency assets that provide mental health supports in that town.
Una comunità educante distribuisce il proprio ruolo educativo tra tutti quei soggetti che collaborano per promuovere un ambiente di apprendimento equo e inclusivo. La scuola rappresenta la principale agenzia di formazione, ma per i ragazzi ospedalizzati la vita scolastica può deviare dalle esperienze dei pari. La scuola in ospedale, quindi, si apre a un insieme di figure professionali che collaborano per fornire un’esperienza educativa personalizzata. Con il presente contributo si intende offrire una riflessione sistematica degli aspetti che fanno della scuola in ospedale una comunità educante, evidenziando come l’istruzione faccia parte del complesso processo di cura e auspicando politiche e percorsi formativi specialistici che possano realmente rispondere ai bisogni dei discenti.
In Türkiye, care for children with disabilities is performed predominantly by mothers, but they lack support from social services and close family, which exacerbates their challenges. This study examines social participation, social relations and perceptions of social support of mothers of children with developmental disabilities (MCDDs) from a social work perspective. A qualitative research method was used to understand MCDDs’ needs. The research population consisted of ten mothers living in Beyoğlu, a district of Istanbul. The data were obtained through semistructured, face-to-face, in-depth interviews. The themes were determined and explored using descriptive analysis. The study revealed that MCDDs bear the responsibility for their children's care with limited support from close family members. As a result, MCDDs face severe social isolation and mental health issues and have uncertain futures due to the inability to work or attend school. Moving forward, the situation of MCDDs requires intervention at the micro-, mezzo- and macrolevels to improve the overall well-being of mothers. The social work profession should intervene and assist mothers in accessing needed programmes and services.
Unpaid carers were profoundly impacted by the coronavirus disease 2019 pandemic and public health responses. In the UK, in March 2020, people identified as clinically extremely vulnerable and their household members were advised to “shield” for an initial 12-week period, which meant minimizing all contacts from outside the household and not leaving the house at all, unless in an emergency. In a modified form, shielding guidance remained in place until August 2020 and was reinstituted from December 2020 until April 1, 2021. This article, reporting on qualitative interviews with 47 unpaid carers in Wales, thematically analyzed using a coding framework, explores the experiences of unpaid carers affected by this shielding guidance and their wider implications for social work with unpaid carers in the future.
Findings
Participants in our study described ways in which their caring role expanded, due to the need to provide additional practical and emotional support for loved ones who were shielding, and who lost access to other avenues of support. Some also described their caring role as becoming more involved and complex due to the declining health or self-care capacity of the person cared-for as a direct consequence of shielding restrictions. Alongside the increase in their caring responsibilities, carers reported losing access to important avenues of support for their own well-being.
Applications
We draw on ecological systems theory to highlight the importance during care planning and management of exploring the carer's mesosystem to identify and optimize sustaining forces, and of attending to the microsystem involving the carer and person cared-for.
Family caregiving is a public health issue because of caregivers’ significant contribution to the health and social care systems, as well as the substantial impact that giving and receiving care has on the health and quality of life of care receivers and caregivers. While there have been many studies that associate caregivers’ care work, financial difficulty, navigation, and other caregiving factors with family caregivers’ psychological distress, we were interested not only in the factors related to family caregiver anxiety but also in hypothesizing how those effects occur. In this study, we used Andrew Hayes’ PROCESS moderation analysis to explore the link between caregiver frailty, weekly care hours, and perceptions of financial difficulty, social support, and anxiety. In this analysis, we included 474 caregivers with relatively complete data on all of the variables. In regression analysis after controlling for gender and age, social loneliness (β = 0.245), frailty (β = 0.199), financial difficulty (β = 0.196), care time (β = 0.143), and navigation confidence (β = 0.131) were all significant. We then used PROCESS Model 6 to determine the significance of the direct, indirect, and total effects through the serial mediation model. The model pathway from frailty to care time to financial difficulty to social loneliness to anxiety was significant. The proportions of family caregivers who were moderately frail, anxious, and experiencing social loneliness after eighteen months of the COVID-19 pandemic found in this survey should be of concern to policymakers and healthcare providers.
Caring for members who are chronically ill is an expected but stressful component of family life. Family caregivers play a vital but largely invisible role in patient care, both in terms of their individual efforts and as members of the labor force (Jacobs, The emotional survival guide for caregivers—Looking after yourself and your family while helping an aging parent, 2006; Levine, The loneliness of the long-term caregiver, 1999). Levine (Always on call: When illness turns families into caregivers, 2004) reports that over 27 million Americans now provide vital long-term home health care for relatives and loved ones—everything from dispensing medication and operating medical equipment, to assisting with physical therapy and personal hygiene, to making sure the bills are paid. They receive no pay for this work, little training, and little respect or support from the health care system. While illness can result in increased intimacy, family members commonly face health risks, financial burdens, emotional strain, mental health problems, workplace issues, retirement insecurity, and lost opportunities (Feinberg et al., Family caregiver support services: Sustaining unpaid family and friends in a time of public fiscal constraint, 2005). Treating chronic illness is a natural and central component of primary health care, focusing on the full spectrum of life stage issues from infancy through death. Thus, it is the ideal venue for addressing how chronic health conditions affect the entire family.
How does caregiving affect health and well-being and what resources help caregivers? This book provides a synthesis of psychological research on caregiver stress and brings attention to the personal, social and structural factors that affect caregivers' well-being and as well as recent behavioral interventions to enhance health. © Tracey A. Revenson, Konstadina Griva, Aleksandra Luszczynska, Val Morrison, Efharis Panagopoulou, Noa Vilchinsky and Mariët Hagedoorn 2016.
This article explores the possibility that romantic love is an attachment process--a biosocial process by which affectional bonds are formed between adult lovers, just as affectional bonds are formed earlier in life between human infants and their parents. Key components of attachment theory, developed by Bowlby, Ainsworth, and others to explain the development of affectional bonds in infancy, were translated into terms appropriate to adult romantic love. The translation centered on the three major styles of attachment in infancy--secure, avoidant, and anxious/ambivalent--and on the notion that continuity of relationship style is due in part to mental models (Bowlby's "inner working models") of self and social life. These models, and hence a person's attachment style, are seen as determined in part by childhood relationships with parents. Two questionnaire studies indicated that relative prevalence of the three attachment styles is roughly the same in adulthood as in infancy, the three kinds of adults differ predictably in the way they experience romantic love, and attachment style is related in theoretically meaningful ways to mental models of self and social relationships and to relationship experiences with parents. Implications for theories of romantic love are discussed, as are measurement problems and other issues related to future tests of the attachment perspective.
This book explores strengths approaches in working with families who face multiple challenges including living in impoverished material conditions.
Caring for the ill, disabled, very old, or very young requires a labor-intensive commitment that is not only essential to the well-being of individuals and to society as a whole, but also fraught with physical, financial, and psychological risks. And despite the critical nature of their job, caregivers rarely have avenues of support.
The Challenges of Mental Health Caregiving addresses the complexities of the situation with uncommon depth and breadth. Suited to researchers, scientist-practitioners and clinicians, and students seeking a rounded understanding of the field, it examines how caregiving affects the lives, work, and mental health of family and professional caregivers. Chapters explore developmental, cultural, and spiritual contexts of care, addressing ongoing concerns about care in relation to larger health systems and emphasizing the need for care to be viewed as a community, rather than an individual or family experience. Further, the book's conclusion strongly advocates for more effective and efficient uses for available funds and resources while offering workable proposals for service improvements at the policy level.
Key areas of coverage:
• The impact of caregiving on physical and mental health.
• Integrating mental health and primary care.
• The promotion of positive mental health outcomes in children and youth.
• Mid-life concerns and caregiver experience.
• Loss, grief, bereavement and the implications for mental health caregiving.
• Policy issues in caregiving and mental health.
The Challenges of Mental Health Caregiving is a clear-sighted reference for researchers, clinicians and scientist-practitioners, and graduate students in the caregiving fields, including clinical psychology, social work, public health/medicine, geriatrics/gerontology, public policy, and educational policy.
How does caregiving affect health and well-being and what resources help caregivers? This book provides a synthesis of psychological research on caregiver stress and brings attention to the personal, social and structural factors that affect caregivers' well-being and as well as recent behavioral interventions to enhance health.
Background:
Family intervention for psychotic disorders is an integral part of psychiatric treatment with positive effects on patients' mental state and relapse rate. However, the effect of such family-based intervention on caregivers' psychological distress and well-being, especially in non-Western countries, has received comparatively much less attention.
Objectives:
To test the effects of guided problem-solving-based manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis over a 6-month period of follow-up, when compared with those in usual family support service.
Design:
A single-centre randomised controlled trial, which was registered at ClinicalTrials.gov (NCT02391649), with a repeated-measures, two-arm (parallel-group) design.
Settings:
One main psychiatric outpatient clinic in the New Territories of Hong Kong.
Participants:
A random sample of 116 family caregiverss of adult outpatients with recent-onset psychosis.
Methods:
Following pre-test measurement, caregivers were assigned randomly to one of two study groups: a 5-month self-help, problem-solving-based manual-guided self-learning (or bibliotherapy) programme (in addition to usual care), or usual family support service only. Varieties of patient and caregiver health outcomes were assessed and compared at baseline and at 1-week and 6-month post-intervention.
Results:
One hundred and eleven (96%) caregivers completed the 6-month follow-up (two post-tests); 55 of them (95%) completed ≥4 modules and attended ≥2 review sessions (i.e., 75% of the intervention). The family participants' mean age was about 38 years and over 64% of them were female and patient's parent or spouse. Multivariate analyses of variance indicated that the manual-guided self-learning group reported significantly greater improvements than the usual care group in family burden [F(1,110)=6.21, p=0.006] and caregiving experience [F(1,110)=6.88, p=0.0004], and patients' psychotic symptoms [F(1,110)=6.25, p=0.0003], functioning [F(1,110)=7.01, p=0.0005] and number of hospitalisations [F(1,110)=5.71, p=0.005] over 6-month follow-up.
Conclusions:
Problem-solving-based, manual-guided self-learning programme for family caregivers of adults with recent-onset psychosis can be an effective self-help programme and provide medium-term benefits to patients' and caregivers' mental health and duration of patients' re-hospitalisations.
Family caregivers
have played a significant role in our society since the beginning of time. Each year, the demand for caregiving affects millions of American families from all socioeconomic, ethnic, and educational backgrounds
. Today, family caregivers play an essential role in our system of care by providing a significant proportion of our health and long-term care for the chronically ill, disabled, and aging
. Feinberg et al. (Valuing the invaluable: 2011 update—the growing contributions and costs of family caregiving, http:// assets. aarp. org/ rgcenter/ ppi/ ltc/ i51-caregiving. pdf, 2011) estimated that the economic value of services provided by family caregivers was US$ 450 billion in 2009.
As Former First Lady Rosalynn Carter suggests, caregiving
is a universal proposition that almost every human will face at some point in their lifetime (Carter and Golant, Helping someone with mental illness: a compassionate guide for family, friends, and caregivers. Three Rivers, New York, 1999; Carter et al., Within our reach: ending the mental health crisis. Rodale, New York, 2010). While caregiving—providing care for an individual with special needs or illnesses—is most often a selfless act of love, the process involves deep personal commitment to situations with great variety, and for some, it also demands incredible personal sacrifice.