Empowerment and the Transition to Housing for Homeless Mentally Ill People: An Anthropological Perspective

Often lacking in scholarly and policy-oriented discussions of homelessness are contextualized understandings of the problems faced, and the values held, by homeless mentally ill people. This article, using an anthropological perspective, examines issues that arise for homeless mentally ill individuals in making the transition from shelter living to permanent residences. The transition occurs as part of a housing initiative driven by the philosophy of consumer empowerment. Project participants are placed in independent apartments or evolving consumer households (ECH) — shared, staffed residences designed to transform themselves into consumer-directed living situations over time. The effects of an empowerment paradigm on the organization of space, the nature of social relations, and the management of economic resources in the ECHs are discussed to show that consumers and staff sometimes have contrasting views of what empowerment entails. It is suggested that anthropological research can help to illuminate the issues at stake in determining policy for homeless people with major mental illness

Empirically identified networks of healthcare providers for adults with mental illness

Background Policies target networks of providers who treat people with mental illnesses, but little is known about the empirical structures of these networks and related variation in patient care. The goal of this paper is to describe networks of providers who treat adults with mental illness in a multi-payer database based medical claims data in a U.S. state. Methods Provider networks were identified and characterized using paid inpatient, outpatient and pharmacy claims related to care for people with a mental health diagnosis from an all-payer claims dataset that covers both public and private payers. Results Three nested levels of network structures were identified: an overall network, which included 21% of providers (N = 8256) and 97% of patients (N = 476,802), five communities and 24 sub-communities. Sub-communities were characterized by size, provider composition, continuity-of-care (CoC), and network structure measures including mean number of connections per provider (degree) and average number of connections who were connected to each other (transitivity). Sub-community size was positively associated with number of connections (r = .37) and the proportion of psychiatrists (r = .41) and uncorrelated with network transitivity (r = −.02) and continuity of care (r = .00). Network transitivity was not associated with CoC after adjustment for provider type, number of patients, and average connection CoC (p = .85). Conclusions These exploratory analyses suggest that network analysis can provide information about the networks of providers that treat people with mental illness that is not captured in traditional measures and may be useful in designing, implementing, and studying interventions to improve systems of care. Though initial results are promising, additional empirical work is needed to develop network-based measures and tools for policymakers

An observational study of the impact of service use on suicidality among adults with mental disorders

Background: It is unclear whether treatment of mental disorders reduces the probability that a) people without suicidal ideation will begin to contemplate suicide, or b) people who have thought about killing themselves (but have not attempted suicide) will go on to make an attempt. Methods: Mental disorders, service use for emotional or substance use problems, and suicidality were assessed using the World Mental Health version of the Composite International Diagnostic Interview. Discrete-time survival analysis was used to establish the temporal priority of mental health service use and suicide-related outcomes among the 5,862 participants in the Collaborative Psychiatric Epidemiological Surveys who reported a mental disorder. Results: Use of specialty mental health services, but not other types of services for emotional or substance use problems, was associated with an increased risk of future suicide ideation (OR = 1.27, CI = 1.01–1.60). However, respondents with a history of suicidal ideation were less likely to report a subsequent suicide attempt if they had received any type of service for emotional or substance use problems (OR = 0.62, CI = 0.46–0.83), regardless of the type of service received (i.e., it did not matter whether the service received was mental health care, general medical care, or non-health care related). Conclusions: Among persons with frank DSM disorders and suicidal ideation, the receipt of treatment is associated with a lower rate of subsequent suicide attempts, compared with those who never received treatment, regardless of treatment provider type. Follow-up studies are a logical next step to our observational investigation

Support for the 21st-Century Reserve Force: Insights to Facilitate Successful Reintegration for Citizen Warriors and Their Families, Summary

Many studies have examined the impact of deployment on military families, but few have assessed either the challenges that guard and reserve families face following deployment or how they manage the reintegration phase of the deployment cycle. This report aims to facilitate the successful reintegration of guard and reserve personnel as they return to civilian life after deployment. Using surveys and interviews with guard and reserve families, along with interviews with resource providers, this report examines how these families fare after deployment, the challenges they confront during that time frame, and the strategies and resources they use to navigate the reintegration phase. Factors associated with reintegration success include the adequacy of communication between families and the service member's unit or Service and between service members and their families, initial readiness for deployment, family finances, and whether the service member returns with a psychological issue or physical injury. Successful reintegration from the families' perspective was related to measures of military readiness, such as the service members' plans to continue guard or reserve service. In addition, there is a wide-ranging and complex "web of support" available to assist families with reintegration, including U.S. Department of Defense (DoD) programs, state and local government agencies, private nonprofit and for-profit resource providers, faith-based organizations, and informal resources (such as family, friends, and social networks). Opportunities for collaboration among providers abound. DoD does not have to "do it all," but the report suggests steps it can take to ensure that reintegration proceeds as smoothly as possible

The Effect of Migration to the United States on Substance Use Disorders Among Returned Mexican Migrants and Families of Migrants

Objectives. We examined the association between substance use disorders and migration to the United States in a nationally representative sample of the Mexican population