Libro
Libro
Mental Health and Social Problems is a textbook for social work students and practitioners. It
explores the complicated relationship between mental conditions and societal issues as well as
examining risk and protective factors for the prevalence, course, adaptation to and recovery
from mental illness.
The introductory chapter presents biopsychosocial and life-modeled approaches to helping
individuals and families with mental illness. The book is divided into two parts. Part I addresses
specific social problems, such as poverty, oppression, racism, war, violence, and homelessness,
identifying the factors which contribute to vulnerabilities and risks for the development of
mental health problems, including the barriers to accessing quality services. Part II presents the
most current empirical findings and practice knowledge about prevalence, diagnosis, assess-
ment, and intervention options for a range of common mental health problems – including
personality conditions, eating conditions and affective conditions.
Focusing throughout upon mental health issues for children, adolescents, adults and older
adults, each chapter includes case studies and web resources. This practical book is ideal for
social work students who specialize in mental health.
Nina Rovinelli Heller teaches in the masters and doctoral programs, and is the Chair of the
Mental Health Substantive Area at the University of Connecticut, USA. She has provided
mental health services to individuals and families for thirty years in a range of practice settings.
She is the co-editor of Integrating Psychodynamic Theory with Cognitive Behavioral Techniques and has
published in the area of social work theory and clinical practice.
Alex Gitterman is Zachs Professor of Social Work and Director of the Doctoral Program at
the University of Connecticut School of Social Work. He has co-authored and co-edited a large
number of books including The Life Model of Social Work Practice, Encyclopedia of Social Work with
Groups and The Handbook of Social Work Practice with Vulnerable and Resilient Populations. He served as
the President and on the board of the Association for the Advancement of Social Work with
Groups, an international professional organization.
Mental Health
and Social Problems
A social work perspective
To purchase your own copy of this or any of Taylor & Francis or Routledge’s
collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.
All rights reserved. No part of this book may be reprinted or reproduced or utilized
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
Mental health and social problems : a social work perspective / edited by
Nina Rovinelli Heller and Alex Gitterman.
p. cm.
Includes bibliographical references.
1. Psychiatric social work. 2. Mental illness–Etiology. 3. Social problems.
I. Heller, Nina Rovinelli. II. Gitterman, Alex, 1938–
[DNLM: 1. Mental Disorders. 2. Mental Disorders--etiology. 3. Social Problems. 4.
Social Work, Psychiatric. WM 31 M5444 2011]
HV689.M46 2011
362.2'042–dc22
2010017265
List of contributors ix
Preface xi
Acknowledgements xvii
PART I
Social problems and mental health/illness 19
PART II
Mental health conditions 257
Index 502
Contributors
Mental Health and Social Problems: A social work perspective is written as a textbook and reference book
for social work students and practitioners. In serving as editors, we invited leading social work
experts to present the state of interdisciplinary knowledge and practice wisdom about the
complex bidirectional relationship between societal issues and mental health as well as about
numerous mental health conditions and related life stressors. We divided the book into two
parts. In Part I, we examine the societal, political and economic contexts of mental health
conditions. In Part II, we examine the most current empirical findings, practice knowledge and
wisdom about the major mental health conditions faced by our clients.
In Part I, our contributors examine the impact of oppression and stigma, poverty, racism,
war, homelessness, corrections, immigration, childhood maltreatment, intimate partner
violence, and community violence on our clients’ mental health. Our contributors follow a
common outline to organize their respective chapters. After introducing the contextual focus,
each author discusses the societal, political, economic definitions of the social issue and its effects
on mental health and mental illness. This discussion is followed by a review of the social
problem’s demographics, incidences and prevalence rates. The influences of race, gender, life
course, sexual orientation, and ability/disability are also examined. To provide a “human face”
to the empirical data, each author presents a practice illustration, and discusses relevant and
salient assessment and interventions themes that emerge from the illustration. The contri-
butions of social work and the importance of social work involvement are explicated. Chapters
conclude with boxed texts consisting of web resources.
In Chapter 2, Professors Watson and Eack examine the deleterious impact of oppression and
stigma on mental health. The authors begin with a discussion of the stigmatization process,
which consists of five interrelated components. The first component is labeling of human
differences, and attributing negative attributes to the differences. The next component is
separating “us” from “them” (healthy from mentally ill). The “them” become stigmatized and
the “us” become the stigmatizers. The stigmatized experience loss of social status, prejudice and
discrimination. Persons suffering from mental illness are stereotyped as “dangerous, unpre-
dictable, incompetent, irresponsible; at fault for their illness, and unlikely to recover.” These
negative stereotypes affect every dimension of the life of a person suffering from mental illness:
education, employment, housing, health and mental health care, and interpersonal rela-
tionships.
In Chapter 3, Professor Rank analyzes the effects of poverty on mental health. He begins by
describing the nature and scope of poverty in the United States. He estimates that approxi-
mately 60 million of people living in the United States live in or near poverty. At greatest risk of
being poor are people with less education, who are young or old, non-white, have a disability,
live in single parent families or reside in economically depressed inner cities or rural areas.
Professor Rank presents a large body of research that indicates a strong association between
xii Preface
poverty and diminished mental health. Subsequently, he raises the difficult and illusive ques-
tion: how does one determine the direction of causality between poverty and diminished mental
health? Research evidence, on the one hand, suggests that individuals with mental health
problems are more likely to drift downward into poverty. Concomitantly, research evidence, on
the other hand, suggests that the conditions associated with poverty decrease the quality of poor
people’s mental health. Professor Rank offers a trenchant observation: The direction of
causality might be related to the type of mental health condition itself. The severity of schizo-
phrenia, for example, may cause downward economic mobility that results in poverty. In
contrast, poverty might trigger anxiety and mood conditions.
In Chapter 4, Professor Miehls explores the insidious effects of repeated manifestations of
individual, institutional and structural and institutionalized racism on the mental health of
People of Color. Those suffering from mental illness are even more likely than other People of
Color to experience the devastating effects of racism, such as homelessness, unemployment,
incarceration, school failure, and restricted access to health and mental health services. The
concept of “microaggressions” is used to capture how the day-to-day experiences of being
marginalized impacts the mental health of People of Color.
Professor Harding, in Chapter 5, examines the destructive effects of war and the devastating
social and mental health consequences. Participating in or being exposed to military conflict
exacerbates existing mental health problems and creates new ones. Harding identifies the
changing face of war globally, the “new war” characterized by unconventional methods and
asymmetrical warfare and the significant impact that it has had on nations, communities and
individuals across the globe. He notes that there is a paucity of literature on the mental health
sequelae to people who are in the midst of armed conflicts; most research focuses upon those
displaced to refugee camps. Among U.S. veterans of recent wars, high levels of post-traumatic
stress disorder (PTSD), depression, substance abuse and other mental health problems linked to
exposure to combat have been found. The individual and family visible and invisible scars of
war are evident in rising suicide rates among active duty military personnel as well as veterans.
Professor Wise, in Chapter 6, examines the association between homelessness and mental
health conditions. The loss of one’s living place is often precipitated by chronic mental illness
and/or significant traumatic events such as loss of employment, natural or person initiated
disasters, escape from a domestic violence circumstance, or a combination of simultaneously
occurring life transitions and traumatic events. The author differentiates the chronically,
situationally and episodically homeless, and insightfully examines the bidirectional associations
among complicated conditions such as trauma, trauma responses to homelessness and mental
health conditions.
In Chapter 7, Professor Alexander cites a study that estimates that 56 percent of state
prisoners, 45 percent of federal prisoners, and 64 percent of jail detainees have mental health
problems. Similarly, data show high numbers of incarcerated juveniles with significant mental
health issues. Clearly, a certain percentage of adult and youth prisoners enter the correctional
system with mental health problems. Certainly, prison life exacerbates their mental health
conditions. The cumulative stress associated with confinement, violence, and lack of treatment
makes worse their original condition and creates new mental problems. It is important to note
that race is a critical factor in imprisonment. African American males are incarcerated at 6.6
times the rate for White males.
In Chapter 8, Professors Acevedo and González discuss the profound mental health conse-
quences of the dislocation of “place” that immigration involves. Historically, immigration is
associated with social problems, such as poverty, racial and ethnic conflict, and disenfranchise-
ment. The profession of social work plays a critical function with the social problems and the
personal, familial, and community instabilities and that are associated with immigration.
Preface xiii
In Chapter 9, Professor Knight explores the mental health effects of childhood victimization
and maltreatment. In many social work settings such as addictions, domestic violence and
mental health, the majority of clients have experienced some sort of victimization in childhood.
Childhood and adolescent victimization and maltreatment have serious and long-lasting
consequences, particularly if sexual victimization is involved. The consequences include: mental
conditions such as post-traumatic stress, depression, anxiety, dissociative identity, borderline
personality, and substance abuse.
Professor Carlson, in Chapter 10, identifies a broad range of mental health symptoms and
problems that have been identified as a consequence of physical, emotional, and sexual abuse,
including depression, PTSD, other forms of anxiety, and substance abuse. Intimate partner
violence consists of “physical violence, sexual abuse or assault, and emotional or psychological
abuse that is perpetrated by partners or acquaintances, including current or former spouses,
cohabiting partners, boyfriends or girlfriends, and dating partners.” The devastating conse-
quences of intimate partner violence is evident in the fact that more than half of abused women
meet the diagnostic criteria for at least one mental health condition.
Community violence occurs in various settings, such as neighborhoods, streets, schools,
other local institutions, stores, and playgrounds. In Chapter 11, Ms. Vorhies and Professors
Guterman and Haj-Yahia offer a profound insight: “witnessing community violence or simply
hearing about community violence occurring has been linked to just as serious negative mental
health outcomes as direct exposure through victimization or perpetration.” While youth aged
18 and younger represent approximately 25 percent of the U.S. population, they account for
approximately 50 percent of the witnesses and victims of violent acts. Annually, 75 percent of
African American and Latino youth are exposed to school violence and 50 percent to com-
munity violence. The authors explore the consequences of exposure to community violence.
In Part II, leading social work experts present the state of interdisciplinary knowledge and
wisdom about the myriad effects and challenges of a range of mental health conditions faced by
individuals and their families. The mental health conditions presented are the autism spectrum
conditions; executive function conditions and self-deficits; oppositional defiant and conduct
conditions; mood conditions; anxiety conditions; eating conditions; personality conditions;
psychotic conditions; substance abuse; and dementia and related problems in cognition and
memory. The relevant issues in helping people with mental health conditions are framed within
the context of biopsychosocial and life-modeled approaches, and life course framework. In Part
II, the authors also follow a common outline to organize their respective mental health
conditions and associated life challenges.
The authors begin by offering political and theoretical definitions and explanations of the
mental health condition and their effects on service providers and service users. An examination
of the demographics, incidence and prevalence rates of the mental health condition follow
the definitional analyses. Subsequently, the authors examine the developmental course and
respective challenges for generational cohorts posed by the mental health condition. The
assessment and diagnostic patterns and different access to mental health services according to
gender, race, ethnicity, life course, sexual orientation and ability/disability are also explored.
Next the authors discuss social work programs and services: their availability, evidence of
effectiveness, and the roles played by social workers. More specifically, the contributors describe
and illustrate responsive professional methods and interventions. The authors conclude with an
examination of social work contributions and the importance of social work involvement with
the identified population. Each chapter ends with boxed texts consisting of web resources.
In Chapter 12, Professors Walsh and Corcoran discuss the severe and persistent impair-
ments associated with the spectrum of autism. Several areas of development are reciprocally
affected, including social interaction, communication skills, and a stereotypical, repetitive range
xiv Preface
of ritualized behaviors. These children demonstrate a lack of awareness of the feelings of others,
a limited ability to imitate and express emotion, and to participate in social and symbolic play.
Approximately 60 to 70 percent of persons dealing with autism suffer from distinct neurological
abnormalities and various levels of mental retardation. The authors present creative assessment
tools and evidenced-based interventions.
Professor Palombo, in Chapter 13, discusses executive function conditions and self-deficits,
presents recent developments in the neurosciences and integrates them into social work
practice. Certain individuals suffer from a disorganization, which interferes with their ability to
successfully complete the tasks they undertake. Initiating steps to implement plans and manag-
ing time to organize resources to self-monitor and to self-regulate their actions creates complex
challenges. The author discusses and illustrates distinctive assessments and interventions, which
are responsive to clients with neuropsychological impairments.
In Chapter 14, Ms. Barczyk and Professor Springer focus on children who suffer from oppo-
sitional defiant and conduct conditions. These mental health conditions display similar char-
acteristics such as breaking of societal norms, disruptive behavior, and disobedient behavior.
This chapter provides an overview of these conditions, and examines the social worker’s role in
working with youth with these problems. Evidenced-based practices that have been utilized to
help these youth, including videotape modeling parent program, problem-solving skills train-
ing, parent management training, functional family therapy, and family behavior therapy are
presented and illustrated.
Professor Smith, in Chapter 15, discusses mood conditions, the leading cause of disability
among people aged 15–44. The author’s perspective is that the etiology of depression is
complex and multi-determined. It exists on a continuum, merging from factors within the
person (endogenous), as well as from the external environment (reactive). Psychological, social,
environmental, and biological factors reciprocally influence one another. Significant disparities
exist in terms of both accurate diagnosis and access to appropriate mental health services.
Professors Heller and Werkmeister Rozas, in Chapter 16, examine the full range of anxiety
conditions which cause great distress and impaired functioning in people across the life course.
They stress the importance of understanding the evolutionary history of adaptive anxiety as a
means of self-preservation while understanding the multiple biological, social and cultural
influences which exacerbate and mediate the experience of maladaptive anxiety. They pay
particular attention to the culture bound syndromes, typically overlooked, and overrepresented
among the anxiety conditions. The authors provide full discussion of the bidirectional rela-
tionship between the influences of race, ethnicity and culture with the differential mani-
festations and responses to anxiety. They stress the importance of cultural competency for social
workers in order to understand both the meanings and functions of anxiety symptoms to both
the client and their respective culture.
Dr. Bodenheimer and Professor Heller, in Chapter 17, discuss eating conditions, anorexia
nervosa, bulimia nervosa, binge eating disorder, and obesity related conditions. These perplex-
ing conditions in which physiological changes interact with social, cultural, and psychological
factors are both psychiatric and social problems, and increasingly, a public health problem.
Given the ample evidence that sociocultural influences are significant in the development of
eating conditions and that each generational cohort appears to be at greater risk, preventive
strategies are critical, social work plays a critical function with people with eating conditions.
In Chapter 18, Professor Northcut astutely describes the multiple factors that predispose,
influence, create, trigger and maintain consistently rigidly dysfunctional behavior associated
with personality conditions. The author cautions that people suffering from a personality
disorder tend to be difficult to engage in a helping relationship. The very nature of the diagnosis
requires the personality condition be of lengthy duration, pervasive in scope and rigidity of style,
Preface xv
which “interferes with seeking out and staying with any form of treatment.” The author
discusses and illustrates responsive approaches that pay equal attention to intra-psychic,
interpersonal and environmental forces.
In Chapter 19, Professor Lukens and Ms. Ogden present a comprehensive overview of
psychotic conditions, and promising, empirically based practices for persons diagnosed with the
most severe forms of psychosis. The authors examine the complex hurdles that the psychotic
conditions present for persons with illness, for their families and other informal caregivers, as
well as for mental health providers and policy makers. The roles for social workers in building,
implementing, and advocating for recovery-oriented programs are explicated and illustrated.
Professor Hanson, in Chapter 20, views substance abuse as a biopsychosocial condition in
which “personal lifestyle factors, physiological conditions, social structural arrangements and
cultural practices may contribute to the emergence and development of substance abuse.”
Clients with other mental health conditions are likely to experience difficulties associated with
the use of alcohol and other drugs. The author perceptively emphasizes that social work’s
ecosystem’s multidimensional person-environment perspective uniquely positions the profes-
sion to be responsive to the forces that trigger the development of substance abuse and help
persons suffering from its consequences.
The progression of dementia has a devastating impact on the individual, family and care-
givers. Over time, the person becomes an empty shell. A sense of hopelessness and helplessness
overwhelms as one observes this “disease dissolve the past memories, present lives, and future
dreams.” In Chapter 21, Professor Sanders and Ms. Osterhaus poignantly describe the impact
of dementia on the individual and caretakers, and the diverse roles social workers assume with
these clients and their significant social networks.
Our contributors present contemporary theoretical perspectives, empirical findings, and most
effective social work programs and practices. Historically, the social work profession has been
the primary social service provider to people (and their support networks) dealing with mental
health conditions. In the current social context, providing social work services has become
significantly more difficult to fulfill. For the stubborn truth is that problems have been
increasing, while resources to mitigate them decrease. In our opinion, the social work profes-
sion has made heroic efforts to provide quality social work services. Through descriptions of
responsive social programs and social work’s contributions to them and presentation and
discussion of practice illustrations, this book attempts to capture the profession’s resilience and
creativity.
Acknowledgements
We wish to express our appreciation to the authors for their outstanding contributions to this
book, each reflecting clarity of presentation and mastery of the material.
We are very grateful to our faculty and administrative colleagues and to the support staff for
making the University of Connecticut School of Social Work a special work environment. The
support of our colleagues, their commitment to teaching and service and to the development
and dissemination of knowledge, provide us with an exciting professional home.
Our masters and doctoral students remind us every day that to teach is to learn twice over.
They are our master teachers and we write with them in mind.
We acknowledge our respective spouses, children and grandchildren. They provide richness
and meaning in our lives.
Finally, we acknowledge each other. Editing this book has been a wonderful intellectual
journey. We have shared ideas, explored ideas and argued ideas. Through this process, we have
both grown and developed a special friendship.
Nina and Alex
1 Introduction to social problems
and mental health/illness
Nina Rovinelli Heller and Alex Gitterman
The social work profession has a dual mission: “to enhance human well being and help meet
the basic human needs of all people, with particular attention to the needs and empower-
ment of people who are vulnerable, oppressed, and living in poverty” (National Association of
Social Workers (NASW), 2008). Individuals who struggle with ongoing mental health issues
experience challenges in all spheres of functioning, on a daily basis. Daily life stressors and
struggles can generate cumulative and chronic stress. In accordance with our profession’s
mission, social work practitioners help clients to restore their optimal levels of overall func-
tioning in various domains. Because a wide range of social and personal conditions and
influences promote or mitigate mental health and illness, social workers must have a clear
appreciation of the power of these social and personal conditions and influences. Social work
practice theory emphasizes the importance of understanding the complex relationships between
people and their environments and this represents one of the distinguishing features of our
profession. One of the first ecologically based practice models, the Life Model of Social Work
Practice (Germain & Gitterman, 1980) provides a theoretical and practice framework for
understanding the transactional and bidirectional relationships between social and personal
problems and mental health and illness. The model rests upon several key concepts, including
the reciprocity of person-environment exchanges; adaptedness and adaptation; human habitat
and niches; vulnerability, oppression and misuse of power; social and technological pollution;
the life course conception of unique pathways in human development; the importance of
considerations of historical, social and individual time; life stressors and related coping tasks;
resilience; the interdependence of all phenomena and ecological feminism (Gitterman &
Germain, 2008, pp. 1–2). These concepts are central to our understanding of the importance of
a dual perspective when assessing individual and social vulnerabilities and resiliencies, while
understanding the transactional effects of living in the world with a mental health condition.
This model serves us particularly well today. Our knowledge base regarding mental
health has grown exponentially since the 1980s. As we understand more about the biological
determinants (genetics, brain structures and functions) of many mental health conditions
we are better positioned to develop preventive and remedial strategies that can ameliorate
the suffering of our clients and their families. However, there are necessary cautions in our
use of this knowledge; we risk making our understanding of the human condition of mental
illness unidimensional. The social work profession’s strength in bringing together the under-
standing of biopsychosocial factors and their relationships to each other is critically important. We
are increasingly familiar with the biological determinants of mental conditions and social
workers with expertise in mental health have long contributed their understanding of psycho-
logical and environmental factors. Likewise, all social workers including micro and macro
practitioners are aware of the impact of social forces and influences on our clients, their families
and communities.
2 Nina Rovinelli Heller and Alex Gitterman
However, in many undergraduate and graduate schools of social work, we continue to teach
mental health content as separate from other social work content, particularly from macro
social issues. While we no longer tend to call these courses “Psychopathology” or “Abnormal
Psychology for Social Workers,” the content is tilted toward the psychological and increasingly
toward the biological. Lacasse and Gomory (2003), in a survey of what they described as
“psychopathology syllabi” from 58 social work schools, found a nearly exclusive focus on
biological psychiatry. Fortunately, we are beginning to include more content on mental health
care disparities as we begin to identify that mental health issues both affect and manifest
differently among various ethnic and racial groups. While this is an important advance, we
think all of the historical and contemporary social influences and problems that impact the
experience of living with a mental illness must be considered.
Hurricane Katrina provides one sobering example of the importance of understanding
the importance and utility of this bidirectionality between social problems and mental
health conditions. We are all familiar with the difficulties in the FEMA (Federal Emergency
Management Agency) response to the hurricane victims, particularly those who lacked the
economic resources to flee the city before the hurricane or to resettle quickly afterwards. Many
of the victims initially “housed” at the Civic Center were residents of the Ninth Ward, a
predominantly African American neighborhood. While we tend to believe that natural disasters
affect people without regard to race or class, this is not so (Prilleltensky, 2003). Nor is this a new
observation; Spriggs (2006) reminds us of the Titanic, where discrepant safety planning resulted
in lifeboats for first class passengers and none for those in steerage. In the case of Hurricane
Katrina, Voorhees, Vick, and Perkins (2007) note that,
it was poverty which primarily determined who lived in the most vulnerable, low-lying
neighborhoods (that flooded first and emptied last), who was uninsured, who was unable to
escape the storm and flood (and thus who lived and died), who had fewer choices in
relocating, and who did not have the resources to return and rebuild.
(Voorhees et al., 2007, p. 417)
Logan (2006) reported that indeed, preexisting disparities of race and class existed; the damaged
areas were 45.8 percent African American and 29.9 percent lived under the poverty line. These
represent much higher percentages than those living in the nearby, undamaged areas. These
disparities put this vulnerable population at further heightened risk for many deleterious
personal and social outcomes, one of which may be the mental health sequelae in the post-
natural disaster period. The very issues, which place a person at greater risk for developing a
particular mental condition, affect the course, outcome and experience of the illness.
In one of the first comprehensive studies of indicators of mental health conditions among the
hurricane survivors, Kessler et al. (2008) used existing baseline date (pre-hurricane) from the
National Comorbidity Survey Replication Study (NCRS) and did follow-up studies with
survivors at 5–8 months post-hurricane and again a year later. They found that during that
time, post-traumatic stress disorder (PTSD), serious mental illness, suicidal ideation, and suicide
plans all increased significantly in the one-year interval. This finding is in contrast to prior ones
related to natural disasters, in which post-disaster mental health problems tend to decrease with
time. While the initial results suggested that adverse effects were weakly related to socio-
demographic variables, one variable, low family income, consistently and significantly predicted
increased prevalence of severe mental illness, PTSD and suicidal ideation. These results may
not fully reflect the disparities in the incidence of post-Katrina mental health conditions because
the authors note that the original (pre-hurricane) survey may have left the most marginalized
segments of the population underrepresented (for example those who were unreachable by
Introduction to social problems and mental health 3
phone). Clearly, experiencing the effects of a natural disaster is not good for anyone; however,
we do know that certain disadvantaged populations are at higher risk for the disaster itself, and
hence for the complicated after effects. The social work response to the incidence of mental
health problems in this population must consider interventions at all levels, in addition to the
direct practice provisions of a range of mental health interventions and services. At the same
time, we need to pay attention to the social issues and inequities, which create, promote and
maintain elevated risk for a number of variables.
Consider the following practice example:
If we consider only the “facts” of symptoms, we might conclude that Jonya has a preexisting
condition, which has been exacerbated by her ordeal. We might consider a panic disorder,
obsessive compulsive disorder, post-traumatic stress disorder, selective mutism. We would also
4 Nina Rovinelli Heller and Alex Gitterman
note that there was a possibility of the history of schizophrenia or another psychotic condition
on the paternal side (grandmother was “crazy”, sent away, and never to be seen again).
However, we would also need to consider Jonya in terms of her developmental stage, her
gender, her race, the stigma her mother associated with her grandmother’s psychiatric history,
her lack of financial resources, the trauma of the disaster, her vulnerability to internalized
racism, and the revictimizing experience of the delayed federal response to the disaster. We
would also note that in spite of all of this, by the second or third session, Jonya was able to
confide in the worker, accept services and begin to put together a coherent narrative of her
harrowing experience. While Jonya might well need additional interventions, including
medication evaluation, the ecological perspective and life modeled practice remind us of the
interdependence of many factors as well as the resiliency of human beings under acute stress.
The experience of Hurricane Katrina is extreme but illustrates the “perfect storm” of natural,
personal, social and political phenomena. We are also increasingly aware of the deleterious and
complex effects of war, poverty, immigration status, oppression, racism, sexism, and all forms of
violence, upon the well-being of individuals, families and communities. These pernicious
influences disproportionately affect the most vulnerable (by temperament, health status or social
status) among us.
Social workers tend to emphasize either the “mental health” side or the “social problems/
social justice” side of the equation. However, in doing so, we lose a great deal, the profession
loses, and most importantly, our clients lose. We risk losing our appreciation of the complexity
of the human condition and the ways in which the environment and social forces have the
capacity to either ameliorate or advance an individual’s experience with mental health and
illness. We also risk assigning blame to individuals for their struggles, without considering the
impact of pervasive damaging social influences. This book is a realization of our attempts to
bring together both sides of our social work mission as it is reflected in our knowledge base, our
practice skills and our professional values. As social workers we carry a responsibility and charge
to attend to people who are suffering, triumphing, and living with both the multiple effects of
mental illness and the social problems, which influence them.
Mental health can be conceptualized as a state of well-being in which the individual realizes
his or her own abilities, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community.
(WHO, 2007)
10 Nina Rovinelli Heller and Alex Gitterman
From the WHO’s constitution: “Health is a state of completed physical, mental and social well-
being and not merely the absence of disease or infirmity.”
Definitions of recovery focus upon the pathways from illness to health. White, Boyle, and
Loveland (2005) write:
recovery from mental illness must be defined as a complex, dynamic and enduring process
rather than a biological end-state described by an absence of symptoms . . . Recovery is, in
its essence, a lived experience of moving through and beyond the limits of one’s disorder.
(White et al., 2005, p. 235)
In their comprehensive view of the literature, they highlight several other characteristics of a
recovery perspective: individuals must recover from illness, stigma, and at times, the iatrogenic
effects of treatment (Spaniol, Gagne & Koehler, 2003); recovery exists on a continuum; there is
a necessary balance between recovery debits and recovery capital (Granfield & Cloud, 1999);
and there are many varieties of recovery experience. White (1996) identifies different styles of
recovery: acultural whereby an individual has no affiliation with a community of others with
similar struggles, bicultural whereby an individual affiliates with those within and without the
community; and culturally enmeshed styles of recovery, wherein a person is totally immersed in a
culture of recovery. Individuals in recovery may also experience critical developmental points,
which heighten the likelihood of entry or acceleration into recovery (Young & Ensing, 1999).
Additionally, families of persons with mental health conditions must also struggle with and
adapt to both incremental and cumulative changes related to the recovery process of their loved
one (Spaniol & Zipple, 1994). These principles are congruent with the best of our social work
traditions; the importance of the individual: environment transactions and fit; client self-
determination, and the importance of mutual aid supports. In recovery focused mental health
practice, the client, rather than the worker or the intervention, may well be considered the
central change agent. This is a powerful reformulating of recovery.
Demographics
The scope of mental illness nationally is staggering and can be understood through statistics, role
disability, financial burden of disease, and notably, by the face of both human suffering and resiliency. The
National Comorbidity Survey Replication Study (NCS-R) provides comprehensive statistics on
the prevalence, severity and comorbidity (the occurrence of two or more diagnoses in an
individual) of mental illness in the United States. Kessler, Chiu, Demler and Walters (2005)
reported that 26.2 percent of Americans aged 18 and older suffer from a diagnosable mental
disorder in a given year, which translates to nearly 60 million people. This figure pertains to the
occurrence of diagnoses with various severity; they clarify that 6 percent of the population
suffers from serious mental illness. However, nearly half of those with any mental health
condition suffer from a second or more. These figures do not apply for children or early or
middle stage adolescents, a growing subgroup of those experiencing psychiatric difficulties. By
and large, the most prevalent diagnoses among the adult population are the mood conditions,
which are strongly comorbid with anxiety disorders and substance abuse. Of the depressive
disorders, major depression is the most prevalent and occurs nearly double the rate in women
as in men (Kessler et al., 2003). Schizophrenia affects 2.4 million adults in a given year (1.1
percent of the population) (Regier et al., 1993). Anxiety disorders affect 40 million adults (18.1
percent), also have high rates of comorbidity, often with other anxiety disorders and have earlier
ages of onset (Kessler et al., 2005). There has been greater attention to the incidence of post-
traumatic stress disorder in the past several decades and this affects 7.7 million adults (3.5
Introduction to social problems and mental health 11
percent) (Kessler et al., 2003). Some groups are at significantly higher risk; 19 percent of
Vietnam veterans suffer PTSD at some point after serving (Dohrenwend et al., 2007).
The numbers are particularly troubling in regard to children and adolescents. The National
Health and Nutrition Examination Survey (NHANES), a collaboration between the National
Institute of Mental Health (NIMH) and the National Center for Health Statistics at the Centers
for Disease Control (CDC), studied children ages 8–15. Thirteen percent of subjects met criteria
for one of the following six disorders: attention deficit hyperactivity disorder, depression,
conduct disorder, anxiety disorder or eating disorders (NIMH). Importantly, Kessler et al.
(2005) found that half of all lifetime cases of mental illness begin by age 14, and three-quarters
by age 24. These numbers raise critical questions about diagnosing patterns and trends, the
possibility of the medicalization of normal childhood behaviors and the dramatic increase in use
of psychotropic medication for children, even preschoolers.
The examination of role disability provides a much more nuanced understanding of both the
individual and communal effects of psychiatric conditions. Merikangas et al. (2007) reported
that 53 percent of adults in the United States have a mental or physical condition which
interferes with either their attendance at work or conducting their usual activities for several
days per year. Of that group, each experienced an average of 32 days of disability per year.
Major depression was second among all conditions in disability days, at 387 million. Any of us
who work with clients whose level of depression is this debilitating, understand the human costs
of being unable to function as usual. While these data provide a clear picture of the economic
impact of role disability, they do not reflect the personal and relational impact. For example,
people with major depression are going to experience role disability in their roles as mothers
and fathers, partner, relative and friend clearly affecting the well-being of families on both acute
and chronic bases.
In terms of the financial burden of disease, Kessler et al. (2008) report that major depressive and
anxiety disorders (those defined as disorders which have seriously impaired the person’s ability
to function for at least 30 days in the previous year) cost the nation nearly $200 billion in lost
earnings. The costs are actually much higher, as the study did not include people with condi-
tions such as schizophrenia and autism. Indirect costs, less easily computed, are also high and
include the costs of treating these conditions and of providing Social Security payments for
the disabled population. People are often incarcerated or are homeless as direct or indirect
consequences of having a mental condition; these situations carry high financial and social costs
to the nation as well. Kessler et al. (2008) also reported that there was a calculable effect on
individual wage earners as well; those with serious mental illness (SMI), as defined in the study
reported incomes significantly lower than those without SMI, sufficient enough to propel some
individuals and families into poverty.
There is also a human face to the challenges and triumphs of living with a chronic mental
health condition. A 37-year-old woman, Ruth, a social worker, took very seriously her
professional mandate to confront social problems and injustices. In the midst of the 2009
national recession and massive budget cuts to social service and mental health agencies, she
addressed a committee of a west coast state legislature. She spoke as a social worker and as a
mental health consumer:
My prognosis about 15 years ago was that I would end up in a state hospital for the rest
of my life. I had been in psychiatric hospitals at least six times between the ages of 12 and
19. I was in and out of short-term and long-term residential placements, partial hospital
12 Nina Rovinelli Heller and Alex Gitterman
programs, a special education school and an adult group home. I have multiple
psychiatric diagnoses including major depressive disorder and post-traumatic stress
disorder.
When I was 12 I became involved with the Department of Mental Health (DMH).
DMH provided case management support, access to resources, and continuity in my life.
I was lucky to have the same case manager during my time with DMH and she knew me
well and could help when it was needed. This connection has remained important
throughout my life. It was through my case manager that I became involved with
supported education services. Through my worker I was supported through many phases
of my life. She provided so much more than meets the eye. It was through her that I was
able to access important resources, navigate a daunting system, find funding, utilize state
rehabilitation services and apply to schools and the list could go on. I knew I could always
count on her support and she remained a guiding force throughout my schooling and
beyond. It is with her support and many others that I was able to obtain an Associate’s
degree, a Bachelor degree in Social Work and an MSW. Without this support, I do not
believe I would be where I am today. My experiences working with refugees and my
studies with spiritual leaders and others provide me the support to carry on.
I feel truly lucky to have had all the support I have had in my life. I have an amazing
psychiatrist and an incredible social worker. I continue to struggle with mental illness but
I know that no matter what condition I am in I know I can count on the support of these
professionals, family and friends. I work full time as a social worker and while that can be
challenging at times, I am able to support myself. I have a wonderful supervisor who
supports me and believes in me. I have had many struggles in the past months but it has
been with all of this help that I have survived, prospered, and become who I am today.
I cannot stress enough the importance of having a good support system. I know that in
my life and with my clients’ lives this can be a guiding force in surviving mental illness.
Departments of mental health have the ability to help clients with mental illness to
become more than just a diagnosis. They have the ability to help clients achieve more
than they thought possible. Some may say too many resources were used on me and too
many resources are used on people with mental illness today. I like to think it is money
well spent. In helping people to prosper, you help society as a whole. It is easy in tough
economic times to cut mental health services with the thought that each service is too
costly and unnecessary. I would encourage you to take a broader look at what this means
for people. It means increased hospitalizations, increased medications, and an increase in homelessness
. . . and the list goes on.
I continue to need support and know that I can count on the people in my life to
provide it. It is my hope that others will be in this same position. A position where they
are not only obtaining services but also helping to provide services to some of the most
vulnerable in our society. I like to think that it is through my experiences that I am able
to better serve clients.
Ruth speaks of the pain and the pride involved in her ongoing struggles with chronic mental
health conditions. She is well aware of the social issues, which affect both the etiology and the
course of the psychiatric conditions in her life. More importantly, for her as a person, a client
and a social worker, she knows what social conditions favorably impact the lives of people living
with mental health problems. She calls for comprehensive, ongoing, integrated services that
Introduction to social problems and mental health 13
support all areas of her life. She also warns of the social problems created when people do not
have access to these services – more restrictive and costly interventions, overreliance on
medication, and increased rates of homelessness and poverty. She also speaks powerfully about
the importance of the helping relationships she has developed with her own social workers and
other professionals. Ruth says little about her own attributes, strengths and resilience. However,
they come through in her testimony and through her own work with clients.
Web resources
Council on Social Work Education
www.cswe.org
National Association of Social Workers
www.nasw.org
National Institute of Mental Health
www.nimh.gov
References
Acker, G.M. (1999). The impact of clients’ mental illness on social workers’ job satisfaction and burnout.
Health and Social Work, 24, 112–119.
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders, (4th ed.,
Text revision) Washington, DC: APA.
Bentley, K.J. (ed.) (2002). Social work practice in mental health: Contemporary roles, tasks, and techniques. Pacific
Grove, CA: Brooks/Cole.
Bentley, K.J. (2005). Women, mental health, and the psychiatric enterprise: A review. Health and Social
Work, 30, (1), 56–63.
Bright, C. (2004). Deconstructing reparative therapy: An examination of the processes involved when
attempting to change sexual orientation. Clinical Social Work Journal, 32 (4), 225–254.
Center for Health Workforce Studies (CHWS). (2006). National study of licensed social workers. Retrieved
January 29, 2010, from www.workforce.socialworkers.org/studies/natstudy.asp
Conrad, P. (1980). On the medicalization of deviance and social control. In D. Fogarty (ed.), The Critical
psychiatry: The politics of mental health. New York: Pantheon.
Courtney, M.E., & Specht, H. (1994). Unfaithful angels: How social work has abandoned its mission. New York:
Free Press.
Davidson, J.R., & Davidson, T. (1996). Confidentiality and managed care: Ethical and legal concerns.
Health and Social Work, 21 (3), 208–215.
Dohrenwend, B., Turner, J., Turse, N., Adams, B., Koenen, K., & Marshall, R. (2007). Continuing
controversy over the psychological risks of Vietnam for U.S. veterans. Journal of Traumatic Stress, 20 (4),
449–465.
Eack, S.M., & Newhill, C.E. (2008). What influences social workers’ attitudes toward working with clients
with severe mental illness? Families in Society: Journal of Contemporary Social Services, 89 (3), 419–428.
Farone, D.W. (2002). Mental illness, social construction, and managed care: Implications for social work.
Social Work in Mental Health, 1 (1), 99–113.
Frazer, P., Westhuis, D., Daley, J.G., & Phillips, I. (2009). How clinical social workers are using the DSM-
IV: A national study. Social Work in Mental Health, 7 (4), 325–339.
Furman, R., & Langer, C.L. (2006). Managed care and the care of the soul. Journal of Social Work Values and
Ethics, 3 (2). Retrieved January 29, 2010, from www.socialworker.com/jswve/content/blogcategory/
13/46/
Germain, C.B., & Gitterman, A. (1980). The life model of social work practice. New York: Columbia University
Press.
Gitterman, A. (1983). Uses of resistance: A transactional view. Social Work, 28 (2), 19–23.
Gitterman, A. (1989). Testing professional authority and boundaries. Social Casework, 70 (March), 165–171.
16 Nina Rovinelli Heller and Alex Gitterman
Gitterman, A., & Germain, C.B. (2008). The life model of social work practice: Advances in theory and practice (3rd
ed.). New York: Columbia University Press.
Gitterman, A., & Nadelman, A. (1999). The white professional and the black client revisited. Reflections:
Narrative of Professional Helping, 5 (4), 67–79.
Gitterman, A., & Schaeffer (1972). The white professional and the black client. Social Casework, 53 (spring),
280–291.
Goleman, D. (1985, April 30) Social workers vault into a leading role in psychotherapy. The New York
Times, p. 1.
Granfield, R., & Cloud, W. (1999). Coming clean: Overcoming addiction without treatment. New York: New York
University Press.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K.R. et al. (2003). The
epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication
(NCS-R). Journal of the American Medical Association, 289 (23), 3095–3105.
Kessler, R.C., Chiu, W.T., Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of
twelve month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of
General Psychiatry, 62 (6), 617–627.
Kessler, R.C., Galea, S., Gruber, M.J., Sampson, N.A., Ursano, R.J., & Wessely, S. (2008). Trends in
mental illness and suicidality after Hurricane Katrina. Molecular Psychiatry, 13 (4), 374–384.
Kirk, S.A. (ed.). (2005). Mental disorders in the social environment: Critical perspectives. New York: Columbia
University Press.
Kirk, S.A., & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. Hawthorn, NY:
Aldine de Gruyter.
Kirk, S., & Kutchins, H. (1995). Should DSM be the basis for teaching social work practice in mental
health? No! Journal of Social Work Education, 31, 159–168.
Kutchins, H., & Kirk, S.A. (1988). The business of diagnosis: DSM-III and clinical social work. Social Work,
33, 215–220.
Kutchins, H., & Kirk, S.A. (1989). DSM-III-R: The conflict over new psychiatric diagnoses. Health and
Social Work, 14 (2), 91–101.
Lacasse, J.R., & Gomory, T. (2003). Is graduate social work education promoting a critical approach to
mental health practice? Journal of Social Work Education, 39 (3), 383–408.
Lee, S., & Kleinman, A. (2007). Are somatoform disorders changing with time: The case of neurasthenia
in China. Psychosomatic Medicine, 69, 846–849.
Logan, J. (2006). The impact of Katrina: Race and class in storm damaged neighborhoods. Retrieved
February 12, 2010, from Brown University, www.s4.brown.edu/Katrina/report.pdf
López, S.R., & Guarnaccia, P.J. (2005). Cultural dimensions of psychopathology. In J.E. Maddux & B.A.
Winstead (eds) Psychopathology: Foundations for a contemporary understanding (pp. 19–38). Mahwah, NJ:
Lawrence Erlbaum Associates.
Mason, K., Olmos-Gallos, A., Bacon, D., McQuilken, M., Henley, A., & Fisher, S. (2004). Exploring the
consumer’s and provider’s perspective on service quality in community mental health care. Community
Mental Health Journal, 40, 33–46.
Merikangas, K.R., Ames, M., Cui, L., Stang, P.E., Ustun, T.B., von Korff, M., & Kessler, R.C. (2007).
The impact of comorbidity of mental and physical conditions on role disability in the US adult
population. Archives of General Psychiatry, 64 (10), 632–650.
National Association of Social Workers (NASW). (2005). Assuring the sufficiency of a frontline workforce: A national
study of licensed social workers. Washington, DC: NASW Press.
National Association of Social Workers (NASW). (2008). Code of ethics of the National Association of Social
Workers. Washington, DC: NASW Press.
Newhill, C.E., & Korr, W.S. (2004). Practice with people with severe mental illness: Rewards, challenges,
burdens. Health & Social Work, 29 (4), 297–305.
Prilleltensky, I. (2003). Poverty and power. In S. Carr & T. Sloan (eds), Poverty and power: From global
perspective to local practice (pp. 19–44). New York: Kluwer Academic/Plenum.
Reamer, F. (1997). Managing ethics under managed care. Families in Society, 78(1), 96–101.
Introduction to social problems and mental health 17
Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locked, B.Z., & Goodwin, F.K. (1993).
The de facto mental and addictive disorders service system: Epidemiologic Catchment Area
prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50 (2), 85–94.
Reid, Y., Johnson, S., Morant, N., Kuipers, E., Szmukler, G., Thornicroft, G. et al. (1999). Explanations
for stress and satisfaction in mental health professionals: A qualitative study. Social Psychiatry and
Psychiatric Epidemiology, 34, 301–308.
Schamess, G. (1998). Corporate values and managed mental health care. In G. Schamess and A.
Lightburn (eds), Humane managed care? (pp. 23–35). Washington, DC: NASW Press.
Scheyett, A. (2005). The mark of madness: Stigma, serious mental illnesses, and social work. Social Work in
Mental Health, 3 (4), 79–98.
Spaniol, S., & Zipple, A.M. (1994). The family recovery process. Journal of the California Alliance for the
Mentally Ill, 5 (2), 57–59.
Spaniol, J., Gagne, C., & Koehler, M. (2003). The recovery framework in rehabilitation and mental
health. In D.R. Moxley & J.R. Finch (eds), Sourcebook of rehabilitation and mental health practice (pp. 37–50).
New York: Kluwer Academic/Plenum.
Spriggs, W.E. (2006). Poverty in America: The poor are getting poorer. The Crisis, 13, 14–16.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2001). Mental health, United
States, 2000 (DHHS Pub. No. [SMA] 01–3537). Washington, DC: SAMHSA.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). Mental health, United
States, 2004. R.W. Manderscheid & J.T. Berry (eds), DHHS Pub No. (SMA) 06-4195. Rockville, MD:
SAMHSA.
U.S. Department of Health and Human Services (DHHS). (2005). National consensus statement on mental health
recovery. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved
January 29, 2010, from www.mentalhealth.samhsa.gov/publications/allpubs/sma05-4129
Voorhees, C.C.W., Vick, J., & Perkins, D.D. (2007). “Came hell and high water”: The intersection of
Hurricane Katrina, the news media, race and poverty. Journal of Community and Applied Social Psychology,
17 (6), 415–429.
Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.
White, W. (1996). Pathways from the culture of addiction to the culture of recovery. Center City, MN: Hazelden.
White, W., Boyle, M., & Loveland, D. (2005). Recovery from addiction and mental illness: Shared and
contrasting lessons. In R. Ralph & P. Corrigan (eds), Recovery in mental illness: Broadening our understanding
of wellness. (pp. 233–258). Washington, DC: American Psychological Association.
Whitaker, T., Wilson, M., & Arrington, P. (2008). Professional development. NASW Membership Workforce
Study. Washington, DC: National Association of Social Workers. Retrieved January 29, 2010, from
www.workforce.socialworkers.org/studies/Prof.Dev.pdf
World Health Organization. (2007). Fact Sheet N220. Retrieved January 29, 2010, from www.who.
int/mediacentre/en
Young, S., & Ensing, D. (1999). Exploring recovery from the perspective of people with psychiatric
disabilities. Psychiatric Rehabilitation Journal, 22 (3), 219–239.
References
Furman, R., & Langer, C.L. (2006). Managed care and the
care of the soul. Journal of Social Work Values and
Ethics, 3 (2). Retrieved January 29, 2010, from
www.socialworker.com/jswve/content/blogcategory/ 13/46/
Frank, R.G., & Glied, S.A. (2006). Better but not well:
Mental health policy in the United States since 1950.
Baltimore, MD: Johns Hopkins University Press.
Link, B.G., Andrews, H., & Cullen, F.T. (1992). The violent
and illegal behavior of mental patients reconsidered.
American Sociological Review, 52, 96–112.
Bane, M.J., & Ellwood, D.T. (1986). Slipping into and out
of poverty: The dynamics of spells. Journal of Human
Resources, 21, 1–23.
Drake, B., & Rank, M.R. (2009). The racial divide among
American children in poverty: Reassessing the importance of
neighborhood. Children and Youth Services Review, 31,
1264–1271.
Goodman, E., Huang, B., Wade, T.J., & Kahn, R.S. (2003). A
multilevel analysis of the relation of socioeconomic status
to adolescent depressive symptoms: Does school context
matter? Journal of Pediatrics, 143 , 451–456.
Wilson, W.J. (2009). More than just race: Being black and
poor in the inner city. New York: W.W. Norton.
4 Racism and its effects
Garb, H.N. (1997). Race bias, social class bias, and gender
bias in clinical judgment. Clinical Psychology: Science and
Practice, 4 (2). 99–120.
Ghods, B., Roter, D., Ford, D., Larson, S., Arbelaez, J., &
Cooper, L. (2008). Patient-physician communication in the
primary care visits of African Americans and Whites with
depression. Journal of General Internal Medicine, 23 (5),
600–606.
Kataoka, S.H., Zhang, L., & Wells, K.B. (2002). Unmet need
for mental health care among U.S. children: Variation by
ethnicity and insurance status. American Journal of
Psychiatry, 159, 1548–1555.
Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W., &
LaFromboise, T. (2005). State of the science on
psychosocial interventions for ethnic minorities. Annual
Review of Psychology, 1, 113–142.
Swartz, M., Wagner, H., Swanson, J., Burns, B., George, L.,
& Padgett, D. (1998). Administrative update: Utilization of
services. I. Comparing use of public and private mental
health services: The enduring barriers of race and age.
Community Mental Health Journal, 34 (2), 133–144.
Wood, P., Yeh, M., Pan, D., Lambros, K., McCabe, K., &
Hough, R. (2005). Exploring the relationship between
race/ethnicity, age of first school-based services
utilization, and age of fi rst specialty mental health care
for at-risk youth. Mental Health Services Research, 7 (3),
185–196.
Boss, P., Beaulieu, L., Wieling, E., Turner, W., & LaCruz,
S. (2003). Healing loss, ambiguity, and trauma: A
community-based intervention with families of union workers
missing after the 9/11 attack in New York City. Journal of
Marital and Family Therapy, 29 (4), 455–467.
Byers, M. (2005). War law: Understanding international law
and armed conflict. New York: Grove Press.
Ghosh, N., Mohit, A., & Murthy, R.S. (2004). Mental health
promotion in post-conflict countries. Journal of the Royal
Society for the Promotion of Health, 124 (6), 268–270.
Levy, B.S., & Sidel, V.W. (2008). War and public health
(2nd ed.). New York: Oxford University Press.
Nash, M., Wong, J., & Trlin, A. (2006). Civic and social
integration: A new field of social work practice with
immigrants, refugees and asylum seekers. International
Social Work, 49 (3), 345–363.
Watts, S., Siddiqi, S., Shukrullah, A., Karim, K., & Serag,
H. (2007). Social determinants of health in countries in
conflict: The Eastern Mediterranean perspective . Cairo,
Egypt: Commission on Social Determinants of Health, Health
Policy and Planning Unit, Division of Health Systems and
Service Development, World Health Organization.
Black, D.W., Gunter, T., Allen, J., Blum, N., Arndt, S.,
Wenman, G., & Sieleni, B. (2007). Borderline personality
disorder in male and female offenders newly committed to
prison. Comprehensive Psychiatry, 48, 400–405.
Primm, A.B., Osher, F.C., & Gomez, M.B. (2005). Race and
ethnicity, mental health services and cultural competence
in the criminal justice system: Are we ready to change?
Community Mental Health Journal, 41 (5), 557–569.
Ref erences
Ali, T., Dunmore, E., Clark, D., & Ehlers, A. (2002). The
role of negative beliefs in posttraumatic stress disorder:
A comparison of assault victims and non victims. Behavioral
and Cognitive Psychotherapy, 30, 249–257.
van der Kolk, B., van der Hart, O., & Burbridge, J. (2002).
Approaches to the treatment of PTSD. In M. Williams & J.
Sommers (eds), Simple and complex PTSD: Strategies for
comprehensive treatment in clinical practice (pp. 23–46).
New York: Haworth Press.
Carlson, B.E., McNutt, L.A., Choi, D., & Rose, I.M. (2002).
Intimate partner abuse and mental health: The role of
social support and other protective factors. Violence
Against Women, 8, 720–745.
Silva, C., McFarlane, J., Soeken, K., Parker, B., & Reel,
S. (1997). Symptoms of post-traumatic stress disorder in
abused women in a primary care setting. Journal of Women’s
Health, 6, 543–552.
Zink, T., Fisher, B.S., Regan, S., & Pabst, S. (2005). The
prevalence and incidence of intimate partner violence in
older women in primary care practices. Journal of General
Internal Medicine, 20, 884–888.
Kataoka, S., Langley, A., Stein, B., Jaycox, L., Zhang, L.,
Sanchez, N., & Wong, N. (2009). Violence exposure and PTSD:
The role of English language fluency in Latino youth.
Journal of Child and Family Studies, 18 , 334–341.
Osofsky, J.D., Wewers, S., Hann, D.M., & Fick, A.C. (1993).
Chronic community violence: What is happening to our
children? Psychiatry, 56, 36–45.
Wilson, D., Kliewer, W., Teasley, N., Plybon, L., & Sica,
D. (2002). Violence exposure, catecholamine excretion, and
blood pressure non-dipping status in African-American male
versus female adolescents. Psychosomatic Medicine, 64,
906–915.
Gabriels, R.L., Hill, D., Pierce, R., Rogers, S., & Wehner,
B. (2001). Predictors of treatment outcome in young
children with autism. Autism: International Journal of
Research and Practice, 5 (4), 407–429.
Volkmar, F., Lord, C., Bailey, A., Schultz, R.T., & Klin,
A. (2004). Autism and pervasive developmental disorders.
Journal of Child Psychology and Psychiatry, 45 (1),
135–170.
Solms, M., & Turnbull, O. (2002). The brain and the inner
world: An introduction to the neuroscience of subjective
experience. New York: Other Press.
Bird, H., Canino, G., Davies, M., Zhang, H., Ramirez, R., &
Lahey, B. (2001). Prevalence and correlates of antisocial
behaviors among three ethnic groups. Journal of Abnormal
Child Psychology, 29 (6), 465–478.
F inch, A.J., Jr., Nelson, W.M., III, & Hart, K.J. (2006).
Conduct disorder: Description, prevalence, and e tiology.
In W.M. Nelson, III, A.J. Finch, Jr., & K.J. Hart (eds), C
onduct disorders: A practitioner’s guide to comparative
treatments. (pp. 1–13). New York: Springer.
Maughan, B., Rowe, R., Messer, J., Goodman, R., & Meltzer,
H. (2004). Conduct disorder and oppositional defiant
disorder in a national sample: Developmental epidemiology.
Journal of Child Psychology and Psychiatry, 45 (3),
609–621.
Clarkin, J., Carpenter, D., Hull, J., Wilner, P., & Glick,
I. (1998). Effects of psychoeducational intervention for
married patients with bipolar disorder and their spouses.
Psychiatric Services, 49 (4), 531–533.
Depp, C., Lindamer, L., Folsom, D., Gilmer, T., Hough, R.,
Garcia, P. et al. (2005). Differences in clinical features
and mental health service use in bipolar disorder across
the life span. American Journal of Geriatric Psychiatry,
13 (4), 290–298.
Ford, D., Pincus, H., Unützer, J., Bauer, M., Gonzalez, J.,
& Wells, K. (2002). Practice-based interventions. Mental
Health Services Research, 4 (4), 199–204.
Holosko, M., Jean-Baptiste, N., Le, T., Eaton, A., & Power,
L. (2007). Major depressive disorder. In B. Thyer & J.
Wodarksi (eds), Social work in mental health: An
evidence-based approach (pp. 289–306). Hoboken, NJ: John
Wiley & Sons.
Hsu, G., Wan, Y., Adler, D., Rand, W., Choi, E., & Tsang,
B. (2005). Detection of major depressive disorder in
Chinese Americans in primary care. Hong Kong Journal of
Psychiatry, 15 (3), 71–76.
Kawa, I., Carter, J., Joyce, P., Doughty, C., Frampton, C.,
Wells, J. et al. (2005). Gender differences in bipolar
disorder: Age of onset, course, comorbidity, and symptom
presentation. Bipolar Disorders, 7, 119–125.
K eck, P., McElroy, S., Strakowski, S., West, S., Sax, K.,
Hawkins, J. et al. (1998). Twelve-month outcome o f
patients with bipolar disorder following hospitalization
for a manic or mixed episode. A merican Journal of
Psychiatry, 155 (5), 646–652.
Kilbourne, A., Haas, G., Benoit, M., Bauer, M., & Pincus,
H. (2004). Concurrent psychiatric diagnoses by age and race
among persons with bipolar disorder. Psychiatric Services,
55 (8), 931–933.
Lesser, I., Castro, D., Gaynes, B., Gonzalez, J., Rush, J.,
Alpert, J. et al. (2007). Ethnicity/race and outcome in the
treatment of depression: Results from STAR*D. Medical
Care, 45 (11), 1043–1051.
Paykel, E., Abbott, R., Morriss, R., Hayhurst, H., & Scott,
J. (2006). Sub-syndromal and syndromal symptoms in the
longitudinal course of bipolar disorder. British Journal
of Psychiatry, 189 (2), 118–123.
Perlick, D., Rosenheck, R., Clarkin, J., Sirey, J., & Raue,
P. (1999). Symptoms predicting inpatient service use among
patients with bipolar affective disorder. Psychiatric
Services, 50 (6), 806–812.
Rasgon, N., Bauer, M., Grof, P., Gyulai, L., Elman, S.,
Glenn, T. et al. (2005). Sex-specific self-reported mood
changes by patients with bipolar disorder. Journal of
Psychiatric Research, 39 (1), 77–83.
Toprac, M., Rush, J., Conner, T., Crismon, M., Dees, M.,
Hopkins, C. et al. (2000). The Texas Medication Algorithm
Project and Patient and Family Education Program: A
consumer-guided initiative. Journal of Clinical
Psychiatry, 61 (7), 477–486.
Wenzel, A., Steer, R., & Beck, A. (2005). Are there any
gender differences in frequency of self-reported somatic
symptoms of depression? Journal of Affective Disorders, 89
(1–3), 177–181.
Alegria, M., Canino, G., Shrout, P., Woo, M., Duan, M.,
Vila, D. et al. (2008). Prevalence of mental illness in
immigrant and non-immigrant US Latino groups. American
Journal of Psychiatry, 165, 359–369.
Beesdo, K., Knappe, S., & Pine, D.S. (2009). Anxiety and
anxiety disorders in children and adolescents:
Developmental issues and implications for DSM-V.
Psychiatric Clinics of North America, 32 (3), 483–524.
Furr, J.M., Tiwari, S., Suveg, C., & Kendall, P.C. (2009).
Anxiety disorders in children and adolescents. In M.B.
Stein (ed.), Oxford handbook of anxiety and related
disorders (pp. 636–656). New York: Oxford University Press.
Stein, M.B., Cox, B.J., Afifi, T., Belik, S., & Sareen, J.
(2006). Does comorbid depressive illness magnify the impact
of chronic physical illness: A population based
perspective. Psychological Medicine, 36, 587–596.
Wittchen, H.U., Nocon, A., Beesdo, K., Pine, D., Hofl er,
M., Lieb, R. et al. (2008). Agoraphobia and panic:
Prospective-longitudinal relations suggest a rethinking of
diagnostic concepts. Psychotherapy and Psychosomatics, 77,
147–157.
Crow, S., Peel, P.K., Thuras, P., & Mitchell, J.E. (2004).
Bulimia symptoms and other risk behaviors during pregnancy
in women with bulimia. International Journal of Eating
Disorders, 36, 220–223.
Crow, S., Agras, W., Crosby, R., Halmi, K., & Mitchell, J.
(2008). Eating disorders in pregnancy: A prospective study.
International Journal of Eating Disorders, 41 (3),
277–279.
Hudson, J.I., Hiripi, E., Pope, H.G., Jr., & Kessler, R.C.
(2007). The prevalence and correlates of eating disorders
in the national comorbidity survey replication. Biological
Psychiatry, 61 (3), 348–358.
Yager, J., Andersen, A., Devlin, M., Egger, H., Herzog, D.,
Mitchell, J. et al. (2002). Practice guidelines for the
treatment of patients with eating disorders (2nd ed.). In
APA Steering Committee on Practice Guidelines (eds),
American psychiatric association practice guidelines for
the treatment of psychiatric disorders: Compendium 2002
(pp. 697–766). Washington, DC: American Psychiatric
Association.
Thuo, J., Ndetei, D.M., Maru, H., & Kuria, M. (2008). The
prevalence of personality disorders in a Kenyan inpatient
sample. Journal of Personality Disorders, 22 (2), 217–220.
an der Heiden, W., Konnecke, R., Maurer, K., Ropeter, D., &
Hafner, H. (2005). Depression in the longterm course of
schizophrenia. European Archives of Psychiatry and
Clinical Neuroscience, 255 (3), 174–184.
Barnes, T., Leeson, V., Mutsatsa, S., Watt, H., Hutton, S.,
& Joyce, E. (2008). Duration of untreated psychosis and
social function: One-year follow-up study of first-episode
schizophrenia. British Journal of Psychiatry, 193 (3),
203–209.
Cohen, C.I., Cohen, G.D., Blank, K., Gaitz, C., Katz, I.R.,
Leychter, A. et al. (2000). Schizophrenia in older adults,
an overview: Directions for research and policy. American
Journal of Geriatric Psychiatry, 8 (1), 19–28.
Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The
prevalence of mental disorders among the homeless in
western countries: Systematic review and meta-regression
analysis. PLoS Medicine, 5 (12), e225.
Harrison, G., Hopper, K., Craig, T., Laska, E., Siegel, C.,
Wanderling, J. et al. (2001). Recovery from psychotic
illness: A 15- and 25-year international follow-up study.
British Journal of Psychiatry, 178, 506–517.
Koen, L., Uys, S., Niehaus, D.J., & Emsley, R.A. (2007).
Negative symptoms and HIV/AIDS riskbehavior knowledge in
schizophrenia. Psychosomatics, 48 (2), 128–134.
Minsky, S., Vega, W., Miskimen, T., Gara, M., & Escobar, J.
(2003). Diagnostic patterns in Latino, African American,
and European American psychiatric patients. Archives of
General Psychiatry, 60 (6), 637–644.
Mueser, K.T., Torrey, W.C., Lynde, D., Singer, P., & Drake,
R.E. (2003). Implementing evidence-based practices for
people with severe mental illness. Behaviour Modification,
27 (3), 387–411.
West, J.C., Wilk, J.E., Olfson, M., Rae, D.S., Marcus, S.,
Narrow, W.E. et al. (2005). Patterns and quality of
treatment for patients with schizophrenia in routine
psychiatric practice. Psychiatric Services, 56 (3),
283–291.
Wilk, J.E., West, J.C., Narrow, W.E., Rae, D.S., & Regier,
D.A. (2005). Access to psychiatrists in the public sector
and in managed health plans. Psychiatric Services, 56 (4),
408–410.
Botvin, G., Schinke, S., Epstein, J., Diaz, T., & Botvin,
E. (1995). Effectiveness of culturally focused and generic
skills training approaches to alcohol and drug abuse
prevention among minority adolescents: Two-year follow-up
results. Psychology of Addictive Behaviors, 9 (3),
183–194.
Dick, D.M., Birut, L., Hinrichs, A., Fox, L., Bucholz, K.,
Kramer, J. et al. (2006). The role of GABRA2 i n risk for
conduct disorder and alcohol and drug dependence across
developmental stages. B ehavior Genetics, 36, 577–590.
Gray, M. (1998). Drug crazy: How we got into this mess and
how we can get out. New York: Random House.
Nock, M.K., Goldman, J.L., Wang, Y., & Albano, A.M. (2004).
From science to practice: The flexible use of
evidence-based treatments in clinical settings. Journal of
the American Academy of Child and Adolescent Psychiatry, 43
, 777–780.
Artero, S., Ancelin, M.L., Portet, F., Dupuy, A., Berr, C.,
Dartigues, J.F. et al. (2008). Risk profiles for mild
cognitive impairment and progression to dementia are gender
specific. Journal of Neurology, Neurosurgery, and
Psychiatry, 79 (9), 979–984.
Chrisman, M., Tabar, D., Whall, A.L. & Booth, D.E. (1991).
Agitated behavior in the cognitively impaired elderly.
Journal of Geronotological Nursing, 17, 9–13.
Haley, W.E., Bergman, E., Roth, D., McVie, T., Gaugler, J.,
& Mittelman, M. (2008). Long-term effects of bereavement
and caregiver intervention on dementia caregiver depressive
symptoms. Gerontologist, 48 (6), 732–740.
Hinton, L., Franz, C.E., Yeo, G., & Levkoff, S.E. (2005).
Conceptions of dementia in a Multi-ethnic sample of family
caregivers. Journal of the American Geriatrics Society,
53, 1405–1410.
Hughes, J., Bagley, H., Reilly, S., Burns, A., & Challis,
D. (2008). Care staff working with people with dementia:
Training, knowledge, and confidence. Dementia, 7, 227–238.
Jorm, A.F., Scott, R., Henderson, A.S., & Kay, D.W. (1988).
Educational level differences on the Mini Mental State: The
role of test bias. Psychological Medicine, 18, 727–731.
Shumaker, S., Legault, C., Rapp, S., Thal, L., Wallace, R.,
Ockene, J. et al. (2003). Estrogen plus progestin and the
incidence of dementia and mild cognitive impairment in
postmenopausal women: The Women’s Health Initiative Memory
Study: A randomized controlled trial. Journal of the
American Medical Association, 289 (20), 2651–2662.
Yaffe, K., Fox, P., Newcomer, R., Sands, L., Lindquist, K.,
Dane, K., & Covinsky, K.E. (2002). Patient and caregiver
characteristics and nursing home placement in patients with
dementia. Journal of the American Medical Association, 287,
2090–2097.