International Journal of Social Psychiatry

The aim of this article is to provide a narrative literature review of the ‘third gender’ phenomenon in Brazil (Travestis), India (Hijras) and Mexico (Muxes), considering the social stigma, the legal and health aspects of these identities.

These three groups share similar experiences of stigmatisation, marginalisation, sexual abuse, HIV infection, infringement of civil rights and harassment accessing health services. Brazil, India and Mexico public services for the third gender conditions are still very scarce and inadequate for the heavy demand from potential users.

Although all three countries have used legislation to promote provision of comprehensive healthcare services for third gender, there is still strong resistance to implementation of such laws and policies. Brazil, India and Mexico face a huge challenge to become countries where all human rights are respected.

The individual placement and support (IPS) intervention supports persons with severe mental illness in achieving competitive employment. Although the IPS intervention is labelled a recovery-oriented intervention, little is known about how participants experience IPS to influence recovery. The aim was to investigate how IPS and employment influence recovery in persons with severe mental illness.

A qualitative phenomenological hermeneutic study of experiences of 12 participants in IPS.

IPS and competitive work have an impact on personal recovery, may influence work functioning and decrease depressive symptoms, but do not seem to have an impact on psychotic symptoms.

Stigma is very common among caregivers of patients with severe mental disorder; however, there is lack of national level data from India.

To assess affiliate stigma and its correlates among caregivers of patients with severe mental disorders.

For this, caregivers of patients with schizophrenia (N = 707), bipolar disorder (N = 344) and recurrent depressive disorder (N = 352) were assessed on Stigma scale for Caregivers of People with Mental Illness and General Health Questionnaire.

Caregivers of patients with schizophrenia reported significantly higher stigma than patients with bipolar disorder and recurrent depressive disorder. Caregiver of patients with bipolar disorder reported significantly greater stigma than the caregivers of patients with recurrent depressive disorder. Higher caregiver stigma in all the diagnostic groups was associated with higher psychological morbidity in caregivers. Higher stigma in caregivers of schizophrenia was seen when the patient had younger age of onset and longer duration of treatment. In the bipolar disorder group, higher stigma in caregivers was seen when patient had higher residual manic symptoms.

This study suggests that caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder and recurrent depressive disorder. Higher stigma is associated with higher psychological morbidity in the caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma.

In Northern Malawi, the duration of untreated psychosis (DUP) is longer than that in high-income countries. The reasons for the delay in help-seeking are not known, although studies show multiple reasons. This research was conducted to establish health care help-seeking behaviours and identify barriers that exist between service users and health care providers. The study also intended to establish the beliefs that clients and family members have regarding the causes of mental illness which profoundly shape help-seeking, care giving process and outcomes.

The study employed the exploratory phenomenological method, utilizing focus group discussions (FGDs) in the sampled population. The Health Belief Model and Disease Explanatory Models were conveniently chosen a priori by researchers to develop guide questions to explore clients’ and carers’ perceptions of the illness and their health care help-seeking behaviours.

Results show a bio-psycho-social inclination of disease causation and help-seeking behaviour. Causes of mental illness are understood in three categories, namely: physical/biological, psychological and socio-cultural. The majority of participants attributed mental illness to socio-cultural factors, with witchcraft, spirit possession and curses as main determinants. Causal perceptions also influenced help-seeking pathways. Many participants reported consulting traditional healers first, for diagnosis and to know who was responsible.

In this study, it has been found that help-seeking is influenced by the understanding of the source of the illness – which has a bio-psychosocial inclination. The socio-cultural explanation of witchcraft and spirit possession is dominant and a determinant of help-seeking behaviour. While participants noted benefits to hospital treatment, barriers and bio-psychosocial in nature were also noted. Guardians and not clients hold the key to choice of treatment modality and therefore a potential ally in all treatment interventions promotive, preventive and curative. There is need for strengthening of a bio-psychosocial intervention model in the treatment of mental illness.

Previous evidence suggests that how an individual conceptualises the cause of a health problem can impact on subsequent perceptions and behaviour.

This study explored the beliefs about the causes of psychosis in a group of mental health professionals. The study also sought to examine the relationship between causal beliefs and the perceived helpfulness of different treatments.

A total of 219 clinicians completed a questionnaire about the provision of cognitive behavioural therapy (CBT) and antipsychotic medication for their clients who were experiencing psychosis and their opinions about the helpfulness of these treatments. Causal beliefs were also assessed.

Clients were twice as likely to be offered medication compared to CBT. Clinicians held a multifactorial model of aetiology, but were more likely to endorse psychosocial causes than biological factors. Clinicians with psychosocial beliefs were more likely to rate CBT as effective, whereas those with biological models were more likely to endorse the helpfulness of medication. Clinicians adopt a multi-causal approach when conceptualising the aetiology of psychosis and these beliefs were related to opinions about the helpfulness of treatment. Beliefs about the aetiology of their client’s experiences could blind clinicians to the benefits of offering different approaches.

The role of family in supporting service users in coping with illness and engaging in relapse prevention in early psychosis is important. Taking on this caring though is stressful and challenging, and it has been found that support and information for carers assists in their coping and reduces isolation.

To evaluate the current utility of a psychoeducation group program in a public adult mental health service, for the families of people experiencing early psychosis.

A purpose-designed pre- and post-intervention questionnaire was administered to quantitatively measure group participants’ changes in perceptions of their understanding of mental illness and its treatment through attending the group. Additional qualitative items were used to determine other knowledge, benefits and any critical feedback.

The group program continues to result in highly significant improvements in family members’ understanding of psychosis, recovery, medications, relapse prevention and substance co-morbidities. Additional feedback reaffirmed previous findings that family members find group peer support valuable and that this reduces isolation and the experience of stigma.

The current evaluation, conducted following 10 years of early psychosis group work, found there to be efficacy in family peer support groups and that it is important to provide family interventions in public early psychosis mental health services.

Mental disorders have been associated worldwide with human rights’ violations. Controversially, many occur in mental health facilities.

This work aimed to assess the rights of people with mental disorders in healthcare facilities in Tunisia.

A cross-sectional study, using the World Health Organization (WHO) quality-rights toolkit, assessed the human rights levels of achievement in Elrazi Hospital, the only psychiatric hospital in Tunisia, in comparison with the National Institute of Nutrition (NIN). The framework was the Convention on the Rights of Persons with Disabilities (CRPD). The assessment was carried through observation, documentation review, and interviews with service users, staff, and family members. The sample was composed of 113 interviewees.

In Elrazi Hospital, three out of the five evaluated rights were assessed as only initiated: the right to an adequate standard of living, to exercise legal capacity and to be free from inhuman treatment. By comparison, these rights were partially achieved in the NIN. The right to enjoyment of the highest attainable standard of health was partially achieved and the right to live independently and to be included in the community was not even initiated. These last two rights were at the same level of achievement in the NIN.

Significant improvements are needed to adapt the practice in Elrazi Hospital to comply with human rights, especially since the achievement level of these rights is lower than in a non-psychiatric hospital. Our study emphasizes the importance of spreading the CRPD as a standardized framework.

Social network size and strength is an important determinant of overall health.

This study describes the extent and strength of the social network among a sample of individuals with serious mental illness (SMI) and explores the relationship between an individual’s social network and their experience of internal stigma and recovery attitudes.

Over a 2-year period, consecutive new patients with SMI attending two community mental health clinics were recruited and interviewed using a comprehensive battery of assessments including assessment of internalized stigma, recovery attitudes and symptom severity.

Among the 271 patients interviewed, social network size was small across all diagnostic categories. In adjusted results, the number of friends and support from relatives and friends was significantly related to the personal confidence and hope recovery attitude (p < .05). The number of relatives and friends and support from relatives was significantly related to internalized stigma (p < .05). Frequency of contact with relatives or friends was not related to either recovery factors or internalized stigma.

There is a significant positive relationship between the size and perceived strength of an individual’s social network and internalized stigma and some recovery attitudes. Clinical programs that address any of these factors could potentially improve outcomes for this population.

This study draws on old and well-established evidence that economic change, and especially recession, affects people’s lives, behavior and mental health. Even though the literature is rich on the relationship between unemployment and mental distress, there is a renewed research interest on the link between socio-economic inequalities and psychological health.

The study investigates the relationship of social class with mental distress during the hard times of persistent and severe economic crisis in Greece by conducting a comparative, community study in the country’s second largest city, Thessaloniki.

A face-to-face structured interview covering living conditions, life events, chronic stressors and coping strategies was employed to 300 residents of socio-economically contrasting neighborhood areas. Social class was operationalized by Erik Olin Wright’s social class position typology, based on ownership and control over productive assets. The method of multiple correspondence analysis (MCA) was also applied to analyze the collected data.

The results indicated that mental distress was significantly differentiated across social classes and in each residential area. Unemployed and unskilled workers were the most vulnerable groups in terms of psychological health. Chronic stress arose in this study as a risk factor for poor mental health outcomes and it was associated to low marital quality, intense economic burden and impoverished housing conditions.

Those who face income loss, job loss and disability are at high risk for poverty and marginalization, suffering from greater psychological distress.