Research on homelessness among persons with severe mental illness tends to focus on aspects of de... more Research on homelessness among persons with severe mental illness tends to focus on aspects of demand, such as risk factors or structural and economic forces. The authors address the complementary role of supply factors, arguing that "solutions" to residential instability-typically, a series of institutional placements alternating with shelter stays-effectively perpetuate homelessness among some persons with severe mental illness. Thirty-six consecutive applicants for shelter in Westchester County, New York, in the first half of 1995 who were judged to be severely mentally ill by intake workers were interviewed using a modified life chart format. Detailed narrative histories were constructed and reviewed with the subjects. Twenty of the 36 subjects had spent a mean of 59 percent of the last five years in institutions and shelters. Analysis of the residential histories of the 36 subjects revealed that shelters functioned in four distinctive ways in their lives: as part of a more extended institutional circuit, as a temporary source of transitional housing, as a surrogate for exhausted support from kin, and as a haphazard resource in essentially nomadic lives. The first pattern dominated in this group. Shelters and other custodial institutions have acquired hybrid functions that effectively substitute for more stable and appropriate housing for some persons with severe mental illness.
Kim Hopper est chercheur au Nathan Kline Institute for Psychiatric Research et intervenant a l’un... more Kim Hopper est chercheur au Nathan Kline Institute for Psychiatric Research et intervenant a l’universite de Columbia. Il travaille depuis une vingtaine d’annees sur le sans-abrisme, et est le promoteur d’une sociologie engagee dont temoigne son ouvrage Reckoning with homelessness (Ithaca, Cornell University Press, 2003), dont nous traduisons ici des extraits de l’introduction. Cet ouvrage comporte une analyse des mouvements de defense des sans-abri (auxquels il a participe), et rappelle la n...
Warner's 2nd edition (of Recovery from Schizophrenia) remains a refreshingly different view... more Warner's 2nd edition (of Recovery from Schizophrenia) remains a refreshingly different view of psychiatry's favorite conundrumschizophrenia; a problem psychiatry wants to own, to legitimise itself, but does not want to deal with its socio-contextual origins. Warner, in this updated ...
... of Outcome of Severe Mental Disorder (DOSMeD) 113 Vijoy K. Varma 11 Chandigarh, India 115 Vij... more ... of Outcome of Severe Mental Disorder (DOSMeD) 113 Vijoy K. Varma 11 Chandigarh, India 115 Vijoy K. Varma and Savita Malhotra 12 Dublin, Ireland Aine Finnerty, Fiona Keogh, Anne O'Grady Walshe, and Dermot Walsh 13 Honolulu, Hawai'i Anthony J. Marsella, Edward ...
PART I. BACKGROUND 1. Twenty-five Years of WHO: Coordinated Activities Concerned with Schizophren... more PART I. BACKGROUND 1. Twenty-five Years of WHO: Coordinated Activities Concerned with Schizophrenia 2. Study Methodology PART II. FINDINGS 3. An Overview of Course and Outcome in ISoS 4. Predictors of Long-Term Course and Outcome for the DOSMeD Cohort 5. Long-Term Diagnostic Stability in International Cohorts of Persons with Schizophrenia and Related Psychoses 6. Long-Term Mortality Experience of International Cohorts of Persons with Schizophrenia and Related Psychoses 7. Identifying Prognostic Factors That Predict Recovery in the Prescence of Loss to Follow-Up PART III. THE CENTERS SECTION III.B INTERNATIONAL PILOT STUDY OF SCHIZOPHRENIA (IPSS) 8. IPSS: Agra, India 9. IPSS: Cali, Columbia 10. IPSS: Prague, Czech Republic SECTION III.B DETERMINANTS OF OUTCOME OF SEVERE MENTAL DISORDER (DISMED) 11. Chandigarh, India 12. Dublin, Ireland 13. Honolulu, Hawai'i 14. Moscow, Russia 15. Nagasaki, Japan 16. Nottingham, UK 17. Rochester, New York SECTION III.C REDUCTION AND ASSESSMENT OF ...
Resurgent hopes for recovery from schizophrenia in the late 1980s had less to do with fresh empir... more Resurgent hopes for recovery from schizophrenia in the late 1980s had less to do with fresh empirical evidence than with focused political agitation. Recovery’s promise was transformative: reworking traditional power relationships, conferring distinctive expertise on service users, rewriting the mandate of public mental health systems. Its institutional imprint has been considerably weaker. This article takes sympathetic measure of that outcome and provides an alternative framework for what recovery might mean, one drawn from disability studies and Sen’s capabilities approach. By re-enfranchising agency, redressing material and symbolic disadvantage, raising the bar on fundamental entitlements and claiming institutional support for complex competencies, a capabilities approach could convert flaccid doctrine into useful guidelines and tools for public mental health. Published by Elsevier Ltd.
The disadvantaged social position of public mental health service users reflects synergistic rela... more The disadvantaged social position of public mental health service users reflects synergistic relationships among tangible disadvantage and stigma and its consequences. Limited literacy, an important factor in social disadvantage and an additional source of stigma, is virtually absent from the discussion. Employing a mixed-methods, service user–informed design, we explore the meaning and impact of limited literacy in the lives of public mental health service users in the United States. Of 267 participants, 184 (69 percent) read at or below an eighth-grade level. Next, we demonstrate levels of and explore relationships among both literacy and mental illness concealment stigma and stigma consciousness (for mental illness). Finally, informed by our qualitative data, we describe how people encounter and manage this double burden of stigma with respect to: contexts of concealment, dilemmas of disclosure, and reduction and exclusion. Limited literacy and its associated stigma are important...
Research on homelessness among persons with severe mental illness tends to focus on aspects of de... more Research on homelessness among persons with severe mental illness tends to focus on aspects of demand, such as risk factors or structural and economic forces. The authors address the complementary role of supply factors, arguing that "solutions" to residential instability-typically, a series of institutional placements alternating with shelter stays-effectively perpetuate homelessness among some persons with severe mental illness. Thirty-six consecutive applicants for shelter in Westchester County, New York, in the first half of 1995 who were judged to be severely mentally ill by intake workers were interviewed using a modified life chart format. Detailed narrative histories were constructed and reviewed with the subjects. Twenty of the 36 subjects had spent a mean of 59 percent of the last five years in institutions and shelters. Analysis of the residential histories of the 36 subjects revealed that shelters functioned in four distinctive ways in their lives: as part of a more extended institutional circuit, as a temporary source of transitional housing, as a surrogate for exhausted support from kin, and as a haphazard resource in essentially nomadic lives. The first pattern dominated in this group. Shelters and other custodial institutions have acquired hybrid functions that effectively substitute for more stable and appropriate housing for some persons with severe mental illness.
Kim Hopper est chercheur au Nathan Kline Institute for Psychiatric Research et intervenant a l’un... more Kim Hopper est chercheur au Nathan Kline Institute for Psychiatric Research et intervenant a l’universite de Columbia. Il travaille depuis une vingtaine d’annees sur le sans-abrisme, et est le promoteur d’une sociologie engagee dont temoigne son ouvrage Reckoning with homelessness (Ithaca, Cornell University Press, 2003), dont nous traduisons ici des extraits de l’introduction. Cet ouvrage comporte une analyse des mouvements de defense des sans-abri (auxquels il a participe), et rappelle la n...
Warner's 2nd edition (of Recovery from Schizophrenia) remains a refreshingly different view... more Warner's 2nd edition (of Recovery from Schizophrenia) remains a refreshingly different view of psychiatry's favorite conundrumschizophrenia; a problem psychiatry wants to own, to legitimise itself, but does not want to deal with its socio-contextual origins. Warner, in this updated ...
... of Outcome of Severe Mental Disorder (DOSMeD) 113 Vijoy K. Varma 11 Chandigarh, India 115 Vij... more ... of Outcome of Severe Mental Disorder (DOSMeD) 113 Vijoy K. Varma 11 Chandigarh, India 115 Vijoy K. Varma and Savita Malhotra 12 Dublin, Ireland Aine Finnerty, Fiona Keogh, Anne O'Grady Walshe, and Dermot Walsh 13 Honolulu, Hawai'i Anthony J. Marsella, Edward ...
PART I. BACKGROUND 1. Twenty-five Years of WHO: Coordinated Activities Concerned with Schizophren... more PART I. BACKGROUND 1. Twenty-five Years of WHO: Coordinated Activities Concerned with Schizophrenia 2. Study Methodology PART II. FINDINGS 3. An Overview of Course and Outcome in ISoS 4. Predictors of Long-Term Course and Outcome for the DOSMeD Cohort 5. Long-Term Diagnostic Stability in International Cohorts of Persons with Schizophrenia and Related Psychoses 6. Long-Term Mortality Experience of International Cohorts of Persons with Schizophrenia and Related Psychoses 7. Identifying Prognostic Factors That Predict Recovery in the Prescence of Loss to Follow-Up PART III. THE CENTERS SECTION III.B INTERNATIONAL PILOT STUDY OF SCHIZOPHRENIA (IPSS) 8. IPSS: Agra, India 9. IPSS: Cali, Columbia 10. IPSS: Prague, Czech Republic SECTION III.B DETERMINANTS OF OUTCOME OF SEVERE MENTAL DISORDER (DISMED) 11. Chandigarh, India 12. Dublin, Ireland 13. Honolulu, Hawai'i 14. Moscow, Russia 15. Nagasaki, Japan 16. Nottingham, UK 17. Rochester, New York SECTION III.C REDUCTION AND ASSESSMENT OF ...
Resurgent hopes for recovery from schizophrenia in the late 1980s had less to do with fresh empir... more Resurgent hopes for recovery from schizophrenia in the late 1980s had less to do with fresh empirical evidence than with focused political agitation. Recovery’s promise was transformative: reworking traditional power relationships, conferring distinctive expertise on service users, rewriting the mandate of public mental health systems. Its institutional imprint has been considerably weaker. This article takes sympathetic measure of that outcome and provides an alternative framework for what recovery might mean, one drawn from disability studies and Sen’s capabilities approach. By re-enfranchising agency, redressing material and symbolic disadvantage, raising the bar on fundamental entitlements and claiming institutional support for complex competencies, a capabilities approach could convert flaccid doctrine into useful guidelines and tools for public mental health. Published by Elsevier Ltd.
The disadvantaged social position of public mental health service users reflects synergistic rela... more The disadvantaged social position of public mental health service users reflects synergistic relationships among tangible disadvantage and stigma and its consequences. Limited literacy, an important factor in social disadvantage and an additional source of stigma, is virtually absent from the discussion. Employing a mixed-methods, service user–informed design, we explore the meaning and impact of limited literacy in the lives of public mental health service users in the United States. Of 267 participants, 184 (69 percent) read at or below an eighth-grade level. Next, we demonstrate levels of and explore relationships among both literacy and mental illness concealment stigma and stigma consciousness (for mental illness). Finally, informed by our qualitative data, we describe how people encounter and manage this double burden of stigma with respect to: contexts of concealment, dilemmas of disclosure, and reduction and exclusion. Limited literacy and its associated stigma are important...
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