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This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system. Drawing on years of fieldwork in a community psychiatry outreach team, Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates. At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. The experiences of these clinicians pose a single overarching question: how should we bear responsibility for the most vulnerable among us?

As the global psychiatric community enters a new era of transformation, this book explores lessons learned from previous efforts with the goal of \"getting it right\" this time. In response to the common refrain that we know about and 'do' recovery already, the authors set the recovery movement within the conceptual framework of major thinkers and achievers in the history of psychiatry, such as Philippe Pinel, Dorothea Dix, Adolf Meyer, Harry Stack Sullivan, and Franco Basaglia. The book reaches beyond the usual boundaries of psychiatry to incorporate lessons from related fields, such as psychology, sociology, social welfare, philosophy, political economic theory, and civil rights. From Jane Addams and the Settlement House movement to Martin Luther King, Jr., and Gilles Deleuze, this book identifies the less well-known and less visible dimensions of the recovery concept and movement that underlie concrete clinical practice. In addition, the authors highlight the limitations of previous efforts to reform and transform mental health practice, such as the de-institutionalization movement begun in the 1950s, in the hope that the field will not have to repeat these same mistakes. Their thoughtful analysis and valuable advice will benefit people in recovery, their loved ones, the practitioners who serve them, and society at large. Foreword by Fred Frese, Founder of the Community and State Hospital Section of the American Psychological Association and past president of the National Mental Health Consumers' Association.

Background Community-based psychiatric rehabilitation (CBPR) helps patients reintegrate into society while enabling them to live autonomously in supportive environments. CBPR uses multi-modal approach to address patients’ needs in health, education, livelihood, empowerment and social functioning. In addition to pharmacotherapy, other interventions such as metacognitive training, lifestyle interventions, psychoeducation, arts therapy may be used to improve functioning and quality of life. Storytelling as a new intervention was implemented in a community-based rehabilitation setting with patients with mental health issues to test its feasibility and potential to improve life satisfaction. Methods Stories presenting difficult lives and complicated relationships were narrated and discussed in eight storytelling sessions for members of a civil organization involved in psychiatric rehabilitation in four months. Acceptability was tested by following participation rate and feedback with scales after each session. Demographic as well as mental health data including sense of coherence, distress, self-efficacy, and life satisfaction were investigated by standard scales before the first and after the last session. Results Participation ranged from 31 to 49% compared to all persons present at the setting. Participants (mean age: 53.41 ± 12.23 years, 63% females) found the stories highly interesting (mean: 8.93 ± 1.62) and comprehensible (8.67 ± 1.9) on a 1–10 scale though the means of individual sessions somewhat varied. Significant positive correlation was found between the stories being interesting and comprehensible (Spearman’s rho = 0.656) but significant negative correlation was found between story length and comprehension (Spearman’s rho=-0.183). Based on the responses from participants who completed the questionnaires before and after the intervention, life satisfaction significantly increased. Psychological variables such as self-efficacy, sense of coherence, pathological distress showed improving tendency without reaching significance. Pre-intervention data showed significant positive correlation between self-efficacy and sense of coherence (Pearson’s r  = 0.659). Psychological distress was negatively related to both self-efficacy (Pearson’s r =-0.728) and sense of coherence (Pearson’s r =-0.825). Conclusions Storytelling as a means for promoting health proved to be feasible in a group of rehabilitated patients with mental disorders. Their life satisfaction significantly improved in four months. Carefully selected stories narrated and discussed in group settings may result in the gradual shift of participants’ perspectives leading to improved life satisfaction.

This study examined the relationship between the Duration of Untreated Psychosis (DUP) and functional outcomes at baseline, 6 months, and 12 months after admission to Coordinated Specialty Care (CSC). A total of 246 participants from two U.S. public-sector CSC programs were categorized into Low and High DUP groups using two criteria: (i) a median split of the DUP distribution and (ii) the World Health Organization (WHO) aspirational standard of 3 months. Changes in global functioning (GAF), social functioning (GF: Social), and occupational functioning (GF: Role), symptom severity (PANSS), and quality of life (QoL) were assessed using a Linear Mixed Model Repeated Measures (MMRM) analysis across the three time points. A Generalized Linear Model (GLM) with a logit link function was applied to analyze binary outcomes, specifically the status of being Neither in the Labor Force, Education, or Training (NLFET). Both models adjusted for time and site as covariates and used an unstructured variance-covariance matrix to account for within-subject correlations in repeated measures. The difference-in-differences method was employed to estimate the impact of DUP on outcomes over time, with results reported as least square means for continuous outcomes, odds ratios for binary outcomes, and 95% confidence intervals (CI) for both Low and High DUP groups. No significant differences were observed between the Low and High DUP groups at baseline. By 6 months, participants in the Low DUP group (DUP < 3 months) exhibited significantly greater improvements (reduction) in NLFET status (3-month OR = 3.25, p = 0.03; median split OR = 2.25, p = 0.03) and global functioning, GF: Role, and GF: Social. By 12 months, the Low DUP group continued to show significantly greater NLFET status improvement (3-month OR = 3.59, p = 0.03; median split OR = 3.40, p = 0.0032). Improvements in global functioning were sustained at 12 months, while social and occupational functioning gains were not. No significant differences were observed between groups for quality of life or symptom severity over time. Shorter DUP is linked to more rapid functional recovery within the first year after CSC admission.

This book critiques the connection between Western society and madness, scrutinizing if and how societal insanity affects the cause, construction, and consequence of madness. Looking beyond the affected individual to their social, political, economic, ecological, and cultural context, this book examines whether society itself, and its institutions, divisions, practices, and values, is mad. That society's insanity is relevant to the sanity and insanity of its citizens has been argued by Fromm in The Sane Society, but also by a host of sociologists, social thinkers, epidemiologists and biologists. This book builds on classic texts such as Foucault's History of Madness, Scull's Marxist-oriented works and more recent publications which have arisen from a range of socio-political and patient-orientated movements. Chapters in this book draw on biology, psychology, sociological and anthropological thinking that argues that where madness is concerned, society matters. Providing an extended case study of how the sociological imagination should operate in a contemporary setting, this book draws on genetics, neuro-science, cognitive science, radical psychology, and evolutionary psychology/psychiatry. It is an important read for students and scholars of sociology, anthropology, social policy, criminology, health, and mental health.