Job Satisfaction Among Swedish Mental Health Nursing Staff: A Cross-Sectional Survey

There is limited amount of empirical studies concerning job satisfaction in inpatient psychiatric care. However, job satisfaction has several implications on public administration and management. The objective of this study is to identify factors having positive impact on job satisfaction among Swedish psychiatric nursing staff in an inpatient psychiatric clinic. The cross-sectional study is based on Herzberg’s motivation-hygiene theory. The survey was distributed among nursing staff at a psychiatric university hospital clinic in Western Sweden. Overall, job satisfaction was rated relatively high, and salary was rated the lowest of all factors investigated. Unlike the premises in Herzberg’s theory, salary showed a positive correlation with job satisfaction and not only in preventing dissatisfaction. Hospital managers must be attentive to salary levels and staff turnover. Psychiatric nursing personnel in Sweden lack competitive salaries, and hospital administrators should encourage nursing staff to improve relationships between staff and managers and establish good relationships among colleagues.     

Trade Liberalization in Indonesian Health Services: Prospects and Policies

The worldwide increase in demand for health services offers developing countries, like Indonesia, significant opportunities to expand international trade in this area. However, policy aimed at achieving this objective must carefully consider the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). For signatory nations and those considering becoming signatory nations, the procedural, structural, and other effects of the GATS make it a formidable challenge for national health policy alongside its impact on trade liberalization. Invoking the four GATS health care trade modes, this article develops possible approaches to Indonesian health services in the context of trade liberalization.     

Chapter 6. Psychosocial Stressors,Psychiatric Diagnoses and Utilization of Mental Health Services Among Undocumented Immigrant Latinos

Abstract

The combined effects of minority status, specific ethnic group experiences (political, economic, trauma and immigration history), poverty, and illegal status pose a set of unique psychiatric risks for undocumented Latinos in the United States. Restrictive legislation and policy measures have limited access to health care, and other basic human services to undocumented immigrants and their children throughout the nation. However, little is known about the patterns of mental health care use, psychiatric diagnoses and psychosocial problems prevalent among the undocumented who do succeed in presenting to clinical settings and to the mental health sector. To begin to address the need for further understanding in this area, we completed a clinical chart review of 197 outpatient adult psychiatric charts in a Latino mental health outpatient treatment program located in an urban hospital system.

We compared the diagnoses and mental health care use of undocumented Latino immigrants (15%) with that of documented (73%) and US born Latinos (12%) treated in this clinical setting. The undocumented Latinos in our study were more likely to have a diagnosis of anxiety, adjustment and alcohol abuse disorders. The undocumented also had a significantly greater mean number of concurrent psychosocial stressors (mean number = 5, p < .001) ascompared to documented immigrants and US born groups, which both had a mean number of 3 stressors identified at evaluation. The undocumented were more likely to have psychosocial problems related to occupation, access to healthcare and the legal system. However, the undocumented had a lower mean number of total mental health appointments attended (mean visits = 4.3, p < .001) in which to address these stressors as compared to documented immigrants (mean visits = 7.9) and US born (mean visits = 13.3). In terms of other previous mental health service use, the undocumented group had lower rates of lifetime inpatient and outpatient treatment use.

The results of this study suggest the importance of early assessment of psychosocial stressors, substance use and barriers to care when treating undocumented immigrants. Although all Latino groups included in this investigation demonstrated numerable concurrent stressors, our investigation highlights the particular importance of accessible social services and supports for addressing psychosocial stressors in the lives of undocumented patients. Our results stress the importance of reexamining policies, that restrict access to social services and healthcare for the undocumented. Our results also suggest the importance of culturally appropriate evaluation and treatment of substance abuse disorders as well as addressing other psychological and behavioral responses to multiple stressors among undocumented individuals.     

Chapter 4. Concepts of Mental Health and Mental Illness in Older Hispanics

Abstract

The effect of cultural context in symptom expression and interpretation among older Hispanics, and how they experience psychological distress are not well-understood. We use the illness representation model to learn about older Puerto Ricans' and Dominicans' conceptions and causes of positive mental health, the causes of emotional problems, the conceptions and causes of depression and anxiety, the distinction between depression and anxiety, and the relationship between age and depression. Greater understanding of the meaning of symptoms and syndromes of depression and anxiety might help to define more culturally-sensitive mental health treatments and service delivery systems.     

Effects of Out-of-Pocket Payments on Access to Maternal Health Services in Almaty,Kazakhstan: A Qualitative Study

The current study addresses health care reform in transitional countries and explores the impact of out-of-pocket payments on access to maternal health services drawing on Kazakhstan's case. Data on out-of-pocket payments and access to maternity care were generated through qualitative in-depth interviews conducted in Almaty during the period 2009–2010. The results indicate that while health sector reform was designed to improve the quality of care and equity, the introduction of official user charges accompanied by a rapid growth of informal payments created financial barriers that prevented women from accessing maternal services leading to reduction in utilisation of maternity care.     

The CLAS Challenge: Promoting Culturally and Linguistically Appropriate Services in Health Care

Abstract

Vista Community Clinic's Cultural Awareness Program (CAP), funded by the US Office of Minority Health, aims to institutionalize culturally and linguistically appropriate services as outlined in the federal Culturally and Linguistically Appropriate Services (CLAS) Standards for the diverse San Diego County population through the promotion of organizational change at all levels of health care. The CAP program hopes to contribute to this end through offering educational sessions, aiding health care organizations in making changes to their structure in the areas of culture and language, as well as through the development of a website and a resource manual. Facilitating systems change in culturally and linguistically appropriate service delivery has proven to be the most challenging component of the CAP program. Based on seven years of experience in this area, CAP program staff proposes that the success of culturally and linguistically appropriate services depends on the degree to which organizational “buy-in” is achieved, the enforcement of the standards and the ability of health care organizations to work in collaboration with the community in which they serve.     

A Psychological Re-Examination of Mental Health Problems among the 9/11 Terrorists

ABSTRACT

More than 15 years have passed since the terrorist attacks of 11 September 2001, and a comprehensive re-examination of the 9/11 attackers is now warranted. Research on the psychology of terrorists has evolved dramatically, and there is also new information on some offenders. The present study provides the available psychological and psychiatric evidence on each of the 9/11 pilots, muscle hijackers, and thwarted hijackers who intended to participate in the “planes operation.” Overall, findings suggest that the 9/11 terrorists may have had significantly more mental health problems than previously assumed, and the leaders who planned 9/11 personally approved suicide attackers with prior histories of mental illness. By widely publicizing this information, security officials may be able to more effectively delegitimize suicide terrorism and reduce the number of individuals who would consider funding, supporting, or committing these deadly attacks.     

Knowledge management and communities of practice in the private sector: lessons for modernizing the National Health Service in England and Wales

The National Health Service (NHS) in England and Wales has embarked upon a radical and far–reaching programme of change and reform. However, to date the results of organizational quality and service improvement initiatives in the public sector have been mixed, if not to say disappointing, with anticipated gains often failing to materialize or to be sustained in the longer term. This paper draws on the authors' recent extensive research into one of the principal methodologies for bringing about the sought after step change in the quality of health care in England and Wales. It explores how private sector knowledge management (KM) concepts and practices might contribute to the further development of public sector quality improvement initiatives in general and to the reform of the NHS in particular. Our analysis suggests there have been a number of problems and challenges in practice, not least a considerable naïvety around the issue of knowledge transfer and 'knowledge into practice' within health care organizations. We suggest four broad areas for possible development which also have important implications for other public sector organizations.     

Chapter 2. Mental Health in the Hispanic Immigrant Community

Abstract

This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.     

An Evaluation Framework for Budget Reforms: A Guide for Assessing Public Budget Systems and Selecting Budget Process Reforms

While new tax proposals are evaluated with reference to formal evaluation criteria, no such standards exist for evaluating budget proposals. We propose an analytic framework to assess budgets across a series of dimensions, including whether it instills aggregate fiscal discipline, facilitates strategic prioritization of expenditures, and encourages effective and efficient use of budgeted resources, offering fiscal stability. The process also may be transparent, timely, and support public awareness and participation. We use this framework to evaluate the US budget, considering both areas of systematic inefficiency, while reviewing the history of budget reforms. We examine recent, frequently offered proposals that target specific budget process goals, considering how each affects all the budgeting goals, including interactions. We consider how a potential reform, aimed at addressing the failure to accomplish one normative goal, may impacts other goals, sometimes to the point of undermining overall progress.     

Public Sector Commissioning: Experiences of Voluntary Organizations Delivering Health and Social Services

The perceived benefits to users and beneficiaries of voluntary organizations delivering public sector services have been well documented and include the engagement with parts of society that the state cannot reach, personalized service delivery, and improved services. There is a lack of clarity, however, as to whether these perceived benefits are being realized. This article presents the experiences of voluntary sector organizations involved in public sector commissioning. The research suggests that the public sector is limiting the voluntary sector's engagement in service design and performance monitoring. These findings raise questions about the role of the voluntary sector in public service provision.     

Resilience in the Face of Adversity: African Immigrants' Mental Health Needs and the American Transition

The aims of this qualitative study were to explore key sources of emotional distress and coping strategies among West African immigrants. Thirty-eight adult West African immigrants participated in six semistructured, open-ended focus group sessions. Focus group data were analyzed using a grounded theory approach. While participants reported high levels of psychological distress associated with racial/cultural discrimination, intimate partner violence, parenting, extended-family demands, and problematic immigration status, they demonstrated resilience and the ability to identify a range of coping strategies that draw on their cultural heritage. Only two of the participants reported having used psychological services; both outcomes were negative. The findings of this study are considered in terms of their clinical implications.     

The Audit Commission's View of Politics: A Critical Evaluation of the CPA Process

The Comprehensive Performance Assessment (CPA) process introduced in the wake of the Local Government Act 2000 was in essence a managerial tool applied to a political environment. An analysis of the Commission's first tranche of CPA reports reveals a particular perspective on the role of politics and parties in local authorities which raises issues about the Commission's competence and legitimacy to make such judgements. Composite pictures of the ‘good political authority’ and the ‘poor political authority’ can be drawn up, which display a degree of political naivety and a failure to recognise the differences between political and managerial logic. It is concluded that the CPA process should have taken the political culture of an authority as a ‘given’ (at least in the short term), and evaluated the performance of the authority's management in the political circumstances in which they had to operate. Finally the role of the CPA process in contributing to the government-led pressures for depoliticisation of local decision-making is examined, with a particular concern about the substitution of the concept of ‘the good of the area’ for the different priorities and visions of different parties.     

American Views About Public Services: A Challenging Paradox for Public Administrators

This review of public opinion about the role of government in the United States finds a perhaps surprising combination of conservative and liberal beliefs. For example, while they are strongly supportive of tax cuts, Americans also want more government activism in a wide variety of areas. This certainly presents a challenge for public administrators and government since the means for fulfilling these desires of the citizens are far from readily apparent.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

An East-West Approach to Serving Chinese Immigrants in a Mental Health Setting

Abstract

This article discusses the unique design of a community day treatment program that addresses the issues of loss and acculturation for a Chinese American immigrant population who suffers from chronic mental illness. The program utilizes an integrated, multi-cultural milieu of staff and clients to create a microcosm of the diversity of American society, and reflects the agency's belief in the affirmation of the clients' cultural heritage as a more effective way of supporting clients in their recovery process. Case vignettes are used to illustrate the importance of helping immigrant clients who are marginalized in society to feel accepted, empowered and hopeful in their lives in a new country.