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This paper provides an overview of psychosocial and mental health theory and practice as it has emerged in contexts of war, post-war, and transitional situations. It identifies several models that have guided much of this work until now, critically examines their underlying assumptions, and posits a series of limitations inherent in the dominant paradigm of post-traumatic stress disorder, especially as applied in the aftermath of political violence. It argues that psychosocial work as part of reparations processes must be designed and enacted within specific historical, cultural, sociopolitical contexts, with singular individuals and their particular communities. This perspective permits more effective ways of responding to and working within the diversity of challenges facing societies seeking to reconstruct in the wake of war and other forms of organized political violence. An alternative framework for this work is proposed, which must be articulated and shaped in practice by individuals, families, and groups in their neighborhoods, communities, and societies. Exhumations and reburials, in two distinct contexts, are examined as sites for psychosocial work within reparation processes. The paper concludes by describing ongoing questions that challenge psychosocial workers hoping to contribute to reparations work.

This epilogue presents some concluding thoughts. It argues that America's therapeutic trend in ethics — the tendency to approach moral matters in terms of mental health — was politicized by America's culture wars during the second half of the 20th century. It comments on the political resonance of three themes: healthy morality, responsibility for health, and mental health as moral-laden.

This chapter discusses consumption disparities in outpatient mental health services among a diverse insured working population. It first observes that despite paying equal insurance premiums and enjoying equal insurance coverage, lower-income and non-white workers consume fewer insurance benefits than their white and higher-income coworkers. It finds no evidence, however, that this disparity leads to adverse health outcomes. It additionally finds that non-whites and low-income individuals are more likely than their white and high-income counterparts to obtain mental health care from general practitioners rather than mental healthcare providers, and nearly twice as likely not to follow up with a mental health provider after hospitalization with a mental health diagnosis. These findings suggest that low-income and non-white individuals might be paying for health services that primarily benefit their white and more affluent coworkers. Many of these regressive consequences can be attributed to mental health insurance carve-outs, which are a product of the fragmented delivery of health care.

This chapter reviews studies of mental health service need and use in children involved in the child welfare system. It presents two comprehensive views: one of the research literature leading up to the NSCAW study, and another that depicts mental health service use in this population over a full 36 months. It considers three distinct age groups of children: those aged 2 to 5 years, those 5 to 10 years, and those 11 years or older. In addition to offering the most detailed examination of the use of mental health care by the younger children involved in child welfare, the chapter is perhaps the first study that uses a measure of developmental functioning to examine need for care in the youngest group (2-5 year olds). The striking finding is the larger gap between need and use for this youngest segment of the NSCAW cohort. Meanwhile, the findings about the powerful role of race/ethnicity in use patterns confirms at the nationwide level major findings from all local studies that have examined this question.

The conventional model of treatment for mental illness involves a dynamic of expert and patient. By contrast, a social development approach to treating mental illness embraces the core tenets of the client-led wellness, recovery and resiliency movement. This chapter compares the two approaches and explores how a social development approach can harness social capital and human capital to promote wellness and integrate mentally ill people into their communities. These principles are explored through a case study of the Village, a residential community located in Long Beach, California, where clients are involved in every level of organizational decision-making, provide peer-support services, and run businesses including catering and a credit union.

This chapter focuses on the ways moral values are embedded in conceptions of mental disorders and positive health, focusing on when mental health is defined negatively, as in the absence of mental disorders. In the Republic, Plato proposes that the health of the mind consists in exercising the cardinal virtues: practical wisdom in making judgments, courage in confronting dangers, temperance in satisfying appetites, and justice in manifesting inner harmony in desirable conduct. Immorality is the absence of healthy self-governance, whether due to ignorance, cowardice, lack of self-control, or inner chaos. For Plato, “moral health” and “moral sickness” are not mere metaphors. They refer to mental health and pathology as defined by concepts of virtue and vice. Critics of the therapeutic trend denounce Plato's proposal as a dangerous confusion — dangerous, because equating morality with mental health gives health professionals alarming power in moral matters; confusion, because mental health and virtue are entirely different. The chapter affirms Plato's core insight: mental health and moral virtue are significantly interwoven in their meaning and reference. This is true when mental health is defined negatively, as the absence of mental disorders.

This chapter gives an overview of the wide range in capacity and availability of mental health services around the globe. The first section discusses the concepts, definitions, measurement instruments, and sources of data bearing on global mental health and mental illness. That information provides background for the balance of the discussion by exposing the dearth of system-level instruments and readily comparable global data to help guide international public mental health policy. This is followed by an exploration of selected data on mental health systems around the world. Finally, the chapter presents a brief summary of mental health-related activities by leading international agencies.

This chapter shows a high level of continuity in mental health care use over the 36-month NSCAW study period. The pattern of continuity is robust across methods, which confers additional confidence in the finding. This hopeful finding suggests not only that the child welfare system serves as a gateway to the mental health system, but also that the pathway through it to mental health service survives termination of child welfare system involvement.

This chapter analyzes the mental health care needs and service use for caregivers involved with the child welfare system, who experience symptoms of depression warranting a psychiatric diagnosis. Noteworthy findings include the high rate of caregiver depression, a 40% rate that greatly exceeds both the rate of depression in the general population and the rate for female welfare recipients; and the large gap between need for mental health care and reported use of such care for serious depression. An unusual feature of the chapter is the highly innovative use of NSCAW longitudinal data to group depressed caregivers into the categories early recovery, recovered and relapsed, and delayed recovery, in order that these caregivers' use of mental health services may be compared. It also reports a number of sobering consequences of caregivers' depressive illnesses for children and the role that mental health services may play in affecting those consequences. The chapter provides a model discussion of clinical and practice implications emerging from these empirical findings.

This chapter is a casebook of specific examples, drawn largely from interviews conducted with community researchers studying different aspects of children's health. The cases are intended to serve as a reference guide for those wanting to conduct collaborative community research.

This chapter continues the discussion began in Chapter 1 on the ways moral values are embedded in conceptions of mental disorders and positive health, focusing on when mental health is defined positively, as psychological well-being. Positive conceptions of health invariably embody or presuppose moral values. Marie Jahoda identified six (overlapping) criteria for positive health, which today, is the starting point for many contemporary discussions. These are: (1) self-esteem, (2) psychological integration, (3) personal autonomy, (4) self-actualization, (5) social coping, and (6) realistic cognition. It is argued that these criteria are closely linked, respectively, to self-respect, integrity, moral autonomy, authenticity, responsibility, and truthfulness. They are not synonymous with these virtues, however, and each feature can be unfolded in subjective or objective directions, thereby reflecting ambiguities in the therapeutic trend.

This chapter outlines key principles of collaboration that can guide efforts to involve consumers, family members, providers, administrators, and community members more fully in child mental health services research efforts. It then highlights opportunities for collaboration across the research process, from the development of guiding research questions, to study methods and procedures, to interpretation of study results and dissemination activities. Examples of the challenges that arise in collaborative efforts with youth and their families, providers, systems, and communities are discussed. Finally, a discussion of next steps for child mental health services research is offered.

This introductory chapter begins by laying out the theoretical foundations of this book, namely, that (1) sound morality is healthy; (2) we are responsible for our health, mental as well as physical; and (3) moral values permeate psychotherapy and conceptions of mental health. It then considers some moral controversies, such as drugs, homosexuality, and child abuse that illustrate the cultural ambivalence about how morality and mental health are related. The integration of morality and therapy, and pragmatism and virtue ethics are discussed.

This chapter documents how activism in education politics turned the attention of conservative women to professional psychology as a logical next target. Fears of “brainwashing” segued into fears of mental health professionals and the policy making they promoted in Washington, D.C., resulting in conservative protest of an amorphous “mental health establishment.” Anticommunist activists characterized psychology as a dangerous medicine that could be used to manipulate thought and, by extension, political will. Although conservative intellectuals scoffed at the conspiracy theories circulated by the “hysterical” housewives, the women's arguments nevertheless found their way into criticism articulated by scholars and politicians by the mid-1960s.

This chapter examines pathways to the service system and the effects of stigma on both access to and utilization of mental health services. It first presents an overview of the process of seeking mental health treatment in community-based settings and briefly discusses stigma and financial barriers to mental health care. It then explores some of the most significant public health campaigns targeting the stigma associated with mental illness and treatment seeking. Finally, it examines a range of policy initiatives that have sought to eliminate or reduce financial barriers that stand between treatment need and treatment receipt.

Mental models are the largely unconscious ideas and beliefs that structure what we think about–and what we do not consider. Mental models represent mental short-cuts and limitations. This chapter looks at the mental models that shape our organizations, especially healthcare and human service delivery environments. Looking through the lens of mental models enables us to see the ethical conflicts that lie at the heart of so many caring environments today. The chapter then focuses the lens on the mental health system and discusses the ways in which the chronic and disabling conditions that affect the mental health system represent a “system under siege”.

Based on alumni interviews, this chapter reports on the mental and physical health functioning of alumni, thus providing more empirical data about the short-term and long-term functioning of maltreated youth who were placed in foster care. The primary hypothesis was that alumni would exhibit mental and physical health difficulties that would be more severe than those of the general population.

This chapter explores how the local destiny of Chile's national program for depression was forged through pharmaceuticals. How and when women use antidepressants reflect both their practical knowledge of everyday afflictions and the shifting affective configurations of their domestic lives. In La Pincoya, psychopharmaceuticals distributed by the local primary care center in the framework of community mental health are absorbed into domestic relations. As material substrates, they can manifest care among neighbors and kin when shared in a variety of ways. They have entered a local formulary of medications informed by practical knowledges of the bodily symptoms and afflictions that are often reactions to labor instability, kinship relations, and economic indebtedness. The chapter examines how these knowledges work in relation to “health,” experienced locally, and how these knowledges—in tandem with institutional failures—can obscure rare disease processes.