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• The combination of coping with mental health problems and caring for children makes parents vulnerable.• Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of parents with a mental illness, thus contributing to their recovery.• Parents with mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting; parenthood also offers a basis for social participation.• Dedication to the parental role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children, and parenting prompts them to find adequate sources of support and leads to a valued identity.• Practitioners can support parents with mental health problems to set and address parenting related goals.
Higher and advanced vocational education prepare young adults for a career and enhance their life goals.The onset of mental illness generally occurs between 17 and 25 years. For young adults with psychiatric disabilities, educational resources are largely unavailable.
ACHTERGRONDMDMA (ecstasy) is een relatief veilige drug en induceert weinig afhankelijkheid, maar staat desondanks samen met andere harddrugs op lijst I van de Nederlandse Opiumwet. Bezorgdheid over de aan MDMA gerelateerde criminaliteit, het aantal gezondheidsincidenten en de mogelijk onterechte plaatsing van MDMA op lijst I hebben geleid tot een voortdurend debat over het huidige Nederlandse ecstasybeleid.DOELOntwikkeling van een rationeel MDMA-beleid waarbij men rekening houdt met alle aspecten gerelateerd aan de productie, verkoop en gebruik van MDMA.METHODEEen interdisciplinaire groep van 18 experts formuleerde een wetenschappelijk onderbouwd MDMA-beleid door de verwachte effecten van 95 beleidsopties op 25 uitkomsten te beoordelen, waaronder gezondheid, criminaliteit, rechtshandhaving en financiën. Het optimale beleidsmodel werd gevormd door een combinatie van 22 beleidsopties met de hoogste totaalscore op alle 25 uitkomsten. RESULTAAT Het optimale beleidsmodel bestond uit een vorm van gereguleerde productie en verkoop van MDMA, beter kwaliteitsbeheer van ecstasypillen en intensievere bestrijding van de MDMA-gerelateerde georganiseerde criminaliteit. Een dergelijk beleid zou leiden tot een kleine toename in de prevalentie van ecstasygebruik, maar met minder gezondheidsschade, minder MDMA-gerelateerde misdaad en minder milieuschade. Om de praktische uitvoerbaarheid en de politieke haalbaarheid te vergroten werd het optimale model enigszins aangepast.CONCLUSIEHet ontwikkelde optimale model biedt een politiek en maatschappelijk haalbare set van beleidsinstrumentopties, waarmee men plaatsing van MDMA op lijst I kan herzien, wat de schade van MDMA voor gebruikers en de samenleving kan verminderen. Voor de psychiatrie betekent het bevordering van therapeutisch onderzoek en minder hinder door nodeloze stigmatisering bij de behandeling van patiënten.--English:SUMMARYThe development of a rational national MDMA policy and itsrelevance for psychiatry.J.G.C. van Amsterdam, T. Nabben, G.-J. Peters, F. van Bakkum, J. Noijen, W. van den BrinkBackground MDMA (ecstasy) is a relatively safe drug and induces little dependence, but is nevertheless scheduled as a hard drug (Dutch Opium Act, List 1). Concerns about MDMA-related crime, health incidents and possible inappropriate listing of MDMA on List I have led to an ongoing debate about current Dutch ecstasy policy.Aim To develop a rational MDMA policy that takes into account all aspects related to production, sale and use ofMDMA.Method An interdisciplinary group of 18 experts formulates a science-based MDMA policy by assessing the expected effects of 95 policy options on 25 outcomes, including health, crime, law enforcement and finance. The optimal policy model consists of the combination of the 22 policy options with the highest total score on all 25 outcomes.Results The optimal policy model consisted of a form of regulated production and sale of MDMA, better qualitymanagement of ecstasy tablets and more intensive fight against MDMA-related organized crime. Such a policywould lead to a small increase in the prevalence of ecstasy use, but with less health damage, less MDMA-related crime, and less environmental damage. To increase practicality and political feasibility, the optimal model was slightly modified.Conclusion The developed optimal model offers a politically and socially feasible set of policy instrument options, with which the placement of MDMA on List I can be revised, thereby reducing the damage of MDMA to users and society. For psychiatry, it means promoting therapeutic research and less nuisance from unnecessary stigmatization in the treatment of patients.
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What happens when an etic category or label like “first-generation students” enters public discourse? In the Netherlands, public discussions of first-generation or first-in-family students and their predicaments have arisen in recent years. But few people grow up thinking of themselves in those terms. Not a common identity-marker, the concept is introduced in other moments, like in news items or in participatory research projects. But to what effect? And does it stigmatize or help?
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People with psychiatric disabilities frequently experience difficulties in pursuing higher education. For instance, the nature of their disability and its treatment, stigmatization and discrimination can be overwhelming obstacles. These difficulties can eventually lead to early school leaving and consequently to un- or underemployment. Unfortunately, support services for (future) students with psychiatric disabilities are often not available at colleges and universities or at mental health organizations.For the social inclusion and (future) labor opportunities of people with psychiatric disabilities it is of the utmost importance that they have better access to higher education, and are able to complete such study successfully. Supported Education is a means to reach these goals. Supported Education is defined as the provision of individualized, practical support and instruction to assist people with psychiatric disabilities to achieve their educational goals (Anthony, Cohen, Farkas, & Gagne, 2002).The main aim of the ImpulSE project (see Appendix 1 for information about the project's organization) was the development of a toolkit for Supported Education services for (future) students with psychiatric disabilities. The toolkit is based upon needs and resources assessments from the four participating countries, as well as good practices from these.Secondly, a European network of Supported Education (ENSEd) is initiated, starting with a first International Conference on Supported Education. The aim of ENSEd is to raise awareness in the EU about the educational needs of (future) students with psychiatric disabilities and for services that help to remove the barriers for this target group.The toolkit is aimed at students’ counselors, trainers, teachers and tutors, mental health managers and workers, and local authority officials involved in policymaking concerning people with psychiatric disabilities. It enables field workers to improve guidance and counseling to (future) students with psychiatric disabilities, supporting them in their educational careers.In the Netherlands alone, it is estimated that six per cent of the total student population suffers from a psychiatric disability—that is, a total of 40,000 students. On a European scale, the number of students with a psychiatric disability is therefore considerably high. We hope that through the project these students will be better empowered to be successful in their educational careers and that their chances in the labor market and their participation in society at large will be improved.
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This article describes a European project which was aimed at improving the situation of persons with psychiatric or learning disabilities with regard to social participation and citizenship. The project took place in three countries (Estonia, Hungary and the Netherlands) and four cities (Tallinn, Budapest, Amersfoort and Maastricht). The project included research and actions at the policy level, the organizational level and the practice level. At the policy level, the framework of the United Nations Convention on the Rights of Persons with Disabilities (United Nations, 2006) and the European Disability Strategy (European Commission, 2010) were used to look at national and local policies, at the reality of the lives of those with disabilities and at the support that professional services offer with regard to participation and inclusion. The project generated a number of insights, recommendations and methods by which to improve the quality of services and increase the number of opportunities for community engagement. In this article, we present some of the lessons learned from the meta-analysis. Although the circumstances in each country are quite different with regard to policy, culture and service systems, it is remarkable that people with disabilities face many of the same problems. The study shows that in all three countries, access to services could be improved. Barriers include bureaucratic procedures and a lack of services. The research identified that in every country and city there are considerable barriers regarding equal participation in the field of housing, work and leisure activities. In addition to financial barriers, there are the barriers of stigma and self-stigmatization. Marginalization keeps people in an unequal position and hinders their recovery and participation. In all countries, professionals need to develop a stronger focus on supporting the participation of their clients in public life and in the development of different roles pertaining to citizenship
A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.
Cannabis is commonly characterized as the most normalized illicit drug. However, it remains a prohibited substance in most parts of the world, including Europe, and users can still be subject to stigmatization. The objective of this study is to assess to what extent and how cannabis users in different countries with different cannabis policies perceive, experience and respond to stigmatization. We conducted a survey in the Dutch coffeeshops among 1225 last year cannabis users from seven European countries, with national cannabis policies ranging from relatively liberal to punitive. Three dimensions of cannabis-related stigma were investigated (discrimination, perceived devaluation and alienation) and a sum score was used to reflect the general level of stigmatization. Perceived devaluation was the highest-scoring dimension of stigma and discrimination the lowest-scoring. The general level of stigmatization was lowest in the Netherlands and highest in Greece. This indicates that punitive cannabis policy is associated with stigma and liberal cannabis policy is associated with de-stigmatization. Besides country, daily cannabis use was also found to be a significant predictor of stigma, but gender, age, household type and employment status were not.
