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Since the introduction of the Mental Health Act (MHA) in 1995, mental health services have expanded at the community level in Korea. While community facilities for mental health have grown considerably, large numbers of people with mental disorders are accommodated as before in private mental hospitals. Korea needs to reduce the level of dependence on long-term treatments in hospitals and expand coverage of services for the people with mental illness (PMI) to all in local communities. To achieve this objective, the significant legislative changes were made through the amendment of the MHA. The completely revised act indicates that the Korean government seeks a harmonized balance between inpatient care and outpatient care by declaring the necessity of various welfare services to ensure human rights of the PMI. Particularly, mental health system furthers to provide comprehensive services for the majority of community population to monitor risk factors of mental disorders as well as for the PMI. In this sense, the Korean government could refer to the British case of “Improving Access to Psychological Therapies” as suggested by an OECD investigation team. Achieving the goal calls for both a deliberate realignment of existing services and additional resources in line with legislative reforms. Further public efforts should be made in collaboration with medical institutions and private service providers to realize the valuable goals pursued by the amended act.

Domestic violence is a prevalent social issue in Korea affecting a significant number of people every day. It is thus important to examine how the experience of domestic violence affects their mental health to better address their needs. Using stress-coping theory as a theoretical framework, this study examines the domestic violence and depression relationship among Korean men and women. Two aspects of self-esteem and informal and formal social support are examined as potential mediators of this relationship. The data was the first wave of Korean Welfare Panel Study data including 2477 individuals with experiences of abuse. Structural equation modeling procedures were used for analyses. Domestic violence was significantly associated with self-worth, self-deprecation, and depression. The experiences of violence eroded self-worth while reinforcing self-deprecation and those with more exposure to violence showed a higher level of depression. Self-deprecation played a significant role in mediating the effect of domestic violence on depression. However, different findings were yielded for social support. While informal social support was significantly associated with domestic violence, formal social support was not associated with domestic violence. Findings suggest for mental health interventions targeting self-esteem, particularly the diminution of self-deprecation in working with the victims. Suggestions for future research and implications for social work are also discussed.

As most previous studies have focused on a unidirectional relationship between depression and alcohol use using cross-sectional data, not much is known about the reciprocal relationship between them. Using two waves of longitudinal data, this study examines their reciprocal relationship and whether it varies by employment status, using structural equation modeling (SEM). A theory-based SEM was developed based on the tension reduction hypothesis and the intoxication hypothesis. The reciprocal relationship between alcohol consumption and depressive symptoms was found to be statistically significant. However, the relationship between the two varied by employment status. For the unemployed, the effect of depressive symptoms on alcohol consumption was significant whereas the effect of alcohol consumption on depressive symptoms was significant among the employed. These findings suggest that alcohol and mental health prevention programs should be tailored in terms of the users’ employment status.

SUMMARY This study examines whether the factor structure of the Rosenberg Self-Esteem Scale consists of two dimensions (Owens, 1993), and whether the two dimensions are associated with different predictive factors and behavioral outcomes among individuals with severe mental illness who are served by community-based, psychosocial rehabilitation agencies. Confirmatory factor analyses of data from these individuals indicated that the traditional global self-esteem scale does reflect two dimensions-i.e., self-enhancement and self-deprecation. Bivariate and multivariate analyses revealed that factors associated with self-enhancement differ from factors associated with self-deprecation. These findings support the validity of two dimensions of self-esteem. Implications for social work practice and research are presented.

Deinstitutionalization has increased the importance of community mental health services, resulting in increasing numbers of consumers living in communities and more community-based psychosocial rehabilitation (PSR.) services agencies (Reid, 1995; Segal, 1995). PSR service agencies differ from traditional community mental health programs that mainly focus on managing psychiatric symptoms. In addition to symptom control, PSR agencies aim to better support consumers' choices and to promote more effective adaptation to society (Silverstein, 2000). Specifically, these agencies focus on social or vocational rehabilitation services to enhance consumers' social and vocational skills, assuming that attaining higher levels of education (Mowbray, Collins, & Bybee, 1999) or obtaining competitive employment (Mueser et al., 1997) are critical for consumers' successful adaptation to modern society. One of the most significant problems encountered by psychiatric consumers is the experience of the stigma of mental illness (MI) (Farina, Fisher, & Fisher, 1992), which limits opportunities for education, employment, and social relations. In addition to the nature of MI, limited opportunities are the consequences of not only social rejection and discrimination (Noe, 1997; Link, Cullen, Frank, & Wozniak, 1987), but also social withdrawal (Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). To do well in education or employment, psychiatric consumers must successfully cope with the stigma of MI that may negatively influence their self-esteem and behavioral coping (Link et al., 1989). How can social workers help consumers develop healthy behavioral coping mechanisms with more selectively tailored interventions corresponding to their psychological and behavioral characteristics? Because of a lack of empirical research on this question, limited practice guidelines are available. THEORETICAL BACKGROUND Attitude theory posits that individuals' behaviors are directed by their attitudes, which are influenced by cognitive and affective traits (Fiske, 1998; Petty, Wegener, & Fabrigar, 1997). Attitudes are commonly defined as summary evaluations of objects (Petty, et al., 1997) that range from positive to negative (Petty, Priester, & Wegener, 1994). Rosenberg (1965) defined self-esteem as a positive or negative attitude toward the self. Thus, self-esteem reflects how individuals evaluate themselves (Brown, Dutton, & Cook, 2001). Conceptualizing self-esteem as an attitude toward the self allows us to use the paradigm of attitude theory in examining the mechanisms affecting and factors determinant of consumers' behaviors. Behavioral Coping Withdrawal as a coping behavior can undermine the provision of opportunities in education or employment. By contrast, inappropriate revelations of mental health treatment history (rather than keeping it secret) may cause social rejection and discrimination because of negative cultural beliefs (that is, stigma) associated with MI (Link et al., 1989; 1997). For psychiatric consumers served in rehabilitation agencies, healthy behavioral coping can be critical to success. According to attitude theory, behavioral coping is frequently determined by self-attitudes and psychological characteristics such as affective and cognitive traits. Psychological Characteristics Individuals' psychological characteristics are critical to the attitude formation process (Petty et al., 1997), and affective and cognitive traits influence self-evaluations (Levine, Wyer, & Schwarz, 1994). Although it has not been applied exactly from the perspective of attitude theory, the modified labeling theory developed by Link and colleagues (1989) accounts for the importance of cognitive traits (that is, beliefs in devaluation--discrimination) as predictors of self-esteem. Earlier studies endorsing this model (for example, Link, 1987; Link et al. …

This study analyzed factors affecting self-esteem among individuals with severe mental illness to identify effective targets for social work interventions. Data were obtained from 290 individuals with psychiatric disability recruited from community-based psychosocial rehabilitation agencies. Analyses using structural equation modeling revealed that self-esteem consists of two independent dimensions--self-worth and self-deprecation; affective characteristics are more influential than cognitive characteristics in predicting self-esteem; and the predictive factors and paths of the two dimensions differ from each other. Implications for future social work research are discussed. Key words: affect; cognition; mental illness; social work practice; stigma ********** Due to deinstitutionalization and improved treatment and rehabilitation services, more individuals with mental illness (MI) receive services at community, agencies. Social work is a major professional discipline for community mental health service providers (Stromwall, 2002). Unfortunately, the stigma of MI remains a significant problem encountered by psychiatric consumers (Dudley, 2000; Farina, Fisher, & Fisher, 1992), especially those pursuing education or employment (Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997). The influence of stigma encompasses stereotype, prejudice, discrimination, separation, and status loss (Corrigan & Lundin, 2001; Corrigan & Penn, 1999; Link & Phelan, 2001), which make individuals with MI more vulnerable to social rejection, income loss, limited opportunities for employment or education, relapse, and experiencing another psychiatric disorder (Link et al., 1989, 1997). Stigma conveys a devalued social identity and expedites loss of self-esteem (Crocker, Major, & Steele, 1998; Goffman, 1963). As maintaining a certain level of self-esteem is crucial to a successful recovery for individuals with MI (Davidson & Strauss, 1992), a significant amount of stigma research has focused on self-esteem (Link, Struening, Neese-Todd, & Phelan, 2001). The literature on stigma and self-esteem has been largely sociological, positing that expected stigma--that is, cognitive beliefs in devaluation-discrimination concerning individuals with MI (Link et al., 1989, 2001)--negatively affects self-esteem. Cognitive and affective processes are often intertwined in individual evaluations of the self (Levine, Wyer, & Schwarz, 1994). However, sociological stigma studies have not examined "affective factors" in relationship to self-esteem, nor how they are intertwined with social and cognitive processes. If affective factors are influential, they could provide additional targets and strategies for social work interventions. The current study takes a step toward an integrated model that includes both cognitive and affective factors influencing self-esteem. THEORETICAL BACKGROUND Sociological Approach Modified labeling theory (MLT), developed by Link and colleagues (1987, 1989, 1997), has provided a paradigm for examining the processes involved in MI stigma, suggesting hypothetical mechanisms to explain the negative outcomes of labeling. MLT proposes that both individuals with MI and the general public internalize negative societal conceptions of "devaluation-discrimination" associated with MI. When a person is diagnosed as mentally ill, these negative conceptions become personally relevant. The psychological, behavioral, social, and mental health outcomes of individuals with MI are thus negatively affected. According to MLT, self-esteem is critically influenced by internalized beliefs in devaluation-discrimination; and both beliefs and self-esteem are further affected by sociodemographics, mental health history (for example, diagnosis or duration of mental illness), clinical characteristics (for example, symptoms), and rejection experiences. …

We explored parenting self-construals among mothers with serious mental illness (n = 379). Mothers reported feeling moderately positively about themselves as parents, more efficacious than inefficacious, more positive than negative, more valued than disvalued; but also at least somewhat restricted and burdened by motherhood. Factor analyses revealed 3 parenting self-construal factors: efficacious, burdened, and parenting as a personal growth experience. In hierarchical regression analyses, parenting self-construal factors significantly added to prediction of parenting behaviors and attitudes (nurturance, explanatory parenting style, and parenting stress), once demographic, mental health history, and current social context variables (support, stress, and current mental health) were taken into account. Maternal parenting self-efficacy increased (while self-construal of parenting as a burden decreased) positive parenting style.

This paper provides an overview of mental health services in Korea. In order to understand the historical background of mental health service system development in Korea, this paper first provides a brief description on the history of the Korean mental health services, including a notably recent transition of mental health policy from long-term hospitalization to community-based mental health services. This paper then summarizes the characteristics of contemporary Korean mental health services in terms of its service delivery system, types of programs, characteristics of psychiatric service consumers, characteristics of service providers, and trends in the number of beds in Korea compared to those of Organization for Economic Cooperation and Development countries. In addition, discussions for future directions of the Korean mental health services are provided.