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  • ItemOpen Access
    Critical reflections on the concept and impact of “scaling up” in Global Mental Health
    (SAGE Publications, 2023) Bayetti C; Bakhshi P; Davar B; Khemka GC; Kothari P; Kumar M; Kwon W; Mathias, Kaaren; Mills C; Montenegro CR; Trani JF; Jain S
    The field of Global Mental Health (GMH) aims to address the global burden of mental illness by focusing on closing the “treatment gap” faced by many low- and middle-income countries (LMICs). To increase access to services, GMH prioritizes “scaling up” mental health services, primarily advocating for the export of Western centred and developed biomedical and psychosocial “evidence-based” approaches to the Global South. While this emphasis on scalability has resulted in the increased availability of mental health services in some LMICs, there have been few critical discussions of this strategy. This commentary critically appraises the scalability of GMH by questioning the validity and sustainability of its approach. We argue that the current approach emphasizes the development of mental health services and interventions in “silos,” focusing on the treatment of mental illnesses at the exclusion of a holistic and contextualized approach to people's needs. We also question the opportunities that the current approach to GMH offers for the growth of mental health programmes of local NGOs and investigate the potential pitfalls that scalability may have on NGOs’ impact and ability to innovate. This commentary argues that any “scaling up” of mental health services must place sustainability at the core of its mission by favouring the growth and development of local solutions and wider forms of support that prioritize social inclusion and long-lasting mental health recovery.
  • ItemOpen Access
    Dignity and Right to health award: ICMDA leadership in Christian health and development initiative
    (Christian Journal for Global Health, 2019) Mathias, Kaaren; Burke , Michael
    The Dignity and Right to Health Award (DRH) is an activity of the International Christian Medical and Dental Association (ICMDA) Leadership in Christian Health and Development Initiative. The WHO Constitution (1946) envisages “... the highest attainable standard of health as a fundamental right of every human being.”
  • ItemOpen Access
    Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study.
    (Cambridge University Press (CUP), 2023) Agarwal , Disha; Bailie , Christopher R.; Rana, Samson; Balan , Laxman; Grills , Nathan J.; Mathias, Kaaren
    Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.
  • ItemOpen Access
    Does the "Nae Umeed" group intervention improve mental health and social participation? A pre–post study in Uttarakhand, India
    (Cambridge University Press (CUP), 2023) Bailie , Christopher R.; Pillai , Pooja S; Goodwin Singh , Atul; Leishman , Jed; Grills, Nathan J.; Mathias, Kaaren
    Abstract There are few evidence-based interventions to support caregiver mental health developed for low- and middle-income countries. Nae Umeed is a community-based group intervention developed with collaboratively with local community health workers in Uttarakhand, India primarily to promote mental wellbeing for caregivers and others. This pre–post study aimed to evaluate whether Nae Umeed improved mental health and social participation for people with mental distress, including caregivers. The intervention consisted of 14 structured group sessions facilitated by community health workers. Among 115 adult participants, 20% were caregivers and 80% were people with disability and other vulnerable community members; 62% had no formal education and 92% were female. Substantial and statistically significant improvements occurred in validated psychometric measures for mental health (12-Item General Health Questionnaire, Patient Health Questionnaire-9) and social participation (Participation Scale). Improvements occurred regardless of caregiver status. This intervention addressed mental health and social participation for marginalised groups that are typically without access to formal mental health care and findings suggest Nae Umeed improved mental health and social participation; however, a controlled community trial would be required to prove causation. Community-based group interventions are a promising approach to improving the mental health of vulnerable groups in South Asia.
  • ItemOpen Access
    Mutuality as a method: advancing a social paradigm for global mental health through mutual learning
    (Springer Science and Business Media LLC, 2023) Bemme , Dörte; Roberts , Tessa; Ae-Ngibise , Kenneth A.; Gumbonzvanda , Nyaradzayi; Joag , Kaustubh; Kagee , Ashraf; Machisa , Mercilene; van der Westhuizen , Claire; van Rensburg , André; Willan , Samantha; Wuerth , Milena; Aoun , May; Jain , Sumeet; Lund , Crick; Mathias, Kaaren; Read , Ursula; Taylor Salisbury , Tatiana; Burgess, Rochelle A.
    Purpose: Calls for “mutuality” in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. Methods: We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. Results: Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators’ needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. Conclusion: Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.
  • ItemOpen Access
    A qualitative study to explore various meanings of mental distress and help-seeking in the Yamuna Valley, North India
    (Medknow, 2021) Rawat , Meenal; Jadhav , Sushrut; Bayetti , Clement; Mathias, Kaaren
    Context: In rural India, mental healthcare remains limited due to scant state services and incongruency between provider- and patient-framing distress. Help-seeking by people with mental health problems is related to how meanings of distress are understood differently by individuals, based on their interaction with various actors in the community and the available cultural explanation within their local ecologies. Methodology: This study examines the mutually constituted relationship between meanings of mental distress and help-seeking among people residing in the Upper Yamuna Valley, Uttarakhand, North India. This qualitative study builds on six in-depth interviews with people with severe mental health issues and one person with epilepsy, referred as people with psychosocial disability (PPSD) in the study. The data analysis was iterative and followed thematic approach. Results: The study found that personal belief based on one's experience, such as negative self-judgment and wider cultural explanations, such as supernatural beliefs, as well as gender roles, impacted the way people address their mental health problems, in turn shaping their help-seeking behavior. Participants lost hope for a cure after years of trying to find an effective solution. Moreover, lack of access to care and remoteness of the mountainous area made help-seeking and recovery feel impossible. Conclusions: This study underscores the need for researchers and policy professionals to explore the local context and culture to improve care and treatment quality. The study also explains that personal explanation of psychosocial problems and help seeking are not unidirectional. It is a complex phenomenon layered with the local contexts which should be addressed in clinical practice, as well as future research. Finally, clinicians' training should address the local cultural language of distress to identify the problem and suggest an effective solution.
  • ItemOpen Access
    Opening up the ‘black-box’: what strategies do community mental health workers use to address the social dimensions of mental health?
    (Springer Science and Business Media LLC, 2024) Jain, Sumeet; Pillai , Pooja; Mathias, Kaaren
    Purpose: Community-based workers promote mental health in communities. Recent literature has called for more attention to the ways they operate and the strategies used. For example, how do they translate biomedical concepts into frameworks that are acceptable and accessible to communities? How do micro-innovations lead to positive mental health outcomes, including social inclusion and recovery? The aim of this study was to examine the types of skills and strategies to address social dimensions of mental health used by community health workers (CHWs) working together with people with psychosocial disability (PPSD) in urban north India. Methods: We interviewed CHWs (n = 46) about their registered PPSD who were randomly selected from 1000 people registered with a local non-profit community mental health provider. Notes taken during interviews were cross-checked with audio recordings and coded and analyzed thematically. Results: CHWs displayed social, cultural, and psychological skills in forming trusting relationships and in-depth knowledge of the context of their client's lives and family dynamics. They used this information to analyze political, social, and economic factors influencing mental health for the client and their family members. The diverse range of analysis and intervention skills of community health workers built on contextual knowledge to implement micro-innovations in a be-spoke way, applying these to the local ecology of people with psychosocial disabilities (PPSD). These approaches contributed to addressing the social and structural determinants that shaped the mental health of PPSD. Conclusion: Community health workers (CHWs) in this study addressed social aspects of mental health, individually, and by engaging with wider structural factors. The micro-innovations of CHWs are dependent on non-linear elements, including local knowledge, time, and relationships. Global mental health requires further attentive qualitative research to consider how these, and other factors shape the work of CHWs in different locales to inform locally appropriate mental health care.
  • ItemOpen Access
    Women's freedom of movement and participation in psychosocial support groups: Qualitative study in northern India
    (Springer Science and Business Media LLC, 2019) Gailits N; Mathias, Kaaren; Nouvet E; Pillai P; Schwartz L
    Background: Depression, the world's leading cause of disability, disproportionately affects women. Women in India, one of the most gender unequal countries worldwide, face systemic gender disadvantage that significantly increases the risk of common mental disorders. This study's objective was to examine the factors influencing women's participation in psychosocial support groups, within an approach where community members work together to collectively strengthen their community's mental health. Methods: This community-based qualitative study was conducted from May to July 2016, across three peri-urban sites in Dehradun district, Uttarakhand, Northern India. Set within an NGO-run mental health project, data were collected through focus group discussions with individuals involved in psychosocial support groups including women with psychosocial disabilities as well as caregivers (N = 10, representing 59 women), and key informant interviews (N = 8) with community members and mental health professionals. Data were analyzed using a thematic analysis approach. Results: The principal barrier to participating in psychosocial support groups was restrictions on women's freedom of movement. Women in the community are not normally permitted to leave home, unless going to market or work, making it difficult for women to leave their home to participate in the groups. The restrictions emanated from the overall community's attitude toward gender relations, the women's own internalized gender expectations, and most significantly, the decision-making power of husbands and mothers-in-law. Other factors including employment and education shaped women's ability to participate in psychosocial support groups; however, the role of these additional factors must be understood in connection to a gender order limiting women's freedom of movement. Conclusions: Mental health access and gender inequality are inseparable in the context of Northern India, and women's mental health cannot be addressed without first addressing underlying gender relations. Community-based mental health programs are an effective tool and can be used to strengthen communities collectively; however, attention towards the gender constraints that restrict women's freedom of movement and their ability to access care is required. To our knowledge, this is the first study to clearly document and analyze the connection between access to community mental health services in South Asia and women's freedom of movement.
  • ItemOpen Access
    Establishing a child and adolescent mental health center in Herat, Afghanistan: a project description
    (Elsevier BV, 2023) Najm , Abdul Fattah; Niazi , Aziz-ur-Rahman; Alekozay , Mina; Allan , Emily B.; Mathias, Kaaren
    Objective: Afghanistan has witnessed a long-lasting 4-decade armed conflict, which together with high levels of poverty and interpersonal violence, resulted in high incidence and prevalence of mental disorders in general population, including children and adolescents. Until mid-2018, there was neither mental health care facility nor a child psychiatrist in Afghanistan. Here, we report the establishment of the first children and adolescents’ mental health center (CAMHC) in Herat province of Afghanistan. Methods: In July 2018, CAMHC was initiated at Mental Health Training Center – Herat. CAMHC was initially planned by the International Assistance Mission (IAM) and Herat Public Health Directorate; and financially supported by the Tearfund UK, the United Methodist Committee on Relief and Tearfund Australia. The target population of CAMHC was children and adolescents in Herat and neighboring provinces, healthcare professionals, staff of government and non-governmental organizations, school teachers and community leaders. Results: A group of eight mental health professionals were trained and made the interdisciplinary board for diagnosis and management of mental disorders in children and adolescents. During the initial three-year period, 2 448 patients, including 1 264 (51.6%) boys and 1 184 (48.4%) girls, presented with mental disorders to CAMHC. Diagnosis and management of mental disorders were performed according to standard international protocols. Eighteen awareness-raising seminars were held; 2 000 leaflets, 10 000 posters, and 30 000 brochures were prepared and distributed; and two short video clips were produced and broadcast via IAM website, social media and local TV channels. A database was developed to house for project data, assessment of outcomes and reporting to stakeholders. Conclusion: Establishment of CAMHC resulted in significant achievements in diagnosis and management of mental disorders among children and adolescents, healthcare staff capacity building, and awareness-raising about mental disorders. Data obtained in CAMHC offers government, mental health professionals and the community the opportunity of improving mental health in the region.
  • ItemOpen Access
    Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: A quasi-experimental study
    (Springer Science and Business Media LLC, 2018) Mathias, Kaaren; Pandey, A.; Armstrong , G.; Diksha , P.; Kermode , M.
    Background: Mental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Psycho-social assets in adolescents can moderate these impacts and be strengthened. The aim of this study was to assess the effectiveness of a brief mental health and resilience intervention among disadvantaged young women in urban North India. Methods: We used an uncontrolled repeated measures design to evaluate the effectiveness of the 15-module mental health and resilience curriculum among young women residing in a slum in Dehradun, Uttarakhand. Standardised psychometric assessments were done to assess outcomes of the intervention at three time-points: pre-intervention (T1), post-intervention (T2), and 8-months post-intervention (T3), covering domains of self-efficacy, resilience, anxiety, depression and gender attitudes. Results: Young women completing the intervention (n=106) had all left school before 10th class. A statistically significant improvement in all psychometric measures was found at T2. These improvements were sustained at T3 in the areas of anxiety, depression and gender equality attitudes, while the measures of resilience and self-efficacy had declined to baseline. Conclusions: This intervention delivered by community-based peers among highly disadvantaged young women can lead to sustained improvements in anxiety and depression and attitudes to gender equality. While other studies in LMIC have shown increased adolescent resilience through peer-led curriculums, this study demonstrates improvements in mental health and gender attitudes can endure 8-months post-intervention. This low-cost, brief intervention can improve mental health resiliency and self-efficacy among disadvantaged young people. Further research should explore how to bring sustained improvements in resilience.
  • ItemOpen Access
    This pākehā life: an unsettled memoir
    (2022) Mathias, Kaaren
  • ItemOpen Access
    The governance of local health systems in the era of Sustainable Development Goals: Reflections on collaborative action to address complex health needs in four country contexts
    (BMJ, 2019) Schneider, Helen; Zulu , Joseph Mumba; Mathias, Kaaren; Cloete , Keith; Hurtig , Anna-Karin
    This analysis reflects on experiences and lessons from four country settings - Zambia, India, Sweden and South Africa - on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, non-governmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.
  • ItemOpen Access
    Empowering community control over alcohol availability as a suicide and self-harm prevention measure: Policy opportunity in Aotearoa New Zealand
    (Elsevier BV, 2022) Boden , J; Hetrick S, S; Bowden, N; Fortune, S; Marek, Lukas; Theodore, R; Ruhe, T; Kokaua, J; Hobbs, Matt
    One of the most pressing issues in public health in Aotearoa New Zealand (NZ) is our rate of suicide and self-harm, particularly among young people.1,2 The 2018 New Zealand Government Inquiry into Mental Health and Addiction recognised the challenge of reducing these rates, and raised the important issue of the role of alcohol and other substance use in increasing suicide risk.
  • ItemOpen Access
    Telehealth-delivered naturalistic developmental behavioural intervention with and without caregiver acceptance and commitment therapy for autistic children and their caregivers: Protocol for a multi-arm parallel group randomised clinical trial
    (BMJ, 2023) McLay, Laurie; Emerson, Lisa-Marie; Waddington H; van Deurs, Jenna; Hunter J; Blampied, Neville; Hāpuku, Aaron; Macfarlane, Sonja; Bowden N; Van Noorden L; Rispoli M
    Introduction Timely access to early support that optimises autistic children's development and their caregiver's mental health is critical. Naturalistic developmental behavioural interventions (NDBIs) and acceptance and commitment therapy (ACT) are evidence-based supports that can enhance child learning and behaviour, and adult well-being, respectively. The traditional face-to-face delivery of these approaches is resource intensive. Further, little is known about the benefit of parallel child-focused and caregiver-focused supports. The aims of this trial are to evaluate the effectiveness and social validity of telehealth-delivered, caregiver-implemented, child-focused NDBI and caregiver-focused ACT when delivered alone and in parallel, on autistic children's social communication and caregiver well-being. Methods and analysis The study will use a randomised, single-blind clinical trial with three parallel arms: NDBI; ACT and ACT+NDBI. We will recruit a minimum of 78, 2-5-year-old autistic children and their families throughout Aotearoa New Zealand. Support will be delivered over 13 weeks using a combination of culturally enhanced web-based modules and online group coaching. Primary outcome variables include children's social communication/engagement with their caregiver as well as caregiver stress and will be evaluated using a repeated measures multivariate analysis of variance. Outcome variables are assessed at baseline (before randomisation), immediately postparticipation and at 3-month follow-up. Ethics and dissemination The trial is approved by the Health and Disability Ethics Committee (2022 FULL 12058). The findings of this trial will be disseminated through peer-reviewed journals and national and international conference proceedings regardless of the magnitude/direction of effect. Additionally, data will be shared with stakeholder groups, service providers and health professionals. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12622001134718).
  • ItemOpen Access
    Effect of Indian clubbell exercises on cricket fast bowlers’ shoulder kinematics
    (2023) Walter, Sibi; Moltchanova, Elena; Petersen, Carl
    Background: The glenohumeral joint’s rotational range of motion (ROM) and muscle strength are essential to execute the cricket bowling action. Performing shoulder rotation exercises may increase the rotator cuff muscle strength and rotational ROM. Objectives: The aim of this study was to test the effect of a six-week exercise programme on shoulder rotational ROM and muscle strength. Methods: Twenty-one healthy male cricket fast bowlers were recruited, ranked and pair-matched on initial shoulder rotator muscle strength and assigned to either a shoulder exercise (SE) group or cricket training (CT) only group. The SE group incorporated Indian clubbell exercises in addition to their cricket training. Results: Bowlers in both groups displayed a large increase on the dominant shoulder’s internal rotation (IR) ROM, but only the SE group’s bowlers displayed ROM improvements (p<0.001) bilaterally for both internal and external rotation. The CT group’s fast bowler’s non-dominant shoulder IR ROM significantly decreased (p=0.02) during the six weeks. Between groups, only the SE group’s bowler’s internal rotator muscle strength improved (p<0.001) bilaterally. The observed kinematic changes were statistically significantly greater at a 5% level for the SE group’s bowlers (bilateral internal rotators muscle strength, non-dominant shoulder IR ROM and horizontal adduction ROM). Conclusion: Maintenance of the shoulder’s rotational ROM and muscle strength is vital for a fast bowler. Cricket bowlers who perform regular clubbell exercises might increase their shoulder’s ROM and internal rotator cuffs’ muscle strength, which may aid in stabilising their glenohumeral joint while bowling.
  • ItemOpen Access
    Developing relevant community mental health programmes in North India: Five questions we ask when co-producing knowledge with experts by experience
    (BMJ, 2023) Pillai , Pooja; Rawat , Meenal; Jain S, Sumeet; Martin , Rachelle Anne; Shelly K, Kakul; Mathias, Kaaren
    Knowledge co-production can improve the quality and accessibility of health, and also benefit service users, allowing them to be recognised as skilled and capable. Yet despite these clear benefits, there are inherent challenges in the power relations of co-production, particularly when experts by experience (EBE) are structurally disadvantaged in communication skills or literacy. The processes of how knowledge is co-produced and negotiated are seldom described. This paper aims to describe processes of co-production building on the experiences of EBE (people with lived experience of psychosocial or physical disability), practitioners and researchers working together with a non-profit community mental health programme in North India. We describe processes of group formation, relationship building, reflexive discussion and negotiation over a 7-year period with six diverse EBE groups. Through a process of discussion and review, we propose these five questions which may optimise co-production processes in communities: (1) Who is included in co-production? (2) How can we optimise participation by people with diverse sociodemographic identities? (3) How do we build relationships of trust within EBE groups? (4) How can we combine psychosocial support and knowledge co-production agendas in groups? and (5) How is the expertise of experts by experience acknowledged?
  • ItemOpen Access
    Trajectories of Successful Aging Among Older Adults in Aotearoa New Zealand
    (SAGE Publications, 2023) Fasoro A; Maddocks, Wendy; Barnett P, Pauline; Basu, Arindam
    Successful aging was defined as having no multimorbidity, high functional capacity, active life engagement, and good health-related quality of life. This study analyzed data from 1433 older adults who were followed up for 12 years across seven waves from the New Zealand Health, Work and Retirement study by examining the trajectories of successful aging. Latent growth curve modeling was used to assess the growth factors of successful aging trajectories of older adults. The mean successful aging score was 3.53 (range: 0–6) in 2006 and linearly declined by 0.064 units every year. Those with higher successful aging scores at baseline had a slower decline. Successful aging scores were lower among females, Māori, and those aged 65 years and above at baseline. The findings from this study suggest that gender and ethnic inequalities play significant roles in successful aging among older adults in New Zealand.
  • ItemOpen Access
    Nurse Anaesthetists in the First World War
    (2023) Maddocks, Wendy
  • ItemOpen Access
    Improving mental ill-health with psycho-social group interventions in South Asia-A scoping review using a realist lens.
    (Public Library of Science (PLoS), 2023) Mathias, Kaaren; Jain , Sumeet; Fraser , Robert; Davis , Meghan; Kimijima-Dennemeyer , Rita; Pillai , Pooja; Deshpande , Smita N.; Wolters , Maria; Nalecz H
    This scoping review aimed to synthesise current evidence related to psycho-social groups as part of community-based mental health interventions in South Asia. We used a realist lens to pay attention to the contexts and mechanisms supporting positive outcomes. We included studies published from January 2007 to February 2022 that: were based in communities in South Asia, included a group component, reported on interventions with a clear psychosocial component, targeted adults and were implemented by lay community health workers. Two reviewers extracted data on intervention components, groups and facilitators, participant demographics and enabling contexts, mechanisms and outcomes. Expert reference panels including people with lived experience of psycho-social disability, mental health professionals and policy makers confirmed the validity and relevance of initial review findings. The review examined 15 interventions represented by 42 papers. Only four interventions were solely psycho-social and nearly all included psychoeducation and economic support. Only 8 of the 46 quantitative outcome measures used were developed in South Asia. In a context of social exclusion and limited autonomy for people with psychosocial disability, psychosocial support groups triggered five key mechanisms. Trusted relationships undergirded all mechanisms, and provided a sense of inclusion, social support and of being able to manage mental distress due to improved skills and knowledge. Over time group members felt a sense of belonging and collective strength meaning they were better able to advocate for their own well-being and address upstream social health determinants. This led to outcomes of improved mental health and social participation across the realms of intrapersonal, interpersonal and community. Psychosocial groups merit greater attention as an active ingredient in community interventions and also as an effective, relevant, acceptable and scalable platform that can promote and increase mental health in communities, through facilitation by lay community health workers.
  • ItemOpen Access
    Adoptee activism: I am not your “child for all purposes”.
    (2022) Blake, Denise; Ahuriri-Driscoll, Annabel; Sumner , Barbara
    In this article, we, three adoptee scholars, share collectively our experiences of adoption while engaging in activism that contests adoption practices. We apply autoethnographic and re!exive strategies to unpack our shared conversation in order to foreground the plight of adoptees and o"er insight into adoption and the importance of the current law reform in Aotearoa New Zealand. We draw on a model of adoptee consciousness to frame the complexity of our ‘lived experience’ and activism. In doing this we outline some of the challenges we face as adoptees because adoption, as a human-rights injustice, is largely misunderstood, overlooked, or ignored. To begin, however, it is necessary to outline the history of closed stranger adoption in Aotearoa New Zealand with the purpose of providing context.