soci 321 readings

Gatekeeper Role in Community Mental Health

The primary role of intake clinicians in the community mental health center, involving triaging service requests and often refusing up to seventy percent of requests due to overwhelming demand and limited capacity. This role required careful documentation (a "paper trail") to ensure the institution was legally defensible in denying service

Psychiatric Hash

The bewildering volume of extensive documentation and conflicting assessments generated about James during his intensive hospital workup. The narrator notes this hash would follow him, potentially damaging his sense of self and having damning legal implications

MASH Unit Metaphor for CMHC

The community mental health center is compared to a Mobile Army Surgical Hospital (MASH unit) due to limited resources, understaffing, and the need for whoever can handle the next casualty to attend to the incoming "wounded"

Professional Ostracization

The "brutal backlash" experienced by the narrator (a clinical counselor) and her social worker colleague upon being hired for intake positions, which was historically a nursing "stronghold," illustrating acute conflict within the multidisciplinary team. Successfully navigating this hostility led the narrator to feel aligned with "the most unwanted" patients, like James

Pseudo-intellectuality

The term used by specialists to patronize James' genuine interest in philosophical, cosmological, and spiritual matters. The narrator argued this inclination was actually the "first inarticulate murmurings of a calling" that could have been fostered as a "saving grace" or way out of his suffering

Therapeutic Breakthrough Mechanism

The moment the narrator broke through James' emotional flatness by dropping the professional façade. She sincerely apologized for the system's failure and mismanagement, confirmed his negative experience, and confessed her deep concern that he would kill himself

Ethical Transgression / Boundary Crossing

The narrator's subsequent decision to step beyond professional boundaries to support James' spiritual quest. This included introducing him to her Buddhist community, attending a weekend retreat with him, and exchanging home phone numbers, a clear professional taboo

James' Final Outcome

James achieved significant, lasting gains, including resolving his suicidality and stopping drug use. By age 21, he bore himself with immense dignity and quiet confidence, demonstrating the equanimity of a Buddhist monk

Care Economy

The constellation of social relations (market, household, familial, community, state) through which care needs and wants are met. This labour is historically feminized, undervalued, and essential, as it underpins the productive economy

Firefighter Role Shift

Canadian professional firefighters, a hyper-masculinized workforce, now respond overwhelmingly to Emergency Medical Response (EMR) calls (often 50% to 75% or more of responses). These calls typically concern unmet, routine care deficits related to chronic illness, disability, or frailty

Supply-Side Driver (Managerialism)

The pressure on fire services to justify their large budgets and labour forces due to declining fire incidence. Public sector managerialism demanded measurable productive activity instead of mere "readiness," making EMR the "magic bullet" activity to win back jobs and justify staff size

Demand-Side Driver (Neoliberal Restructuring)

The rapid escalation in EMR calls consistent with the fragility and restructuring of the social welfare system since the mid-1990s. Federal funding cuts, deinstitutionalization, and hospital capacity reduction created an extreme care deficit, forcing vulnerable people to rely on 9-1-1

Gendered Division of Labour Contradiction

The involvement of secure, well-compensated, hyper-masculinized male firefighters in typically feminized, undervalued care work presents a contradiction to the unequal gendered division of labour. Fire services are structured for paramilitary, protective responses, not care

Re-casting Care

The tendency of a newer cohort of firefighters to actively redefine emergency medical care as a masculinized endeavour, despite opposition from the "old guard" who view the work as monotonous and inappropriate for their role

Mutual Support (in Encampments)

Peers who have come together for mutual assistance to meet common needs that existing social institutions fail to satisfy. This support facilitated meeting daily needs (food, supplies, security) and was instrumental (material goods) rather than purely informational/emotional, reflecting the socioeconomic deprivation faced

Safety in Numbers (Encampments)

The phenomenon where residents experienced protection from significant risks, including violence, sexual violence, and the negative effects of public stigmatization. This was enabled by the presence of a trusting community or "family" built through shared marginalization

Overdose Risk Reduction (Encampments)

The enhanced safety mechanism in encampments compared to isolation in shelters. Residents engaged in peer-to-peer checking ("I'm going to go use, can you come check on me in a bit?"), helping to reduce fatal overdose risks

Relational Autonomy (Encampments)

A concept acknowledging that people's agency is tied to their interdependence with others. Encampment residents found greater self-determination and collective control over decisions compared to the rigid rules and power structures imposed in shelter settings

Violent Uncertainty

A form of violence enacted through systematic institutional and social instability that exacerbates inequality and injects fear. It refers specifically to the harms inflicted on migrants, asylum seekers, and refugees by policies that intentionally prolong insecure immigration status

Slow Violence (Asylum System)

The daily compounding harm inflicted on asylum seekers through the punitive nature of the waiting process, including low financial support, inability to work or study, and constant threat of removal, which consumes their daily existence with the act of survival

Health Impact of Waiting Time (Refugees)

Longer asylum waiting time is associated with poorer self-reported emotional and physical health at the time refugee status is granted. Critically, this negative effect on emotional health persists 21 months post-settlement

Gendered Vulnerability (Refugees)

Female refugees were significantly more likely than men to report poorer emotional and physical health outcomes. Moreover, the negative association between longer asylum waiting time and poor health was found to be statistically stronger among women refugees

In the case of James, what were the key presenting issues when the author first met him at almost 19 years old

he was profoundly suicidal, had been hospitalized after fantasizing about killing his parents and himself, abused marjiuana, and had dropped out of college

what coercive treatment did James experience at the beginning of his hospital stay?

he was sedated and placed in isolation in a ‘quiet room’

the author describes the community mental health centre’s intake position as primarily that of a

gatekeeper

what percentage of requests for service was the author’s intake team refusing at the community mental health center

up to 70% and more

what was the source of the acrimonious rift between nursing staff and other clinical professionals at the author’s mental health centre

the hiring of a clinical counsellor (the author) and a social worker to fill intake positions traditionally held by nurses

what was the ultimate vague but extensive diagnosis given to James after his hospitalization

it ranged from major depression and anxiety to prodromal psychosis, borderline or antisocial personality disorder, complicated by marijuana abuse

James’s interest in philosophical matters was noted by specialists and patronized as

intellectual posturing

after being discharged from the hospital the first time, what remarkable advice was James given?

to go home and monitor himself for signs of psychosis

what did the author initially feel halfway through her first session with james

she knew beyond all doubt that she did not want to work with him because he scared her

the community mental health center is compared to a __ unit, with limited resources and staff attending to incoming casualties

MASH

What argument did the author use to try to transfer James’s file, which placed her line manager in an ethically compromising bind?

she claimed it meant ‘working outside of my scope of practice’

how did James react when the author confessed her part in the mismanagement of his case and her concerns for him?

his flat-eyed impassivity fell away almost immediately, and he became eager to share his project

what did James’s journals reveal about his internal state?

his search for patterns in the universe, self-loathing, rage, terror, and a desire to share his unique perspective

how did the seasoned psychiatrist at the mental health center treat James during his assessment?

he humiliated James by asking him to extemporize on Kant and waited while James sat dumbly, unable to answer

the author suggests that James’s interest in philosophy was not seen as a potential calling but was instead inerpreted as something ___ that needed to be rooted out and shamed

phony and insincere

what professional boundary did the author cross when she took James to his first Buddhist meditation retreat?

she transported a patient in her personal vehicle, which was uninsured for such purposes, and exchanged home phone numbers

what advice did the world-renowned meditation teacher give James, contradicting the authors hopes

he assured james that he had much to gain by meditating alone

what was one of the most significant improvements James made in the first several months of therapy

he stopped using cannabis and LSD

according to the author, James’s relentless pursuit of something beyond himself, or its pursuit of him, had been his

saving grace

why was james refused admission to train as a monk at a Buddhist temple

because he was still under the care of mental health and on medication

by the end of his treatment, what did the psychiatrist who had initially treated james with disdain comment about his transformation

he commented with amazement that james appeared to habe the poise of a man twice his age

according to Braedley, what type of work are professional urban fire services in the US and Canada now significantly engaged in?

care work, as emergency medical first responders

Term: Care Economy

the constellation of social relations through which care needs and wants are met, including market, household, familial, community, and state actors

feminist political economists refer to the labour involved in care activities as

social reproduction

what is the ‘care crisis’ as identified by feminist political economists

a net overextension of an undervalued care labour force and growing unmet needs for care

fire services work remains highly __, meaning its norms, values, and culture are organized for male bodies and those socialized as men

masculinzed

what is a key supply-side factor that led fire services to become more implicated in care work

the introduction of the 911 emergency response system, which positioned them as first responders due to their rapid arrival times

what perspective did public sector managerialism bring to the evaluation of fire services’ productivity

it switched the benchmark from ‘readiness’ to ‘activity,’ expecting firefighters to produce measurable output throughout the workday

what was the ‘magic bullet’ that allowed fire services to justify their budgets and labour force size amidst declining fire incidence?

emergency medical response, which quickly became their single largest category of response

what major demand-side factor, starting in the 1990s, dramatically increased the need for emergency medical response in Canada?

neoliberal restructuring of the Canadian social welfare system, which cut funding for health care, social services, and deinstitutionalized vulnerable populations

what did Braedleys research finding regarding ‘regulars’ in the context of fire services’ medical calls?

they are people to whom firefighters respond repeatedly due to chronic illnesses, disabilities, and lack of access to appropriate services

in the observed division of labour between firefighters and paramedics, what tasks did firefighters most often perform?

lifting and moving bodies, soothing individuals and families, and gathering belongings, freeing paramedics to focus on medical assessment

how is the emergency care work being actively re-cast by some newer firefighters

it is being re-cast as a masculinized endeavour that requires toughness and emotional skill to handle difficult situations

the increased use of emergency medical response is concurrent with shifts that pushed more care out of public institutions and onto

private homes, marketized providers, and community groups

according to Boucher et al., what is ‘mutual support’ in the context of people experiencing homelessness

it is support between peers who share similar challenges and perceive their needs are not met by existing social institutions

Concept: Relational Autonomy

a conception of autonomy that highlights how a person’s agency is embedded in and cannot be understood without considering their interdependence with other people and their social environment

what were the three key types of supportive interactions identified among encampment residents

1. informational (advice)

2. emotional (caring)

3. instrumental (sharing material goods)

what was a key benefit of encampment living that almost all participants emphasized

being able to watch each other’s personal possessions when someone had to leave

how did mutual support among encampment residents reduce the risk of fatal overdose

residents would ask friends to check on them while using drugs, creating a peer-to-peer support system absent in isolating shelter hotels

how did encampment residents often buffer themselves against the stigmatization and discrimination they faced from the public

through the support and solidarity they had with other residents in their community

a participant contrasted the outside world’s security with the encampment’s community, stating: ‘They have their security, we have our….”

community

what positive impact did living in the encampment community have one one resident’s mental health, according to her doctor

her doctor said she could hear in the resident’s voice that she ‘didn’t sound completely traumatized for the first time in months’

compared to restrictive shelters, the mutually supportive community in encampments allowed for greater __ among residents

autonomy

The study by Boucher et al. suggests that social services should honour and reinforce people's existing support networks within the homeless community, rather than only focusing on connections _____ that community.

outside

What is the concept of 'violent uncertainty' as introduced by Grace et al.?

A form of violence inflicted on migrants enacted through systematic personal, social, and institutional instability that injects fear into daily interactions.

What is an example of a direct harm created by government policies of uncertainty for asylum seekers?

The impact on mental and physical health from undermining their security through detention, travel bans, and public degradation.

In the UK, while awaiting an asylum decision, asylum-seekers' lives are intentionally put '_____'.

on hold

The Phillimore & Cheung study hypothesized that a longer asylum wait time _____ the likelihood of self-reported health problems.

increases

What did Phillimore & Cheung's study find regarding the persistence of the link between asylum waiting time and health?

The negative effect on emotional health persists 21 months after the refugee status is granted.

According to the Phillimore & Cheung study, which gender was more likely to report poor emotional and physical health due to long waiting times?

female refugees

The hypothesis that religion _____ the negative association between waiting time and health was only partially supported.

ameliorates

What was the key finding regarding the association between waiting time and emotional health for male refugees at the time of grant?

There was no statistically significant association.

The study's findings support claims that policies of uncertainty have the potential to _____ the integration of those granted refuge.

undermine

Menjívar and Perreira refer to the '_____' of adversities and disadvantages over time and place, with gender being a key dimension.

accumulation

In the author's community mental health centre, cases were presented by intake nurses and assigned, sometimes under _____, to clinical staff.

duress

What did James do after his first hospital stay that showed the system was too overwhelmed to notice or care?

He stopped his medications and dropped out of the system.

The author admitted to James that she represented the gross inadequacy of a system that sustained her at his _____.

expense

James's candour combined intellectual maturity with innocence and urgency, and he addressed the author as an _____.

equal

Why did the author initially evade James's personal questions about her spiritual practice?

She was afraid of influencing him, revealing her own ragged spiritual history, and stepping beyond her professional role.

What was the author's 'tipping point' that stripped away the final vestiges of her professional identity?

The day James brought her religious tracts from the Buddhist temple, exposing her own 'fraudulence' in the face of his wholeheartedness.

Neoliberal reforms in the care economy have included initiatives to privatize, restrict, or end public sector service provision and send more responsibilities to _____.

households

According to one firefighter, most of their medical calls are to deal with 'the lonely, the _____, and the unlucky'.

losers

The study on encampments found that the homelessness sector should acknowledge that residents form their own _____ communities.

positive

The common enforcement of bylaws against encampments in Canada has continued to harm residents and violate international _____ law.

human rights

In the study on asylum seekers, longer waiting time was significantly associated with greater odds of reporting poorer emotional health for which gender?

Female refugees.

The study by Phillimore & Cheung uses data from what longitudinal survey?

The Survey of New Refugees (SNR).

What was the author's primary fear regarding James that led her to try to transfer his file?

She was afraid he might be a danger to her, find out where she lived, come to her home, or kill himself on her watch.

James believed that what substances had been responsible for altering his mind and opening it to a source of understanding he now craved?

Marijuana and LSD.

According to Braedley, public sector _____ created pressure for fire services to justify their large labour forces and budgets as fire incidence declined.

managerialism

According to a firefighter in Braedley's study, a marked increase in calls from people who couldn't cope occurred almost the day that what policy went into effect?

The policy of phasing down programs for disability or mental health and 'mainstreaming' people into the public.

The study on Toronto encampments suggests that policies should not isolate people from their beneficial _____.

social connections

What was the ruling of the Ontario Superior Court of Justice regarding an injunction to stop encampment evictions during the COVID-19 pandemic?

The injunction was rejected in October 2020

The concept that people experiencing homelessness are put in the position of proving their '_____' to receive supports is a key aspect of their social exclusion.

deservingness

The study on violent uncertainty found that being a victim of an attack significantly increased the odds of reporting poorer emotional and _____ health.

physical

in 2023, Canada welcomed close to 472,000…

immigrants

who was “Marcus”

• an undocumented migrant who came to Canada in 2008

why did Marcus come to Canada

• better opportunity

• more difficult to go to the US

• easier to come to Canada

• back home heard Canada would allow him to find jobs to help his family

has Marcus had the opportunity to go home and see family

no

• “it’s hard”