Papers by Ippolytos Kalofonos
Community Mental Health Journal
The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visi... more The Hearing Voices (HV) Movement promotes diverse understandings of voice-hearing and seeing visions, which mental health professionals commonly refer to as ‘auditory hallucinations,’ ‘schizophrenia,’ or ‘psychosis.’ Central to this movement are peer support groups through which attendees connect with others who have similar experiences. This paper describes an adaptation of a Hearing Voices group facilitation training at VA Greater Los Angeles (VAGLA) and discusses training modifications, along with trainee perceptions and implementation and intervention outcomes. This is a first step towards adapting HV-inspired groups to VA systems of care. Data collection involved surveys of trainees (n = 18) and field notes throughout the 24 h online training. Findings indicate high acceptability and appropriateness of the training and high feasibility in implementation, suggesting the training was well-adapted to VAGLA. This research contributes to global efforts to integrate the Hearing Voice...
Journal of General Internal Medicine
New England Journal of Medicine
Biological Citizenship A man with multiple mental health conditions stops attending the clinic wh... more Biological Citizenship A man with multiple mental health conditions stops attending the clinic where he received wrap-around services. Denied Supplemental Security Income because his psychiatrist h...
Current Psychiatry Reports
Purpose of Review We review recent community interventions to promote mental health and social eq... more Purpose of Review We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/ or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, schoolbased interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. Recent Findings There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. Summary There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations. Keywords Mental health (MeSH). Mental health intervention (MeSH). Community networks (MeSH). Social problems (MeSH). Community interventions (MeSH). Community-based interventions (MeSH). Social determinants of health. Mental health equity. Health disparities. Multi-sector interventions
Anthropological Quarterly, 2017
Neely Laurenzo Myers, Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency.... more Neely Laurenzo Myers, Recovery's Edge: An Ethnography of Mental Health Care and Moral Agency. Nashville: Vanderbilt University Press, 2015. 208 pp."Recovery" has been a dominant paradigm shaping mental health policy in the United States since the turn of the millennium. A treatment philosophy that emerged from the disaster of deinstitutionalization and the disappointment of the psychopharmaceutical revolution, it draws on sources eclectic as antipsychiatry, the psychiatric survivors and consumer rights movements, and psychosocial rehabilitation (Braslow 2013). Recovery advocates envision a new system of care that produces citizens no longer doomed by the hopelessness of biological reductionism, nor dependent on social services. The central precepts of recovery have been summarized as: renewing a sense of possibility, regaining competencies, reconnecting and finding a place in society, and repairing disruptions in self and career (Hopper 2007). The role of people with lived experience of mental illness, or "peers" is central to this approach at every level, from research, policy-making, and advocacy to frontline care provision. The recovery movement's ostensibly radical "core concepts of empowerment, self-determination, and freedom of choice" (Myers 2015:7) were enshrined in George W. Bush's Presidential New Freedom Commission of 2003, an unfunded set of recommendations that many states have subsequently tried to implement. Critics see this embrace of recovery by neoliberal reformers as a move to withdraw care and services from the chronically mentally ill by declaring them "recovered" and substituting care with choice (Braslow 2013, Myers 2015:8).This is the point of departure of Neely Myers's powerful book, in which she ethnographically documents how one community mental health agency in the urban US, called Horizons, navigated the shift from "traditional" mental health services to recovery-oriented care through the creation of a peer-led treatment program. Myers documents her own intimate journey as she developed relationships with the staff and clients, or "members," of the agency. She provides a contextualized account of the stark realities of living with severe, chronic mental illness and poverty in the urban US, revealing the promises, pitfalls, complexities, and contradictions of contemporary mental health reform and the social abandonment members and staff worked against. Her detailed observations, poignant reflections, and incisive critique create a compelling account and an important contribution to medical anthropology and community psychiatry. Recovery's Edge is a story of relationships, therapeutic and traumatic, personal and professional, ruptured and repaired, lost and longed for, and often tragically unattainable.Myers's central thesis is that moral agency, "the ability to be recognized as a 'good' person in a way that makes possible intimate connections with others," is the "oft-overlooked driver of recovery" (13). Mental health crisis results in an initial loss of moral agency. This loss is perpetuated by the ways people with mental illness are treated, both by society in general and by traditional mental health programs in particular. As a result, those with chronic, severe mental illness remain isolated and marginalized.Chapter 2, "No Direction Home," establishes the context with an account of the history of deinstitutionalization and the never-delivered promise of community-based care. A major theme introduced here is the contradictions and double binds members faced as they sought to rebuild their lives despite recurring mental health crisis. One classic trap they faced was a dependence on Social Security insurance and Medicaid to pay for their high healthcare costs, yet full time, competitive employment would disqualify them of these benefits without providing a viable alternative. Members cycled through the "institutional circuit," including hospitals, jails, prisons, shelters, nursing homes, outpatient day programs, and the streets. …
Journal of Gender, Culture, and Health, 1999
Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups... more Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups to receive adequate prenatal care during their pregnancy. However, it is unclear whether this trend is the result of political economic conditions that limit access of many Latinos in the United States to adequate health services in general, or of sociocultural conditions that restrict the
Global Public Health, 2014
This paper tracks the intertwined biographies of a community home-based care (CHBC) volunteer, Ar... more This paper tracks the intertwined biographies of a community home-based care (CHBC) volunteer, Arminda, the community-based organisation she worked for, Mufudzi, and the HIV scale-up in Mozambique. The focus is on Arminda--the experiences, aspirations, skills, and values she brought to her work as a volunteer, and the ways her own life converged with the rise and fall of the organisation that pioneered CHBC in this region. CHBC began in Mozambique in the mid-1990s as a community-level response to the AIDS epidemic at a time when there were few such organised efforts. The rapid pace and technical orientation of the scale-up as well as the influx of funding altered the practice of CHBC by expanding the scope of the work to become more technically comprehensive, but at the same time more narrowly defining 'care' as clinically-oriented work. Over the course of the scale-up, Arminda and her colleagues felt exploited and ultimately abandoned, despite their work having served as the vanguard and national model for CHBC. This paper considers how this happened and raises questions about the communities constituted by global health interventions and about the role of and the voice of community health workers in large-scale interventions such as the HIV scale-up.
Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complicati... more Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complications of Weil's syndrome and a mortality of 8% were identified in Salvador, Brazil. We conducted a population-based casecontrol study to identify risk factors for acquisition of leptospirosis in neighborhoods with high endemicity during the rainy season-associated urban epidemic. Sixty-six (65%) of 101 laboratory-confirmed cases and 125 age and sex-matched healthy neighborhood controls were interviewed. Residence in proximity to an open sewer (matched odds ratio [OR] ס 5.15, 95% confidence interval [CI] ס 1.80-14.74), peri-domiciliary sighting of rats (OR ס 4.49, 95% CI ס 1.57-12.83), sighting groups of five or more rats (OR ס 3.90, 95% CI ס 1.35-11.27), and workplace exposure to contaminated environmental sources (OR ס 3.71, 95% CI ס 1.35-10.17) were found to be independent risk factors for acquiring disease. Some of these risk factors are amenable to focused interventions, which include provision of closed drainage systems for sewage and reduction of rodent populations in the peri-domicilary environment. Environmental control of transmission may help to greatly reduce the incidence of severe leptospirosis.
American Journal of Tropical Medicine and Hygiene, 2002
Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complicati... more Between March and October 2000, 157 suspected cases of leptospirosis hospitalized with complications of Weil's syndrome and a mortality of 8% were identified in Salvador, Brazil. We conducted a population-based case-control study to identify risk factors for acquisition of leptospirosis in neighborhoods with high endemicity during the rainy season-associated urban epidemic. Sixty-six (65%) of 101 laboratory-confirmed cases and 125 age and sex-matched healthy neighborhood controls were interviewed. Residence in proximity to an open sewer (matched odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.80-14.74), peri-domiciliary sighting of rats (OR = 4.49, 95% CI = 1.57-12.83), sighting groups of five or more rats (OR = 3.90, 95% CI = 1.35-11.27), and workplace exposure to contaminated environmental sources (OR = 3.71, 95% CI = 1.35-10.17) were found to be independent risk factors for acquiring disease. Some of these risk factors are amenable to focused interventions, which inc...
Author(s): Kalofonos, Ippolytos Andreas | Advisor(s): Adams, Vincanne | Abstract: Antiretroviral ... more Author(s): Kalofonos, Ippolytos Andreas | Advisor(s): Adams, Vincanne | Abstract: Antiretroviral (ARV) treatment first became publicly available in Mozambique in June of 2004. The steadily rising count of "lives saved" seems to represent a success story of high-tech treatment being provided in one of the poorest contexts in the world, and in some ways it does, as people with AIDS are experiencing dramatic recoveries and living longer. But the numbers say little about how life has changed for people with the disease. This ethnographic study uses participant observation and in-depth interviews to offer accounts of people living with HIV/AIDS at the start of the "treatment era" in central Mozambique. In a context of chronic underemployment and threadbare public infrastructure, the HIV positive status offered eligibility for free medical care and other material benefits. The number of those eligible for benefits far outnumbered availability, however, triggering inten...
Many actors in global health are concerned with improving community health worker (CHW) policy an... more Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs' desires for alleviation of their own and others' economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions.
Drawing on comparative ethnographic fieldwork conducted in urban Mozambique, the United States, a... more Drawing on comparative ethnographic fieldwork conducted in urban Mozambique, the United States, and Sierra Leone, the article is broadly concerned with the globalization of temporal logics and how specific ideologies of time and temporality accompany health interventions, such as those for human immunodeficiency virus (HIV) infection and AIDS (HIV/AIDS). More specifically, we explore how HIV-positive individuals have been increasingly encouraged to pursue healthier and more fulfilling lives through a set of moral, physical, and social practices called “positive living” since the advent of antiretroviral therapies. We describe how positive living, a feature of HIV/AIDS programs throughout the world, has taken root across varied political, social, and economic contexts and how temporal rationalities, which have largely been underexamined in the HIV/AIDS literature, shape communities’ responses and interpretations of positive living. Our approach is ethnographic and comparative, with i...
Many global health practitioners are currently reaffirming the importance of recruiting and retai... more Many global health practitioners are currently reaffirming the importance of recruiting and retaining effective community health workers (CHWs) in order to achieve major public health goals. This raises policy-relevant questions about why people become and remain CHWs. This paper addresses these questions, drawing on ethnographic work in Addis Ababa, the capital of Ethiopia, between 2006 and 2009, and in Chimoio, a provincial town in central Mozambique, between 2003 and 2010. Participant observation and in-depth interviews were used to understand the life histories that lead people to become CHWs, their relationships with intended beneficiaries after becoming CHWs, and their social and economic aspirations. People in Ethiopia and Mozambique have faced similar political and economic challenges in the last few decades, involving war, structural adjustment, and food price inflation. Results suggest that these challenges, as well as the socio-moral values that people come to uphold thro...
American Journal of Public Health, 2014
Many actors in global health are concerned with improving community health worker (CHW) policy an... more Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs' desires for alleviation of their own and others' economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions.
Medical Anthropology Quarterly, 2010
... managed with the Ministry of Health, nearly all of the funds from the largest donor, PEPFAR, ... more ... managed with the Ministry of Health, nearly all of the funds from the largest donor, PEPFAR, go to private and foreign organizations, undermining public sector services (Oomman et al ... Conroy, Anne C., Jeffrey D. Sachs, Alan Whiteside, Malcolm J. Blackie, and Justin C. Malewezi ...
Community Mental Health Journal
Individuals attending residential rehabilitation programs for substance misuse are particularly v... more Individuals attending residential rehabilitation programs for substance misuse are particularly vulnerable to treatment disruptions spurred by the novel coronavirus disease 2019 (COVID-19) pandemic. We describe adaptations to services within a large residential rehabilitation program for under-resourced veterans, report veterans' experiences with these changes, and outline successes and challenges encountered throughout adjustment to the pandemic. Data collected from two focus groups with nine veterans engaged in this program during the pandemic highlight experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation. Overall, these findings suggest the need for health systems to support clients in taking an active role in communications, provide additional technical and social support in transitioning to virtual health services, and offer alternative means for clients to maintain social connection during a pandemic. Understanding clients' perspectives can inform strategies to promote continuity of care and enhanced care experiences.
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Papers by Ippolytos Kalofonos