Assisting adults with severe mental illness in transitioning from parental homes to independent living

Selecting the right treatment plan for schizophrenia in postmenopausal women: an update of the literature

INTRODUCTION

The transition from reproductive to menopausal status constitutes amajor rite of passage for women, biologically, psychologically, and socially. For women with adiagnosis of schizophrenia, this stage of life is complicated by worsening psychotic symptoms and diminished effectiveness of antipsychotic drugs. This frequently leads to increased doses and subsequently increased adverse effects.

AREAS COVERED

The aim of this narrative review is to determine what management changes are needed at this time of life for women with schizophrenia. Searched and highlighted are the areas of sleep, cognition, occupation/employment, psychotic symptoms, side effects of treatment, and non-psychiatric as well as psychiatric co-morbidities which, when not adequately treated, can undermine quality of life and lead to premature death.

EXPERT OPINION

Many of the problems associated with menopause in women with schizophrenia can be prevented or remediated. Nevertheless, more research addressing the changes that occur in women with schizophrenia from pre- to post-menopause will help to bring clinical attention to this important health issue.

Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review

Community integration has emerged as a priority area among mental health advocates, policy makers, and researchers (Townley, Miller, & Kloos, 2013; Ware, Hopper, Tugenberg, Dickey, & Fisher, 2007). Past research suggests that social support influences community integration for individuals with serious mental illnesses (Davidson, Haglund, Stayner, Rakfeldt, Chinman, & Tebes, 2001; Davidson, Stayner, Nickou, Styron, Rowe, & Chinman, 2001; Wong & Solomon, 2002), but there has not yet been a systematic review on this topic. Therefore, the purpose of this paper was to explore the influence of social support on community integration through a review of the existing literature. An extensive literature search was conducted, resulting in 32 articles that met the search criteria. These articles were organized into three categories: defining community integration, supportive relationships, and mental health services. The search results are analyzed according to the types of support being provided. Article strengths, limitations, implications, and future directions are also addressed. Overall, the findings of this review suggest that social support, which may be provided by a variety of individuals and services, plays an important role in promoting community integration for individuals with serious mental illnesses. Therefore, as community mental health research and practice continues to promote community integration for individuals with serious mental illnesses, the mental health field should emphasize the importance of social support as a key factor influencing community integration.

Stranger support: How former prisoners with mental illnesses navigate the public landscape of reentry

BACKGROUND

Prisoners with mental illnesses (MI) are released from prison into environments where they are under-treated and under-supported by our criminal justice, social service, and health systems. Public space and interactions within those spaces have been shown to have positive effects in similar populations, including individuals with MI. This qualitative study explored the role different interactions play during the course of reentry. The study aimed to understand the more everyday relational dynamics that former prisoners with MI experience in public and private spaces.

METHODS

Semi-structured interviews on both experiences of public spaces and interactions within were conducted with 36 former prisoners with MI. Go-along interviews were conducted as a follow-up to these interviews with a subsample of 11 participants in order to identify and describe public spaces and interactions within those spaces. Phenomenological analysis was used to analyze data collected.

RESULTS

Participants described an array of supportive relationships with familiar strangers fostered in public spaces. Participants also described receiving stranger support from relationships typically associated with conventional and institutional supports. This form of "stranger support" was juxtaposed against the burdens and risks of reciprocal intimate relationships.

IMPLICATIONS

Public space and public space interactions can provide support streams to counterbalance the more complex support of intimate relationships. Providers might consider the utility of familiar strangers in helping clients to navigate these sometimes risky, but potentially fruitful spaces.

"What's Wrong with the Seed?" A Comparative Examination of an Empowering Community-Centered Approach to Recovery in Community Mental Health

This cross-sectional group comparison aimed to examine whether personal empowerment, recovery and community integration were associated with the individual's participation in an empowering community-centered model of intervention. Ninety-three participants from an empowering community-centered community mental health organization were compared with a matched group of individuals from standard interventions of four equivalent organizations. Results showed that participants taking advantage of the empowering community-centered approach were more involved in high recovery-oriented programs; and attained higher levels of personal goals and hope, empowerment, and of community integration. An involvement in high recovery-oriented programs (supported employment or independent housing) revealed improved outcomes for the individual. In conclusion, the findings suggested a transformative impact of the empowering community-centered model both at the individual and the program level by altering the resource accessibility and social conditions for people who experience mental illness. The implications of findings for transforming community mental health practice are discussed in detail.

Changing perceptions of illness in the early course of psychosis: psychological pathways to self-determination and self-management of treatment

Treatment early in the course of psychosis can improve prognostic outcomes, facilitate adaptive functioning, and reduce familial and societal burden. However, little is known about the pathway of first episode psychosis (FEP) from the perspective of highly adherent adolescents and young adults. This study sought to understand the pathways in youth self-determination and self-management of treatment by investigating youth and parents' changing perceptions of illness in the early course of psychosis. Twenty-eight (n = 28) interviews were conducted using a semistructured interview guide on 12 adolescents following their FEP hospitalization and 16 parents. Standardized self-report forms and hospital inpatient records were used to collect and confirm demographic and clinical data. On average, three years had passed from initial hospitalization (age 16.2 years, SD = 1.2) to time of interview (age 19.3 years, SD = 2.3), thus allowing for a range of experiences across the early period of illness. Highly adherent adolescents experienced identifiable temporal phases of early psychosis, comprised of emergent and specific themes. Parents described a parallel pathway toward supporting their child's self-determination and self-management of treatments, with some distinct experiential differences. Five dominant themes that emerged across time were symptom recognition, awareness of change, negative appraisals, positive appraisals, and treatment self-management. Examining how these themes evolve over the early course of psychosis can help guide interventions that are compatible with the parent and adolescent's perceptions of illness at that point in time, and can therefore work in concert with the family's existing efforts to understand and manage their emerging condition and progress toward recovery.

A little goes a long way: the impact of distal social support on community integration and recovery of individuals with psychiatric disabilities

Although an extensive body of literature highlights the important role of social support for individuals with psychiatric disabilities, definitions of support tend to be restricted-focusing on intimate relationships such as friend and family networks and ignoring the role of casual relationships existing naturally in the community. This mixed-methods study of 300 consumers of mental health services in the Southeastern US aims to better understand the impact of community supports, termed distal supports, on community integration and recovery from mental illness. Qualitative content analysis, tests of group mean differences, and hierarchical linear regression analyses revealed the following: (1) participants primarily reported receiving tangible support (e.g., free medication/discounted goods) from distal supports rather than emotional support (e.g., displays of warmth/affection) or informational support (e.g., provision of advice); (2) women and older participants reported more distal supports than men or younger participants; and (3) distal supports played a unique role in predicting community integration and recovery even after accounting for the influence of traditional support networks. Results highlight the importance of considering diverse types of social support in naturally occurring settings when designing treatment plans and interventions aimed at encouraging community participation and adaptive functioning for individuals with psychiatric disabilities.

Discharge practices in a time-unlimited intervention: the perspectives of practitioners in assertive community treatment

The Assertive Community Treatment (ACT) model for people with severe mental illness has typically been viewed as a time-unlimited intervention. Without a proscribed service duration, discharge from ACT largely depends on individual clients' situations and practitioners' discretion. We conducted semi-structured focus groups and interviews with practitioners to explore their discharge practices and considerations. Results highlight the heterogeneity of the clientele served in ACT, and therefore the importance of individualized treatment and discharge planning, guidance on assessing the timing of discharge for individual cases, practice strategies that balance independence and social connectedness to promote recovery, and the need for substantial system reform to facilitate transition after discharge.