An unholy alliance: substance abuse and social exclusion among assertive outreach patients

Social isolation enhances cued-reinstatement of sucrose and nicotine seeking, but this is reversed by a return to social housing

Physical or perceived (i.e. loneliness) social isolation is increasing in Western cultures. Unfortunately, social isolation is associated with a range of negative physical and mental health outcomes, including increased incidence of obesity and smoking. Here we monitored the impact of social isolation on a range of physical measures, and then tested whether social isolation in adult rats changes how reward-related stimuli motivate sucrose- or nicotine-seeking. Socially isolated rats showed elevated baseline CORT, gained significantly less weight across the study, were more active in response to a novel or familiar environment. Isolated rats also acquired nose-poking for a food pellet more rapidly, and showed increased susceptibility to cue-, but not reward-induced reinstatement. Notably, these effects are partially mitigated by a return to group housing, suggesting that they are not necessarily permanent, and that a return to a social setting can quickly reverse any deficits or changes associated with social isolation. This study advances our understanding of altered reward-processing in socially isolated individuals and reiterates the importance of socialisation in the treatment of disorders such as overeating and addiction.

Tracking Study on the Relapse and Aftercare Effect of Drug Patients Released From a Compulsory Isolated Detoxification Center

BACKGROUND AND AIMS

There are no accurate statistical data on the relapse rate of drug abstainers after compulsory detoxification in China. This study aimed to collect relapse data for drug abstainers through follow-up visits, verify the effectiveness of professional social worker services and explore significant factors affecting relapse.

DESIGN AND SETTING

The drug abstainers released from Guangzhou T Compulsory Isolated Detoxification Center were randomly divided into two groups. The difference between the experimental group and the control group is that assistance services were provided by social workers to the former.

PARTICIPANTS

The study included 510 drug abstainers released from T Center, including 153 in the experimental group and 357 in the control group.

MEASUREMENTS

Demographic information, history of drug abuse, and motivation for drug rehabilitation (SOCRATES) were collected 1 month prior to drug abstainer release from compulsory detoxification. Then, the relapse situation after their release was tracked according to fixed time points.

FINDINGS

The overall relapse rate of 510 drug abstainers after their release from compulsory detoxification was 47.6%. The average survival time to relapse based on survival analysis was 220 days (N = 486), as calculated with Bayesian estimation by the MCMC method. The average survival times to relapse of the experimental group and control group were 393 and 175 days, respectively. By taking the specific survival time as the dependent variable and the group as the control variable (OR = 25.362), logistic regression analysis showed that marital status (OR = 2.666), previous compulsory detoxification experience (OR = 2.329) and location of household registration (OR = 1.557) had a significant impact on the survival time to relapse.

CONCLUSIONS

The occurrence of relapse among drug patients released from compulsory detoxification can be delayed effectively through the intervention of professional social worker services. Regardless of whether patients receive aftercare after compulsory detoxification, drug-using patients who are single, have multiple detoxification experiences and whose households are registered in other provinces deserve special attention. Relevant suggestions to avoid relapse are provided.

Social exclusion of people with severe mental illness in Switzerland: results from the Swiss Health Survey

AIMS

People with severe mental illness (SMI) have a high risk of living socially excluded from the mainstream society. Policy initiatives and health systems aim to improve the social situation of people who suffer from mental health disabilities. The aim of this study was to explore the extent of social exclusion (employment and income, social network and social activities, health problems) of people with SMI in Switzerland.

METHODS

Data from the Swiss Health Survey 2012 were used to compare the social exclusion magnitude of people with SMI with those suffering from severe physical illness, common mental illness and the general population.

RESULTS

With the exception of Instrumental Activities of Daily Living, we found a gradient of social exclusion that showed people with SMI to be more excluded than the comparison groups. Loneliness and poverty were widespread among people with SMI. Logistic regression analyses on each individual exclusion indicator revealed that people with SMI and people with severe physical illness were similarly excluded on many indicators, whereas people with common mental illness and the general population were much more socially included.

CONCLUSIONS

In contrast to political and health system goals, many people with SMI suffer from social exclusion. Social policy and clinical support should increase the efforts to counter exclusionary trends, especially in terms of loneliness and poverty.

Assertive community treatment and associations with delinquency

This article draws on a prospective longitudinal study in which Assertive Community Treatment (ACT) model fidelity and patient outcomes were assessed in twenty outpatient treatment teams. 530 severely mentally ill patients participated in the study. Delinquency outcomes were assessed three times during a two-year follow-up period. At baseline, 49% of the patients had a recent criminal history, meaning that they had at least one reported contact with the police and/or the justice system in the past year. Patients with a recent criminal history had more serious psychosocial problems at baseline compared to those without a recent criminal history. Delinquency outcomes showed improvement over time, but this was not associated with ACT model fidelity. The study shows an association for homelessness and criminal activity. The persistent criminal activities of some of the patients showed that for this group extra interventions are needed that specifically target reduction of criminal behavior.

Development and preliminary validation of a measure of social inclusion for use in people with mental health problems: the SInQUE

BACKGROUND

Social exclusion can be both a cause and a consequence of mental health problems. Socially inclusive practice by mental health professionals can mitigate against the stigmatizing and excluding effects of severe mental illness.

AIM

To develop and test the validity of a measure of social inclusion for individuals with severe mental illness - the Social Inclusion Questionnaire User Experience (SInQUE).

METHOD

The domains of the SInQUE were chosen to reflect the domains of social inclusion identified in the Poverty and Social Exclusion Survey. Patients with severe mental illness were recruited from rehabilitation, general and forensic psychiatric services and were asked to complete the questionnaire in an individual interview with a researcher.

RESULTS

Sixty six patients with schizophrenia and schizoaffective disorder completed the SInQUE, alongside measures of psychiatric symptoms, needs and quality of life, to assess its acceptability, and concurrent and construct (convergent and discriminant) validity. The SInQUE took 45 minutes to complete and was found to have good concurrent and discriminant validity. Convergent validity was established for two domains: social integration and productivity.

CONCLUSION

Preliminary findings suggest that the SInQUE may be a useful tool for assessing and monitoring social inclusion in individuals with severe mental illness. It has construct and concurrent validity with measures of unmet need and quality of life in this group. Further testing of the reliability of the SInQUE on a larger population is indicated.

Concepts of social inclusion, exclusion and mental health: a review of the international literature

Social inclusion and exclusion are concepts which have been widely associated with politics and policy in the first decade of the 2000s. People with mental health problems have become the focus of a range of social inclusion initiatives. A literature review was conducted to explore the peer-reviewed evidence relating social inclusion/exclusion and mental health. In total 36 papers were included in the review from the UK, Canada, Australia and Scandinavia. The papers had used a range of different approaches to research and evaluation. The included papers associated being socially included to: social roles and responsibilities such as employment, participation in social activities, environmental work and voting. Although some papers engaged in a critical discussion of the concept, many offered only simplistic accounts or definitions. Social inclusion is such a widely used term within political and policy discourses that it is surprising so little research is available within the mental health realm. There was a lack of clarity related to the concept of social exclusion and the qualitative studies focused entirely on the experiences of being excluded within an institutional or semi-institutional setting. The relationship between exclusion, inequality and injustice is identified and the relevance of the concept to current and future mental health policy is questioned.

Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. A systematic review

BACKGROUND

Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such 'dual diagnosis'. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background.

METHODS

A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups.

RESULTS

There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6-15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38-50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis.

CONCLUSIONS

Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.

A real-life observational study of the effectiveness of FACT in a Dutch mental health region

BACKGROUND

ACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may "dilute" care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT.

METHODS

In 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on "baseline" symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms.

RESULTS

The probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms (OR = 6.70, p = 0.002; 95% CI = 1.97-22.7).

CONCLUSION

Compared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.

A pilot of team‐based dual diagnosis training for assertive Outreach teams

Assertive outreach teams are working with a significant proportion of people with complex needs, including dual diagnosis. Government policy has highlighted the role of assertive outreach in engaging and intervening with this group. This paper reports on the development and evaluation of a specific team‐focused training package and its trial in the Eastern and West Midlands regions.

Social exclusion and mental health: conceptual and methodological review

BACKGROUND

The concept of social exclusion is now widely used in discussions about the nature of disadvantage, and there are ongoing initiatives to promote social inclusion among those with mental health problems.

AIMS

To conduct a conceptual and methodological review of social exclusion, focusing initially on the origins and definitions of the concept and then on approaches to its measurement, both in general and in relation to mental health.

METHOD

We used two main strategies. First, we utilised expertise within the study team to identify major texts and reviews on social exclusion and related topics. Second, we searched major bibliographic databases for literature on social exclusion and mental health. We adopted a non-quantitative approach to synthesising the findings.

RESULTS

There is no single accepted definition of social exclusion. However, most emphasise lack of participation in social activities as the core characteristic. There are a number of approaches to measuring social exclusion, including use of indicator lists and dimensions. In the mental health literature, social exclusion is poorly defined and measured.

CONCLUSIONS

If social exclusion is a useful concept for understanding the social experiences of those with mental health problems, there is an urgent need for more conceptual and methodological work.

Research issues in forensic psychiatry

PURPOSE OF REVIEW

Forensic psychiatry is a multidisciplinary specialty within the context of criminal and civil law. This paper reviews a broad spectrum of research areas within the forensic psychiatric field, covering publications in 2006.

RECENT FINDINGS

New developments can be divided into four subject areas. The first relates to risk assessment, the second to the epidemiology of violence, the third refers to treatment outcome studies, and the fourth relates to topics of interest within different offender groups.

SUMMARY

There seems to be a growing interest in specifying the needs of different offender groups, such as intellectually-disabled patients, adolescents and women. When it comes to effective treatment models for these subgroups, however, it is not always clear if sufficient attention is paid to the presence of comorbid disorders and their consequences, even in research publications.