Health outcomes for people with serious mental illness: a case study

The meaning of social support for persons with serious mental illness: A family member perspective

Objective: Social support is essential to the health and well-being of persons with serious mental illness (SMI), and family members are a primary source of this support. Despite the primary role of family in the lives of persons with SMI, family is an understudied source of support. This study investigated the types of social support beneficial for persons with SMI from the perspective of family members. Method: Participants were 14 adult family members recruited from a Bay Area National Alliance on Mental Illness who provided regular support for a family member with SMI. Focus group data was analyzed using NVivo10 and consensual qualitative research. Results: Results revealed five support categories: (a) person-centered support, (b) autonomy support, (c) community participation support, (d) health management support, and (e) day-to-day living support. Discussion: Participants described family supports that are conceptually distinct from traditional models of social support and uniquely tied to SMI-related stressors. Findings are also aligned with the mental health recovery model and self-determination theory. Conclusion: Results advance our understanding of SMI-specific types of social support by describing five support categories grounded in the voices of family members supporting a loved one with SMI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

The influence of sense of community on the relationship between community participation and mental health for individuals with serious mental illnesses

The goal of the current study is to better understand the association between community participation and mental health by investigating sense of community as a potential mediating factor between community participation, psychological distress, and mental health functioning. A survey was administered to 300 adults with serious mental illnesses using community mental health services in the United States in a cross-sectional design. Hayes PROCESS macro (model 4, version 2.16; Hayes, 2013) was employed to test all of the hypotheses. Results indicate that sense of community partially mediated the association between community participation and psychological distress, as well as mental health functioning. Implications include contributing to the current knowledge base about the influence of community factors on mental health and informing future interventions aimed at promoting community participation of adults with serious mental illnesses.

Using Geospatial Research Methods to Examine Resource Accessibility and Availability as it Relates to Community Participation of Individuals with Serious Mental Illnesses

Greater community participation among individuals with serious mental illnesses is associated with better psychosocial and health outcomes. Typically, studies examining community participation have utilized self-report measures and been conducted in limited settings. The introduction of methodological advances to examining community participation of individuals with serious mental illnesses has the potential to advance the science of community mental health research and invigorate the work of community psychologists in this area. This study employed an innovative geospatial approach to examine the relationship between community participation and resource accessibility (i.e., proximity) and availability (i.e., concentration) among 294 individuals utilizing community mental health services throughout the United States. Findings suggest small but significant associations between community participation and the accessibility and availability of resources needed for participation. Furthermore, findings demonstrate the importance of car access for individuals residing in both urban and non-urban settings. The methods and results presented in this study have implications for community mental health research and services and provide an illustration of ways that geospatial methodologies can be used to investigate environmental factors that impact community inclusion and participation of individuals with serious mental illnesses.

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research

BACKGROUND

The current fourth paper on the International College of Neuropsychopharmacology guidelines for the treatment of bipolar disorder reports on the unmet needs that became apparent after an extensive review of the literature and also serves as a conclusion to the project of the International College of Neuropsychopharmacology workgroup.

MATERIALS AND METHODS

The systematic review of the literature that was performed to develop the International College of Neuropsychopharmacology guidelines for bipolar disorder identified and classified a number of potential shortcomings.

RESULTS

Problems identified concerned the reliability and validity of the diagnosis of bipolar disorder and especially of bipolar depression. This, in turn, has profound consequences for early detection and correct treatment of the disorder. Another area that needs improvement is the unsatisfactory efficacy and effectiveness of therapeutic options, especially in special populations such as those with mixed features and rapid cycling course. Gender issues and adherence problems constitute an additional challenge. The literature suggests that while treatment providers are concerned more with treatment-related issues, patients and their caregivers worry more about issues pertaining to the availability of services and care, quality of life, and various types of burden. The workgroup identified additional unmet needs related to the current standard of research in bipolar disorder. These include the fragmentation of bipolar disorder into phases that are handled as being almost absolutely independent from each other, and thus the development of an overall therapeutic strategy on the basis of the existing evidence is very difficult. Trials are not always designed in a way that outcomes cover the most important aspects of bipolar disorder, and often the reporting of the results is biased and unsatisfactory. The data on combination treatments and high dosages are sparse, whereas they are common in real world practice.

CONCLUSIONS

The workgroup endorses the full release of raw study data to the scientific community, and the development of uniform clinical trial standards (also including more realistic outcomes) and the reporting of results. The 2 large appendices summarize the results of this systematic review with regard to the areas of lack of knowledge where further focused research is necessary.

Does education plays a role in meeting the human rights needs of Indian women with mental illness?

BACKGROUND

Globally women are one of the vulnerable populations and women without education and with mental illness are doubly disadvantaged.

AIM

To find out the role of education in meeting the human rights needs of women with mental illness at family and community levels.

MATERIALS AND METHODS

A descriptive design was carried out among randomly selected recovered women (N = 100) with mental illness at a tertiary care center. Data was collected through face-to-face interview using a structured questionnaire.

RESULTS

Our findings revealed that human rights needs in physical needs dimension, i.e. access to safe drinking water (χ(2) = 7.447, P < 0.059) and serving in the same utensils (χ(2) = 10.866, P < 0.012), were rated higher in women with illiteracy. The human rights needs in emotional dimension, i.e. afraid of family members (χ(2) = 13.266, P < 0.004), not involved in making decisions regarding family matters (χ(2) = 21.133, P < 0.00) and called with filthy nicknames (χ(2) = 8.334, P < 0.040), were rated higher in literate women. The human rights needs in religious needs dimension, i.e. allowed to go to temple, church, mosque etc. (χ(2) = 9.459, P < 0.024), were not satisfied by the illiterate women. Similarly, literate women felt that they were discriminated by community members due to their illness (χ(2) = 9.823, P < 0.044).

CONCLUSION

The findings of the present study suggested that women without education were more deprived of human rights needs than literate women. Thus, there is an urgent need to improve literacy of women and to strengthen the legal framework to protect the rights of the women with mental illness.

Human rights violations among economically disadvantaged women with mental illness: An Indian perspective

BACKGROUND

Globally women confront manifold violations of human rights and women with poverty and mental illness are doubly disadvantaged.

AIM

The aim was to examine the influence of poverty in meeting human rights needs among recovered women with mental illness at family and community level.

MATERIALS AND METHODS

This was a descriptive study carried out among randomly selected (n = 100) recovered women with mental illness at a tertiary care center. Data were collected through face-to-face interview using structured needs assessment questionnaire.

RESULTS

Our findings revealed that below poverty line (BPL) participants were not satisfied in meeting their physical needs such as "access to safe drinking water" (χ(2) = 8.994, P < 0.02), "served in the same utensils" (χ(2) = 13.648, P < 0.00), had adequate food (χ(2) = 11.025, P < 0.02), and allowed to use toilet facilities (χ(2) = 13.565, P < 0.00). The human rights needs in emotional dimension, that is, afraid of family members (χ(2) = 8.233, P < 0.04) and hurt by bad words (χ(2) = 9.014, P < 0.02) were rated higher in above poverty line (APL) participants. Similarly, 88.9% of women from APL group expressed that they were discriminated and exploited by the community members (χ(2) = 17.490, P < 0.00). More than three-fourths of BPL participants (76.1%) believed that there were wondering homeless mentally ill in their community (χ(2) = 11.848, P < 0.01).

CONCLUSION

There is an urgent need to implement social welfare programs to provide employment opportunities, disability allowance, housing and other social security for women with mental illness. Further, mental health professionals play an essential role in educating the family and public regarding human rights of people with mental illness.

Perceived human rights violation in persons with mental illness: role of education

BACKGROUND

People with mental illness are vulnerable to human rights violations and people with illiteracy and mental illness are at a double disadvantage.

OBJECTIVE

To determine the role of education in ascertaining human rights needs of people with mental illness.

METHODOLOGY

This was a descriptive study carried out among randomly selected (N = 100) recovered psychiatric patients with mental illness in the past based on the Clinical Global Impression-Improvement scale at a tertiary care centre. Data were collected through face-to-face interview using structured needs assessment questionnaire comprising two sections related to family and community domains. Data were analysed and interpreted using descriptive and inferential statistics.

FINDINGS

Our findings revealed that human rights needs in the physical needs dimension--i.e., access to electricity (χ2 = 5.523, p < .019) and safe drinking water facilities (χ2 = 9.665, p < .022)--were rated higher in illiterates than in literates. The human rights needs in emotional dimension - i.e. feeling separated from their families because of their illness (χ2 = 13.118, p < .004), afraid of family members (χ2 = 13.388, p < .004) and called filthy nicknames (χ2 = 17.759, p < .000) - were rated higher in literates than in illiterates. The human rights needs in the religious needs dimension - i.e. allowed to go to temple, church, mosque etc. (χ2 = 12.000, p < .007) - and in the social needs dimension - i.e. friendliness with family members -were rated higher in illiterates than in literates (χ2 = 9.661, p < .022).

CONCLUSION

Empowering people with mental illness by providing adequate opportunity to pursue education will play an important role in fulfilling the obligation of the United Nations Convention on the Rights of Persons with Disabilities.

Gender-related differences in the human rights needs of patients with mental illness

BACKGROUND

Individuals with mental illness commonly experience human rights violations while seeking to meet their basic needs. There is lack of research in developing countries on gender-related differences in human rights needs.

PURPOSE

This study investigated gender differences in perceived human rights needs at the family and community levels in individuals with mental illness in India.

METHODS

This descriptive study surveyed 100 asymptomatic individuals with mental illness at a tertiary care center. Subject selection employed a random sampling method. Data were collected using face-to-face interviews based on a structured needs assessment questionnaire. Data were analyzed and interpreted using descriptive and inferential statistics.

RESULTS

Subjects enjoyed a satisfactory level of fulfillment in the physical dimension of human rights needs, which included food, housing, and clothing. Men expressed lower satisfaction than women with perceived human rights needs fulfillment in the emotional dimension. This included fear of family members (χ = 9.419, p < .024) and being called derogatory names (χ = 8.661, p < .034). Women expressed lower satisfaction than men with perceived human rights needs fulfillment in social and ethical dimensions. The former included freedom to leave the home (χ = 11.277, p < .010), and the latter included sexual abuse by family members (χ = 9.491, p < .019). Men felt more discriminated than women due to perceptions of mental illness in the community domain (χ = 10.197, p < .037).

CONCLUSION

This study suggests that family members and communities need to be educated regarding the human rights needs of people with mental illness and that legislation must be strengthened to meet the human rights needs of this disadvantaged population.

Needs of persons with serious mental illness following discharge from inpatient treatment: patient and family views

Patients with serious mental illnesses often struggle with persistent symptoms that interfere with daily functioning in the community. The first days and weeks following inpatient treatment for an acute episode may be a critical time for patients to connect with the recommended community follow-up. Residual symptoms may interfere with their ability to access and benefit from these services to meet their needs. A descriptive study was conducted to explore perceptions of patients and families of patients' needs, functioning, coping and social support in the first 4 weeks after inpatient treatment. Results suggested that these patients had residual symptoms after discharge that interfered with functioning despite the availability of follow-up services. Patients identified unmet needs related to their illness. Family members identified concerns related to the lack of improvement in their ill relatives over time. Patients expressed satisfaction with care and felt supported by their families. Both patients and families seemed to lack a thorough understanding of goals for follow-up care.

Nurses' perceptions of nursing interventions supporting quality of life in acute psychiatric wards

PURPOSE

This study aimed to examine nurses' (N=29) perceptions of nursing interventions in supporting patients' quality of life (QoL) in acute psychiatric inpatient settings.

DESIGN AND METHOD

An explorative descriptive study design was applied. The data were generated through seven focus group interviews and analyzed with qualitative content analysis.

FINDINGS

Five main categories of nursing interventions to support patients' QoL were identified. Interventions were related to care planning, empowering interventions, social interventions, activating interventions, and security interventions.

PRACTICE IMPLICATIONS

Emphasis should be placed on nurses' opportunities to improve patients' QoL according to patients' individual needs.

Occupational therapy consultation for case managers in community mental health: exploring strategies to improve job satisfaction and self-efficacy

The purpose of this study was 2-fold: (1) to examine to what extent case managers' job satisfaction and self-efficacy were impacted by the addition of an occupational therapy consultation model and (2) to identify factors that both positively and negatively impacted the occupational therapy consultation services.

PRIMARY PRACTICE SETTING

The study was conducted at a mental health community support program in a local homeless center.

METHODOLOGY AND SAMPLE

In a 2-year study, a mixed-methods design was used to study changes over time in job satisfaction and perceived self-efficacy among 14 case managers who received ongoing occupational therapy consultation. Job satisfaction and self-efficacy data were obtained using standardized questionnaires. Qualitative data related to factors impacting the consultation program were obtained using open-ended written questions, focus groups, and individual interviews.

RESULTS

Statistically significant differences in job satisfaction and perceptions of self-efficacy were found 18 months into the study, when case managers were more actively seeking occupational therapy consultation services and were reporting improved client outcomes from occupational therapy intervention. In addition, themes related to both positive and negative factors impacting the occupational therapy consultation program were identified and provided useful data for development of future consultation services. IMPLICATION FOR CASE MANAGEMENT PRACTICE: Results suggest that ongoing training and professional support for case managers who are paraprofessionals and/or new to mental health practice may improve job satisfaction and efficacy. Occupational therapy consultation may be helpful in developing services for health promotion, including self-care management, cognitive assessments, activity-based programming, and home safety evaluation and modification. In addition, new graduates and paraprofessional case managers working with clients who are high utilizers of services may benefit from smaller caseloads and support from clinical professionals.

Depression and health-promoting lifestyles of persons with mental illnesses

This descriptive study examined relationships between depression, health-promoting lifestyles, and physical illnesses in a sample of persons living in the community who self-reported being diagnosed with mental illnesses. Variables of age, gender, and participation in psychiatric rehabilitation services were investigated to determine significant relationships to depression and lifestyles. Fifty adults completed a demographic survey, the CES-Depression scale, and the Health-Promoting Lifestyle Profile II. The findings emphasize the importance of psychiatric nurses assessing health-promoting lifestyles comprehensively in persons with serious mental illnesses and facilitating changes to improve both physical and mental health.

The sexual partnerships of people with serious mental illness

We compared the sexualities of people with serious mental illness and the general population using the National Health and Social Life Survey (Laumann et al., 1994) and the Indiana Mental Health Services and HIV Risk Study (Wright, 2003). We investigated whether and how the sexual behaviors and relationships of people with serious mental illness differ from the general populations and identified factors differently influencing the organization of sexuality in these two groups. We found evidence that the relationships of people with serious mental illness are characterized by less intimacy and commitment than those of the general population. Additionally, although people with serious mental illness use condoms more consistently, they are also more likely to have concurrent relationships and tend to have sex sooner with new partners, which may contribute to a higher risk of contracting HIV. Our findings point to a need for a paradigm shift in the way that clinicians and researchers conceptualize and manage client sexuality. A less individualistic approach that takes into consideration the relationship context and social and institutional constraints is needed.

Consultative intervention to improve outcomes of high utilizers in a public mental health system

PURPOSE

To examine the effectiveness of an academic consultation on outcomes among consumers in a public mental health system and to compare outcomes between high-cost/high-utilizer and midcost consumers.

METHODS

Participants (N = 36) completed all questionnaires during three semistructured interviews. Using a repeated-measures experimental design, the outcomes of global functioning, quality of life, service use and need, costs, and consumer satisfaction were examined.

FINDINGS

The hypothesis that consultation would change medication practices and reduce costs was supported.

CONCLUSIONS

Consultation with a senior clinician helped change medication practices and reduced costs. Consultation may lead to recognition of a new diagnosis (medical, neurologic, or psychiatric) or suggestions for modifying a treatment regimen that could improve functioning and QOL. In a busy public mental health system, there is often little time for consultation and little thought to second opinions. For clients who cost the system the greatest amount, the small additional cost of a consultation is a good potential investment.