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Spiro L, Swarbrick M. Peer-Run Respite Approaches to Supporting People Experiencing an Emotional Crisis. Psychiatr Serv 2024:appips20230599. [PMID: 38835253 DOI: 10.1176/appi.ps.20230599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Research shows that guests experience peer-run respites as empowering and safe places where they feel more seen, heard, and respected than they do in conventional settings. This column describes the successful and unique processes of peer-run respites that support guests in emotional crisis and facilitate healing. In a discussion informed by their experiences and the literature, the authors examine how peer-run respites differ from conventional psychiatric crisis response services in their basic philosophy: how emotional crisis is understood, the goal of crisis response, how trauma is viewed, the importance of self-determination, power dynamics, and relationality.
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Affiliation(s)
- Lauren Spiro
- Lauren Spiro and Associates (Spiro); Collaborative Support Programs of New Jersey, Freehold, and Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey (Swarbrick)
| | - Margaret Swarbrick
- Lauren Spiro and Associates (Spiro); Collaborative Support Programs of New Jersey, Freehold, and Center of Alcohol and Substance Use Studies, Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey (Swarbrick)
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2
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Roennfeldt H, Hill N, Byrne L, Hamilton B. Exploring the lived experience of receiving mental health crisis care at emergency departments, crisis phone lines and crisis care alternatives. Health Expect 2024; 27:e14045. [PMID: 38590099 PMCID: PMC11002315 DOI: 10.1111/hex.14045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 03/24/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Mental health crisis care includes emergency departments (EDs), crisis phone lines and crisis alternatives. Currently, there is an overreliance on EDs to provide mental health crisis care, with evidence that responses are often inadequate to meet the needs of people experiencing mental health crises. However, the complexities of how individuals experience crisis care across the varying contexts of EDs, crisis phone lines and crisis alternatives remain underresearched. METHOD This study used a hermeneutical phenomenological approach to understand the lived experience of accessing care during a mental health crisis. Thirty-one Australian adults who had accessed crisis services at ED, phone lines and/or crisis alternatives participated in in-depth interviews. RESULTS The findings are organised across the temporal narratives of participants' experiences from (1) point of contact, (2) positive and negative care experiences and (3) enduring impacts. Several themes were generated during these phases. The findings demonstrate the interrelated nature of care experiences and enduring impacts. With some exceptions, care received within EDs was harmful, resulting in lasting adverse effects. Responses from crisis phone lines were mixed, with participants appreciating the accessibility of after-hour phone support but finding standardised risk assessments unhelpful. Responses from crisis alternatives to ED were promising, aligning with the need for validation and human connection, but were not always accessible or easy to mobilise during a crisis. Notably, across all settings, positive effects were firmly attributed to the quality of the relationship with specific crisis providers. CONCLUSION The findings bring into sharp focus the lived experience of people accessing crisis care and contribute to the shortage of literature on subjective experiences. Providers may better meet the needs of those experiencing mental health crises by understanding the enduring impact of these interactions and the role of human connection beyond a focus on risk assessment, thereby providing opportunities for a joint understanding of risk and meaning-making. Furthermore, understanding the subjective experience of crisis care can guide reforms to ED and develop crisis alternatives to better meet the needs of people in crisis. PATIENT OR CONSUMER CONTRIBUTION The first author and the third author are in designated lived experience (Consumer) roles. The first author conducted the interviews and was explicit regarding their lived experience when engaging with participants. Service users were involved as advisors to the study and provided input into the design.
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Affiliation(s)
- Helena Roennfeldt
- Centre for Mental Health NursingUniversity of MelbourneMelbourneVictoriaAustralia
| | - Nicole Hill
- Department of Social WorkUniversity of MelbourneMelbourneVictoriaAustralia
| | - Louise Byrne
- School of ManagementRMIT UniversityMelbourneVictoriaAustralia
- Program for Recovery and Community Health, Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Bridget Hamilton
- Centre for Mental Health NursingUniversity of MelbourneMelbourneVictoriaAustralia
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3
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Bergström T, Seikkula J, Alakare B, Kurtti M, Köngäs-Saviaro P, Löhönen E, Miettunen J, Mäkiollitervo H, Taskila JJ, Virta K, Valtanen K. The 10-year treatment outcome of open dialogue-based psychiatric services for adolescents: A nationwide longitudinal register-based study. Early Interv Psychiatry 2022; 16:1368-1375. [PMID: 35332989 PMCID: PMC10078679 DOI: 10.1111/eip.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIM To evaluate the 10-year treatment outcomes and cost-effectiveness of adolescents' mental health treatment initiated under the social network-oriented open dialogue (OD) approach. METHODS This longitudinal register-based study included all persons who, for the first time, received psychiatric treatment in Finland during the period 1 January 2003-31 December 2008, and who were aged 13-20 at onset (n = 44 868). The OD group included all persons whose treatment commenced in the Western Lapland catchment area (n = 780), this being the only region in Finland where OD covered the entire mental healthcare service at the time of inclusion. The comparison group (CG) included the rest of Finland (n = 44 088). The primary outcome variables were psychiatric treatment and/or disability allowances at the end of the 10-year follow-up, or death. The secondary outcome variables were treatment and disability expenses. Generalized linear models weighted by inverse probability of treatment were used to study the association between OD and the primary outcomes. Population proportions were used to evaluate the cost-effectiveness of the approaches. RESULTS Treatment that commenced outside OD was associated with higher odds of continuing to receive treatment (adjusted odds ratio [aOR] 1.4; 95%CI 1.2-1.6) and disability allowances (aOR 1.6; 95%CI 1.2-2.1) at the end of the 10-year follow-up. No significant difference in the mortality ratio emerged. The cumulative 10-year expenses per capita were lower under OD. CONCLUSIONS OD associated with favourable long-term outcomes, but due the observational design and possible residual confounding, further studies with a more robust research design are required.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.,Faculty of Health and Sport, University of Agder, Kristiansand, Norway
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Mia Kurtti
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | | | - Elina Löhönen
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Katriina Virta
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
| | - Kari Valtanen
- Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland
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Price A, de Bell S, Shaw N, Bethel A, Anderson R, Coon JT. What is the volume, diversity and nature of recent, robust evidence for the use of peer support in health and social care? An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1264. [PMID: 36909883 PMCID: PMC9316011 DOI: 10.1002/cl2.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Peer support interventions involve people drawing on shared personal experience to help one another improve their physical or mental health, or reduce social isolation. If effective, they may also lessen the demand on health and social care services, reducing costs. However, the design and delivery of peer support varies greatly, from the targeted problem or need, the setting and mode of delivery, to the number and content of sessions. Robust evidence is essential for policymakers commissioning peer support and practitioners delivering services in health care and community settings. This map draws together evidence on different types of peer support to support the design and delivery of interventions. Objectives The aim of this map was to provide an overview of the volume, diversity and nature of recent, high quality evidence on the effectiveness and cost-effectiveness of the use of peer support in health and social care. Search Methods We searched MEDLINE, seven further bibliographic databases, and Epistemonikos for systematic reviews (in October 2020), randomised controlled trials (in March 2021) and economic evaluations (in May 2021) on the effectiveness of peer support interventions in health and social care. We also conducted searches of Google Scholar, two trial registers, PROSPERO, and completed citation chasing on included studies. Selection Criteria Systematic reviews, randomised controlled trials and economic evaluations were included in the map. Included studies focused on adult populations with a defined health or social care need, were conducted in high-income countries, and published since 2015. Any measure of effectiveness was included, as was any form of peer support providing the peer had shared experience with the participant and a formalised role. Data Collection and Analysis Data were extracted on the type of peer support intervention and outcomes assessed in included studies. Standardised tools were used to assess study quality for all studies: assessing the methodological quality of systematic reviews 2 for systematic reviews; Cochrane risk of bias tool for randomised controlled trials; and consensus health economic criteria list for economic evaluations. Main Results We included 91 studies: 32 systematic reviews; 52 randomised controlled trials; and 7 economic evaluations. Whilst most included systematic reviews and economic evaluations were assessed to be of low or medium quality, the majority of randomised controlled trials were of higher quality. There were concentrations of evidence relating to different types of peer support, including education, psychological support, self-care/self-management and social support. Populations with long-term health conditions were most commonly studied. The majority of studies measured health-related indicators as outcomes; few studies assessed cost-effectiveness. Studies were unevenly distributed geographically, with most being conducted in the USA. Several gaps were evident regarding the delivery of peer support, particularly the integration of peers and professionals in delivering support and interventions of longer duration. Authors' Conclusions Although there is evidence available to inform the commissioning and delivery of peer support in health and social care, there are also clear gaps that need to be addressed to further support provision, particularly regarding cost-effectiveness. The effectiveness of peer support in different countries, with varying health and social care systems, is a priority for future research, as is the integration of peers with professionals in delivering peer support.
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Affiliation(s)
- Anna Price
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Siân de Bell
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Naomi Shaw
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Alison Bethel
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Rob Anderson
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Jo Thompson Coon
- Exeter HS&DR Evidence Synthesis CentreUniversity of Exeter Medical School, University of ExeterExeterUK
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Bergström T, Seikkula J, Holma J, Köngäs-Saviaro P, Taskila JJ, Alakare B. Retrospective Experiences of First-Episode Psychosis Treatment Under Open Dialogue-Based Services: A Qualitative Study. Community Ment Health J 2022; 58:887-894. [PMID: 34550512 PMCID: PMC9187564 DOI: 10.1007/s10597-021-00895-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023]
Abstract
Open Dialogue (OD) is an integrated approach to mental health care, which has demonstrated promising outcomes in the treatment of first-episode psychosis (FEP) in Finnish Western Lapland region. However, little is known how treatment under OD is retrospectively experienced by the service users themselves. To address this, twenty participants from the original Western Lapland research cohort diagnosed with psychosis (F20-F29) were asked about their treatment of FEP, initiated under OD 10-23 years previously. Thematic analysis was used to explore how the treatment was experienced. Most participants viewed network treatment meetings as an important part of their treatment, as they enabled interactions with other people and the chance to go through difficult experiences. A minority of the participants had mixed experiences regarding family involvement and immediate home visits. OD may have the potential to promote therapeutic relationships, but replications from other catchment areas are needed.
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Affiliation(s)
- Tomi Bergström
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland.
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland.
| | - Jaakko Seikkula
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | - Juha Holma
- Department of Psychology, University of Jyväskylä, Jyvaskyla, Finland
| | | | - Jyri J Taskila
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
| | - Birgitta Alakare
- Department of Psychiatry, Länsi-Pohja Hospital District, Kemi, Finland
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Thieling AMS, Swarbrick M, Brice G, Nemec P. A Welcoming Space to Manage Crisis: The Wellness Respite Program. J Psychosoc Nurs Ment Health Serv 2022; 60:26-32. [PMID: 35522937 DOI: 10.3928/02793695-20220428-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The need for behavioral health care prevention, treatment, and recovery supports, including crisis alternatives, has grown and is now receiving federal support through enhanced funding. When a person experiences severe emotional distress, crisis alternatives are a viable option instead of inpatient hospitalization to address the distress and restore balance. Peer respite programs are voluntary, short-term, crisis alternatives for people experiencing mental distress. Models have evolved in response to funding and regulatory requirements, yet research is limited. The current article describes a unique peer-led program, Wellness Respite, in operation for 7 years, including data from recent satisfaction surveys and the role of nurses in the program. Implications of a home-like, short-term crisis alternative and the role of the nurse are emphasized. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Klim C, Vitous CA, Keller-Cohen D, Vega E, Forman J, Lapidos A, Abraham KM, Pfeiffer PN. Characterizing suicide-related self-disclosure by peer specialists: a qualitative analysis of audio-recorded sessions. Adv Ment Health 2022; 20:170-180. [PMID: 35756076 PMCID: PMC9231833 DOI: 10.1080/18387357.2021.2010585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective We characterized peer support specialists' self-disclosures related to suicide and recipient responses to inform services for high-risk individuals that may include peer support. Method We used an inductive approach and thematic analysis to identify themes from audio recordings of initial sessions between peer support specialists trained in suicide-related self-disclosure and 10 study participants who were admitted to inpatient psychiatry units with suicidal ideation or a suicide attempt. Results The first theme, "I've been suicidal, but those details are not important", reflects that peers mentioned suicide-related aspects of their histories briefly, often as part of introductions, without participants responding specifically to those aspects. The second theme, "Being suicidal is one of the challenges I've faced", reflects that in more detailed disclosures by peer specialists and in participant responses, suicide is a part of the mental health challenges and life stressors discussed, not the focus. The third theme "Let's focus on my recovery and what I've learned" reflects that peers steered their self-disclosures away from suicide and towards what was helpful in their recovery. Conclusions Suicide-related self-disclosures embedded within peer specialists' introduction or overall recovery narrative convey a shared experience while focusing conversation on mental health challenges other than suicide.
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Affiliation(s)
- Casimir Klim
- Department of Psychiatry and Psychology, Mayo Clinic Center for Graduate Medical Education
| | - C. Ann Vitous
- Department of Surgery, University of Michigan Medical School
| | | | | | - Jane Forman
- VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System
| | | | | | - Paul N. Pfeiffer
- VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System,Department of Psychiatry, University of Michigan Medical School
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8
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Drake RE, Bond GR. Psychiatric Crisis Care and the More is Less Paradox. Community Ment Health J 2021; 57:1230-1236. [PMID: 33993362 PMCID: PMC8123092 DOI: 10.1007/s10597-021-00829-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/17/2021] [Indexed: 10/24/2022]
Abstract
Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html , 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention-proven strategies that decrease costs and improve outcomes.
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Affiliation(s)
- Robert E Drake
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA.
| | - Gary R Bond
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA
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9
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Gaiser MG, Buche JL, Wayment CC, Schoebel V, Smith JE, Chapman SA, Beck AJ. A Systematic Review of the Roles and Contributions of Peer Providers in the Behavioral Health Workforce. Am J Prev Med 2021; 61:e203-e210. [PMID: 34175172 DOI: 10.1016/j.amepre.2021.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/10/2021] [Accepted: 03/30/2021] [Indexed: 01/16/2023]
Abstract
CONTEXT Peer providers with lived experiences of mental health and substance use are a growing component of the workforce responsible for the prevention and treatment of behavioral health disorders. This systematic literature review aims to better define the roles of peers and their unique contributions to behavioral health care. EVIDENCE ACQUISITION Researchers searched MEDLINE, CINAHL Complete, PsycINFO, Cochrane Central, and Scopus databases for studies published between January 1, 2013 and April 3, 2020. Studies were included if they (1) were experimental or observational studies, (2) included an adult population of people with a behavioral health disorder, and (3) used paid peer providers in addition to traditional behavioral health services. Researchers extracted sample demographics, intervention characteristics, outcome data, and significant associations from studies that met inclusion criteria and assessed the trends in these data in May 2020. EVIDENCE SYNTHESIS A total of 23 articles assessing peer-provided services were included. Peers were employed most frequently in mental healthcare roles in the Department of Veterans Affairs, hospital, and community health facilities. A total of 14 studies observed significant clinical improvements in participants' social functioning, quality of life, patient activation, and behavioral health. A majority of studies involved the supervision of peers and required peers to have completed training in service delivery. CONCLUSIONS Peers are effective providers of behavioral health treatment and relapse prevention services who encourage recovery through resilience building, empowerment, and self-advocacy. There remains a need for more evidence-based interventions on the efficacy of peers in substance use disorder treatment and the impact of formalized certification and training opportunities.
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Affiliation(s)
- Maria G Gaiser
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jessica L Buche
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Caitlyn C Wayment
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Victoria Schoebel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Judith E Smith
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan
| | - Susan A Chapman
- Department of Social & Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California
| | - Angela J Beck
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
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10
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Bowersox NW, Jagusch J, Garlick J, Chen JI, Pfeiffer PN. Peer-based interventions targeting suicide prevention: A scoping review. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 68:232-248. [PMID: 33720444 PMCID: PMC9165581 DOI: 10.1002/ajcp.12510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Peers of individuals at risk for suicide may be able to play important roles in suicide prevention. The aim of the current study is to conduct a scoping review to characterize the breadth of peer-delivered suicide prevention services and their outcomes to inform future service delivery and research. Articles were selected based on search terms related to peers, suicide, or crisis. After reviews of identified abstracts (N = 2681), selected full-text articles (N = 286), and additional references (N = 62), a total of 84 articles were retained for the final review sample. Types of suicide prevention services delivered by peers included being a gatekeeper, on-demand crisis support, crisis support in acute care settings, and crisis or relapse prevention. Peer relationships employed in suicide prevention services included fellow laypersons; members of the same sociodemographic subgroup (e.g., racial minority), workplace, or institution (e.g., university, correctional facility); and the shared experience of having a mental condition. The majority of published studies were program descriptions or uncontrolled trials, with only three of 84 articles qualifying as randomized controlled trials. Despite a lack of methodological rigor in identified studies, peer support interventions for suicide prevention have been implemented utilizing a diverse range of peer provider types and functions. New and existing peer-delivered suicide prevention services should incorporate more rigorous evaluation methods regarding acceptability and effectiveness.
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Affiliation(s)
- Nicholas W. Bowersox
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jennifer Jagusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - James Garlick
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jason I. Chen
- VA Center to Improve Veteran Involvement in Care, Portland, OR, USA
| | - Paul N. Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Center for Clinical Management Research, Ann Arbor, MI, USA
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11
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von Peter S, Schwarz J. [Mutual Support by People with Lived Experience of Mental Distress in Crisis Respites - A Scoping Review]. PSYCHIATRISCHE PRAXIS 2020; 48:65-72. [PMID: 33271624 DOI: 10.1055/a-1307-7160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In various places around the world, crises respites (CR) are being implemented as an alternative to psychiatric treatment, and to offer mutual, short-term residential support by people with lived experience. In this paper, it is examined, how CR are structured, and how - using which approaches and leading to which results - they have been evaluated. METHODS A systematic scoping review of the international literature was carried out. Studies were included, also from the "grey" literature, if they were based on empirical material. RESULTS 12 articles, relating to 10 CR, were selected. The organisational structures of the included CR were found to be quite heterogeneous. Further, different approaches were used for evaluation (RCT, qualitative, mixed methods). CONCLUSION CR are no substitute for psychiatric care, but a distinct, effective form of support. The influence of people with lived experience is crucial to the implementation and evaluation of CR to preserve their distinctiveness.
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Affiliation(s)
- Sebastian von Peter
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf
| | - Julian Schwarz
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik Rüdersdorf
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12
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Gabet M, Grenier G, Cao Z, Fleury MJ. Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res 2020; 20:854. [PMID: 32917199 PMCID: PMC7488576 DOI: 10.1186/s12913-020-05708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
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Affiliation(s)
- Morgane Gabet
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada.,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada. .,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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13
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Poremski D, Wang P, Hendriks M, Tham J, Koh D, Cheng L. Reasons for Frequent Psychiatric Emergency Service Use in a Large Urban Center. Psychiatr Serv 2020; 71:440-446. [PMID: 31996113 DOI: 10.1176/appi.ps.201800532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Reasons for frequent use of psychiatric emergency services are complex and numerous, but research has largely depended on quantitative methods to describe the phenomenon. The goal of this study was to describe the reasons for frequent use in Singapore and the ways service seekers changed because of frequent use. METHODS Semistructured qualitative interviews were conducted with 44 adults between July 2016 and December 2017. These people visited the psychiatric emergency department of a large tertiary care institute in Singapore five or more times in 12 months. Thematic analysis was conducted to categorize the reasons for frequent use. RESULTS Participants were 39 years old on average, and their median length of contact with emergency services was 3.5 years. Psychotic, depressive, adjustment, and personality disorders were most common. Reasons for frequent use included seeking psychiatric services outside of office hours, seeking the safety of admission, seeking the comfort of speaking with an empathetic professional, intoxication, contact with police, and families seeking respite. Because their frequent use gave them knowledge of standard operating procedures, participants censored their disclosure of symptoms instead of reporting the full depth of their crisis in order to reach their desired outcome of the visit. CONCLUSIONS Frequent use of emergency services led to changes in people's willingness to disclose important details of their crisis. These adjustments allowed service users to reach their desired outcome. Service providers and policy makers must be mindful that the package of care they deliver may prescribe medical solutions to social distress because of a lack of better alternatives.
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Affiliation(s)
- Daniel Poremski
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
| | - Peizhi Wang
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
| | - Margaret Hendriks
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
| | - Josephine Tham
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
| | - Doris Koh
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
| | - Lee Cheng
- Health Intelligence Unit (Poremski), Research Division (Wang), Case Management Department (Hendriks, Tham), and Emergency Services (Koh, Cheng), Institute of Mental Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Cheng)
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