A Qualitative Study of Implementation Challenges of Mental Health Clubhouse Rehabilitation Services in China's Hunan Province

The role of family caregiving in the management of individuals with mental illnesses and the outcome of family-based interventions for mental illnesses in China: a scoping review

The effects of China's rapid economic development and urbanisation on family caregivers' responsibilities for providing essential practical, social, and psychological support to family members with mental illnesses are unclear. This scoping review identified 176 relevant studies published from 1 January 2000 to 31 December 2023 in six English-language and three Chinese-language databases. Most studies focus on family caregiving for individuals with schizophrenia (63 studies), autism (40 studies), or dementia (39 studies). Family caregiving-subclassified as informational, concrete, or psychological-was beneficial both for patients and their family members, but providing support often necessitated substantial sacrifices by family caregivers, many of whom experience psychological distress and financial difficulties. The type and intensity of the support provided are influenced by the severity of the patient's symptoms, financial and other resources of the patient's family, community members' beliefs about mental illnesses, and the local availability of mental health and social welfare services. Results from intervention studies indicate that different methods of enhancing family caregiving improved outcomes for individuals with mental illnesses. However, the methodological quality of the intervention studies was poor, and most of the studies were conducted in inpatient settings, so the benefits of these family-based strategies remain uncertain. Rapid economic development and urbanisation in China are resulting in fundamental changes in the relative responsibilities of different stakeholders for providing social welfare services-individuals, families, communities, and governmental agencies. Understanding and enhancing the role that families play in the support of community members with mental illnesses will require improving the quality of research about this issue, expanding the range of mental health conditions considered, and, most importantly, developing a dynamic overarching theoretical framework that integrates the many factors influencing ongoing changes in the structure and functioning of Chinese families.

A Contemporary Review of the Clubhouse Model of Psychosocial Rehabilitation: Past, Present, and Emerging Directions

Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015-2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery-aims that may yield implications beyond the realm of serious mental illness.

Quality Improvement Approach to Increasing Psychiatric Rehabilitation in the Inpatient Setting

This clinical practice improvement project (CPIP) sought to increase the rate of referrals to psychiatric rehabilitation units among inpatients on a 44-bed men's ward at the Institute of Mental Health, Singapore. Three root causes of low referral rates were targeted for intervention, and three plan-do-study-act cycles were conducted to address these causes. Interrupted time-series analysis was used to assess the impact of the interventions. Addressing these causes significantly and sustainably improved the rate of referral. The rate of rehabilitation program attrition did not worsen because of the increased number of referrals. These findings indicate that CPIPs can significantly improve processes.

Factors influencing medication adherence among patients with severe mental disorders from the perspective of mental health professionals

BACKGROUND

Medication adherence is a common issue influenced by various factors among patients with severe mental disorders worldwide. However, most literature to date has been primarily quantitative and has focused on medication adherence issue from the perspective of patients or their caregivers. Moreover, research focused on medication adherence issue in China is scarce. Present study aims to explore the influential factors of medication adherence among patients with severe mental disorders form the perspective of mental health professionals in Hunan Province, China.

METHODS

A qualitative study was performed in Hunan Province, China with 31 mental health professionals recruited from October to November 2017. And semi-structured interviews or focus group interviews were conducted along with audio recordings of all interviews. Interview transcripts were then coded and analyzed in Nvivo software with standard qualitative approaches.

RESULTS

Three major themes influencing medication adherence among patients with severe mental disorders were identified as: (1) attitudes towards mental disorder/treatment; (2) inadequate aftercare; (3) resource shortages.

CONCLUSIONS

This qualitative study identified the factors influencing medication adherence among patients with severe mental disorders in China. As a locally driven research study, it provides practical advice on medication adherence promotion for mental health workers and suggests culturally tailored models that improve the management of patients with severe mental disorders in order to reduce economic burden on individual and societal level.

Clubhouse Model of Psychiatric Rehabilitation in China to Promote Recovery of People With Schizophrenia: A Systematic Review and Meta-Analysis

Background: Whether the clubhouse model of psychiatric rehabilitation is well-implemented in China and whether patients with schizophrenia successfully achieve symptom remission and functional recovery through engaging in the clubhouse remain unclear. Methods: Seven electronic databases were searched for relevant articles from inception to April 21, 2021. Quality assessment, data synthesis, and subgroup analysis were performed on the included studies. Results: Seven randomized controlled studies with 682 participants were included in the present meta-analysis. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting the remission of psychiatric symptoms, especially negative symptoms. However, it does not show a definite effect on promoting recovery of positive symptoms. The clubhouse model of psychiatric rehabilitation has a significant effect on promoting social functioning recovery, reducing the family burden, improving the quality of life, and promoting the remission of depressive and anxiety symptoms of patients with schizophrenia in China. Conclusions: Our findings suggest that the clubhouse model of psychiatric rehabilitation can promote the remission of symptoms and functional recovery of Chinese with schizophrenia. It may be suitable to address the urgent need for better mental health services in China.