1
|
Poppe A, Tiles-Sar N, Konings SRA, Habtewold TD, Bruggeman R, Alizadeh BZ, van der Meer L. Moving from supported to independent living: what are the barriers and facilitators for individuals with psychosis? Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-023-02586-x. [PMID: 38189942 DOI: 10.1007/s00127-023-02586-x] [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] [Received: 05/09/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Living independently, as opposed to in sheltered housing or with caregivers, is an important aim in the recovery of individuals with psychosis, but the transition to independence can be challenging. This study aims to investigate how individuals with psychosis move between living arrangements and to identify the barriers and facilitators of moving towards independence. METHODS The living arrangements of 1119 individuals with non-affective psychosis from the Genetic Risk and Outcome of Psychosis study were assessed at baseline, at three- and six-year follow-ups and further categorized as either supported (sheltered housing or with parents) or independent (single or with partner/family). We estimated the probabilities of transitioning between the living statuses and investigated the influence of demographic characteristics, symptomatology, cognition, social support, and premorbid social adjustment on transition using Markov chain modelling. RESULTS The majority of individuals living in supported housing remained there during the six-year follow-up period (~ 60%). The likelihood of moving from supported to independent living was twice as high for participants who were younger, five-to-six times higher for women, twice as high for individuals with better overall cognition, and five times higher for those with a course of low positive symptoms. CONCLUSION This study highlights that a large group of individuals with psychosis in supported housing is unlikely to move to independent living. Older men with cognitive impairments and who show continuous severe positive symptoms are the least likely to move living independently. Tailored interventions for these at-risk individuals could increase their chances of moving to independent living.
Collapse
Affiliation(s)
- Anika Poppe
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands.
| | - Natalia Tiles-Sar
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Stefan R A Konings
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
| |
Collapse
|
2
|
Stewart V, McMillan SS, Hu J, Ng R, El-Den S, O'Reilly C, Wheeler AJ. Goal planning in mental health service delivery: A systematic integrative review. Front Psychiatry 2022; 13:1057915. [PMID: 36601527 PMCID: PMC9807176 DOI: 10.3389/fpsyt.2022.1057915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Goal planning is routinely employed in mental health service delivery to identify priorities for treatment and support the achievement and evaluation of outcomes. Previous systematic reviews of the literature have focused on the use of goal planning in a range of physical and cognitive disability settings, but there is a lack of information regarding how goal planning is used in mental healthcare. AIMS This systematic integrative review aimed to understand the types of goals, effectiveness of goal planning, the experience of goal planning and barriers and facilitators to effective goal planning in mental healthcare settings. METHODS Five databases were systematically searched using key terms related to mental health AND goal planning. The search was supplemented through citation chaining. Due to the heterogeneity of the studies, a narrative synthesis approach to data analysis was undertaken. RESULTS Fifty-four studies were identified through the search of the literature following the PRISMA guidelines. Data was systematically extracted and thematically organized. There was a high level of heterogeneity among the studies, originating from a range of countries and with diverse characteristics and focus. Four themes emerged from the data analysis and included: (i) goal planning as a central aspect of interventions; (ii) types of goals planned; (iii) factors that influenced goal planning and/or attainment; and (iv) collaboration and concordance in goal planning. CONCLUSION This review found some support for the use of goal planning to improve outcomes in mental healthcare although there was no identified standardized approach to the use of goal planning. Individualized, recovery-oriented and collaborative goal planning was recommended but not always used in practice. Further research to understanding the most appropriate skills and training needed to support collaborative and effective goal planning is needed. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020220595].
Collapse
Affiliation(s)
- Victoria Stewart
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia.,Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Sara S McMillan
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia.,Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Jie Hu
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia.,Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Ricki Ng
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Claire O'Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Amanda J Wheeler
- Centre for Mental Health, Griffith University, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
3
|
Lachapelle É, Archambault L, Blouin C, Perreault M. Perspectives of people with opioid use disorder on improving addiction treatments and services. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2020.1833837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | - Michel Perreault
- Douglas Hospital Research Centre, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| |
Collapse
|
4
|
Soares LDML, Silva PRFD. Serviços Residenciais Terapêuticos na cidade do Rio de Janeiro: uma análise da estrutura e do processo de cuidado. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O objetivo do artigo foi analisar a estrutura e o processo de cuidado nos Serviços Residenciais Terapêuticos existentes no município do Rio de Janeiro. Trata-se de um estudo transversal que se concentrou na coleta de informações primárias por meio de instrumento estruturado. A pesquisa foi realizada em todos os dispositivos em funcionamento no mês de dezembro de 2016. No Rio de Janeiro, as Residências Terapêuticas recebem essencialmente pacientes egressos de internações psiquiátricas de longa permanência (94,3%), com grande oferta de vagas em dispositivos com presença de equipe nas 24 horas do dia (63,8%). Foi constatado que parte significativa dos moradores apresentava baixa frequência nas atividades assistenciais dos Centros de Atenção Psicossocial (48,7%). O cuidado interno nos dispositivos residenciais aponta para uma modelagem com forte entrelaçamento entre a moradia e as ações de reabilitação psicossocial. A baixa rotatividade de usuários mostra uma tendência para constituição de serviços com cuidado de longo prazo, o que deve ser levado em conta na manutenção e na expansão do programa no intuito de planejar serviços efetivos. Os resultados apontam que as bolsas de apoio à desinstitucionalização e, principalmente, a renda contínua aferida mediante o Benefício de Prestação Continuada são vitais para a sustentabilidade do programa.
Collapse
|
5
|
Vederhus JK, Clausen T, Humphreys K. Assessing understandings of substance use disorders among Norwegian treatment professionals, patients and the general public. BMC Health Serv Res 2016; 16:52. [PMID: 26873360 PMCID: PMC4752790 DOI: 10.1186/s12913-016-1306-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 02/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background Beliefs about substance use disorder (SUD) shape how patients, treatment professionals and the general public view addiction and its treatment. A U.S. developed scale exists to assess such beliefs, but it has never been tested in Norway nor normed on any general population sample. Methods The Short Understanding of Substance Abuse Scale (SUSS) was translated from English to Norwegian and used to assess beliefs about the nature of addiction among addiction treatment professionals (N = 291), patients with SUDs (N = 133) and respondents from the general public (N = 216). The disease and psychosocial model subscales of the SUSS were examined with a multigroup factor analysis to confirm that the constructs were invariant across the studied groups. We also controlled for demographic covariates in a multiple indicator multiple cause model. Results The multigroup confirmatory factor analysis of the SUSS yielded a partial scalar invariant model and thus, we were able to compare latent means between groups. In unadjusted comparisons, patients and the general public reported significantly higher endorsement of disease model beliefs than did professionals. However, the difference between professionals and the general public disappeared when the comparison was adjusted for covariates (i.e., age, gender, education). In both unadjusted and adjusted analyses, the general public group but not the patient group scored significantly lower than professionals on the psychosocial belief scale. Conclusion The SUSS is useable with slight adaptations in Norwegian samples. Norwegian treatment professionals have different views of substance use disorder than do patients and the general public. This may create opportunities for dialogue and mutual learning, but also presents risk of miscommunication and distrust.
Collapse
Affiliation(s)
- John-Kåre Vederhus
- Addiction Unit, Sørlandet Hospital HF, P.b. 416, 4604, Kristiansand, Norway.
| | - Thomas Clausen
- Addiction Unit, Sørlandet Hospital HF, P.b. 416, 4604, Kristiansand, Norway.,Norwegian Center for Addiction Research, University of Oslo, Oslo, Norway
| | - Keith Humphreys
- Veterans Health Administration, Palo Alto, California, USA.,Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
6
|
Abstract
BACKGROUND There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia. OBJECTIVE We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement. METHOD The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009-2010, 4 years after a baseline assessment. RESULTS Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society. CONCLUSION This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience.
Collapse
|
7
|
The new asylums in the community: severely ill psychiatric patients living in psychiatric supported housing facilities. A Danish register-based study of prognostic factors, use of psychiatric services, and mortality. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1251-61. [PMID: 21947476 DOI: 10.1007/s00127-011-0432-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Reorganization of psychiatric treatment in Denmark involved a declining number of psychiatric long-stay beds and an increasing number of psychiatric supported housing facilities in the community. Very few studies have focused on the population in such facilities. METHODS Information was generated combining addresses of supported psychiatric housing facilities with information from the Danish Civil Registration System to create a case register of persons living in supported psychiatric housing facilities. Through linkage with the Danish Psychiatric Central Register, we examined predictors of becoming a resident in a psychiatric housing facility, use of psychiatric services around the time of entrance to a supported psychiatric housing facility, and mortality rates for residents in a psychiatric housing facility compared to non-residents and to persons in the general population who never experienced a psychiatric admission. RESULTS We identified schizophrenia as the strongest diagnostic predictor of becoming a resident in a supported psychiatric housing facility, followed by organic mental disorders, substance abuse, and affective disorder. In addition, the higher the number of psychiatric bed days, the higher the risk. Compared to the years before the first entrance to a supported psychiatric housing facility, the number of bed days in the year following the first entrance dropped more among residents than among comparable psychiatric patients. Mortality rates were slightly higher among residents in a supported psychiatric housing facility than among comparable psychiatric patients, but more than tenfold higher when compared to the general population of Danes. CONCLUSION The vast majority of persons who became residents in supported psychiatric housing facilities had previously been diagnosed with schizophrenia, schizophrenia-like disorders, and organic mental disorders, and a large proportion had substance abuse and a high use of bed days. Moving into such a facility reduced the number of bed days.
Collapse
|
8
|
Ammeraal MA, Coppers J. Understanding living skills: first steps to evidence-based practice. Lessons learned from a practice-based journey in the Netherlands. Occup Ther Int 2012; 19:45-53. [PMID: 22314611 DOI: 10.1002/oti.1323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/05/2012] [Accepted: 01/05/2012] [Indexed: 11/08/2022] Open
Abstract
Living skills training is a commonly used but sparsely described and researched - occupational therapy - intervention for people with severe mental health problems. A service improvement project was established in a mental health organization in the Netherlands starting in 2006 to design more effective living skills training courses for individuals and groups. The steps of the evidence-based practice process underpinned the project. Theoretical and empirical evidence was derived from an extensive literature review. This was supplemented by the preferences of clients and their families as an equally valued source of evidence as is the experience and knowledge of a range of mental health professionals. Information from these three sources provided building blocks for the development of living skills training, resulting in an individual process guideline and two group courses. Implications for practice is that living skills training needs to be part of multidisciplinary treatment and can be best provided in the client's natural context. Limitations of this study are the lack of an evaluation of both the group courses and of the individual process guideline, also due to the continuous implementation in an ever-changing context. There is further need for research into the clinical and cost effectiveness of living skills training, both for individuals and groups, to support evidence-based decision making and service planning.
Collapse
Affiliation(s)
- Marion A Ammeraal
- Actenz, GGZ inGeest, Valeriusplein 9, 1075 BG, Amsterdam, The Netherlands.
| | | |
Collapse
|
9
|
Semrau M, Barley EA, Law A, Thornicroft G. Lessons learned in developing community mental health care in Europe. World Psychiatry 2011; 10:217-25. [PMID: 21991282 PMCID: PMC3188777 DOI: 10.1002/j.2051-5545.2011.tb00060.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This paper summarizes the findings for the European Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. The article presents a description of the region, an overview of mental health policies and legislation, a summary of relevant research in the region, a precis of community mental health services, a discussion of the key lessons learned, and some recommendations for the future.
Collapse
Affiliation(s)
- Maya Semrau
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
| | | | | | | |
Collapse
|
10
|
Joosten EAG, De Weert-Van Oene GH, Sensky T, Van Der Staak CPF, De Jong CAJ. Treatment goals in addiction healthcare: the perspectives of patients and clinicians. Int J Soc Psychiatry 2011; 57:263-76. [PMID: 20068024 DOI: 10.1177/0020764009354835] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about the perspectives of either patients or clinicians regarding treatment goals in addiction healthcare. In general, treatment goals involve abstinence or at least reduction of substance use. AIM To examine and compare the treatment goals indicated by both patients and clinicians at baseline, interim and exit measurement. METHOD A descriptive study was performed with multiple measurements of treatment goals. Patients (n = 111) and clinicians (n = 20) were recruited from three addiction treatment centres in the Netherlands. A Shared Decision Making Intervention (SDMI) was undertaken to promote and evaluate treatment agreement. RESULTS Patients identified treatment goals of daytime activities and abstinence or reduced alcohol consumption as most important. Clinicians indicated psychological distress, daytime activities and substance use as most important. Differences between patients and clinicians were found for the treatment goals of physical health (patient > clinician) and psychological distress (clinician > patient). The results further showed that treatment goals of both patients and clinicians become more closely aligned during the course of treatment. CONCLUSION SDMI provides a method to explore and discuss discrepancy between patients' and clinicians' goals of treatment which leads to convergence. Such convergence is likely to be a necessary prerequisite for positive treatment outcomes.
Collapse
Affiliation(s)
- E A G Joosten
- Radboud University Nijmegen, Academic Centre for Social Sciences, Nijmegen Institute for Scientist-Practitioners in Addiction, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. Following on from a recent review focusing on consumer participation in mental health services, this paper looks at consumer participation in housing. Housing is a critical element in recovery from mental illness. Without suitable housing, people have little chance of maintaining other resources in their lives, such as supportive social relationships and meaningful activities. CONCLUSIONS Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. The importance of appropriate housing to the recovery of people living with mental illness cannot be underestimated. Even well-meaning and well-resourced housing initiatives can fall short of meeting consumers' recovery goals when they do not incorporate the expressed needs of consumers. These expressed needs include keeping units small in size and employing drop-in support models.
Collapse
Affiliation(s)
- Graeme Browne
- Gold Coast Mental Health & ATOD Services, Robina, QLD, Australia.
| | | |
Collapse
|
12
|
|
13
|
Priebe S, Saidi M, Want A, Mangalore R, Knapp M. Housing services for people with mental disorders in England: patient characteristics, care provision and costs. Soc Psychiatry Psychiatr Epidemiol 2009; 44:805-14. [PMID: 19277440 DOI: 10.1007/s00127-009-0001-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 01/30/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Since de-institutionalisation, housing services have taken a central role in the care of patients with severe mental illness. Yet, little is known about the characteristics of patients in different housing services, what care they receive, and what costs are generated. This study aimed to assess patient characteristics, care provision and costs in different types of housing services in England. METHODS In 12 representative local areas in England, 250 housing services were randomly selected. Information on services, characteristics of randomly selected patients and care received were obtained from managers. RESULTS Data from 153 services (61% response rate) and 414 patients were analysed. Most patients receive support with activities of daily living and are involved in some sort of occupational activities. 52% have a care co-ordinator in a community mental health team. Care provision and costs differed significantly between care homes, supported housing services and floating support services. CONCLUSIONS Quality standards may have to be defined and applied to ensure that all patients in housing services receive appropriate care. More input of mental health services may be required for the rehabilitation and recovery of patients.
Collapse
Affiliation(s)
- Stefan Priebe
- Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | |
Collapse
|
14
|
Taylor TL, Killaspy H, Wright C, Turton P, White S, Kallert TW, Schuster M, Cervilla JA, Brangier P, Raboch J, Kališová L, Onchev G, Dimitrov H, Mezzina R, Wolf K, Wiersma D, Visser E, Kiejna A, Piotrowski P, Ploumpidis D, Gonidakis F, Caldas-de-Almeida J, Cardoso G, King MB. A systematic review of the international published literature relating to quality of institutional care for people with longer term mental health problems. BMC Psychiatry 2009; 9:55. [PMID: 19735562 PMCID: PMC2753585 DOI: 10.1186/1471-244x-9-55] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 09/07/2009] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. METHODS We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. RESULTS We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). CONCLUSION Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening.
Collapse
Affiliation(s)
- Tatiana L Taylor
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Helen Killaspy
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| | - Christine Wright
- Division of Mental Health, St. George's University London, London, UK
| | - Penny Turton
- Division of Mental Health, St. George's University London, London, UK
| | - Sarah White
- Division of Mental Health, St. George's University London, London, UK
| | - Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | - Mirjam Schuster
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Dresden, Germany
| | | | | | - Jiri Raboch
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Kališová
- Psychiatric Department of the First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Georgi Onchev
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Hristo Dimitrov
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Kinou Wolf
- Dipartimento di Salute Mentale, University of Trieste, Trieste, Italy
| | - Durk Wiersma
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Ellen Visser
- Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - José Caldas-de-Almeida
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Department of Mental Health, Faculdade de Ciencias Medicas, New University of Lisbon, Lisbon, Portugal
| | - Michael B King
- Research Department of Mental Health Sciences, UCL Medical School, London, UK
| |
Collapse
|
15
|
Browne G, Hemsley M, St John W. Consumer perspectives on recovery: a focus on housing following discharge from hospital. Int J Ment Health Nurs 2008; 17:402-9. [PMID: 19128287 DOI: 10.1111/j.1447-0349.2008.00575.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Housing is a critical element in recovery from mental illness. Without suitable housing, people have little chance of maintaining other resources in their lives, such as supportive social relationships and meaningful activities. This study investigated consumers' perspectives on the recovery needs of people who are living with a mental illness, especially those who might need supported accommodation as part of their reintegration into the community. Good quality housing is a critical element in recovery for people living with a mental illness. Findings indicate that when people become unwell, they can destroy resources in their lives, such as housing and friendships. A lack of financial stability can be a problem and exacerbate other difficulties. Having a mental illness means living with loss, stigma, and loneliness, but having someone who understands contributes significantly to recovery. The literature suggests that 'recovery' can relate to the relief of symptoms or from the stigma of the illness, recovering from the effects of treatment, from the lack of opportunities, and from the destructive aspects of mental illness. Findings from this study support these aspects, but also that recovery seems to be more. After spending time with the participants, the authors concluded that recovery also means the recovery of a life that includes supportive friends, living in a community in which at least some people 'understand', and of recovering a life that includes activities that give that life meaning. Consumers can make a significant contribution to our understanding of mental illness and recovery.
Collapse
Affiliation(s)
- Graeme Browne
- Gold Coast and Gold Coast Mental Health and ATOD Services and University Queensland School of Medicine, Queensland, Australia.
| | | | | |
Collapse
|
16
|
Montgomery P, Forchuk C, Duncan C, Rose D, Bailey PH, Veluri R. Supported housing programs for persons with serious mental illness in rural northern communities: a mixed method evaluation. BMC Health Serv Res 2008; 8:156. [PMID: 18652689 PMCID: PMC2527314 DOI: 10.1186/1472-6963-8-156] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/24/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the past two decades, consumers, providers and policy makers have recognized the role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able to live independently in the community. Much of supported housing research to date, however, has been conducted in large urban centers rather than northern and rural communities. Northern conditional and contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing housing markets, lack of a continuum of support or housing services, and in some communities, a poor quality of housing challenge the viability of effective supported housing services. The current research proposal aims to describe and evaluate the processes and outcomes of supported housing programs for persons living with SMI in northern and rural communities from the perspective of clients, their families, and community providers. METHODS This research will use a mixed method design guided by participatory action research. The study will be conducted over two years, in four stages. Stage I will involve setting up the research in each of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information about the three client outcomes: housing history, quality of life and housing preference. In Stage III two participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of supported housing services. In the last stage findings from the study will be re-presented to the participants, as well as other key community individuals in order to translate them into policy. CONCLUSION Supported housing intervention is a core feature of mental health care, and it requires evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data collection approaches, contributes to a comprehensive, systems-level examination of supported housing in smaller communities. It is anticipated that the study's findings will not only have utility across Ontario, but also Canada.
Collapse
Affiliation(s)
- Phyllis Montgomery
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada
| | - Cheryl Forchuk
- Faculty of Health Sciences, Lawson Health Research Institute, University of Western Ontario, 1151 Richmond Street, Suite 2, Health Sciences Addition, H38 London, Ontario, N6A5C1, Canada
| | - Craig Duncan
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada
| | - Don Rose
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada
| | - Patricia H Bailey
- School of Nursing, Laurentian University, Ramsey Lake Road, Sudbury, Ontario, P3E 2C6, Canada
| | - Ramamohan Veluri
- Department of Psychiatry, University of Western Ontario and Northern Ontario School of Medicine 680 Kirkwood Drive, Sudbury, Ontario, P3E 1X3, Canada
| |
Collapse
|
17
|
Tyrer P, Balod A, Germanavicius A, McDonald A, Varadan M, Thomas J. Perceptions of assertive community treatment in the UK and Lithuania. Int J Soc Psychiatry 2007; 53:498-506. [PMID: 18181352 DOI: 10.1177/0020764007083868] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is current uncertainty over the future of assertive community and outreach teams in view of recent evidence suggesting that they no longer reduce hospital admissions. Despite this, assertive teams remain popular among practitioners. AIMS To examine the views of assertive community team members and other mental health professionals in London (UK) and Vilnius (Lithuania) to determine important differences in attitudes. METHOD A questionnaire, involving the assessment of statements giving common opinions on assertive community teams, was given to 62 staff in Vilnius, Lithuania and West London, UK, 33 from assertive community or outreach teams and 29 from other mental health professionals. RESULTS The results of the questionnaire showed that personnel in experienced assertive outreach teams in London believed that they gave more intensive care (p < 0.001), felt it of greater value to see patients in the community (p < 0.001) and were not just well-resourced community teams with low caseloads (p < 0.01) than did other groups, but they placed lower value on assertiveness (p = 0.04) and comprehensive care (p < 0.04). These differences were less marked in Lithuania where staff regarded home treatment as similar to clinic treatment and were more supportive of comprehensive care. CONCLUSION The results suggest that in experienced community teams the notion of assertiveness has become less important in planned intensive community care and so the term ACT may be outmoded. However, for countries such as Lithuania, somewhat similar to the United States in 1972 when ACT began, the original principles are still appropriate and 'assertive' is a major component of their effectiveness.
Collapse
Affiliation(s)
- Peter Tyrer
- Department of Psychological Medicine, Imperial College, Charing Cross Campus, London, UK.
| | | | | | | | | | | |
Collapse
|