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Sampietro HM, Gómez-Benito J, Guilera G, Rojo JE, Barrios M, Berrío ÁI. Evidence of Validity and Reliability for the Spanish Version of the Self-Identified Stage of Recovery. Psicothema 2024; 36:165-173. [PMID: 38661163 DOI: 10.7334/psicothema2023.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The Self-Identified Stage of Recovery (SISR) () is a scale used to assess both the stage of recovery (SISR-A) and the components of the process of personal recovery (SISR-B). This study aimed to develop the Spanish version of the SISR and obtain evidence of validity and reliability in a sample of 230 users of community mental health services. METHOD The Spanish version of the SISR was developed following the translation-back translation procedure, with the support of a committee of experienced experts. The SISR was examined in terms of dimensional structure, internal consistency, relationships with other variables (i.e., the Maryland Recovery Assessment Scale [MARS-12] and the Dispositional Hope Scale [DHS]), and temporal stability ( = 66). Differential item functioning (DIF) by gender was analysed. RESULTS The study confirmed the unidimensionality of the SISR-B and suitable internal consistency of its scores (ω = .83, α = .83). Scores from both SISR-A and SISR-B showed good temporal stability and the SISR-B displayed strong correlations with the MARS-12 ( = .78) and the DHS ( = .67). No DIF was found. CONCLUSIONS This study supports the validity and reliability of the scores of the Spanish version of the SISR.
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Affiliation(s)
- Hernán María Sampietro
- ActivaMent Catalunya Associació, Universidad de Barcelona (Spain). https://orcid.org/0000-0002-2315-0656
| | | | - Georgina Guilera
- Universitat de Barcelona (Spain), Institute of Neurosciences, University of Barcelona (Spain), https://orcid.org/0000-0002-4941-2511
| | - J Emilio Rojo
- Benito Menni CASM Hermanas Hospitalarias; Universitat Internacional de Catalunya (Spain). https://orcid.org/0000-0002-7274-0900
| | - Maite Barrios
- Universidad de Barcelona (Spain). https://orcid.org/0000-0003-1979-0818
| | - Ángela I Berrío
- Universidad de Barcelona (Spain). https://orcid.org/0000-0003-2064-4594
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Delforterie MJ, Turhan A, Driessen M, Neijmeijer L, Hesper B, Didden R. Reliability and validity of the dynamic risk outcome scales-short version for clients with mild intellectual disabilities or borderline intellectual functioning. J Appl Res Intellect Disabil 2024; 37:e13212. [PMID: 38382539 DOI: 10.1111/jar.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/15/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This study investigated the reliability and validity of the dynamic risk outcome scales-short version (DROS-SV). This instrument is developed to monitor treatment progress using dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning and behavioural and/or mental health problems. METHOD Data were collected from 264 clients who received Flexible Assertive Community Treatment (FACT), a form of intensive outpatient treatment. RESULTS A principal component analysis showed that there were six components explaining 73.9% of the variance. Furthermore, the DROS-SV showed good internal consistency of its subscales and total score (α > 0.78). Correlating the DROS-SV with the Historical and Clinical subscales of the Historical, Clinical and Future-30 indicated convergent and divergent validity. DISCUSSION The DROS-SV has good psychometric properties for measuring dynamic risk factors in clients with mild intellectual disabilities or borderline intellectual functioning in FACT teams.
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Affiliation(s)
- M J Delforterie
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - A Turhan
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - L Neijmeijer
- Indigo Midden Nederland, Hilversum, The Netherlands
| | - B Hesper
- Trajectum, Zwolle, The Netherlands
| | - R Didden
- Trajectum, Zwolle, The Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Hill N, Graham N, Forrester RL. Routine Sensitive Enquiry of Adult Interpersonal Trauma in Community Mental Health Teams: An Audit of the Initial Assessment Tool. Community Ment Health J 2024; 60:691-698. [PMID: 38363438 PMCID: PMC11001718 DOI: 10.1007/s10597-023-01220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024]
Abstract
This audit aimed to evaluate the utility of the Initial Assessment Tool (IAT) in documenting routine sensitive enquiry of adult interpersonal trauma within three Community Mental Health Teams (CMHTs) in North-East Glasgow. In addition, it sought to evaluate if disclosures informed patient risk assessments and if patients were signposted to additional support services. 57% of 90 IATs had evidence of routine sensitive enquiry. Of 51 casefiles with evidence of routine sensitive enquiry, 61% had evidence of the information informing their risk assessments and 14% had documented recommendations of support organisations. The IAT appeared able to assist clinicians with routine sensitive enquiry in adulthood. However, there may be advantage in supporting staff understanding of how to ask questions to specific populations and to use this information to inform treatment planning. Given the prevalence of adult interpersonal trauma experienced by patients presenting to CMHTs, trauma-informed approaches to care should be implemented.
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Affiliation(s)
- Natasha Hill
- Department of Clinical Psychology, Gartnavel Hospital, University of Glasgow, Glasgow, Scotland, UK.
| | - Nicholas Graham
- Dykebar Hospital, NHS Greater Glasgow & Clyde, Grahamston Road, Glasgow, Scotland, UK
| | - Rebecca L Forrester
- Arndale Resource Centre, NHS Greater Glasgow & Clyde, Kinfauns Road, Glasgow, Scotland, UK
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Klodnick VV, Johnson RP, Sapiro B, Fagan MA, Cohen DA. How Young Adults with Serious Mental Health Diagnoses Navigate Poverty Post-emancipation: The Complex Roles of Community Mental Health Services & Informal Social Support. Community Ment Health J 2024; 60:635-648. [PMID: 37789173 DOI: 10.1007/s10597-023-01188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023]
Abstract
Serious mental health diagnoses are prevalent among youth who "age out" of foster care by reaching the maximum age for child welfare service eligibility. Post-emancipation, little is known about how youth engage in community mental health services, or leverage informal social networks, to navigate independence. Twenty emancipating youth completed three interviews over 16 months. All emancipated into poverty; most lived alone and initially connected to adult community mental health teams. Four service use and informal support profiles emerged from analysis: (1) Navigators (n = 2) actively used mental health services and provided limited informal support; Treaders (n = 9) passively used mental health services and heavily exchanged informal support; Survivors (n = 5) used mental health services when in crisis and heavily provided informal support; and Strugglers (n = 4) avoided mental health services and took resources from informal connections. Findings have implications for both child and adult mental health and social service providers.
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Affiliation(s)
- Vanessa V Klodnick
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA.
- Thresholds Youth & Young Adult Services, Chicago, IL, USA.
| | - Rebecca P Johnson
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA
- Thresholds Youth & Young Adult Services, Chicago, IL, USA
| | - Beth Sapiro
- Department of Social Work and Child Advocacy, College of Humanities and Social Sciences, Montclair State University, Montclair, NJ, USA
| | - Marc A Fagan
- Thresholds Youth & Young Adult Services, Chicago, IL, USA
| | - Deborah A Cohen
- Steve Hicks School of Social Work, Texas Institute for Excellence in Mental Health, The University of Texas at Austin, Austin, USA
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, USA
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Iacobucci G. Community mental health services need support to improve patient satisfaction, says NHS leader. BMJ 2024; 385:q908. [PMID: 38641351 DOI: 10.1136/bmj.q908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
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Taban M, Nooraeen S, Tanha K, Moradi-Lakeh M, Malakouti SK. Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:256. [PMID: 38575916 PMCID: PMC10993444 DOI: 10.1186/s12888-024-05666-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Severe mental illness (SMI) imposes a substantial worldwide burden of disability, highlighting the need for comprehensive and adaptable mental health services. This study aims to assess the efficacy and cost-effectiveness of community-based mental health services (CBMHS) in reducing relapse and rehospitalization rates among individuals with SMI in Iran. METHOD A systematic review and meta-analysis were conducted. Medline, EMBASE, ISI, SCOPUS, and ProQuest were searched until December 2022. We focused on randomized controlled trials, quasi-experimental studies, or economic studies related to individuals with SMI. Out of 127 articles, 17 were selected for a full-text review. The primary outcomes were the severity of psychopathology, rehospitalization rates, and the mental health of caregivers. We also examined community-based interventions and their impact on various outcomes. Data extraction and risk of bias assessment were performed, and critical appraisal was conducted using JBI checklists. Meta-analysis was carried out using STATA software. (PROSPERO registration. CRD42022332660). RESULT Rehospitalization rates among patients who received CBMHS were significantly lower, with an odds ratio of 2.14 (95% CI: 1.44 to 3.19), indicating a 2.14 times lower likelihood than those who received treatment as usual. A reduction in psychopathology accompanied this, SMD: -0.31, 95% CI: -0.49 to -0.13, I2 = 40.23%). Moreover, there was a notable improvement in social skills (SMD: -0.7, 95% CI: -0.98 to -0.44, I2 = 0.00%). The burden on caregivers also decreased (SMD: -0.55, 95% CI: -0.99 to -0.1, I2 = 63.2). The Incremental Cost-Effectiveness Ratio (ICER) for QUALY was acceptable, albeit with a wide range of 613 to 8400 Dollars. CONCLUSION CBMHS has demonstrated effectiveness and efficiency in Iran as a developing country. Additionally, it shows promise in mitigating the shortage of acute psychiatry beds. Using multiple data collection tools poses a limitation regarding data consolidation and conducting a meta-analysis.
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Affiliation(s)
- Mozhgan Taban
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Nooraeen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kiarash Tanha
- Oxford Vaccine Group, Department of Pediatrics, University of Oxford, Oxford, U.K
| | - Maziar Moradi-Lakeh
- Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
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Muusse CGR, Mulder CL, Kroon H, Pols J. Uncertainty Work: Dealing with a Psychiatric Crisis in Two European Community Mental Health Teams. Med Anthropol 2024; 43:247-261. [PMID: 38329492 DOI: 10.1080/01459740.2024.2310857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
The quest for how to deal with a crisis in a community setting, with the aim of deinstitutionalizing mental health care, and reducing hospitalization and coercion, is important. In this article, we argue that to understand how this can be done, we need to shift the attention from acute moments to daily uncertainty work conducted in community mental health teams. By drawing on an empirical ethics approach, we contrast the modes of caring of two teams in Utrecht and Trieste. Our analysis shows how temporality structures, such as watchful waiting, are important in dealing with the uncertainty of a crisis.
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Affiliation(s)
- Christina Gerdien Roelofke Muusse
- Zorg & Participatie, Trimbos-Institute, Utrecht, Netherlands
- Ethics, Law & Humanities, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands
- Antes, Parnassia Psych-Medical Centre, The Hague, Netherlands
| | - Hans Kroon
- Zorg & Participatie, Trimbos-Institute, Utrecht, Netherlands
- Tranzo Scientific Center for Care and Welfare, Tilburg University Tilburg School of Social and Behavioral Sciences, Tilburg, Netherlands
| | - Jeannette Pols
- Ethics, Law & Humanities, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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Green S, Rosenbaum D, Beder M. Heat Resilience and Severe & Persistent Mental Illness. Can J Psychiatry 2024; 69:239-241. [PMID: 38115689 PMCID: PMC10924578 DOI: 10.1177/07067437231220797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Samantha Green
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Unity Health Toronto Ringgold Standard Institution, Toronto, Canada
| | - Daniel Rosenbaum
- Department of Psychiatry, University of Toronto Faculty of Medicine Ringgold Standard Institution–Psychiatry, Toronto, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto Faculty of Medicine Ringgold Standard Institution–Psychiatry, Toronto, Canada
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9
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Ingoglia C, Farley David R. Broad Reach of Certified Community Behavioral Health Centers. Psychiatr Serv 2024; 75:397-398. [PMID: 38557131 DOI: 10.1176/appi.ps.20240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
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10
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Hewitt C. "Broken" mental health services: government promises must be monitored. BMJ 2024; 384:q703. [PMID: 38514078 DOI: 10.1136/bmj.q703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
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11
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Grammeniati A, Mantziou A, Peritogiannis V. First-contact patients with a community mental health service in rural Greece: A 3-year prospective study of treatment attendance and its co-relations. Int J Soc Psychiatry 2024; 70:355-363. [PMID: 38193429 DOI: 10.1177/00207640231212097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Treatment continuation is essential for the optimal management of patients with mental disorders in the community, but treatment and outcome are often undermined by the high rates of service disengagement and treatment non-adherence across all psychiatric diagnoses. The phenomenon may be even more relevant in rural settings. AIMS The aim of the present study was to explore attendance to treatment in first-contact patients in a community-based treatment setting in rural Greece and to explore the associations of treatment attendance with demographic and clinical factors. METHOD Data were collected prospectively over a 3-year period, with 1-year follow-up interval. All first-contact cases with the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T), Northwest Greece were considered, but only clinical cases were processed. RESULTS The sample size consisted of 446 patients, with a mean age 65.4 ± 18.8 years. The rate of 12-month attendance to mental health treatment was 13.5% (60 out of 446 patients). Treatment attendance was found to be correlated with younger age, the diagnosis of schizophrenia-spectrum disorder, and patients' referral by other psychiatric services. First examination over the year 2019 had been significantly inversely associated with treatment engagement. CONCLUSION Rates of subsequent attendance after initial assessment in a rural community mental healthcare setting were rather low in the present study. Several variables that have been previously associated with service engagement were found to be related in this study too, whereas other were not. Research on treatment engagement in rural treatment settings should be ongoing to reveal all associated factors.
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Affiliation(s)
- Aikaterini Grammeniati
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Alexandra Mantziou
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
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12
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Mulligan D, O'Callaghan AK, Guerandel A. "Don't Look Up": Eco-anxiety presenting in a Community Mental Health Service. Ir J Psychol Med 2024; 41:144-147. [PMID: 37522169 DOI: 10.1017/ipm.2023.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This case report discusses a 25-year-old male who was referred to community mental health services from primary care with symptoms of anxiety and depression related to climate change, which the referring clinician believed were of delusional intensity. This case report gives the history of his interaction with the service. A literature review is performed noting the dearth of case reports in this area and a subsequent discussion charts the emerging literature on mental health issues related to climate change. Finally the paper makes some broad recommendations for mental health practitioners on how to approach these issues.
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Affiliation(s)
- D Mulligan
- St Vincent's University Hospital, Elm Mount Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A K O'Callaghan
- St Vincent's University Hospital, Elm Mount Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - A Guerandel
- St Vincent's University Hospital, Elm Mount Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
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Wu J, Siddiqui FJ, Mak CCM, Chua ISY, Thangayah JR, Tan EXX, Seet HY, Rao AK, Tan HY, Mohamed A, Hartman M, Leong BSH, Ong MEH, Mao DR. Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol. BMC Health Serv Res 2024; 24:256. [PMID: 38419049 PMCID: PMC10900701 DOI: 10.1186/s12913-023-10516-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy-in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions. METHODS Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores. DISCUSSION Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT's efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model's prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations. TRIAL REGISTRATION ClinicalTrials.gov, NCT04447079. Initiated on 25 June 2020.
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Affiliation(s)
- Juntian Wu
- Health Services Research Centre, SingHealth, Outram, Singapore.
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore.
| | - Fahad Javaid Siddiqui
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Outram, Singapore
| | - Charles Chia Meng Mak
- National Addictions Management Service, Institute of Mental Health, Buangkok, Singapore
| | - Ivan Si Yong Chua
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
| | | | - Esther Xi Xiang Tan
- Department of Emergency Medicine, Ng Teng Fong General Hospital, Jurong East, Singapore, Singapore
| | - Huey Ying Seet
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Adriel Kailing Rao
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Hann Yee Tan
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
| | - Asif Mohamed
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Novena, Singapore
| | - Mikael Hartman
- Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
- Department of Surgery, National University Hospital, Kent Ridge, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Kent Ridge, Singapore
| | | | - Marcus Eng Hock Ong
- Health Services and Systems Research, Duke-NUS Medical School, Outram, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Outram, Singapore
- Unit for Pre-hospital Emergency Care, Ministry of Health, Outram, Singapore
| | - Desmond Renhao Mao
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, Yishun, Singapore
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Dissanayake R, Olivieri R, Aguey-Zinsou M, Yule E, Dunn L. Exploring mental health consumer experiences of the strengths model of case management: A phenomenological study. Int J Ment Health Nurs 2024; 33:175-184. [PMID: 37792607 DOI: 10.1111/inm.13238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
The strengths of model of case management is a recovery-oriented model of community mental health care that has been linked to positive consumer outcomes. The aim of this qualitative study was to explore the consumer perspective of the strengths model of case management using a descriptive phenomenological approach. Data were collected through in-depth, semi-structured interviews. In total, six consumers from a metropolitan community mental health service were interviewed. Interview transcripts were analysed using Colaizzi's phenomenological method. Three major themes were identified: the relationship between the consumer and the case manager is valuable, the strengths assessment supports identifying strengths and areas for action and the strengths model of case management promotes recovery and goal achievement. Implications for practice include an increased understanding of consumer preferences and promoting the consumer voice, thereby supporting the provision of higher quality evidence-based practice.
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Affiliation(s)
- Rashmi Dissanayake
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Rebecca Olivieri
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Melissa Aguey-Zinsou
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Elisa Yule
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia
| | - Leonie Dunn
- South Eastern Sydney Local Health District, NSW Health, Sydney, New South Wales, Australia
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15
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Tan RXR, Goh YS. Perceptions of community mental health services among culturally diverse adult Singaporeans with major depressive disorder: A descriptive qualitative study. Int J Ment Health Nurs 2024; 33:143-158. [PMID: 37743553 DOI: 10.1111/inm.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
Persons with major depressive disorder (PMDDs) often experience pernicious ramifications on the biopsychosocial aspects of their health. While community mental health services (CMHSs) in Singapore are increasingly leveraged to meet the escalating demand for mental healthcare, shortcomings such as a substantial treatment gap and the lack of holistic, culturally sensitive care have been highlighted. Of note, the perspectives of the service users, which have hardly been studied in the literature, are crucial to our understanding of their needs to continuously improve CMHSs. Accordingly, this qualitative descriptive study explored the perceptions and experiences of community-dwelling adults with major depressive disorder in their use of CMHSs in Singapore. Seventeen adults with major depressive disorder purposefully sampled from a CMHS provider were interviewed through a semi-structured guide between October and November 2021. Data analysis via Braun and Clarke's six-step thematic framework yielded five themes corresponding to three different phases: pre-CMHS encounter ((i) procrastination to seek help and (ii) factors influencing CMHS utilization); intra-CMHS encounter ((iii) incongruous perceptions of the impacts on biopsychosocial health and (iv) differing perceptions and experiences of culturally sensitive care); and post-CMHS encounter ((v) enhancing CMHSs for PMDDs based on end-users' experiences). Our findings underscore the need to improve the delivery of personalized mental healthcare services, use of settings- and culturally-specific anti-stigma strategies, and nationwide mental health literacy in symptom recognition and awareness of help-seeking resources.
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Affiliation(s)
- Ronel Xian Rong Tan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Naeem F, Khan N, Sohani N, Safa F, Masud M, Ahmed S, Thandi G, Mutta B, Kasaam A, Tello K, Husain MI, Husain MO, Kidd SA, McKenzie K. Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study. Can J Psychiatry 2024; 69:54-68. [PMID: 37376808 PMCID: PMC10867407 DOI: 10.1177/07067437231178958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions. METHOD The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design. RESULTS Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors. CONCLUSIONS Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.
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Affiliation(s)
- Farooq Naeem
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nagina Khan
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nazia Sohani
- Immigrant Services, Ottawa Newcomer Health Centre, Ottawa, ON, Canada
| | - Farhana Safa
- Punjabi Community Health Services, Brampton, ON, Canada
| | | | - Sarah Ahmed
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Gary Thandi
- Moving Forward Family Services, Vancouver, Canada
| | - Baldev Mutta
- Punjabi Community Health Services, Toronto, Canada
| | - Azaad Kasaam
- Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Kamlesh Tello
- Access to Quality Mental Health Services, Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kwame McKenzie
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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17
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Reardon B, Toles M, Cuddeback G, Travers D. Perceptions of ACT Team Members on the Implementation of Physical Health Services: A Qualitative Study. J Am Psychiatr Nurses Assoc 2024; 30:108-120. [PMID: 35220783 DOI: 10.1177/10783903221079800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults with severe mental illnesses have mortality rates 2.5 to 3 times higher than the general population, largely due to medical illnesses. Those with the most profound mental illnesses are served by assertive community treatment (ACT) teams that provide intensive mental health care; however, there are no clearly established models to integrate physical health treatment into ACT and this is a critical gap in the literature. AIMS To describe perceptions of ACT team members regarding services provided for their clients to treat physical health, how those services can be improved, and what implementation strategies would likely be needed to promote uptake and sustainability of those services on ACT teams. METHOD Qualitative interviews were conducted via Zoom using a semistructured interview guide with 19 employees from three ACT teams in a southeastern state. Interview transcripts were analyzed, using manifest content analysis, a form of qualitative analysis, to identify key themes in the interview transcripts. RESULTS ACT team members described limited physical health services for their clients. They reported (1) system-level barriers to improving physical health care, such as inadequate tools and training; and (2) patient-level barriers, such as limited awareness of physical care needs. ACT team members reported the need for additional medical staff and strengthened relationships with primary care providers. They also recommended changes in policy, education, and quality monitoring to implement new physical health care services. CONCLUSIONS Findings suggest intervention components and implementation strategies for improving physical health care of ACT consumers.
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Affiliation(s)
- Brandy Reardon
- Brandy Reardon, PhD, RN, University of North Carolina at Chapel Hill, NC, USA
| | - Mark Toles
- Mark Toles, PhD, RN, FAAN, University of North Carolina at Chapel Hill, NC, USA
| | - Gary Cuddeback
- Gary Cuddeback, PhD, MSW, MPH, University of North Carolina at Chapel Hill, NC, USA
| | - Debbie Travers
- Debbie Travers, PhD, RN, FAEN, Duke University, Chapel Hill, NC, USA
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Fehily C, Jackson B, Hansen V, Stettaford T, Bartlem K, Clancy R, Bowman J. Increasing chronic disease preventive care in community mental health services: clinician-generated strategies. BMC Psychiatry 2023; 23:933. [PMID: 38082423 PMCID: PMC10714530 DOI: 10.1186/s12888-023-05311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People with a mental health condition experience a high prevalence of chronic disease risk behaviours e.g., tobacco smoking and physical inactivity. Recommended 'preventive care' to address these risks is infrequently provided by community mental health services. This study aimed to elucidate, among community mental health managers and clinicians, suggestions for strategies to support provision of preventive care. METHODS Three qualitative focus groups (n = 14 clinicians) were undertaken in one regional community mental health service to gather perspectives of barriers to preventive care provision, deductively coded against the domains of the Theoretical Domains Framework (TDF). Drawing on the learnings from the focus groups, individual interviews (n = 15 managers and clinicians) were conducted in two services to identify suggestions for strategies to increase preventive care. Strategies were inductively coded and mapped into TDF domains. RESULTS Barriers were identified across a wide range of TDF domains, most notably knowledge and environmental context and resources. Nine strategies were identified across three themes: training, resources and systems changes; mapping to all 14 TDF domains. CONCLUSION Future research seeking to increase implementation of preventive care may be guided by these findings. There is need for greater recognition and resourcing of preventive care as a priority and integral component of mental health treatment.
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Affiliation(s)
- Caitlin Fehily
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia.
| | - Belinda Jackson
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Vibeke Hansen
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
| | - Tegan Stettaford
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
| | - Richard Clancy
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
- Hunter New England Mental Health, Hunter New England Local Health District, NSW Health, New Lambton, NSW, Australia
- School of Nursing and Midwifery, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Jenny Bowman
- School of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, NSW, Australia
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McDonald A, Still M, Sommer J, Coniglio F. Riding the tides: Directions in mental health rehabilitation in NSW. Australas Psychiatry 2023; 31:791-794. [PMID: 37907834 DOI: 10.1177/10398562231205129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVE This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. CONCLUSION The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses.
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Affiliation(s)
- Andrew McDonald
- Mental Health Services, Sydney Local Health District, Concord, NSW, Australia
| | - Megan Still
- Mental Health Services, Sydney Local Health District, Concord, NSW, Australia
| | - Joanne Sommer
- New South Wales Ministry of Health, Sydney, NSW, Australia
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20
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Williams KE. Evaluation of a mental health service reform program, the Pathways to Community Living Initiative, for people with severe mental illness and complex needs. Australas Psychiatry 2023; 31:806-812. [PMID: 37965777 PMCID: PMC10725626 DOI: 10.1177/10398562231211673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVE The Pathways to Community Living Initiative (PCLI) aims to reform mental health care for people with severe and persistent mental illness (SPMI) and complex needs. This study reports independent evaluation findings on transitions from hospital and practice change in mental health services. METHODS Data for this mixed-methods evaluation were obtained from administrative collections and semi-structured interviews with PCLI program managers, teams and executive leads; aged care managers; and leaders in inpatient, community and older people's mental health services. RESULTS Between July 2015 and December 2020, 674 participants (67% of those eligible for the PCLI) were transitioned from hospital to community. Of those transitioned, 21 required subsequent long-stay admissions. The PCLI introduced resources, clearly defined processes, and state-wide networks to guide changes in practice which are becoming embedded in the operations and governance of mental health services across New South Wales. CONCLUSIONS Severe and persistent mental illness and complex needs can be managed in community settings with highly individualised planning and care, supported by specialised clinical teams in partnership with mental health, aged care and disability services. Evaluation findings highlight the importance of continued investment in rehabilitation psychiatry.
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Affiliation(s)
- Kathryn E Williams
- Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
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21
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Skinner A, Occhipinti JA, Song YJC, Scott EM, Hickie IB. Dynamic modelling of the impact of community-based acute mental health services for children and adolescents. Aust N Z J Psychiatry 2023; 57:1562-1569. [PMID: 37641519 PMCID: PMC10666480 DOI: 10.1177/00048674231195555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To evaluate the potential impact of the recently announced 'Safeguards' initiative on mental health-related emergency department presentation rates for children and adolescents (0-17 years). This state-funded initiative aims to establish 25 Child and Adolescent Acute Response Teams across New South Wales. METHODS We estimated the effects of the 'Safeguards' initiative using a state-level dynamic model of child and adolescent acute mental health care. Potential reductions in total numbers of mental health-related emergency department presentations and re-presentations (i.e. presentations within 3 months of an initial presentation) were assessed via a series of simulation experiments in which we systematically varied the total number of Child and Adolescent Acute Response Teams and the mean duration of care per patient. RESULTS Assuming a mean treatment duration of 6 weeks per patient, 25 Child and Adolescent Acute Response Teams are projected to reduce total numbers of mental health-related emergency department presentations and re-presentations over the period 2022-2031 by 15.0% (95% interval, 12.0-18.2%) and 31.7% (26.2-37.8%), respectively. Increasing the total number of Child and Adolescent Acute Response Teams above 25 has minimal additional impact on projected reductions in numbers of emergency department presentations and re-presentations, provided the mean duration of care is no more than 8 weeks. However, where the mean duration of care is greater than 4 weeks, a decrease in the number of Child and Adolescent Acute Response Teams below 25 reduces the potential effectiveness of the 'Safeguards' initiative significantly. CONCLUSION Our simulation results indicate that full and timely implementation will be critical if the potentially substantial impact of the 'Safeguards' initiative on demand for hospital-based emergency mental health care is to be realised.
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Affiliation(s)
- Adam Skinner
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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22
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Perkes I. Serious mental illness? Categorical measurement for health service systems. Aust N Z J Psychiatry 2023; 57:1505-1507. [PMID: 37968941 DOI: 10.1177/00048674231214872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Iain Perkes
- Discipline of Paediatrics & Child Health and Discipline of Psychiatry & Mental Health, School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, Kensington, NSW, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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23
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Martinelli A, Bonetto C, Pozzan T, Procura E, Cristofalo D, Ruggeri M, Killaspy H. Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy. BMC Psychiatry 2023; 23:834. [PMID: 37957583 PMCID: PMC10644654 DOI: 10.1186/s12888-023-05307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). METHODS Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. RESULTS Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). CONCLUSIONS Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.
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Affiliation(s)
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tecla Pozzan
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena Procura
- Mental Health Center, Isola Della Scala, Ospedale Di Bussolengo, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Lim J, White J, Withington T, Catania S, Wilson D, Knight P, Rees B, Middeldorp C, Krishnamoorthy G. Family-based treatment takes longer for adolescents with mental health comorbidities: findings from a community mental health service. Eat Disord 2023; 31:588-609. [PMID: 37066723 DOI: 10.1080/10640266.2023.2201995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Children and adolescents diagnosed with an eating disorder often meet the diagnosis of another mental health disorder. In addition to eating disorders, individuals with comorbid disorders have higher suicide rates and more severe and chronic eating disorder symptoms. The present research aimed to investigate the influence of comorbid conditions on the treatment outcomes of children and adolescents that attended a public community mental health service. It was hypothesised that the patients with comorbidities would have a more extended treatment duration, slower rates of weight restoration, more hospital admissions for medical compromise, and poorer functioning than those without comorbidities. Data from 78 past patients at the Eating Disorder Program in Queensland, Australia, were analysed. Patients with comorbidities demonstrated similar recovery rates to those without comorbidities. However, those with comorbid conditions had longer episodes of treatment. The study's results support using Family Based Treatment for patients with and without comorbidities. The implications of the findings for public mental health services and directions for future research are discussed.
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Affiliation(s)
- Jacqueline Lim
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Jacinda White
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Tania Withington
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Salvatore Catania
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | - Daniel Wilson
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Penny Knight
- Child and Youth Mental Health Service, Children's Health Queensland, Ipswich, Australia
| | | | - Christel Middeldorp
- Child Health Research Center, University of Queensland, South Brisbane, Australia
| | - Govind Krishnamoorthy
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
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Cho E, Cook JR, Hawley KM. A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers. Adm Policy Ment Health 2023; 50:876-887. [PMID: 37458956 DOI: 10.1007/s10488-023-01286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 10/01/2023]
Abstract
Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, USA
- Harvard University, Cambridge, USA
| | - Jonathan R Cook
- University of Missouri, Columbia, USA
- Pacific Anxiety Group, Belmont, USA
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Lindberg MS, Brattmyr M, Lundqvist J, Roos E, Solem S, Hjemdal O, Havnen A. Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway. Qual Life Res 2023; 32:3135-3145. [PMID: 37338784 PMCID: PMC10522514 DOI: 10.1007/s11136-023-03461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. METHODS In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. RESULTS Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. CONCLUSION The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.
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Affiliation(s)
- Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
- Health and Welfare, Trondheim Municipality, Trondheim, Norway.
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Eirik Roos
- Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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Brekke E, Clausen H, Brodahl M, Landheim AS. Patients' experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry 2023; 23:764. [PMID: 37853402 PMCID: PMC10585822 DOI: 10.1186/s12888-023-05264-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? METHOD Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. RESULTS Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. CONCLUSION Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway.
| | - Hanne Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
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Roberts SH, Bailey J. Exergaming (physically active video gaming) for mental health service users in a community mental health care setting: an ethnographic observational feasibility study. BMC Psychiatry 2023; 23:752. [PMID: 37845683 PMCID: PMC10577994 DOI: 10.1186/s12888-023-05233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND People with severe and enduring mental illness experience health inequalities with premature mortality; lifestyle behaviours are known to be contributing factors with low levels of physical activity reported. Facilitating physical activity to help maintain or improve health for those who are disadvantaged is essential. Exergaming (gaming involving physical movement) is increasingly used to improve physical activity across the lifespan and for those with a range clinical conditions; this might offer a way to increase physical activity for those with severe mental illness. The aim of this study was to explore engagement of mental health service users with exergaming to increase physical activity in a community mental health care setting. METHODS An ethnographic observational feasibility study was undertaken through participant observation and semi-structured interviews. A gaming console was made available for 2 days per week for 12 months in a community mental health setting. A reflexive thematic analysis was performed on the data. RESULTS Twenty one mental health service users engaged with the intervention, with two thirds exergaming more than once. One participant completed the semi-structured interview. Key themes identified from the observational field notes were: support (peer and staff support); opportunity and accessibility; self-monitoring; and perceived benefits. Related themes that emerged from interview data were: benefits; motivators; barriers; and delivery of the intervention. Integrating these findings, we highlight social support; fun, enjoyment and confidence building; motivation and self-monitoring; and, accessibility and delivery in community mental health care context are key domains of interest for mental health care providers. CONCLUSIONS We provide evidence that exergaming engages people with SMI with physical activity. The value, acceptability and feasibility of open access exergaming in a community mental health service context is supported. Facilitating exergaming has the potential to increase physical activity for mental health service users leading to possible additional health benefits.
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Affiliation(s)
- Seren Haf Roberts
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF144XN, UK.
| | - Jois Bailey
- Betsi Cadwaladr University Health Board, Wrexham, UK
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Stefanidou T, Ambler G, Bartl G, Barber N, Billings J, Bogatsu T, Carroll R, Chipp B, Conneely M, Downey AM, Evlat G, Hunter R, Le Novere M, Lewis G, Mackay T, Marwaha S, Matin Z, Naughton G, Nekitsing C, O'Sullivan M, Pinfold V, Pan S, Sobers A, Thompson KJ, Vasikaran J, Webber M, Johnson S, Lloyd-Evans B. Randomised controlled trial of the Community Navigator programme to reduce loneliness and depression for adults with treatment-resistant depression in secondary community mental health services: trial protocol. Trials 2023; 24:652. [PMID: 37803385 PMCID: PMC10559405 DOI: 10.1186/s13063-023-07684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND New treatments are needed for people with treatment-resistant depression (TRD), who do not benefit from anti-depressants and many of whom do not recover fully with psychological treatments. The Community Navigator programme was co-produced with service users and practitioners. It is a novel social intervention which aims to reduce loneliness and thus improve health outcomes for people with TRD. Participants receive up to 10 individual meetings with a Community Navigator, who helps them to map their social world and set and enact goals to enhance their social connections and reduce loneliness. Participants may also access group meet-ups with others in the programme every 2 months, and may be offered modest financial support to enable activities to support social connections. METHODS A researcher-blind, multi-site, 1:1 randomised controlled trial with N = 306 participants will test the effectiveness of the Community Navigator programme for people with TRD in secondary community mental health teams (CMHTs). Our primary hypothesis is that people who are offered the Community Navigator programme as an addition to usual CMHT care will be less depressed, assessed using the PHQ-9 self-report measure, at 8-month, end-of-treatment follow-up, compared to a control group receiving usual CMHT care and a booklet with information about local social groups and activities. We will follow participants up at end-of-treatment and at 14 months, 6 months after end-of-treatment follow-up. Secondary outcomes include the following: loneliness, anxiety, personal recovery, self-efficacy, social network, social identities. We will collect data about health-related quality of life and service use to investigate the cost-effectiveness of the Community Navigator programme. DISCUSSION This trial will provide definitive evidence about the effectiveness and cost-effectiveness of the Community Navigator programme and whether it can be recommended for use in practice. The trial is due to finish in August 2025. TRIAL REGISTRATION Prospectively registered on 8th July 2022 at: ISRCTN13205972.
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Affiliation(s)
- Theodora Stefanidou
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gareth Ambler
- Department of Statistical Sciences, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Gergely Bartl
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nick Barber
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- The McPin Foundation, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Beverley Chipp
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- The McPin Foundation, London, UK
| | - Maev Conneely
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | - Gamze Evlat
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Rachael Hunter
- Priment Clinical Trials Unit, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Le Novere
- Priment Clinical Trials Unit, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Priment Clinical Trials Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Zubair Matin
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | | | - Millie O'Sullivan
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Shengning Pan
- Department of Statistical Sciences, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Angela Sobers
- Barnet, Enfield and Haringey, NHS Mental Health Trust, London, UK
| | - Keith J Thompson
- The McPin Foundation, London, UK
- Tees, Esk and Wear Valley, NHS Foundation Trust, Durham, UK
| | - Jerusaa Vasikaran
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Martin Webber
- School for Business and Society, University of York, York, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Gang J, Kim J. The Intersection of Culture, Community, and Mental Health. Psychiatr Serv 2023; 74:1009. [PMID: 37777860 DOI: 10.1176/appi.ps.23074016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- James Gang
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, New York
| | - Joseph Kim
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Bronx, New York
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de Bruijn E, Jochems EC, Wierdsma AI, Voskes Y. The Overlooked Part of Flexible Assertive Community Treatment-A Retrospective Study on Factors Related to Discharge from FACT for Clients with a Psychotic Disorder. Community Ment Health J 2023; 59:1313-1320. [PMID: 37086300 PMCID: PMC10447266 DOI: 10.1007/s10597-023-01115-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/23/2023]
Abstract
Flexible assertive community treatment (FACT) is a recovery-based treatment and its manual describes discharge criteria for clients who are recovered. Yet research on discharge is lacking. In this retrospective and observational study, between 2009 and 2019, we explored how sociodemographic, clinical, and treatment factors are associated with planned discharge or no discharge. We included 1734 clients with a psychotic disorder of which 38.5% were discharged after a mutual decision that FACT was no longer necessary. Logistic regression analysis was used to create a discharge profile which was more favorable for discharged clients. They were older at the start of FACT, had lower HoNOS scores, were diagnosed with another psychotic disorder, and had fewer contacts with non-FACT members. Discharge is a part of FACT and is more common than anticipated. While this study provides preliminary answers, further research is necessary to better understand discharge and its associated factors.
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Affiliation(s)
- Eva de Bruijn
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
| | | | | | - Yolande Voskes
- GGZ Breburg, Tilburg, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, The Netherlands
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Killaspy H. The renaissance of mental health rehabilitation services. Australas Psychiatry 2023; 31:579-581. [PMID: 37489244 DOI: 10.1177/10398562231190540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Parker SM, Paine K, Spooner C, Harris M. Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review. BMC Health Serv Res 2023; 23:977. [PMID: 37697280 PMCID: PMC10494334 DOI: 10.1186/s12913-023-09918-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND People with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers' access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population. METHODS We searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods. RESULTS We identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care. CONCLUSION Our results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing "goals and knowledge, mutual respect" and engaging in "frequent, timely, accurate, problem-solving communication", supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
| | - Katrina Paine
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales , Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Abstract
OBJECTIVES Burnout has been associated with medical errors and low levels should be considered an indicator of service quality. This study examined the level of personal, work and client-related burnout in medical, other clinical and non-clinical staff in an adult community mental health service. METHODS An anonymous study-specific questionnaire was designed and circulated to all staff with an explanatory document. The Copenhagen Burnout Inventory was used as a validated measure of burnout, with high levels reflecting high rates of stress and burnout. Further questions were added from Maslach Burnout Inventory and effort-reward imbalance index. Information on demographics, job satisfaction, turnover intention, feeling valued and effort/reward balance was gathered and analysed. RESULTS The overall response rate was 47.4% (63/133), of whom 43 were clinical staff. Overall levels of burnout were low and similar across staff type, with only 30.1% showing moderate levels of burnout, and none in the 'high-burnout' category. All staff displayed positive disposition towards patients, with lower client burnout, as compared to personal and work-related burnout. All medical staff felt valued in their work, with lower rates in the other groups (48.7% of non-medical clinicians and 58.3% of non-clinical staff). CONCLUSIONS Relatively low levels of overall burnout were reported among clinical and non-clinical staff working in our adult mental health service. These rates are similar to the levels identified in a national study of burnout in Irish hospital doctors but lower than the levels found among consultants in Irish child and adolescent mental health services.
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Affiliation(s)
- Norella Broderick
- Cluain Mhuire Community Services, Newtownpark Avenue, Blackrock, Ireland
| | - Roisin Vaughan
- Cluain Mhuire Community Services, Newtownpark Avenue, Blackrock, Ireland
| | - Fiona McNicholas
- Lucena Clinic, Rathgar, Dublin 6, Ireland
- CHI Crumlin, Dublin 12, Ireland
- SMMS University College Dublin, Dublin, Ireland
| | - Larkin Feeney
- Cluain Mhuire Community Services, Newtownpark Avenue, Blackrock, Ireland
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O'Sullivan R, Cosgrave M, Butler A, Lyne JP. Characteristics of a later life population in a general adult community mental health service setting. Ir J Psychol Med 2023; 40:450-456. [PMID: 34130771 DOI: 10.1017/ipm.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Globally, increasing life expectancy has escalated demands on psychiatric services caring for a later life population. It is recognised that those with enduring mental illness may have specific needs with advancing age. In this study, we describe the characteristics of a population aged over 60 years attending a general adult community psychiatric service and compare demographic and clinical features across age and diagnostic categories. The study aims to gather preliminary information which may guide future local mental health service planning. METHODS We conducted a cross-sectional observational study using retrospective chart review of all patients aged over 60 years attending four community mental health teams in North Dublin. Cohorts of attenders were stratified by age comparing 60-64 year age group with the population aged 65 years and over. Attenders were also stratified by diagnosis and regression analysis was used to determine predictors of psychotic disorder diagnosis. RESULTS The study included 127 patients. There was a higher prevalence of psychotic disorders among those aged 65 years and over (n = 73), while those aged 60-64 years (n = 54) were more likely to have depression and non-affective, non-psychotic disorders. Among the population aged 65 years and over 78% (n = 57) were long-term psychiatric service attenders. CONCLUSIONS The majority of the sample aged 65 years and over were long-term service attenders with a diagnosis of severe mental illness. Further research is warranted to determine optimal service delivery for later life psychiatric service attenders.
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Affiliation(s)
- R O'Sullivan
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
| | - M Cosgrave
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
| | - A Butler
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
| | - J P Lyne
- Department of Psychiatry, Ashlin Centre, Beaumont Road, Dublin, Ireland
- Royal College of Surgeons in Ireland, 111 St. Stephen's Green, Dublin 2, Ireland
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Kamino M, Watanabe K, Nakano H, Takashina N H, Ito H, Ohira T, Nomura K, Tsutsumi A. [Evidence building and social implementation of information and communications technology-based mental health care services]. Nihon Koshu Eisei Zasshi 2023; 70:465-473. [PMID: 37286489 DOI: 10.11236/jph.23-024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Keiller E, Masood S, Wong BHC, Avent C, Bediako K, Bird RM, Boege I, Casanovas M, Dobler VB, James M, Kiernan J, Martinez-Herves M, Ngo TVT, Pascual-Sanchez A, Pilecka I, Plener PL, Prillinger K, Lim IS, Saour T, Singh N, Skouta E, Steffen M, Tolmac J, Velani H, Woolhouse R, Zundel T, Ougrin D. Intensive community care services for children and young people in psychiatric crisis: an expert opinion. BMC Med 2023; 21:303. [PMID: 37563713 PMCID: PMC10413710 DOI: 10.1186/s12916-023-02986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Children and young people's (CYP) mental health is worsening, and an increasing number are seeking psychiatric and mental health care. Whilst many CYPs with low-to-medium levels of psychiatric distress can be treated in outpatient services, CYPs in crisis often require inpatient hospital treatment. Although necessary in many cases, inpatient care can be distressing for CYPs and their families. Amongst other things, inpatient stays often isolate CYPs from their support networks and disrupt their education. In response to such limitations, and in order to effectively support CYPs with complex mental health needs, intensive community-based treatment models, which are known in this paper as intensive community care services (ICCS), have been developed. Although ICCS have been developed in a number of settings, there is, at present, little to no consensus of what ICCS entails. METHODS A group of child and adolescent mental health clinicians, researchers and academics convened in London in January 2023. They met to discuss and agree upon the minimum requirements of ICCS. The discussion was semi-structured and used the Dartmouth Assertive Community Treatment Fidelity Scale as a framework. Following the meeting, the agreed features of ICCS, as described in this paper, were written up. RESULTS ICCS was defined as a service which provides treatment primarily outside of hospital in community settings such as the school or home. Alongside this, ICCS should provide at least some out-of-hours support, and a minimum of 90% of CYPs should be supported at least twice per week. The maximum caseload should be approximately 5 clients per full time equivalent (FTE), and the minimum number of staff for an ICCS team should be 4 FTE. The group also confirmed the importance of supporting CYPs engagement with their communities and the need to remain flexible in treatment provision. Finally, the importance of robust evaluation utilising tools including the Children's Global Assessment Scale were agreed. CONCLUSIONS This paper presents the agreed minimum requirements of intensive community-based psychiatric care. Using the parameters laid out herein, clinicians, academics, and related colleagues working in ICCS should seek to further develop the evidence base for this treatment model.
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Affiliation(s)
| | | | | | - Cerian Avent
- Central and North West London NHS Foundation Trust, London, UK
| | | | | | - Isabel Boege
- Medical University Graz & ZfP Südwürttemberg, Graz, Austria
| | | | | | - Maya James
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Jane Kiernan
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | | | | | | | | | | | | | | | | | - Nidhita Singh
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Eirini Skouta
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | | | - Jovanka Tolmac
- Central and North West London NHS Foundation Trust, London, UK
| | - Hemma Velani
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Dennis Ougrin
- East London NHS Foundation Trust & Queen Mary University of London, London, UK
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Gur S, Weizman S, Hermesh H, Matalon A, Meyerovitch J, Krivoy A. Comparison of medical treatment of patients with schizophrenia in general practitioners' clinics versus mental health clinics: A cohort study. J Psychosom Res 2023; 171:111383. [PMID: 37269644 DOI: 10.1016/j.jpsychores.2023.111383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/30/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Individuals with schizophrenia have more cardiometabolic comorbidities than the general population, live about twenty years less and consume more medical services. They are treated at general practitioners' clinics (GPCs) or at mental health clinics (MHCs). In this cohort study we investigated the association between patients' main treatment setting, cardiometabolic comorbidities and medical services utilization. METHODS Demographics, healthcare services utilization, cardiometabolic comorbidities and medication prescriptions of patients with schizophrenia were retrieved from an electronic database for the period 1.1.2011 to 31.12.2012 and compared between patients treated mostly in MHCs (N = 260) and those treated mostly in GPCs (N = 115). RESULTS GPC patients tended to be older (mean age 39.8 ± 13.7 vs. 34.6 ± 12.3 yrs., p < 0.0001), of lower socioeconomic status (42.6% vs 24.6%, p = 0.001) and have more cardiometabolic diagnoses (hypertension: 19.1% vs 10.8%, diabetes mellitus: 25.2% vs 17.0%, p < 0.05) than MHC patients. The former received more cardiometabolic disorder medications and utilized more secondary and tertiary medical services. Charlson Comorbidity Index (CCI) was higher in the GPC group than in the MHC group (1.8 ± 1.9 vs.1.2 ± 1. 6, p < 0.0001). A multivariate binary logistic regression analysis, adjusted for age, sex, SES and CCI found lower adjusted odds ratio for the MHC group versus the GPC group, of visiting an EMD, a specialist or to be hospitalized. CONCLUSIONS The current study highlights the critical importance of integrating GPCs and MHCs, thus offering patients combined physical and mental care at a single location. More studies on the potential benefits of such integration to patients' health are warranted.
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Affiliation(s)
- Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel.
| | - Shira Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Abarbanel Mental Health Center, Bat Yam, Israel
| | - Haggai Hermesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
| | - Andre Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Dan-Petah Tikva District, Clalit Health Services, Petah Tikva, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel and Chief Pediatrician's Office, Community Division, Clalit Health Services, Tel Aviv, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
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Liebenberg L, Reich J, Denny JF, Gould MR, Hutt-MacLeod D. Two-eyed Seeing for youth wellness: Promoting positive outcomes with interwoven resilience resources. Transcult Psychiatry 2023; 60:613-625. [PMID: 35818776 DOI: 10.1177/13634615221111025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.
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Affiliation(s)
- Linda Liebenberg
- Faculty of Graduate Studies, Dalhousie University, Halifax, NS, Canada
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Lugg W, Levine A, Boyd R. Consumer? Views and preferences of people receiving public mental health care in Australia on the terms used to refer to them. Australas Psychiatry 2023; 31:435-440. [PMID: 37102589 DOI: 10.1177/10398562231172414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES To understand: a) whether adults receiving public mental health care were aware they were officially referred to as 'consumers' and, b) their views and preferences on the terms used to refer to them. METHODS Single-page, anonymous survey conducted across two community mental health services in Northern New South Wales (NNSW). Ethics approval obtained from the local research office. RESULTS 108 people completed the survey with a response rate of approximately 22%. The vast majority (77%) of respondents were not aware that they were officially referred to as 'consumers'. 32% of respondents disliked the term 'consumer' and 11% found it offensive. Half preferred the term 'patient', particularly when consulting a psychiatrist (55%). A small minority (5-7%) preferred the term 'consumer' for any care interaction. CONCLUSION Most respondents in this survey wished to be referred to as a 'patient' and a large proportion disliked being referred to as a 'consumer' or found it offensive. Further surveys should include broader sociodemographic and diagnostic/treatment variables. Official terms used to refer to people receiving public mental health care should be person-centred and evidence based.
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Affiliation(s)
- William Lugg
- Northern New South Wales Local Health District (NNSWLHD), Tweed Heads Community Mental Health Service, Tweed Heads, NSW, Australia; and
- Department of Psychiatry, The Alfred Hospital, Prahran, VIC, Australia
| | - Andrew Levine
- Department of Psychiatry, The Alfred Hospital, Prahran, VIC, Australia
| | - Robert Boyd
- NNSWLHD, Byron Community Mental Health Service, Byron Bay, NSW, Australia
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Abstract
OBJECTIVE To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators. METHOD Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed. RESULTS Between 2015-16 and 2019-20, overall CAMHS expenditure increased by an average annual rate of 3.6%. Per capita expenditure increased at a higher rate than for other subspeciality services. CAMHS admissions had a higher cost per patient day, shorter length of stay, higher readmission rate and lower rates of significant improvement. Adolescents aged 12-17 had high community CAMHS utilisation, based on proportion of population coverage and number of service contacts. CAMHS outpatient outcomes were similar to other age-groups. There were high rates of 'Mental disorder not otherwise specified', depression and adjustment/stress-related disorders as principal diagnoses in community CAMHS episodes. CONCLUSIONS CAMHS inpatient admissions had lower rates of significant improvement and higher 14-day readmission rates than other ages. Australia's young population had a high outpatient CAMHS contact rate. Evidence-based modelling of CAMHS providers and outcomes may inform future service improvement.
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Affiliation(s)
- Matthew Brazel
- Matthew Brazel, Psychiatrist and Lecturer, Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Building 4, Level 2, The Canberra Hospital, PO Box 11, Garran, AU-ACT 2605, Australia.
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Nyassi S, Abdi YA, Minto J, Osman F. "Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland. Community Ment Health J 2023; 59:1051-1063. [PMID: 36602699 PMCID: PMC10289922 DOI: 10.1007/s10597-022-01085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.
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Affiliation(s)
- Sungkutu Nyassi
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Yakoub Aden Abdi
- College of Health Science, Amoud University, Amoud Valley, Borama, Somaliland Somalia
| | - John Minto
- University of the West of Scotland, Paisley, Scotland
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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Erickson BR, Marti FA, Choi K, Eberhart N, Ashwood JS, Zima B, Montero A, Kataoka S, Bromley E. "They Just Helped Save My Life:" Client Perspectives on the Los Angeles County Full Service Partnership (FSP) Program for Serious Mental Illness. Community Ment Health J 2023; 59:1227-1234. [PMID: 36735205 PMCID: PMC10330294 DOI: 10.1007/s10597-023-01096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/18/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
The purpose of this qualitative study was to elicit client perspectives on the Los Angeles County Full Service Partnership (FSP) program - an adaptation of Assertive Community Treatment (ACT). Semi-structured interviews were conducted with 20 FSP clients. Qualitative data were analyzed using thematic analysis. Two major themes were identified from the interview data: (1) Clients' acknowledgement of the material benefits of the FSP program; and (2) FSP's impact on restoring and stabilizing clients' social and treatment relationships. Interviewees greatly valued the material (i.e., basic needs, housing assistance) and relational (i.e., relationships with providers, restored personal relationships) aspects of the program, but did not ascribe the same degree of value to mental health treatment. Interviewees' emphases on material and relational aspects reflect the status of assertive mental health treatment as an intervention on intermediary determinants of health in the lives of persons diagnosed with serious mental illness.
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Affiliation(s)
- Blake R Erickson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Manhattan, NY, USA.
- New York State Psychiatric Institute, Manhattan, NY, USA.
| | - F Alethea Marti
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristen Choi
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Bonnie Zima
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alanna Montero
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sheryl Kataoka
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Goulet MH, Lessard-Deschênes C, Pariseau-Legault P, Breton R, Crocker AG. Community treatment orders: A qualitative study of stakeholder perspectives. Int J Law Psychiatry 2023; 89:101901. [PMID: 37301058 DOI: 10.1016/j.ijlp.2023.101901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION For people with a serious mental disorder, a community treatment order (CTO) is a legal response that requires them to undergo psychiatric treatment unwillingly under certain conditions. Qualitative studies have explored the perspectives of individuals involved in CTOs, including persons with lived experiences of a CTO, family members and mental health care providers, who are directly involved in these procedures. However, few studies have integrated their different perspectives. METHOD This descriptive and qualitative study aimed to explore the experience associated with a CTO in hospital and community settings among individuals with a history of CTO, relatives, and mental health care providers. Using a participatory research approach, individual semi-structured interviews were conducted with 35 participants. The data were reviewed using content analysis. RESULTS Three themes and seven sub-themes were identified: 1) differential positions as a function of meaning conferred to CTOs; 2) a risk management tool; and 3) coping strategies used to deal with CTOs. Overall, relatives' and mental health care providers' perspectives tended to be in opposition to those who went under a CTO. CONCLUSIONS In a context of recovery-oriented care, more research is needed to reconcile the seemingly contradictory positions of individual with experiential knowledge and the legal leverage that deprives them of their fundamental right to autonomy.
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Affiliation(s)
- Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada.
| | - Clara Lessard-Deschênes
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada; Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | | | - Richard Breton
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Anne G Crocker
- Department of Psychiatry & Addictions and School of Criminology, Université de Montréal, Montreal, Quebec, Canada; Institut National de Psychiatrie Légale Philippe-Pinel Research Center, Montreal, Quebec, Canada
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Adisa O, McManus S. Community mental health through a complex systems lens. Lancet Public Health 2023; 8:e392-e393. [PMID: 37094595 DOI: 10.1016/s2468-2667(23)00080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Olumide Adisa
- Violence and Society Centre, City, University of London, London EC1V 0HB, UK; Institute of Social Justice and Crime, University of Suffolk, Ipswich, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, London EC1V 0HB, UK; School of Health and Psychological Sciences, City, University of London, London EC1V 0HB, UK; National Centre for Social Research, London, UK.
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Cappo D, Mutamba B, Ayesiga K, Kebirungi E, Chelangat D, Fegan G, Jacob ST, Nsangi E, Ntabazi I, Nalubwama D, Nakasujja N, Odoki E, Odoi P, Mpairwe I, Verity F. YouBelong Home: A Ugandan Community Mental Health Intervention. Community Ment Health J 2023; 59:770-783. [PMID: 36477688 PMCID: PMC9734846 DOI: 10.1007/s10597-022-01058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
In Uganda, low resources for mental health provision combine with disadvantage and inadequate supports for family and community-based care. Catalysed by the need to reduce overcrowded psychiatric hospital wards and frequent readmissions at Butabika National Referral Mental Hospital (BNRMH) in Kampala, the nongovernment organisation YouBelong Uganda (YBU) developed the YouBelong Home (YBH) intervention. YBH is a theoretically eclectic pre and post hospital discharge intervention. This paper reports on qualitative findings of the project Curtailing Hospital Readmissions for Patients with Severe Mental Illness in Africa (CHaRISMA), which explored how to refine the YBH intervention. The project was funded by a UK Joint Global Health Trials (JGHT) Development Grant. Data was collected through structured interviews with service users and caregivers, reflective practice by the YBH implementing team and a stakeholder focus group. A summary of refinements to the YBH intervention follows the TIDieR format (Template for Intervention Description and Replication).
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Affiliation(s)
- D Cappo
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - B Mutamba
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - K Ayesiga
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - E Kebirungi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - D Chelangat
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - G Fegan
- Faculty of Medicine, Health and Life Science, Swansea University, Singleton, SA28PP, Swansea, Wales, UK
| | - S T Jacob
- Liverpool School of Tropical Medicine, Pembroke Pl, L3 5QA, Liverpool, United Kingdom
- Walimu, Plot 5-7, Coral Crescent, Kololo, P.O. Box 9924, Kampala, Uganda
| | - E Nsangi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - I Ntabazi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - D Nalubwama
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - N Nakasujja
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - E Odoki
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - P Odoi
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - I Mpairwe
- YouBelong Uganda, P.O Box 36510, Kampala, Uganda
| | - F Verity
- Faculty of Medicine, Health and Life Science, Swansea University, Singleton, SA28PP, Swansea, Wales, UK.
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Hansen HG, Starzer M, Nilsson SF, Hjorthøj C, Albert N, Nordentoft M. Clinical Recovery and Long-Term Association of Specialized Early Intervention Services vs Treatment as Usual Among Individuals With First-Episode Schizophrenia Spectrum Disorder: 20-Year Follow-up of the OPUS Trial. JAMA Psychiatry 2023; 80:371-379. [PMID: 36811902 PMCID: PMC9947803 DOI: 10.1001/jamapsychiatry.2022.5164] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
Importance The OPUS 20-year follow-up is the longest follow-up of a randomized clinical trial testing early intervention services (EIS) among individuals with first-episode schizophrenia spectrum disorder. Objective To report on long-term associations of EIS compared with treatment as usual (TAU) for first-episode schizophrenia spectrum disorder. Design, Setting, and Participants A total of 547 individuals were included in this Danish multicenter randomized clinical trial between January 1998 and December 2000 and allocated to early intervention program group (OPUS) or TAU. Raters who were blinded to the original treatment performed the 20-year follow-up. A population-based sample aged 18 to 45 years with first-episode schizophrenia spectrum disorder were included. Individuals were excluded if they were treated with antipsychotics (>12 weeks prior to randomization), had substance-induced psychosis, had mental disability, or had organic mental disorders. Analysis took place between December 2021 and August 2022. Interventions EIS (OPUS) consisted of 2 years of assertive community treatment including social skill training, psychoeducation, and family involvement by a multidisciplinary team. TAU consisted of the available community mental health treatment. Main Outcomes and Measures Psychopathological and functional outcomes, mortality, days of psychiatric hospitalizations, number of psychiatric outpatient contacts, use of supported housing/homeless shelters, symptom remission, and clinical recovery. Results Of 547 participants, 164 (30%) were interviewed at 20-year follow-up (mean [SD] age, 45.9 [5.6] years; 85 [51.8%] female). No significant differences were found between the OPUS group compared with the TAU group on global functional levels (estimated mean difference, -3.72 [95% CI, -7.67 to 0.22]; P = .06), psychotic symptom dimensions (estimated mean difference, 0.14 [95% CI, -0.25 to 0.52]; P = .48), and negative symptom dimensions (estimated mean difference, 0.13 [95% CI, -0.18 to 0.44]; P = .41). The mortality rate was 13.1% (n = 36) in the OPUS group and 15.1% (n = 41) in the TAU group. Likewise, no differences were found 10 to 20 years after randomization between the OPUS and TAU groups on days of psychiatric hospitalizations (incidence rate ratio, 1.20 [95% CI, 0.73-1.20]; P = .46) or number of outpatient contacts (incidence rate ratio, 1.20 [95% CI, 0.89-1.61]; P = .24). Of the entire sample, 53 participants (40%) were in symptom remission and 23 (18%) were in clinical recovery. Conclusions and Relevance In this follow-up study of a randomized clinical trial, no differences between 2 years of EIS vs TAU among individuals with diagnosed schizophrenia spectrum disorders at 20 years were found. New initiatives are needed to maintain the positive outcomes achieved after 2 years of EIS and furthermore improve very long-term outcomes. While registry data was without attrition, interpretation of clinical assessments are limited by high attrition rate. However, this attrition bias most likely confirms the lack of an observed long-term association of OPUS with outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT00157313.
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Affiliation(s)
- Helene Gjervig Hansen
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Marie Starzer
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Feodor Nilsson
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nikolai Albert
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Mental Health Center Amager, Mental Health Services in the Capital Region, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Mental Health Center Copenhagen, Mental Health Services in the Capital Region, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Maeng D, Tsun ZY, Lesch E, Jacobowitz DB, Strawderman RL, Harrington DK, Li Y, Weisman RL, Lamberti JS. Affordability of Forensic Assertive Community Treatment Programs: A Return-on-Investment Analysis. Psychiatr Serv 2023; 74:358-364. [PMID: 36065582 DOI: 10.1176/appi.ps.20220186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors assessed return on investment (ROI) associated with a forensic assertive community treatment (FACT) program. METHODS A retrospective secondary data analysis of a randomized controlled trial comprising 70 legal-involved patients with severe mental illness was conducted in Rochester, New York. Patients were randomly assigned to receive either FACT or outpatient psychiatric treatment including intensive case management. Unit of service costs associated with psychiatric emergency department visits, psychiatric inpatient days, and days in jail were obtained from records of New York State Medicaid and the Department of Corrections. The total dollar value difference between the two trial arms calculated on a per-patient-per-year (PPPY) basis constituted the return from the FACT intervention. The FACT investment cost was defined by the total additional PPPY cost associated with FACT implementation relative to the control group. ROI was calculated by dividing the return by the investment cost. RESULTS The estimated return from FACT was $27,588 PPPY (in 2019 dollars; 95% confidence interval [CI]=$3,262-$51,913), which was driven largely by reductions in psychiatric inpatient days, and the estimated investment cost was $18,440 PPPY (95% CI=$15,215-$21,665), implying an ROI of 1.50 (95% CI=0.35-2.97) for FACT. CONCLUSIONS The Rochester FACT program was associated with approximately $1.50 return for every $1 spent on its implementation, even without considering potential returns from other sources, including reductions in acute medical care, crime-related damages, and public safety costs. ROI estimates were highly dependent on context-specific factors, particularly Medicaid reimbursement rates for assertive community treatment and hospital stays.
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Affiliation(s)
- Daniel Maeng
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Zhi-Yang Tsun
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Eric Lesch
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - David B Jacobowitz
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Strawderman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Donald K Harrington
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Yue Li
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - Robert L Weisman
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
| | - J Steven Lamberti
- Departments of Psychiatry (Maeng, Tsun, Lesch, Jacobowitz, Weisman, Lamberti), Biostatistics and Computational Biology (Strawderman, Harrington), and Public Health Sciences (Li), University of Rochester Medical Center, Rochester, New York
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Watson TM, Benassi PV, Agic B, Maharaj A, Sockalingam S. Community-Based Mental Health and Substance Use Services for People Leaving Prison: Equity and Inclusion Strengths and Limitations in Specialized Service Inventory Development. Community Ment Health J 2023; 59:421-427. [PMID: 36380033 PMCID: PMC9667000 DOI: 10.1007/s10597-022-01050-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community reentry from prison is a challenging process, especially for persons with lived and living experience of mental health concerns. Access to appropriate community-based care for those leaving prison is a key part of improving health equity for this population. Our work to develop a cross-Canada inventory of active community mental health and substance use services for criminal justice-involved persons represents a valuable example for others hoping to conduct projects that are similar in nature and scope. We describe the strengths and limitations of our health equity-informed, multi-pronged approach to service inventory development, highlighting the importance of considering and addressing search- and stakeholder-related biases. Investment of time and resources is critical to ensuring comprehensive and inclusive identification of community-based mental health services and meaningful resource development.
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Affiliation(s)
- Tara Marie Watson
- Centre for Addiction and Mental Health (CAMH), 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada.
- Provincial System Support Program, CAMH, 33 Ursula Franklin Street, Toronto, ON, M5S 2S1, Canada.
| | - Paul Victor Benassi
- Centre for Addiction and Mental Health (CAMH), 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health (CAMH), 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Asha Maharaj
- Centre for Addiction and Mental Health (CAMH), 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health (CAMH), 1000 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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50
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Sammells E, Logan A, Sheppard L. Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers. Community Ment Health J 2023; 59:428-438. [PMID: 36074286 PMCID: PMC9981707 DOI: 10.1007/s10597-022-01020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.
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Affiliation(s)
- Eliza Sammells
- Occupational Therapist, BOccThy (HONS), Australian Catholic University, Melbourne, Australia
| | - Alexandra Logan
- Occupational Therapy Senior Lecturer, School of Allied Health, Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Loretta Sheppard
- Occupational Therapy, Deputy Head, School of Allied Health, Australian Catholic University, Melbourne, Australia.
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