Leading from the Middle: Practical Innovation in Public Mental Health

Leaders in public mental health are responsible for ensuring the care environment is conducive to provider wellbeing, and ultimately patient care. Given the effects of stress and burnout, healthcare organizations must explore interventions to support their employees. The Leadership + Innovation Lab is a pilot project focused on enhancing leadership skills, innovation capacity, and peer connections among clinical managers. Participants executed individual or group projects to improve the care environment and co-created a peer consultation program. They reported increased connection with peers, innovation and leadership skills, and capacity to facilitate a better experience for their provider staff as a result of the program. This model can be used in other settings to help achieve the goals of the Quadruple Aim and improve communication.

The Stress and Resilience Town Hall: A systems response to support the health workforce during COVID-19 and beyond

OBJECTIVE

The COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic.

METHOD

We conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85).

RESULTS

We identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time.

CONCLUSIONS

The virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.

Predictive validity of conversion from the clinical high risk syndrome to frank psychosis

Although the clinical high risk for psychosis (CHR) paradigm has become well-established over the past two decades, one key component has received surprisingly little investigative attention: the predictive validity of the criteria for conversion or transition to frank psychosis. The current study evaluates the predictive validity of the transition to psychosis as measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS) in CHR individuals. Participants included 33 SIPS converters and 399 CHR non-converters both from the North American Prodromal Longitudinal Study (NAPLS-2), as well as a sample of 67 separately ascertained first-episode psychosis (FEP) patients from the STEP program. Comparisons were made at baseline and one-year follow-up on demographic, diagnostic stability (SCID), and available measurement domains relating to severity of illness (psychotropic medication, psychosocial treatment, and resource utilization). Principal findings are: 1) a large majority of cases in both SIPS converters (n = 27/33, 81.8%) and FEP (n = 57/67, 85.1%) samples met criteria for continued psychosis at one-year follow-up; 2) follow-up prescription rates for current antipsychotic medication were higher in SIPS converters (n = 17/32, 53.1%) compared to SIPS non-converters (n = 81/397, 20.4%), and similar as compared to FEP cases (n = 39/65, 60%); and 3) at follow-up, SIPS converters had higher rates of resource utilization (psychiatric hospitalizations, day hospital admissions, and ER visits) than SIPS non-converters and were similar to FEP in most categories. The results suggest that the SIPS definition of psychosis onset carries substantial predictive validity. Limitations and future directions are discussed.

Citizenship and Community Mental Health Care

Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social-environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.

Social and clinical dimensions of citizenship from the mental health-care provider perspective

OBJECTIVE

Citizenship is a theoretical framework regarding social inclusion and community participation of people with mental illnesses. It is defined by a person's connection to rights, responsibilities, roles, resources, and relationships. The application of this framework in public mental health settings is in its early stages. This study was an exploration of mental health providers' views of the potential contribution of this framework.

METHOD

Eight focus groups were conducted with 77 providers on teams in a large mental health center. A 12-item brief version of a 46-item measure of citizenship was a starting point for discussion of the relevance of the framework and citizenship supports in public mental health care.

RESULTS

Two themes were presented: social, including relatedness, stigma, and meaningful choices, and clinical, including client empowerment and barriers to citizenship work in clinical settings. These themes are discussed in relation to the introduction of citizenship-oriented practices in mental health care. Participant comments reflect openness to the concept of citizenship and the need for greater access to normative community life for clients, but also skepticism regarding the ability of providers and mental health centers to incorporate citizenship approaches in current care models.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Findings suggest there are challenges to developing and implementing citizenship supports in public mental health settings based on social and clinical factors and limitations. However, it is also noted that efforts to address challenges through consultation and education of providers can support the goal of a life in the community for persons with mental illness. (PsycINFO Database Record

Training in Mental Health Recovery and Social Justice in the Public Sector

Individuals who experience serious mental illness (SMI) frequently encounter stigma and disenfranchisement. Attention to this concern necessitates a social justice focus within the mental health field. This article explores the significance and critical foundations of a psychology training experience grounded in a social justice and recovery-oriented perspective to answer the call for a focus on social justice and empowerment for individuals with SMI in mental health recovery. A specific training program is highlighted as an example of how social justice and recovery-oriented psychology training can be conducted. It includes theoretical foundations, trainee and supervision factors, a training model, and a description of didactic, clinical, consultation, interdisciplinary, and recovery-initiative training experiences. Last, specific successes and challenges of this type of training experience, as well as recommendations for future program development, are shared.

Homelessness, behavioral health disorders and intimate partner violence: barriers to services for women

Homeless women comprise a significant portion of the homeless population and may encounter multiple life stressors including mental illness, substance abuse, and trauma. Women who are homeless may experience difficulty gaining access to resources such as shelter and health care. In addition, the interaction of behavioral health problems with intimate partner violence (IPV) may create extraordinary barriers to their engagement in services. This paper explores the co-occurrence of homelessness, behavioral health problems, and IPV and lessons learned through a gender-specific homeless services program designed to reach women who are unengaged in traditional services. Recommendations for providing gender-responsive services are discussed.

Teaching an interdisciplinary approach to the treatment of chronic mental illness: challenges and rewards

OBJECTIVE

National policy makers and psychiatric educators have established the goals of teaching and promoting interdisciplinary care as high priorities. This article describes the implementation of an interprofessional seminar for which the dual aims were to provide a knowledge base for treating individuals with serious mental illness and to teach how to work collaboratively with other disciplines.

METHOD

A seminar, the "Treatment of chronic or recurrent mental illness: recovery, rehabilitation and interdisciplinary collaboration," was developed in an academic community mental health center. Pre- and postseminar surveys were administered in order to test the hypothesis that the seminar would have a positive impact on trainees' attitudes about working with the seriously mentally ill and within an interdisciplinary team. A combination of 5-point Likert scales and open-ended questions were used to gather the data. Paired samples t tests were conducted to test for significant differences between the pre- and postmeasures.

RESULTS

The seminar participants included 24 students from psychiatry, nursing, social work, and psychology with a wide range of experience. Complete pre- and postseminar data were obtained from 14 participants. Although participants valued the seminar experience, they reported that the actual interdisciplinary work with the seriously mentally ill was less gratifying than expected. They described several advantages and challenges of care-oriented collaboration and shared learning.

CONCLUSION

Bringing together a diverse group of graduate and postgraduate trainees to learn together and to learn about each other's disciplines appeared to be a successful venture, but the authors were not able to detect a positive impact on their actual work life during the course of the year. Further development of strategies to inspire professionals to engage in and promote interdisciplinary care of the seriously mentally ill is needed.

Toward promoting generative cultures of intentional mentoring within academic settings

Mentoring promotes ongoing learning of clinical psychologists, regardless of their expertise and experience. Most academic programs, however, do not possess vigorous mentoring cultures in which mentors simultaneously are learners. Academic programs are largely based on "mastery" philosophies that tacitly aim mentoring at less-experienced peers. This orientation can make stigmatizing mentoring opportunities, especially for psychologists from underrepresented populations. Using concepts from experiential learning theory, we articulate interventions to invigorate mentoring cultures and make mentoring less stigmatizing.

Experience of maltreatment as a child and acceptance of violence in adult intimate relationships: mediating effects of distortions in cognitive schemas

Links exist between being subjected to maltreatment as a child and tendencies to accept violence as normative in adult relationships. Constructivist Self Development Theory suggests that such relationships may be affected by "cognitive disruptions" in "self" and "other" schemas. Mediating effects of distorted cognitive schemas on the association between history of child maltreatment and the acceptance of violence in intimate interpersonal relationships were investigated among 433 men and women. Outcomes indicated that individuals who reported childhood maltreatment were more likely to display distortions in their cognitive schemas and those individuals with disrupted schemas were more likely to accept relationship violence. Least-square multiple regression analyses revealed that distorted beliefs fully mediated the relationship between reporting childhood maltreatment and acceptance of violence, for both men and women. Subsidiary analyses suggested that this full mediation was replicated for schemas involving the self but not for schemas about others.