Community Mental Health Journal最新文献

Peer support specialists (PSS) are essential in behavioral health and substance use crisis services by providing support, hope, and encouragement to those in crisis. Despite their benefits, there is a lack of consensus on the core competencies required for PSS working in crisis settings. This study identifies key competencies to inform the development of a Crisis Peer Support Specialist Training curriculum. An e-Delphi survey method was used to collect opinions from subject matter experts (SMEs) working Early Intervention Support Services (EISS) programs. The three-round process gathered qualitative and quantitative input on the required competencies of PSS in crisis settings. Responses from SME were analyzed using thematic coding and a Likert-scale ranking system to determine perceived importance. Four key areas were identified as essential competencies: knowledge, skills, attitudes, and unique contributions. The highest-ranked competencies emphasized ethics and maintaining professional boundaries, demonstrating empathy, and providing a welcoming presence. Consensus from the SME was reached on the core competencies necessary for PSS in crisis settings. Findings highlight the key competencies a PSS requires for delivering services in crisis settings. The results informed the development of a specialized training program for PSS in these settings. Future research should continue to explore the required competencies across different crisis care settings.

Day centres provide low-threshold support for people with severe and prolonged mental illness. However, their effectiveness has not yet been empirically evaluated. This study examines whether regular attendance at day centres improves mental health outcomes. Two surveys were conducted: a cross-sectional survey of 87 service users and a longitudinal study of 16 new admissions (assessments at baseline, one month, and three months after admission). Psychosocial participation limitations (IMET), quality of life (MANSA), symptom severity (SCL-K-9, PHQ-9), self-esteem (G-SISE) and self-efficacy (ASKU) were measured. Descriptive statistics and the Wilcoxon-signed-rank test were used for analysis. Three primary goals for attending a day centre were most important: daily routines, social contacts, and meaningful activities. Significant improvements (p < 0.05) were observed in all outcomes, with large effect sizes (r = > 0.5). This study provides initial evidence that the use of day centres supports recovery from mental illness by restoring key psychosocial functions.

Recovery orientation is a vital feature of contemporary mental health models of care such as Prevention and Recovery Care (PARC) services. Despite the importance of PARC services in providing a recovery-oriented alternative to a stay in hospital for mental health consumers in Victoria, Australia, there are limited studies exploring the views of staff about these services. This study was part of a larger body of work that investigated the appropriateness, effectiveness and efficiency of PARC services across Victoria. As part of the qualitative component of this mixed-methods study, the aim for this project was to explore the perceptions of staff around the meaning of recovery-oriented care and how it is implemented through PARC services. We conducted 20 semi-structured interviews with multidisciplinary staff who worked in 19 PARC services across Victoria. A reflexive thematic analysis was undertaken guided by Braun and Clarke's approach. Participants' responses were organised around themes related to staff interpretations of the meaning and implementation of recovery-oriented mental health care within the context of PARC services. Recovery-oriented care was framed by staff as non-clinical, non-linear, subjective, person-centred, about seeking meaning and fulfilment, identity building and being holistic. Staff described the role of PARC services in contributing to recovery through providing structure and routine, offering opportunities to build relationships, develop skills and offer choice and autonomy.

While shared decision-making (SDM) is widely recognized as a reference model in adult psychiatry, its implementation in youth psychiatry remains under-explored, despite the specific challenges inherent to this field. This exploratory qualitative study investigates how child and adolescent psychiatrists describe and adjust their decision-making practices in clinical care, including their attitudes, strategies, and perceived limits of SDM. Sixteen semi-structured interviews were conducted with youth psychiatrists via videoconferencing. Data were analyzed using thematic analysis. Five overarching themes were developed : (1) the perceived benefits of SDM, such as improved adherence and engagement; (2) a dynamic continuum of decision-making practices, from full collaboration to ethically guided protective decisions; (3) the role of parents as co-participants in the decision-making process; (4) the modulation of the clinician-patient relationship along a vertical-horizontal axis; and (5) contextual influences, including institutional constraints and limited resources. Psychiatrists generally support SDM as a desirable framework. However, their accounts point to a broader and more flexible continuum of practices, in which the degree of sharedness varies depending on factors such as the young person's age, developmental stage, illness severity, crisis situations, and parental involvement. Some practices described by clinicians fall outside strict definitions of SDM and belong instead to the domain of substituted or protective decision-making. These findings invite a nuanced and context-sensitive understanding of decision-making in youth psychiatry.

Patients with methamphetamine use disorder (MaUD) face social, financial, and systemic barriers to accessing evidence-based addiction treatment. We designed a care navigation intervention to better engage patients with MaUD in treatment after an acute care encounter. This intervention was modeled after linkage-to-care strategies for infectious diseases and emphasized rapport building, trauma-informed care, and practical assistance in overcoming barriers to treatment. We also added elements of contingency management given its treatment efficacy with MaUD. We describe the development of the care navigation model, characteristics and care needs of subjects receiving the intervention, and intervention engagement outcomes. Among 94 patients who received this intervention as part of a randomized controlled trial, 64% were considered engaged with at least 2 or more visits with the care navigator Patients had substantial barriers to care-85% of patients were not stably housed, 83% were unemployed, and 46% lacked access to a phone-and the most common domains of need were accessing addiction treatment, housing resources, or communication needs such as a phone or interpreter services. This intervention poses a model for connecting patients with MaUD to treatment after acute care encounters.

Culturally responsive peer support services can improve access to and engagement with substance use and mental health services among Latinx persons, but how to implement a culturally responsive peer support program in a Spanish-speaking peer-run behavioral health organization is unclear. This qualitative study used the Consolidated Framework for Implementation Research (CFIR) to explore determinants for implementing a culturally responsive peer support program. We conducted 14 interviews with peer support program leadership, Certified Peer Specialists (CPS), and CPS supervisors about implementation of and experience with the peer support program. Interviews were conducted and analyzed in Spanish and English using constant comparative methods and organized according to the CFIR. Key CFIR elements included: (1) Intervention characteristics: a culturally responsive approach that alleviated stigma while celebrating recovery culture and Latinx peer culture; (2) Outer setting: outside of the study setting, barriers to accessing behavioral health care were driven by cultural differences between providers and clients; (3) Inner setting: A robust model of culturally responsive and linguistically appropriate peer-to-peer supervision and a built environment that fosters a mutual aid-oriented organizational culture; (4) Individuals involved: supervision strengthens CPS knowledge and skills to deliver peer support; (5) Implementation Process: despite organizational supports, CPS work is emotionally draining. Future studies should explore the scalability of the supervision model and other implementation supports described here, using a culturally responsive lens.

During the perinatal period, many parents experience mental health difficulties of varying severity, which have been associated with adverse outcomes. Examples include perinatal obsessive-compulsive disorder (OCD) which can be thought to exist on a continuum from subclinical symptoms (e.g., intrusive thoughts (ITs)) to clinical diagnosis of OCD. Similarly postpartum psychosis can range from subclinical 'psychotic like experiences' (PLEs) to clinical diagnosis. These disorders are distinct conditions, yet some argue an overlap or comorbidity in symptoms, including co-occurrence postnatally, and they are therefore explored in tandem in this study. Limited literature explores these difficulties in community perinatal populations, and less is known about distress, or potential associations with parenting experiences. A cross-sectional, quantitative design was applied. Participants were parents in the postnatal period (12 months after birth); they completed an anonymous, online survey, exploring experiences of ITs, PLEs, parenting (perceived competence and stress) and mental health (depression, anxiety, and stress). Of 349 participants, 96% reported at least one IT, 90.8% reported associated distress and 95% engaged in behaviours to cope. Considering PLEs, 89% experienced at least one PLE, 88.8% reported associated distress and 30.4% could be considered 'at-risk' for developing psychosis. Distressing ITs and PLEs were significantly associated with lower perceived competence and satisfaction, increased parenting stress and mental health symptoms, although this relationship was indirectly mediated by depression and anxiety. Males reported more ITs, parenting stress, depression, anxiety, and lower perceived competence than females. More research is needed to better understand ITs and PLEs across and beyond the perinatal period.