Community Mental Health Journal最新文献

An unavoidable piece of the American healthcare system that is often overlooked concerns billing and payment in community mental health agencies. Practitioners are faced with ethical dilemmas surrounding productivity billing that require their ability to strike a delicate balance between efficiency and providing quality care. In line with the American Psychological Association's Ethical Principals of Psychologists and Code of Conduct (2017), this paper examines ethical issues for mental health agencies and managers employing productivity-driven billing practices and reviews the impact these models have on practitioners and their clients. More specifically, it will speak to ethical concerns that impact not only the practitioners who are working at these agencies, but also the clients who are directly affected by the implementation and structure of this model. We conclude with a discussion regarding how agencies can play a more significant role in reducing unethical practices by improving operational standards to maximize quality care.

A growing number of police departments in the United States have adopted specialized training models to handle situations involving people with mental illness (PWMI), including the Crisis Intervention Team (CIT) model and other models with reduced training hours (OMRTH). However, research on police chiefs' attitudes toward these training models, especially those working in rural areas, remains limited. To address this gap in the literature, this study explored the attitudes of rural police chiefs across two states regarding two categories of police training models (the CIT model and OMRTH) and examined factors influencing their viewpoints. The results revealed that chiefs in rural areas demonstrated favorable attitudes toward the CIT model but negative attitudes toward OMRTH. Policy implications and suggestions for future research are discussed.

This study explored the experiences of postpartum individuals in early substance use disorder (SUD) recovery and key aspects of their social networks using the Socioecological Model (SEM). We conducted a qualitative study of 22 postpartum individuals (< 1 year since delivery) in residential SUD treatment from July to November 2023. Transcribed, audio-recorded interviews were analyzed using Atlas.ti, with findings organized by SEM levels. Participants, primarily White (81.8%), single (86.3%), and living below the poverty line (81.8%), reported opioid (40.1%) and stimulant (81.8%) use disorders. Challenges spanned SEM levels, including navigating parenthood, accessing trauma-informed care, and overcoming structural barriers such as housing instability, transportation, and childcare access. Findings underscore the need for family-centered, trauma-informed recovery programs and flexible policies addressing childcare and social service barriers to support long-term recovery and maternal well-being.

Physical activity improves mental health in individuals with schizophrenia. Yet, limited access, low motivation, and social isolation make participation in face-to-face programs challenging. This 16-week pilot randomized controlled trial examined differences in symptoms and loneliness between adults with schizophrenia that were randomized to a virtual group-based walking program ("Virtual PACE-Life", n = 17) or Fitbit Alone (n = 20). The Positive and Negative Syndrome Scale and UCLA Loneliness scale were administered at baseline, 8 weeks, 16 weeks, and one-month follow-up. Standardized effects (SE) and confidence intervals from mixed effects models were used to evaluate group differences. Results demonstrated small-to-moderate effects (SE: 0.1-0.3) on total, negative, disorganization, excitement, and emotional distress symptoms favoring Virtual PACE-Life; however, negligible effects were observed for positive symptoms or loneliness. Despite the small sample size, these findings may suggest symptom but not loneliness benefits of a virtual group-based physical activity program for people with schizophrenia.

Community/Crisis Cafés offer an alternative, out-of-hours mental health support by providing a safe, peer/clinician-supported environment for individuals in crisis. These cafés utilise peer support models that draw on personal experience, fostering connections and aiding in crisis management. Despite the growing global implementation of these cafés, limited research exists on how service users and carers experience and benefit from them. This study aims to explore the perspectives of service users and carers on accessing and utilising support through community/crisis cafés both nationally and internationally. A scoping review was guided by Arksey and O'Malley's framework and included keyword searches of eight databases (Academic Search Complete, APA PsychInfo, CINAHL, Cochrane, Embase, Medline, Scopus, and Web of Science), combined with grey literature searches of LENSUS, Health Service Executive, WHO Global Index, NHS, and Open Grey. Backward and forward chaining of references was also completed to ensure all literature was sourced. Papers were limited to 2010-2023 and in English. Covidence was used for the screening process, ten papers met the review criteria and are reported as per the PRISMA-ScR checklist and PRISMA flow diagram. The findings of ten papers on service users and carers experiences indicate that Community/Crisis Cafés can have a positive impact on mental health management, alleviate social isolation, and reduce emergency department use. However, challenges such as consistency in service delivery and accessibility were noted. Further research and ongoing evaluation are necessary to fully understand the efficacy and limitations of this alternative co-produced, community mental health service delivery model.

Climate anxiety can motivate adaptive behaviors but can become debilitating when excessive. People with schizophrenia are particularly vulnerable to extreme climate events, yet little is known about their climate-related concerns. This study examines climate anxiety levels and perceptions of government responses in outpatients with schizophrenia to inform targeted mental health interventions. From March to July 2024, 108 adult outpatients with schizophrenia participated in semi-structured interviews using two validated surveys assessing climate-related emotions and beliefs about government responses. Many participants reported moderate climate anxiety, with some dissatisfaction regarding government actions. Severe functional impairments due to climate anxiety were uncommon. Understanding climate anxiety in people with schizophrenia, an easily overlooked vulnerable group to climate change-related morbidity and mortality, is critical to enhance preparedness and mitigate psychiatric and physical health risks.

People living with bipolar disorders may face a range of treatment challenges, however, the treatment needs of those living with bipolar disorder in Australia have not been directly assessed. The present study aimed to explore the treatment and care preferences of people living with bipolar disorder in Australia. Participants were part of a large co-designed survey that assessed preferred settings, barriers, and access to treatment. A total of 494 participants provided responses regarding preferred treatment settings with 188 (38%) preferring the public system, 175 (35%) private, and 153 (31%) indicating a preference for both/either private or public care. The setting that was most frequently endorsed was at home (n = 343; 69%), then outpatient (n = 155; 31%), and inpatient (n = 93; 19%). Affordability, resourcing, geographical and timely access, improving education and addressing stigma were reported as key unmet needs, indicating that more work is needed to improve access to care for Australians.

Children Of Parents with severe and enduring Mental Illness (COPMI) face an elevated risk for inherited mental health issues and diminished quality of life across various domains. While social factors such as social networks (the set of active, valued social ties surrounding an individual) are recognised as protective, they are often inadequately conceptualised, preventing effective leverage to promote positive outcomes. This brief report provides information regarding common network related issues faced by families, opportunities for supportive intervention, barriers and facilitators to social network conscious work with COPMI according to professionals. Professionals who work with individuals or families affected by parental mental illness provided insights as to how social network considerations can or do feature in their work via focus group discussions. Focus group transcripts were analysed through an a priori framework developed through framework analysis in order to identify common issues, potential interventions, and barriers and facilitators in their work. Commonly observed issues within family networks included the impact of caring roles, structural limitations to networks, and experiences related to stigma and trust. Network related intervention opportunities included early identification, support for community integration efforts, and child skills building. Barriers included lack of needs identification, communication gaps, and staff workload pressures. Potential facilitators include ongoing training, interdisciplinary collaboration, and consistency in staff/family relationships. This brief report offers valuable insights for practitioners, policymakers, and researchers emphasising the utility of relational approaches when working with families affected by parental mental illness.

Guided by the Ottawa Decision Support Framework, we created a depression care decision aid for Latinx and African American individuals with major depressive disorder (MDD) at a network of Federally Qualified Health Centers. We surveyed 94 African American and Latinx individuals with MDD about their decision making needs. Focus groups elaborated on these preferences. Results show that about half of the sample preferred a collaborative role in decision making. Respondents report greater preference for receiving information about care compared to lower preferences for shared decision making. Focus group themes included fear of judgment, importance of being informed of care options and exploring care preferences, value of a provider who is a trusted friend and medical expert, and the importance of flexible decision making. Survey and focus groups results were used to iteratively develop a depression care decision aid. Future work will evaluate acceptability, feasibility, and effect of the depression care decision aid.

Rural communities in the United States (US) are disproportionately burdened with higher suicide rates than non-rural ones, facing structural and cultural barriers that make it less likely for suicidal individuals to obtain help. Community-based interventions have been called for to address the need for integrative approaches relevant to the rural landscape. To facilitate increased adaptation/implementation of rural suicide prevention programming, we conducted a scoping review of the literature to evaluate the state-of-the-science. Following PRISMA-ScR guidelines, we searched for and identified relevant peer-reviewed literature across four databases, using dual screening/extraction throughout. We extracted information on key article characteristics, program descriptions, and methodological approaches to identify trends, gaps, and emergent themes. 29 articles were included in this review. Studies predominantly focused on suicide prevention for youth, particularly amongst Indigenous communities, with papers also concentrating on medical settings and US veterans. While a wide range of intervention and evaluation approaches were employed, few studies measured clinical outcomes, utilized theoretical frameworks or official rural definitions, or used comprehensive prevention strategies. This review offers investigators a guide to the existing evidence base and growing patterns in the field of suicide prevention in rural US areas. Results highlight the dearth of literature on prevention programming in this much needed yet overlooked area of study. Future intervention research should consider using context-specific rural classifications, relevant clinical outcomes, and comprehensive theory-backed strategies embedded in their approach.