Community Mental Health Journal最新文献

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Individuals with serious mental illnesses (SMIs) face safety risks related to their mental health conditions that are often compounded by experiences of trauma, victimization, residence in impoverished neighborhoods, and histories of homelessness. Stigma and safety challenges significantly impact community integration for individuals with SMIs, particularly women, who often bear a disproportionate burden of vulnerability, gender-based stigma, violence, and other inequalities. This study investigates how women with SMIs engage in the meaning-making of their safety and stigma experiences that, in turn, influence their community integration. From a large multi-site study exploring community experiences of racially/ethnically diverse participants with SMIs, a subsample of 28 cis and trans-gender women, who reported experiencing gendered stigma and a lack of safety, were chosen for the current study. The interviews were analyzed using modified principles of Interpretive Phenomenological Analysis (IPA) to understand how women with SMIs made meaning of their safety and stigma encounters in their families, communities, and neighborhoods. IPA analysis resulted in the emergence of themes within a broad category of safety that represented participants' meaning-making about their physical safety and stigma experiences. Specifically, we used the broad themes from an existing framework of safety called 'Navigating Safety' model as sensitizing concepts for our analysis. Physical and psychological aspects of safety for this study were experienced in tandem whereby the women made sense of how their experiences of a lack of physical safety in multiple contexts shaped their sense of self, internalized stigma, and their social relationships. Within the broad theme of physical safety, participants described unsafe neighborhoods, exposure to domestic and intimate partner violence, and vulnerability to sexual violence. Additionally, under psychological safety, we identified how gender-based norms, race and ethnicity, sources of stigma (internalized, familial, and societal), and social isolation contributed to their mental health and social relationships (particularly with family). These findings highlight how the compounding influence of the intersection of multiple stigmatized identities exerts safety challenges on the lives and community experiences of women with SMIs. Focusing on access and affordability of appropriate gender-responsive resources for women, including trauma-informed care, could reduce hospitalizations, mental health symptoms, and stigma so they can safely integrate into their communities.

Acculturation after settlement has been identified as a risk factor affecting the mental health of immigrant youth. Increasing rates of immigration and expanding populations of immigrant youth mean that addressing their mental is a priority. Acculturative stress is the stress-response resulting from the effects of multiple stressors that result from the need to acculturate. Among youth within the developmental stages of late adolescence and emerging adulthood, increased sensitivity to stress, and developmental demands, impact their mental health. The effects of acculturative stress place an additional burden on the mental health of immigrant youth. This scoping review examined existing literature that investigated a variety of relationships between acculturative stress and youth mental health. A comprehensive search strategy that focused on studies involving youth, mainly aged between 15-24, with a proximal history of international migration, published between 2012-2022, resulted in a collection of fifty-three studies. This review examined significant relationships between acculturative stress and major depression, anxiety disorders, eating disorders, substance misuse, behavioural problems and poor psychological wellbeing. This scoping review was truly explorative as it included youth from immigrant minorities, had no geographical limits, and included various study designs. Acculturative stress continues to be an important contributor to the mental health of youth who have a proximal history of international migration. This review provided an exploration of the state of research, identified the importance of the settlement context, and provided recommendations for the direction of future studies, supportive policies, and practice considerations, related to the mental health of immigrant youth.

Rural primary care (RPC) clinics may face unique barriers to implementing the Collaborative Care Model (CoCM). We used mixed methods to explore RPC staff and practice facilitator (PF) perspectives on CoCM implementation. PFs reported on barriers and facilitators experienced after each monthly meeting with clinics (n = 459 surveys across 23 clinics). Data were analyzed descriptively and informed qualitative interviews with a purposive sample (n = 11) of clinic staff and PFs. Interviews were analyzed using Rapid Assessment Process and triangulated with quantitative data. The most prominent barriers experienced were: (1) the COVID-19 pandemic, (2) limited availability of site staff to participate in implementation activities, and (3) hiring of new CoCM staff. Qualitative data further characterized the ways these barriers uniquely influenced RPC settings and promising implementation strategies. RPC settings face unique challenges to CoCM implementation, but several promising implementation strategies - when tailored to RPC contexts - may help.

The cardiometabolic health outcomes and life expectancy of people living with serious mental illness (SMI) continue to significantly flag behind that of the general population. This study explores the possibility of using the evidence-based Assertive Community Treatment (ACT) model and infrastructure to increase access to primary care and improve cardiometabolic outcomes of people with SMI. Four ACT teams in a large urban area received the services of a primary care consultant who was co-located at a Federally Qualified Health Center (FQHC), met regularly with ACT team clinicians to review a cardiometabolic registry of participants, and engaged participants in primary care services. Health screening rates, primary care utilization, and cardiometabolic outcomes-body mass index, blood pressure, hemoglobin A1c, cholesterol, and tobacco smoking status-were monitored over the course of a year. The efficacy of this integrated care model was also explored through focus groups with ACT team staff and participants. Significant improvements in screening rates were found for the ACT teams that received this integrated care intervention; however, only modest improvements in cardiometabolic outcomes were found. Future longitudinal, multi-site studies are needed to fully determine the impact of integrated care models on the physical health outcomes of this vulnerable population.

Racialized immigrants have low rates of accessing mental healthcare services. However, there are notable differences among immigrant groups (e.g., refugees, international students, dependants). The aim of this study is to understand racialized immigrants' experiences of accessing mental healthcare services at both systemic and individual levels. Through a qualitative descriptive methodology, interviews were conducted in English with 16 racialized immigrants to understand barriers and facilitators encountered. Additionally, focusing on how cultural and social conceptualizations ideas shape mental healthcare services. Interviews were analyzed through Braun & Clarke's six-step method to reflexive thematic analysis in identifying factors. Three major themes were identified: structural constraints, individual influences, and appraisal of services. With the first, racialized immigrants signaled to issues related to the systemic level that included affordability, wait times, and trust in the system. Individual influences highlighted factors of mental health literacy, social supports, stigma, severity of the issues, and awareness of services themselves. Lastly, extending on the previous theme, appraisal of services was reflective of how social and cultural ideals shaped attitudes towards the appropriateness of the provider or services themselves. The findings from this paper emphasize that racialized immigrants are not homogenous in their experiences and attitudes towards mental healthcare services. While there were similarities across different groups in the individual and systemic factors identified, there were key distinctions driven by appraisal of services themselves and if they were congruent based on their needs, more specifically, what was contributing to their negative mental health status.

In Ghana, a severe mental healthcare gap of 95-98% exists due to limited services. Ghana Somubi Dwumadie set out to address this by developing district mental healthcare plans (DMHPs) in three demonstration districts. Following the Programme for Improving Mental Healthcare model, district mental health operations teams were formed and used Theory of Change (ToC) to develop DMHPs. Key elements included training non-specialist health workers and enrolling individuals in relevant healthcare programmes. Evaluation methods included routine data, health facility surveys, and qualitative analysis within the ToC framework. Results showed improved integration of mental health services, enhanced case management through training, and increased service utilisation, shown through 691 service user enrollments. However, there was limited commitment of new resources and no significant improvement in primary care workers' capacity to detect priority mental health conditions. The study concludes that DMHPs, implemented with an integrated approach, can improve mental health service utilisation, contingent on committed leadership, resource availability, and stakeholder engagement.

Since 2009, the 'Reform 107' has been carrying out a substantial transformation of mental healthcare in Belgium, underpinned by two high ideals: ambulatory treatment and personalised care. Whilst there is broad support for the reform, its implementation is not without its problems and little data exists as to its effects. With that in mind, this article endeavours to assess the care provided by a Brussels-based mobile crisis team. Established by funding generated for the reform, this team has taken these ideals fully on board and, as a crisis response measure providing intensive and short-term care, is playing a central role in the organisation and management of mental healthcare across its territory. Therefore, with an approach at the intersection of the sociology of health and the sociology of public action, this article asks the following question: how are these ambitions- ambulatory treatment and personalised care- enacted in concrete terms in this mobile crisis team's care provision practices? The analysis, based on eight years of activity records of this team, has brought to light that, on the one hand, the care interventions provided and patient referrals, when they occur, are for the most part ambulatory, but that hospitalisations still play a prominent role. On the other hand, this mobile team's care provision is personalised, in particular regarding its duration. It emerges that this duration is correlated with certain individual characteristics, but the analyses nevertheless highlight the presence of other circumstantial determinants, calling for more research to be carried out as to their impact.

Smoking among people with Serious Mental Illness (SMI) is a pleading public health concern as the rates are much higher compared to the general population. Although different interventions are available to provide cessation support, there is limited evidence of assessing psychiatrists' perspectives on smoking cessation among people with SMI. The study aims to explore the perspectives of psychiatrists regarding smoking cessation among people with SMI. The study used a qualitative approach. In-depth interviews were conducted with ten psychiatrists, exploring their opinions about smoking and its cessation among people with SMI. Purposive sampling was employed. Data saturation was achieved when no new information was gathered. The verbatim transcripts were analysed using thematic analyses. A total of 14 subthemes emerged under seven themes, highlighting the perspective of psychiatrists in terms of the utilisation of smoking as a coping mechanism among people with SMI. Findings, such as priority of care, time constraints and patient initiative, emphasised the factors impacting cessation. Psychiatrists expressed that support from peers and family members significantly influences smoking cessation among people with SMI. Furthermore, merely engaging in asking, assessing and advicing components from the World Health Organisation 5As scale implied insufficient usage of the 5As tool while discussing cessation. Psychiatrists recognise the impact of cessation on mental health outcomes, like the utilisation of smoking as a coping mechanism. Their experiences and challenges with cessation highlighted time commitment and priority of care while contemplating cessation. The deepened insight provided by our study findings has been instrumental in shaping the content of tailored interventions related to smoking cessation among people with SMI.

This study investigated the relationship between perceived discrimination, help-seeking behaviors, and the adequacy of social participation services among individuals with serious mental illness in South Korea. Data were drawn from a 2020 survey conducted by the National Human Rights Commission of Korea, involving 607 participants who used community-based mental health rehabilitation facilities. Structural equation modeling was employed to examine the extent to which perceived discrimination in healthcare, employment, and personal-social relationships affects help-seeking behaviors, including the mediating effect of perceived adequacy of social participation services. Results revealed that experiences of discrimination in healthcare and employment significantly influenced help-seeking, whereas discrimination in personal-social relationships did not. Although the adequacy of social participation services positively impacted help-seeking, it did not mediate the relationship between discrimination and help-seeking behaviors. The findings suggest addressing discrimination in healthcare and employment and expanding diverse, accessible social participation services are crucial for encouraging help-seeking among individuals with serious mental illness across regions in Korea.