Community Mental Health Journal最新文献

Interorganizational collaboration (i.e., organizations working together towards one goal) is one approach that can be used by community-based organizations to ensure marginalized individuals receive needed care. Though there has been some research on the mechanisms of collaboration from the perspective of leadership, less literature has focused on the perspective of staff working in community-based settings. The study aimed to explore staff perceptions of interorganizational collaboration within a North Carolina county and to gather their recommendations for strengthening such collaboration. Semi-structured interviews were conducted with twenty community-based staff that worked with behavioral health clients, were employed in varying roles and occupied different levels of the organization. Employing a generic qualitative methodology, data were analyzed using an inductive coding approach with the help of a research assistant. Thematic analysis was used across codes to generate seven themes. Community-based staff viewed collaboration as primarily driven by historic relationships and being facilitated by the possession of similar technological infrastructure. Staff reflected on the disconnect between interpersonal relationships and organizational relationships when it came to prioritizing client care. Solutions to improving collaboration as a way of strengthening a client's access to care included organizations providing time and space to network, building out technological infrastructure for more organizations, and emphasizing the ability to provide holistic care through collaboration. Using staff-driven solutions to improving collaboration can encourage buy-in and can build sustainable relationships.

The collaborative care model (CoCM) is an evidence-based model shown to improve treatment of depression and anxiety in the primary care setting. However, there is limited research on CoCM outcomes in underserved populations and which factors impact outcomes. We performed a retrospective chart review to examine GAD-7 scores for patients (N = 1,034) seen in primary care clinics within an urban, safety-net hospital system. The Wilcoxon signed-rank test and linear mixed models were used. Our population was 81% female and 89% self-identified Black or African American. There were significant reductions on GAD-7 scores from baseline to 3-, 6-, 9-, and 12-months follow-up (p < .001). The analysis suggested gender, patient age, clinic setting, and number of visits were significant. The effect sizes for these covariates were 0.94, 3.77, 1.98, and 0.74, respectively. Further research including patients' social determinants of health and comorbidities may help refine CoCM and optimize its effectiveness.

Research suggests shame plays a mediatory role in the relationship between trauma and psychosis, however, there is limited information on how this may occur. This qualitative study explored how experiences of shame in people living with psychosis is linked to past trauma. Fourteen adults completed semi-structured interviews. Reflexive thematic analysis was used to develop four themes: (1) shame maintains trauma; (2) trauma-related shame drives disconnection from the self; (3) avoiding shame from trauma leads to disconnection from aliveness; and (4) pervasive shame from trauma leads to isolation. The findings suggest that shame may play a key role in maintaining the influence of trauma on sense of self and on the way people engage with the world, including in the context of psychosis. Future research could explore whether addressing shame through intervention has any impact on the influence trauma has on people experiencing psychosis.

The health effects of social conditions such as income, education, and employment have been demonstrated to be persistent and wide-reaching. In this study, we examine the effect of social determinants of health, those conditions in which people live, among individuals with serious mental illnesses (SMI) who are actively engaged with mental health services. Using a sample of 203 clients at a community mental health clinic, this study (1) explores the prevalence of three social determinants of health: food insecurity, homelessness, and neighborhood disorder, and (2) assesses their associations with five outcomes of health, including mental health (overall mental health and life satisfaction) and physical health (overall physical health, number of chronic health conditions, and perceived daily limits). Our findings demonstrated that food insecurity and neighborhood disorder were prevalent within our sample of people with SMI (64% and 93% respectively), while homelessness was not (7%). Furthermore, a series of OLS regressions showed food insecurity and neighborhood disorder to be associated with poor mental and physical health, while homelessness was not significantly associated with any outcomes. These findings suggest that individuals with SMI who are actively engaged in treatment have increased risk of food insecurity and poor neighborhood conditions, which in turn may negatively impact their overall health. We suggest that mental health service providers be aware of the influence of social conditions on their patients and that clinics may be uniquely positioned to identify and intervene for individuals at risk of experiences that may be detrimental to their recovery.

In mental health, joint crisis plans facilitate advance care planning between clinicians and patients who experience psychiatric crises. Little research focuses on advance care planning with migrants with mental health problems. This study investigated clinician and interpreter perspectives on the use of joint crisis plans in intercultural and multilingual settings. Focus groups were conducted: two with mental health clinicians (6 participants per group) and two with interpreters (5 to 6 participants per group). The participants in the study identified several challenges associated with using joint crisis plans for patients with a migration background: Diverging ideas about mental health etiologies and roles in decision-making processes; patients' fears of undesirable interferences between joint crisis plans and administrative procedures for residence permits; language barriers; and the collaboration with interpreters. However, interpreters are also found to play a central role by fostering patients' trust in the clinicians and the joint crisis plan.

People with mental health challenges and problematic substance use may experience low quality of life (QoL) because of illness-related factors and psychosocial stressors. Evidence indicates that regular exercise can improve QoL for people with a range of mental health and substance use issues, and Accredited Exercise Physiologists (AEPs) provide evidence-based exercise interventions for people with a range of health conditions. This study examined QoL changes in people with mental health challenges and problematic substance use while engaged in an AEP service. The service was implemented over three years and involved weekly group exercise sessions and health education. Linear mixed-effects models were used to evaluate trajectories of QoL total score and each dimension (independent living, pain, senses, relationships, mental health, coping). A total of 295 participants were inducted, with 161 completing at least two assessments. QoL improved by 5.8% per year (95%CI: 1.8-9.8%), predominantly in mental health and coping dimensions. This study demonstrates the feasibility and adoption of AEP services to inform service planning for improving QoL in people with mental health challenges and problematic substance use.

Research indicates high prevalence rates of adverse experiences in people experiencing first-episode psychosis. Despite recommendations that mental health staff should routinely ask about adverse experiences, documentation indicates these are not being recorded in service-users' clinical records across different mental health settings. This study audited 48 service-user records in a UK early intervention in psychosis (EIP) community mental health service to examine how often, where, and by whom adverse experiences were recorded. Searching for 22 adverse experience terms, 64.6% of clinical records documented at least one adverse experience, with 80.6% reporting more than one. The profession that most often recorded adverse experiences in service-users' clinical records was psychiatrists. While EIP services may document adverse experiences more frequently than other community mental health settings, recorded rates remain lower than expected based on previous research prevalence rates. Further studies should consider adverse experiences recording across UK EIP services to ensure service-users with adverse experiences receive appropriate support.