Community Mental Health Journal最新文献

This qualitative service evaluation aims to provide in-depth insights of service providers' perspectives of a new integrated community mental health service piloted in one NHS Integrated Care Board locality in South West England, UK, considering to what extent the service is meeting the mental health support needs of adults who are in between primary and secondary care services. In total, 21 semi-structured remote interviews were carried out in June-August 2023 with service providers and lived experience representatives. The evaluation was carried out through a researcher in residence -placement. Qualitative analysis drew on framework and thematic analysis, which was completed using Nvivo 20. Thematic analysis drew on a framework of context, mechanisms and intended or unintended consequences. These showed that service providers' positive expectations of the service were undermined by insufficient integration, which was evident from the imbalances in information flow and presence of pre-existing provider specific practices. The evaluation found several improvement opportunities: a need for deepening integration beyond the initial service development phase; aligning working practices with service delivery aims and ensuring that new services are not rolled out prematurely before service delivery practices have been fully developed.

There is no consensus on the definition of recovery of people with psychosis. This may be attributed to the broad concept including clinical, functional and personal recovery domains and the diverse interests of stakeholders involved. We hypothesized that service users, informal caregivers and healthcare professionals would exhibit differences in prioritization, reflecting varying roles and viewpoints. Through an open online anonymous questionnaire, stakeholders shared their perspectives on most important aspects of clinical, functional and personal recovery and on facilitators and barriers of recovery. Stakeholder collaboration in study design and interpretation enhanced the study's robustness. The answers on open questions of respondents were categorized for statistical analyses to compare the answers between respondent groups on the different aspects of recovery. 226 stakeholders participated. While commonalities prevailed, distinctions emerged in recovery domain priorities. Service users and informal caregivers accorded equal importance to clinical, functional and personal recovery, whereas healthcare professionals emphasized clinical recovery. Regarding functional recovery, service users seemed to focus on practical issues while informal caregivers addressed the underlying causes. Disparities were notable in the role of healthcare that was considered as both a facilitator or a barrier to recovery, with informal caregivers prioritizing aspects of healthcare more frequently as most important than healthcare professionals. While commonalities prevailed, we identified several differences in prioritizing recovery domains among stakeholder groups. Awareness and understanding of these differences is crucial for effective communication and collaboration between stakeholders in recovery-oriented healthcare. The study underscores the need for ongoing dialogue between stakeholders.

This study examined the impact of Patient-Centered Communication (PCC), Open Dialogue-inspired changes to rounding practices and culture, on patient perceptions of care on an inpatient psychotic disorders unit. A retrospective cohort analysis was conducted based on medical records, restraint and seclusion records, and hospital Perceptions of Care (PoC) surveys. The analysis compared data from 6-month periods before and after implementation of PCC to quantify whether the implementation of PCC was associated with more positive care ratings. There were trends toward improvement suggestive of an effect on patients' perception that their care was adequately explained, that they felt involved in care, that they felt respected, and that they were supported during hospitalization, although improvements did not achieve statistical significance. Greater improvement was observed for teams that incorporated a greater number of interventions. Dialogic practice-inspired changes on an acute inpatient unit may improve patient perceptions of inclusion and respect in their care.

"Neorecovery" is a portmanteau used to describe the distortions that neoliberalism engendered in the original recovery philosophy. I describe how neoliberalism as an economic model acted externally to the recovery movement to preclude opportunities to implement a wide range of innovative mental health approaches and to curtail safety net and social justice policies for persons with severe mental illness. In addition, I illustrate how the neoliberalism philosophy acted internally by inducing the recovery movement to adopt an individual-focused ethos that minimized the impact of broader social structures that affect well-being and opportunities for self-realization. Recovery's potentially radical transformative vision can only be achieved by seriously acknowledging the social and political structures that underlie the mental health system and their relationship to the broader society, and ultimately, altering them so that people experiencing severe mental illness can truly flourish.

This article uses autoethnography to explore the author's lived experiences of mental distress and how she has conceptualised and explained these symptoms to herself using both the biomedical and recovery models of care. Autoethnography is a process of personal reflection that enables connection between the personal and the political. Experiences of mental distress are recounted alongside the decision to reduce medication. This personal experience is then explored in the context of limited evidence base on the effectiveness of reducing medication and the situation in which prescribers often feel reluctant to recommend and support service users in these choices. Shared decision-making in medication management is introduced which is an approach which draws on the models of recovery and co-production challenging traditional biomedical approaches which locate the prescriber as expert. Moreover, the radical service user led model is highlighted, within which, the Hearing Voices Network and Open Dialogue offer alternative approaches which promote co-production and empowerment. The author connects the personal to the political and reflects on her dual identity as an expert-by-experience and social work academic. She details how she has drawn on biomedical explanations to describe her distress yet has been challenged by the recovery model throughout her journey of recovery. She concludes that her own position, in identifying herself as an academic and expert-by-experience is an important step in challenging notions of expertise and approaches to mental health care.

In this qualitative study conducted at a public mental health outpatient clinic in Norway, the integration of patients' social network in treatment was examined. The aim was to explore the experiences of patients and their network during dialogical network meetings and discuss any similarities and differences between the two participant groups. Reflexive thematic analysis was performed on data obtained from fifty-three meetings, resulting in the development of five themes. For patients, there were two themes: "Enhanced trust within our relationships" and "Providing us a safe space to talk openly," and for network members there were three: "Empowered through participation," Being welcomed and taken seriously," and "Provide more clarity to enhance our ability to contribute." Mattering was employed as a conceptual framework to discuss the similarities and differences between the themes of the two participant groups. Both patients and network members placed strong emphasis on the freedom of expression and acknowledged the crucial role of the meeting leaders in facilitating discussions on important and challenging topics. Differences included network members' emphasis on feeling welcome and their need to add value, while patients emphasized strengthened relationships and feeling valued and empowered by being trusted to control the discussion content. Overall, mattering appears to be a valuable tool for understanding the relational dynamics within network meetings..

According to William Anthony's "Recovery from mental illness: the guiding vision of the mental health service system in the 1990s," mental health recovery means "changing one's attitudes, values, feelings, goals, and skills in order to live a satisfying life within the limitations caused by illness." This seminal work served as an overarching goal, a call to action, and a roadmap for the enhancement of psychiatric recovery. Unfortunately, from many viewpoints, the goals encouraged by Anthony have not been achieved. Through semi-structured interviews with psychiatry clinicians and senior faculty members, this article aims to elucidate the current status of psychiatric recovery, how the movement progressed to this point, and where we could go from here. The development of the recovery movement will be discussed, along with its assumptions and explicit goals. The interviews focus on the extent to which these goals have been achieved, barriers to progress, whether goals should be revised, and how to achieve these goals.

A major component of recovery is the inclusion of lived experience to transform the culture of Mental Health (MH) services. In Israel lived experience has been increasingly integrated into services through peer roles. However, lived experience knowledge and expertise has not been sufficiently nor systematically integrated into the design of mental health research. This paper documents an attempt to initiate change by convening multiple stakeholders (with and without lived experience) in a specialized workshop aiming to learn and discuss the potential role of lived experience for mental health research in Israel. Participants raised ideas and core questions on how lived experience can shape research and augment mental health practices and policies. They highlighted current challenges regarding self-disclosure facing lived experience researchers, as well as challenges for developing participatory research collaborations among consumers, family members and practitioners. By bringing to the fore-front the 'insider perspective' of MH system as experienced among service users and families, we expect a development of a research culture with reduced paternalism, increased coproduction and recovery-orientation. We hope this endeavor will inspire others and help develop a lived experience expertise-based research network of interested stakeholders.

We aimed to examine the role of shared decision-making (SDM) in family participation in the treatment of adolescents and young adults with first-episode psychosis (FEP). Based on responses of 144 family members of OnTrackNY (OTNY) participants, we divided the sample into low participators and high participators. We calculated the total SDM score for each participant by summing the ratings across items inquiring about SDM and assessed the extent to which loved ones encouraged family participation in their care. Our results indicated that the level of loved ones' encouragement was significantly related to family participation. When controlling for loved ones' encouragement, we found that the total SDM score was significantly higher in the high participator group. These findings suggest that SDM may be influenced by loved ones' attitudes towards family involvement in treatment and SDM may play a role in promoting family participation in care for individuals with FEP.

Recovery from serious mental illness requires persons to make their own meaning and deal with evolving challenges and possibilities. Psychiatric rehabilitation thus must offer more than manualized curricula that address symptoms and skills. We suggest that exposure to the humanities and in particular literature may offer practitioners unique avenues for developing interventions that are sensitive to the processes that enable meaning to be made. We suggest that through what the poet Keats called negative capability, reading novels may enhance practitioners? abilities to see and accept uncertainty, tolerate ambiguity without need for complete resolution, and accept the complex and ambiguous nature of persons. As an illustration we described how reading two novels, The Trial and Slaughterhouse-Five enhanced the process of meaning making while supporting the recovery of one prototypical person with serious mental illness during his efforts to make sense of his experience of returning to work.