Community Mental Health Journal最新文献

During the 2019 training course on "Early Intervention in Psychosis" (EIP), mental health professionals from all Departments of Mental Health in the Emilia-Romagna region (Northern Italy) were provided with an update on the multi-component intervention program for early psychosis indicated in the current international guidelines. At the end of the training sessions, participants completed the "Scale of Perceived Self-Efficacy and Satisfaction in the Activity of the Psychotherapist" (SAS-P). They also answered open-ended questions, providing opinions on key challenges, suggestions for improvement, and observations on the program's strengths and criticalities. Results showed that psychotherapists felt themselves effective in facilitating therapeutic change, responding to patients' needs, and coordinating multidisciplinary teams. However, they reported difficulties in managing work-related stress, maintaining a suitable psychotherapeutic setting in public services, and influencing organizational structures. Open-ended responses highlighted other key challenges, including limited resources, poor integration between services, and communication gaps within teams. In conclusion, the findings highlight disparities among local mental health services in implementing the specialized EIP program. They also emphasize the need to address these challenges to ensure more effective and consistent interventions.

Individuals with serious mental illness (SMI) often require ongoing medication managed through intensive community-based service delivery (IC-BSD) programs. While these programs support the SMI population, they face challenges with efficiency and effectiveness. Innovative technological solutions like the Medherent™ telehealth platform, which automates medication dispensing and tracks adherence, offer potential improvements. However, research on their use in SMI populations and implementation barriers in community settings is limited. This study examines the implementation of Medherent™ to support medication management in community mental health settings. Using a mixed-methods approach, we assessed the appropriateness, acceptability, adoption, and feasibility of Medherent™. The Work Observation Method by Activity Timing (WOMBAT) was employed to quantify medication management tasks in three community mental health agencies, and qualitative interviews with 28 staff members were conducted. Results suggest that Medherent™ can save up to 7.35 h of staff time per client each month, enabling staff to focus on higher-value rehabilitation activities. Staff generally found Medherent™ acceptable, reporting increased efficiency and enhanced client independence. However, challenges included technical issues such as power outages, Wi-Fi connectivity, and the need for ongoing staff training. This study emphasizes the importance of organizational readiness and effective communication between agencies and pharmacy providers for successful implementation. Future research should explore broader impacts on clinical outcomes and assess the telehealth platform's long-term feasibility.

This study examined the workplace experiences of young adult peer support workers (YPSWs), including how these experiences differ by certification status and what barriers and recommendations YPSWs identify for improving their work environments. A cross-sectional survey was conducted via REDCap with 49 YPSWs aged 18-30 currently employed in a paid peer support role in the United States. Participants completed quantitative items assessing satisfaction with various workplace aspects, supervision, intergenerational inclusiveness, and stigma, and open-ended questions about workplace barriers and recommendations. Analyses included descriptive statistics, one-way ANOVA tests comparing certified and non-certified YPSWs, and thematic analysis of qualitative responses. Respondents reported relatively high satisfaction with fringe benefits, training, and supervision, but lower satisfaction with opportunities and rewards. Most reported a positive intergenerational climate and little stigma from coworkers. Youth certified peer specialists reported significantly lower satisfaction with opportunities and rewards and benefits than non-certified peers, and significantly lower satisfaction with supervision than general certified peer specialists. Qualitative data revealed key workload, policy, and individual barriers as well as age-related issues (e.g., lack of respect, imposter syndrome). Respondents recommended improvements for leadership, policy, job incentives, workforce capacity and support, peer integration, and collaboration and inclusion. Findings highlight both strengths and challenges in YPSW work environments, with notable disparities by certification status. Given their unique developmental stage and experiences of marginalization, strengthening this workforce will require attention to compensation, role clarity, and inclusion through a positive youth development lens.

Psychosocial interventions support functional recovery and social integration for people with severe mental illness (SMI); however, their implementation remains fragmented and inconsistent. This rapid scoping review maps the landscape of psychosocial interventions for adults with SMI in high-income countries, identifying their key components, implementation challenges, and strategies to optimise delivery. Following the Cochrane rapid review guidelines, we searched MEDLINE and CINAHL (January 2009 - May 2024) and conducted manual reference screening. Eligible studies focused on non-pharmacological, community-based interventions. Thematic analysis was used to identify implementation barriers and enablers. Of 8,624 screened records, 464 studies met inclusion criteria, covering 15 intervention types. Cognitive-focused interventions (n = 100) supported employment (n = 86), and behavioural therapies (n = 66) were most studied. Outcomes focused on symptom (n = 179), daily living skills (n = 160), and cognitive states (n = 157). Implementation was often constrained by systemic, organisational, and individual-level barriers. Systemic challenges included fragmented services, stigma, cultural and linguistic barriers, and economic constraints, highlighting the need for integrated care models, policy reforms, and culturally responsive approaches. Organisational challenges such as staff resistance, insufficient training, and resource limitations underscored the importance of leadership, stakeholder engagement, and investment. At the individual level, low motivation, logistical difficulties, trauma histories, and goal misalignment reduced engagement and retention, highlighting the need for flexible, person-centred, trauma-informed approaches, strong social networks, and a balance between structure and adaptability. Selecting, adapting, and funding psychosocial interventions remain complex. This review provides a foundation for future systematic reviews of homogeneous intervention subsets to better inform policy and practice.

The United States is in need of novel solutions to deliver mental health care, especially in the wake of inadequate community health financing following deinstitutionalization. The community mental health work model, in which lay providers deliver basic mental health care and refer to higher levels of care as needed, is proven internationally and has started to be implemented within the United States. Securing sustainable financing for the expansion of these programs remains a challenge. Here, we discuss three avenues for advancing the funding of United States based community mental health work programs. First, by implementing a volunteer model similar to that which has been done internationally; second, by bolstering pre-existing U.S. healthcare funding mechanisms; third, by pursuing a novel collaborative financing mechanism that is rooted in public good economics.

The present study aimed to identify the types of coercive practices in healthcare services and to analyze their relationship with psychosocial disability and days in crisis among individuals with suicide attempts in Colombia. A mixed-methods design was adopted. The quantitative component consisted of an analytical cross-sectional study with a stratified sample of 622 individuals, using validated instruments to assess depressive symptoms, resilience, subjective well-being, loneliness, continuity of care and psychosocial disability. The qualitative component involved 30 semi-structured interviews, analyzed using reflexive thematic analysis. Multivariate analysis explained 45.1% of the variance in days in crisis. Coercive practices were significantly associated with higher levels of psychosocial disability, more severe depressive symptoms, and lower scores in resilience and subjective well-being (p <.001). Qualitative findings revealed perceptions of dehumanizing treatment, normalization of coercion by health personnel and disruption of the therapeutic relationship. Coercive practices represent a risk factor for psychosocial recovery.

Digital literacy, the ability of an individual to use and interact with technology, is increasingly recognized as a social determinant of health, especially for accessing healthcare today. Despite the proliferation of digital health tools, a digital divide remains concerning the ability of everyone to benefit from these digital resources, disproportionately impacting individuals with serious mental illnesses. Many existing digital literacy assessments, such as e-HEALS, SPIDER, and DHLS, identify gaps in digital literacy but do not offer actionable steps to address them. To bridge this divide, we developed the Technology Use Survey and Matching Guide, an actionable tool designed to assess digital literacy and align individuals' needs with tailored training resources through the Digital Outreach for Obtaining Resources and Skills program. Piloted with diverse populations, including individuals in inpatient psychiatric units, community health centers, and mental health clubhouses, this new scale and matching tool were able to identify knowledge gaps, address learning barriers, and enhance digital health engagement. Case studies demonstrate how targeted interventions improved functional outcomes and access to healthcare. By merging assessment with actionable education, our framework promotes digital equity and allows all individuals to engage meaningfully with technology. Future research will refine these tools and evaluate long-term outcomes.

Youth peer support workers (YPSWs) use lived/living experience to provide support. However, there is a knowledge gap about service impact on YPSWs themselves. To understand (1) impact being a YPSW has on well-being, (2) experience of being a YPSW, and (3) barriers and facilitators of being a YPSW. Eighteen YPSWs at an integrated youth services (IYS) initiative in British Columbia, Canada, completed semi-structured interviews in fall 2023. Interviews were analysed thematically using an inductive approach. Themes were identified relating to the YPSW role extending beyond employment, providing a sense of purpose and contributing to personal and professional growth as a low-barrier employment opportunity. YPSWs also identified barriers and facilitators within their role. Findings highlight the value of YPSWs as an occupation and the distinction of this role. To strengthen the profession and increase supports for YPSWs, the development of clear policies and standards is essential.

Increasingly, adolescents are struggling with poor mental health outcomes, making it essential to improve access to high-quality mental health services. Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) act as key "safety-net" health centers for low-income youth seeking mental health services, as the majority accept Medicaid. This study examines how administrative burdens, i.e., challenges citizens face when interacting with a government agency, may act as barriers to accessing mental health services, especially for adolescents and their caregivers. This exploratory sequential mixed-methods study uses data from semi-structured interviews with hospital- and community-based social workers, and from a mystery shopper study conducted during the COVID-19 pandemic with CMHCs and FQHCs in a large metropolitan county in the United States. It addresses three questions: (1) what kinds of administrative burdens exist in accessing mental health care for adolescents and their families at FQHCs and CMHCs? (2) how do these burdens convey potential learning, compliance, and psychological costs to prospective clients? (3) how do these burdens act as distinct barriers to accessing mental health services for adolescents and their families within safety-net health centers? Moreso than CMHCs, FQHCs implemented a variety of administrative burdens on prospective clients, such as a requirement to designate their primary care physician into the FQHCs network through their insurance prior to scheduling, difficult-to-navigate phone trees, unanswered voicemails, rude or discriminatory interactions with schedulers, and complex referral processes. This study finds that administrative burdens may act as distinct barriers to accessing mental healthcare. Recommendations to reduce administrative burdens at the organizational- and system-levels are discussed.

Objective: This study examines the prevalence of specialized police responses to persons experiencing a mental health crisis across U.S. law enforcement agencies and explores whether organizational and community factors are associated with their presence.

Methods: This study used 2020 data from a nationally representative survey of over 2,500 law enforcement agencies. The primary outcomes included whether agencies implemented one of four responses: (1) designated unit, (2) designated personnel, (3) addressed mental health without designated unit or personnel, or (4) did not address. Logistic regression models assessed factors associated with each response type.

Results: Over half (51.0%, n = 1,349) of agencies addressed mental health but lacked designated units or personnel, while 6.9% (n = 183) did not specifically address mental health. Larger agencies, agencies located in urban areas, as well as those with external partnerships, and a higher number of use of force complaints were significantly more likely to designate a unit or personnel.

Conclusions: Fewer than half of law enforcement agencies have responses for mental health crises. Further research is needed to identify barriers and facilitators to adopting specialized responses, particularly among rural and under-resourced agencies.