Community Mental Health Journal最新文献

This study sought to understand the unique types of social support salient to mental health service-users from the perspective of case managers. The sample consisted of case managers working in county mental health agencies in the southwest and west coast. Data was gathered from three focus groups and analyzed using NVivo 10 and Consensual Qualitative Research. Six themes were described including relational support, consistency support, validation and affirmation support, social connection support, day-to-day living support and vocational support. While the social support domains described in this study share conceptual underpinnings with traditional conceptualizations of support, our findings reveal unique types of support from the perspective of case managers. Findings from this study offer an important perspective-case managers-to the extant body of research investigating the meaning of social support for people with lived mental health experiences. Of particular interest is the finding that relational support, affirmative and validation support, and consistency support are salient case manager functions.

We implemented a pilot study to investigate symptoms and functional outcomes of Asian Americans treated in urban community mental health centers for a diagnosis of schizophrenia spectrum disorder. Furthermore, we investigated whether these outcomes differed between East and Southeast Asians. We collected quantitative data from 75 participants recruited using a nonprobability sampling strategy from six urban community mental health centers. We used the Positive and Negative Syndrome Scale (Kay et al. in Schizophrenia Bulletin 13(2):261-276, 1987) and the Strauss and Carpenter Outcome Scale (Strauss and Carpenter in Archives of General Psychiatry 27(6):739-746, 1972) to measure their symptoms and functional outcomes. To compare the outcomes between East and Southeast Asians, we used a multivariable logistic regression model, which adjusted for the estimated effects of age, sex assigned at birth, and age at onset of illness for each outcome examined. The data shows that the treatment outcomes for this group are poor. Only a small number of participants experienced symptomatic remission (30.67%), role restoration (34.67%), and clinical recovery (21.33%). The majority of those who did not experience clinical recovery had difficulties sustaining symptomatic remission and restoring role functioning (54.67%). However, more participants achieved social restoration (68.00%). The results did not vary by national origin groups and sex assigned at birth. However, the participant's age, the age at which the illness began, or both determined whether the treatment outcomes were favorable. Findings underscore the need for interventions that improve symptom control to increase the likelihood of other favorable outcomes.

Though significant research highlights higher rates of mental ill-health and substance use among trans, non-binary and gender diverse (henceforth 'trans') young people, little research has considered patterns, contextual characteristics, and correlates of co-occurring experiences of mental ill-health and substance use among trans young people. Using data from the Trans Pathways study, we used prevalence ratios and age- and gender-adjusted logistic regression models to examine prevalence and differences of co-occurring substance use (past six-month cigarette use, alcohol use, and other drug use) and contextual characteristics of substance use (past six-month solitary alcohol and/or drug use, substance use for coping) by mental ill-health (depression disorder, anxiety disorder, past 12-month self-harm thoughts and behaviours, suicidal thoughts, planning, and attempt/s). Age- and gender-adjusted models assessed associations between co-occurring depressive and anxiety disorders and recent cigarette, alcohol, and other drug use (six co-occurring items total) and 18 interpersonal stressors. Significantly increased odds of smoking or recent use of cannabis or sedatives was observed among trans young people reporting depressive disorder, anxiety disorder (aORs ranging 1.8-3.1). Trans young people who reported recent smoking or use of cannabis, inhalants, or sedatives, had 40% to 80% reduced odds of past 12-month self-harm thoughts, self-harm behaviours, suicidal thoughts, and suicide attempt/s (aORs ranging 0.2-0.6). On the other hand, solitary alcohol and/or other drug use and substance use for coping was significantly associated with increased odds of all mental ill-health outcomes. Issues with school, secure housing, and intimate partner abuse were the most robust correlates of co-occurring mental ill-health and substance use. Trans young people using substances, especially cigarettes, cannabis, and sedatives, often so do with co-occurring experiences of depression and anxiety though limited substance use in more 'social' contexts may confer benefits for preventing self-harm and suicide thoughts and behaviours. Continued research in partnership with trans young people is warranted to conceptualise more nuanced and precise conceptual parameters of trans-affirming substance use harm reduction approaches.

This article explores the historic impact of the COVID-19 pandemic on turnover rates among staff in community mental health and substance use organizations in the United States. While existing literature extensively covers turnover in physical healthcare settings, the mental health and substance use sector's unique challenges have received less attention. The study utilizes a six-year dataset from a large multi-service organization in the northeast to analyze turnover patterns before, during, and after the pandemic. Key findings include a spike in turnover during the pandemic, particularly in Hospital Diversion Programs, and significant variations by age and gender. Despite the pandemic not significantly affecting overall turnover rates, the results offer insights into specific groups at risk for turnover, such as staff under 29 years old. The study concludes by discussing the implications for targeted retention strategies, especially as mental health organizations nationwide adopt the Certified Community Behavioral Health Center model.

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.

Young adults with early psychosis are at higher risk of violent behavior, but no studies have explored using CBT-based interventions to reduce violence in specialized early intervention services (EIS) settings. This study describes formative research about the acceptability and feasibility of the Psychological Intervention for Complex PTSD and Schizophrenia-Spectrum disorder (PICASSO) to reduce violence, using interviews with EIS participants and staff. Generated themes regarding acceptability included negative experiences of violence and the desire to control and minimize violence. Themes regarding feasibility raised concerns about time constraints, consistency of participation in the intervention, and implementation issues in the context of stigma related to both psychosis and perpetration of violence. Findings from this study suggest there is a need for an intervention addressing violence risk. If adequate resources are devoted to addressing implementation issues, a CBT intervention for violence like PICASSO appears both acceptable and feasible for EIS participants and staff.

Early support for young people experiencing psychosis is key to preventing negative outcomes. First and second-generation Black immigrants to predominantly white countries are at higher risk for psychosis (Bourque et al. in Psychol Med 41(5):897-910, 2011) and novel interventions are needed to help support immigrants youths and families. African immigrant pastors are culturally valued and poised to help congregants with psychosis and their families, but we know little about the supports pastors offer and what kinds of tools they might need to address the needs of their congregants. This qualitative study explores semi-structured interviews with 16 primarily nondenominational, Christian, African immigrant pastors to elucidate how they served young adult congregants experiencing symptoms of psychosis and their families. Using grounded theory analytic methods, five key themes emerged: (1) building supportive relationships; (2) identifying the source; (3) healing the problem; (4) families as partners in care; and, (5) referring congregants to and collaborating with mental health professionals. These findings describe an initial set of care practices as a starting point for understanding the current and future role of African immigrant pastors as partners in providing mental health care.

Most people who seek mental health treatment cannot access it. Certain groups (e.g., Medicaid enrollees and the uninsured) face particularly severe treatment access barriers along the care continuum. We interviewed 31 clinicians across two studies about their perspectives working in New York City's public mental health system. Because every clinician across both studies reported gaps in the system, we deployed an emergent, "serendipitous finding" approach and qualitatively analyzed the interviews together. Clinicians described three public mental health system gaps. First, many treatment-seekers must wait long periods of time to receive care and some never receive it at all. Second, patients with more serious challenges cannot access longer-term, higher-intensity, or specialized treatment. Third, some patients receiving high-intensity services may benefit from lower-intensity mental health support that is better integrated with medical and social service support. Coordinated and sustained financial investments at every step of the mental healthcare continuum are needed.