Community Mental Health Journal最新文献

Assertive Community Treatment (ACT) is a community-based, multidisciplinary mental health treatment model with improved housing stability as a treatment goal. We know little about factors contributing to housing stability among ACT participants with co-occurring serious mental illness and substance use disorders, who account for 30% of the ACT participant population. Informed by the behavioral model of health service use, the present study aimed to examine the relationship between housing stability and theoretically relevant factors. We retrospectively abstracted the data from two ACT teams' treatment service planning and tracking system. Stable housing was defined by living in a private residence or permanent supportive housing throughout the assessment periods; unstable housing was defined by having at least one unstable housing situation (e.g., jail or prison) throughout the assessment periods. The sample included 57 individuals with 272 assessment charts. Multivariate logistic regression results show that service engagement was associated with housing stability and that receiving housing supportive services was inversely associated with housing stability. The findings support prior literature in that service engagement remained a "critical ingredient" of the ACT model and highlights the importance of the supportive aspect of housing services in improving housing stability among individuals with co-occurring disorders.

The causal explanations voice-hearers have for their voice-hearing experiences may influence affective outcome and clinical decision making. Voice-hearers endorse a range of explanatory models, which do not consistently align with explanatory models held by healthcare professionals. Research has established that explanatory models for voice-hearing are dynamic rather than fixed, and are influenced by internal beliefs and motivations, culture, and contact with significant others. Although social meaning making is potentially significant, opportunities to engage in this may be limited. Hearing Voices Groups are one venue in which shared meaning making might be more available or acceptable. This study was designed to seek further information about how shared sense-making is involved in the development of causal models, and what is the role of Hearing Voices Groups in supporting this. Semi-structured interviews were conducted with 10 participants who self-identified as voice-hearers and had attended at least three Hearing Voices Network group sessions in the UK. The interviews were analysed using reflexive Thematic Analysis. Two themes, with six subthemes were developed concerning the role of Hearing Voices Network Groups in the sense-making process. Hearing Voices Network groups were found to offer qualities of commonality, authenticity, understanding, and being non-judgemental, and with freedom to talk about voices without external pressure. This study broadens our understanding of how social sense-making is enhanced by the Hearing Voices Network groups. These qualities are suggested as important to social sense-making. They are not consistently found in clinical services accessed by voice-hearers.

Recovery is a holistic approach to mental health care which focusses on the ability of people with mental disorders to achieve their goals and live full, meaningful lives despite their limitations. Recovery assessment tools are instruments that make it possible to measure the progress of people with mental disorders on their path to recovery. To explore, map and describe patient-reported outcome measures (PROMs) found in the literature related to the recovery process in people with mental disorders (MDs). A scoping review was carried out of papers proposing personal recovery assessment tools. The search was performed in seven data bases: SCOPUS, CINAHL, Medline, Web of Science, Teseo, Opengrey and Dart-Europe. It included studies published between 1970 and 2023 with adult participants suffering from some form of MD. It excluded studies involving patients with intellectual disability and/or addictions. 82% of the instruments described in the 50 studies found used self-administered questionnaires. The most frequently referenced dimensions were hope, empowerment and wellbeing, with an average of 35 items per questionnaire. The most frequently assessed psychometric property was internal consistency, which was evaluated in 84% of the studies. Recovery is a complex concept which is not integrally measured in any of the existing scales. However, the tools identified in the review can help mental health professionals assess the recovery of MD patients and develop personalised treatment plans.

The increased prevalence of behavioral health problems in the US is intensified by the critical shortage of providers in the field. The historical failure of behavioral health specialties to attract BIPOC students and workers limits leadership, access to quality care, and the generalizability of research findings. Most workforce development programs serve only those with earned graduate degrees. This report describes a service-learning program that is successfully attracting new graduates with bachelor's degrees and culturally diverse professionals into the behavioral health workforce.

Community mental health care is a practice setting conducive to the emergence of special situations since the intervention takes place in the client's living environment, a context fraught with multiple and often unpredictable events and triggers. In addition, the healthcare workers are often alone in making decisions. This can lead to a persistent feeling of discomfort when the situation can be seen from several different angles and the healthcare workers find it difficult to make the right decision or are uncomfortable with the consequences of a decision they must make. This is the phenomenon of ethical discomfort. The aim of this study was to develop a grounded theory to better understand the relationships between ethical discomfort situations, their impact on lived experience by healthcare workers, and the mental processes and strategies employed by community mental health workers. We used a constructivist grounded theory methodology and conducted focus group interviews with five rural and urban community mental health teams. Our findings describe the context and process surrounding the identification of ethical discomfort by community mental health workers. Strategies such as dialogue with oneself, colleagues, or clients were helpful in deepening ethical reflection and alleviating ethical discomfort. Future research on ethical issues in community mental health care could help to develop ethical support interventions adapted to this mental health care context.

Mentally ill offenders face stigma, being perceived as both dangerous and unpredictable. This leads to social discrimination, which causes devaluation, distancing, and unequal treatment towards them. Critical and dismissive attitudes of healthcare professionals and police toward these patients undermine their care, treatment, and prospects for rehabilitation. This study investigated the attitudes and stereotypes of health professionals and police officers who frequently interact with mentally ill offenders. Participants completed three scales: Attitudes Toward Mentally Ill Offenders (ATMIO), Community Attitudes Toward the Mentally Ill (CAMI), and Familiarity Level Scale. The sample included 523 professionals, 283 health professionals, 139 mental health professionals, and 101 police officers, with an average age of 41.4 years and 40.3% having over 20 years of experience. Results showed that all groups displayed negative attitudes toward mentally ill offenders, with little variation between them. This highlights the need for professionals to recognize their biases when caring for this population.

This study examined treatment utilization across in-person and virtual treatment modalities in veterans who were on medications for opioid use disorder (MOUD; N = 139). Treatment records for veterans in addiction treatment on MOUD were examined for 3-months prior to telehealth conversions ("Pre-Telehealth," 12/02/2019-03/14/2020), 3-months during the initial telehealth transition ("Telehealth," 03/15/2020-06/30/2020) and 3-months during post-telehealth transition ("Re-Entry," 07/01/2020-10/01/2020). Analyses examined the relationship between treatment modality and demographic features, psychiatric comorbidities, treatment engagement, and illness severity as measured by psychiatric emergency room (PER) utilization. Results demonstrated that modality was not associated with PER utilization. Past-year PER visits, alcohol use disorder (AUD), and psychotic disorders were associated with PER utilization during Telehealth, while AUD was associated with Re-Entry PER utilization. Given the likelihood of virtual treatment in the future, frequent in-person visits may not be necessary for MOUD; however, individuals with comorbid AUD and psychotic disorders may need additional support to prevent emergency care.

Individuals with significant mental health problems (SMHP) have historically faced challenges accessing mental health care due to gaps between primary and secondary care services. The National Health Service (NHS) Long Term Plan aims to bridge this gap through the introduction of integrated primary care services that provide holistic, person-centred, multidisciplinary support for people with SMHP. This evaluation aimed to explore the experience of service users, carers and staff working within this new model of care. A qualitative approach was employed, and semi-structured interviews were conducted with N = 123 participants (n = 106 staff, n = 15 service users, n = 2 carers). Thematic analysis identified three themes: 'opening doors and improving experiences', 'tailored and timely care' and 'connected communities'. Findings showed that the Integrated Primary Care Mental Health Service enabled earlier and easier access to mental health support for people with SMHP and supported community engagement and cross-collaboration between the NHS and partner agencies. The findings underscore the value of the Integrated Service in providing accessible, comprehensive, and person-centred mental health support at a primary care level, highlighting the benefits of cross-partnership working.

Transition-age youth (TAY) diagnosed with serious mental health diagnoses have low employment rates. Supported Employment (SE) is a widely adopted evidence-based approach. However, SE engagement and outcomes are mixed with TAY, who have unique developmental needs. This study evaluates the "Career Opportunity Readiness Experience" (CORE), a TAY transitional employment SE add-on. CORE runs in 15-week cycles with 6-8 TAY, supported by Vocational Peer Mentors. CORE includes: (1) workshops, (2) paid internship, and (3) SE transition. CORE participation, key outcomes and feedback were tracked over nine cycles, and for six-months post-CORE participation. Most (97%; 55 of 57) experienced positive outcomes: 74% enrolled in SE, 42% secured employment and 23% enrolled in an education program. Most (82%) reported positive CORE experiences. CORE workshops, internships and vocational peer mentoring are promising TAY SE practices. More research is needed to understand CORE implementation barriers and facilitators and key change mechanisms.