Community Mental Health Journal最新文献

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.

Compared to the general population, young adults with early psychosis are at increased risk of violent behavior. Existing research has found contextual similarities between violent behavior and suicidal behavior. Therefore, this study examines the drivers and consequences of violent ideation and behavior among young adults with early psychosis by applying frameworks developed for suicide prevention. This research was conducted at OnTrackNY, a network of early intervention services (EIS) that provides coordinated specialty care services to young adults with non-affective psychosis that began within the past two years. Qualitative interviews were conducted with 6 EIS participants and 12 EIS staff members. The interview guide applied the "suicide narrative" format from the Stanley-Brown Safety Planning Intervention by asking EIS staff and EIS participants detailed questions about a specific episode of violent ideation or behavior. Participant responses were then categorized using Fluid Vulnerability Theory (FVT). This study found that it was feasible to discuss information about a specific violence-related crisis for young adults with early psychosis and their treatment teams by eliciting violence narratives. In doing so, EIS participants and staff identified several risk factors from the FVT domains that previously sparked either violent ideation or behavior. In addition to identifying potential target mechanisms for future interventions, these narratives may lead to more compassionate and therapeutic understandings of violence for young adults with early psychosis. Future research is recommended to explore how best to incorporate violence narratives in the treatment of early psychosis.

Farmers are at increased risk for suicide compared to the general population, with estimates 56% higher among males in agriculture/forestry/fishing roles than the male working population. This study explored a farmer-developed suicide prevention intervention using an adapted military challenge coin for agriculture. An agricultural community member shared a message of appreciation with the farmer recipient. Farmers recently receiving a challenge coin were purposively sampled. Semi-structured interviews via telephone/videoconference explored farmers' challenge coin experiences and perceptions. Interviews were transcribed verbatim and de-identified before thematic coding. Participants (n = 14) were aged 28-68 years. All interviewees were non-Hispanic White, and 71% had off-farm jobs. Themes included the reception of the challenge coin, feelings elicited, and protective nature of the challenge coin against suicide, encouraging farmer connectedness and demonstrating appreciation. These data provide initial exploration of challenge coins adapted for farmer suicide prevention, developed within a farming community. Additional research regarding the impact is needed.