Community Mental Health Journal最新文献

This research explores patients' perspectives on the decision-making process for long-term antipsychotic treatment. Twenty individuals on non-compulsory antipsychotic medications were interviewed, and their responses were analyzed using grounded theory. The analysis revealed three interconnected themes that suggest a cyclical process potentially eroding patient autonomy: According to participants' accounts, they often received limited information about dependence, withdrawal symptoms, or expected treatment duration before starting medication. Subsequently, many reported developing desires to stop or reduce their antipsychotic treatment. Participants then described experiencing dismissal of their reported side effects or treatment ineffectiveness, lack of alternatives, and opposition to reduction attempts from their psychiatrists. These experiences formed a cycle where initial information gaps contributed to later challenges when attempting treatment modifications. The findings emphasize the value of comprehensive information delivery, serious consideration of patients' reported experiences, and treatment processes that enhance patients' sense of autonomy in their psychiatric care.

The Commonwealth Psychosocial Support Program, funded by the Australian Government, offers psychosocial support to individuals with severe mental illness. Currently, little research has addressed the challenges confronting its workforce. This study aimed to assess whether recruitment, retention, and staff skills pose significant issues for the Commonwealth Psychosocial Support Program and to identify contributing factors. This study used a mixed-methods explanatory sequential design. 159 mental health support staff across Australia participated in an online survey. From this sample, 16 participated in a semi-structured interview. Survey data was analysed using descriptive statistics and chi-squared tests, while qualitative data was examined through deductive content analysis. 84%, 77% and 56% of staff agreed that recruitment, retention and the skill of staff are significant issues affecting the delivery of the Commonwealth Psychosocial Support Program, respectively. While no significant differences were found in staff characteristics for recruitment and retention concerns, geographical location showed notable disparities in perceptions of staff skill (χ²(4, N = 153) = 11.318, p = 0.023). Specifically, a higher proportion of rural or remote (68%) and regional (63%) staff identified staff skill as an issue compared to metropolitan counterparts (39%). Key factors contributing to poor recruitment included short-term contracts (77%), while burnout (74%) and job insecurity (72%) were indicated for poor retention. Inadequate skill was attributed to infrequent professional development (53%), insufficient on-the-job training (53%), limited mentoring and supervision (50%), and unclear role expectations (50%). Addressing these multifaceted issues is imperative for enhancing the effectiveness of community-based mental health services and ensuring sustained support for individuals with severe mental illness across diverse geographical locations.

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.

Satisfaction with services among service users is an important aspect of quality in mental health care. This prospective study investigated associations between service and treatment factors at baseline and satisfaction with services at 18-month follow-up among service users with psychosis in specialist mental health services. Data were collected from 119 service users with psychosis and their clinicians from 26 clinical sites across Norway at baseline and after 18 months. Satisfaction with services was measured using the Client Satisfaction Questionnaire-8 (CSQ-8). Linear mixed models with random intercepts for units were estimated to test the association between service- and treatment-related predictors and the CSQ-8. Participating in the Individual Placement and Support program or other interventions to promote work or study, receiving well-coordinated services, and receiving helpful assistance from a general practitioner at baseline were positively associated with satisfaction with services at 18-month follow-up. The present results suggest that receiving integrated and well-coordinated services and targeting the goal of facilitating employment and study opportunities is important for satisfaction with services among service users with psychosis.

The opioid crisis in Boston necessitated multifaceted prevention strategies. This qualitative descriptive study engaged stakeholders' perspectives to explore the role of community empowerment and educational strategies in opioid overdose prevention. Fifteen officials from law enforcement, healthcare, policy, and community organizations participated in semi-structured interviews conducted from January to March 2024. Thematic analysis using Braun and Clarke's approach, facilitated by MAXQDA software, revealed three themes: Perceived Role of Community Empowerment in Opioid Overdose Prevention, highlighting the importance of local leadership, personal recovery, and grassroots initiatives; Effectiveness of Educational Strategies in Opioid Overdose Prevention, focusing on awareness, harm reduction, and bridging gaps post-incarceration; and Challenges and Innovations in Empowering Communities and Enhancing Public Safety, emphasizing the integration of law enforcement with technological solutions and community collaboration. The study underscores the importance of integrating public health approaches with enhanced law enforcement strategies and community-driven solutions to balance immediate intervention with long-term community resilience.

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.

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.

Trialogue meetings, aligned with the Recovery model in mental healthcare, foster the development of a shared language and mutual understanding among persons with lived experience, their relatives, and professionals. This study analysed the first mental health trialogue experience in Barcelona, involving six meetings with thirteen voluntary participants over three months. Using qualitative methods for data collection and reflexive thematic analysis, three main themes emerged: Recovery process, Interaction with mental health services, and Trialogue dynamics. Benefits included open dialogues in a safe space, learning from diverse perspectives, and sharing expertise. The meetings created an environment of empathy and respect while promoting open communication. This approach holds substantial potential for transforming mental healthcare systems, suggesting trialogues can be an effective tool for enhancing communication within community-based mental health initiatives. The findings provide a comprehensive picture of the trialogue process, highlighting its potential to foster mutual understanding among participants.

Haven for Hope is a 501(c)(3) nonprofit organization that has been rarely described in the research literature but has become nationally known for its comprehensive homeless response system in San Antonio, Texas. Haven for Hope operates a 22-acre campus that includes a Transformational Campus and a Courtyard that serves over 9,000 clients annually, including chronically homeless individuals, veterans, children, and families. Haven for Hope offers a "one-stop" design that allows dozens of community partner organizations to provide housing, meals, healthcare, job training, education, childcare, and pet services on-site. To maintain community collaborations, Haven for Hope undertakes numerous operational activities on a regular basis and employs individuals with lived experience at all organizational levels. Lessons can be extracted from history and current operations of Haven for Hope. Further research at Haven for Hope is needed to understand what and how its various models and programs benefit individuals and families experiencing homelessness.