Community Mental Health Journal最新文献

Peer support, endorsed by WHO and national guidelines, is increasingly recognised as a key component of mental health care innovation. However, while peer support has gained increasing attention, the effective integration of Peer Support Workers (PSWs) within mental health services-and the systemic challenges it involves-remains a relatively under-investigated area. This study investigates the integration of PSWs in Trieste and its region, a pivotal site of Italy's psychiatric reform, where the deinstitutionalisation movement fostered the transition to a community-based care model. The present study adopted an ethnographic methodology, encompassing a six-month field study involving participant observation and 22 semi-structured interviews with 12 PSWs and 10 mental health professionals. PSWs contribute to enhancing empathy, user engagement, and social inclusion, while also fostering a recovery and community-oriented approach to care. However, challenges have emerged, including role ambiguity, institutional under-recognition, and professional resistance. These tensions often reflect broader issues around power dynamics and the epistemic legitimacy of lived experience. The study also identifies strategies to support PSW integration, including safeguarding practices, interprofessional training, and institutional recognition. In addition to their clinical and relational contributions, PSWs offer an opportunity for mental health services to critically reflect on their practices, assumptions, and power structures. Their meaningful inclusion can catalyse a shift towards more participatory, rights-based, and recovery-oriented care.

High-risk issues, such as overdose, suicidality, hoarding, violence, property damage, and apartment takeovers, are known challenges in supportive housing and Housing First programs. However, the effects of these incidents on residents, service providers, and programs have been minimally studied. The objective of this mixed-methods study was to understand what service providers perceived as the impacts of various high-risk issues in supportive housing and Housing First programs, with an emphasis on housing tenure. This descriptive study used an exploratory sequential mixed-methods design, with unequal weighting (QUAL→quan). In-depth interviews were held with 32 service providers working in supportive housing and Housing First programs, followed by an online survey of 202 additional service providers across Canada. In the qualitative dataset, high-risk issues were identified as having three types of potentially harmful impacts: [1] "we have to evict certain people sometimes" (residents' housing stability); [2] "we're exposed to these traumas as well" (service providers' mental health); and [3] "we're losing our stock, basically" (organizational relationships with landlords and access to housing units). Convergence was generally found in the quantitative findings, with high-risk issues affecting other individuals and property being perceived as more likely to cause housing loss. Service providers working in scattered-site programs reported that hoarding, overdose, and apartment takeovers were significantly more likely to cause housing loss than did participants of single-site programs. Overall, study findings underscore how high-risk issues, particularly those affecting others and property, can be potential housing trajectory-altering events and that this is further shaped by housing and support models.

People with psychosis typically show high levels of sedentary behaviour and low levels of physical activity. Effective interventions are needed, and staff will play a crucial role in implementation. Aims: To understand staff perspectives on reducing sedentary behaviour and increasing physical activity. Eighteen staff from NHS mental health trust community teams were interviewed, with data analysed using reflexive thematic analysis. Four themes were developed: (1) Choosing to target movement: staff recognise the need to address movement but struggle to prioritise it; (2) Encouraging but not steamrolling: balancing encouragement without pushing too hard is essential for motivation; (3) Tapping the reservoir of staff knowledge: staff possess valuable expertise to leverage; (4) Using lived experience: lived experience accounts effectively motivate and inspire hope. Despite recognising the importance of the issue, limited resources in services hinders prioritisation of increasing patient movement, and interventions are often not attempted. Adapting routine practices and recruiting support (e.g. from willing carers) may increase intervention success without burdening staff.

Peer support specialists (PSS) are essential in behavioral health and substance use crisis services by providing support, hope, and encouragement to those in crisis. Despite their benefits, there is a lack of consensus on the core competencies required for PSS working in crisis settings. This study identifies key competencies to inform the development of a Crisis Peer Support Specialist Training curriculum. An e-Delphi survey method was used to collect opinions from subject matter experts (SMEs) working Early Intervention Support Services (EISS) programs. The three-round process gathered qualitative and quantitative input on the required competencies of PSS in crisis settings. Responses from SME were analyzed using thematic coding and a Likert-scale ranking system to determine perceived importance. Four key areas were identified as essential competencies: knowledge, skills, attitudes, and unique contributions. The highest-ranked competencies emphasized ethics and maintaining professional boundaries, demonstrating empathy, and providing a welcoming presence. Consensus from the SME was reached on the core competencies necessary for PSS in crisis settings. Findings highlight the key competencies a PSS requires for delivering services in crisis settings. The results informed the development of a specialized training program for PSS in these settings. Future research should continue to explore the required competencies across different crisis care settings.

Day centres provide low-threshold support for people with severe and prolonged mental illness. However, their effectiveness has not yet been empirically evaluated. This study examines whether regular attendance at day centres improves mental health outcomes. Two surveys were conducted: a cross-sectional survey of 87 service users and a longitudinal study of 16 new admissions (assessments at baseline, one month, and three months after admission). Psychosocial participation limitations (IMET), quality of life (MANSA), symptom severity (SCL-K-9, PHQ-9), self-esteem (G-SISE) and self-efficacy (ASKU) were measured. Descriptive statistics and the Wilcoxon-signed-rank test were used for analysis. Three primary goals for attending a day centre were most important: daily routines, social contacts, and meaningful activities. Significant improvements (p < 0.05) were observed in all outcomes, with large effect sizes (r = > 0.5). This study provides initial evidence that the use of day centres supports recovery from mental illness by restoring key psychosocial functions.

Recovery orientation is a vital feature of contemporary mental health models of care such as Prevention and Recovery Care (PARC) services. Despite the importance of PARC services in providing a recovery-oriented alternative to a stay in hospital for mental health consumers in Victoria, Australia, there are limited studies exploring the views of staff about these services. This study was part of a larger body of work that investigated the appropriateness, effectiveness and efficiency of PARC services across Victoria. As part of the qualitative component of this mixed-methods study, the aim for this project was to explore the perceptions of staff around the meaning of recovery-oriented care and how it is implemented through PARC services. We conducted 20 semi-structured interviews with multidisciplinary staff who worked in 19 PARC services across Victoria. A reflexive thematic analysis was undertaken guided by Braun and Clarke's approach. Participants' responses were organised around themes related to staff interpretations of the meaning and implementation of recovery-oriented mental health care within the context of PARC services. Recovery-oriented care was framed by staff as non-clinical, non-linear, subjective, person-centred, about seeking meaning and fulfilment, identity building and being holistic. Staff described the role of PARC services in contributing to recovery through providing structure and routine, offering opportunities to build relationships, develop skills and offer choice and autonomy.

While shared decision-making (SDM) is widely recognized as a reference model in adult psychiatry, its implementation in youth psychiatry remains under-explored, despite the specific challenges inherent to this field. This exploratory qualitative study investigates how child and adolescent psychiatrists describe and adjust their decision-making practices in clinical care, including their attitudes, strategies, and perceived limits of SDM. Sixteen semi-structured interviews were conducted with youth psychiatrists via videoconferencing. Data were analyzed using thematic analysis. Five overarching themes were developed : (1) the perceived benefits of SDM, such as improved adherence and engagement; (2) a dynamic continuum of decision-making practices, from full collaboration to ethically guided protective decisions; (3) the role of parents as co-participants in the decision-making process; (4) the modulation of the clinician-patient relationship along a vertical-horizontal axis; and (5) contextual influences, including institutional constraints and limited resources. Psychiatrists generally support SDM as a desirable framework. However, their accounts point to a broader and more flexible continuum of practices, in which the degree of sharedness varies depending on factors such as the young person's age, developmental stage, illness severity, crisis situations, and parental involvement. Some practices described by clinicians fall outside strict definitions of SDM and belong instead to the domain of substituted or protective decision-making. These findings invite a nuanced and context-sensitive understanding of decision-making in youth psychiatry.

Patients with methamphetamine use disorder (MaUD) face social, financial, and systemic barriers to accessing evidence-based addiction treatment. We designed a care navigation intervention to better engage patients with MaUD in treatment after an acute care encounter. This intervention was modeled after linkage-to-care strategies for infectious diseases and emphasized rapport building, trauma-informed care, and practical assistance in overcoming barriers to treatment. We also added elements of contingency management given its treatment efficacy with MaUD. We describe the development of the care navigation model, characteristics and care needs of subjects receiving the intervention, and intervention engagement outcomes. Among 94 patients who received this intervention as part of a randomized controlled trial, 64% were considered engaged with at least 2 or more visits with the care navigator Patients had substantial barriers to care-85% of patients were not stably housed, 83% were unemployed, and 46% lacked access to a phone-and the most common domains of need were accessing addiction treatment, housing resources, or communication needs such as a phone or interpreter services. This intervention poses a model for connecting patients with MaUD to treatment after acute care encounters.