Community Mental Health Journal最新文献

Engaging residents with the support available at community-based residential mental health rehabilitation facilities is an ongoing challenge for health services. This study explored factors associated with residential rehabilitation engagement across Queensland, Australia through regression modelling of cross-sectional data from a statewide benchmarking activity completed in 2023 (n = 208). The Residential Rehabilitation Engagement Scale (RRES) assessed each resident's rehabilitation engagement. A broad range of potential predictors were considered, including resident and unit-level variables. Only 45.2% of residents had an average RRES score consistent with being engaged with rehabilitation support usually or always. Higher levels of rehabilitation engagement were significantly associated with lower levels of psychosocial disability (B = - 0.413, p < .001), length of treatment (B = - 0.165, p = .008), care under the integrated staffing model (B = 0.156, p = .012), higher staff recovery knowledge and attitudes (B = 0.138, p = .037), and physical illness or disability (B = 0.129, p = .045). In conclusion, engagement in residential rehabilitation was associated with both resident and staff factors. The observation that engagement was higher where unit staff endorsed recovery knowledge and attitudes, and under the integrated staffing model is important. This suggests potential modifiable service characteristics that may support improved rehabilitation engagement in the future.

Major depressive disorder (MDD) is a serious public health concern in the United States. Prior research has shown that neighborhood characteristics serve as protective factors against depression in adolescents. Few studies have examined the association between perceived neighborhood characteristics and depression during middle and older adulthood. We examined the association between each perceived neighborhood social environment (i.e., social cohesion and safety) and the presence of MDD among Midlife in the United States III (MIDUS) participants (n = 2,435, mean age = 63.6 years, Female = 54.4%). Moreover, we investigated whether these associations were moderated by sex and income, separately. All models were adjusted for demographic variables. Overall, perceived neighborhood social cohesion and safety were negatively associated with the presence of MDD. The associations varied when analyses were stratified by sex and income. Findings offer support for the perceived neighborhood social environments as protective factors against depression during middle and older adulthood.

Recovery support and treatment linkages are critical during transitions from incarceration to community but can be challenging to deliver to hard-to-reach populations. This paper will examine Facebook contacts between peer navigators (PNs) and women with opioid use disorder (OUD) following jail release to explore women's use of PN services, including purpose and content of Facebook messages. As part of a larger clinical trial under the Justice Community Opioid Innovation Network (JCOIN), PNs provided OUD treatment navigation and recovery support for 12 weeks following women's release from jail, using remote options such as Facebook. Facebook Messenger transcripts between PNs and participants were qualitatively coded by general and specific conversation topic, and described using quantitative measures (e.g., number of messages). Of the 231 women contacted by PNs through Messenger, 53.7% (n = 124) interacted with their PN. About a third of participants who interacted through Messenger (31.6%) were provided with resource referrals (M = 2.9 resources sent). Most conversations were coded generally as needs/struggles (70.7%) or successes (24.2%). Conversations most frequently discussed family, friends, or partners (15.8%), financial and work matters (14.7%), or housing (13.0%). Analyses indicated that PNs used similar supportive strategies over Facebook as they would in other modalities, including sharing lived experience and providing motivation or encouragement. Peer recovery supports are valuable for women, particularly at critical transitions, like jail release. Social media platforms like Facebook can be a viable strategy to engage participants and provide remote support, especially in areas that may lack in-person resources (e.g., rural regions).

There is increasing recognition of the importance of integrating social determinants of mental health (SDoMH) into research frameworks to better understand how socioeconomic and environmental stressors shape mental health outcomes, particularly in low-resource settings. This paper presents an innovative conceptual approach that combines the Research Domain Criteria (RDoC) with a social determinants lens to explore the pathways linking social adversity to mental health challenges. Drawing on insights from the NIH-funded TOPOWA Study, which examines the effects of poverty and social disadvantage on young women's mental health in urban Uganda, the approach integrates diverse data sources, including biomarkers, wearable sensors, and self-report surveys, to capture multilevel influences on mental health. This framework illustrates how RDoC can be adapted for community-based, context-sensitive research and supports the development of more targeted mental health interventions in low resource settings. By situating individual-level processes within broader structural conditions, the model contributes to a more nuanced understanding of mental health risk and resilience. While grounded in a specific study, the framework offers a scalable model for advancing mental health research and intervention in other low-resource or underserved contexts.

Nationwide around 226,080 homeless individuals are unsheltered each night. The U.S. Department of Veterans Affairs (VA) Low Demand program is a community-based model which provides supportive transitional housing to hard-to-reach, unsheltered veterans who often have complex needs and may be unable or unwilling to participate in supportive services which aim to prevent or rapidly re-house veterans when facing housing instability or homelessness. The goal of this study was to examine Low Demand community providers' perceptions of the facilitators and barriers to Low Demand model engagement and effectiveness among unsheltered homeless veterans. Semi-structured interviews, composed of 20 open-ended questions, were conducted with a convenience sample of VA Low Demand community providers and VA staff affiliated with the programs. Interviews were transcribed verbatim, and an inductive approach was employed allowing the data to determine the main categories and subthemes. Three coders independently summarized, coded, and compared transcripts. Qualitative analyses were performed in Atlas.ti. Forty-five Low Demand community providers completed the interview. Providers reported an average four years (range: 3 weeks-14 years) of experience in their current role. Five categories were identified from the qualitative data: (1) Barriers to Low Demand model success, (2) Facilitators of Low Demand model success, (3) Collaborative assessments with VA guide Low Demand program resident retention, (4) Recommendations to reduce returns to homelessness among Low Demand residents, and (5) Low Demand model areas for improvement. Community providers consider the Low Demand model to be an effective option for housing unsheltered veterans who have complex needs. Barriers to retaining and transitioning Low Demand residents to permanent housing were noted. In-facility basic life skills education, financial planning, and relationship reconstruction along with onsite mental health services may support positive program exits. Engaging veterans in aftercare programs and/or retention case management is crucial in the prevention of returns to homelessness. Strong community and VA collaborations are essential to maximizing positive Low Demand program outcomes.

Drug Treatment Courts (DTCs) serve as alternative to incarceration, addressing substance use and legal challenges of offenders. Many individuals enrolled in DTCs have co-occurring mental health and substance use disorders (CODs). Although multicomponent treatment like MISSION-CJ can improve outcomes for DTC clients with CODs, the impact of Adverse Childhood Experiences (ACEs) on outcomes remains unclear. This pilot study examined how criminal legal involvement, substance use and mental health functioning outcomes changed over time and differed based on ACEs levels. Sixty-two DTC clients with CODs received one-year of MISSION-CJ services. Generalized linear mixed models (GLMMs) assessed 6-month and 12-month outcomes, comparing low and high ACEs groups. Results showed significant overall improvement in outcomes, with greater mental health functioning improvements among clients with high ACEs. Although MISSION-CJ was not designed to address the needs of individuals with ACEs, these data suggest it might improve clinical outcomes for this vulnerable group.

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.

As a Norwegian/Swedish research network based on a family-focused practice in mental healthcare, we recognise the need to highlight this approach for the future quality and sustainability of the care and services provided. The role of family members in caring for individuals with mental health conditions is situational and diverse, encompassing several support areas such as emotional support, continuation of social and living skills, economic assistance, and monitoring for signs of illness and relapse prevention. In this context, volunteers have also been encouraged to contribute as partners in the support and follow-up of individuals with mental health issues. Although mental health services were primarily hospital-based in the past, there has been a shift in recent decades towards community-based care with support from specialist services. The aim has been to foster a respectful partnership between patients, families, and professionals, including a commitment to increasing family involvement and providing greater support to family members. Despite the recommendation for family-focused practice, we believe that health professionals still prioritise their alliance with the patient as their foremost responsibility. In this article, we advocate for an enhanced emphasis on family-focused approaches and underscore the importance of utilising knowledge-based family-focused practice models.

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.