Community Mental Health Journal最新文献

Trauma-informed care as an organisational intervention has gained increasing attention in recent years. Substance use settings may be overrepresented with service users who have experienced trauma and adversity. This systematic review will examine the effectiveness of trauma -informed care as an organisational intervention from an implementation perspective. The preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines were followed. Three databases were searched; Academic Search Complete, Embase, and Scopus, supplemented with a Google Scholar search. Articles were included if they were peer reviewed in the English language from inception to February 2024 and reported on trauma- informed care in substance use settings with an implementation context. Quality appraisal was conducted with the Mixed Method Appraisal Tool. This systematic review of trauma-informed care with implementation domains in substance use settings included (N = 15) studies of varying quality; studies were classified as low quality in (n = 5), moderate in (n = 1) and high in (n = 6). Studies reported positive findings on reductions in substance use, and reductions on mental health and trauma symptoms, and treatment retention across community and residential settings. While satisfaction with services provided was also highlighted as an outcome for service users and employees. The results further highlight the importance of the role of leadership across implementation domains, and the possibility of using the 10 trauma informed implementation domains in different treatment contexts as a framework to support implementation. Findings in this review are mapped onto these 10-trauma- informed care implementation domains and reported as a narrative synthesis. Trauma- informed care is a promising organisational wide intervention with the potential to improve outcomes for service users and employees. Implementation can be supported by using the 10 trauma- informed care implementation domains described in this review. However, most of the studies were qualitative and quantitative descriptive meaning drawing causal inferences is difficult. As such, further research should be undertaken.

Supported living plays an important role in the community-based care for people with mental illness. However, support services like floating outreach have hardly been the subject of longer-term research to date, especially with regard to Germany. Thus, the main aim of this prospective observational study was to evaluate the psychosocial outcomes of floating outreach support for non-homeless people with severe mental illness across a one-year period. In a group of n = 119 people (M = 41 years old, 36% with affective disorders) the quantitative analyses revealed significant improvements in quality of life (MANSA), overall social functioning (SFS), as well as general support and care needs (CAN-EU). Nevertheless, there were still some unmet (and even increasing) care needs among the respondents after one year, especially in the domains of "physical health" and "company of others". These findings therefore indicate areas of support that should be given more attention in the future.

There are few studies of impacts of arts on recovery in schizophrenia, on audience and cast responses. We developed a formative qualitative evaluation of audience and cast discussions after viewing live performances in a university setting of an opera based on Elyn Saks' journey from psychosis, teaching law and falling in love, coupled with pre-opera workshop on community approaches to resilience. Live discussions were conducted with audience, cast members, and workshop presenters after performance of the opera, with recording and transcription, and reflexive thematic qualitative analysis sequentially conducted by 3 investigators/2 event leaders). Across 3 events, there were 81 comments (65'10" total time) from facilitator, audience members, cast and creators. Key themes across participant groups were: (1) Connecting with the story; (2) Identifying "normal" lifestyles with mental illness; (3) Refocusing goals of care for providers; (4) Increasing awareness around mental health; with an overarching theme the value of art on mental health to highlight awareness of these issues. Live art events (opera with pre-workshop) on mental health with author with lived experience present, were noted by audience and cast as enhancing connection, enhancing understanding of mental illness and clarifying goals for care, through the shared experience of art. This may inform future research and art events on mental health.

Suicidality frequently leads to emergency department (ED) visits, yet few interventions are offered in EDs to mitigate suicide risk. This study uses a descriptive interpretative design to evaluate the key components for a successful use of such an intervention, the Stanley-Brown safety plan, in EDs. Semi-structured interviews were conducted with patients and ED clinicians and were analyzed using a thematic analysis approach. Participants' perspectives revealed 6 key recommendations for a successful use of the safety plan in EDs: (1) personalize the content of the safety plan, (2) offer a variety of formats, (3) avoid periods of high emotional intensity, (4) engage a broad range of professionals in safety planning, (5) use limited time to make meaningful interventions, (6) propose alternative interventions. A change in the ED culture is needed to ensure that the management of suicidal patients in EDs includes brief therapeutic interventions like safety planning, to mitigate suicide risk.

Implementation of quality improvement (QI) initiatives within community mental health settings is crucial to addressing equity-related issues affecting mental health services delivery, including for co-occurring substance use disorders. Given the growing recognition of QI interventions as an effective framework to facilitate structural change within systems of care, it is important to equip mental health providers with the knowledge and ability to execute QI initiatives that are feasible, sustainable, and integrate a health equity lens. To demystify the QI process, we describe the design and methodologies of four fellows' capstone projects conducted during the 2022-2023 academic year at the University of California, San Francisco (UCSF) Public Psychiatry Fellowship at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). By highlighting fellows' experiences with leading QI initiatives within community mental health settings, we discuss strategies for overcoming implementation barriers including stakeholder engagement and transparency factors, resource and time constraints, unexpected changes in direction, and lack of infrastructure for QI. Lastly, we reflect on best practices and sustainability considerations for leading QI initiatives in partnership with academic centers, departments of public health, and community mental health clinics.

As mental health needs increase for youth across the United States, little is known about how these youth engage with emergency psychiatric services (EPS) and how accessing of these services is experienced by the family caregivers. This study utilized interviews with 19 youth and their adult caregivers, detailing their experiences with EPS and community needs. Interviews were conducted in-person and over the phone, lasting approximately 45 min. Qualitative data were analyzed following grounded theory to elicit a potential new theoretical view of youth and family experiences and needs associated with EPS. Themes elicited included: (1) family and school challenges, (2) challenges for caregivers, (3) structural and system challenges exacerbate issues, (4) family and friend supports, (5) community supports. Families in this study struggled with numerous family, school, and community barriers, indicating a need for targeted supports that address the family and community systems.

The purpose of this study is to examine the relationship between the type of mental health care received and metropolitan status. We combined data from the National Survey for Drug Use and Health (NSDUH) to examine mental health treatment. We grouped participants by metropolitan status and receipt of mental health treatment. We conducted a logistic regression using interaction terms to compare the likelihood of receiving inpatient and/or outpatient treatment for mental health, relative to prescription medication alone. There was an association between the type of mental health treatment received and metropolitan status. For women, living outside a large metropolitan area was associated with a higher likelihood of receiving only prescription medication (p < 0.001). Policy makers may use these results to consider ways to increase access to care, including increasing funding for behavioral health or recruitment incentives for specialists.

Little is known about the factors and circumstances that relate to how incarcerated individuals with serious mental illness (SMI) view their own needs upon reentry and their ability to meet them. In this study, 101 imprisoned adults with SMI rated their level of concern over meeting their basic needs and obtaining services following incarceration. Greater reentry concern was predicted by anticipated barriers to psychological care and increased psychological distress. When participants were asked what factors concerned them most, 51% identified housing, 41% financial concerns, and 39% obtaining services. The extent level of concern related to recidivism (rearrest during the 6-month follow-up post-release) was also examined; no significant relationship was observed. Findings align with prior research, suggesting that there should be less emphasis on convincing individuals of the value of mental health care and a greater focus on how to help them meet other demands that may prevent them from seeking such services.