Community Mental Health Journal最新文献

Culturally responsive peer support services can improve access to and engagement with substance use and mental health services among Latinx persons, but how to implement a culturally responsive peer support program in a Spanish-speaking peer-run behavioral health organization is unclear. This qualitative study used the Consolidated Framework for Implementation Research (CFIR) to explore determinants for implementing a culturally responsive peer support program. We conducted 14 interviews with peer support program leadership, Certified Peer Specialists (CPS), and CPS supervisors about implementation of and experience with the peer support program. Interviews were conducted and analyzed in Spanish and English using constant comparative methods and organized according to the CFIR. Key CFIR elements included: (1) Intervention characteristics: a culturally responsive approach that alleviated stigma while celebrating recovery culture and Latinx peer culture; (2) Outer setting: outside of the study setting, barriers to accessing behavioral health care were driven by cultural differences between providers and clients; (3) Inner setting: A robust model of culturally responsive and linguistically appropriate peer-to-peer supervision and a built environment that fosters a mutual aid-oriented organizational culture; (4) Individuals involved: supervision strengthens CPS knowledge and skills to deliver peer support; (5) Implementation Process: despite organizational supports, CPS work is emotionally draining. Future studies should explore the scalability of the supervision model and other implementation supports described here, using a culturally responsive lens.

During the perinatal period, many parents experience mental health difficulties of varying severity, which have been associated with adverse outcomes. Examples include perinatal obsessive-compulsive disorder (OCD) which can be thought to exist on a continuum from subclinical symptoms (e.g., intrusive thoughts (ITs)) to clinical diagnosis of OCD. Similarly postpartum psychosis can range from subclinical 'psychotic like experiences' (PLEs) to clinical diagnosis. These disorders are distinct conditions, yet some argue an overlap or comorbidity in symptoms, including co-occurrence postnatally, and they are therefore explored in tandem in this study. Limited literature explores these difficulties in community perinatal populations, and less is known about distress, or potential associations with parenting experiences. A cross-sectional, quantitative design was applied. Participants were parents in the postnatal period (12 months after birth); they completed an anonymous, online survey, exploring experiences of ITs, PLEs, parenting (perceived competence and stress) and mental health (depression, anxiety, and stress). Of 349 participants, 96% reported at least one IT, 90.8% reported associated distress and 95% engaged in behaviours to cope. Considering PLEs, 89% experienced at least one PLE, 88.8% reported associated distress and 30.4% could be considered 'at-risk' for developing psychosis. Distressing ITs and PLEs were significantly associated with lower perceived competence and satisfaction, increased parenting stress and mental health symptoms, although this relationship was indirectly mediated by depression and anxiety. Males reported more ITs, parenting stress, depression, anxiety, and lower perceived competence than females. More research is needed to better understand ITs and PLEs across and beyond the perinatal period.

Place-based health interventions are becoming popular in public health, but have been less common in behavioral health services. This study implemented mental health screenings with a total of 195 individuals across seven laundromats in Texas from March 2024-April 2025 to examine the potential to treat laundromats as a new, unique setting for place-based behavioral health interventions. The sample of laundromat users was screened for Major Depressive Disorder (MDD) and Alcohol Use Disorder (AUD) and asked about their receptiveness to receiving healthcare interventions in laundromats. Multivariable analyses were conducted to examine individual characteristics associated with positive screens for MDD and AUD. Results found that 19.9% of laundromat users screened positive for MDD, which was comparable to county, state, and national estimates. However, 17.4% screened positive for AUD, which was higher than state and national estimates. The majority of the sample was Hispanic, had less than a college education, and reported annual incomes below $50,000. Laundromat users who were aged 60 years or older or who reported financial barriers to healthcare were significantly more likely to screen positive for MDD. Of the total sample, 83 (42.6%) completed a 1-month follow-up assessment and were re-screened for MDD and AUD which revealed no significant changes in rates of either disorder. Generally, participants reported a positive experience with the screenings in laundromats and reported being receptive to receiving other healthcare interventions in laundromats. In conclusion, this study found that providing health screenings in laundromats may reach underserved individuals. Laundromats may serve an important setting for further interventions after screenings.

Tobacco use among individuals with behavioral health conditions is higher than in the general population and a leading cause for morbidity and early mortality. This study examines a value-based payment (VBP) model to incentivize provision of tobacco cessation counseling (TCC) and pharmacological treatment with varenicline among 38 behavioral health homes (a person-centered approach to coordinating comprehensive healthcare in behavioral health service settings for individuals with chronic behavioral and physical health conditions) within a non-profit Medicaid behavioral health managed care network utilizing the Behavioral Health Home Plus (BHHP) model. Pre-post comparisons indicate that rates of filled varenicline prescriptions increased in the BHHP population from 10.01 per 1,000 service users to 19.01 per 1,000 service users following implementation of the VBP (p < .0001). Comparisons with other in-network behavioral health service users without BHHP or VBP indicate higher receipt of TCC (p < .0001) and varenicline (p < .0001) among the BHHP VBP group. This study provides some evidence that value-based purchasing may be used to incentivize provider agencies with behavioral health homes to increase access to tobacco cessation treatment for individuals with behavioral health conditions.

This study aimed to evaluate the effectiveness of a CHIME-based psychoeducational group intervention on personal recovery in individuals diagnosed with schizophrenia. A randomized controlled trial with a pretest-posttest design was conducted between January and July 2024. A total of 60 participants receiving services from a Community Mental Health Center and meeting the inclusion criteria were randomly assigned to either the intervention group (n = 29) or the control group (n = 30). The intervention group participated in a structured "CHIME-Based Psychoeducation Program" comprising seven weekly sessions, each lasting approximately 60 min. Outcome measures included the Subjective Recovery Assessment Scale (SRAS), Psychological Resilience Assessment Scale (PRAS), and Schizophrenia Hope Scale (SHS). Assessments were conducted at baseline, post-intervention, and three-month follow-up. Both groups continued to receive standard community mental health services throughout the study. Statistical analyses included descriptive statistics, Chi-square tests, Mann-Whitney U tests, Friedman tests, and intention-to-treat (ITT) analysis for handling missing data. Accordingly, the CHIME-Based Group Psychoeducation Program can be considered an effective intervention to enhance personal recovery, psychological resilience, and hope. ClinicalTrials.gov Identifier number is NCT06284096.

Prior research has shown the Fordham Risk Screening Tool (FRST) to be accurate in assessment of violence risk when compared to more comprehensive risk assessment instruments. However, a link between any violence risk screening tool and actual markers of violent behavior is absent in the literature. This study, therefore, sought to determine whether the FRST could be used to accurately assess the likelihood of violence, and markers of violence, during an inpatient psychiatric admission. This retrospective health records survey examined data from a consecutive cohort of adults (N = 423) admitted to an inpatient psychiatric unit from the emergency department (ED) from September 1, 2022, through June 30, 2023. Both electronic and manual abstraction strategies were used to evaluate FRST screening tool results collected in the ED and markers of violent behavior during subsequent inpatient hospitalization. When comparing the proportion of subjects who experienced a violent incident while hospitalized in the FRST positive and FRST negative groups, a significant difference was noted with a greater proportion of those with a positive FRST screening experiencing a violent event (33.0% vs. 8.1%, for the positive and negative screening groups, respectively, χ² = 41.046, df = 1, p < 0.001). Sensitivity and specificity were 33.0% (95% CI: 24.7%-42.5%) and 91.9% (95% CI: 88.1%-94.6%), respectively. The positive predictive value was 60.3% (95% CI: 47.2%-72.2%) and the negative predictive value was 78.6% (95% CI: 73.9%-82.7%). The area under the receiver operating characteristic curve (AUROC) for the predictive ability of the FRST was 0.305 (standard error [SE] 0.038), 95% CI: 0.230-0.381). Overall, the FRST instrument showed mixed results as a screening tool to detect the potential of violent behavior in admitted psychiatric inpatient adults. While there was a significant difference in violent events between FRST positive and negative groups, metrics assessing predictive validity and reliability of the FRST were limited. Utilization of a screening tool such as the FRST should continue to be paired with additional efforts to evaluate inpatient risk of violent behavior.

Obesity-associated diseases, such as type 2 diabetes, metabolic syndrome, and dyslipidemia, are common in individuals with mental disorders. The relative contribution of mental disorders, psychotropic medication, and BMI remains unclear. In this cross-sectional study, individuals aged 18-60 years with a BMI ≥ 30 kg/m² were referred to the University Hospital of Southern Denmark, Esbjerg, and screened for diabetes, prediabetes, metabolic syndrome, hypertension, blood lipid abnormalities, liver disease, and sleep apnea. Individuals with mental disorders were compared to those without using binomial logistic regression adjusted for BMI, age, sex, and use of psychotropic medication. We included 345 participants with and 317 without mental disorders, all with BMI ≥ 30 kg/m². Participants with mental disorders were younger (40.9 ± 10.9 vs. 44.2 ± 10.8 years) and had higher BMI (42.8 ± 7.9 vs. 40.9 ± 6.4 kg/m²). Adjusted analyses showed no increased odds of obesity-related disease except for blood lipid abnormalities and steatosis. BMI significantly influenced most models but not the association with blood lipid abnormalities. Apart from blood lipid abnormalities and steatosis, obesity-related diseases in individuals with mental disorders appears to be largely attributable to obesity. Weight management should be prioritized, with additional focus on blood lipid abnormalities.

This is the first study to specifically explore the experiences of people with BPD in an IPS employment program. Understanding the experiences of individuals with BPD can assist those delivering IPS employment programs to ensure that they are effectively meeting the needs of this diagnostic group. To understand the experiences and perspectives of individuals who participated in a pilot Individual Placement and Support (IPS) program for people with Borderline Personality Disorder (BPD). Data were gathered through semi-structured interviews with four people who had participated in the pilot program and analysed using reflexive thematic analysis. Participants were invited to provide feedback on draft themes, which informed the final analysis. Factors that shaped the participants' generally positive experiences of the program fell into three broad themes. 'Wanting to do it' came from having work-related goals, a perception that it was the right time and a sense of being in control. 'Somebody on your side' described participants' experience of relationship with their employment consultant being characterised by understanding, encouragement and flexibility. Finally, 'it's all in one place' centred on their experience of the integration of the mental health service and employment program as increasing trust, accessibility, and support. IPS was well accepted by participants in this study with findings highlighting factors that supported this acceptability. Further research investigating the perspectives and outcomes of IPS for individuals with BPD is suggested.