Community Mental Health Journal最新文献

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.

Measurement-based care (MBC) is an evidence-based practice that can improve the identification of co-occurring mental health conditions and substance use disorders, as well as population differences in care in lower resource settings, through ongoing monitoring of patient-reported symptoms. The current study examined, as reported by different stakeholders prior to implementation, barriers and facilitators of implementing screening tools to monitor mental health and substance use symptoms in the outpatient behavioral health setting at a safety-net hospital. A purposeful sampling approach was used to recruit stakeholders from two outpatient clinics (child, adult) to participate in individual interviews (clinic leadership) and stakeholder-specific focus groups (clinicians and administrative staff). De-identified transcripts were coded using a directed content analytic approach guided by constructs from the Consolidated Framework for Implementation Research (CFIR). A total of 14 clinicians, 6 clinic leaders, and 4 administrative staff participated in interviews and focus groups. Results indicate stakeholder agreement on specific implementation constructs (e.g., patient needs, networks and communication) and unique perspectives influenced by the stakeholders' day-to-day responsibilities. However, there were inconsistent responses regarding networks and communication across stakeholder groups. Clinicians only identified barriers, clinic leadership only identified facilitators, and administrative staff did not identify communication as a barrier or facilitator. Thus, when implementing MBC within a safety-net behavioral health clinic setting, cohesive communication may be perceived differently by clinicians, clinic leadership, and administrative staff and should be validated across staff roles.

Implementation fidelity is the extent to which an intervention is delivered in the manner in which it was designed. Within randomized-controlled trials (RCTs), fidelity is often rigorously ensured through strategies out of reach for most organizations. This limitation may be of particular concern for trauma-focused evidence-based treatments/evidence-based practices (EBT/EBPs), as the needs of individuals and families seeking trauma-based treatment are often complex, with existing comorbidities that can complicate recovery. The present study used the Consolidated Framework for Implementation Research (CFIR) to examine implementation process and individual characteristics, as well as interactions among these factors in impacting provider's perceptions of fidelity. Data came from 598 primarily child serving mental health providers, who completed an online survey regarding provider demographics, perceptions of personal effectiveness, work experiences such as secondary traumatic stress (STS) and compassion satisfaction, and organizational implementation strategies used for a trauma-focused EBT/EBP. Significant positive associations were found between perceptions of implementation fidelity and compassion satisfaction, implementation strategy use, and personal effectiveness. Further, STS was significantly negatively associated with implementation fidelity. Significant differences were found based on population served and use of consultation calls and in-person supervision. Within a regression model, a significant two-way interaction between STS and implementation strategy use was significant, along with a three-way interaction between STS, implementations strategy use, and personal effectiveness. This study advances our understanding of how fidelity is created, maintained and understood in implementation settings that provide EBT/EBPs to individuals exposed to trauma.

Introduction: This study explores what family members of individuals with mental illness hope for, and how their hopes are shaped, sustained, or challenged through participation in a group-based psychoeducational intervention program for informal carers. Although hope is a key concept in recovery-oriented practice, little is known about the hopes of carers themselves, or how hope is supported through preventive interventions.

Method: The study draws on qualitative data from a questionnaire completed by 36 family members of individuals with mental illness participating in a group-based psychoeducational intervention program. Of these participants, three were subsequently interviewed according to realist-informed principles. In both cases, data was analyzed thematically.

Results: Family members' hopes related to their loved one's recovery, well-being, and societal inclusion, but also to regaining everyday roles, relationships, and identities that had been disrupted by mental illness. Hope was expressed as both a personal and a relational process, situated within wider social and structural contexts. Stories shared within the group played a central role in hope processes, functioning as mirrors (recognizing one's experiences and feeling reflected in the words of others) and windows (seeing what one could become or might have been) that created perspective and a sense of shared humanity. However, some encounters were experienced as overwhelming or re-traumatizing.

Conclusion: Hope among family members is multifaceted, encompassing personal, relational, and structural dimensions. The findings underscore the importance of programs that actively support carers in sustaining hope as part of the broader recovery context.

Caregivers of persons with mental illness experience stressors and anxiety during the psychiatric hospitalization of a family member. The implementation of a family-centered model could reduce these feelings, and therefore, such a model was developed in Israel. To examine whether the model's implementation makes a difference in the stress and anxiety experienced by caregivers, a comparative study was conducted in two psychiatric hospitals. Questionnaires were delivered twice to caregivers in an intervention group (n = 93) and a control group (n = 75). The anxiety level was lower in the intervention group than in the control group in the second delivery of the questionnaire. In addition, a lower level of anxiety was found in the intervention group in the second delivery of the questionnaire in comparison to the first. The findings, which can be attributed to the model's application, highlight the need for a paradigm shift to a family-centered model in psychiatric hospitals.

Asian Americans (AA) have experienced increased rates of serious mental illness over the past decade. Past research has identified perceived and personal mental illness stigma as significant barriers to seeking treatment for mental health concerns, particularly in the Asian American community. One way to address stigma has been through narratives told from the perspective of community members of a stigmatized identity. Therefore, this study examines the impact of This Is My Brave: Stories from the Asian, Pacific Islander, and Desi American Community (TIMB: SAC; a narrative-based stigma reduction intervention) on audience members. Participants (N = 89; mean age = 27.62[SD = 9.82]) had a significant increase in intentions to seek care and a significant decrease in personal mental illness stigma, perceived mental illness stigma, and anti-Asian American stereotypes from pre-intervention to post-intervention. We did not find any significant differences between AA and non-AA individuals on any of the dependent measures (personal stigma, perceived stigma, anti-racism, anti-Asian attitudes, and intentions to seek care). This study has implications for TIMB: SAC as a stigma reduction intervention.