Community Mental Health Journal最新文献

Mental health support workers (MHSWs) are an important workforce within the mental health care system. Research shows that support services delivered by MHSWs are effective at improving the outcomes of individuals with mental illness. However, there is also literature suggesting that this group of workers are facing many challenges in their roles. This qualitative systematic review sought to explore, analyze and synthesize available primary research literature on the experiences of MHSWs with the aim of identifying the barriers to and facilitators of effective delivery of their roles. An electronic search of Medline, CINAHL, PsycINFO, and Web of Science was conducted for studies from database inception to March 28, 2025. Additional search was conducted via Google Scholar and in the reference lists of the included articles. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of included articles. Fourteen primary research articles met the eligibility criteria and were included in the review. Data synthesis from these articles generated 116 findings and 20 categories, which were aggregated into four synthesized findings: a supportive work environment, service user care barriers, professional and role-related barriers, and operational and support barriers. The review highlights the importance of a supportive work environment in the delivery of support work roles. However, several barriers were also identified and recommendations that can be used to inform practice and policies of mental health support work provided. If addressed, the identified barriers can be translated into facilitators that would enhance the provision of quality care to people with mental illness and enhance the overall job satisfaction of MHSWs.

Community treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care for people with severe mental disorders. Since their introduction in Switzerland in 2013, the Swiss Canton of Vaud (846'300 inhabitants) has been engaged in the monitoring of CTOs. This study describes the use of this measure in the Canton of Vaud over the 10 years since its introduction and examines the profile of people undergoing CTOs during this period, the form that these measures took and the factors associated with their duration and outcome. Between 2013 and 2022, 530 CTOs have been ordered. As their incidence remained low and fluctuated between 5 and 10 CTOs per 100'000 inhabitants, their prevalence rose from 5 to 25 per 100'000 inhabitants. The profile of people placed under CTOs was comparable to that observed in other studies. The measures concerned mainly Swiss male in their forties, single or divorced/separated, living independently and under legal guardianship. The main diagnosis was schizophrenia, schizotypal or delusional disorders. On the 31st of December 2022, 329 CTOs (62.1%) had been discharged. Their average duration was slightly more than two years. Among the 329 CTOs discharged at the 31st of December 2022, five groups were identified according to the reasons for discharge: CTO success (38.7%), breached conditions with (24.0%) and without involuntary hospitalisation (11.5%), death of the patient (13.0%) and other reasons for discharge (12.8%). Prototypical situations for each group were identified.

Electroconvulsive Therapy (ECT) remains a stigmatized treatment despite its well-established efficacy and safety in various psychiatric conditions. Among individuals with schizophrenia-who already face high levels of illness-related stigma-ECT-related stigma may represent an additional barrier to treatment acceptance. This case-control study aimed to examine how direct experience with ECT, either personally or through a family member, influences knowledge, perceptions, and treatment acceptance among individuals with schizophrenia and their relatives. A total of 200 participants, including 100 individuals with schizophrenia (50 with prior ECT experience and 50 without) and 100 of their relatives, completed standardized assessments measuring cognitive function, symptom severity, internalized stigma, attitudes toward psychiatric medications, and ECT-related knowledge and perceptions. The results showed that patients and relatives with prior ECT experience demonstrated higher levels of knowledge and more positive perceptions of ECT compared to those without such experience. Patients with previous ECT were also more likely to accept future ECT, and this acceptance was associated with more favorable attitudes toward psychiatric medications. While internalized stigma levels did not significantly differ between groups, higher stigma in patients was correlated with more negative beliefs about mental illness among their relatives. These findings suggest that individuals with firsthand ECT experience and their families may serve as effective advocates for reducing stigma and promoting informed decision-making in schizophrenia care.

Mental health stigma is a pervasive issue which can adversely affect patient care and outcomes. Stigma may manifest through discrimination and negative stereotypes, and can be damaging when inadvertently perpetuated by practitioners and trainees. This study aims explore the effect of experiential learning in decreasing stigma measured by changes in the perceived attitudes and behaviours of trainees at a specialized mental health hospital. Participants (N = 139) are trainees who were scheduled to undergo clinical or non-clinical placement at a mental health hospital. Participants completed a demographic survey prior to placement and a qualitative student evaluation after placement. Validated scales measuring changes in attitude (MICA-4) and behaviour (RIBS), were used as both pre- and post-placement evaluations. Trainee placement variations were accounted for using correlation analysis of the MICA-4 and RIBS data. Most participants identified as females with a college or university education, in their second to fourth years of study. Analysis of both MICA-4 (P = 0.0001) and RIBS (P = 0.009) revealed significant differences between pre-placement and post-placement scores on stigma-related attitudes and behaviours, respectively. These results were supported by qualitative responses which revealed alignment with recovery-oriented philosophy and reflections of stigma. Overall, this study demonstrates possible benefits of experiential learning in mental health care settings to address stigma in clinical and non-clinical trainees.

Adolescents with existing mental health and substance use disorders are at higher risk for homelessness, and being homeless can further exacerbate these issues. However, no systematic review has specifically assessed the prevalence of mental health and substance use disorders among homeless adolescents using validated diagnostic measures. The objective of this study was to determine the prevalence of mental health and substance use disorders among adolescents experiencing homelessness, based on studies employing validated diagnostic measures. A systematic search was conducted across electronic databases, including AMED, Cochrane, Embase, CINAHL, PsycINFO, MEDLINE, and PubMed, from inception through February 3, 2024. Studies were included if they assessed the prevalence of mental health and substance use disorders using validated diagnostic measures in adolescents aged 12-17 years who were experiencing homelessness. Data extraction was performed using Covidence and reviewed for accuracy by two independent reviewers. Weighted average prevalence rates for mental health and substance use disorders among homeless adolescents were calculated, along with 95% confidence intervals (CIs). Out of 7,729 citations, 116 studies were reviewed in full, and two studies met all criteria (N = 226). The most common mental health disorder identified, based on diagnostic classifications used in earlier versions of the DSM and ICD, was drug abuse disorder (43%, 95% CI [34, 53]), followed by disruptive behavior disorder (39%, 95% CI [25, 53]) and alcohol abuse disorder (38%, 95% CI [28, 48]). This systematic review highlights the limited evidence available on the prevalence of mental health and substance use disorders among homeless adolescents from studies using validated diagnostic measures. Further research is essential to enhance understanding and to develop data-driven intervention strategies to better address the needs and challenges faced by this vulnerable population.

An unavoidable piece of the American healthcare system that is often overlooked concerns billing and payment in community mental health agencies. Practitioners are faced with ethical dilemmas surrounding productivity billing that require their ability to strike a delicate balance between efficiency and providing quality care. In line with the American Psychological Association's Ethical Principals of Psychologists and Code of Conduct (2017), this paper examines ethical issues for mental health agencies and managers employing productivity-driven billing practices and reviews the impact these models have on practitioners and their clients. More specifically, it will speak to ethical concerns that impact not only the practitioners who are working at these agencies, but also the clients who are directly affected by the implementation and structure of this model. We conclude with a discussion regarding how agencies can play a more significant role in reducing unethical practices by improving operational standards to maximize quality care.

A growing number of police departments in the United States have adopted specialized training models to handle situations involving people with mental illness (PWMI), including the Crisis Intervention Team (CIT) model and other models with reduced training hours (OMRTH). However, research on police chiefs' attitudes toward these training models, especially those working in rural areas, remains limited. To address this gap in the literature, this study explored the attitudes of rural police chiefs across two states regarding two categories of police training models (the CIT model and OMRTH) and examined factors influencing their viewpoints. The results revealed that chiefs in rural areas demonstrated favorable attitudes toward the CIT model but negative attitudes toward OMRTH. Policy implications and suggestions for future research are discussed.

This study explored the experiences of postpartum individuals in early substance use disorder (SUD) recovery and key aspects of their social networks using the Socioecological Model (SEM). We conducted a qualitative study of 22 postpartum individuals (< 1 year since delivery) in residential SUD treatment from July to November 2023. Transcribed, audio-recorded interviews were analyzed using Atlas.ti, with findings organized by SEM levels. Participants, primarily White (81.8%), single (86.3%), and living below the poverty line (81.8%), reported opioid (40.1%) and stimulant (81.8%) use disorders. Challenges spanned SEM levels, including navigating parenthood, accessing trauma-informed care, and overcoming structural barriers such as housing instability, transportation, and childcare access. Findings underscore the need for family-centered, trauma-informed recovery programs and flexible policies addressing childcare and social service barriers to support long-term recovery and maternal well-being.

Physical activity improves mental health in individuals with schizophrenia. Yet, limited access, low motivation, and social isolation make participation in face-to-face programs challenging. This 16-week pilot randomized controlled trial examined differences in symptoms and loneliness between adults with schizophrenia that were randomized to a virtual group-based walking program ("Virtual PACE-Life", n = 17) or Fitbit Alone (n = 20). The Positive and Negative Syndrome Scale and UCLA Loneliness scale were administered at baseline, 8 weeks, 16 weeks, and one-month follow-up. Standardized effects (SE) and confidence intervals from mixed effects models were used to evaluate group differences. Results demonstrated small-to-moderate effects (SE: 0.1-0.3) on total, negative, disorganization, excitement, and emotional distress symptoms favoring Virtual PACE-Life; however, negligible effects were observed for positive symptoms or loneliness. Despite the small sample size, these findings may suggest symptom but not loneliness benefits of a virtual group-based physical activity program for people with schizophrenia.

Community/Crisis Cafés offer an alternative, out-of-hours mental health support by providing a safe, peer/clinician-supported environment for individuals in crisis. These cafés utilise peer support models that draw on personal experience, fostering connections and aiding in crisis management. Despite the growing global implementation of these cafés, limited research exists on how service users and carers experience and benefit from them. This study aims to explore the perspectives of service users and carers on accessing and utilising support through community/crisis cafés both nationally and internationally. A scoping review was guided by Arksey and O'Malley's framework and included keyword searches of eight databases (Academic Search Complete, APA PsychInfo, CINAHL, Cochrane, Embase, Medline, Scopus, and Web of Science), combined with grey literature searches of LENSUS, Health Service Executive, WHO Global Index, NHS, and Open Grey. Backward and forward chaining of references was also completed to ensure all literature was sourced. Papers were limited to 2010-2023 and in English. Covidence was used for the screening process, ten papers met the review criteria and are reported as per the PRISMA-ScR checklist and PRISMA flow diagram. The findings of ten papers on service users and carers experiences indicate that Community/Crisis Cafés can have a positive impact on mental health management, alleviate social isolation, and reduce emergency department use. However, challenges such as consistency in service delivery and accessibility were noted. Further research and ongoing evaluation are necessary to fully understand the efficacy and limitations of this alternative co-produced, community mental health service delivery model.