Psychiatric Rehabilitation Journal最新文献

A brief autoethnographic commentary that describes the harms of a pervasive emphasis on medications and medication adherence in the treatment of schizophrenia, including within "best practice" early psychosis programs. The narrative emphasizes the extent to which, in spite of endless rhetoric of person-centered, recovery-oriented care, the reality remains that medication-centric treatment tends to dominate clinical services and programs, fueling the objectification and alienation of service users, and ultimately, in all too many cases, disengagement. The author's personal experiences are provided as an illustration of the potentially devastating impacts that a narrow and rigid focus on medications (and medicalized clinical relationships) can have. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The present research investigates the dynamics of consent in the context of antipsychotic drug therapy, with a particular emphasis on the essential attributes that constitute free and informed consent within medical treatment scenarios.

Method: Twenty individuals treated with antipsychotic drugs with consent underwent semistructured interviews.

Results: The following major themes were identified: (a) lack or total absence of information regarding the treatment, emphasizing side effects, risks, chances of success, and treatment alternatives. (b) A subjective experience of the lack of free choice that was sometimes also accompanied by the conditioning of psychiatric rehabilitation services or receiving treatment in an open ward by taking antipsychotic medication.

Conclusions and implications for practice: The research findings may indicate a problem in obtaining informed consent for antipsychotic treatment that should be addressed. The themes highlight the need to examine the interface between rehabilitation services and psychiatric treatment from the legal and ethical perspective of the autonomy of individuals receiving care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study examines adaptations, successes, and persistent challenges engaging members in virtual or hybrid community-based psychosocial rehabilitation centers called Clubhouses.

Methods: Fifteen members and staff from five Clubhouses across two Hawaiian Islands participated in a virtual Photovoice process.

Results: Results illustrated several unexpected positive outcomes from the transition to hybrid or virtual formats including opportunities for growth, learning new technology, cross-Clubhouse collaborations, deepened relationships, and better access to some hard-to-reach members. Persistent challenges included members reporting "something missing" in the socioemotional quality of virtual engagement and losing members who had low digital literacy or who preferred in-person engagement.

Conclusions and implications for practice: Overall, participants described that virtual Clubhouse supported their wellness by fostering a sense of purpose, companionship, and potential, despite sustained uncertainty from the COVID-19 pandemic. However, they also made clear that virtual and hybrid formats should be a complement to, not a replacement for, in-person Clubhouse services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The theory of social practice describes a therapeutic community process for people living with serious mental illness, while the methods involve engaging people to become collaborators and contributors to a social environment. Confusion in the mental health field surrounding the applied methods of social practice-as occurring within the clubhouse model-has not been sufficiently addressed. This article aims to outline the methodology of social practice, as well as provide guidance on its practical application.

Methods: Specific constructs of social practice are defined, and empirical support is provided to emphasize how practices to support recovery are applied in the clubhouse.

Results: Five key elements of social practice-that is, transformational social design, engagement, relationship development, natural feedback and intervention, and transitional environments-are described. Practical examples of therapeutic techniques associated with each element are also provided.

Conclusions and implications for practice: Social practice addresses the social determinants of health by focusing on five key elements that support individual and community recovery. Here, we detail social practice techniques utilized in the clubhouse as a way of unifying theory, providing practical guidance to mental health professionals and improving the measurement of community as therapy for serious mental illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The COVID-19 pandemic had a profound impact on the mental health of individuals with serious mental illness, with restricting social gatherings and limiting access to essential community and psychosocial support services. For programs like clubhouses, adapting typically in-person programming to online settings led to the creation of virtual clubhouse programming that persists at many sites even after reopening. Although it has been documented how clubhouses adapted their programming online, it has not been investigated at the individual level how those programs were utilized over time, by different member cohorts, and how they persist in comparison to one another.

Method: The present article presents descriptive and inferential statistics, analysis of variance, and secondary trend analysis of the Fountain House clubhouse in-person and virtual engagements of three member cohorts who enrolled in either three time periods before pandemic restrictions (the prior cohort), during pandemic restrictions (the pandemic cohort), and after lockdown restrictions (the reopening cohort).

Result: Initial findings show that the prior cohort sustained their overall rate of engagement across time periods. The pandemic cohort had a significantly higher rate of engagement than the prior cohort within the during period but demonstrated a significant decrease in engagement rate between the during and after period. Prior and pandemic cohorts had statistically similar virtual and in-person engagement ratios in the after period, but the reopen cohort differed significantly with a predominant ratio of in-person engagements.

Conclusions and implications for practice: Member engagement trends within in-person and virtual offerings across the three different pandemic related time periods indicate important considerations for the sustainability and innovation of clubhouse virtual programming. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The Clubhouse model of psychosocial rehabilitation supports the personal recovery of individuals with severe mental health challenges. To date, there has never been a multisite, longitudinal study examining the outcomes of Clubhouse members in Canada. Therefore, the purpose of the present study was to longitudinally assess the psychosocial outcomes and hospitalization rates of Clubhouse members from six Clubhouses across Canada. An exploratory aim of this study was to assess the psychosocial impact of the COVID-19 pandemic on Clubhouse members.

Method: The present study used a participatory approach with six accredited Clubhouses across Canada. A total of 462 Clubhouse members consented to participate in the study. Members completed a questionnaire battery every 6 months over a 2-year period (five data points total). The last three data points were collected during the COVID-19 pandemic. Primary outcomes included community functioning, measured by the Multnomah Community Ability Scale, and self-reported hospitalization rates. Data were analyzed using multilevel growth models.

Results: The results of the analysis indicated stability over the study period in community functioning and rates of hospitalization. Subscales of community functioning, including interference in functioning and behavioral problems improved over the course of the study, while adjustment to the community and social competence remained stable.

Conclusions and implications for practice: The consistency in outcomes across the study is notable, due to the worldwide impact of COVID-19 on mental health. Clubhouses may have had a buffering effect for members, in that membership diminished the impact of the pandemic on mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Though the efficacy of the Clubhouse model's interventions and practices in supporting recovery from serious mental illness (SMI) have been demonstrated by prior research, the causal mechanisms and theory driving these outcomes have yet to be comprehensively defined. This theory article aims to synthesize existing knowledge of these methods to define a unified theory of social practice, outline its role in SMI recovery, and discuss future implications.

Method: Historical, theoretical, and practical foundations of social practice were synthesized to define a current theory of social practice and expand the term to apply to the methods and interventions that define the Clubhouse model.

Results: Based on prior theory and findings, we define social practice as "the informed application of a specialized form of environmental therapy that utilizes an intentional community to assist people in their recovery." Key facets of social practice in the Clubhouse model of SMI recovery are discussed, including the efficacy of the practice in addressing SMI outcomes such as isolation and low self-efficacy, as well as its impact on both internal and external motivational forces.

Conclusions and implications for practice: The theory of social practice describes a process of engaging people to become collaborators and contributors to a social environment. This article describes the philosophy and practices of Clubhouses and introduces the theory of social practice as an empirical means of unifying and communicating the methods, practices, and outcomes of both the Clubhouse model and the broader implications of intentional community as therapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The Clubhouse model (CM) for serious mental illness is a recovery-oriented and member-driven program that aims to facilitate functional recovery. Efficacy evaluation of the CM is limited by lack of uniform functional disability assessment. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a widely accepted measure of functional disability, but its psychometric properties have yet to be examined within the CM.

Method: This research sought to confirm the generic six-factor structure of the 12-item WHODAS-2.0 using retrospective administrative data from 339 adults with serious mental illness from an accredited Clubhouse. A second-order confirmatory factor analysis was conducted, followed by secondary known-groups analyses to examine whether the WHODAS-2.0 differentiates between subgroups with varying degrees of disability.

Results: The WHODAS-2.0 demonstrated good overall reliability. The generic six-factor structure produced nonsignificant loadings due to lack of independence between the "participation" and "getting along" factors. The items of these two factors were combined into a five-factor model, which displayed excellent fit, with all significant paths and adequate-to-strong loadings, and no correlation among errors. The WHODAS-2.0 significantly differentiated members by receipt of public assistance, employment status, and number of medical comorbidities, supporting construct validity.

Conclusions and implications for practice: These results provide initial support for the use of the 12-item WHODAS-2.0 as a CM-related outcome measure and encourage future research of the full 36-item version. The intentional community approach of the CM is unique and may require adjustments to the factor structure of the WHODAS-2.0 by merging the "participation" and "getting along" domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR.

Methods: Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices.

Results: Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR.

Conclusions and implications for practice: The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This article explores the ideological dilemmas of decision making identified in members' and staff's talk in Clubhouse communities.

Method: The data are drawn from a corpus of 10 video-recorded focus group interviews with Clubhouse members and staff, which were collected at five Finnish Clubhouses in 2020. The method used is discursive psychology, and the analysis identifies interpretative repertoires and ideological dilemmas.

Results: Clubhouse members and staff express diverse opinions regarding decision making at the Clubhouse. We identified six interpretative repertoires and three ideological dilemmas between these repertoires. The first dilemma deals with participation and efficiency, advancing the idea that everybody should be allowed to participate in decision making, but the decision making should be efficient. The second dilemma regards the passivity or activity of the participants, suggesting that decision-makers should be allowed to be themselves, but participation in decision making requires activity. The third dilemma is associated with power structures in decision making, proposing that joint decision making requires active resistance against power structures, but these structures are both inexorable and partially necessary.

Conclusions and implications for practice: In introducing a discursive perspective to joint decision making in the Clubhouse community, this study makes visible the conflicting ideals of decision making. The acknowledgment of these dilemmas can guide interventions aiming at improving genuinely participatory joint decision-making practices at the Clubhouse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).