Psychiatric Rehabilitation Journal最新文献

Objective: The overall aim of this study was to elicit and document the recovery-related perspectives and experiences of Haredi Jews with lived experience of mental illness living in Canada. A more focused objective was to specifically explore self-identified facilitators and barriers toward recovery from mental illness in this group.

Methods: We conducted a qualitative study involving semistructured interviews with 20 women who (a) identified as Haredi Jews, (b) had used mental health services in recent years, and (c) were 18+ years of age. Interviews were transcribed and analyzed using thematic analysis techniques.

Results: Four prominent themes emerged from the analysis. The first two themes were predominantly facilitators, and the last two themes were predominantly barriers. These themes were (i) a close-knit, supportive, and lively community with considerable social capital; (ii) Judaic beliefs and practices regarding Gd, daily life, and health care giving structure, meaning, and purpose; (iii) community stigma and self-stigma, often related to marriageability of self or offspring, as well as notions of perfection; and (iv) a lack of wider mental health literacy, despite participants speaking positively about mental health services such as medication and therapy.

Conclusions and implications for practice: This study indicates several individual-level and community-level factors that are reported to facilitate recovery in Haredi Jews. However, problems of stigma and mental health literacy remain an issue. Targeted antistigma programs, such as co-constructed contact-based educational interventions, may be helpful in contributing to a community climate that further facilitates recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The purpose of this study was to examine the characteristics of people who stay in intensive case management (ICM) for longer than 5 years.

Method: We conducted a secondary analysis of client data collected by a community mental health organization from 2012 to 2022. Using the Gelberg-Andersen Model for Access to Health Services, we conducted a logistic regression with 22 predictor variables, predicting clients in ICM for 5 years or less (N = 531) and those in ICM for longer than 5 years (N = 289).

Results: People who were older and those with psychotic disorder, co-occurring substance use disorder, dual diagnosis (with developmental disability), chronic medical condition, and also in another program in the same agency were more likely to be in ICM for longer than 5 years. People who were returning ICM clients and those who completed the ICM program (rather than withdrawing or disengaging) were more likely to be in ICM for 5 years or less. Higher dose of ICM (in contacts) predicted a shorter time in ICM.

Conclusions and implications for practice: People with serious mental illness, dual diagnosis, concurrent substance use, and chronic medical conditions and those who are older may need additional supports within ICM and when transitioning out of ICM. People in ICM for a longer time have lower numbers of contacts, indicating that a less intense service may meet their needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Persons who cope with serious mental illness (SMI) without immediate physical risk to themselves or others have the right to refuse to be treated. Treatment refusal has implications not only for the individual but also for the family, especially the primary caregivers. Still, less is known about the phenomenon of family burden while coping with a situation where the family member with SMI refuses treatment and lives in the community. The present study aimed to understand and describe the caregivers' lived experience of family burden in the context of treatment refusal among their relatives.

Methods: Using a descriptive phenomenological qualitative approach and a semi-structured interview guide, 15 family caregivers of persons with SMI refusing to receive medicinal treatment and rehabilitation services were interviewed. Inductive thematic analysis was conducted on the interview transcripts.

Results: The caregivers described a complex experience of ongoing and intense burden that had a negative impact on the family cohesion and the caregivers' well-being. Four themes related to the perceived reasons for treatment refusal, the caregivers' experience of the family burden and cohesion, and coping with this situation were identified.

Conclusions and implications for practice: The findings demonstrate the unique family burden experienced by the caregivers, mainly as they are the only ones supporting the individual with SMI who refuses treatment. Practitioners should support these families throughout their coping process-from understanding the reasons for the refusal of treatment to continuous support in their daily coping by locating the control of the situation on the family level. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Ikigai is a Japanese concept of a life worth living and related to eudaimonic well-being. Supporting the pursuit of ikigai is of central importance to recovery-oriented psychiatric rehabilitation for people with serious mental illnesses (SMI). While research suggests that work, leisure, and social relationships are potential sources of ikigai, people with SMI have restricted access to these as they encounter systemic barriers to participating in such activities. This study investigated how people with SMI in Japan pursued sources of ikigai in the face of barriers.

Methods: A total of 21 community-living individuals who had SMI and were recruited from community psychiatric rehabilitation service providers in Japan participated in the study. Photo-elicitation interviews were conducted, and the interview transcripts were analyzed using reflexive thematic analysis.

Results: Three themes were generated: (a) self-determination as a key to ikigai, (b) explorations needed to identify sources of ikigai, and (c) navigating the challenges to engage in the explorations. It was found that a self-determined activity tends to be a source of ikigai. However, participants had to grapple with challenges because identifying a source of ikigai involved the exploration of their personal interests, and the exploration could not be continued without managing the stigma of mental illness.

Conclusions and implications for practice: Results suggest that ikigai cannot be achieved instantly. To achieve eudaimonic well-being outcomes, psychiatric rehabilitation professionals should allow consumers to choose activities based on their personal interests and encourage them to try out various activities while they provide continued support to overcome stigma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study explores the experiences of young adults with psychosis using a smartphone application to promote patient activation and support shared decision making in their outpatient treatment.

Method: Semistructured interviews were conducted with eight participants who had access to the app while receiving mental health treatment. Qualitative data from the interviews were analyzed using thematic analysis aimed at experiences of interacting with the app.

Results: Four themes were extracted from the interviews: supporting users with memory difficulties, giving symptoms substance, a new source of information to guide conversations, and the challenge of capturing complex experiences digitally. While the majority of the themes highlight the benefits of using the app in ways that may facilitate communication between patient and provider, the participants also described some negative experiences when interacting with the app concerning failure to communicate nuances and emotional states satisfyingly.

Conclusion and implications for practice: Experiences with the app were double sided. On the one hand, the use of the app supports communication, and conversely, interaction with the app can create limitations and new challenges for communication. There is a need for more research to understand the use of mental health smartphone apps and their role in supporting interactive processes such as shared decision making in mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Traumatic experiences are prevalent among people with serious mental illness and can significantly worsen outcomes. This study aimed to identify an urban cluster of trauma types, compare continuous distress ratings versus categorical experience of trauma for predicting outcomes such as depression and quality of life, and investigate the mediating role of recovery orientation in the impact of trauma exposure on outcomes.

Method: Data came from an intervention study on African Americans with serious mental illness living in a large urban area; 212 participants completed baseline self-report measures of past trauma experiences, related distress levels, recovery, depression, and quality of life. Data were assessed using correlations and regressive path modeling.

Results: Overall, 56.6% of participants reported experiences with trauma. Analyses suggested an urban cluster of trauma types that was self-reported by over 25% of participants. Distress due to trauma strongly correlated with greater depression as well as reduced quality of life and recovery. Interestingly, the categorical presence of trauma history (yes/no) had no significant relationship with any outcomes. Path analyses revealed that recovery mediated the impact of trauma distress on depression and quality of life, specifically implicating the recovery subfactor of hope.

Conclusions and implications for practice: Results suggested that cognitive reframing focused on positive appraisals of overall recovery, and the hope subfactor can have a positive influence on trauma outcomes. The study supported the role of recovery in posttraumatic growth and suggests that hope can be used to help patients process trauma healthily. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Compared to Western cultures, self-determination needs are expressed and pursued differently in Asian cultures, where interdependence and achieving greater good for the group are prioritized. To accommodate these needs, we propose the use of family-centered decision making (FCDM) to complement the shared decision-making (SDM) practice, fostering collaborative psychiatric care for Asian individuals residing in the United States.

Method: This article synthesizes various literature to outline the similarities and differences between SDM and FCDM, discuss implementation steps, challenges associated with implementation, potential solutions, and future research considerations.

Results: Our review suggests that FCDM is more responsive to and inclusive of Asian cultural experience, better reflecting these cultures' expression of self-determination. We propose a five-step framework for FCDM implementation in psychiatric rehabilitation for Asian and Asian American individuals, while identifying three further practical considerations: logistical difficulties, intrafamilial differences, and making the decision to use FCDM or not.

Conclusions and implications for practice: Given the heterogeneity of Asian individuals in the United States, we urge providers to allow flexibility in practicing FCDM. We outline the important components for providers to help individuals with psychiatric disabilities distinguish between the characteristics of FCDM and SDM, evaluate the potential pros and cons of utilizing FCDM, and then initiate FCDM if appropriate or requested by the individuals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: In Canada and elsewhere, making treatment decisions for a person with serious mental illness (SMI) who was found incapable for treatment decisions via a substitute decision maker (SDM) is the norm. This practice is often called into question from a rights-based perspective. The literature on the views of affected individuals is limited. We explore the experiences of adults with SMI who have had SDMs to gain more in-depth understanding.

Method: We conducted semistructured interviews with 11 consumers of psychiatric services who have had experiences with SDM (range 1-12 years) at an urban hospital in Toronto, Canada.

Results: Thematic analysis showed five main themes and related subthemes, including: (1) strong dissatisfaction with and rejection of the SDM's role and purpose; (2) pervasive sense of stigma associated with having a SDM; (3) ongoing struggles to gain autonomy; (4) mixed changes in relationship with and views about SDM; and (5) views on how to improve SDM process.

Conclusion and implications for practice: Our study highlights substantial dissatisfaction with the current SDM system and approaches among adults with SMI who have had SDMs. Issues of stigma and struggles to regain autonomy are prevalent. We discuss the personal, clinical, and social-legal contexts in which they occur, particularly in light of the United Nations' Convention on the Rights of Persons with Disabilities that calls for replacing SDMs with supported decision making. Rights-based approaches to care carry substantial practice implications and call for thoughtful change management. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The active recovery triad (ART) model provides guidelines for recovery-oriented care in long-term mental health care. The aim of this study is to evaluate whether compliance to the principles of the ART model is related to recovery-oriented care, service user recovery and satisfaction.

Method: A prospective study was conducted including two measurements, in which we investigated compliance to the principles of the ART model (ART fidelity), recovery-oriented care as measured by the Recovery-Oriented Practices Index-Revised (ROPI-R) at team level (n = 18) and outcome measures on service user level (n = 101) related to personal recovery, social roles, level of functioning, clinical recovery, transition, and satisfaction. We used multilevel modeling to evaluate these relationships.

Results: There was a significant association between active recovery triad (ART) fidelity and the ROPI-R. We did not find a significant association between overall ART fidelity and service user outcomes. Yet, we did find that higher ART fidelity in the domains "cooperation in the triad," "professionalization of staff," and "team structure" were related to improved clinical recovery, functioning, social roles, and performance of activities. However, higher ART fidelity in the domain "healing environment" was related to poorer functioning, and a higher score in the domain "safety and prevention of coercion" was related to poorer social roles and performance of activities.

Conclusions and implications for practice: We can conclude that compliance to the principles of the ART model is related to recovery-oriented care, measured with the ROPI-R. In addition, the findings suggest that in particular elements in the ART model are related to meaningful recovery outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This special section is dedicated to collaborative approaches in psychiatric rehabilitation, which are rooted in foundational values such as service user involvement and self-determination.

Methods: Five articles featuring collaborative approaches are included and briefly reviewed here.

Results: These articles highlight innovations in collaborative approaches, addressing existing limitations in research and practice and advancing understanding of collaborative psychiatric care among diverse populations.

Conclusions and implications for practice: They underscore the ongoing need for research and policy reform to promote more routine and widespread implementation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).