Psychiatric Rehabilitation Journal最新文献

Objective: Previous research has established the impact of psychiatric symptoms on social functioning, while there is a paucity of research examining how social functioning relates to personal recovery, an individual's self-assessment of their mental health recovery. This study examined the mediating effect of social engagement, interpersonal communication, and satisfaction with support in the relationship between distinct psychiatric symptom clusters and perceived mental health recovery.

Methods: In a cross-sectional study, both patient self-report and provider assessment data were collected for 250 patients with serious mental illness (SMI) across four mental health service sites. Parallel mediation analytic models were used.

Results: Interpersonal communication partially mediated the relationship between positive and negative symptom clusters and personal recovery. Satisfaction with social supports partially mediated the relationship between excited symptoms and personal recovery. Both interpersonal communication and satisfaction with social supports partially mediated the relationship between general psychological distress and depressive symptoms and personal recovery. Collectively, social functioning mediators explained nearly half of the relationship between general psychological distress and excited symptoms and personal recovery and nearly all of the relationship between positive symptoms and personal recovery.

Conclusions and implications for practice: Clinical providers working with persons with SMI should regularly assess social functioning in addition to assessing psychiatric symptoms and personal recovery factors and should incorporate social skills education into SMI group and individual treatments. Social functioning as a target of treatment may be especially beneficial for patients who are dissatisfied with other interventions or feel they have experienced the maximum benefit from treatment and are seeking additional methods to support personal recovery. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: People from a Black ethnic (BE) background in England and Wales are disproportionately detained as inpatients under the United Kingdom's Mental Health Act (MHA). Qualitative research into the lived experiences of this group is sparse. This study, therefore, aims to explore the experiences of people from a BE background detained under the MHA.

Method: Semistructured interviews were conducted with 12 self-identified adults from a BE background who were currently detained as inpatients under the MHA. Thematic analysis was used to identify themes across the interviews.

Results: Four themes emerged from the interviews: "Help is decided by others, not tailored to me"; "I am not a person-I am a Black patient"; "Mistreated or neglected instead of cared for"; and "Sectioning can be a space for sanctuary and support."

Conclusions and implications for practice: People from a BE background report inpatient detention to be a racist and racialized experience, inseparable from a wider context of systemic racism and inequality. Experiences of detention were also discussed in terms of stigma within BE families and communities, as well as social support that appeared to be lacking outside of the hospital. Systemic racism must be addressed across mental health care, led by the lived experiences of BE people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Research is significantly lacking on exploring how Asian Americans with mental illness (AAMI) begin to accept their mental illness and identifying factors that might have a significant impact on mental health service utilization. To bridge the gap, this study aimed to explore mental illness identity development and service utilization experiences among AAMI using a qualitative, narration-based research design.

Method: Twenty-one AAMI participated in the semistructured interview. Interview questions were designed to assess the participants' perceived experiences of mental illness identity development, microaggression/discrimination experiences, overall positive and negative experiences when using mental health services, and suggestions to make mental health services accessible to AAMI. Thematic analysis was applied to identify key themes throughout multiple steps of coding.

Results: Analyses yielded 13 major themes related to the following: (a) contributing factors influencing mental illness identity development, (b) contributing factors utilizing mental health services, and (c) suggestions to make mental health services more available to AAMI. More specifically, it was worth noting that family played a significant role as either a support system or a barrier to adjusting to participants' mental illness and service utilization. Participants also stated that negative attitudes toward mental illness within the Asian community hindered the development of positive self-concept and utilization of mental health services.

Conclusions and implications for practice: Findings from the present study are expected to assist service providers in implementing culturally informed practices when working with AAMI and developing effective strategies to enhance mental health literacy and service utilization. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Viewing the Substance Abuse and Mental Health Services Administration's recovery principles through an antiracist lens has guided the authors' vision of recovery-oriented systems for all. In this brief letter, they present some considerations arising from their application of recovery principles to areas affected by racial bias. They are also identifying best practices for incorporating micro and macro antiracism efforts into recovery-oriented health care. These are important steps in promoting recovery-oriented care, but there is much more to do. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objectives: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya.

Method: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention.

Results: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement.

Conclusions and implications for practice: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Prior research indicates Black employees may be particularly vulnerable to job dissatisfaction and that social support at work is a potential resource that could influence employee outcomes. This study examined racial differences in workplace social networks and support, and how these factors may contribute to perceived organizational support and, ultimately, job satisfaction among mental health workers.

Method: Using data from an all-employee survey in a community mental health center (N = 128), we assessed racial differences in social network supports, hypothesizing that Black employees would report smaller and less supportive social networks, and lower levels of organizational support and job satisfaction compared to White employees. We also hypothesized that workplace network size and support would be positively associated with perceived organizational support and job satisfaction.

Results: Hypotheses were partially supported. Compared to Whites, Blacks had smaller workplace networks that were less likely to include supervisors, were more likely to report workplace isolation (naming no workplace social ties), and were less likely to seek advice from their social ties at work. Regression analyses showed that Blacks and employees with smaller networks were more likely to perceive lower levels of organizational support, even after controlling for background variables. However, race and network size did not predict overall job satisfaction.

Conclusions and implications for practice: These findings suggest that Black mental health services staff are less likely to have rich, diverse workplace networks than their White colleagues, which may put them at a disadvantage in terms of accessing support and other resources. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content.

Methods: The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness.

Results: A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high.

Conclusions and implications for practice: START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: We present findings from a qualitative study aimed at understanding the experiences of Veterans with schizophrenia and negative symptoms who participated in trial of an intervention to increase social and community participation called Engaging in Community Roles and Experiences (EnCoRE). Our goal was to understand what participants (N = 36) perceived they learned in EnCoRE, how participants used what they learned in their daily lives, and if and how participants built on these experiences in ways that might lead to sustained change.

Method: Our analysis approach was inductive (bottom up), drawing on interpretive phenomenological analysis (IPA; Conroy, 2003), plus some top-down examination of the role of EnCoRE elements in participants' accounts.

Results: We identified three themes: (a) Learning skills led to increased comfort talking to people and planning activities; (b) Increased comfort led to increased confidence to try new things; and (c) The group atmosphere offered support and accountability that helped participants practice and refine new skills.

Conclusions and implications for practice: The process of learning skills, planning to use them, implementing them, and returning to the group for input helped many surmount feelings of low interest and low motivation. Our findings support having proactive discussions with patients about how building confidence can support improved social and community participation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Although racial disparities in psychiatric rehabilitation services are not new, the urgency of systematic approaches to address them has gained increased attention. In particular, the current social and political climate has spotlighted historically persistent and universally prevalent problems in equitable care. This special section, consisting of six studies and a Letter to the Editor, reveals the operation and impact of structural racism and highlights the need for race-conscious practice and research in psychiatric rehabilitation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Objective: Studies focused on prejudice and discrimination have traditionally explored the impact of one kind of prejudicial experience (e.g., race, gender, criminal history) within a particular context and thus, there is weak base of understanding about the experiences of individuals who may contend with concurrent prejudicial and/or discriminatory experiences across multiple characteristics. In this study, our aim was to better understand the prejudicial and/or discriminatory work experiences of Black adults with serious mental illness (SMI). Specifically, we highlight instances where individuals endorse the salience of multiple sources of prejudice and discrimination during a given workplace incident.

Method: Using a semistructured interview guide and a grounded theory approach, we interviewed 24 Black adults with SMI recruited from two clubhouses in the Boston metropolitan area. To validate findings, we also conducted follow-up focus groups with participants (n = 9) at each recruitment site.

Results: We identified 19 personal attributes/characteristics contributing to the prejudicial/discriminatory experiences of Black adults with SMI in the context of work. We also found that respondents would organize these prejudicial/discriminatory experiences in clusters whereby two or more characteristics were viewed as the reasons for prejudice and discrimination during a given workplace incident.

Conclusions and implications for practice: Black adults with SMI contend with a range of prejudicial and discriminatory experiences, often experienced simultaneously, highlighting the importance of an intersectional framework in research designs and/or clinical interventions addressing the needs of this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).