利益相关者对心理健康服务中同伴自我披露的看法和经验。

IF 1.8 4区 医学 Q3 HEALTH POLICY & SERVICES Community Mental Health Journal Pub Date : 2024-10-01 Epub Date: 2024-05-10 DOI:10.1007/s10597-024-01287-2
Inbar Adler Ben-Dor, Eran Kraus, Yael Goldfarb, Alina Grayzman, Bernd Puschner, Galia S Moran
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引用次数: 0

摘要

随着以康复为导向的心理健康(MH)服务的发展,拥有心理健康生活经验的个人越来越多地被聘为同伴服务提供者(同伴)。朋辈的独特之处在于,他们从经验中汲取知识,并与服务使用者保持密切联系,从而提高服务质量,并使精神健康系统的文化人性化。在以色列,有数以百计的同伴受雇于整个精神卫生系统的各种角色和环境。然而,将同伴融入保健服务面临着挑战。其中一个问题涉及到在精神健康服务中使用自我披露(SD)的问题,不同的角色和环境对自我披露的明确程度也不尽相同。本研究旨在了解 MH 健康服务中不同利益相关者对同伴自我披露(经验知识的使用和分享)的看法和经验。作为一个大型国际项目(UPSIDES;ERC Horizon 2020,Moran 等人,《试验》21:371,2020 年)的一部分,进行了 6 次焦点小组讨论和 4 次半结构式访谈(N = 42)。对数据进行了逐字转录,并采用主题分析法对其进行了分析。针对目前医疗卫生组织中同伴自毁行为的观点和经验,确定了四个类别和七个主题:(i) 组织对自毁行为的限制或谨慎态度;(ii) 同伴对自毁行为的态度;(iii) 指定同伴角色对自毁行为的影响;(iv) 在传统角色中工作的同伴不必要的自毁行为。研究结果表明,同伴在心理健康服务中的自毁是一个复杂的过程。组织方法往往控制着非指定同伴的自毁行为;参与者对同伴自毁行为持不同的支持和反对态度;自毁行为根据个人喜好、特定同伴角色和主任对同伴自毁行为的处理方法而发生;在服务使用者和工作人员之间出现了冲突性的自毁行为困境。有时,由于心理健康状况不佳,自毁行为会在未经许可的情况下发生。同伴指定角色的存在对同伴的 SD 有积极影响。我们认为,目前在法定的精神健康服务中,朋辈自毁行为的观点和一般行为与三个方面有关:1.传统的治疗性 SD 模式与朋辈 SD 模式--前者目前占主导地位。2.同伴持续发展的熟练程度和技能发展不足。3.服务使用者和工作人员对同伴持续发展的成见。这些方面相互关联,有时会形成一个消极的循环,造成紧张和混乱。发展同伴指定角色可以对法定医疗卫生服务中的同伴持续发展产生积极影响。需要通过培训、支持和组织干预来进一步支持以同伴为导向的 SD,加强以人为本和康复为导向的 MH 服务。
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Perspectives and Experiences of Stakeholders on Self-Disclosure of Peers in Mental Health Services.

With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems' culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers' SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers' SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers' SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers' SD practices; participants had diverse attitudes for and against peers' SD; SD occurred according to personal preferences, specific peer role and the director's approach to peers' SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model - with the former currently being dominant. 2. Insufficient proficiency and skill development in peers' SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion.A need to develop professionalism of peer SD in statutory services is highlighted alongside enhancing staff and service user acknowledgement of the value of peer SD. Developing peer-designated roles can positively impacts peer SD in MH statutory services. Training, support, and organizational interventions are required to further support for peer-oriented SD and the enhancement of a person-centered and recovery orientation of MH services.

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来源期刊
CiteScore
5.30
自引率
3.70%
发文量
133
期刊介绍: Community Mental Health Journal focuses on the needs of people experiencing serious forms of psychological distress, as well as the structures established to address those needs. Areas of particular interest include critical examination of current paradigms of diagnosis and treatment, socio-structural determinants of mental health, social hierarchies within the public mental health systems, and the intersection of public mental health programs and social/racial justice and health equity. While this is the journal of the American Association for Community Psychiatry, we welcome manuscripts reflecting research from a range of disciplines on recovery-oriented services, public health policy, clinical delivery systems, advocacy, and emerging and innovative practices.
期刊最新文献
Factors Associated with Suicidal Behavior in Adolescents: An Umbrella Review Using the Socio-Ecological Model. Exploring the Relationship Needs of Service Users During Crisis Interventions: A Qualitative Study. Bridging the gap of Inequity in Implementation Science: Adaptations of Group EBPs for those with Serious Mental Illness in the Public Sector. Programmatic and Organizational Barriers and Facilitators to Addressing High-Risk Issues in Supportive Housing and Housing First Programs. Peer Support Workers in Mental Health Services: A Qualitative Exploration of Emotional Burden, Moral Distress and Strategies to Reduce the Risk of Mental Health Crisis.
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