Promoting Healthy Organizational Partnerships and Collaboration Between Consumer-run and Community Mental Health Agencies

User-Focused Monitoring as a Strategy for Involvement and Mental Health Service Development: An Analysis of Swedish Monitoring Reports

User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by people with lived experience of mental ill health. Research on UFM and on user involvement focused on service monitoring and evaluation is lacking. This study addresses this knowledge gap by examining UFM as a strategy for user involvement. More specifically, this study aims to synthesize patterns in UFM reports to characterize the phenomenon, as well as to further discuss negotiation processes and political opportunities in UFM. The empirical material consists of 136 Swedish UFM reports that have been analyzed in two steps: All reports were mapped according to general characteristics and a sample of 20 reports were selected to provide additional information on the method. This study has been conducted in collaboration with actors representing the user movement and municipality-based mental health services. Our analysis shows that long-term contracts between user organizations and service providers are important to create a sustainable implementation of UFM. However, strategies to protect user autonomy must be carefully considered and employed in relation to such collaborations. We further highlight the risks of a restricted focus on consumer satisfaction, and discuss the current development towards including follow-ups in the UFM process as a strategy for counteracting tokenism.

Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study

Background

Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs.

Method

Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced.

Results

Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED.

Conclusions

Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.

Current emergency response in montreal: How does it fit in the services offered to homeless people who use substances?

Background This paper presents an assessment of the current emergency response to homeless people who use substances in Montreal, a major North American city. This project addresses the rising concern about homelessness in high-income countries. Several studies have shown that homeless people frequently use emergency services (i.e., police, paramedical, and hospital), especially in the context of substance use. Yet, the key actors' perspectives are poorly documented. Method Our team conducted a needs analysis using a deliberative democratic evaluation. Data collection strategies included an intersectoral World Café (n = 34, including police, specialized professionals, community stakeholders, political representatives, researchers, and people who have been homeless) and individual interviews with health professionals (n = 5) and homeless people (n = 8). We performed a thematic content analysis based on a conceptual framework of access to health care and of collaboration. Findings This study provided key information on the role of emergency services and the needs of key actors, in terms of the dimensions of access to health care (approachability, acceptability, availability, and appropriateness) and continuity. Our main results show that, according to the participants, the emergency response is relevant when homeless people are a danger to themselves or to others, and during episodes of acute physical and psychological care. However, emergency service providers still stigmatize homelessness and substance use, which negatively affects intervention quality. Finally, our main results highlight the interdependence between the emergency services and health, social, and community services. Conclusion The emergency response is necessary and appropriate in some situations. It remains important to intervene upstream and to improve the attitudes and practices of emergency service providers. Finally, it is necessary to adapt services to the needs of homeless substance users and improve service continuity, for example, by adopting a population-based approach.

Mental Health Recovery: The Effectiveness of Peer Services in the Community

Peer recovery services are a community-based treatment option for people suffering from mental illness and/or substance use problems. Peer services provide an alternative to inpatient care and can help decrease costs associated with hospitalization or incarceration of the mentally ill. Yet, scant research has explored the effect of these services, particularly in rural communities. The current study assesses the impact of peer services on peer mentees' and mentors' recovery capital, quality of life, and general wellness. Consumers of peer services completed three surveys every three months for approximately 18 months. Quantitative analyses demonstrated that subjects had a marginal change in their recovery capital, but quality of life and general wellness were unaffected. Peer providers' experiences were also explored through interviews. Qualitative analyses revealed that providers have a positive outlook regarding peer services but would benefit from greater resources and additional training. Policy and community implications are also discussed.

Organisational and leadership competencies for successful service integration

Purpose

– The purpose of this paper is to describe a two-part study that has explored the organisational and leadership competencies required for successful service integration within a health consortia in Australia. Preliminary organisational and leadership competency frameworks were developed to serve as reference points as the consortia it expanded to cater for increased service demand in the midst of significant health reform.

Design/methodology/approach

– The study design is outlined, which involved literature reviews and semi-structured interviews with key stakeholders to ascertain the key determinants of successful service integration at both organisational and leadership levels.

Findings

– The literature reviews revealed little existing research specifically focused on the organisational and leadership competencies that underpin successful service integration. The themes from the literature reviews and semi-structured interviews informed the preliminary organisational and leadership competency frameworks. Both frameworks are outlined in the paper. Key determinants of successful service integration – at both an organisational and individual leadership level – are also presented.

Research limitations/implications

– This is a one-organisation case study and the competency frameworks presented are preliminary. However, the study findings provide a foundation for further research focusing on the longer-term success of service integration.

Originality/value

– Service integration in health is a new and emerging area, and there is little extant research exploring the organisational and leadership competencies underpinning its success. The competency frameworks presented in the paper may be of interest to other consortia and organisations engaged in service integration and other forms of merger and collaboration.

State of spirituality-infused mental health services in Los Angeles County wellness and client-run centers

Spiritual coping is associated with positive mental health outcomes for individuals with serious mental illness, yet spirituality-infused services are seldom offered in public sector mental health agencies. The Los Angeles County Department of Mental Health introduced a policy addressing spirituality in 2012. This study explored the breadth and degree to which spirituality-infused activities were being offered in 53 Los Angeles wellness and recovery centers after the policy was widely disseminated. More than 98 % of the centers offered options for spirituality-infused activities; one-third offered spirituality-focused groups. Los Angeles's progress may guide implementation of spirituality-infused services in other state or local public mental health systems.

Inpatient service providers' perspectives on service user involvement in Norwegian community mental health centres

BACKGROUND

For two decades, mental health services in Norway have focused on service user involvement. Despite this, there is little knowledge about how inpatient mental health services have promoted user involvement.

AIM

To examine service providers' reports of service user involvement at the individual and departmental levels in Norwegian community mental health centres (CMHCs).

METHODS

One hundred and eighty six (186) inpatient service providers in five CMHCs filled out a questionnaire.

RESULTS

Confirmatory factor analysis showed that service provider perceptions and awareness of service user involvement can be measured by three subscales: organizational user involvement; patient collaboration; and assisted patient involvement. Little user involvement was reported at the departmental level. Providers more often reported user involvement at the individual level. Providers in two of the CMHCs reported a somewhat higher degree of departmental-level user involvement. There were no significant differences across gender, age, leader position, profession and job tenure, though evening/night shift workers reported a lesser degree of user involvement.

CONCLUSION

The results suggest that user involvement at the departmental level needs to be addressed in future efforts to promote user involvement in CMHCs.

Self-help groups and mental health/substance use agencies: the benefits of organizational exchange

Self-help groups benefit clients by linking them to people who have "been there" and are successfully coping with their situations. Mental health/substance use agencies can increase access to evidence-based benefits of self-help groups by engaging them in organizational exchanges. Organizational theories are used to frame beneficial exchanges with self-help groups. Adaptational theory is used to frame exchanges with self-help groups and various service agency subunits, e.g., board, practitioner, and client units. Institutional theory is used to frame joint agency/self-help initiatives to promote community acceptance of self-help groups, which in turn may enhance the credibility of the professional agency.

Les organismes communautaires en santé mentale au Québec : rôle et dynamique partenariale

Cette étude présente un portrait global des 371 organismes communautaires en santé mentale (OCSM) subventionnés par l’État québécois durant l’année 2003-2004, et fait état de leur dynamique partenariale avec les réseaux communautaire, institutionnel et intersectoriel. Les auteurs abordent la diversité des OCSM à partir des dimensions suivantes : période de fondation de l’organisme, type et étendue du territoire couvert, type et nombre de services offerts, profil financier, regroupements et associations, tables de concertation et relations partenariales. L’étendue du territoire, l’importance du budget et la participation à une table de concertation locale et à des comités de travail apparaissent être des conditions qui favorisent la formalisation des relations organisationnelles.

The employment of consumers in mental health services: politically correct tokenism or genuinely useful?

OBJECTIVE

The aim of this paper is to examine the role of consumers as service providers and to describe the successful employment of peer support workers in a public mental health service.

CONCLUSIONS

The Peer Support Worker program in Adelaide, South Australia is consistent with evidence obtained from previous research in demonstrating the successful training and employment of consumers as peer workers in a public mental health service.