1
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Biran-Ovadia A, Strous RD, Bart O, Lipskaya-Velikovsky L. Study of recovery model implementation in psychiatric hospitals: Clients and multidisciplinary staff perspective. Int J Ment Health Nurs 2023; 32:603-614. [PMID: 36562517 DOI: 10.1111/inm.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
The recovery model guides mental health services. However, the delivery of recovery-oriented services in inpatient settings is still a challenge. Factors affecting recovery model implementation can be classified into three types: the hospital environment, the inpatient and the service provider. This study aims to quantitatively evaluate the impact of environment, inpatient and service provider factors on recovery model implementation in hospitals. Forty-five service providers and 42 inpatients from three types of wards (acute locked, acute open and daycare) of two hospitals participated in this cross-sectional study. We assessed inpatient cognition, functional capacity and illness severity. In addition, we retrieved information on service providers' professional status and evaluated the recovery model knowledge and attitudes. Implementation of the recovery model was measured using the Recovery Self-Assessment, both the inpatient and service provider versions. Differences were found between the three types of wards in recovery orientation as reported by service providers ( χ 2 2 = 15.3, P < 0.001), but not by inpatients ( χ 2 2 = 2.34, P > 0.05). Providers' internalized knowledge and attitudes toward recovery, inpatients' functional capacity and age of illness onset were associated with recovery implementation (0.31 < r < 0.48, P < 0.05). The findings confirm quantitatively the multilevel nature of factors that affect the implementation of the recovery model in psychiatric hospitals. The inpatients' perspective should be incorporated into the service development process. Based on the study results, the reduction in the restrictive features of the wards' environment is recommended. Promotion of the recovery model implementation in the hospital setting requires the expansion of staff's internal positive attitudes toward recovery.
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Affiliation(s)
- Ateret Biran-Ovadia
- The Maayenei Hayeshua Medical Center, Bnei-Brak, Israel.,The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Rael D Strous
- The Maayenei Hayeshua Medical Center, Bnei-Brak, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Orit Bart
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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2
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Shue SA, Traylor M, Kukla M, Salyers MP, Rollins AL, Henry N, Eliacin J, Garabrant J, McGuire AB. Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:283-295. [PMID: 36495371 DOI: 10.1007/s10488-022-01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. METHOD VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. RESULTS The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. CONCLUSION Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.
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Affiliation(s)
- Sarah A Shue
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA.
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | - Marina Kukla
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Nancy Henry
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Johanne Eliacin
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Jennifer Garabrant
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Alan B McGuire
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
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3
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Khan N, Tracy DK. The challenges and necessity of situating 'illness narratives' in recovery and mental health treatment. BJPsych Bull 2022; 46:77-82. [PMID: 33597058 PMCID: PMC9074157 DOI: 10.1192/bjb.2021.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In mental health services, recovery constitutes a guiding principle that is endorsed in professional medical guidelines and has become central to mental health policies across the world. However, for many clinicians, it can be a challenge to effectively embed recovery concepts into professionally directed treatment of disease without distortion, and ostensibly away from what matters to those who use the services. We discuss the evolving and multifaceted concept of 'recovery', including illness narratives to frame our discussion. We demonstrate how integration between a person-directed management of illness and a professionally directed treatment of disease can converge, resulting in positive outcomes for people with mental illness.
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Affiliation(s)
| | - Derek K Tracy
- Oxleas NHS Foundation Trust, UK.,King's College London, UK
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4
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Piat M, Wainwright M, Sofouli E, Vachon B, Deslauriers T, Préfontaine C, Frati F. Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Syst Rev 2021; 10:134. [PMID: 33952336 PMCID: PMC8101029 DOI: 10.1186/s13643-021-01646-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Countries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services? METHODS This systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations. RESULTS Seventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed. CONCLUSION The CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada. .,McGill University, Québec, Canada.
| | - Megan Wainwright
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,Department of Anthropology, Durham University, Durham, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,McGill University, Québec, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, Québec, H3C 3J7, Canada
| | - Tania Deslauriers
- School of Rehabilitation, Université de Montréal, 7077 avenue du Parc, Montreal, QC, H3N 1X7, Canada
| | - Cassandra Préfontaine
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 809, Sherbrooke W, Montreal, Québec, H3A 0C9, Canada
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5
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Shields-Zeeman L, Petrea I, Smit F, Walters BH, Dedovic J, Kuzman MR, Nakov V, Nica R, Novotni A, Roth C, Tomcuk A, Wijnen BFM, Wensing M. Towards community-based and recovery-oriented care for severe mental disorders in Southern and Eastern Europe: aims and design of a multi-country implementation and evaluation study (RECOVER-E). Int J Ment Health Syst 2020; 14:30. [PMID: 32336984 PMCID: PMC7178587 DOI: 10.1186/s13033-020-00361-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 04/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background Substantial strides have been made around the world in reforming mental health systems by shifting away from institutional care towards community-based services. Despite an extensive evidence base on what constitutes effective care for people with severe mental ill-health, many people in Europe do not have access to optimal mental health care. In an effort to consolidate previous efforts to improve community mental health care and support the complex transition from hospital-based to community-based care delivery, the RECOVER-E (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE) project aims to implement and evaluate multidisciplinary community mental health teams in five countries in Central and Eastern Europe. This paper provides a brief overview of the RECOVER-E project and its methods. Methods Five implementation sites were selected (Sofia, Bulgaria; Zagreb, Croatia; Skopje, North Macedonia; Kotor, Montenegro; Siret-Suceava, Romania) where hospital-based mental health services are available (care as usual, CAU) for patients with severe mental disorders (severe depression, bipolar disorder, schizophrenia). The intervention consists of the introduction of a new service delivery model in each site, consisting of community-based recovery-oriented care delivered by trained multidisciplinary community mental health teams (including a peer worker with lived experience of a severe mental disorder). The implementation outcomes of the teams and the effect of the team’s approach on patient and service utilisation outcomes will be evaluated using a mix of research methods. The study includes five planned hybrid implementation-effectiveness trials (1 per site) with patient-level randomization (n = 180, with patients randomised to either care as usual or intervention condition). Effectiveness is evaluated using a pragmatic non-blinded design with patients randomised into two parallel groups: receiving new community-based care or receiving usual care in the form of institutional, hospital-based mental health care. Trial-based health economic evaluation will be conducted; implementation outcomes will be evaluated, with data aligned with dimensions from the RE-AIM framework. Pathways to sustaining project results will be developed through policy dialogue sessions, which will be carried out in each country and through ongoing policy engagement activities at the European level. Discussion The RECOVER-E project has been developed and conducted to demonstrate the impact of implementing an evidence-based service delivery model for people with severe mental illness in different contexts in middle-income countries in Central and Eastern Europe. It is expected that the results will contribute to the growing evidence-base on the health and economic benefits of recovery-oriented and community-based service models for health systems in transition. Trial registration Each trial was registered before participant enrolment in the clinicaltrials.gov database: Site—Croatia, Zagreb (Trial Reg. No. NCT03862209); Montenegro, Kotor (Trial Reg. No. NCT03837340); Romania, Suceava (Trial Reg. No. NCT03884933); Macedonia, Skopje (Trial Reg. No. NCT03892473); Bulgaria, Sofia (Trial Reg. No. NCT03922425)
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Affiliation(s)
- Laura Shields-Zeeman
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands.,3Department of Public Mental Health and Prevention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Ionela Petrea
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Filip Smit
- 2Centre for Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,3Department of Public Mental Health and Prevention, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,4Department of Biostatistics and Epidemiology and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Bethany Hipple Walters
- 1Trimbos Institute (Netherlands Institute of Mental Health and Addiction), P.O. Box 725, 3500 AS Utrecht, The Netherlands
| | - Jovo Dedovic
- Special Psychiatric Hospital Dobrota, Kotor, Montenegro
| | | | - Vladimir Nakov
- 7National Center for Public Health Analyses, Sofia, Bulgaria
| | - Raluca Nica
- Romanian League for Mental Health, Bucharest, Romania
| | - Antoni Novotni
- 9University Clinic of Psychiatry, Skopje, North Macedonia
| | - Catharina Roth
- 10Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ben F M Wijnen
- 2Centre for Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Michel Wensing
- 10Department of General Practice and Health Service Research, University Hospital Heidelberg, Heidelberg, Germany
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6
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Mathews M, Bhola P, Herbert H, Chaturvedi SK. Explanatory models of mental illness among family caregivers of persons in psychiatric rehabilitation services: A pilot study. Int J Soc Psychiatry 2019; 65:589-602. [PMID: 31385555 DOI: 10.1177/0020764019866228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Understanding the explanatory models of family caregivers is particularly important in interdependent contexts like India, where they often play a significant role in the help-seeking behaviours, treatment decision-making and long-term care of those diagnosed with mental illness. AIMS This study was planned to explore the diversity of explanatory models among family caregivers at a centre for recovery-oriented rehabilitation services in South India. METHODS The sample for this study included 60 family caregivers of patients referred to Psychiatric Rehabilitation Services within a tertiary-care hospital for mental health and neurosciences. Bart's Explanatory Model Inventory, including a semi-structured interview and a checklist, assessed the family caregivers' explanatory model of distress on five domains: identity, cause, timeline, consequences and control/cure/treatment. RESULTS The results indicated the coexistence of multiple causal explanatory models including psychosocial, supernatural, situational and behavioural contributors. While 36.7% of the caregivers displayed two explanatory models, 33.3% of the caregivers held three explanatory models and 16.6% of the caregivers endorsed four explanatory models. Caregivers shared their concerns about varied consequences of mental illness but less than half of them were aware of the name of the psychiatric disorder. While they accessed various forms of treatments and adjunctive supports such as prayer, medication was the most frequently used treatment method. CONCLUSIONS The findings have implications for collaborative goal setting in recovery-oriented services for persons with mental illness and their families.
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Affiliation(s)
- Manila Mathews
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Poornima Bhola
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Hesi Herbert
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Santosh K Chaturvedi
- 2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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7
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Kerner B, Crisanti AS, DeShaw JL, Ho JMG, Jordan K, Krall RL, Kuntz MJ, Mazurie AJ, Nestsiarovich A, Perkins DJ, Schroeter QL, Smith AN, Tohen M, Volesky E, Zhu Y, Lambert CG. Preferences of Information Dissemination on Treatment for Bipolar Disorder: Patient-Centered Focus Group Study. JMIR Ment Health 2019; 6:e12848. [PMID: 31237566 PMCID: PMC6614999 DOI: 10.2196/12848] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/15/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Patient education has taken center stage in successfully shared decision making between patients and health care providers. However, little is known about how patients with bipolar disorder typically obtain information on their illness and the treatment options available to them. OBJECTIVE This study aimed to obtain the perspectives of patients with bipolar disorder and their family members on the preferred and most effectively used information channels on bipolar disorder and the available treatment options. METHODS We conducted nine focus groups in Montana, New Mexico, and California, in which we surveyed 84 individuals including patients with bipolar disorder and family members of patients with bipolar disorder. The participants were recruited using National Alliance on Mental Illness mailing lists and websites. Written verbatim responses to semistructured questionnaires were analyzed using summative content analysis based on grounded theory. Two annotators coded and analyzed the data on the sentence or phrase level to create themes. Relationships between demographics and information channel were also examined using the Chi-square and Fisher exact tests. RESULTS The focus group participants mentioned a broad range of information channels that were successfully used in the past and could be recommended for future information dissemination. The majority of participants used providers (74%) and internet-based resources (75%) as their main information sources. There was no association between internet use and basic demographics such as age or geographical region of the focus groups. Patients considered time constraints and the fast pace in which an overwhelming amount of information is often presented by the provider as major barriers to successful provider-patient interactions. If Web-based channels were used, the participants perceived information obtained through Web-based channels as more helpful than information received in the provider's office (P<.05). CONCLUSIONS Web-based resources are increasingly used by patients with bipolar disorder and their family members to educate themselves about the disease and its treatment. Although provider-patient interactions are frequently perceived to be burdened with time constraints, Web-based information sources are considered reliable and helpful. Future research should explore how high-quality websites could be used to empower patients and improve provider-patient interactions with the goal of enhancing shared decision making between patients and providers.
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Affiliation(s)
- Berit Kerner
- Semel Institute, University of California, Los Angeles, CA, United States
| | - Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jason L DeShaw
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | | | - Kimmie Jordan
- National Alliance on Mental Illness New Mexico, Albuquerque, NM, United States
| | - Ronald L Krall
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Matt J Kuntz
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | | | - Anastasiya Nestsiarovich
- Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | | | - Alicia N Smith
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Emma Volesky
- National Alliance on Mental Illness Montana, Helena, MT, United States
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Christophe G Lambert
- Division of Translational Informatics, Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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8
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Manning RM, Greenwood RM. Understanding Innovation in Homeless Service Provision: A Study of Frontline Providers' Values-Readiness for Change. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:649-659. [PMID: 31190168 DOI: 10.1007/s10488-019-00943-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Service innovation for adults experiencing mental illness and homelessness typically involves shifting from treatment-led, staircase models toward recovery-oriented, Housing-First models. Aligning frontline service providers' values to those embedded within newer models is an important, but under-investigated, influence on the innovation process. To assess values alignment in this context, we conducted semi-structured qualitative interviews with frontline providers in staircase services in Ireland (n = 50). Data showed that, while their values mostly aligned to the treatment-led model, there was meaningful evidence of more recovery-oriented values, too. Strategies to enhance innovation through values-alignment are discussed.
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Affiliation(s)
- Rachel M Manning
- Department of Psychology, University of Limerick, Room E1-017d, Castletroy, Co Limerick, Ireland.
| | - Ronni Michelle Greenwood
- Department of Psychology, University of Limerick, Room E1-017d, Castletroy, Co Limerick, Ireland
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9
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Ellison ML, Belanger LK, Niles BL, Evans LC, Bauer MS. Explication and Definition of Mental Health Recovery: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:91-102. [PMID: 27709376 DOI: 10.1007/s10488-016-0767-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This review assessed the concordance of the literature on recovery with the definition and components of recovery developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). Each SAMHSA identified recovery component was first explicated with synonyms and keywords and made mutually exclusive by authors. Inter-rater reliability was established on the coding of the presence of 17 recovery components and dimensions in 67 literature reviews on the recovery concept in mental health. The review indicated that concordance varied across SAMHSA components. The components of recovery with greatest concordance were: individualized/person centered, empowerment, purpose, and hope.
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Affiliation(s)
- Marsha Langer Ellison
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, 01730-0012, USA. .,Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Lindsay K Belanger
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Barbara L Niles
- National Center for PTSD Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Leigh C Evans
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,School of Public Health, Boston University, Boston, MA, USA
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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10
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Care Plans in Community Mental Health: an Audit Focusing on People with Recent Hospital Admissions. J Behav Health Serv Res 2019; 44:474-482. [PMID: 26940207 DOI: 10.1007/s11414-016-9504-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Mak WWS, Chan RCH, Yau SSW. Development and validation of Attitudes towards Recovery Questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong. Psychiatry Res 2018; 267:48-55. [PMID: 29883860 DOI: 10.1016/j.psychres.2018.05.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
Considering the lack of existing measures on attitudes toward personal recovery and the need to acknowledge the cultural milieu in recovery attitude assessment, the present study developed and validated the Attitudes towards Recovery Questionnaire (ARQ) in a sample of people in recovery of mental illness, family carers, and mental health service providers in Hong Kong. The ARQ was developed based on existing literature and measures of recovery, and focus group discussions with various stakeholders. Findings of the multi-sample confirmatory factor analyses supported a five-factor structure: (1) resilience as a person in recovery, (2) self-appreciation and development, (3) self-direction, (4) family involvement, and (5) social ties and integration. The ARQ was positively correlated with recovery outcomes, empowerment, recovery knowledge, and recovery orientation of mental health services. As a tool for examining recovery attitudes, the ARQ informs us of the mindset across stakeholders and areas that need enhancement to facilitate the recovery process.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Randolph C H Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
| | - Sania S W Yau
- New Life Psychiatric Rehabilitation Association, Kowloon, Hong Kong
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12
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Abstract
SummarySeclusion is a tool used by psychiatrists primarily to manage aggressive and
disturbed behaviour that is presumed to be due to the patient's mental
disorder. In most parts of the world there are guidelines to using seclusion
that are designed to maximise a patient's freedoms and protect their liberty
while providing a safe environment. Arguments against the use of seclusion
revolve around the deprivation of liberty, the potential for misuse and the
concept of seclusion as a form of social control, and patients generally
report seclusion as a negative, coercive experience. There is little
evidence that seclusion provides long-term benefits in terms of treating
symptoms or reducing aggression, although the literature is mixed in this
regard. Expert opinion recommends a combination of national policy, ward
management and patient-centred interventions to reduce seclusion rates.
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13
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Osborn LA, Stein CH. Community Mental Health Care Providers' Understanding of Recovery Principles and Accounts of Directiveness with Consumers. Psychiatr Q 2017; 88:755-767. [PMID: 28150089 DOI: 10.1007/s11126-017-9495-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present qualitative study examined community mental health providers' accounts of their therapeutic interactions with adults with serious mental illness in a recovery-oriented model of care. Ten long-time mental health care providers discussed their understanding of recovery principles, their use of directive practices, and factors that shape their work with consumers. Content analysis of mental health providers' accounts suggest that providers had no difficulty articulating basic principles of recovery-oriented care. Providers reported engaging in directive practices with consumers and described using traditional clinical factors such as level of functioning, degree of psychiatric symptoms, safety concerns, and legal status to assess consumers' ability for autonomous decision making. Providers generally did not express tension between their views of mental health recovery and their beliefs about utilizing directive approaches with consumers. Implications of present findings for research and practice are discussed.
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Affiliation(s)
- Lawrence A Osborn
- Eastern State Hospital, 4601 Ironbound Road, Williamsburg, VA, 23188, USA.
| | - Catherine H Stein
- Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA
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Pachoud B. Pourquoi la visée du rétablissement en santé mentale implique une priorisation de la dimension éthique ? ANNALES MEDICO-PSYCHOLOGIQUES 2017. [DOI: 10.1016/j.amp.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Piat M, Sofouli E, Sabetti J, Lambrou A, Chodos H, Briand C, Vachon B, Curran J. Protocol for a mixed studies systematic review on the implementation of the recovery approach in adult mental health services. BMJ Open 2017; 7:e017080. [PMID: 28855202 PMCID: PMC5724147 DOI: 10.1136/bmjopen-2017-017080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Recovery is integral to mental health planning in G-8 countries including Canada. A recovery-oriented approach to care aims to promote personal empowerment, illness self-management and a life beyond services for people with serious mental illness (SMI), while reducing the financial burden associated with mental illness. Although there is a growing body of literature on recovery, no synthesis of research on the implementation of recovery into mental health services exists. OBJECTIVES The objective is to conduct a mixed studies systematic review on the operationalisation of recovery into mental health services for adults with SMI. It will inform the transformation of Canadian services to a recovery orientation, but may be applicable to other countries. METHODS AND ANALYSIS Seven databases including PubMed, Ovid Medline, Ovid Embase, Ovid PsycInfo, CINAHL, the Cochrane Library and Scopus will be searched for peer-reviewed empirical studies published from 1998 to December 2016. Systematic reviews and studies using quantitative, qualitative and mixed methodologies will be included. Secondary searches will be conducted in reference lists of all selected full text articles. Handsearches will also be performed in the tables of contents of three recovery-focused journals for the last 5 years. International experts in the field will be contacted for comments and advice. Data extraction will include identification and methodological synthesis of each study; definition of recovery; information on recovery implementation; facilitators and barriers and study outcomes. A quality assessment will be conducted on each study. The data will be synthesised and a stepwise thematic analysis performed. ETHICS AND DISSEMINATION Ethics approval is not required for this knowledge synthesis. Findings will be disseminated through knowledge translation activities including: (1) a 1-day symposium; (2) presentations in national and international conferences and to local stakeholders; (3) publications in peer-reviewed journals; (4) posts on the organisational websites.
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Judith Sabetti
- School of Social Work, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Research Centre, Montreal, Quebec, Canada
| | - Angella Lambrou
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Quebec, Canada
| | - Howard Chodos
- Mental Health Commission of Canada-Ottawa, Ottawa, Ontario, Canada
| | - Catherine Briand
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Brigitte Vachon
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
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Friesen BJ, Cross TL, Jivanjee P, Thirstrup A, Bandurraga A, Gowen LK, Rountree J. Meeting the Transition Needs of Urban American Indian/Alaska Native Youth through Culturally Based Services. J Behav Health Serv Res 2016; 42:191-205. [PMID: 25388647 DOI: 10.1007/s11414-014-9447-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article reports findings from three qualitative studies exploring supports for positive transitions of American Indian/Alaska Native (AI/AN) youth to adulthood. Community-based participatory methods were employed through a research partnership involving a culturally based community agency, the Native American Youth and Family Center (NAYA), the National Indian Child Welfare Association, and Portland State University. Studies utilized a Relational Worldview (RWV) framework, where well-being is understood as a balance among the domains of mind, body, spirit, and context. Collectively, findings demonstrate that NAYA employs culturally grounded interventions to overcome the traumatic histories and current oppressive conditions affecting low-income urban AI/AN youth with mental health challenges and to support their well-being and transition to adulthood. In addition, addressing the mental health and well-being of AI/AN youth in culturally appropriate ways involves consideration of all RWV domains. Recommendations for behavioral health practice are to connect AI/AN youth to culturally specific services whenever possible, utilize cultural consultants, and implement holistic and positive approaches to mental health.
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Affiliation(s)
- Barbara J Friesen
- Pathways to Positive Futures, Regional Research Institute, School of Social Work, Portland State University, Portland, OR, 97207-0715, USA,
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Bulut M, Arslantaş H, Ferhan Dereboy İ. Effects of Psychoeducation Given to Caregivers of People With a Diagnosis of Schizophrenia. Issues Ment Health Nurs 2016; 37:800-810. [PMID: 27696929 DOI: 10.1080/01612840.2016.1222039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the effectiveness of psychoeducation given to caregivers of patients diagnosed with schizophrenia on their perceptions of burden and on clinical course of patients. This was a quasi-experimental study with pre-post tests and a control group and designed as a nonrandomized controlled intervention trial. While the patients in both the intervention and the control group received treatment as usual (TAU), only the caregivers in the study group were offered two sessions of psychoeducation a week for one month, with a total of eight sessions. Effectiveness of the psychoeducation given was evaluated by comparing scores of Perceived Family Burden Scale (PFBS) and Positive and Negative Syndrome Scale (PANSS) obtained before and three months after delivery between the intervention and the control groups. Mean PFBS burden scores of the control group at baseline and follow-up were 45.7 and 44.5, respectively. Mean PFBS burden scores of the intervention group were 45.2 at baseline and 38.6 at follow-up. Analysis of variance revealed significant and medium to large size interaction effects of time and group factors on total burden scores of family members (F1.58 = 5.59; p < 0.05; ηp2 = 0.09) and on total PANSS scores of patients (F1.58 = 104.78; p < 0.001; ηp2 = 0.64). Our findings suggest that psychoeducation offered to the caregivers along with TAU offered to patients might result in diminished perceptions of burden among caregivers and enhanced improvement in the clinical course of patients as a result of psychoeducation offered to caregivers.
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Affiliation(s)
- Müge Bulut
- a Adnan Menderes University, Research and Teaching Hospital Psychiatry Clinic , Aydin , Turkey
| | - Hülya Arslantaş
- b Adnan Menderes University , Aydin Health Sciences Institute Department of Mental Health Nursing , Aydin , Turkey
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18
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Korsbek L. Corecovery: Mental health recovery in a dynamic interplay between humans in a relationship. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1197863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Determining engagement in services for high-need individuals with serious mental illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:588-97. [PMID: 23636712 DOI: 10.1007/s10488-013-0497-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined whether Medicaid claims and other administrative data could identify high-need individuals with serious mental illness in need of outreach in a large urban setting. A claims-based notification algorithm identified individuals belonging to high-need cohorts who may not be receiving needed services. Reviewers contacted providers who previously served the individuals to confirm whether they were in need of outreach. Over 10,000 individuals set a notification flag over 12-months. Disengagement was confirmed in 55 % of completed reviews, but outreach was initiated for only 30 %. Disengagement and outreach status varied by high-need cohort.
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Huguelet P, Guillaume S, Vidal S, Mohr S, Courtet P, Villain L, Girod C, Hasler R, Prada P, Olié E, Perroud N. Values as determinant of meaning among patients with psychiatric disorders in the perspective of recovery. Sci Rep 2016; 6:27617. [PMID: 27272094 PMCID: PMC4897784 DOI: 10.1038/srep27617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/24/2016] [Indexed: 11/08/2022] Open
Abstract
Recovery is a personal process of growth that involves hope, self-identity, meaning in life and responsibility. Determinants of meaning have not been explored among populations of patients with persistent psychiatric conditions. However, an evidence-based approach aiming at assessing such determinants should provide some insight into the psychotherapeutic aspects of recovery. We tested a model hypothesizing that some symptoms and social parameters of patients are related to values, and secondarily to meaning in life, and in turn that meaning is associated with various parameters, such as depressiveness and self-esteem. We assessed 176 patients with schizophrenia, anorexia, borderline personality disorder and bipolar disorder. Overall, our hypotheses proved correct: firstly, characteristics such as depression, hopelessness, self-esteem and the number of relationships influenced values; secondly, the presence and an enactment of values were associated with meaning, and thirdly, meaning was associated with some symptoms and social characteristics. This model was confirmed in the four psychiatric populations under study. These results support the relevance of addressing values and meaning in the recovery-oriented care of patients with persistent psychiatric disorders, in addition to other psychosocial interventions which are more systematically considered in this area.
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Affiliation(s)
- Philippe Huguelet
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sébastien Guillaume
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
- Inserm, U1061, Université Montpellier, Montpellier, France
- Fondamental Foundation, Foundation of Scientific Cooperation, France
| | - Sonia Vidal
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Sylvia Mohr
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
- Inserm, U1061, Université Montpellier, Montpellier, France
- Fondamental Foundation, Foundation of Scientific Cooperation, France
| | - Lucile Villain
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
| | - Chloé Girod
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
| | - Roland Hasler
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, France
- Inserm, U1061, Université Montpellier, Montpellier, France
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
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Abstract
Spirituality and meaning in life are key dimensions of recovery in psychiatric disorders. The aim of this study was to explore spiritual meaning in life in relation to values and mental health among 175 patients with schizophrenia, borderline personality disorder, bipolar disorder, and anorexia nervosa. For 26% of the patients, spirituality was essential in providing meaning in life. Depending on the diagnosis, considering spirituality as essential in life was associated with better social functioning; self-esteem; psychological and social quality of life; fewer negative symptoms; higher endorsement of values such as universalism, tradition (humility, devoutness), and benevolence (helpfulness); and a more meaningful perspective in life. These results highlight the importance of spirituality for recovery-oriented care.
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Piat M, Briand C, Bates E, Labonté L. Recovery Communities of Practice: An Innovative Strategy for Mental Health System Transformation. Psychiatr Serv 2016; 67:10-2. [PMID: 26325462 PMCID: PMC4835235 DOI: 10.1176/appi.ps.201500184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the development of a "community of practice" (CoP) in Quebec, which was implemented in 2012 to promote recovery-oriented practices in mental health care. A group of diverse stakeholders work together to share and transfer knowledge; support diverse practices, strategies, and solutions; develop a culture of collaboration; mobilize opportunities for quality improvement; and influence decision-making bodies. Recent efforts have been successful: the provision of recovery-oriented services is the primary focus of the 2015-2020 Quebec Mental Health Action Plan.
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Affiliation(s)
- Myra Piat
- Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Montreal, Quebec (e-mail: ). She is also with Douglas Mental Health Institute, Montreal, where Ms. Bates is affiliated. Dr. Briand is with the Mental Health University Institute of Montreal, University of Montreal, Montreal. Ms. Labonté is with Quebec Community of Practice on Recovery. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Catherine Briand
- Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Montreal, Quebec (e-mail: ). She is also with Douglas Mental Health Institute, Montreal, where Ms. Bates is affiliated. Dr. Briand is with the Mental Health University Institute of Montreal, University of Montreal, Montreal. Ms. Labonté is with Quebec Community of Practice on Recovery. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Eloise Bates
- Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Montreal, Quebec (e-mail: ). She is also with Douglas Mental Health Institute, Montreal, where Ms. Bates is affiliated. Dr. Briand is with the Mental Health University Institute of Montreal, University of Montreal, Montreal. Ms. Labonté is with Quebec Community of Practice on Recovery. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
| | - Lise Labonté
- Dr. Piat is with the Department of Psychiatry and the Department of Social Work, McGill University, Montreal, Quebec (e-mail: ). She is also with Douglas Mental Health Institute, Montreal, where Ms. Bates is affiliated. Dr. Briand is with the Mental Health University Institute of Montreal, University of Montreal, Montreal. Ms. Labonté is with Quebec Community of Practice on Recovery. Marcela Horvitz-Lennon, M.D., M.P.H., is editor of this column
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Abstract
A recovery paradigm that promotes service user involvement, empowerment, and agency has been a guiding principle for the transformation of mental health services internationally. Incorporating recovery values into traditional mental health care settings, however, has been problematic due to organizational, structural, and attitudinal barriers. A new emphasis on contexts, values, and partnerships with service users requires providers to collectively redefine their roles, creating a shift in both individual and organizational identities. This conceptual article provides an in-depth exploration of the social and cultural factors involved in frontline mental health care, highlighting the nature of shared cognition in organizational learning as well as the conflicting forces that promote social stability and change. Using theory drawn from clinical, organizational, and social science literature, the article will discuss the competing ideologies in mental health care, emphasizing the need to create new learning conversations that honor the system’s capacity while creating the necessary dissonance for transformation.
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Affiliation(s)
- Ronna Schwartz
- McGill University Health Centre, Montreal, Quebec, Canada
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Dahlqvist Jönsson P, Schön UK, Rosenberg D, Sandlund M, Svedberg P. Service users' experiences of participation in decision making in mental health services. J Psychiatr Ment Health Nurs 2015; 22:688-97. [PMID: 26148016 DOI: 10.1111/jpm.12246] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/27/2022]
Abstract
ACCESSIBLE SUMMARY Despite the potential positive impact of shared decision making on service users knowledge and experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. This study highlights the desire of users to participate more actively in decision making and demonstrates that persons with SMI struggle to be seen as competent and equal partners in decision-making situations. Those interviewed did not feel that their strengths, abilities and needs were being recognized, which resulted in a feeling of being omitted from involvement in decision-making situations. The service users describe some essential conditions that could work to promote participation in decision making. These included having personal support, having access to knowledge, being involved in a dialogue and clarity about responsibilities. Mental health nurses can play an essential role for developing and implementing shared decision making as a tool to promote recovery-oriented mental health services. ABSTRACT Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.
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Affiliation(s)
- P Dahlqvist Jönsson
- Department of Research, Development and Education (FoUU), Region of Halland, Sweden.,School of Health and Welfare, Halmstad University, Sweden
| | - U-K Schön
- School of Health and Social Work, Dalarna University, Sweden
| | - D Rosenberg
- Department of Social Work, Umeå University, Sweden
| | - M Sandlund
- Department of Social Work, Umeå University, Sweden.,Department of Clinical Science, Umeå University, Sweden
| | - P Svedberg
- School of Health and Welfare, Halmstad University, Sweden
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Smith-Merry J, Gillespie J, Hancock N, Yen I. Doing mental health care integration: a qualitative study of a new work role. Int J Ment Health Syst 2015; 9:32. [PMID: 26300963 PMCID: PMC4546146 DOI: 10.1186/s13033-015-0025-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health care in Australia is fragmented and inaccessible for people experiencing severe and complex mental ill-health. Partners in Recovery is a Federal Government funded scheme that was designed to improve coordination of care and needs for this group. Support Facilitators are the core service delivery component of this scheme and have been employed to work with clients to coordinate their care needs and, through doing so, bring the system closer together. OBJECTIVE To understand how Partners in Recovery Support Facilitators establish themselves as a new role in the mental health system, their experiences of the role, the challenges that they face and what has enabled their work. METHODS In-depth qualitative interviews were carried out with 15 Support Facilitators and team leaders working in Partners in Recovery in two regions in Western Sydney (representing approximately 35 % of those working in these roles in the regions). Analysis of the interview data focused on the work that the Support Facilitators do, how they conceptualise their role and enablers and barriers to their work. RESULTS The support facilitator role is dominated by efforts to seek out, establish and maintain connections of use in addressing their clients' needs. In doing this Support Facilitators use existing interagency forums and develop their own ad hoc groupings through which they can share knowledge and help each other. Support Facilitators also use these groups to educate the sector about Partners in Recovery, its utility and their own role. The diversity of support facilitator backgrounds are seen as both and asset and a barrier and they describe a process of striving to establish an internally collective identity as well as external role clarity and acceptance. At this early stage of PIR establishment, poor communication was identified as the key barrier to Support Facilitators' work. CONCLUSIONS We find that the Support Facilitators are building the role from within and using trial and error to develop their practice in coordination. We argue that a strong organisational hierarchy is necessary for support facilitation to be effective and to allow the role to develop effectively. We find that their progress is limited by overall program instability caused by changing government policy priorities.
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Affiliation(s)
- Jennifer Smith-Merry
- />Faculty of Health Sciences and Menzies Centre for Health Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Jim Gillespie
- />School of Public Health and Menzies Centre for Health Policy, Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006 Australia
| | - Nicola Hancock
- />Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
| | - Ivy Yen
- />Faculty of Health Sciences and Menzies Centre for Health Policy, University of Sydney, PO Box 170, Lidcombe, NSW 1825 Australia
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Jaeger M, Konrad A, Rueegg S, Rabenschlag F. Patients' subjective perspective on recovery orientation on an acute psychiatric unit. Nord J Psychiatry 2015; 69:188-95. [PMID: 25241849 DOI: 10.3109/08039488.2014.959561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. AIM This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. METHODS During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n = 34 and n = 29) were compared with regard to subjective parameters (e.g. patients' attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). RESULTS Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. CONCLUSIONS The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery.
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Affiliation(s)
- Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry , Zurich , Switzerland
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Wilrycx G, Croon M, Van den Broek A, van Nieuwenhuizen C. Evaluation of a recovery-oriented care training program for mental healthcare professionals: effects on mental health consumer outcomes. Int J Soc Psychiatry 2015; 61:164-73. [PMID: 24965441 DOI: 10.1177/0020764014537638] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine the effects of a recovery-oriented care training program for mental healthcare professionals on mental health consumer outcomes. METHODS The Mental Health Recovery Measure (MHRM) and the Recovery-Promoting Relationship Scale (RPRS) were administered to a sample of 142 consumers with severe mental illness. A repeated measurement design with six measurement occasions was used. ANALYSES Separate analyses were performed for the MHRM and RPRS subscales. Data were analyzed by means of the software package AMOS for structural equation modeling. First, the means of the five scales were computed at each measurement occasion. Next, two series of regression analyses were conducted: the first series aimed to ascertain whether gender and age have a significant effect on the MHRM and RPRS scores, and the second series aimed to detect a systematic trend in the average scale response of the MHRM and RPRS. RESULTS Scores showed a significant change over time for the subscale 'Learning & new potentials' of the MHRM. Significant effects were also found for gender, with men scoring higher than women on the subscales 'Self-empowerment' and 'Learning & new potentials'. Age had no effect on the MHRM and RPRS. The scores on the RPRS showed no significant change over time. CONCLUSIONS One year after completion of the recovery-oriented training program for professionals, positive results were found for two subscales of the MHRM, that is, 'Self- empowerment' and 'Learning & new potentials'.
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Affiliation(s)
- Greet Wilrycx
- Scientific Center for Care and Welfare (Tranzo), University of Tilburg University, Tilburg, The Netherlands GGzBreburg, Institute of Mental Health Care,Tilburg, The Netherlands
| | - Marcel Croon
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | | | - Chijs van Nieuwenhuizen
- Scientific Center for Care and Welfare (Tranzo), University of Tilburg University, Tilburg, The Netherlands GGz Eindhoven, Institute of Mental Health Care, Eindhoven, The Netherlands
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Le Melle S, Clemmey P, Ranz J. Outpatient training in public/community psychiatry and systems-based practices. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2014; 38:693-695. [PMID: 24683054 DOI: 10.1007/s40596-014-0084-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/03/2014] [Indexed: 06/03/2023]
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Shen GC, Snowden LR. Institutionalization of deinstitutionalization: a cross-national analysis of mental health system reform. Int J Ment Health Syst 2014; 8:47. [PMID: 25473417 PMCID: PMC4253997 DOI: 10.1186/1752-4458-8-47] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 11/11/2014] [Indexed: 12/03/2022] Open
Abstract
Background Policies generate accountability in that they offer a standard against which government performance can be assessed. A central question of this study is whether ideological imprint left by policy is realized in the time following its adoption. National mental health policy expressly promotes the notion of deinstitutionalization, which mandates that individuals be cared for in the community rather than in institutional environments. Methods We investigate whether mental health policy adoption induced a transformation in the structure of mental health systems, namely psychiatric beds, using panel data on 193 countries between 2001 and 2011. Results Our striking regression results demonstrate that late-adopters of mental health policy are more likely to reduce psychiatric beds in mental hospitals and other biomedical settings than innovators, whereas they are less likely than non-adopters to reduce psychiatric beds in general hospitals. Conclusions It can be inferred late adopters are motivated to implement deinstitutionalization for technical efficiency rather than social legitimacy reasons. Electronic supplementary material The online version of this article (doi:10.1186/1752-4458-8-47) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gordon C Shen
- School of Public Health, Yale University, 60 College Street, P.O. Box 208034, New Haven, CT 06520 USA
| | - Lonnie R Snowden
- School of Public Health, University of California at Berkeley, 235 University Hall, Berkeley, CA 94720 USA
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Hultqvist J, Eklund M, Leufstadius C. Empowerment and occupational engagement among people with psychiatric disabilities. Scand J Occup Ther 2014; 22:54-61. [PMID: 25100023 DOI: 10.3109/11038128.2014.934916] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Empowerment is essential in the rehabilitation process for people with psychiatric disabilities and knowledge about factors that may play a key role within this process would be valuable for further development of the day centre services. OBJECTIVE The present study investigates day centre attendees' perceptions of empowerment. The aim was to investigate which factors show the strongest relationships to empowerment when considering occupational engagement, client satisfaction with day centres, and health-related and socio-demographic factors as correlates. METHODS 123 Swedish day centre attendees participated in a cross-sectional study by completing questionnaires regarding empowerment and the targeted correlates. Data were analysed with non-parametric statistics. RESULTS Empowerment was shown to be significantly correlated with occupational engagement and client satisfaction and also with self-rated health and symptoms rated by a research assistant. The strongest indicator for belonging to the group with the highest ratings on empowerment was self-rated health, followed by occupational engagement and symptom severity. IMPLICATIONS Occupational engagement added to the beneficial influence of self-rated health on empowerment. Enabling occupational engagement in meaningful activities and providing occupations that can generate client satisfaction is an important focus for day centres in order to assist the attendees' rehabilitation process so that it promotes empowerment.
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Affiliation(s)
- Jenny Hultqvist
- Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University , Sweden
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31
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Exploring the relationship between treatment satisfaction, perceived improvements in functioning and well-being and gambling harm reduction among clients of pathological gambling treatment programs. Community Ment Health J 2014; 50:688-96. [PMID: 23756725 PMCID: PMC4112598 DOI: 10.1007/s10597-013-9635-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
The objective of this study was to evaluate the relationship between treatment service quality, perceived improvement in social, functional, and material well-being and reduction in gambling behaviors among clients of Nevada state-funded pathological gambling treatment programs. Utilizing survey data from 361 clients from 2009 to 2010, analyses revealed that client satisfaction with treatment services is positively associated with perceived improvements in social, functional, and material well-being, abstinence from gambling, reduction in gambling thoughts and reduction in problems associated with gambling, even after controlling for various respondent characteristics. These findings can be useful to treatment program staff in managing program development and allocating resources.
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Huguelet P. The Contribution of Existential Phenomenology in the Recovery-Oriented Care of Patients with Severe Mental Disorders. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2014; 39:346-67. [DOI: 10.1093/jmp/jhu023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction? Psychiatr Q 2014; 85:225-39. [PMID: 24307177 DOI: 10.1007/s11126-013-9285-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project.
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Kidd SA, McKenzie KJ, Virdee G. Mental health reform at a systems level: widening the lens on recovery-oriented care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:243-9. [PMID: 25007277 PMCID: PMC4079144 DOI: 10.1177/070674371405900503] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/01/2014] [Indexed: 11/15/2022]
Abstract
This paper is an initial attempt to collate the literature on psychiatric inpatient recovery-based care and, more broadly, to situate the inpatient care sector within a mental health reform dialogue that, to date, has focused almost exclusively on outpatient and community practices. We make the argument that until an evidence base is developed for recovery-oriented practices on hospital wards, the effort to advance recovery-oriented systems will stagnate. Our scoping review was conducted in line with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (commonly referred to as PRISMA) guidelines. Among the 27 papers selected for review, most were descriptive or uncontrolled outcome studies. Studies addressing strategies for improving care quality provide some modest evidence for reflective dialogue with former inpatient clients, role play and mentorship, and pairing general training in recovery oriented care with training in specific interventions, such as Illness Management and Recovery. Relative to some other fields of medicine, evidence surrounding the question of recovery-oriented care on psychiatric wards and how it may be implemented is underdeveloped. Attention to mental health reform in hospitals is critical to the emergence of recovery-oriented systems of care and the realization of the mandate set forward in the Mental Health Strategy for Canada.
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Affiliation(s)
- Sean A Kidd
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Head, Psychology Service, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario
- Correspondence: Schizophrenia Division, CAMH, 1001 Queen Street West, Unit 2–1, #161, Toronto, ON M6J 1H1;
| | - Kwame J McKenzie
- Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Medical Director, Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Gursharan Virdee
- Student, City University, Department of Psychology, London, England; Research Analyst, Complex Mental Illness Program, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario
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Drake RE, Whitley R. Recovery and severe mental illness: description and analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:236-42. [PMID: 25007276 PMCID: PMC4079142 DOI: 10.1177/070674371405900502] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/01/2014] [Indexed: 11/16/2022]
Abstract
The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system.
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Affiliation(s)
- Robert E Drake
- Professor of Psychiatry, Dartmouth Psychiatric Research Center, Lebanon, New Hampshire
| | - Rob Whitley
- Assistant Professor of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec
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Tickle A, Brown D, Hayward M. Can we risk recovery? A grounded theory of clinical psychologists' perceptions of risk and recovery-oriented mental health services. Psychol Psychother 2014; 87:96-110. [PMID: 24497399 DOI: 10.1111/j.2044-8341.2012.02079.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 08/19/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to explore the views of clinical psychologists towards the concepts of 'risk' and 'recovery' and to set those views against the context of mental health services. DESIGN An exploratory, social constructionist grounded theory methodology was adopted. METHODS Eleven clinical psychologists working in adult mental health services each participated in one individual semistructured interview. RESULTS The clinical psychologists studied were aware of the emergence of recovery-oriented approaches, but felt unable to incorporate them in practice because of perceptions of being bound by both their own limitations and those of their circumstances, including issues of risk, thus giving rise to dilemmas in professional practice. Narrow definitions of risk as equated to danger dominated over broader conceptualizations of risk with positive consequences. The existing culture of mental health services was seen as emphasizing the need to avoid harmful consequences of taking risks, which in turn was seen to limit innovations in implementing recovery-oriented approaches. CONCLUSIONS Participants' ability to work in a recovery-oriented manner seemed to be limited by the way in which services perceived and responded to risk. Participants did not discuss risks arising from stigma, social exclusion, racism, sexism, or iatrogenic effects of psychiatric treatment. Narrow conceptualizations of risk as related to harm and danger seen in this study contribute to a sense of needing to be risk averse. However, the implications for practice included ideas about what might increase the possibilities for adopting recovery approaches across disciplines.
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Affiliation(s)
- Anna Tickle
- Nottinghamshire Healthcare NHS Trust, University of Nottingham, UK
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37
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Smith D, Roche E, O’Loughlin K, Brennan D, Madigan K, Lyne J, Feeney L, O’Donoghue B. Satisfaction with services following voluntary and involuntary admission. J Ment Health 2014; 23:38-45. [DOI: 10.3109/09638237.2013.841864] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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38
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van Gestel-Timmermans JAWM, Brouwers EPM. Feasibility and Usefulness of the Peer-Run Course “Recovery Is Up to You” for People with Addiction Problems: A Qualitative Study. ALCOHOLISM TREATMENT QUARTERLY 2014. [DOI: 10.1080/07347324.2014.856228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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A community engaged curriculum for public service psychiatry fellowship training. Community Ment Health J 2014; 50:17-24. [PMID: 23338834 DOI: 10.1007/s10597-012-9587-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
Abstract
Transforming the mental health system into a recovery oriented, integrated system of care requires a psychiatric work force that understands the relationship between recovery processes and community living. Fellowship programs in public and community psychiatry contribute to this transformation by educating psychiatrists about recovery, system dynamics, leadership, effective administration and community involvement. This paper describes a novel approach to fellowship programming that accomplishes these aims through an organizational strategy that emphasizes community engagement. After describing the administrative background for the program, we describe how the content curriculum and teaching process focus on the engagement of community members-both service users and service providers-as participating faculty. The faculty includes over 100 consumers, family members, advocacy group representatives, clinicians, and administrators. We present evaluation data obtained from 45 of the 100 community and university faculty who participated in the first 2 years' of the fellowship and conclude with a critique and recommendations for further progress in community engaged fellowship training.
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40
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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41
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Aubry T, Flynn RJ, Virley B, Neri J. SOCIAL ROLE VALORIZATION IN COMMUNITY MENTAL HEALTH HOUSING: DOES IT CONTRIBUTE TO THE COMMUNITY INTEGRATION AND LIFE SATISFACTION OF PEOPLE WITH PSYCHIATRIC DISABILITIES? JOURNAL OF COMMUNITY PSYCHOLOGY 2013; 41:218-235. [PMID: 23658470 PMCID: PMC3644172 DOI: 10.1002/jcop.21524] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Despite its importance as a theory in the development of programs for populations with disabilities, social role valorization (SRV) has received relatively little attention in community mental health research. We present findings of a study that examined the relationship of housing-related SRV to community integration and global life satisfaction of persons with psychiatric disabilities. The housing environments and associated supports of a group of 73 persons with psychiatric disabilities living in a mid-sized city were assessed using the PASSING rating system on the extent that their housing environments facilitated SRV. In addition, in-person interviews were conducted to determine the levels of physical integration, psychological integration, social integration, and life satisfaction of study participants. Results showed SRV contributing directly to all three types of community integration. Psychological integration was found to mediate the relationship between SRV and life satisfaction. Implications of the findings are discussed. © 2013 Wiley Periodicals, Inc.
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Bonhomme J, Shim RS, Gooden R, Tyus D, Rust G. Opioid addiction and abuse in primary care practice: a comparison of methadone and buprenorphine as treatment options. J Natl Med Assoc 2012; 104:342-50. [PMID: 23092049 DOI: 10.1016/s0027-9684(15)30175-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Opioid abuse and addiction have increased in frequency in the United States over the past 20 years. In 2009, an estimated 5.3 million persons used opioid medications nonmedically within the past month, 200000 used heroin, and approximately 9.6% of African Americans used an illicit drug. Racial and ethnic minorities experience disparities in availability and access to mental health care, including substance use disorders. Primary care practitioners are often called upon to differentiate between appropriate, medically indicated opioid use in pain management vs inappropriate abuse or addiction. Racial and ethnic minority populations tend to favor primary care treatment settings over specialty mental health settings. Recent therapeutic advances allow patients requiring specialized treatment for opioid abuse and addiction to be managed in primary care settings. The Drug Addiction Treatment Act of 2000 enables qualified physicians with readily available short-term training to treat opioid-dependent patients with buprenorphine in an office-based setting, potentially making primary care physicians active partners in the diagnosis and treatment of opioid use disorders. Methadone and buprenorphine are effective opioid replacement agents for maintenance and/or detoxification of opioid-addicted individuals. However, restrictive federal regulations and stigmatization of opioid addiction and treatment have limited the availability of methadone. The opioid partial agonist-antagonist buprenorphine/naloxone combination has proven an effective alternative. This article reviews the literature on differences between buprenorphine and methadone regarding availability, efficacy, safety, side-effects, and dosing, identifying resources for enhancing the effectiveness of medication-assisted recovery through coordination with behavioral/psychological counseling, embedded in the context of recovery-oriented systems of care.
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Affiliation(s)
- Jean Bonhomme
- Department of Psychiatry and Behavioral Sciences,Morehouse School of Medicine, Atlanta, Georgia, USA.
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43
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Affiliation(s)
| | - Bill Whyte
- Social Work Studies in Criminal and Youth Justice; University of Edinburgh
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44
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Recovery-promoting Care as Experienced by Persons with Severe Mental Illness and Substance Misuse. Int J Ment Health Addict 2011. [DOI: 10.1007/s11469-011-9363-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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45
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Integration of Spirituality and Religion in the Care of Patients with Severe Mental Disorders. RELIGIONS 2011. [DOI: 10.3390/rel2040549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Kresina TF, Lubran R. Improving public health through access to and utilization of medication assisted treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:4102-17. [PMID: 22073031 PMCID: PMC3210600 DOI: 10.3390/ijerph8104102] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/07/2011] [Indexed: 11/16/2022]
Abstract
Providing access to and utilization of medication assisted treatment (MAT) for the treatment of opioid abuse and dependence provides an important opportunity to improve public health. Access to health services comprising MAT in the community is fundamental to achieve broad service coverage. The type and placement of the health services comprising MAT and integration with primary medical care including human immunodeficiency virus (HIV) prevention, care and treatment services are optimal for addressing both substance abuse and co-occurring infectious diseases. As an HIV prevention intervention, integrated (same medical record for HIV services and MAT services) MAT with HIV prevention, care and treatment programs provides the best "one stop shopping" approach for health service utilization. Alternatively, MAT, medical and HIV services can be separately managed but co-located to allow convenient utilization of primary care, MAT and HIV services. A third approach is coordinated care and treatment, where primary care, MAT and HIV services are provided at distinct locations and case managers, peer facilitators, or others promote direct service utilization at the various locations. Developing a continuum of care for patients with opioid dependence throughout the stages MAT enhances the public health and Recovery from opioid dependence. As a stigmatized and medical disenfranchised population with multiple medical, psychological and social needs, people who inject drugs and are opioid dependent have difficulty accessing services and navigating medical systems of coordinated care. MAT programs that offer comprehensive services and medical care options can best contribute to improving the health of these individuals thereby enhancing the health of the community.
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Affiliation(s)
- Thomas F. Kresina
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA; E-Mail:
| | - Robert Lubran
- Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857, USA; E-Mail:
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Davis TS, Gavazzi SM, Scheer SD, Kwon IA, Lammers A, Fristad MA, Uppal R. Measuring Family Caregiver Perceptions of Support in Caring for Children and Youth With Mental Health Concerns. JOURNAL OF SOCIAL SERVICE RESEARCH 2011; 37:500-515. [PMID: 36157531 PMCID: PMC9495926 DOI: 10.1080/01488376.2011.607366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This correlational study assessed how families of children with mental illness perceived the levels of support they received from informal and formal resource providers and the associations between perceived support and child outcomes. Adult caregivers (N = 904) of youth receiving public mental health care services were administered the Family Caregiver Perceptions of Support Scale developed by the authors to assess family caregiver perceptions of support prior to and at termination of services. Factor analysis identified three types of caregiver anticipated supports: informal support resources, support for treatment plan influence, and health care resources. The domains were significantly and positively associated with one another but did not uniformly correlate with youth mental health outcomes. The study provides preliminary evidence that treatment gains in youth mental health outcomes are observed when caregivers perceive support in treatment processes. Suggestions for future research are made, stressing the importance of caregivers and providers working together and describing needs related to future scale improvements.
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Affiliation(s)
- Tamara S. Davis
- The Ohio State University, College of Social Work, Columbus, OH
| | | | - Scott D. Scheer
- The Ohio State University, Human and Community Resource Development & OSU Extension, Columbus, OH
| | - Il An Kwon
- The Ohio State University, Human Development and Family Science, Columbus, OH
| | | | - Mary A. Fristad
- The Ohio State University, Division of Child & Adolescent Psychiatry, Columbus, OH
| | - Reena Uppal
- The Ohio State University, OSU Center for Family Research, Columbus, OH
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Lindström M, Hariz GM, Bernspång B. Dealing with Real-Life Challenges: Outcome of a Home-Based Occupational Therapy Intervention for People with Severe Psychiatric Disability. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2011. [DOI: 10.3928/15394492-20110819-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful daily occupations. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 and 66 years participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a 6-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made. These findings support the use of the ELR intervention and suggest that larger randomized clinical trials are needed.
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Berghofer G, Castille DM, Link B. Evaluation of Client Services (ECS): a measure of treatment satisfaction for people with chronic mental illnesses. Community Ment Health J 2011; 47:399-407. [PMID: 20582570 DOI: 10.1007/s10597-010-9331-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Accepted: 06/08/2010] [Indexed: 01/18/2023]
Abstract
This article describes the development and psychometric assessment of the Evaluation of Client Services (ECS) measure of treatment satisfaction for people with chronic mental illnesses in community treatment settings. The ECS, a 20-item instrument, was validated in a sample of 184 individuals receiving outpatient mental health treatment in New York City. The four dimensions of the ECS, (1) treatment management and treatment outcome, (2) treatment relationship, (3) communication and information exchange, and (4) reachability of treatment facilities are internally consistent and stable over time. Analyses also show that the ECS is a valid indicator of satisfaction with mental health services which meaningfully correlates with quality of life and another measure of treatment satisfaction. The ECS is a brief and easy to understand treatment satisfaction tool with good psychometric properties.
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Affiliation(s)
- Gerlinde Berghofer
- Department of Quality Assurance, Psychosocial Services Vienna, Gonzagagasse 15, 1013 Vienna, Austria.
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50
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Brown TT, Mahoney CB, Adams N, Felton M, Pareja C. What predicts recovery orientation in county departments of mental health? A pilot study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2010; 37:388-98. [PMID: 19888648 PMCID: PMC2929347 DOI: 10.1007/s10488-009-0253-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this pilot study we examined the determinants of recovery orientation among employees and influential stakeholders in a sample of 12 county departments of mental health in California. A two-level hierarchical linear model with random intercepts was estimated. Analyses show that recovery orientation has a U-shaped relationship with the age of staff/influential stakeholders and is negatively related to the difference between the desired level of adhocracy and the current level of adhocracy. Recovery orientation is positively related to the education level of staff/influential stakeholders, satisfying transformational leadership outcomes, and larger mental health budgets per capita. Policy implications are discussed.
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Affiliation(s)
- Timothy T Brown
- Petris Center, School of Public Health, University of California at Berkeley, Berkeley, CA 94704, USA.
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