Six-month outcomes of an integrated assertive community treatment team serving adults with complex behavioral health and housing needs

Current insights of community mental healthcare for people with severe mental illness: A scoping review

Background

For the last four decades, there has been a shift in mental healthcare toward more rehabilitation and following a more humanistic and comprehensive vision on recovery for persons with severe mental illness (SMI). Consequently, many community-based mental healthcare programs and services have been developed internationally. Currently, community mental healthcare is still under development, with a focus on further inclusion of persons with enduring mental health problems. In this review, we aim to provide a comprehensive overview of existing and upcoming community mental healthcare approaches to discover the current vision on the ingredients of community mental healthcare.

Methods

We conducted a scoping review by systematically searching four databases, supplemented with the results of Research Rabbit, a hand-search in reference lists and 10 volumes of two leading journals. We included studies on adults with SMI focusing on stimulating independent living, integrated care, recovery, and social inclusion published in English between January 2011 and December 2022 in peer-reviewed journals.

Results

The search resulted in 56 papers that met the inclusion criteria. Thematic analysis revealed ingredients in 12 areas: multidisciplinary teams; collaboration within and outside the organization; attention to several aspects of health; supporting full citizenship; attention to the recovery of daily life; collaboration with the social network; tailored support; well-trained staff; using digital technologies; housing and living environment; sustainable policies and funding; and reciprocity in relationships.

Conclusion

We found 12 areas of ingredients, including some innovative topics about reciprocity and sustainable policies and funding. There is much attention to individual ingredients for good community-based mental healthcare, but very little is known about their integration and implementation in contemporary, fragmented mental healthcare services. For future studies, we recommend more empirical research on community mental healthcare, as well as further investigation(s) from the social service perspective, and solid research on general terminology about SMI and outpatient support.

[Homelessness and mental illnesses]

Wohnungslosigkeit ist Ausdruck ausgeprägter sozialer Exklusionsphänomene und trifft besonders häufig Menschen mit seelischen Erkrankungen. Hierbei gehen die Erkrankungen meist der Wohnungslosigkeit vorweg, wobei einige seelische Störungen erst infolge der Wohnungslosigkeit auftreten. International wurde eine Vielzahl therapeutischer Unterstützungsformen für wohnungslose Menschen mit seelischen Erkrankungen evaluiert mit vorwiegend aufsuchenden Behandlungsstrategien. Dies wird häufig kombiniert mit niedrigschwelliger Zurverfügungstellung von Wohnraum. Hierbei zeigen sich gute Effekte auf die Zeit des Verbleibs in Wohnungen und auf die Verbesserung psychiatrischer Symptome, allerdings keine ausreichenden Effekte auf Substanzgebrauchsstörungen. Möglichkeiten zukünftiger Projekte liegen am ehesten im Einbezug ehemals Betroffener und in der Verwendung digitaler Medien.

Dual diagnosis: A systematic review of the organization of community health services

BACKGROUND

Dual diagnosis (DD), as the co-occurrence of a substance use disorder and a psychiatric disorder, is underestimated, under-diagnosed and often poorly treated throughout the world, although it is highly prevalent in people suffering from a mental disorder.

AIMS AND METHODS

This review analyzed 48 studies from a PubMed and PsycINFO databases search, in order to verify the state of the art regarding the organization of community health services for DD treatment.

RESULTS

Four macro-themes have been identified: service organization, critical issues, assessment tools and evidence-based interventions. An effective service recognizes the complexity of DD, promotes a common staff culture, and tailors the organization to local needs. The main critical issues in its implementation include the lack of specific staff training, the poor management of resources and the need for greater personalization of care plans, with attention to psychosocial interventions. Integrated service assessment tools can be used as a benchmark measure at the program level for implementation planning and at the national level to affect policy change. The integrated treatment model for DD should also aim to improve access to care and offer treatments based on scientific evidence. It is also evident that the integration of services can improve outcomes but it is not a guarantee for it.

CONCLUSION

There is an urgent need to improve networking between mental health and addiction services in order to deal with DD and create new integrated intervention models, paying attention to an approach to the whole person, seen in his/her absolute uniqueness.

Unidirectionality Between Borderline Personality Disorder Traits and Psychopathology in a Residential Addictions Sample: A Short-Term Longitudinal Study

Borderline personality disorder (BPD) is a barrier to treatment, yet the relationship between BPD features and other psychopathology symptoms in residential addictions treatment samples is understudied. Using a sample of adults enrolled in a residential drug treatment facility measured at baseline and 2-3 month follow-up, the authors examined the prospective relationship between BPD features and five indices of psychopathology: depression, anxiety, interpersonal sensitivity, hostility, and psychoticism, as well as psychopathology global severity. There was no effect of time on any of the forms of psychopathology, but females reported higher levels of BPD features, anxiety symptoms, and interpersonal sensitivity than males. A series of latent change score models indicated that BPD features predicted increases in all psychopathology scales at follow-up, while the reverse was not true. These results suggest that targeting BPD features in residents of drug treatment facilities may reduce the emergence of new psychopathology in the short term.

Preventing brain disorders: a framework for action

INTRODUCTION

Prevention efforts have greatly reduced the prevalence of many communicable and non-communicable diseases worldwide. In contrast, prevention strategies for mental disorders remain in their infancy. This paper provides a summary of the key issues surrounding mental disorder prevention and proposes a framework for how to catalyze action in the area.

MATERIALS AND METHODS

Three core assumptions guide this work (1) the onset of mental disorders is often preventable, (2) among those individuals with a mental disorder, the trajectory of health and functioning can be shaped by external resources, and (3) many specific and generic risk and protective factors for mental disorders are associated with specific stages of the life course.

CONCLUSION

We propose that the adoption of a life course approach to prevention can be clarifying and motivating for both research and practice.