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Weimand B, Johansson A, Sjöström N, Waern M, Ewertzon M. A Vicious Circle of Hope and Despair: Stigma Experienced by Relatives of Persons with Severe Mental Illness. Issues Ment Health Nurs 2024; 45:409-416. [PMID: 38364206 DOI: 10.1080/01612840.2024.2308551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Not only people suffering from severe mental illness (SMI) but also their family members experience stigma. Relatives are met with negative attitudes from healthcare professionals, which adds to the problem. This Swedish study employed a qualitative inductive explorative design in the analysis of written free-text responses from 65 persons who completed a questionnaire for relatives of persons with SMI. The overarching theme, "A vicious circle of hope and despair", was elaborated by four categories which formed a vicious circle: "Wanting openness, understanding and acknowledgement"; "Facing a lack of understanding from others"; "Seeking understanding from mental healthcare professionals but experiencing the opposite"; and "Keeping family experiences private." If this vicious circle of family stigma is to be broken, measures are needed for both relatives and health care professionals.
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Affiliation(s)
- Bente Weimand
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Anita Johansson
- Research and Development Centre, Skaraborg hospital, Skövde, Sweden
| | - Nils Sjöström
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Mats Ewertzon
- Department of Health Care Sciences, Marie Cederschiöld University College, Stockholm, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
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Tholen MG, Martin A, Stemeseder T, Vikoler T, Wageneder B, Aichhorn W, Kaiser AK. Evaluation of a flexible assertive community treatment (FACT) program for patients with severe mental illness: an observational study in Salzburg, Austria. Int J Ment Health Syst 2024; 18:6. [PMID: 38336693 PMCID: PMC10858489 DOI: 10.1186/s13033-024-00628-8] [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] [Received: 09/05/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Inpatient treatment of severe mentally ill patients binds substantial resources and creates the dilemma of "revolving-door hospitalizations". Evidence suggests that these patients benefit more from an assertive outreach community psychiatric treatment. This descriptive study evaluates the implementation of a new treatment program for severe mentally ill patients provided by a flexible assertive community treatment (FACT) team. METHODS An uncontrolled design with routine data was used to measure the total length of stays, readmission rates and number of contacts one year prior to the implementation of the FACT program and the following first three years of treatment. RESULTS A continuous decrease of hospitalization among patients with severe mental illness was observed with the implementation of the FACT program with declines in total length of stays and readmission rates and accompanied with a decreasing number of contacts per year. CONCLUSION Our findings indicate that this program may create effects in stabilizing patients with severe mental illness and may be highly relevant also for other patient groups.
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Affiliation(s)
- Matthias Gerhard Tholen
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria.
| | - Anna Martin
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Theresa Stemeseder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Vikoler
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Barbara Wageneder
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Kurt Kaiser
- Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Paracelsus Medical University, Salzburg, Austria
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Israel P, Ruud T, Weimand B. Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway. Front Psychiatry 2023; 14:1135135. [PMID: 37051169 PMCID: PMC10083239 DOI: 10.3389/fpsyt.2023.1135135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/22/2023] [Indexed: 04/14/2023] Open
Abstract
Background The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. Aims The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. Methods The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Results Family carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery. Conclusions The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.
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Affiliation(s)
- Pravin Israel
- Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
- *Correspondence: Pravin Israel
| | - Torleif Ruud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
| | - Bente Weimand
- Division of Mental Health, Department of Special Psychiatry, Akershus University Hospital, Lørenskog, Norway
- Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
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Momeni P, Ewertzon M, Årestedt K, Winnberg E. Family Members’ Experiences with the Healthcare Professionals in Nursing Homes – A Survey Study. NURSING: RESEARCH AND REVIEWS 2022. [DOI: 10.2147/nrr.s345452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sjöström N, Waern M, Johansson A, Weimand B, Johansson O, Ewertzon M. Relatives' Experiences of Mental Health Care, Family Burden and Family Stigma: Does Participation in Patient-Appointed Resource Group Assertive Community Treatment (RACT) Make a Difference? Issues Ment Health Nurs 2021; 42:1010-1019. [PMID: 34060978 DOI: 10.1080/01612840.2021.1924322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this exploratory cross-sectional study was to investigate the experiences of relatives of individuals with severe mental illness with and without participation in patient-appointed Resource Group Assertive Community Treatment (RACT). A total of 139 relatives (79 with and 60 without RACT) completed the Family Involvement and Alienation Questionnaire, the Burden Inventory for Relatives of Persons with Psychotic Disturbances, and the family version of the Inventory of Stigmatizing Experiences. We found that relatives participating in RACT experienced a more positive approach from the healthcare professionals, as well as a lower degree of alienation from the provision of care. Relatives who did not participate in RACT were more afraid that their ill next of kin would hurt someone. No other differences in family burden were found. Experiences of family stigmatization were similar in both groups. In conclusion, participating in patient-appointed RACT may contribute to a higher level of satisfaction for relatives in their encounter with healthcare professionals and a more positive alliance. Implementation of RACT in new settings would require adaptation to local conditions to facilitate cooperation between healthcare staff and other relevant services. Staff training focuses on the case manager function and needs assessment, as well as how to create an alliance with the patient and his/her relatives.
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Affiliation(s)
- Nils Sjöström
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Margda Waern
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Anita Johansson
- Research and Development Centre, Skaraborgs Hospital, Skövde, Sweden
| | - Bente Weimand
- Faculty of Health and Social Sciences, Department of Health, Social & Welfare Studies, University of South-Eastern Norway, Drammen, Norway.,Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Ola Johansson
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Ewertzon
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Swedish Family Care Competence Centre, Kalmar, Sweden
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Gunnarsson AB, Brunt D, Tjörnstrand C, Argentzell E, Bejerholm U, Eklund M. Navigating in a Misty Landscape - Perceptions of Supporting a Relative Residing in Supported Housing for People with a Psychiatric Disability. Issues Ment Health Nurs 2020; 41:1038-1046. [PMID: 32605419 DOI: 10.1080/01612840.2020.1756012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim was to explore informal carers' perceptions of supporting the everyday life of a relative who has a psychiatric disability and resides in supported housing (SH). A qualitative study based on interviews with 12 informal carers was performed, and the data was analyzed with qualitative content analysis. The theme "Navigating in a misty landscape when striving to support a relative with a psychiatric disability" was identified, encompassing four categories pertaining to residents' needs, collaboration, environmental issues and the carer's situation. SH services can be enhanced by addressing informal carers' experiences and developing greater collaboration involving informal carers, residents and staff.
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Affiliation(s)
- A Birgitta Gunnarsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Kronoberg, Växjö Sweden
| | - David Brunt
- Faculty of Health and Life Sciences, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | | | | | | | - Mona Eklund
- Department of Health Sciences, Lund University, Lund, Sweden
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Abstract
PURPOSE OF REVIEW Assertive Community Treatment is an established evidenced based practice that provides intensive community treatment for individuals with severe mental illness with recurrent hospitalizations and/or homelessness. Emerging evidence indicates limitations in its implementation in terms of to the original ACT model and its current relevance. RECENT FINDINGS Findings from recent studies (2018-2020) reveals challenges with implementation centered around basic implementation activities, such as changes in the psychosocial context of individuals with SMI, clinicians' abilities to demonstrate competencies with new practices, and ongoing evolution of mental health systems of care worldwide. Intermediary and purveyor organizations (IPO) can provide the infrastructure to support the spread of EBPs while addressing challenges and opportunities. Thus, implementation of ACT can be accomplished when employing a rigorous framework and infrastructure that can synthesize and translate science relevant for practice. SUMMARY The relevance of ACT depends on its implementation that is responsive to change. An implementation science-informed approach is key to providing ACT to individuals in the critical space between the hospital and community. With this approach, we can optimize ACT as a service delivery vehicle by careful analysis of how best to furnish and evaluate the latest, most effective and efficient treatments, rehabilitation and support services.
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