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Poppe A, Tiles-Sar N, Konings SRA, Habtewold TD, Bruggeman R, Alizadeh BZ, van der Meer L. Moving from supported to independent living: what are the barriers and facilitators for individuals with psychosis? Soc Psychiatry Psychiatr Epidemiol 2024; 59:1243-1254. [PMID: 38189942 DOI: 10.1007/s00127-023-02586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Living independently, as opposed to in sheltered housing or with caregivers, is an important aim in the recovery of individuals with psychosis, but the transition to independence can be challenging. This study aims to investigate how individuals with psychosis move between living arrangements and to identify the barriers and facilitators of moving towards independence. METHODS The living arrangements of 1119 individuals with non-affective psychosis from the Genetic Risk and Outcome of Psychosis study were assessed at baseline, at three- and six-year follow-ups and further categorized as either supported (sheltered housing or with parents) or independent (single or with partner/family). We estimated the probabilities of transitioning between the living statuses and investigated the influence of demographic characteristics, symptomatology, cognition, social support, and premorbid social adjustment on transition using Markov chain modelling. RESULTS The majority of individuals living in supported housing remained there during the six-year follow-up period (~ 60%). The likelihood of moving from supported to independent living was twice as high for participants who were younger, five-to-six times higher for women, twice as high for individuals with better overall cognition, and five times higher for those with a course of low positive symptoms. CONCLUSION This study highlights that a large group of individuals with psychosis in supported housing is unlikely to move to independent living. Older men with cognitive impairments and who show continuous severe positive symptoms are the least likely to move living independently. Tailored interventions for these at-risk individuals could increase their chances of moving to independent living.
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Affiliation(s)
- Anika Poppe
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands.
| | - Natalia Tiles-Sar
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Stefan R A Konings
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, Rob Giel Research Center, University Medical Center Groningen, University Center for Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands
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Eager S, Killaspy H, C J, Mezey G, McPherson P, Downey M, Thompson G, Lloyd-Evans B. A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study. Interact J Med Res 2024; 13:e45987. [PMID: 38477978 DOI: 10.2196/45987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 12/08/2023] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. OBJECTIVE This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. METHODS This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. RESULTS Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. CONCLUSIONS The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.
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Affiliation(s)
- Sharon Eager
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Joanna C
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gillian Mezey
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Megan Downey
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Georgina Thompson
- Division of Psychiatry, University College London, London, United Kingdom
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Brolin R, Tjörnstrand C, Friis M, Argentzell E, Bejerholm U, Eklund M, Brunt D. "It's not just the residents who need to be motivated for activity": a qualitative study of the perspectives of staff on providing activity support for people with psychiatric disabilities in supported housing in Sweden. Front Psychiatry 2024; 14:1322859. [PMID: 38250283 PMCID: PMC10797039 DOI: 10.3389/fpsyt.2023.1322859] [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: 10/16/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024] Open
Abstract
Background The goals for staff in Supported Housing for people with psychiatric disabilities include helping to develop the residents' independence and self-confidence in activities. However, staff have expressed frustration about providing this type of support when motivating residents to engage in meaningful activities and also about the difficulty in finding suitable levels of independence within a housing setting with limitations. Objective The aim is to explore the views and experiences of housing staff in Supported Housing on how they can stimulate and support engagement in activities for people with psychiatric disabilities. Methods Twenty-six members of staff from 20 supported housing units in 10 municipalities in Sweden were interviewed in five focus groups. A semi-structured interview guide was used, and the transcribed material was analyzed using qualitative content analysis. Results Three main categories emerged from the analysis: Multi-faceted factors influencing the staff's provision of activity support, Staff's approach for supporting activities, and Staff's struggles to develop their work. Obstacles to participating in activities in the community were identified. Many contrasting factors were found, such as spontaneous or structured activities and individual or group activities, which affected the staff's ability to motivate to activity. Conclusion A broad approach encompassing in-house training including a focus on values, recruitment policies, staff supervision and interventions focusing on both residents and staff are ways to support staff in motivating residents toward being more active within Supported Housing.
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Affiliation(s)
- Rosita Brolin
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Tjörnstrand
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Mette Friis
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - Mona Eklund
- Department of Health Sciences/Mental Health, Activity and Participation, Lund University, Lund, Sweden
| | - David Brunt
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Martinelli A, Dal Corso E, Pozzan T, Cristofalo D, Bonetto C, Ruggeri M. Addressing Challenges in Residential Facilities: Promoting Human Rights and Recovery While Pursuing Functional Autonomy. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2023; 6:12-22. [PMID: 38510484 PMCID: PMC10948939 DOI: 10.1176/appi.prcp.20230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 03/22/2024] Open
Abstract
Objective Italian residential facilities (RFs) aim to promote human rights and recovery for individuals with severe mental disorders. Italian RFs can be distinguished into five main types: high-intensity rehabilitation (RF1), medium-intensity rehabilitation (RF2), medium-level support (RF3.1), high-level support (RF3.2), low-level support (RF3.3). This study aimed to assess the effectiveness of Italian RFs in achieving functional autonomy while upholding human rights and recovery. Methods Data on socio-demographics, clinical information, patient and staff assessments of functional autonomy, types of interventions, and RF performance in various domains were collected in a pilot study with a cross-sectional design. Descriptive and inferential analyses were conducted. Results Twelve RFs and 113 patients participated, with varying proportions in each RF type. RF1 patients were the oldest (p < 0.001) with the lowest functional autonomy (p < 0.001), while RF2 patients were the youngest (p < 0.001) with the lowest hospitalization rate (p < 0.001). RF3.1 patients had the highest employment rate (p = 0.024), while RF3.2 had the lowest employment rate (p = 0.024) and the longest service contact (p < 0.001). RF3.3 users had the highest functional autonomy (p < 0.001). The highest functional autonomy was in self-care which received the highest focus in objectives and interventions. Patients rated their functional autonomy higher than professionals (p < 0.001). RFs excelled in the "human rights" and "social interface" domains but performed poorly in "recovery-based practice," with RF1 having the lowest performance and RF3.3 the highest. Conclusions This pilot study suggests that Italian RFs generally aligne with their mission and human rights principles, but personalizing interventions and implementing recovery-oriented practices face challenges.
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Affiliation(s)
| | | | - Tecla Pozzan
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
| | - Doriana Cristofalo
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Chiara Bonetto
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
| | - Mirella Ruggeri
- Section of PsychiatryVerona Hospital TrustAOUIVeronaItaly
- Dipartimento di Neuroscienze, Biomedicina e MovimentoUniversità di VeronaVeronaItaly
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Gamieldien F, Galvaan R, Myers B, Sorsdahl K. Mental Health Service Users and Their Caregivers Perspectives on Personal Recovery from Severe Mental Health Conditions in Cape Town, South Africa: A Qualitative Study. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2023; 11:201-219. [PMID: 38887754 PMCID: PMC11180021 DOI: 10.1007/s40737-023-00341-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/25/2023] [Indexed: 06/20/2024]
Abstract
Severe mental health conditions (SMHCs) significantly contribute to the global disease burden. In low-and-middle-income countries (LMICs) like South Africa, the long-term impact of SMHCs on individuals and their families is serious. However, mental health services focus on clinical recovery, with little attention given to the personal recovery needs of mental health service users (MHSUs) and their caregivers. The CHIME framework outlines five domains characterising personal recovery: connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. This qualitative, descriptive study sought insights from male MHSUs and their caregivers on their perspectives of personal recovery from SMHCs. Four male MHSUs and three of their caregivers were purposively selected from Cape Flats communities in the Western Cape. Data were collected using visual participatory methods, including photovoice, life graphs, community maps, and photo-elicitation interviews with MHSUs. In addition, semi-structured interviews were held with caregivers. Data were thematically analysed, and two main themes emerged: Finding meaningful participation and affirming agency. These themes describe how diverse contextual, socioeconomic, political, demographic, cultural, and spiritual factors help and hinder personal recovery. MHSUs and their caregivers sought support from mental health non-profit organisations (MH-NPOs) because of stigmatising attitudes from their communities. MH-NPOs provided MHSUs with long-term relational support and opportunities to build their capacities which helped them access living, learning, working and socialising opportunities. Understanding the diverse needs of MHSUs and including MH-NPOs in scaling up community-based mental health services in LMICs will enable more accessible services that support personal recovery.
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Affiliation(s)
- Fadia Gamieldien
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Roshan Galvaan
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
- Inclusive Practices Africa Research Unit, Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
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van Genk C, Roeg D, van Vugt M, van Weeghel J, Van Regenmortel T. Current insights of community mental healthcare for people with severe mental illness: A scoping review. Front Psychiatry 2023; 14:1156235. [PMID: 37143787 PMCID: PMC10151504 DOI: 10.3389/fpsyt.2023.1156235] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023] Open
Abstract
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.
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Affiliation(s)
- Caroline van Genk
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- *Correspondence: Caroline van Genk,
| | - Diana Roeg
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Kwintes Housing and Rehabilitation Services, Zeist, Netherlands
| | - Maaike van Vugt
- Trimbos Institute, Dutch Institute of Mental Health and Addiction, Utrecht, Netherlands
- HVO-Querido, Amsterdam, Netherlands
| | - Jaap van Weeghel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | - Tine Van Regenmortel
- School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
- Faculty of Social Sciences – HIVA, University of Leuven, Leuven, Belgium
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Eklund M, Tjörnstrand C. Resident and staff perceptions of an activity- and recovery-based intervention in supported housing for people with severe mental illness - a longitudinal pilot study. BMC Psychiatry 2022; 22:404. [PMID: 35710347 PMCID: PMC9205036 DOI: 10.1186/s12888-022-04050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People with severe mental illness who reside in supported housing (SH) and need a high level of assistance are at risk of an everyday life with little meaning and low community participation. Interventions to counteract that seem warranted, which was the rationale for this study. The aim was to investigate how residents and staff perceived an intervention designed to enhance meaningful everyday activity and personal recovery. METHODS The intervention, termed Active in My Home (AiMH), was led by an occupational therapist. It consisted of five individual and three group sessions, and AiMH staff acted as supporters. Twenty-nine AiMH participants and 43 staff members were included in this un-controlled study with three measurement points - before (T1), at completion (T2), and 6-9 months after completion of AiMH (T3). The data collection was based on self-report questionnaires addressing perceptions of satisfaction, meaningfulness, and recovery-oriented support. RESULTS The residents' satisfaction with the SH per se was rated high (at 75% of the maximum score) and did not change over the study period from T1 to T3 (p = 0.544); nor did the participants' perceived recovery-oriented support from the AiMH supporter (p = 0.235). Satisfaction with AiMH was rated by both participants and staff at T2. Their scores differed regarding general satisfaction (p = 0.008), staff scoring higher, but no differences were found regarding satisfaction with group sessions, individual sessions, or support of activity (p-values 0.062-0.836). The staff rated the SH unit's provision of meaningful activities higher than the AIMH participants at T2 (p = 0.029) but not at T1 (p = 0.226) or T3 (p = 0.499). CONCLUSION This study has offered some glimpses of how AiMH participants and staff perceived the AiMH intervention. It has also generated some ideas for better support for meaningful activity and recovery-oriented support in SH for people with mental illness, such as assisting SH residents in identifying activity opportunities and making activity choices when providing support for meaningful activity in the SH context. TRIAL REGISTRATION Registered at ClinicalTrials.gov ID: NCT05157854.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Lund University, P. O. Box 157, SE-22100, Lund, Sweden.
| | - Carina Tjörnstrand
- grid.4514.40000 0001 0930 2361Department of Health Sciences, Lund University, P. O. Box 157, SE-22100 Lund, Sweden
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Cone P, Giske T. Mental Health Staff Perspectives on Spiritual Care Competencies in Norway: A Pilot Study. Front Psychol 2022; 12:794165. [PMID: 35250693 PMCID: PMC8894710 DOI: 10.3389/fpsyg.2021.794165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Spirituality and spiritual care have long been kept separate from patient care in mental health, primarily because it has been associated with psycho-pathology. Nursing has provided limited spiritual care competency training for staff in mental health due to fears that psychoses may be activated or exacerbated if religion and spirituality are addressed. However, spirituality is broader than simply religion, including more existential issues such as providing non-judgmental presence, attentive listening, respect, and kindness (International Council of Nursing [ICN], 2012). Unfortunately, healthcare personnel working in mental health institutions are not well prepared to address spiritual concerns or resources of their patients (Cone and Giske, 2018). Therefore, a mixed-method pilot study was conducted using a self-assessment survey tool to examine spiritual care competencies of mental health staff in Norway and to understand the perspectives of mental health staff in the Scandinavian context (Stockman, 2018). Five questions and comments related to survey items provided rich qualitative data. While only a small pilot with 24 participants, this study revealed a need for spiritual care educational materials targeted specifically for those who work in mental health, materials that address the approach of improving attitudes, enhancing skills, and increasing knowledge related to spirituality and spiritual care of patients.
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Affiliation(s)
- Pamela Cone
- School of Nursing, Azusa Pacific University, Greater Los Angeles, CA, United States
- *Correspondence: Pamela Cone,
| | - Tove Giske
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
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Beckers T, Maassen N, Koekkoek B, Tiemens B, Hutschemaekers G. Can social support be improved in people with a severe mental illness? A systematic review and meta-analysis. CURRENT PSYCHOLOGY 2022; 42:1-11. [PMID: 35125852 PMCID: PMC8802266 DOI: 10.1007/s12144-021-02694-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
People with a severe mental illness often have less social support than other people, yet these people need social support to face the challenges in their lives. Increasing social support could benefit the person's recovery, but it is not clear whether interventions that aim to improve social support in people with a severe mental illness are effective. A systematic literature search and review in MEDLINE (PubMed), PsycINFO, CINAHL, Cochrane, JSTOR, IBSS, and Embase was performed. Studies were included if they had a control group and they were aimed at improving social support in people with a severe mental illness who were receiving outpatient treatment. Summary data were extracted from the research papers and compared in a meta-analysis by converting outcomes to effect sizes (Hedges's g). Eight studies (total n = 1538) that evaluated ten different interventions met the inclusion criteria. All but one of these studies was of sufficient quality to be included in the review. The studies that were included in the meta-analysis had a combined effect size of 0.17 (confidence interval: 0.02 to 0.32), indicating a small or no effect for the interventions that were evaluated. A subgroup analysis of more personalized studies showed a combined effect size of 0.35 (CI = 0.27 to 0.44), indicating a noteworthy effect for these more personalized studies. This evaluation of interventions aimed at improving social support in people with a severe mental illness suggests that these interventions in general have little or no clinical benefit. However, in a subgroup analysis the more personalized interventions have a larger effect on improving social support and merit further research.
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Affiliation(s)
- Thijs Beckers
- MET Ggz, Primary Healthcare Department, Minister Beverstraat 3, 6042 BL Roermond, the Netherlands
- Research Group Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, the Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Niek Maassen
- Research Group Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, the Netherlands
| | - Bauke Koekkoek
- Research Group Social Psychiatry and Mental Health Nursing, HAN University of Applied Science, Nijmegen, the Netherlands
- Pro Persona Research, Renkum, the Netherlands
| | - Bea Tiemens
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Pro Persona Research, Renkum, the Netherlands
- Indigo, Utrecht, the Netherlands
| | - Giel Hutschemaekers
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Pro Persona Research, Renkum, the Netherlands
- Indigo, Utrecht, the Netherlands
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Lindström M. Development of the Everyday Life Rehabilitation model for persons with long-term and complex mental health needs: Preliminary process findings on usefulness and implementation aspects in sheltered and supported housing facilities. Front Psychiatry 2022; 13:954068. [PMID: 36051549 PMCID: PMC9424656 DOI: 10.3389/fpsyt.2022.954068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED This paper describes the initial phases of the design and development of the Everyday Life Rehabilitation (ELR) intervention, and it presents preliminary findings on usefulness and implementation aspects derived from an ongoing larger trial exploring the effect, cost-effectiveness, and usefulness of ELR. ELR is a model designed to meet the absence of meaningful activities and challenges with integrated, activity- and recovery-oriented rehabilitation in sheltered and supported housing facilities for persons with extensive psychiatric disabilities. The aim of the present study was to examine early experiences of implementing the ELR model from the perspectives of managers, housing staff, and occupational therapists. The paper will sum up preliminary findings based on process data included in an internal pilot prior to a full-scale pragmatic clustered RCT. Four Swedish municipalities with 19 housing facility units were involved and provided process data for the study. Thematic analysis were applied. The informants perceived the methodology to be well suited to the target group and context and to contribute to positive changes in participants' lives. The web-based training was also experienced as relevant and easily accessible to staff, as well as elements of collegial learning and feedback. However, they reported that their municipalities lacked basic conditions for making the whole concept work in such a short time. The ELR is overall perceived as useful, but experiences also make complex difficulties visible regarding integrated, coordinated rehabilitation and organizational readiness. Based on findings, a recommendation on basic prerequisites will be added to the ELR guidance for leadership and management. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov, 24 September 2021], identifier [NCT05056415].
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Affiliation(s)
- Maria Lindström
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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Rocamora-Montenegro M, Compañ-Gabucio LM, Garcia de la Hera M. Occupational therapy interventions for adults with severe mental illness: a scoping review. BMJ Open 2021; 11:e047467. [PMID: 34716157 PMCID: PMC8559113 DOI: 10.1136/bmjopen-2020-047467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the occupational therapy (OT) interventions in adults with severe mental illness (SMI) most investigated in intervention studies and to describe their characteristics. DESIGN Scoping review. DATA SOURCES On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the first quartile of OT according to the SCImago Journal Rank. We updated our search on 10 March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major depression, obsessive-compulsive, severe mental, OT and intervention. STUDY SELECTION The study screening was peer-reviewed. Inclusion criteria were: (1) OT intervention studies in SMI: experimental, randomised, non-randomised and pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive-compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a discipline involved in the intervention; (4) English or Spanish language and (5) studies with full text available. RESULTS Thirty-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention. CONCLUSION Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2-3 weekly 60 min sessions and a duration of 3-6 months.
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Affiliation(s)
- María Rocamora-Montenegro
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
| | - Manuela Garcia de la Hera
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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McPherson P, Lloyd-Evans B, Dalton-Locke C, Killaspy H. A Systematic Review of the Characteristics and Efficacy of Recovery Training for Mental Health Staff: Implications for Supported Accommodation Services. Front Psychiatry 2021; 12:624081. [PMID: 34054593 PMCID: PMC8160251 DOI: 10.3389/fpsyt.2021.624081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/09/2021] [Indexed: 11/13/2022] Open
Abstract
Evidence suggests a link between recovery-oriented practise and service user outcomes in supported accommodation settings. Current clinical guidelines recommend recovery training for supported accommodation staff, however evidence relating to the effectiveness of this type of training is unclear. This review aimed to describe and compare the characteristics and efficacy of existing recovery training packages for mental health staff. The appropriateness and applicability of the interventions was considered in relation to UK supported accommodation services. Initial search processes returned 830 papers. After duplicate removal, inclusion and exclusion criteria were applied to 489 papers, leaving a final sample of seven papers. Data were reviewed using a narrative synthesis approach. The reviewed papers showed variation in the aims, frequency, and duration of the training interventions, although all included content consistent with the five-domains of the CHIME model. All interventions used direct, in-person teaching, and prioritised interactive, experiential learning, however a number were limited by the absence of feedback, the use of one-off, rather than repeated/follow-up sessions, and a reliance on classroom-based, rather than in-vivo, training. There was limited evidence to suggest a consistent effect of training on staff or service user outcomes, and there was no clear association between the delivery and design characteristics of the interventions and reported outcomes. In considering the development of recovery training for supported accommodation staff, little guidance can be taken from the reviewed literature. Any training package must be developed with consideration of the unique contextual and organisational characteristics of these services. The authors recommend viewing training as one component of a broader goal of service transformation.
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Community mental healthcare: new developments and innovative strategies. Curr Opin Psychiatry 2020; 33:491-500. [PMID: 32639361 DOI: 10.1097/yco.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe. RECENT FINDINGS This review highlights the different innovative approaches and strategies being currently used in the field of community mental health. Key approaches found in the reviewed studies include collaborative care with the inclusion of peer workers, growing use of e-health and telepsychiatry, improved reforms on national mental health policies and de-institutionalization, modification of outreach models and mental health promotion in the community. The studies reviewed here suggest that continued innovation and implementation of new models and strategies have the potential to reduce the burden of disease and increase the quality of life for patients with mental health issues. SUMMARY Growing body of evidence shows that integrative care is the new standard of care for people with mental illnesses, with necessity of continuity of care from emergency department to community mental health services. Social determinants of rehabilitation and recovery, and peers support remain a new main topic of research in area of treatment of people with severe mental illnesses. E-health tools are becoming prevalent in the processes of promotion, prevention and treatment in mental healthcare.
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Roeg D, de Winter L, Bergmans C, Couwenbergh C, McPherson P, Killaspy H, van Weeghel J. IPS in Supported Housing: Fidelity and Employment Outcomes Over a 4 Year Period. Front Psychiatry 2020; 11:622061. [PMID: 33519560 PMCID: PMC7840894 DOI: 10.3389/fpsyt.2020.622061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: People with severe mental illness have difficulties finding and maintaining competitive employment. This is particularly so for those living in supported housing who, by definition, have significant day-to-day support needs: in the Netherlands only 3 to 5% of people with serious mental health problems who live in supported housing are competitively employed. To support these people in finding and maintaining competitive employment, Individual Placement, and Support (IPS) was introduced within supported housing services in the Netherlands in 2015. As this is the first country that broadly implemented IPS in supported housing settings, this paper will focus on the first results regarding feasibility and effects on employment in clients of IPS in this sector. Methods: We investigated the feasibility and employment outcomes of delivering IPS in supported housing services using fidelity assessments and quarterly employment outcomes on IPS program level within eight supported housing organizations, and compared these with 21 mental health treatment organizations in the Netherlands over a 4 year period. We investigated possible reasons for our findings and their implications through qualitative evaluations of the IPS fidelity assessors' notes and additional focus groups with IPS specialists and coordinators from supported housing services and fidelity assessors. Results: The overall fidelity scores indicated reasonable implementation of the IPS model within both supported housing services and mental health services. However, there were differences between services with regard to specific fidelity items; mental health treatment organizations scored higher for team integration, whereas supported housing services scored higher for rapid job search and caseload size, diversity of jobs, and employers. Our qualitative data suggested that the difference in team integration between the two sectors was due to differences in their organizational and financial structures, as well as in the specific needs of their clients. Conversely, supported housing services had better connections with employers which facilitated more rapid job searching and greater diversity in employment opportunities. The average total client employment rate did not significantly differ; and was 25.8% per quarter in supported housing services and 29.6% in mental health treatment services. Conclusion: Implementing IPS in supported housing settings is both feasible and effective.
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Affiliation(s)
- Diana Roeg
- Research Department, Kwintes Supported Housing, Zeist, Netherlands.,Academic Center Mental Health, Tranzo, Tilburg University, Tilburg, Netherlands
| | - Lars de Winter
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
| | - Cris Bergmans
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
| | | | - Peter McPherson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jaap van Weeghel
- Academic Center Mental Health, Tranzo, Tilburg University, Tilburg, Netherlands.,Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands
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Zomer LJC, Voskes Y, van Weeghel J, Widdershoven GAM, van Mierlo TFMM, Berkvens BS, Stavenuiter B, van der Meer L. The Active Recovery Triad Model: A New Approach in Dutch Long-Term Mental Health Care. Front Psychiatry 2020; 11:592228. [PMID: 33250796 PMCID: PMC7674651 DOI: 10.3389/fpsyt.2020.592228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Unlike developments in short-term clinical and community care, the recovery movement has not yet gained foothold in long-term mental health services. In the Netherlands, approximately 21,000 people are dependent on long-term mental health care and support. To date, these people have benefited little from recovery-oriented care, rather traditional problem-oriented care has remained the dominant approach. Based on the view that recovery is within reach, also for people with complex needs, a new care model for long-term mental health care was developed, the active recovery triad (ART) model. In a period of 2.5 years, several meetings with a large group of stakeholders in the field of Dutch long-term mental health care took place in order to develop the ART model. Stakeholders involved in the development process were mental health workers, policy advisors, managers, directors, researchers, peer workers, and family representatives. The ART model combines an active role for professionals, service users, and significant others, with focus on recovery and cooperation between service users, family, and professionals in the triad. The principles of ART are translated into seven crucial steps in care and a model fidelity scale in order to provide practical guidelines for teams implementing the ART model in practice. The ART model provides guidance for tailored recovery-oriented care and support to this "low-volume high-need" group of service users in long-term mental health care, aiming to alter their perspective and take steps in the recovery process. Further research should investigate the effects of the ART model on quality of care, recovery, and autonomy of service users and cooperation in the triad.
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Affiliation(s)
- Lieke J C Zomer
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Impact Care Group, GGz Breburg, Tilburg, Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands.,Parnassia Mental Health Center, The Hague, Netherlands
| | | | | | | | | | - Lisette van der Meer
- Department of Clinical & Developmental Neuropsychology, University of Groningen, Groningen, Netherlands.,Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, Netherlands
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