Indicators of empowerment and disempowerment in the subjective evaluation of the psychiatric treatment process by persons with severe and persistent mental illness: a qualitative and quantitative analysis

Perceived empowerment and the impact of negative effects of the COVID-19 pandemic on the quality of life of persons with severe mental illness

Purpose

Beyond its direct effects on physical health the COVID-19 pandemic has been shown to have negative effects on the living situation of people with severe mental illness (SMI). To date, there has been little research on resilience factors preventing people with SMI from experiencing negative effects of the COVID-19 pandemic.

The objective of this study was to investigate the role of perceived empowerment (PE) as a resilience factor, preventing people with SMI from experiencing negative effects of the COVID-19 pandemic on daily living.

Methods

We investigated negative effects of the COVID-19 pandemic on daily living in 931 persons with SMI at two times within six month between June 2020 and Mai 2021. To take into account the longitudinal structure of the data we applied mixed effects regression analyses and longitudinal path models.

Results

A majority of participants experienced negative effects of the COVID-19 pandemic on several dimensions of daily living. Negative effects increased with rising levels of illness-related impairment but decreased as the level of PE rose. While negative effects of the COVID-19 pandemic at follow-up were negatively associated with overall subjective quality of life baseline, PE was negatively associated with the negative impact of the pandemic and positively with quality of life.

Conclusion

Patients with SMI need support to reduce negative effects of the COVID-19 pandemic on their quality of life. The promotion of PE could help strengthen resilience in this target group.

Trial registration

German Clinical Trial Register, DRKS00019086, registered on 3 January 2020. (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00019086).

Children and Youth Environmental Action: The Case of Children and Youth with Disabilities

Youth environmental activism is on the rise. Children and youth with disabilities are disproportionally impacted by environmental problems and environmental activism. They also face barriers towards participating in activism, many of which might also apply to their participation in environmental activism. Using a scoping review approach, we investigated the engagement with children and youth with disabilities by (a) academic literature covering youth environmental activism and their groups and (b) youth environmental activism group (Fridays For Future) tweets. We downloaded 5536 abstracts from the 70 databases of EBSCO-HOST and Scopus and 340 Fridays For Future tweets and analyzed the data using directed qualitative content analysis. Of the 5536 abstracts, none covered children and youth with disabilities as environmental activists, the impact of environmental activism or environmental problems such as climate change on children and youth with disabilities. Fourteen indicated that environmental factors ‘caused’ the ‘impairments’ in children and youth with disabilities. One suggested that nature could be beneficial to children and youth with disabilities. The tweets did not mention children and youth with disabilities. Our findings suggest the need for more engagement with children and youth with disabilities in relation to youth environmental activism and environmental challenges.

How does familiarity impact the stigma of mental illness?

This paper reviews studies on familiarity of mental illness to determine the relationships that familiarity has with public stigma. We propose a U-shaped relationship between familiarity and stigma that includes the expected inverse distribution (greater familiarity leads to less public stigma) and a provocative, positive relationship (familiarity in some groups leads to worse public stigma). Note that despite many studies in this arena, the U-shaped curve is not definitively supported by existing research. We believe its value, however, lies as a heuristic for hypotheses development to better understand the relationship between familiarity and public stigma. After reviewing research, we focus on two roles that comprise the surprising positive relationship: nuclear family members and mental health service providers like clinical psychologists. We then review research that suggests burden and associative stigma might account for the positive relationship between these groups and stigma. We end by using these findings to propose directions for future research, including on the development and evaluation of anti-stigma approaches.

Psychosocial and functional contributors to personal recovery in serious mental illness

Background: Although recovery-oriented services have been conceptualized to improve personal recovery, related research often focuses on measures of clinical recovery. Identifying the relationships between personal recovery, clinical recovery, and psychosocial variables will inform service components and outcome measurement in recovery-oriented services. Aims: This study sought to determine the connection between personal recovery and two sets of potential contributors: psychosocial variables (i.e., empowerment, resilience, and consumer involvement) and functional indicators of clinical recovery. Method: These relationships were examined by analyzing survey data collected from 266 consumers who are receiving public mental health services in the United States. Results: Empowerment, resilience and psychological involvement were associated with personal recovery. Clinical recovery did not uniquely contribute to personal recovery once psychosocial factors were accounted for. Interactions revealed that the relationship between psychological involvement and personal recovery was stronger for those who had been recently hospitalized, and for those with relatively greater resilience. Conclusions: Results indicate that personal recovery is an essential outcome measure for recovery-oriented services that cannot be replaced by clinical recovery outcome measurement. Additionally, empowerment, resilience, and consumer involvement are key components of recovery, which suggests that services and outcome measures should prioritize incorporation of these constructs.

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

Empowerment and its associations in schizophrenia: a cross-sectional study

Empowerment denotes a sense of personal competence which is considered an essential requisite of fair outcome in schizophrenia. The current study assessed empowerment along with other relevant variables in patients with schizophrenia and a comparison group. Hierarchical multiple linear regression analysis identified independent living skills survey score and perceived social support as predicting empowerment in patients with schizophrenia, suggesting a correlational relationship. Empowerment could be a treatment goal in schizophrenia and independent living skills as well as perceived social support could be the mediating factors.

Effects of the two-way communication checklist (2-COM): a one-year cluster randomized study in a group of severely mentally ill persons

BACKGROUND

In a health-care service with the emphasis on improvement related to functioning and well-being, the communication process between patient and professionals is essential. There is a lack of research on this matter.

AIM

The aim was to investigate, in a group of severely mentally ill persons, whether the use of a simple communication tool could influence the sense of empowerment, satisfaction with care, therapeutic alliance and unmet needs.

METHOD

The study had a cluster randomized design. The intervention was a communication tool (2-COM) applied in two teams during one year. In a comparison group of two other teams, the treatment was as usual. At baseline, after six months, and after one year, assessments were made.

RESULTS

After one year the 2-COM groups seemed to have a larger reduction in unmet needs compared to the treatment-as-usual group. However, there were large problems with attrition in the study, and it was not possible to draw relevant conclusions.

CONCLUSIONS

The methodological problems were substantial, and the study may be considered as a pilot study. In a main study the researchers ought to take control over the selection of patients on the basis of the experiences from this study.

Assessing enablement in clinical practice: a systematic review of available instruments

RATIONALE, AIMS AND OBJECTIVES

Enablement is an intervention by which the health care provider recognizes, promotes and enhances patients' ability to control their health and life. An abundant health literature suggests that enablement is associated with good outcomes. In this review, we aimed at identifying and comparing instruments that assess enablement in the health care context.

METHOD

We conducted a systematic literature review using Medline, Embase, Cochrane, Cinahl and PsycINFO databases, 1980 through March 2009, with specific search strategy for each database. Citations were included if they reported: (1) development and/or validation of an instrument; (2) evaluation of enablement in a health care context; and (3) quantitative results following administration of the instrument. The quality of each main retained citation was assessed using a modified version of the Standards for Reporting of Diagnostic Accuracy.

RESULTS

Of 3135 citations identified, 53 were retrieved for detailed evaluation. Four articles were included. Two instruments were found: the Patient Empowerment Scale (PES) and the Empowering Speech Practices Scale (ESPS). Both instruments assessed enablement in hospital setting, one from the inpatient's perspective (PES) and the other from both perspectives (ESPS).

CONCLUSION

Two instruments assess enablement in hospital setting. No instrument is currently available to assess enablement in an ambulatory care context.

Differences in individual empowerment outcomes of socially disadvantaged women: effects of mode of participation and structural changes in a physical activity promotion program

OBJECTIVES

This study explored the differences in individual empowerment outcomes of a group of socially disadvantaged women participating in physical activity promotion. The outcomes observed were assessed in the context of the women's mode of participation and the structural organizational and community level changes, which took place during the implementation of the program.

METHODS

Fifteen semi-structured qualitative interviews were conducted and analyzed using qualitative content analysis. Two groups of women participated in the interviews--those involved in the whole process of planning, implementation and evaluation of the program and those who took part in the program activities.

RESULTS

Individual empowerment outcomes were achieved for all those interviewed, although those participating in the planning, implementation and evaluation of the program achieved the greatest. A number of organizational and community level processes were also identified that supported the individual empowerment of those taking part.

CONCLUSIONS

This study supports the use of multilevel empowerment approaches to health as they help to identify the ideal characteristics that organizations and communities should possess and the potential structural changes required to support individual empowerment.

Program of active aging in a rural Mexican community: a qualitative approach

Background

Education is one of the key elements in the promotion of a thorough paradigm for active aging. The aim of this study is to analyze factors that contribute the empowerment of older adults in a rural Mexican community and, thus, promote active aging.

Methods

The study was conducted in a rural Mexican community (Valle del Mezquital), based on an action-research paradigm. One hundred and fifty-five elderly subjects with elementary school education participated in a formal training program promoting gerontological development and health education. Participants in turn became coordinators of mutual-help groups (gerontological nucleus) in Mexico. In-depth interviews were carried out to assess the empowerment after training for active aging.

Results

It was found that there was an increasing feeling of empowerment, creativity and self-fulfillment among participants. Among the main factors that positively influenced training of the elderly toward active aging were the teaching of gerontology topics themselves; besides, their motivation, the self-esteem, the increased undertaking of responsibility, the feeling of belonging to the group, and the sharing of information based on personal experience and on gerontological knowledge.

Conclusion

The main factors that contribute to empowerment of older adults in a rural Mexican community for participate in active aging programs are the training and teaching of gerontology topics themselves; besides, their interest, experience and involvement.

Stigma and mental health professionals: a review of the evidence on an intricate relationship

In the past decade, mental health professionals have initiated a number of national and international efforts against the stigma of mental illness. While largely successful in beating stigma and discrimination, these programmes have, in part, been criticized to be largely uninformed by the lived realities of people with mental illness and their families. Some critics claimed that anti-stigma efforts led by mental health professionals were in fact a concealed attempt at de-stigmatizing psychiatry itself as a profession. This paper will attempt to throw light on the various ways in which mental health professionals are 'entangled' in anti-stigma activities. It will outline the complex relationships between stigma and the psychiatric profession, presenting evidence on how its members can simultaneously be stigmatizers, stigma recipients and powerful agents of de-stigmatization. In exploring the role of mental health professionals as targets of stigma, new findings will be presented on the role of stigma as a professional stressor in psychiatry. Conclusions will be drawn on how the pursuit of professional self-interest can be a legitimate goal of anti-stigma programmes. Further, ways in which acknowledging psychiatry's own agenda can contribute to both credibility and success of fighting stigma from within psychiatry will be discussed.