Putting policy into practice? Poverty and people with serious mental illness

Unmet Financial Needs of People with Psychotic Disorders-A Cross-Sectional Study in People with Psychotic Disorders, Parents, Siblings, and Controls

Background. Psychotic disorders have a strong negative impact on people's lives, including their financial situation. This study aimed to examine differences in unmet financial needs between people with psychotic disorders, parents, siblings, and controls. Secondly, we aimed to examine whether family clustering contributes to unmet financial needs. Lastly, we aimed to examine to what extent demographic, economic, psychiatric, functional, and cognitive characteristics and substance use predict unmet financial needs in people with psychosis. Methods. Data from the first assessment of people with psychosis (n = 956), siblings (n = 889), parents (n = 858), and controls (n = 496) included in the Genetic Risk and Outcome of Psychosis study were used. Group differences were assessed with Kruskal-Wallis tests (aim 1), while a mixed-effects logistic regression analysis and explorative and confirmative ordinal logistic regression analyses were conducted for aims 2 and 3, respectively. Results. Twenty-four percent of people with psychotic disorders reported unmet financial needs. These levels of unmet financial needs were significantly higher than levels for siblings, parents, and controls. We found a negligible influence of (direct) familial clustering on unmet financial needs. Lastly, cannabis and tobacco use significantly and consistently predicted higher levels of unmet financial needs of people with psychosis. Conclusions. Relatively high levels of unmet financial needs occurred in a heterogeneous group of people with psychosis, especially when people used cannabis or tobacco. Unmet financial needs can have detrimental consequences for mental health, stigmatization, leisure time activities, and social engagement. Thus, it is pivotal to recognize unmet financial needs, especially combined with substance use, as a crucial stressor for people with psychosis.

"Everyone means well but the one person who's really going to go to bat" - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness

In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.

Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members' experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members' interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.

The impact of familial involvement on dropout in a culturally informed group therapy for people diagnosed with 'schizophrenia'

Background

Individuals with schizophrenia diagnoses are high-risk for dropout from mental health treatments, yet few studies have examined whether familial involvement in therapy impacts dropout.

Methods

We examined whether familial involvement and other demographic variables predicted dropout among 101 patients enrolled in culturally informed group therapy for schizophrenia (CIGT-S), which incorporates collectivistic principles and spiritual coping into treatment. We reviewed records and conducted follow-up calls to identify reasons for dropout, and performed survival analyses to identify when dropout was likely.

Results

Familial involvement was linked to greater engagement with treatment and lower dropout, signifying a mechanism for improving treatment attendance in this group. Ethnic minorities and patients with higher symptom severity demonstrated higher rates of dropout. Most patients dropped out of CIGT-S before treatment began. However, significantly lower levels of dropout were observed among those who made it to session 9 (end of the spirituality module). An inability to maintain contact with participants was the most cited reason for dropout within records, and structural reasons (e.g., moving away) were commonly cited among participants who were successfully followed-up with.

Discussion

Future work may identify whether family functioning or the quality of familial relationships may predict familial involvement and, consequently, treatment attendance.

Poverty transitions in severe mental illness: longitudinal analysis of social drift in China, 1994-2015

BACKGROUND

Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China.

METHODS

Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions.

RESULTS

The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty.

CONCLUSIONS

This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.

Deciphering the Link Between Mental Health and Green Space in Shenzhen, China: The Mediating Impact of Residents' Satisfaction

Rapid urbanization and increasing urban density in China threaten residents' mental health. As a vital component of built environments, green space plays a key role in individuals' psychological well-being; however, the mediating effect of residents' satisfaction with the green space environment on the relationship between urban greening and residents' mental health in Chinese contexts has yet to be thoroughly explored. To fill this knowledge gap, this paper attempts to reveal the internal logic and mechanism underlying the linkages between green space, residents' mental health, and their satisfaction with green space in Shenzhen, China. Specifically, this paper explores the mediating role of residents' satisfaction with a green space environment using questionnaire survey data, “Quick Bird-2” high-resolution remote sensing image data, and a multilevel regression model. Our empirical findings indicate that the relative range of neighboring green spaces can directly improve residents' mental health. More importantly, the relationship between the relative scope of green space and residents' mental health is mediated by residents' satisfaction with the green space environment rather than its direct health effects. Given the influence of green space on residents' satisfaction with the environment, green space indirectly affects mental health. These findings should provide the government useful guidance for considering the spatial distribution and quantity of green space. Our results should also help residents improve their actual experiences and subjective satisfaction with the green space environment.

Austerity Britain, poverty management and the missing geographies of mental health

This paper presents the lived experiences of individuals with mental illness as they navigate the benefits landscape in an age of welfare reform in the UK. We focus on the impacts upon their well-being and daily geographies. We articulate the relationship between welfare reform and mental health using the concept of poverty management and its 'missing geographies', in which everyday well-being and routines are dismissed by the restructuring welfare system. We liken this dismissal to a shift towards a narrower and more unforgiving mode of poverty management, where even the smallest misstep can unravel the entire edifice of everyday survival and well-being.

Imbalances in the Study of the Relationship between Leisure and Self-Esteem: A Systematic Review

This systematic review offers a comprehensive examination of the relationship between leisure and self-esteem. The different perspectives were analyzed according to a framework that includes the different approaches for defining and measuring leisure, and a similar one was proposed for self-esteem. Articles indexed in the Web of Science (WoS) up to the end of 2018 were reviewed, specifically those that contained the keywords “leisure”, “self-esteem” or “self esteem” anywhere in the manuscript. Articles that did not present the qualitative or quantitative instruments needed to evaluate leisure or self-esteem were excluded. A total of 49 articles included the final quantitative synthesis. The overall findings showed that the prevailing methodology was objective (external). As regards content, the following combinations predominated: the behavioral approach to leisure with the unidimensional approach to self-esteem and the experiential approach to leisure with the unidimensional approach to self-esteem. Less studies were observed with the combination of mixed approaches and more comprehensive analyses: the behavioral-experiential combined with the multidimensional. To conclude, this study shows there is a demand for further empirical studies that explore the relationships between leisure and self-esteem. It also identified which approaches are most desirable to expand our understanding of the relationships between leisure and self-esteem.

Healthcare professionals' perceptions of the implementation of the transitional discharge model for community integration of psychiatric clients

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes.

The Anatomy of Health-Supportive Neighborhoods: A Multilevel Analysis of Built Environment, Perceived Disorder, Social Interaction and Mental Health in Beijing

Mental health is an exceedingly prevalent concern for the urban population. Mounting evidence has confirmed the plausibility of high incidences of mental disorders in socioeconomically disadvantaged neighborhoods. However, the association between the neighborhood built environment and individual mental health is understudied and far from conclusive, especially in developing countries such as China. The underlying mechanism requires in-depth analysis combining potential intermediates such as perceived environmental disorder and supportive social relationships. Using a health survey conducted in Beijing in 2017, this study investigates for the first time a socio-environmental pathway through which perceived disorder and social interaction account for the relationship between the built environment and mental health under the very notion of the neighborhood effect. The results from multilevel structural equation models indicate that individual mental health is influenced by the neighborhood-scale built environment through three pathways, independent of neighborhood socioeconomic disadvantages: (1) proximity to parks is the sole indicator directly linked to mental health; (2) population density, road connectivity and proximity to parks are indirectly associated with mental health through interactions with neighbors; and (3) population density, road connectivity and facility diversity are partially associated with perceived neighborhood disorder, which is indirectly correlated with mental health through interactions with neighbors. This study is a preliminary attempt to disentangle the complex relationships among the neighborhood environment, social interaction and mental health in the context of developing megacities. The relevant findings provide an important reference for urban planners and administrators regarding how to build health-supportive neighborhoods and healthy cities.

Financial hardship among individuals with serious mental illness

This study explored financial hardship, defined as difficulty in obtaining food, shelter, or medicine in the past 12 months and its personal and clinical correlates in individuals with serious mental illness (SMI) in a sample of 271 adults with SMI newly admitted to two inner city community mental health centers. The study found that 59 percent (n = 161) reported experiencing financial hardship in the past 12 months. Patients with financial hardship were more likely to be female, to experience self-stigma, to experience medical care delays, and to use emergency services. Patients who experienced financial hardship typically had more severe psychiatric symptoms, including depressive symptoms, emotional lability, and interpersonal problems. Financial hardship persisted in nearly half of those with hardship interviewed a year later. The findings highlight the role of multiple social and economic challenges that the SMI patients face in recovery from serious mental illness and the importance of awareness of such challenges by providers treating this population. Though mental health treatment may help alleviate the psychiatric symptoms it alone is not sufficient in addressing persistent hardship. These findings highlight the need for multidisciplinary interventions in order to better serve this vulnerable population.

Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review

Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis. The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.

Mental Health Disparities, Treatment Engagement, and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review

Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.

Money, Social Relationships and the Sense of Self: The Consequences of an Improved Financial Situation for Persons Suffering from Serious Mental Illness

During a 9-month period, 100 persons with SMI were given approx. 73 USD per month above their normal income. Sixteen of the subjects were interviewed. The interviews were analysed according to the methods of thematic analysis. The money was used for personal pleasure and to re-establish reciprocal relations to others. The ways in which different individuals used the money at their disposal impacted their sense of self through experiences of mastery, agency, reciprocity, recognition and security. The findings underline the importance of including social circumstances in our understanding of mental health problems, their trajectories and the recovery process.

Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to estimate effects of lifestyle intervention participation on weight reduction among overweight and obese adults with serious mental illness.

METHOD

We systematically searched electronic databases for randomized controlled trials comparing lifestyle interventions with other interventions or usual care controls in overweight and obese adults with serious mental illness, including schizophrenia spectrum or mood disorders. Included studies reported change in weight [kg] or body mass index (BMI) [kg/m2] from baseline to follow-up. Standardized mean differences (SMD) were calculated for change in weight from baseline between intervention and control groups.

RESULTS

Seventeen studies met inclusion criteria (1968 participants; 50% male; 66% schizophrenia spectrum disorders). Studies were grouped by intervention duration (≤6-months or ≥12-months). Lifestyle interventions of ≤6-months duration showed greater weight reduction compared with controls as indicated by effect size for weight change from baseline (SMD=-0.20; 95% CI=-0.34, -0.05; 10 studies), but high statistical heterogeneity (I2=90%). Lifestyle interventions of ≥12-months duration also showed greater weight reduction compared with controls (SMD=-0.24; 95% CI=-0.36, -0.12; 6 studies) with low statistical heterogeneity (I2=0%).

CONCLUSION

Lifestyle interventions appear effective for treating overweight and obesity among people with serious mental illness. Interventions of ≥12-months duration compared to ≤6-months duration appear to achieve more consistent outcomes, though effect sizes are similar for both shorter and longer duration interventions.

Religion involvement and quality of life in caregivers of patients with schizophrenia in Latin-America

The aim of the study was to explore the relationship between religious involvement (RI) and quality of life (QoL) in caregivers of patients with schizophrenia, while adjusting for key confounding factors such as socio-demographic and clinical characteristics. This study was conducted in the public mental health services in Bolivia, Peru and Chile. The data collected included RI, socio-demographic information, clinical characteristic of the patients and caregiver's QoL using the S-CGQoL questionnaire. A multivariate analysis using multiple linear regressions was performed to determine variables potentially associated with QoL levels. Two hundred and fifty-three patients with their caregivers participated in the study. Caregivers' RI was not significantly associated with overall QoL nor its individual components. The only exception was an unexpected modest inverse association between RI and one QoL dimension (psychological and physical well-being). In contrast, the following caregivers' socio-cultural and economic factors were significantly associated with low QoL level of caregivers: being a mother, identifying with Aymara ethnicity and having lower family income. Among patients, the clinical characteristics of being woman, younger, and having lower age of onset and more severe symptoms was associated with lower QoL. Our study found that socio-cultural, economic and clinical factors were associated with caregivers' QoL.

What Physical Health Means to Me: Perspectives of People with Mental Illness

There are significant inequalities in physical health and life expectancy between people with and without a mental illness. Understanding perspectives of people with mental illness on personal meanings of physical health is essential to ensuring health services are aligned with consumer understandings, needs, and values. A qualitative exploratory study was undertaken involving focus groups with 31 consumers in The Australian Capital Territory, Australia. Participants were asked: "What does physical health mean to you?" Thematic analysis was applied to interview transcripts. Five themes are discussed, representing different emphases in the meaning of physical health: (1) physical and mental are interconnected, (2) absence of disease, (3) moving the body, (4) struggling for healthy diet, and (5) functioning and participation. Physical pain was a difficulty that arose across these themes. Mental health consumers see physical health as always connected with well-being. Nurses would benefit from been informed by consumer understandings of physical health. In addition, there should be more attention to quality of life measures of people with mental illness as these are more congruent with consumer perspectives on physical health than biomedical measures.

Participative mental health consumer research for improving physical health care: An integrative review

People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co-investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness.

After the Asylum? The New Institutional Landscape

During the last decades services to people with severe mental health problems have gone through important changes. Terms as de-, trans-, reinstitutionalisation and dehospitalisation has been used. The objective of the study was to collected data about the changes in a welfare society about the new institutional landscape after the mental hospital area. Data about interventions from social welfare agencies, psychiatric care, and prisons were collected from local and national register as well as data about cause of death and socio-economic status for 1355 persons treated with a diagnosis of psychosis in a Stockholm area 2004-2008. Psychiatric in-patient care and prisons are marginalized. Different interventions in open care touched a very large number of persons. Social welfare agencies play an increasing role in this context. The total institutions have been replaced by a network of micro-institutions sometimes offering help but also control.

Code Red: Explaining Average Age of Death in the City of Hamilton

The aim of this study is to identify the underlying factors that explain the average age of death in the City of Hamilton, Ontario, Canada, as identified in the Code Red Series of articles that were published in the city's local newspaper in 2010. Using a combination of data from the Canadian Census, the Government of Ontario and the Canadian Institute for Health Information, factor analysis was performed yielding three factors relating to poverty, working class, and health and aging. In a regression analysis these factors account for 42% of the total variability in the average ages of death observed at the census tract level of geography within the city.

The relationships between patients' and caregivers' beliefs about the causes of schizophrenia and clinical outcomes in Latin American countries

Beliefs about the causes of schizophrenia are thought to impact treatment outcomes. We investigated 3 theoretically opposing belief systems (biological, psychosocial, magical-religious) in relation to the severity of positive and negative symptoms and to attitudes towards medications. We recruited 253 patients with schizophrenia and their primary caregivers from public mental health clinics in Bolivia, Chile, and Peru. We assessed patients' and caregivers' beliefs about the causes of schizophrenia, which were used as predictors of symptom severity and medication attitudes in linear regression analyses. Patients' scores on biological, psychosocial, and magical-religious beliefs were positively correlated with one another, indicating that these domains were not, as anticipated, "opposing". Patients with higher levels of biological and psychosocial beliefs had significantly lower levels of positive and negative symptoms; in contrast, higher levels of magical-religious beliefs were associated with increased positive symptoms and less favorable attitudes towards medications. Patients' belief systems are significant predictors of symptom severity and medication attitudes. Research is needed on the extent to which psychotherapeutic treatments for schizophrenia should bolster patients' beliefs in the biological and psychosocial domains and weaken beliefs in the magical-religious domain; this research should also attend to the ethical considerations involved in intervening on belief systems cross-culturally.

Human rights violations among economically disadvantaged women with mental illness: An Indian perspective

BACKGROUND

Globally women confront manifold violations of human rights and women with poverty and mental illness are doubly disadvantaged.

AIM

The aim was to examine the influence of poverty in meeting human rights needs among recovered women with mental illness at family and community level.

MATERIALS AND METHODS

This was a descriptive study carried out among randomly selected (n = 100) recovered women with mental illness at a tertiary care center. Data were collected through face-to-face interview using structured needs assessment questionnaire.

RESULTS

Our findings revealed that below poverty line (BPL) participants were not satisfied in meeting their physical needs such as "access to safe drinking water" (χ(2) = 8.994, P < 0.02), "served in the same utensils" (χ(2) = 13.648, P < 0.00), had adequate food (χ(2) = 11.025, P < 0.02), and allowed to use toilet facilities (χ(2) = 13.565, P < 0.00). The human rights needs in emotional dimension, that is, afraid of family members (χ(2) = 8.233, P < 0.04) and hurt by bad words (χ(2) = 9.014, P < 0.02) were rated higher in above poverty line (APL) participants. Similarly, 88.9% of women from APL group expressed that they were discriminated and exploited by the community members (χ(2) = 17.490, P < 0.00). More than three-fourths of BPL participants (76.1%) believed that there were wondering homeless mentally ill in their community (χ(2) = 11.848, P < 0.01).

CONCLUSION

There is an urgent need to implement social welfare programs to provide employment opportunities, disability allowance, housing and other social security for women with mental illness. Further, mental health professionals play an essential role in educating the family and public regarding human rights of people with mental illness.

Impact of socio-economic status in meeting the needs of people with mental illness; human rights perspective

The present descriptive study investigated the impact of socio-economic status in meeting the human rights needs among randomly selected recovered psychiatric patients (n = 100) at a tertiary care center. Data was collected through face to face interview, using structured Needs Assessment Questionnaire. The findings revealed that the participants from below poverty line were deprived of physical needs such as 'electricity facilities' (χ (2) = 6.821, p < .009) 'safe drinking water' (χ (2) = 13.506, p < .004) and purchasing medications (χ (2) = 9.958, p < .019). Conversely, participants from above poverty line were dissatisfied in emotional needs dimension i.e. 'commenting on physical appearance (χ (2) = 8.337, p < .040), afraid of family members (χ (2) = 17.809, p < .000). Thus, there is an urgent need to implement mental illness awareness campaigns and government should take active steps for providing employment, disability pension, free housing, free treatment and free transportation service for people with mental illness to attend hospital or rehabilitation centres.

Diabetes care and mental illness: constraining elements to physical activity and social participation in a residential care facility

OBJECTIVE

To explore barriers and constraints to physical activity, as an integral component of diabetes care, in those with serious mental illness who reside in a for-profit group home.

METHODS

Institutional ethnography was the approach used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents who had diabetes as well as with care providers, field workers and health professionals. Observations and document analysis were further methods used to reveal the disjuncture between diabetes care guidelines and the actualities of living within imposed constraints of group home care.

RESULTS

The residents in this government-regulated group home were sedentary, obtaining approximately 10 minutes per day of low-intensity exercise. The overarching government interest in cost containment created a context of rationing that resulted in a lack of opportunities to exercise and fully participate in social life. Furthermore, group home policies regulated systems of safety, reporting and financial accountability, but did not promote health.

CONCLUSIONS

The findings indicate an urgent need for government financial support for quality of life initiatives and amendments to group home policies that give primacy to health promotion, illness prevention and medical management of prevalent comorbid conditions such as diabetes.

Smokers with behavioral health comorbidity should be designated a tobacco use disparity group

Smokers with co-occurring mental illness or substance use disorders are not designated a disparity group or priority population by most national public health and tobacco control groups. These smokers fulfill the criteria commonly used to identify groups that merit special attention: targeted marketing by the tobacco industry, high smoking prevalence rates, heavy economic and health burdens from tobacco, limited access to treatment, and longer durations of smoking with less cessation. A national effort to increase surveillance, research, and treatment is needed. Designating smokers with behavioral health comorbidity a priority group will bring much-needed attention and resources. The disparity in smoking rates among persons with behavioral health issues relative to the general population will worsen over time if their needs remain unaddressed.

Early intervention services for psychosis and time until application for disability income support: a survival analysis

Ensuring the financial security of individuals recovering from first episode psychosis is imperative, but disability income programs can be powerful disincentives to employment, compromising the social and occupational aspects of recovery. Survival analysis and Cox regression analysis were used to examine the rate at which individuals served by early intervention for psychosis (EIP) services apply for government disability income benefits and factors that predict rate of application. Health records for 558 individuals served by EIP programs were reviewed. Within the first year of receiving services 30% will make application for disability income; 60% will do so by 5 years. Rate of application is predicted by rate of hospital admission, financial status and engagement in productivity roles at the time of entry to EIP service. The findings suggest the need to examine the extent to which the recovery goals of EI services are undermined by early application for government income support. They also suggest the need to develop best practice guidelines related to ensuring the economic security of individuals served.

An urban neo-poverty population-based quality of life and related social characteristics investigation from northeast China

Objective

To investigate quality of life (QOL) and related characteristics among an urban neo-poverty population in northeast China, and to compare this population with a traditional poverty cohort.

Design

The research was a cross-sectional survey executed from June 2005 to October 2007, with a sample of 2940 individuals ages 36 to 55 in three different industrial cities of northeast China. Data were collected on QOL status and sociodemographic characteristics. QOL was assessed using the 36-item Short Form Health Survey (Chinese version). Multiple regression analysis was employed to analyze association between sociodemographic variables and QOL.

Results

The scores for QOL in the neo-poverty group were higher than those in the traditional poverty group, but lower than those in the general population. When the neo-poverty population was divided into two subgroups by age, 36–45 years and 46–55 years, the differences in QOL scores were not significant. However, there were significant differences in several dimensions between two subgroups according to unemployment time (<5 years and >5 years). Additionally, stepwise regression analysis indicated that disease burden, including disease and medical expenditures, was a common risk factor for declining QOL in the neo-poverty group.

Conclusions

Despite some limitations, this study provides initial evidence that the QOL of the urban neo-poverty population lies between that of the general population and traditional poverty. QOL of the neo-poverty group approached QOL of the traditional poverty group with increased unemployment years. In addition to decreased income, disease burden is the most important factor influencing QOL status in urban neo-poverty.

Housing for people with serious mental illness: a comparison of values and research

This article contrasts values associated with the delivery of housing programs for people with serious mental illness with the typical topics pertaining to housing that are studied by researchers. Six values were identified through a search and content analysis of the literature on housing for people with serious mental illness. A second review of the literature was conducted to identify research on housing for this population. A comparison of findings from the two reviews suggested that whereas values concerned with the therapeutic benefits of housing had received considerable research attention, those concerned with a citizenship dimension had received relatively little. The findings are discussed in terms of their implications for the delivery of housing services and for housing research.

Mental health and the city: Intra-urban mobility among individuals with schizophrenia

Intra-urban residential mobility of a cohort with schizophrenia was compared to a matched cohort with no mental illness using population-based administrative data. The percentage of individuals with one or more changes in postal code in the three-year mobility study period was examined, along with measures of the movement between different intra-urban areas. The schizophrenia cohort was more likely to move than the matched cohort; however, this depends on their age, income level, and area of residence at baseline. Age, gender, marital status, income quintile, and use of physicians and hospitalizations were associated with mobility. Individuals in the schizophrenia cohort were significantly more likely to move from the suburb to the inner city, and significantly less likely to move from the inner city to the suburb than those with no mental illness. Implications of the findings and directions for future research are discussed, with particular attention paid to the utility of administrative data for further mental health research.