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Green HD, Pescosolido BA. Social pathways to care: how community-based network ties shape the health care response of individuals with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2024; 59:431-442. [PMID: 37072564 PMCID: PMC10113125 DOI: 10.1007/s00127-023-02476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Mental health research has powerfully documented inequities related to characteristics, such as ethnicity and gender. Yet how and where disparities like unmet need occur have been more elusive. Drawing from a now modest body of research that deployed the Network Episode Model (NEM), we examine how individuals create patterns of response to mental health problems, influenced by the culture and resources embedded in their social networks. METHODS The Person-to-Person Health Interview Study (P2P; N ~ 2,700, 2018-2021) provides representative, community-based, NEM-tailored data. Both descriptive, latent class and multinomial regression analyses mark mental health care-seeking patterns, including individuals consulted and activities used, as well as the influence of the structure and cultural content of social networks. RESULTS Latent class analysis detected five pathways with good fit statistics. The Networked General Care Path (37.0%) and The Kin General Care Path (14.5%) differ only in whether friends are activated in using the general care sector. The Networked Multi-Sector Care Path (32.5%) and The Saturated Path (12.6%) involve family, friends, and both general and specialty care with only the latter expanding consultation to coworkers and clergy. The Null Path (3.3%), or no contacts, is not used as perceived problem severity increases. Network size and strength are associated with the more complex pathways that activate ties, respectively. Trust in doctors is associated with pathways that include specialty providers but not others at work or church. Race, age, and rural residence have specific pathway effects, while gender has no significant impact. CONCLUSIONS Social networks propel individuals with mental health problems into action. Tie strength and trust produce care responses that are fuller and more targeted. Considering the nature of homophily, results also suggest that majority status and college education are clearly implicated in networked pathways. Overall, findings support community-targeted rather than individually based efforts to increase service use.
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Affiliation(s)
- Harold D Green
- Department of Applied Health Science, School of Public Health and the Irsay Institute, Indiana University, Bloomington, IN, USA.
| | - Bernice A Pescosolido
- Department of Sociology, College of Arts & Sciences and the Irsay Institute, Indiana University, Bloomington, IN, USA
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Tudehope L, Harris N, Vorage L, Sofija E. What methods are used to examine representation of mental ill-health on social media? A systematic review. BMC Psychol 2024; 12:105. [PMID: 38424653 PMCID: PMC10905888 DOI: 10.1186/s40359-024-01603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
There has been an increasing number of papers which explore the representation of mental health on social media using various social media platforms and methodologies. It is timely to review methodologies employed in this growing body of research in order to understand their strengths and weaknesses. This systematic literature review provides a comprehensive overview and evaluation of the methods used to investigate the representation of mental ill-health on social media, shedding light on the current state of this field. Seven databases were searched with keywords related to social media, mental health, and aspects of representation (e.g., trivialisation or stigma). Of the 36 studies which met inclusion criteria, the most frequently selected social media platforms for data collection were Twitter (n = 22, 61.1%), Sina Weibo (n = 5, 13.9%) and YouTube (n = 4, 11.1%). The vast majority of studies analysed social media data using manual content analysis (n = 24, 66.7%), with limited studies employing more contemporary data analysis techniques, such as machine learning (n = 5, 13.9%). Few studies analysed visual data (n = 7, 19.4%). To enable a more complete understanding of mental ill-health representation on social media, further research is needed focussing on popular and influential image and video-based platforms, moving beyond text-based data like Twitter. Future research in this field should also employ a combination of both manual and computer-assisted approaches for analysis.
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Affiliation(s)
- Lucy Tudehope
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, 1 Parklands Drive, 4222, Southport, Gold Coast, QLD, Australia.
| | - Neil Harris
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, 1 Parklands Drive, 4222, Southport, Gold Coast, QLD, Australia
| | - Lieke Vorage
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, 1 Parklands Drive, 4222, Southport, Gold Coast, QLD, Australia
| | - Ernesta Sofija
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, 1 Parklands Drive, 4222, Southport, Gold Coast, QLD, Australia
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Fekih-Romdhane F, Boukadida Y, Abassi B, Chaibi LS, Conus P, Krebs MO, Thornicroft G, Cheour M, Jahrami HA. French validation of the barriers to access to care evaluation (BACE-3) scale. L'ENCEPHALE 2024:S0013-7006(24)00010-1. [PMID: 38311478 DOI: 10.1016/j.encep.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND The aim of this study was to develop and evaluate a French version of the Barriers to Access to Care Evaluation (BACE-3) scale that is tailored to the socio-cultural and language setting of the study. METHODS The translation of the BACE-3 into French and its validation were the two key components of this psychometric investigation. An online survey was created and circulated to French-speaking participants who volunteered to participate in the study. RESULTS For all translated questions, the reliability analysis key results (Cronbach's alpha and McDonald's Omega) were both>0.95, which is an excellent reliability value. The BACE-3 items were shown to be positively related to one another, implying excellent validity. Results of exploratory and confirmatory factor analyses showed that all stigma-related items were loaded under the same factor. CONCLUSIONS The BACE-3 has been validated in French, and its psychometric qualities have been thoroughly evaluated and found to be excellent.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia.
| | - Youssef Boukadida
- The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Bouthaina Abassi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Leila Sarra Chaibi
- The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Philippe Conus
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie-Odile Krebs
- Laboratoire de physiopathologie des maladies psychiatriques, UMR_S1266 institut de psychiatrie et neurosciences de Paris, université Paris Descartes, Inserm, Paris, France; Institut de psychiatrie (CNRS GDR 3557), Paris, France; Service hospitalo universitaire, faculté de médecine Paris Descartes, centre hospitalier Sainte-Anne, université Paris Descartes, Paris, France
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia; The Tunisian Center of Early Intervention is Psychiatry, Department of psychiatry "Ibn Omrane", Razi Hospital, 1, rue des orangers, 2010 Manouba, Tunisia
| | - Haitham A Jahrami
- Ministry of Health, Manama, Bahrain; Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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Gillard S, Anderson K, Clarke G, Crowe C, Goldsmith L, Jarman H, Johnson S, Lomani J, McDaid D, Pariza P, Park AL, Smith J, Turner K, Yoeli H. Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental, qualitative and health economic evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-221. [PMID: 38149657 DOI: 10.3310/pbsm2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Background People experiencing mental health crises in the community often present to emergency departments and are admitted to a psychiatric hospital. Because of the demands on emergency department and inpatient care, psychiatric decision units have emerged to provide a more suitable environment for assessment and signposting to appropriate care. Objectives The study aimed to ascertain the structure and activities of psychiatric decision units in England and to provide an evidence base for their effectiveness, costs and benefits, and optimal configuration. Design This was a mixed-methods study comprising survey, systematic review, interrupted time series, synthetic control study, cohort study, qualitative interview study and health economic evaluation, using a critical interpretive synthesis approach. Setting The study took place in four mental health National Health Service trusts with psychiatric decision units, and six acute hospital National Health Service trusts where emergency departments referred to psychiatric decision units in each mental health trust. Participants Participants in the cohort study (n = 2110) were first-time referrals to psychiatric decision units for two 5-month periods from 1 October 2018 and 1 October 2019, respectively. Participants in the qualitative study were first-time referrals to psychiatric decision units recruited within 1 month of discharge (n = 39), members of psychiatric decision unit clinical teams (n = 15) and clinicians referring to psychiatric decision units (n = 19). Outcomes Primary mental health outcome in the interrupted time series and cohort study was informal psychiatric hospital admission, and in the synthetic control any psychiatric hospital admission; primary emergency department outcome in the interrupted time series and synthetic control was mental health attendance at emergency department. Data for the interrupted time series and cohort study were extracted from electronic patient record in mental health and acute trusts; data for the synthetic control study were obtained through NHS Digital from Hospital Episode Statistics admitted patient care for psychiatric admissions and Hospital Episode Statistics Accident and Emergency for emergency department attendances. The health economic evaluation used data from all studies. Relevant databases were searched for controlled or comparison group studies of hospital-based mental health assessments permitting overnight stays of a maximum of 1 week that measured adult acute psychiatric admissions and/or mental health presentations at emergency department. Selection, data extraction and quality rating of studies were double assessed. Narrative synthesis of included studies was undertaken and meta-analyses were performed where sufficient studies reported outcomes. Results Psychiatric decision units have the potential to reduce informal psychiatric admissions, mental health presentations and wait times at emergency department. Cost savings are largely marginal and do not offset the cost of units. First-time referrals to psychiatric decision units use more inpatient and community care and less emergency department-based liaison psychiatry in the months following the first visit. Psychiatric decision units work best when configured to reduce either informal psychiatric admissions (longer length of stay, higher staff-to-patient ratio, use of psychosocial interventions), resulting in improved quality of crisis care or demand on the emergency department (higher capacity, shorter length of stay). To function well, psychiatric decision units should be integrated into the crisis care pathway alongside a range of community-based support. Limitations The availability and quality of data imposed limitations on the reliability of some analyses. Future work Psychiatric decision units should not be commissioned with an expectation of short-term financial return on investment but, if appropriately configured, they can provide better quality of care for people in crisis who would not benefit from acute admission or reduce pressure on emergency department. Study registration The systematic review was registered on the International Prospective Register of Systematic Reviews as CRD42019151043. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/70) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 25. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Steve Gillard
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - Katie Anderson
- School of Health and Psychological Sciences, City, University of London, London, UK
| | | | - Chloe Crowe
- Adult Acute Mental Health Services, North East London NHS Foundation Trust, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Jarman
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Jo Lomani
- School of Health and Psychological Sciences, City, University of London, London, UK
| | - David McDaid
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Paris Pariza
- Improvement Analytics Unit, Health Foundation, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Jared Smith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kati Turner
- Population Health Research Institute, St George's, University of London, London, UK
| | - Heather Yoeli
- School of Health and Psychological Sciences, City, University of London, London, UK
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5
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Hackmann C, Komashie A, Handley M, Murdoch J, Wagner AP, Grünwald LM, Waller S, Kaminskiy E, Zeilig H, Jones J, Bray J, Bagge S, Simpson A, Dalkin SM, Clarkson J, Borghini G, Kipouros T, Rohricht F, Taousi Z, Haighton C, Rae S, Wilson J. Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach. BMJ Open 2023; 13:e071272. [PMID: 37709323 PMCID: PMC10503342 DOI: 10.1136/bmjopen-2022-071272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/26/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. METHODS AND ANALYSIS The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. ETHICS AND DISSEMINATION MINDS stage 1 has received ethical approval from Yorkshire & The Humber-Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. TRIAL REGISTRATION NUMBER MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42021293255.
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Affiliation(s)
- Corinna Hackmann
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
| | - Alexander Komashie
- Department of Enginering, University of Cambridge School of Technology, Cambridge, UK
| | - Melanie Handley
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jamie Murdoch
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Adam P Wagner
- NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Marie Grünwald
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Sam Waller
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Emma Kaminskiy
- School of Psychology and Sports Science, Anglia Ruskin University, Chelmsford, UK
| | - Hannah Zeilig
- London College of Fashion, University of the Arts London, London, UK
| | - Julia Jones
- Centre for Research in Primary & Community Care, University of Hertfordshire, Hatfield, UK
| | | | - Sophie Bagge
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alan Simpson
- Health Services and Population Research, King's College London, London, UK
| | - Sonia Michelle Dalkin
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - John Clarkson
- Engineering Design Centre, University of Cambridge, Cambridge, UK
| | | | | | - Frank Rohricht
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- East London NHS Foundation Trust, London, UK
| | - Zohra Taousi
- Hertfordshire and Peterborough NHS Foundation Trust, St Albans, UK
| | - Catherine Haighton
- Department of Social Work, Education & Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Jon Wilson
- Research and Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
- Noriwch Medical School, The University of East Anglia, Norwich, UK
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6
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Anderson KK, Rodrigues R. Differences in clinical presentation at first hospitalization and the impact on involuntary admissions among first-generation migrant groups with non-affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1329-1341. [PMID: 36922459 DOI: 10.1007/s00127-023-02465-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission. METHODS Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009-2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared clinician-rated symptoms and behaviours at admission between first-generation immigrants and refugees and the general population, and adjusted for these variables to ascertain whether the elevated prevalence of involuntary admission persisted. RESULTS Immigrants and refugee groups tended to have lower ratings for affective symptoms, self-harm behaviours, and substance use, as well as higher levels of medication nonadherence and poor insight. Immigrant groups were more likely to be perceived as aggressive and a risk of harm to others, and both groups were perceived as having self-care issues. Adjustment for perceived differences in clinical presentation at admission did not attenuate the higher prevalence of involuntary admission for immigrant and refugee groups. CONCLUSIONS First-generation migrant groups may differ in clinical presentation during the early course of psychotic illness, although these perceived differences did not explain the elevated rates of involuntary admission. Further research using outpatient samples and tools with established cross-cultural validity are warranted.
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Affiliation(s)
- Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada.
- Department of Psychiatry, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada.
- ICES, London, ON, Canada.
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, 1465 Richmond Street, PHFM 3135, London, ON, N6G 2M1, Canada
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Degnan A, Berry K, Crossley N, Edge D. Social network characteristics of Black African and Caribbean people with psychosis in the UK. J Psychiatr Res 2023; 161:62-70. [PMID: 36898328 DOI: 10.1016/j.jpsychires.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
Poorer social networks predict more coercive pathways to care and other adverse outcomes in people with psychosis. People from Black African and Caribbean backgrounds have more negative experiences within UK mental health care systems and family relationships often breakdown. This study aimed to examine the social network characteristics of Black African and Caribbean people experiencing psychosis and associations between network characteristics and severity of psychosis, negative symptoms, and general psychopathology. Fifty-one participants completed social network mapping interviews (a gold standard approach to assessing social network composition) and the Positive and Negative Syndrome Scale. This is the first study to explicitly measure social network size amongst Black people with psychosis living within the UK and results showed that participants' social network size (mean = 12) was comparable to that of other psychosis samples. Networks were of moderate density and comprised disproportionately more relatives than other relationship types. Poor network quality was related to more severe psychosis symptoms suggesting that social network quality may be an important factor in influencing the severity of psychosis. Findings highlight the need for community-based interventions and family therapies to mobilise sources of social support for Black people with psychosis within the UK.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, The University of Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, The University of Manchester, UK.
| | - Nick Crossley
- The Mitchell Centre for Social Network Analysis, School of Social Sciences, The University of Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, The University of Manchester, UK
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Differences in mental health inequalities based on university attendance: Intersectional multilevel analyses of individual heterogeneity and discriminatory accuracy. SSM Popul Health 2022; 19:101149. [PMID: 35800663 PMCID: PMC9253404 DOI: 10.1016/j.ssmph.2022.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/29/2022] [Accepted: 06/15/2022] [Indexed: 11/21/2022] Open
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Jones N, Gius B, Shields M, Florence A, Collings S, Green K, Watson A, Munson M. Youths' and Young Adults' Experiences of Police Involvement During Initiation of Involuntary Psychiatric Holds and Transport. Psychiatr Serv 2022; 73:910-917. [PMID: 34911351 DOI: 10.1176/appi.ps.202100263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Over the past decade, police involvement in behavioral health crisis response has generated concern and controversy. Despite the salience and timeliness of this topic, the literature on service user experiences of interactions with officers is small and studies of youths and young adults are nonexistent. The authors aimed to investigate youths' and young adults' experiences of police involvement in involuntary psychiatric hold initiation and transport. In-depth interviews were conducted with 40 participants (ages 16-27) who had experienced an involuntary hold; the 28 participants who reported police involvement are the focus of this analysis. Data were inductively coded, and codes were grouped into larger themes. A majority of participants reported negative experiences; major themes characterizing negative encounters were the framing of distress as criminal or of intervention as disciplinary rather than therapeutic, perceived aggression and callousness from police officers, and poor communication. The authors also characterized the positive experiences of officer involvement reported by a minority of participants and youths' perspectives on the degree of control officers could exert over initiation and transport decisions. Findings help center the voices of youths and young adults with mental health challenges and raise important questions about contemporary policies regarding police involvement in crisis response and, more broadly, about coercive responses to distress or emotional crisis.
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Affiliation(s)
- Nev Jones
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Becky Gius
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Morgan Shields
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Ana Florence
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Shira Collings
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Kelly Green
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Amy Watson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
| | - Michelle Munson
- School of Social Work, University of Pittsburgh, Pittsburgh (Jones); Department of Psychology, University of South Florida, Tampa (Gius); Center for Mental Health (Shields) and Center for the Prevention of Suicide (Green), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Program on Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Florence); private practice, Philadelphia (Collings); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Silver School of Social Work, New York University, New York City (Munson)
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Dorrington S, Carr E, Stevelink S, Ashworth M, Broadbent M, Madan I, Hatch S, Hotopf M. Access to mental healthcare in the year after first fit note: a longitudinal study of linked clinical records. BMJ Open 2021; 11:e044725. [PMID: 34764162 PMCID: PMC8587470 DOI: 10.1136/bmjopen-2020-044725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Sickness absence is strongly associated with poor mental health, and mental disorders often go untreated. In this population-based cohort study, we identified people receiving fit notes from their general practitioner (GP) and determined access to mental health treatment stratified by health complaint and demographic variables. DESIGN Longitudinal study of health records. SETTING Primary care and secondary mental health care in the borough of Lambeth, South London. Forty-five GP practices in Lambeth and the local secondary mental healthcare trust. PARTICIPANTS The analytical sample included 293 933 working age adults (16-60 years) registered at a Lambeth GP practice between 1 January 2014 and 30 April 2016. PRIMARY AND SECONDARY OUTCOME MEASURES Three indicators of mental healthcare in the year after first fit note were antidepressant prescription, contact with Improving Access to Psychological Therapy (IAPT) services and contact with secondary mental health services. RESULTS 75% of people with an identified mental health condition at first fit note had an indicator of mental healthcare in the following year. Black Caribbean and Black African groups presenting with mental disorders were less likely to have a mental healthcare indicator compared with White British groups. CONCLUSIONS The majority of those with an identified mental health need receive some treatment in the year following a fit note; however, our results suggest Black African and Black Caribbean groups with an identified mental healthcare need have less complete access compared to the White British group.
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Affiliation(s)
- Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Sharon Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College London, London, London, UK
| | - Matthew Broadbent
- National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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11
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Jones N, Gius BK, Shields M, Collings S, Rosen C, Munson M. Investigating the impact of involuntary psychiatric hospitalization on youth and young adult trust and help-seeking in pathways to care. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2017-2027. [PMID: 33751175 PMCID: PMC10105343 DOI: 10.1007/s00127-021-02048-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Few studies have focused on the experience of involuntary psychiatric hospitalization among youth, especially the impact of these experiences on engagement with mental health services post-discharge. In this study, we contribute to a deeper understanding of youth experiences of involuntary hospitalization (IH) and its subsequent impacts on trust, help-seeking, and engagement with clinicians. METHODS The study utilized a grounded theory approach, conducting in-depth interviews with 40 youth and young adults (ages 16-27) who had experienced at least one prior involuntary hospitalization. RESULTS Three quarters of the youth reported negative impacts of IH on trust, including unwillingness to disclose suicidal feelings or intentions. Selective non-disclosure of suicidal feelings was reported even in instances in which the participant continued to meet with providers following discharge. Factors identified as contributing to distrust included perceptions of inpatient treatment as more punitive than therapeutic, staff as more judgmental than empathetic, and hospitalization overall failing to meet therapeutic needs. Conversely, participants reporting more mixed experiences of hospitalization and simultaneously strong indirect benefits, including greater family support, diminished family judgement members and greater access to care. CONCLUSION Findings draw attention to the ways in which coercive experiences may impact youth pathways to and through care. Additional research is needed to understand the impact of these experiences across larger samples, and their influence on downstream outcomes including engagement and long-term wellbeing. Finally, these data may inform the development and testing of inpatient and post-discharge interventions designed to mitigate potential harm.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA.
| | - Becky K Gius
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Morgan Shields
- Department of Psychiatry, Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Shira Collings
- Department of Counseling, Troy University, Tampa, FL, USA
| | - Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle Munson
- Silver School of Social Work, New York University, New York, NY, USA
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12
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Lawrence V, McCombie C, Nikolakopoulos G, Morgan C. Navigating the mental health system: Narratives of identity and recovery among people with psychosis across ethnic groups. Soc Sci Med 2021; 279:113981. [PMID: 33991793 DOI: 10.1016/j.socscimed.2021.113981] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
There is consistent evidence that members of the black Caribbean population in the UK are more likely to have coercive relationships with mental health services, typified by high levels of police involvement and compulsory treatment. This research has relied upon a medical epidemiological framework that has enumerated differences in service use but failed to unravel the complex interplay of individual, social, and cultural factors that inform the pathway to care. The purpose of this study was to explore the journey through mental health services from the perspective of individuals from the black Caribbean and majority white British population to help understand variation in the use of mental health services. Individual interviews were conducted with 17 black Caribbean, 15 white British, and 3 non-British white people with psychosis as part of AESOP-10, a 10 year follow up of an ethnically diverse cohort of individuals with first episode psychosis in the UK. Thematic narrative analysis identified three overarching narrative categories: 'losing self within the system' narratives gave primacy to individuals' identity as a chronic psychiatric patient with participants unable to break the cycle of service use; 'steadying self through the system' narratives combined recognition of the value of psychiatry and its limitations with the ability to access psychological therapy and protect valued social roles; 'finding strength beyond the system' narratives challenged negative dominant discourses and emphasised social, interpersonal and intrapersonal factors in recovery. We found variation in narratives across ethnic groups with 'losing self within the system' and 'finding strength beyond the system' narratives most common, though not exclusive to, black Caribbean participants. Distress appeared rooted in social structures that disadvantage black people, and psychiatry appeared to be experienced as a further form of oppression, that initially provoked resistance and fear, and over time, resignation to the identity of psychiatric patient.
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Affiliation(s)
- Vanessa Lawrence
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Catherine McCombie
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Georgios Nikolakopoulos
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
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13
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Nguyen J, Goldsmith L, Rains LS, Gillard S. Peer support in early intervention in psychosis: a qualitative research study. J Ment Health 2021; 31:196-202. [PMID: 33961753 DOI: 10.1080/09638237.2021.1922647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is evidence that peer support can be helpful for people suffering from psychosis, but there is a lack of research describing peer support in the context of Early Intervention in Psychosis (EIP). AIMS We aim to investigate the key elements of peer support in EIP and how peer support workers might best be recruited and supported in their work. METHOD We used purposive sampling to recruit seven participants for semi-structured interviews. Thematic analysis was used to analyse the data. RESULTS Destigmatisation of psychotic experiences is a central concept that runs through all themes. Participants perceived peer support as a meaningful source of support that could provide benefits to peers (service users) and peer support workers. Themes included a "symbol of hope," "practical support," "mutuality and reciprocity," "bridge between service and peers," "ideal requirements of peer support workers," "delivering peer support," and "team-working and role clarification." CONCLUSIONS Peer support makes a strong contribution to destigmatising psychosis. Findings potentially contribute to developing peer support workers' roles in EIP. Future research is recommended to investigate the perspectives of ethnic minorities on this topic and practical applications of these findings.
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Affiliation(s)
- Jen Nguyen
- Department of Psychiatry, University College London, London, UK
| | - Lucy Goldsmith
- Population Health Research Institute, St George's, University of London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Steve Gillard
- School of Health Sciences, City, University of London, London, UK
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14
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Tarricone I, D'Andrea G, Storbini V, Braca M, Ferrari S, Reggianini C, Rigatelli M, Gramaglia C, Zeppegno P, Gambaro E, Luciano M, Ceregato A, Altamura M, Barrasso G, Primavera D, Carpiniello B, Todarello O, Berlincioni V, Podavini F, Morgan C, Murray RM, Di Forti M, Muratori R, Berardi D. First-episode Psychosis and Migration in Italy: Results from a Study in the Italian Mental Health Services (Pep-Ita Study). J Immigr Minor Health 2021; 23:519-527. [PMID: 33689115 PMCID: PMC8068695 DOI: 10.1007/s10903-021-01168-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
Background: Migrants present high rates of psychosis. A better understanding of this phenomenon is needed. Methods: We conducted a multicentre First-Episode Psychosis (FEP) prospective study over two years (January 2012–December 2013) to evaluate first-generation migrants presenting with FEP at the participating Community Mental Health Centers (CMHCs). Results: 109 FEP migrants were identified. Almost half of them were highly educated, employed and in a stable affective relationship. The average age was 32.8 (± 9.8) years, and the average length of stay in Italy was 8.6 (± 8.8) years. About 2/3 of patients were referred to CMHCs following Emergency Department access or psychiatric admission. Conclusions: Our finding of a “high functioning portrait” of FEP migrants allow us to hypothesize that a high burden of negative psychosocial factors is likely to be needed for the FEP onset. Furtherly, mental health services should implement more appropriate resources and organizational methods to respond to migrants’ health needs.
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Affiliation(s)
- Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy. .,Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.
| | - Giuseppe D'Andrea
- Department of Medical and Surgical Sciences, Bologna Transcultural Psychosomatic Team (BoTPT), University of Bologna, Viale C. Pepoli 5, 40123, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Viviana Storbini
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Mauro Braca
- Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Corinna Reggianini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Marco Rigatelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Institute of Psychiatry, Università del Piemonte Orientale, Novara, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessio Ceregato
- Mental Health Department A.S.L. TO4, Community Mental Health Service, Chivasso, TO, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Section of Psychiatry and Clinical Psychology, University of Foggia, Foggia, Italy
| | | | - Diego Primavera
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Medical Science and Public Health-Section of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Orlando Todarello
- U.O. di Psichiatria - Azienda Ospedaliero-Universitaria "Consorziale Policlinico" Bari; Dipartimento Di Scienze Mediche Di Base, Neuroscienze Ed Organi Di Senso, Università Degli Studi Aldo Moro Di Bari, Bari BA, Italy
| | - Vanna Berlincioni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Podavini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Craig Morgan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Marta Di Forti
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Roberto Muratori
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy
| | - Domenico Berardi
- Department of Mental Health and Pathological Addiction, Local Health Authority, Bologna, Italy.,Department of Biomedical and NeuroMotor Sciences, Psychiatry Unit, University of Bologna, Bologna, Italy
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15
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Jensen E, Carr R, Degnan A, Berry K, Edge D. Exploring service user and family perspectives of a Culturally adapted Family Intervention (CaFI) for African-Caribbean people with psychosis: A qualitative study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:270-289. [PMID: 33651377 DOI: 10.1111/bjc.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 09/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the UK, people of African-Caribbean background have the highest rates of psychosis and greatest inequity in mental health services of all ethnicities. National policies have highlighted the lack of evidence-based psychological interventions for this group. The aim of this study was to examine the acceptability of a novel Culturally adapted Family Intervention (CaFI) for African-Caribbean individuals diagnosed with non-affective psychosis and their relatives. DESIGN A qualitative design. METHODS Semi-structured interviews conducted with 22 service users and 12 family members following participation in CaFI. The interview topic guide included perceptions of the needs and benefits of CaFI; usefulness, cultural specificity and accessibility of CaFI therapy and supporting materials; content and delivering of CaFI sessions; views and experiences of working with CaFI therapists; and perceived barriers and facilitators to implementation. RESULTS Deductive framework analysis identified three main themes for service users: perceived benefits, barriers and limitations, and delivery of the therapy. Four themes were identified for family members: perceived benefits, perceptions of therapists, delivery of therapy, and accessibility of therapy content, supporting materials, and cultural appropriateness. CONCLUSIONS CaFI was found to be an acceptable intervention for African-Caribbean service users with psychosis and their relatives. Family interventions considering the needs of ethnic and cultural groups have the potential to improve the mental health care and experiences of service users and their families. PRACTITIONER POINTS The Culturally adapted Family Intervention (CaFI) was viewed as acceptable to African-Caribbean service users with psychosis and their families. Through adapting interventions to be more culturally sensitive, it is possible to enhance the care of those who typically have poor engagement with mental health services. In-keeping with their ethos of individualized care delivery, mental health services should place more emphasis on being able to offer appropriate, culturally adapted interventions to their service users.
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Affiliation(s)
- Eve Jensen
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Rosie Carr
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
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16
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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17
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Ethnicity and power in the mental health system: experiences of white British and black Caribbean people with psychosis. Epidemiol Psychiatr Sci 2021; 30:e12. [PMID: 33543688 PMCID: PMC8057456 DOI: 10.1017/s2045796020001043] [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] [Indexed: 11/16/2022] Open
Abstract
AIMS Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. METHOD Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. RESULTS Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to - or at the best passive acceptance of - intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. CONCLUSIONS Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.
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18
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Eylem O, van Straten A, de Wit L, Rathod S, Bhui K, Kerkhof AJFM. Reducing suicidal ideation among Turkish migrants in the Netherlands and in the UK: the feasibility of a randomised controlled trial of a guided online intervention. Pilot Feasibility Stud 2021; 7:30. [PMID: 33494831 PMCID: PMC7830826 DOI: 10.1186/s40814-021-00772-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The evidence for the effectiveness of e-mental health interventions among ethnic minorities is still preliminary. This mixed methods study investigates the feasibility of a culturally adapted, guided online intervention with the intention to understand how it works and for whom to inform refinement. It also examines its likely effectiveness in reducing suicidal ideation when compared with the treatment as usual. METHODS Turkish migrants with mild to moderate suicidal thoughts were recruited from the general population using social media and newspaper advertisements. The intervention group obtained direct access to a 6-week guided online intervention while participants in the waiting list condition had to wait for 6 weeks. The intervention is based on an existing online intervention and was culturally adapted. Participants in both conditions completed baseline, post-test, and follow-up questionnaires on suicidal ideation (primary outcome), depression, worrying, hopelessness, suicide attempt and self-harm, acculturation, quality of life, and usability. In addition, participants were interviewed to examine the feasibility and mechanisms of action in more depth. The responses were analysed by inductive thematic analysis. RESULTS Eighty-five people signed up via the study website, and we included 18 (10 intervention, 8 waitlist control). While the therapeutic benefits were emphasised (e.g. feeling connected with the intervention), the feasibility was judged to be low. The main reasons given were not having severe suicidal thoughts and not being represented by the culturally adapted intervention. No suicide attempts were recorded during the study. The suicidal ideation, depression, and hopelessness scores were improved in both groups. CONCLUSION Although intended to be a definitive trial, the current study became a feasibility study with process evaluation to understand the components and how they operate. The online intervention was not superior to the control condition. Future studies need to attend the implementation issues raised including measures of stigma, acculturation, and careful cultural adaptations alongside more attention to coaching and relational support. They should also consider how to improve engagement alongside selection of those who are motivated to use online interventions and offer alternatives for those who are not. TRIAL REGISTRATION Netherlands Trial Register, NTR5028 . Registered on 1 March 2015.
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Affiliation(s)
- Ozlem Eylem
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands.
- Amsterdam Institute of Public Health, Amsterdam, Netherlands.
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ, UK.
| | - Annemieke van Straten
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
| | - Leonore de Wit
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Charterhouse Square, London, EC1M 6BQ, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Ad J F M Kerkhof
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, 7 van der Boechorststraat, Amsterdam, 1081, BT, Netherlands
- Amsterdam Institute of Public Health, Amsterdam, Netherlands
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19
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A systematic review of PTSD to the experience of psychosis: prevalence and associated factors. BMC Psychiatry 2021; 21:9. [PMID: 33413179 PMCID: PMC7789184 DOI: 10.1186/s12888-020-02999-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD). Previous research has focussed on the trauma of first episode psychosis (FEP) and the only review to date of PTSD beyond the first episode period was not systematic and is potentially outdated. METHODS We searched electronic databases and reference lists using predetermined inclusion criteria to retrieve studies that reported prevalence rates and associated factors of psychosis-related PTSD across all stages of the course of psychosis. Studies were included if they measured PTSD specifically related to the experience of psychosis. Risk of bias was assessed using an adapted version of the Newcastle Ottawa Scale. Results were synthesised narratively. RESULTS Six papers met inclusion criteria. Prevalence estimates of psychosis-related PTSD varied from 14 to 47%. Studies either assessed first-episode samples or did not specify the number of episodes experienced. Depression was consistently associated with psychosis-related PTSD. Other potential associations included treatment-related factors, psychosis severity, childhood trauma, and individual psychosocial reactions to trauma. CONCLUSIONS Psychosis-related PTSD is a common problem in people with psychosis. There is a lack of published research on this beyond first episode psychosis. Further research is needed on larger, more generalizable samples. Our results tentatively suggest that prevalence rates of psychosis-related PTSD have not reduced over the past decade despite ambitions to provide trauma-informed care. Prospero registration number: CRD42019138750.
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Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in south east London. Eur Child Adolesc Psychiatry 2021; 30:1113-1128. [PMID: 32683491 PMCID: PMC8295086 DOI: 10.1007/s00787-020-01603-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
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Affiliation(s)
- Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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Jongsma HE, Karlsen S, Kirkbride JB, Jones PB. Understanding the excess psychosis risk in ethnic minorities: the impact of structure and identity. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1913-1921. [PMID: 34427699 PMCID: PMC8519854 DOI: 10.1007/s00127-021-02042-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/29/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE Psychotic disorders, which are associated with substantially increased morbidity and mortality, are up to five times more common in some ethnic minority groups compared with the white majority in Western countries. This long-standing and well-replicated public mental health disparity has hitherto largely eluded adequate explanation. We argue that this might have arisen in part due to the lack of attention given to theoretical work characterising the complex and multidimensional social nature of ethnicity by those epidemiological investigations that have dominated the literature. METHODS To bridge this gap, we draw on theoretical and empirical literature from across the social sciences considering the ontological significance of ethnicity (as biology, migration, racialised structures and identity) and its relationships with psychotic disorders to illuminate probable drivers of excess psychosis risk. RESULTS The largest gains in our theoretical understanding of excess psychosis risk among ethnic minority groups are to be made by considering ethnicity in relation to disempowerment resulting from structural and identity-based exclusion. The former is readily studied through the social gradient in health: socioeconomic disadvantage clusters in some ethnic minorities and increases the risk of poor health outcomes, including psychosis. Furthermore, limitations on identity acquisition and expression imposed by the ethnic majority can further contribute to alienate ethnic minorities and increase psychosocial disempowerment (a lack of control over one's life). CONCLUSION We theorise that structural and identity-based exclusion act as the primary drivers shaping variation in rates of psychotic disorder by ethnic minority status.
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Affiliation(s)
- Hannah E. Jongsma
- grid.83440.3b0000000121901201PsyLife Group, Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7DN UK ,grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK ,Present Address: Centre for Transcultural Psychiatry ‘Veldzicht’, Ommerweg 67, 7707 AT Balkbrug, The Netherlands
| | - Saffron Karlsen
- grid.5337.20000 0004 1936 7603School of Sociology, Politics and International Studies, University of Bristol, 11 Priory Road, Bristol, BS8 1TU UK
| | - James B. Kirkbride
- grid.83440.3b0000000121901201PsyLife Group, Division of Psychiatry, UCL, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7DN UK
| | - Peter B. Jones
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge, CB2 0SZ UK ,grid.450563.10000 0004 0412 9303CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF UK
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Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study. Community Ment Health J 2020; 56:1457-1472. [PMID: 32133547 DOI: 10.1007/s10597-020-00590-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.
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23
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Inequality, distress and harm-reduction: a social justice approach to self-injury. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00146-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Risk of involuntary admission among first-generation ethnic minority groups with early psychosis: a retrospective cohort study using health administrative data. Epidemiol Psychiatr Sci 2019; 29:e59. [PMID: 31610825 PMCID: PMC8061249 DOI: 10.1017/s2045796019000556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS Ethnic minority groups often have more complex and aversive pathways to mental health care. However, large population-based studies are lacking, particularly regarding involuntary hospitalisation. We sought to examine the risk of involuntary admission among first-generation ethnic minority groups with early psychosis in Ontario, Canada. METHODS Using health administrative data, we constructed a retrospective cohort (2009-2013) of people with first-onset non-affective psychotic disorder aged 16-35 years. This cohort was linked to immigration data to ascertain migrant status and country of birth. We identified the first involuntary admission within 2 years and compared the risk of involuntary admission for first-generation migrant groups to the general population. To control for the role of migrant status, we restricted the sample to first-generation migrants and examined differences by country of birth, comparing risk of involuntary admission among ethnic minority groups to a European reference. We further explored the role of migrant class by adjusting for immigrant vs refugee status within the migrant cohort. We also explored effect modification of migrant class by ethnic minority group. RESULTS We identified 15 844 incident cases of psychotic disorder, of whom 19% (n = 3049) were first-generation migrants. Risk of involuntary admission was higher than the general population in five of seven ethnic minority groups. African and Caribbean migrants had the highest risk of involuntary admission (African: risk ratio (RR) = 1.52, 95% CI = 1.34-1.73; Caribbean: RR = 1.58, 95% CI = 1.37-1.82), and were the only groups where the elevated risk persisted when compared to the European reference group within the migrant cohort (African: RR = 1.24, 95% CI = 1.04-1.48; Caribbean: RR = 1.29, 95% CI = 1.07-1.56). Refugee status was independently associated with involuntary admission (RR = 1.16, 95% CI = 1.02-1.32); however, this risk varied by ethnic minority group, with Caribbean refugees having an elevated risk of involuntary admission compared with Caribbean immigrants (RR = 1.72, 95% CI = 1.15-2.58). CONCLUSIONS Our findings are consistent with the international literature showing increased rates of involuntary admission among some ethnic minority groups with early psychosis. Interventions aimed at improving pathways to care could be targeted at these groups to reduce disparities.
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Postma A, Bekmann S, Havenaar JM, Braam AW. Trashing Property: Characteristics of Psychiatric Patients Who Engage in Domestic Property Damaging. Community Ment Health J 2019; 55:1194-1201. [PMID: 31183586 PMCID: PMC6744387 DOI: 10.1007/s10597-019-00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/03/2019] [Indexed: 11/26/2022]
Abstract
This descriptive record-based study included 75 patients who had engaged in domestic property damaging (DPD) and needed assessment by an urban emergency psychiatric service team in The Netherlands. The DPD patients were compared to 1145 other patients referred because of aggression, suicidality or other reasons. DPD patients were more often diagnosed with a psychotic disorder or a manic episode, had more often a migration background, were less often diagnosed with depression, and had lower GAF scores. There were no differences with respect to personality disorders or substance use. DPD patients were two to six times more likely to be (mostly involuntarily) admitted to a psychiatric department (64%), than the other patient groups (aggression 45%, suicidality 21%, other referral reasons 37%). The findings indicate that DPD patients represent an exclusive group who possibly have more intercultural and communication disadvantages due to less cultural acceptance or lack of knowledge about mental healthcare in the Netherlands.
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Affiliation(s)
- Amber Postma
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
- Crisisdienst Utrecht, Altrecht, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
| | - Sophie Bekmann
- Department of Psychiatry, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Johan M. Havenaar
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
| | - Arjan W. Braam
- Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands
- Altrecht research section ‘Schroeder van der Kolk’, Utrecht, The Netherlands
- Crisisdienst Utrecht, Altrecht, Lange Nieuwstraat 119, 3512 PG Utrecht, The Netherlands
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Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry 2019; 18:247-258. [PMID: 31496097 PMCID: PMC6732691 DOI: 10.1002/wps.20655] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.
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Affiliation(s)
- Craig Morgan
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gemma Knowles
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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27
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Rotenberg M. Rehabilitation and recovery for ethnic minority patients with severe mental illness. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYThere is growing evidence to support recovery and rehabilitation services and interventions for people with severe mental illness (SMI). However, those from ethnic minority communities face inequitable outcomes and access to mental health services and poorer functional outcomes. This article reviews the evidence and discusses facilitators and barriers in the recovery journey of people with SMI from ethnic minority groups. Although there is limited evidence for specific interventions for ethnic minority patients, areas for future study and action are discussed.LEARNING OBJECTIVESAfter reading this article you will be able to:•understand the scope of rehabilitation practices and interventions and evidence for use with ethnic minority patients with severe mental illness•describe differences and similarities in the conceptualisation of recovery by majority and minority ethnic communities•appreciate facilitators and barriers to rehabilitation and recovery for ethnic minority patients with SMI.DECLARATION OF INTERESTNone.
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28
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Rodrigues R, MacDougall AG, Zou G, Lebenbaum M, Kurdyak P, Li L, Shariff SZ, Anderson KK. Involuntary hospitalization among young people with early psychosis: A population-based study using health administrative data. Schizophr Res 2019; 208:276-284. [PMID: 30728106 DOI: 10.1016/j.schres.2019.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/24/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Early psychosis is an important window for establishing long-term trajectories. Involuntary hospitalization during this period may impact subsequent service engagement in people with newly diagnosed psychotic disorder. However, population-based studies of involuntary hospitalization in early psychosis are lacking. We sought to estimate the proportion of people aged 16 to 35 years with early psychosis in Ontario who are hospitalized involuntarily at first admission, and to identify the associated risk factors and outcomes. METHODS Using linked population-based health administrative data, we identified incident cases of non-affective psychosis over a five-year period (2009-2013) and followed cases for two years to ascertain the first psychiatric hospitalization. We used modified Poisson regression to model sociodemographic, clinical, and service-related risk factors, and compared service-related outcomes for cases admitted on an involuntary versus voluntary basis. RESULTS Among 17,725 incident cases of non-affective psychosis, 38% were hospitalized within two years, and 81% of these admissions occurred on an involuntary basis (26% of cohort). Sociodemographic factors associated with an increased risk of involuntary admission included younger age (16-20), and first-generation migrant status. The strongest risk factors were poor illness insight, recent police involvement, and admission to a general (versus psychiatric) hospital. Outcomes associated with involuntary admission included increased likelihood of control intervention use and a shorter length of stay. CONCLUSIONS One in four young people with first-episode psychosis will have an involuntary admission early in the course of their illness. Our findings highlight areas for intervention to improve pathways to care for people with psychotic disorder.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Arlene G MacDougall
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Guangyong Zou
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Paul Kurdyak
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada; Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lihua Li
- Institute for Clinical Evaluate Sciences, Toronto, ON, Canada
| | | | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Institute for Clinical Evaluate Sciences, Toronto, ON, Canada.
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29
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Edge D, Lemetyinen H. Psychology across cultures: Challenges and opportunities. Psychol Psychother 2019; 92:261-276. [PMID: 31001925 DOI: 10.1111/papt.12229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Indexed: 12/27/2022]
Abstract
Large variations of inequalities in rates of mental health disorders and access to mental health care exist within and between countries. Globally, disparities range from countries where there is little provision to those where, despite the availability of evidence-based mental health care, service access and outcomes are mediated by social factors such as socio-economic status, race/ethnicity, and culture. This is salient because increasingly diverse populations are inevitably created with globalization. We posit that in multicultural contexts, effective therapeutic engagement requires therapists who are competent and confident to work with diversity and difference, utilizing insights into their own as well as their clients' internal and external worlds. Although there are many reasons why psychotherapies can be insensitive and harmful, for example, the inherent power imbalance in therapeutic relationships, a lack of awareness of cultural and ethnic variation and needs are among them. Acquisition of 'cultural competence' and increasing availability of culturally-adapted interventions should, in theory, enable practitioners to work with a range of individuals with whom they might have little in common. However, whilst cultural adaptation appears promising, there are concerns regarding its viability as a strategy for tackling disparities in access to psychological care. Evidence for cultural competency is patchy at best. We show how and why delivering effective psychotherapy in the twenty-first century requires a paradigm shift from current approaches to truly integrated models, developed in collaboration with recipients of care. Coproducing interventions, training, and means of evaluating them with clients necessitates taking into consideration social contexts, alternative conceptualizations of mental health and disorders and difficulties, and what constitutes appropriate helpful interventions for psychological distress. PRACTITIONER POINTS: Upskilling therapists to work with diversity and difference is essential for effective delivery of psychological treatments. Increasing the availability of culturally-adapted interventions together with therapists who are sufficiently competent and confident to deliver them should enable practitioners to work with a range of individuals with whom they might have little in common. Coproducing culturally appropriate means of responding to mental health difficulties, staff training and development, and service evaluation methods with clients necessitates taking into consideration social contexts, alternative explanatory models of mental health and 'illness', and what constitutes helpful interventions for psychological distress.
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Affiliation(s)
- Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK.,Research & Innovation, Greater Manchester Mental Health NHS Trust, UK
| | - Henna Lemetyinen
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, The University of Manchester, UK
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Hernandez M, Franco R, Kopelowicz A, Hernandez MY, Mejia Y, Barrio C, López SR. Lessons Learned in Clinical Research Recruitment of Immigrants and Minority Group Members with First-Episode Psychosis. J Immigr Minor Health 2019; 21:123-128. [PMID: 29368059 DOI: 10.1007/s10903-018-0704-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recruitment of immigrants and racial and ethnic minorities with first-episode psychosis (FEP) for research studies presents numerous challenges. We describe methods used to recruit 43 U.S. Latinos with FEP and their family caregivers (n = 41) participating in a study to reduce duration of untreated psychosis. A key challenge was that patients were not continuing treatment at an outpatient clinic, as initially expected. To facilitate identification of patients prior to outpatient care, we collaborated with clinic and hospital administrators. Many patients and families were grappling with the aftermath of a hospitalization or adjusting to a diagnosis of a serious mental illness. A considerable amount of time was devoted to addressing participants' concerns and when possible, facilitating needed services. Our experience underscores the importance of establishing long-term relationships through multiple contacts with patients, families, and stakeholders to address recruitment barriers among underserved groups with FEP.
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Affiliation(s)
- Mercedes Hernandez
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Boulevard (D3500), Austin, TX, 78712-1405, USA.
| | - Richard Franco
- Department of Psychiatry & Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alex Kopelowicz
- Department of Psychiatry & Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maria Y Hernandez
- School of Social Work, California State University, Los Angeles, Los Angeles, CA, USA
| | - Yesenia Mejia
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Concepción Barrio
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Steven Regeser López
- Department of Psychology, University of Southern California, 3620 S. McClintock Avenue, Los Angeles, CA, 90089-1061, USA.
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Stigma in Mental Health at the Macro and Micro Levels: Implications for Mental Health Consumers and Professionals. Community Ment Health J 2019; 55:369-374. [PMID: 30069706 DOI: 10.1007/s10597-018-0308-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
Despite increasing mental health promotion and advocacy, stigma persists and poses a significant threat to the healthy functioning at the macro and micro-sociological levels. Stigma is gradually evolving with the incorporation of broader social contexts at the micro and macro levels in which individuals, institutions and larger cultural constructs shape and influence the perception of what is different and therefore stigmatized. This theoretical paper based on literature underscores how mental health stigma discourages individuals from getting proper mental health treatment. The interface of mental illness, stigma, and mental health treatment has ethical and potentially moral implications.
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32
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Access to and Use of Psychiatric Services by Migrants Resettled in Northern Italy. J Immigr Minor Health 2019; 20:1309-1316. [PMID: 29354861 DOI: 10.1007/s10903-018-0703-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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Maraj A, Iyer SN, Shah JL. Enhancing the Engagement of Immigrant and Ethnocultural Minority Clients in Canadian Early Intervention Services for Psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:740-747. [PMID: 30067385 PMCID: PMC6299191 DOI: 10.1177/0706743718773752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anika Maraj
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
- ACCESS Open Minds (Pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, Quebec
- Frayme, Networks for Centres of Excellence focused on youth mental health and substance use, Canada
- These authors contributed equally to this work
| | - Jai L. Shah
- Prevention and Early Intervention Program for Psychoses, Douglas Mental Health University Institute, Montréal, Quebec
- Department of Psychiatry, McGill University, Montreal, Quebec
- ACCESS Open Minds (Pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, Quebec
- These authors contributed equally to this work
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Amaral CE, Onocko-Campos R, de Oliveira PRS, Pereira MB, Ricci ÉC, Pequeno ML, Emerich B, dos Santos RC, Thornicroft G. Systematic review of pathways to mental health care in Brazil: narrative synthesis of quantitative and qualitative studies. Int J Ment Health Syst 2018; 12:65. [PMID: 30450125 PMCID: PMC6208112 DOI: 10.1186/s13033-018-0237-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil. METHODS LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil. The results were organized in pathway stages, based on Goldberg and Huxley's 'model of Levels and Filters' and on Kleinman's framework of 'Popular, Folk and Professional health sectors'. Analysis also considered the changes in national mental health policy over time. RESULTS 25 papers were found, with data ranging from 1989 to 2013. Complex social networks were involved in the initial recognition of MH issues. The preferred points of first contact also varied with the nature and severity of problems. A high proportion of patients is treated in specialized services, including mild cases. There is limited capacity of primary care professionals to identify and treat MH problems, with some improvement from collaborative care in the more recent years. The model for crisis management and acute care remains unclear: scarce evidence was found over the different arrangements used, mostly stressing lack of integration between emergency, hospital and community services and fragile continuity of care. CONCLUSIONS The performance of primary care and the regulation of acute demands, especially crisis management, are the most critical aspects on PMHC. Although primary care performance seems to be improving, the balanced provision and integration between services for adequate acute and long-term care is yet to be achieved.
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Affiliation(s)
- Carlos Eduardo Amaral
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
- Department of Psychology, University Centre Unicatólica of Quixadá, Quixadá, Brazil
- Fortaleza, Ceará CEP 60125-001 Brazil
| | - Rosana Onocko-Campos
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Mariana Barbosa Pereira
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Éllen Cristina Ricci
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Bruno Emerich
- Department of Collective Health, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Kamens S, Davidson L, Hyun E, Jones N, Morawski J, Kurtz M, Pollard J, van Schalkwyk GI, Srihari V. The Duration of Untreated Psychosis: A Phenomenological Study. PSYCHOSIS 2018; 10:307-318. [PMID: 31871485 PMCID: PMC6927331 DOI: 10.1080/17522439.2018.1524924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mounting evidence has indicated that early intervention leads to improved clinical and functional outcomes for young persons experiencing recent onset psychosis. As part of a large early detection campaign, the present study aimed to investigate subjective experiences during the duration of untreated psychosis (DUP), or time between psychosis onset and treatment contact. Participants were 10 young adults participating in early intervention services for psychosis. After DUP was estimated during standardized baseline assessment, participants engaged in qualitative interviews focused on their life experiences prior to treatment and leading up to the present. Mixed methods data analyses compared standardized DUP estimates with participants' subjective narratives. Findings revealed that participants experienced and conceptualized a longer trajectory of subjective difficulties (TSD) beginning before and extending beyond standardized DUP estimates. Participants emphasized striving for independence and social belonging. The majority of participants reported benefiting from their current services and believed that earlier support of some kind would have been beneficial. These findings support previous research on subjective barriers to early detection and treatment seeking in young adults experiencing psychosis. Implications and future research directions include further efforts to differentiate the struggles unique to early psychosis from psychosocial risk factors and other challenges of young adulthood.
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Affiliation(s)
- Sarah Kamens
- Department of Psychology, Wesleyan University
- Specialized Treatment Early in Psychosis (STEP) program, Yale University School of Medicine
| | - Larry Davidson
- Program for Recovery and Community Health (PRCH), Yale University School of Medicine
| | - Emily Hyun
- Specialized Treatment Early in Psychosis (STEP) program, Yale University School of Medicine
| | - Nev Jones
- Department of Mental Health Law & Policy, University of South Florida
| | | | | | - Jessica Pollard
- Specialized Treatment Early in Psychosis (STEP) program, Yale University School of Medicine
| | - Gerrit Ian van Schalkwyk
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | - Vinod Srihari
- Specialized Treatment Early in Psychosis (STEP) program, Yale University School of Medicine
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Culturally adapted Family Intervention (CaFI): case examples from therapists’ perspectives. COGNITIVE BEHAVIOUR THERAPIST 2018. [DOI: 10.1017/s1754470x18000156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis paper describes three case examples from a recent trial of family intervention specifically designed for people of African-Caribbean descent. These examples, told from the therapists’ perspectives, highlight key components of the intervention and issues that arose in working with this client group. Findings from the study suggest that it is possible to engage this client-group in family therapy similar to traditional evidenced-based family interventions, although as illustrated in the paper, it is important that therapists pay attention to themes that are likely to be particularly pertinent for this group, including experiences of discrimination and mistrust of services. The use of Family Support Members, consisting of members of the person's care team or volunteers recruited from the community, may also help support people to engage in therapy in the absence of biological relatives.
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Abstract
In this paper, we explore ethnic inequalities in severe mental illness and care experiences. We consider the barriers to progressive and cohesive action and propose ways of overcoming these. Clinical and policy leadership must bring together hidden patient voices, divergent professional narratives and quality research.Declaration of interestK.B. is Editor of the British Journal of Psychiatry, but has not played any role in the decision-making for this paper. K.B. leads and J.N. is a partner and K.H. a researcher in the Synergi Collaborative Centre.
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Affiliation(s)
- Kamaldeep Bhui
- Professor of Cultural Psychiatry and Epidemiology,Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts & The London School of Medicine and Dentistry,Queen Mary University of London and Consultant Psychiatrist,East London NHS Foundation Trust,UK
| | - Kristoffer Halvorsrud
- Research Fellow,Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts & The London School of Medicine and Dentistry,Queen Mary University of London,UK
| | - James Nazroo
- Professor of Sociology,School of Social Sciences & Cathie Marsh Institute for Social Research,University of Manchester,UK
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MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1005-1038. [PMID: 30136192 PMCID: PMC6182505 DOI: 10.1007/s00127-018-1578-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems. METHODS Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data. RESULTS Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways. CONCLUSIONS Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada.
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Edge D, Grey P. An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families. Ethn Dis 2018; 28:485-492. [PMID: 30202202 DOI: 10.18865/ed.28.s2.485] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To determine how to improve the cultural appropriateness and acceptability of an extant evidence-based model of family intervention (FI), a form of 'talking treatment,' for use with African Caribbean service users diagnosed with schizophrenia and their families. Design Community partnered participatory research (CPPR) using four focus groups comprising 31 key stakeholders. Setting Community locations and National Health Service (NHS) mental health care settings in northwest England, UK. Participants African Caribbean service users (n=10), family members, caregivers and advocates (n=14) and health care professionals (n=7). Results According to participants, components of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to improve cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called 'shared learning.' This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists' cultural competence was regarded as fundamental for successful therapeutic engagement and outcomes. Conclusions Despite being labelled 'hard-to-reach' by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Caribbean community were highly motivated to engage in all aspects of research. Participating in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.
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Affiliation(s)
- Dawn Edge
- School of Health Sciences, Faculty of Biology, Medicine & Health; University of Manchester, UK
| | - Paul Grey
- New Testament Church of God, Grey Services, Manchester, UK
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Edge D, Degnan A, Cotterill S, Berry K, Baker J, Drake R, Abel K. Culturally adapted Family Intervention (CaFI) for African-Caribbean people diagnosed with schizophrenia and their families: a mixed-methods feasibility study of development, implementation and acceptability. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BackgroundAfrican-Caribbean people in the UK experience the highest incidence of schizophrenia and the greatest inequity in mental health care. There is an urgent need to improve their access to evidence-based care and outcomes. Family intervention (FI) is a National Institute for Health and Care Excellence-approved psychosocial intervention. Although clinically effective and cost-effective for schizophrenia, it is rarely offered. Evidence for any research into FI is lacking for ethnic minority people generally and for African-Caribbean people specifically.Aims(1) To assess the feasibility of delivering a novel, culturally appropriate psychosocial intervention within a ‘high-risk’ population to improve engagement and access to evidence-based care. (2) To test the feasibility and acceptability of delivering FI via ‘proxy families’.DesignA mixed-methods, feasibility cohort study, incorporating focus groups and an expert consensus conference.SettingTwo mental health trusts in north-west England.ParticipantsWe recruited a convenience sample of 31 African-Caribbean service users. Twenty-six family units [service users, relatives/family support members (FSMs) or both] commenced therapy. Half of the service users (n = 13, 50%), who did not have access to their biological families, participated by working with FSMs.InterventionsAn extant FI model was culturally adapted with key stakeholders using a literature-derived framework [Culturally adapted Family Intervention (CaFI)]. Ten CaFI sessions were offered to each service user and associated family.Main outcome measuresRecruitment (number approached vs. number consented), attendance (number of sessions attended), attrition (number of dropouts at each time point), retention (proportion of participants who completed therapy sessions), and completeness of outcome measurement.ResultsOf 74 eligible service users, 31 (42%) consented to take part in the feasibility trial. The majority (n = 21, 67.7%) were recruited from community settings, seven (22.6%) were recruited from rehabilitation settings and three (9.7%) were recruited from acute wards. Twenty-four family units (92%) completed all 10 therapy sessions. The proportion who completed treatment was 77.42% (24/31). The mean number of sessions attended was 7.90 (standard deviation 3.96 sessions) out of 10. It proved feasible to collect a range of outcome data at baseline, post intervention and at the 3-month follow-up. The rating of sessions and the qualitative findings indicated that CaFI was acceptable to service users, families, FSMs and health-care professionals.LimitationsThe lack of a control group and the limited sample size mean that there is insufficient power to assess efficacy. The findings are not generalisable beyond this population.ConclusionsIt proved feasible to culturally adapt and test FI with a sample of African-Caribbean service users and their families. Our study yielded high rates of recruitment, attendance, retention and data completion. We delivered CaFI via FSMs in the absence of biological families. This novel aspect of the study has implications for other groups who do not have access to their biological families. We also demonstrated the feasibility of collecting a range of outcomes to inform future trials and confirmed CaFI’s acceptability to key stakeholders. These are important findings. If CaFI can be delivered to the group of service users with the most serious and persistent disparities in schizophrenia care, it has the potential to be modified for and delivered to other underserved groups.Future workA fully powered, multicentre trial, comparing CaFI with usual care, is planned.Trial registrationCurrent Controlled Trials ISRCTN94393315.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Dawn Edge
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Cotterill
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Baker
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Richard Drake
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn Abel
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jeyagurunathan A, Abdin E, Shafie S, Wang P, Chang S, Ong HL, Abdul Rahman RF, Sagayadevan V, Samari E, Chua YC, Vaingankar JA, Verma SK, Wei KC, Chong SA, Subramaniam M. Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore. Int J Soc Psychiatry 2018; 64:554-562. [PMID: 29947273 PMCID: PMC6116080 DOI: 10.1177/0020764018784632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services. AIM The current study aimed to explore the associations of patients' socio-demographic characteristics with pathways to first contact and duration of untreated mental illness. METHOD A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations. RESULTS Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own. CONCLUSION Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.
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Affiliation(s)
| | | | - Saleha Shafie
- 1 Research Division, Institute of Mental Health, Singapore
| | - Peizhi Wang
- 1 Research Division, Institute of Mental Health, Singapore
| | - Sherilyn Chang
- 1 Research Division, Institute of Mental Health, Singapore
| | - Hui Lin Ong
- 1 Research Division, Institute of Mental Health, Singapore
| | | | | | | | - Yi Chian Chua
- 1 Research Division, Institute of Mental Health, Singapore
| | | | - Swapna Kamal Verma
- 2 Early Psychosis Intervention Programme (EPIP) & General Psychiatry (GP1), Institute of Mental Health, Singapore
| | - Ker-Chiah Wei
- 3 Community Psychiatry, Institute of Mental Health, Singapore
| | - Siow Ann Chong
- 1 Research Division, Institute of Mental Health, Singapore
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Hanna LA, Bakir M, Hall M. UK Pharmacy Students' Opinions on Mental Health Conditions. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6560. [PMID: 30323391 PMCID: PMC6181156 DOI: 10.5688/ajpe6560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/02/2017] [Indexed: 06/01/2023]
Abstract
Objective. To determine future pharmacists' opinions on mental health conditions and investigate the influence of gender. Methods. Final-year Master of Pharmacy students at Queen's University Belfast completed a paper-based questionnaire. Section A of the questionnaire was adapted from a United Kingdom public opinion questionnaire on mental health. Section B gathered non-identifiable demographic data. Descriptive statistics were undertaken. Mann-Whitney U and Chi-square tests were used for gender comparisons. Results. An 89% (97/109) response rate was obtained. Most survey respondents considered that pharmacological and non-pharmacological measures were beneficial in the management of mental health conditions (89% and 96%, respectively) and that people with mental illness had the same rights to jobs as anyone else (82%). However, only 57% of the respondents felt confident discussing mental health issues with patients and 36% deemed university training to be satisfactory. Males were more likely than females to "agree strongly" or "agree slightly" that they would not want to live next door to someone who has been mentally ill. Conclusion. While some positive opinions were evident, more work is needed to prepare future pharmacists for roles within mental health care teams.
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Affiliation(s)
- Lezley-Anne Hanna
- School of Pharmacy, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Mohammad Bakir
- School of Pharmacy, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Maurice Hall
- School of Pharmacy, Queen's University Belfast, Northern Ireland, United Kingdom
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Sweeney A, Filson B, Kennedy A, Collinson L, Gillard S. A paradigm shift: relationships in trauma-informed mental health services. BJPSYCH ADVANCES 2018; 24:319-333. [PMID: 30174829 PMCID: PMC6088388 DOI: 10.1192/bja.2018.29] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?’. This article, authored by trauma survivors and service providers, describes trauma-informed approaches to mental healthcare, why they are needed and how barriers can be overcome so that they can be implemented as an organisational change process. It also describes how past trauma can be understood as the cause of mental distress for many service users, how service users can be retraumatised by ‘trauma-uninformed’ staff and how staff can experience vicariously the service user's trauma and can themselves be traumatised by practices such as restraint and seclusion. Trauma-informed mental healthcare offers opportunities to improve service users' experiences, improve working environments for staff, increase job satisfaction and reduce stress levels by improving the relationships between staff and patients through greater understanding, respect and trust.
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Affiliation(s)
- Angela Sweeney
- Trauma survivor and researcher. She has worked in mental health research since 2001, and has a particular interest in perinatal mental health and trauma-informed approaches (TIA). Her current research is aimed at understanding and improving assessment processes for talking therapies
| | - Beth Filson
- US-based writer and trainer in TIA. She works with diverse groups to integrate TIA in policy and practice. She also contributes to the development of Intentional Peer Support and peer support alternatives to the psychiatric system. Her early experience of multiple hospital admissions informs her work
| | - Angela Kennedy
- Clinical psychologist who has worked in the NHS since 1990. She is trauma informed care lead for a large Mental Health Trust and is mental health lead for the North of England Clinical Network. Her focus is applying clinical knowledge to system-wide change, including compassion-focused cultures and leadership
| | - Lucie Collinson
- Public health specialty registrar on the London training scheme and NIHR Academic Clinical Fellow at the London School of Hygiene and Tropical Medicine. She has worked as a doctor in the NHS and overseas and has experience in health services research
| | - Steve Gillard
- Reader in social and community mental health. His current research focuses on the increasing role played by people with lived experience in producing the services that they use - the development of more distributed forms of mental health practice
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Martin IDS, Ciccone Giacon BC, Giacchero Vedana KG, Guidorizzi Zanetti AC, Fendrich L, Frari Galera SA. Where to seek help? Barriers to beginning treatment during the first-episode psychosis. Int J Nurs Sci 2018; 5:249-254. [PMID: 31406833 PMCID: PMC6626253 DOI: 10.1016/j.ijnss.2018.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/26/2018] [Accepted: 06/28/2018] [Indexed: 11/01/2022] Open
Abstract
Objective As decreasing the duration of untreated psychosis has been highlighted as key indicator in relation to improved prognosis, this study aims to identify the access barriers to beginning early treatment of young people in first-episode psychosis (FEP), based on family reports on the experience of perceiving illness and help-seeking. Method A qualitative research was carried out with 12 relatives of 12 young people passing through their first psychiatric hospital admission as a result of their FEP. Depth interviews were used for data collection and thematic content method for data analysis. Results Barriers to beginning treatment were lack of knowledge and difficulty in recognizing mental illness, lack of knowledge on where to seek specialized treatment, and stigma and resistance to psychiatric treatment. Conclusion It was demonstrated that the family members are protagonists in the search for treatment of young people in their FPE, given that the initiative for seeking treatment came from them.
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Affiliation(s)
- Isabela Dos Santos Martin
- Department of Psychiatric Nursing and Human Sciences of University of São Paulo, Ribeirao Preto College of Nursing, Brazil
| | | | | | | | - Lorena Fendrich
- Department of Psychiatric Nursing and Human Sciences of University of São Paulo, Ribeirao Preto College of Nursing, Brazil
| | - Sueli Aparecida Frari Galera
- Department of Psychiatric Nursing and Human Sciences of University of São Paulo, Ribeirao Preto College of Nursing, Brazil
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Ferrari M, Flora N, Anderson KK, Haughton A, Tuck A, Archie S, Kidd S, McKenzie K. Gender differences in pathways to care for early psychosis. Early Interv Psychiatry 2018; 12:355-361. [PMID: 27017924 DOI: 10.1111/eip.12324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 01/02/2016] [Accepted: 01/15/2016] [Indexed: 12/22/2022]
Abstract
AIMS Gender is a critical demographic determinant in first-episode psychosis research. We used data from the ACE Pathways to Care Project, which examined pathways to care in African-origin, Caribbean-origin and European-origin participants, to investigate the role of gender in pathways to early intervention programmes. METHOD A qualitative approach was used to examine gender differences in the routes to care. We conducted four focus groups and four individual in-depth interviews with 25 service users of early intervention services from African-origin, Caribbean-origin and European-origin populations. RESULTS Gender stereotypes negatively influence the first service contact for women, and the early phase of the help seeking process for men. Women reported trying to seek care. However, family members and service providers often questioned their calls for help. Men described having difficulties in talking about their symptoms, as the act of seeking help was perceived as a sign of weakness by peers. CONCLUSIONS The findings of this study suggest that gender stereotypes shape the journey to specialized care in different ways for men and women. Awareness of the impact that gender stereotypes have when a young person is seeking care for psychosis could help to promote a shift in attitudes among health-care providers and the provision of more compassionate and patient-centred care during this critical time.
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Affiliation(s)
- Manuela Ferrari
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Nina Flora
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Asante Haughton
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Sean Kidd
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Development, validation and cultural-adaptation of the knowledge about psychosis questionnaire for African-Caribbean people in the UK. Psychiatry Res 2018; 263:199-206. [PMID: 29573660 DOI: 10.1016/j.psychres.2018.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/21/2022]
Abstract
The absence of assessment tools incorporating different cultural models of mental illness is a major barrier to recruiting ethnic minorities into clinical trials, reducing generalisability of findings and potentially increasing disparities in access to evidence-based care. This study aimed to develop and validate a new Knowledge about Psychosis (KAP) self-report measure and a culturally-adapted version for African-Caribbean people (CaKAP). Content and face validity were achieved through consultations with experts in psychosis and a focus group with service users, carers, and community members. Eighty-seven predominantly White British participants and 79 African-Caribbean participants completed the knowledge questionnaires (KAP and CaKAP) and measures of help-seeking and stigma. Overall, the measures showed good internal consistency and test re-test reliability. Construct validity was evidenced via significant positive associations between knowledge about psychosis and help-seeking and significant negative associations between knowledge and stigma. These measures could improve the delivery of psychosocial interventions and outcome measurement in research trials.
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Abstract
The present study was conducted to describe access to and use of psychiatric services by migrants resettled in a large and well-defined catchment area. The study was conducted in a catchment area of 459,536 inhabitants in Verona, a city located in the Northeast of Italy. Using a psychiatric case register, all native and migrant individuals with a first ever psychiatric contact from 2000 to 2015 were identified. Service use data during the 12 months following first contact were collected. During the study period a total of 2610 migrants and 28,860 natives had at least one psychiatric contact. A progressive rise in the proportion of migrants seeking psychiatric care was observed, from 2.5% in 2000 to more than 14% in 2015. During the 12 months following first contact, the proportion of patients with a single consultation did not differ between resettled migrants and natives. However, migrants were more often marked users or heavy users of psychiatric services. Multivariate linear regression analyses showed that younger male individuals with psychotic disorders experienced higher psychiatric services use regardless their native or migrant condition. In a large catchment area with a well-developed community-based system of mental health care a progressive rise in the number of migrants seeking psychiatric care was observed. The pattern of service use during the 12 months after first contact was not related to nationality, suggesting the capacity of community psychiatric services to retain people in care. These findings call for the development of culturally and linguistically appropriate community psychiatric services.
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Nilforooshan R, Amin R, Warner J. Ethnicity and outcome of appeal after detention under the Mental Health Act 1983. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.108.021360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThere is insufficient research into the relationship between ethnicity and appeals against detention under mental health legislation. We sought to identify rates and success of appeals in different ethnic groups through a retrospective analysis of all detentions under the Mental Health Act 1983 over 1 year.ResultsWe found high rates of appeals overall, with substantial differences between ethnic groups (36 (39%) White British compared with 71 (63%) Black Caribbean (P = 0.0001) and 21 (68%) White Irish (P = 0.01) individuals (Yates corrected chi-squared)). Success rates on appeal were very low in all groups.Clinical ImplicationsThere are significant ethnic differences in appeals against detention under the Mental Health Act.
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Morgan C, Fearon P, Lappin J, Heslin M, Donoghue K, Lomas B, Reininghaus U, Onyejiaka A, Croudace T, Jones PB, Murray RM, Doody GA, Dazzan P. Ethnicity and long-term course and outcome of psychotic disorders in a UK sample: the ÆSOP-10 study. Br J Psychiatry 2017; 211. [PMID: 28642258 PMCID: PMC5537567 DOI: 10.1192/bjp.bp.116.193342] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundThe incidence of psychotic disorders is elevated in some minority ethnic populations. However, we know little about the outcome of psychoses in these populations.AimsTo investigate patterns and determinants of long-term course and outcome of psychoses by ethnic group following a first episode.MethodÆSOP-10 is a 10-year follow-up of an ethnically diverse cohort of 532 individuals with first-episode psychosis identified in the UK. Information was collected, at baseline, on clinical presentation and neurodevelopmental and social factors and, at follow-up, on course and outcome.ResultsThere was evidence that, compared with White British, Black Caribbean patients experienced worse clinical, social and service use outcomes and Black African patients experienced worse social and service use outcomes. There was evidence that baseline social disadvantage contributed to these disparities.ConclusionsThese findings suggest ethnic disparities in the incidence of psychoses extend, for some groups, to worse outcomes in multiple domains.
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Affiliation(s)
- Craig Morgan
- Craig Morgan, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Paul Fearon, MRCPsych, Department of Psychiatry, Trinity College Dublin, Dublin, Ireland; Julia Lappin, MRCPsych, School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia; Margaret Heslin, MSc, Kim Donoghue, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Ben Lomas, MRCPsych, Division of Psychiatry, University of Nottingham, Nottingham, UK; Ulrich Reininghaus, PhD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK and School of Mental Health and Neuroscience, Maastricht University, The Netherlands; Adanna Onyejiaka, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; Tim Croudace, PhD, School of Nursing and Midwifery, University of Dundee, UK; Peter B. Jones, FRCPsych, Department of Psychiatry, University of Cambridge, Cambridge, UK; Robin M. Murray, FRS, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Gillian A. Doody, MRCPsych, Division of Psychiatry, University of Nottingham, Nottingham, UK; Paola Dazzan, MRCPsych, Institute of Psychiatry, Psychology & Neuroscience, King's College London and National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Rotenberg M, Tuck A, Ptashny R, McKenzie K. The role of ethnicity in pathways to emergency psychiatric services for clients with psychosis. BMC Psychiatry 2017; 17:137. [PMID: 28407748 PMCID: PMC5390361 DOI: 10.1186/s12888-017-1285-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/24/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study investigates the role of ethnicity in pathways to emergency mental health care in Toronto for clients with psychosis, while taking into account neighborhood factors. Previous literature has focused on Afro-Caribbean clients, reporting an increased risk of accessing mental health care through negative pathways. METHODS A retrospective chart review for clients from 6 different ethnic origin groups presenting with psychosis - East Asian, South Asian, Black African, Black Caribbean, White European, and White North American - was undertaken in a psychiatric emergency department (ED). Logistic regression models were constructed to examine the relationship between pathways to care (involuntary detention under the Mental Health Act (MHA), police or ambulance referral, accompaniment by family or friends) with individual and neighbourhood factors. RESULTS A total of 765 clients were included in the study. East Asian (OR =2.36, p < 0.01) and South Asian (OR 2.99, p < 0.01) origin clients have increased odds of presenting to the ED while involuntarily detained under the MHA. Involuntary status under the MHA increased the odds of presenting via police or ambulance (OR 8.27, p < 0.001). East Asian origin clients have increased odds of presenting to the ED by police or ambulance (OR =2.10, p < 0.05). Clients from neighbourhoods with higher levels of residential instability have increased odds of presenting by police or ambulance (OR =1.35, p < 0.01), while clients from neighbourhoods with higher levels of ethnic concentration have increased odds of being accompanied to the ED by family or friends (OR =1.33, p < 0.01). CONCLUSION In contrast to previous studies, East Asian and South Asian origin clients with psychosis have increased odds of a coercive pathway to emergency psychiatric services in Toronto. Black African and Black Caribbean origin clients do not have increased odds of a coercive pathway. Clients living in areas with high levels of residential instability are more likely to encounter a negative pathway. Ethnic concentration may be a supportive factor in family and friend accompaniment.
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Affiliation(s)
- Martin Rotenberg
- University of Toronto, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Andrew Tuck
- grid.155956.bCentre for Addiction and Mental Health, Toronto, ON Canada
| | - Rachel Ptashny
- grid.155956.bCentre for Addiction and Mental Health & Youthdale Treatment Centres, Toronto, ON Canada ,Social Aetiology of Mental Illness (SAMI) CIHR Strategic Training Initiative, Toronto, Canada
| | - Kwame McKenzie
- grid.17063.33University of Toronto, Centre for Addiction and Mental Health, Toronto, ON Canada
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