1
|
Huggett C, Peters S, Gooding P, Berry N, Pratt D. A systematic review and meta-ethnography of client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Clin Psychol Rev 2024; 113:102469. [PMID: 39098267 DOI: 10.1016/j.cpr.2024.102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/28/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; 'Working on the edge' and 'Being ready, willing, and able to build an alliance in the context of suicidal experiences'. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety.
Collapse
Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK.
| | - Sarah Peters
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| |
Collapse
|
2
|
Chisholm J, Hope J, Fossey E, Petrakis M. Mental Health Clinician Attitudes about Service User and Family Agency and Involvement in Recovery-Oriented Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6787. [PMID: 37754647 PMCID: PMC10531441 DOI: 10.3390/ijerph20186787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Recovery-oriented practice (ROP) is a framework focusing on recovery through hope, choice, and meaning, to live with or without enduring symptoms and challenges. AIMS To examine clinicians' attitudes about the involvement of service users and family or supporters in ROP. METHODS A bespoke Qualtrics survey obtained views of mental health clinicians working in an Australian public mental health service about service user and family involvement in ROP, using a five-point Likert scale of agreement and free-text responses. Data were analysed with descriptive statistics and content analysis methods. RESULTS Two hundred and three clinicians completed the survey. Most (79%) clinicians agreed with the statement that service users want clinicians to use ROP principles, and the majority (63%) also 'strongly believed' that ROP made a difference to service users' mental health outcomes. Only 15% 'strongly agreed' and 57% somewhat agreed with the statement that service users know what treatment is best for them, and only 20% of clinicians 'strongly agreed' that supporters of service users believed in and wanted ROP for their family member or friend. FUTURE DIRECTIONS This study adds to the literature on clinicians' views about ROP and shows that although clinicians are supportive of ROP, they also express substantial ambivalence about whether service users and families know what treatment is best. For ROP implementation to be successful, workforce training needs to support clinicians to reflect on these views with service users and families, and to encourage supported decision making. Future studies should focus on changes in clinicians' views and practice post ROP training.
Collapse
Affiliation(s)
- Janice Chisholm
- Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3145, Australia
- Mental Health and Wellbeing Program, Eastern Health, Centre for Education and Research, Melbourne, VIC 3128, Australia
| | - Judy Hope
- Mental Health and Wellbeing Program, Eastern Health, Centre for Education and Research, Melbourne, VIC 3128, Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3128, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3199, Australia
| | - Melissa Petrakis
- Department of Social Work, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC 3145, Australia
- St Vincent’s Hospital Mental Health Service, Melbourne, VIC 3065, Australia
| |
Collapse
|
3
|
Khazanov GK, Jager-Hyman S, Harrison J, Candon M, Buttenheim A, Pieri MF, Oslin DW, Wolk CB. Leveraging behavioral economics and implementation science to engage patients at risk for suicide in mental health treatment: a pilot study protocol. Pilot Feasibility Stud 2022; 8:181. [PMID: 35964151 PMCID: PMC9375238 DOI: 10.1186/s40814-022-01131-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Primary care is an ideal setting to connect individuals at risk for suicide to follow-up care; however, only half of the patients referred from the primary care attend an initial mental health visit. We aim to develop acceptable, feasible, low-cost, and effective new strategies to increase treatment initiation among at-risk individuals identified in primary care. Methods We will conduct a multi-phase, mixed-methods study. First, we will conduct a chart review study by using administrative data, including medical records, to identify characteristics of primary care patients at risk for suicide who do or do not attend an initial mental health visit following a referral. Second, we will conduct a mixed methods study by using direct observations and qualitative interviews with key stakeholders (N = 65) to understand barriers and facilitators to mental health service initiation among at-risk individuals. Stakeholders will include patients with suicidal ideation referred from primary care who do and do not attend a first mental health visit, primary care and behavioral health providers, and individuals involved in the referral process. We also will collect preliminary self-report and behavioral data regarding potential mechanisms of behavior change (i.e., self-regulation and social support) from patients. Third, we will leverage these findings, relevant frameworks, and the extant literature to conduct a multi-arm, non-randomized feasibility trial. During this trial, we will rapidly prototype and test strategies to support attendance at initial mental health visits. Strategies will be developed with subject matter experts (N = 10) and iteratively pilot tested (~5 patients per strategy) and refined. Research will be completed in the Penn Integrated Care Program (PIC), which includes fourteen primary care clinics in Philadelphia that provide infrastructure for electronic referrals, patient communication, and data access. Discussion We will leverage frameworks and methods from behavioral economics and implementation science to develop strategies to increase mental health treatment initiation among individuals at risk for suicide identified in primary care. This project will lead to an evaluation of these strategies in a fully powered randomized trial and contribute to improvements in access to and engagement in mental health services for individuals at risk for suicide. Trial registration ClinicalTrials.gov Identifier: NCT05021224
Collapse
Affiliation(s)
- Gabriela Kattan Khazanov
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA. .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Shari Jager-Hyman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Joseph Harrison
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Philadelphia College of Osteopathic Medicine, School of Professional and Applied Psychology, Philadelphia, PA, USA
| | - Molly Candon
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Alison Buttenheim
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.,Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Matteo F Pieri
- Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - David W Oslin
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Courtney Benjamin Wolk
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| |
Collapse
|
4
|
Alonzo D, Zapata Pratto DA. Mental health services for individuals at risk of suicide in Peru: Attitudes and perspectives of mental health professionals. Int J Soc Psychiatry 2021; 67:209-218. [PMID: 32847415 DOI: 10.1177/0020764020946786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mental Health professionals often have to deal with at-risk individuals in crises and lack specialized training on suicide risk assessment and intervention. This study examined mental health professionals' attitudes toward at-risk individuals and their perceptions of the quality of training and treatment available for assessing and intervening with this population. METHODS A total of 32 mental health professionals (13 psychiatrists, 16 psychologists, 2 psychiatric nurses; 1 social assistant) from highly vulnerable communities in Lima, Peru discussed their perceptions in four focus groups conducted by the authors. RESULTS Participants reported glaring deficiencies in all areas explored including training, knowledge and skills regarding suicide assessment and management. In addition, using ground theory analysis, three domains of findings emerged representing barriers and facilitators of treatment engagement, risk and protective factors of suicide and pros and cons of the current mental health care system including micro-, mezzo- and macro-level factors. The most frequently identified barrier was the perception that suicide is illegal; facilitator was family involvement; risk factor was poor parenting; protective factor was religious beliefs; pro of mental health care system was establishment of community-based services and con of mental health care system was lack of access to psychiatrists. CONCLUSION The lack of specialized training available in the institutions that are designed to prepare mental health professionals for working with at-risk individuals is notable and has a direct and known impact self-identified by helping professionals. The need and desire for targeted training is palpable and essential to address growing rates of suicide, particularly among youth, in Peru.
Collapse
Affiliation(s)
- Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA.,Suicide Prevention Research Program, Fordham University, West Harrison, NY, USA
| | - Dafne Aida Zapata Pratto
- Suicide Prevention Research Program, Fordham University, West Harrison, NY, USA.,Universidad Antonio Ruiz de Montoya, Lima, Peru
| |
Collapse
|
5
|
Munasinghe S, Page A, Mannan H, Ferdousi S, Peek B. Determinants of treatment disengagement among those at risk of suicide referred to primary mental health care services in Western Sydney, Australia. Aust N Z J Psychiatry 2021; 55:277-288. [PMID: 33032444 DOI: 10.1177/0004867420963738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. METHOD This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. RESULTS There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. CONCLUSION These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.
Collapse
Affiliation(s)
- Sithum Munasinghe
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Andrew Page
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Shahana Ferdousi
- Western Sydney Primary Health Network, Blacktown, NSW, Australia
| | - Brendan Peek
- Royal Australasian College of Dental Surgeons, Sydney, NSW, Australia
| |
Collapse
|
6
|
Alonzo D. Pros and cons of mental health treatment: reports from depressed clients with suicidal ideation. J Ment Health 2020; 31:332-339. [PMID: 32687417 DOI: 10.1080/09638237.2020.1793121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Suicide is a major public health problem; rates in the US have risen significantly across all age groups over the past decade. Outpatient mental health services can help to mitigate the risk of suicide. Despite highly positive effects, fewer than half of those individuals diagnosed with a mental illness receive needed mental health treatment. AIMS This study aims to examine the pros and cons of mental health treatment utilization and non-utilization from the perspective of depressed individual with suicidal ideation via a decisional balance worksheet. METHODS Depressed adults with suicidal ideation presenting to an emergency room for treatment recorded the pros and cons they associate with mental health treatment utilization and non-utilization. RESULTS Participants generated pros of non-utilization the least frequently (11.6%), and the pros of treatment utilization most frequently (39.6%). The most frequently cited pro of treatment utilization was "Learning New Skills", representing 40% of identified pros of utilizing treatment. CONCLUSION Findings suggest that reinforcing the new skills treatment can provide and ensuring every client understands treatment strategies and the reasons that treatment can be effective for their individual case may be an effective means of increasing the treatment engagement of at-risk individuals.
Collapse
Affiliation(s)
- Dana Alonzo
- Fordham University, Graduate School of Social Service, West Harrison, NY, USA
| |
Collapse
|
7
|
Riblet N, Shiner B, Scott R, Bruce ML, Wasserman D, Watts BV. Exploring Psychiatric Inpatients' Beliefs About the Role of Post-discharge Follow-up Care in Suicide Prevention. Mil Med 2019; 184:e91-e100. [PMID: 29860477 PMCID: PMC8801294 DOI: 10.1093/milmed/usy129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/15/2018] [Indexed: 01/25/2023] Open
Abstract
Introduction: Patients are at increased risk for death by suicide following a psychiatric hospitalization. There has been limited study of the association between patient engagement in follow-up care after psychiatric hospitalization and suicide risk. Understanding why psychiatric inpatients choose to engage in post-discharge care is important in developing effective suicide prevention strategies. Materials and Methods: The theory of planned behavior (TPB) has been widely used to understand many health behaviors including healthcare utilization. Using the TPB, we developed an interview guide that assessed psychiatric inpatients’ attitudes and beliefs about the role of post-discharge care in addressing suicide risk. We also inquired about perception of future risk for suicide after discharge. We conducted semi-structured interviews prior to discharge and administered the Columbia-Suicide Severity Rating Scale (C-SSRS). We assessed healthcare utilization at 1 and 3 mo after discharge. We coded and grouped the transcribed data according to the three domains of the TPB model: attitudes, subjective norms, and perceived behavioral control. Results: Sixteen individuals consented to enrollment. More than half (N = 10) believed that they were at no or low future suicide risk after discharge. Participants who felt that their future risk for suicide was low or none were significantly older (mean 59.3 yr, SD: 8.3) and reported significantly less severe suicidal ideation in the past month (mean CSSR-S 2.5, SD 2.1) compared to those participants who believed that their future risk was high (mean age 47.5, SD: 8.6; mean CSSR-S 4.7, SD 0.5, p < 0.05). However, all participants had a lifetime history of severe suicidal ideation (mean CSSR-S > 4.7). Many participants felt that peers facilitated treatment engagement. However, participants expressed a tendency to avoid treatment if they experienced unwanted side effects, encountered stigma, or experienced poor-therapeutic alliance. Five participants experienced poor continuity of care after discharge. Of these participants, four reported at the time of discharge no or low perceived future risk of suicide and three were readmitted within 90 d after discharge. Conclusions: Individuals may not appreciate that they are at heightened risk for suicide after hospitalization and this may negatively impact treatment engagement.
Collapse
Affiliation(s)
- Natalie Riblet
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Brian Shiner
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Robert Scott
- Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT.,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH
| | - Martha L Bruce
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill Health (NASP), Karolinska Instituet, Stockholm, Sweden
| | - Bradley V Watts
- Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH.,VA National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Ann Arbor, MI
| |
Collapse
|