The relationship between involvement in activities and quality of life for people with severe and enduring mental illness

The implementation of exercise therapy within hospital-based mental healthcare: Delphi study

BACKGROUND

The physical health comorbidities and premature mortality experienced by people with mental illness has led to an increase in exercise services embedded as part of standard care in hospital-based mental health services. Despite the increase in access to exercise services for people experiencing mental illness, there is currently a lack of guidelines on the assessment and triage of patients into exercise therapy.

AIMS

To develop guidelines for the pre-exercise screening and health assessment of patients engaged with exercise services in hospital-based mental healthcare and to establish an exercise therapy triage framework for use in hospital-based mental healthcare.

METHOD

A Delphi technique consisting of two online surveys and two rounds of focus group discussions was used to gain consensus from a multidisciplinary panel of experts.

RESULTS

Consensus was reached on aspects of pre-exercise health screening, health domain assessment, assessment tools representing high-value clinical assessment, and the creation and proposed utilisation of an exercise therapy triage framework within exercise therapy.

CONCLUSIONS

This study is the first of its kind to provide guidance on the implementation of exercise therapy within Australian hospital-based mental healthcare. The results provide recommendations for appropriate health assessment and screening of patients in exercise therapy, and provide guidance on the implementation and triage of patients into exercise therapy via a stepped framework to determine (a) the timeliness of exercise therapy required and (b) the level of support required in the delivery of their exercise therapy.

Occupational engagement and cognitive functioning among persons with schizophrenia: an explorative study

BACKGROUND

Cognitive functioning may have implications for engagement in daily occupations among people with schizophrenia.

OBJECTIVES

This cross-sectional study explores relationships between time use assessed occupational engagement and cognitive functioning among persons with schizophrenia.

METHODS

Thirty-nine participants from four mental health care services in Sweden participated. The Profile of Occupational Engagement among persons with Severe mental illness (POES) and a cognitive test battery was used.

RESULTS

Higher attention and psychomotor speed and higher scores in information processing speed, immediate and delayed verbal recall, and immediate and delayed visual recall were significantly correlated with higher scores in occupational engagement. Regression analyzes revealed that information processing speed and delayed visual recall best explained the variance in occupational engagement (R²=0.36).

CONCLUSIONS

Cognitive functioning has implications for occupational engagement, and thus the ability to perform daily occupations in a balanced rhythm within various social and physical environments.

Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol

BACKGROUND

People with Severe Mental Illness (SMI) frequently experience problems with regard to societal participation (i.e. work, education and daily activities outside the home), and require professional support in this area. The Boston University approach to Psychiatric Rehabilitation (BPR) is a comprehensive methodology that can offer this type of support. To date, several Randomised Controlled Trials (RCT's) investigating the effectiveness of BPR have yielded positive outcomes with regard to societal participation. However, information about the cost-effectiveness and budgetary impact of the methodology, which may be important for broader dissemination of the approach, is lacking. BPR may be more cost effective than Care As Usual (CAU) because an increase in participation and independence may reduce the costs to society. Therefore, the aim of this study is to investigate, from a societal perspective, the cost-effectiveness of BPR for people with SMI who wish to increase their societal participation. In addition, the budget impact of implementing BPR in the Dutch healthcare setting will be assessed by means of a budget impact analysis (BIA) after completion of the trial.

METHODS

In a multisite RCT, 225 adults (18-64 years of age) with SMI will be randomly allocated to the experimental (BPR) or the control condition (CAU). Additionally, a pilot study will be conducted with a group of 25 patients with severe and enduring eating disorders. All participants will be offered support aimed at personal rehabilitation goals, and will be monitored over a period of a year. Outcomes will be measured at baseline, and at 6 and 12 months after enrolment. Based on trial results, further analyses will be performed to assess cost-effectiveness and the budgetary impact of implementation scenarios.

DISCUSSION

The trial results will provide insight into the cost-effectiveness of BPR in supporting people with SMI who would like to increase their level of societal participation. These results can be used to make decisions about further implementation of the method. Also, assessing budgetary impact will facilitate policymaking. The large sample size, geographic coverage and heterogeneity of the study group will ensure reliable generalisation of the study results.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN88987322. Registered 13 May 2014.

The effect of service satisfaction and spiritual well-being on the quality of life of patients with schizophrenia

Quality of life (QOL) has been considered an important outcome measure in psychiatric research and determinants of QOL have been widely investigated. We aimed at detecting predictors of QOL at baseline and at testing the longitudinal interrelations of the baseline predictors with QOL scores at a 1-year follow-up in a sample of patients living in Residential Facilities (RFs). Logistic regression models were adopted to evaluate the association between WHOQoL-Bref scores and potential determinants of QOL. In addition, all variables significantly associated with QOL domains in the final logistic regression model were included by using the Structural Equation Modeling (SEM). We included 139 patients with a diagnosis of schizophrenia spectrum. In the final logistic regression model level of activity, social support, age, service satisfaction, spiritual well-being and symptoms' severity were identified as predictors of QOL scores at baseline. Longitudinal analyses carried out by SEM showed that 40% of QOL follow-up variability was explained by QOL at baseline, and significant indirect effects toward QOL at follow-up were found for satisfaction with services and for social support. Rehabilitation plans for people with schizophrenia living in RFs should also consider mediators of change in subjective QOL such as satisfaction with mental health services.

Developing a tool for collecting and costing activity data on psychiatric inpatient wards

BACKGROUND.

Increasing therapeutic inpatient activities may improve the quality and outcomes of care. Evaluation of these interventions is necessary including assessment of cost-effectiveness. The aim of this paper is to describe the development and reliability of a tool to collect information on care contacts and therapeutic activities of patients on inpatient wards.

METHOD.

The development of the tool consisted of: 1) literature review, 2) interviews with staff, 3) expert consultation, 4) feasibility study, 5) focus groups with staff members, and 6) reliability tests. Service use data were collected with the tool and costs calculated.

RESULTS.

Service users' reported more use of activities than that contained in case notes during a 7-day period. This resulted in a cost difference of £10 per person. Case notes had more one-to-one nursing contacts, with a cost difference of £4 per person. One-day data showed less nurse contact time reported by participants compared to observational data (p < 0.001) but similar use of activities. Costs were £46 for the tool and £67 for the observational data.

CONCLUSIONS.

This tool is a good source of information on the number of activities attended by service users and contacts with psychiatrists. There is some disagreement with other sources of information on interactions between service users and nurses, possibly reflecting different definitions of a ‘meaningful contact’. This does not have a major impact on cost given that for much of the care received there is reasonable agreement.

Socially supportive activity inventory: reliability and validity of a social activity instrument for long-term care institutions

BACKGROUND

: Diverse social and recreational activities in elder care institutions have been provided to enrich a person's mental well-being amidst what is a relatively monotonous life. However, few instruments that measure the social activities of long-term care residents are available.

PURPOSE

: This study was designed to develop a culturally sensitive instrument (Socially Supportive Activity Inventory, SSAI) to assess quantity and quality of social activities for long-term care institutions and validate the instrument's psychometric properties.

METHODS

: The SSAI was developed on the basis of the social support theory, a synthesis of literature, and Taiwanese cultural mores. The instrument was rigorously subjected to a two-stage process to evaluate its reliability and validity. In Stage 1, six experts from diverse backgrounds were recruited to evaluate instrument items and estimate the content validity of the instrument using a content validity questionnaire. Items were modified and refined on the basis of the responses of the expert panel and a set of criteria. After obtaining approval from a university institutional review board, in the second stage of evaluating test-retest reliability, a convenience sample of 10 Taiwanese institutionalized elders in a pilot study, recruited from a nursing home, completed the revised instrument at two separate times over 2 weeks.

RESULTS

: Results showed a content validity of .96. Test-retest reliability from a sample of 10 participants yielded stability coefficients of .76-1.00. The stability coefficient was 1.00 for the component of frequency, .76-1.00 for the component of meaningfulness, and .78-1.00 for the component of enjoyment.

CONCLUSION

: The SSAI is a highly relevant and reliable culturally based instrument that can measure social activity in long-term care facilities. Because of the pilot nature of this study, future directions include further exploration of the SSAI instrument's psychometric properties. This should be done by enlarging the sample size to include more long-term care facilities and individual participants. Future studies can utilize diverse measures of social activity for comparison and validation of the SSAI.

Community rehabilitation for persons with psychiatric disabilities: comparison of the effectiveness of segregated and integrated programs in Israel

This study compares the effectiveness of a segregative and an integrative psychosocial recreational program for persons with psychiatric disabilities in Israel. Comparison of changes in 97 members of a segregated social club with those of 89 participants in an integrative program in their local community center shows that both reported significantly greater satisfaction with their social life, having more friends than previously, increased support from friends, less loneliness, greater social support, and engaging in more leisure activities. The only significant differences were that the participants in the segregative program reported making more new friends, while those in the integrative program reported a greater increase in the number of leisure activities in which they engaged. With this, the findings also show that the participants in the integrative program were generally stronger and in better clinical condition than those in the segregative program. These findings point to the need for different types of recreational programs to meet the needs of persons with different levels of disability.

A model of subjective quality of life for outpatients with schizophrenia and other psychoses

This study investigated predictors of quality of life among persons with schizophrenia and other psychoses. On the basis of previous research, it was hypothesised that objective life circumstances, self-variables, psychopathology, activity level, satisfaction with daily activities, and satisfaction with medical care would be determinants of quality of life. 134 persons were investigated, and the analysis was based on Structural Equation Modelling (SEM). A model with two quality of life variables, General quality of life and Security, fitted the data best. A self-variable, Sense of self, and Satisfaction with daily activities, Psychopathology, and Satisfaction with medical care served as mediators and explained the variation in the quality of life variables. External to the mediators, and related to these, were Activity level, Educational level, and Independent living. In conclusion, a self-variable showed the strongest association with quality of life, but two aspects that should be feasible to influence in mental health care, daily activity and medical care, contributed to the subjects' self-rated quality of life. These results render a somewhat optimistic view on how to accomplish a better self-perceived quality of life among people with severe mental illness.

Adversity as opportunity: living with schizophrenia and developing a resilient self

Approximately 1% of the population is diagnosed with schizophrenia, and despite longstanding critiques of the (bio)medical model, understanding of the disorder still arises primarily through (bio)medical explanations. In turn, causation, symptoms and treatments are increasingly sophisticated and well known while understanding of other aspects of the disorder, especially the intersubjective experience of people living with schizophrenia, remains fragmented. For this reason, the present study sought to understand how people experience schizophrenia. To do this, the stories of 19 people diagnosed with the disorder were hermeneutically interpreted. These stories appeared in The Schizophrenia Bulletin--a journal which publishes 'first person accounts', sometimes anonymously, of people's experience of mental illness. Within the study context, the findings indicate that facing the adversity of schizophrenia means living: (i) wisely--understanding the nature of self-with-schizophrenia and of life-with-schizophrenia; (ii) mindfully--keeping understandings in conscious thought; and (iii) purposefully--acting deliberately. Doing this results in a stable and meaningful life and in a different, more resilient self.

A balanced approach to dealing with violence and aggression at work

The Government has introduced tough measures in dealing with violence and aggression in the workplace. Employers have a duty to provide adequate safety measures and training to reduce risks and ensure, where possible, the health, safety and welfare of their employees. This article highlights the responsibilities of employers and the pressures in both hospital and community environments on staff at risk from violent or abusive incidents. The patient's perspective is discussed, suggesting that more understanding between patients and staff is needed. The article looks at the "NHS Zero Tolerance Zone Campaign" and whether this can be enhanced by introducing training of an empathetic nature along with other practical environmental issues. It suggests that there are alternative and more effective, techniques in dealing with violence and aggression that can be used to defuse a situation before it ever becomes a physical altercation. The philosophies of eastern martial arts can teach us a lot about personal self-esteem and confidence which are two key elements in managing conflict situations.

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

This paper addresses the effects of chronic poverty on people with serious mental illness. More specifically, we are concerned with the extent to which welfare restructuring, by deepening the poverty facing people with serious mental illness, undermines the expressed intent of mental health policy to improve the quality of life (QOL) of this population. The province of Ontario in Canada forms the setting for the study. The paper first examines recent trends in mental health care and social assistance policy in Ontario. While income support is consistently recognized as a core element of mental health care, welfare restructuring has led to a significant decline in the real value of income supports received by people with serious mental illness. The paper then examines the implications of this trend for the QOL of residential care facility tenants in Hamilton, Ontario. Here, the case study is explicitly connected to QOL scholarship. In addition, the study is grounded in an analysis of the broader transformation of the welfare state in Ontario. Interview data suggest that tenants experience chronic poverty that has a deleterious impact on multiple life domains including basic needs, family, social relations, leisure and self-esteem. Implications for research and policy are discussed.