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Aass LK, Moen ØL, Skundberg-Kletthagen H, Lundqvist LO, Schröder A. Family support and quality of community mental health care: Perspectives from families living with mental illness. J Clin Nurs 2021; 31:935-948. [PMID: 34240499 DOI: 10.1111/jocn.15948] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES Describe patients' and family members' perceptions of family support from nurses and other mental healthcare professionals, and quality of care in community mental healthcare service. Further, compare the perceptions of patients and family members. BACKGROUND While patients value family involvement, family members feel unprepared and lack the necessary skills to be supportive. Since healthcare professionals predominantly focus on patients, they may fail to understand the complex needs of families. Family perceived support and quality of community mental health care may vary across patients and family members. DESIGN AND METHODS Cross-sectional study with patients suffering from mental illness and family members in community mental healthcare services in Norway. Altogether 86 participants, of whom 33 patients and 33 family members had a family relationship-paired samples. Participants filled in the translated version of the Iceland Family Perceived Support Questionnaire (FPSQ-N) and Quality in Psychiatric Care-Community Out-Patient (QPC-COP) and Community Out-Patient Next of Kin (QPC-COPNK). STROBE checklist was used. RESULTS Family members scored family perceived support and quality of community mental health care lower than patients. Family members feel the loss of support. Patient and family members found the Patient-healthcare professionals' relationship to be of high quality, while family members gave low score to being respected and invited to take part in care by nurses and other mental healthcare professionals. CONCLUSION Family members' unmet need of support highlights the need for nurses and other community mental healthcare professionals to assess complex family needs and to intervene. Barriers to collaboration exist, and family members need to be respected and invited into community mental health care. RELEVANCE TO CLINICAL PRACTICE Contributes knowledge of how to meet the family's needs and provides a basis for further care and treatment development in similar contexts nationally and internationally.
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Affiliation(s)
- Lisbeth Kjelsrud Aass
- Department of Health Sciences, Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Øyfrid Larsen Moen
- Department of Health Sciences, Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Hege Skundberg-Kletthagen
- Department of Health Sciences, Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Lars-Olov Lundqvist
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Agneta Schröder
- Department of Health Sciences, Faculty of Medicine and Health Sciences (MH), Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
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Allan S, Mcleod H, Bradstreet S, Bell I, Whitehill H, Wilson-Kay A, Clark A, Matrunola C, Morton E, Farhall J, Gleeson J, Gumley A. Perspectives of Trial Staff on the Barriers to Recruitment in a Digital Intervention for Psychosis and How to Work Around Them: Qualitative Study Within a Trial. JMIR Hum Factors 2021; 8:e24055. [PMID: 33666555 PMCID: PMC7980120 DOI: 10.2196/24055] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recruitment processes for clinical trials of digital interventions for psychosis are seldom described in detail in the literature. Although trial staff have expertise in describing barriers to and facilitators of recruitment, a specific focus on understanding recruitment from the point of view of trial staff is rare, and because trial staff are responsible for meeting recruitment targets, a lack of research on their point of view is a key limitation. OBJECTIVE The primary aim of this study was to understand recruitment from the point of view of trial staff and discover what they consider important. METHODS We applied pluralistic ethnographic methods, including analysis of trial documents, observation, and focus groups, and explored the recruitment processes of the EMPOWER (Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-being, Engagement, and Recovery) feasibility trial, which is a digital app-based intervention for people diagnosed with schizophrenia. RESULTS Recruitment barriers were categorized into 2 main themes: service characteristics (lack of time available for mental health staff to support recruitment, staff turnover, patient turnover [within Australia only], management styles of community mental health teams, and physical environment) and clinician expectations (filtering effects and resistance to research participation). Trial staff negotiated these barriers through strategies such as emotional labor (trial staff managing feelings and expressions to successfully recruit participants) and trying to build relationships with clinical staff working within community mental health teams. CONCLUSIONS Researchers in clinical trials for digital psychosis interventions face numerous recruitment barriers and do their best to work flexibly and to negotiate these barriers and meet recruitment targets. The recruitment process appeared to be enhanced by trial staff supporting each other throughout the recruitment stage of the trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Emma Morton
- University of British Columbia, Vancouver, BC, Canada
| | | | - John Gleeson
- Australian Catholic University, Melbourne, Australia
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3
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Byrne L, Wykes T. A role for lived experience mental health leadership in the age of Covid-19. J Ment Health 2020; 29:243-246. [DOI: 10.1080/09638237.2020.1766002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Louise Byrne
- Fulbright Fellow, Lived Experience Researcher, School of Management, RMIT University, Melbourne, Australia
- Program for Recovery and Community Health, Department of Psychiatry, School of Medicine, Yale, New Haven, CT, USA
| | - Til Wykes
- Professor of Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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4
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Wykes T, Evans J. Gender diversity in the Journal of Mental Health - how are we doing and what do we need to do? J Ment Health 2020; 29:493-495. [PMID: 32191147 DOI: 10.1080/09638237.2020.1739254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jo Evans
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Jones CL, Deane FP, Wolstencroft K, Zimmermann A. File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study. ACTA ACUST UNITED AC 2019; 77:50. [PMID: 31768253 PMCID: PMC6874813 DOI: 10.1186/s13690-019-0377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 11/08/2019] [Indexed: 11/15/2022]
Abstract
Background Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework – the Collaborative Recovery Model could be sustained over time. Method The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier. Results The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the ‘Action Plan Review’ audit item. Conclusions A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.
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Affiliation(s)
- Cara L Jones
- 1Clinical Psychologist, School of Psychology, University of Wollongong, Wollongong, Australia
| | - Frank P Deane
- 2Illawarra Institute for Mental Health, Building 22, School of Psychology, University of Wollongong, Wollongong, NSW 2522 Australia
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6
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
- South London and Maudsley NHS Foundation Trust, London
| | - Angela Sweeney
- Population Health Institute, St George's University of London, London, London, United Kingdom of Great Britain and Northern Ireland
| | - Martin Guha
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
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7
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Schofield P, Kordowicz M, Pennycooke E, Armstrong D. Ethnic differences in psychosis-Lay epidemiology explanations. Health Expect 2019; 22:965-973. [PMID: 31037803 PMCID: PMC6803396 DOI: 10.1111/hex.12901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/27/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Much research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves. AIMS To determine how Black African and Caribbean service users perceive and explain these apparent differences. METHODS We conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts. RESULTS Each group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself. CONCLUSIONS Black mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.
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Affiliation(s)
- Peter Schofield
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Maria Kordowicz
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | | | - David Armstrong
- School of Population Health & Environmental Sciences, King's College London, London, UK
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8
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London,London, UK
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Wolstencroft KE, Deane FP, Jones CL, Zimmermann A, Cox M. Consumer and staff perspectives of the implementation frequency and value of recovery and wellbeing oriented practices. Int J Ment Health Syst 2018; 12:60. [PMID: 30377442 PMCID: PMC6195683 DOI: 10.1186/s13033-018-0244-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 10/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted. Methods The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman's r correlational analysis explored associations between importance, frequency and helpfulness of sessions. Results Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between 'encouragement to set tasks to complete between support visits' and perceived helpfulness. Conclusions Consumer and staff responses revealed that the key practice elements of the CRM were frequently implemented during service engagement interactions and were seen as valuable for assisting recovery. The level of agreement between raters suggests firstly, that the key practice elements were apparent and able to be rated as occurring, and secondly that the CRM approach is seen as responsive to consumer needs. The results have implications for translating recovery and wellbeing oriented knowledge into mental health service practice.
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Affiliation(s)
| | - Frank P Deane
- 2Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW Australia
| | - Cara L Jones
- 3School of Psychology, University of Wollongong, Wollongong, NSW Australia
| | | | - Merrilee Cox
- Mental Health Association of Central Australia, Alice Springs, NT Australia
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Terp M, Jørgensen R, Laursen BS, Mainz J, Bjørnes CD. A Smartphone App to Foster Power in the Everyday Management of Living With Schizophrenia: Qualitative Analysis of Young Adults' Perspectives. JMIR Ment Health 2018; 5:e10157. [PMID: 30274966 PMCID: PMC6231723 DOI: 10.2196/10157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Literature indicates that using smartphone technology is a feasible way of empowering young adults recently diagnosed with schizophrenia to manage everyday living with their illness. The perspective of young adults on this matter, however, is unexplored. OBJECTIVE This study aimed at exploring how young adults recently diagnosed with schizophrenia used and perceived a smartphone app (MindFrame) as a tool to foster power in the everyday management of living with their illness. METHODS Using participatory design thinking and methods, MindFrame was iteratively developed. MindFrame consists of a smartphone app that allows young adults to access resources to aid their self-management. The app is affiliated with a website to support collaboration with their health care providers (HCPs). From January to December 2016, community-dwelling young adults with a recent diagnosis of schizophrenia were invited to use MindFrame as part of their care. They customized the resources while assessing their health on a daily basis. Then, they were invited to evaluate the use and provide their perspective on the app. The evaluation was qualitative, and data were generated from in-depth interviews. Data were analyzed using a hermeneutical approach. RESULTS A total of 98 individuals were eligible for the study (mean age 24.8, range 18-36). Of these, 27 used MindFrame and 13 participated in the evaluation. The analysis showed that to the young adults, MindFrame served to foster power in their everyday management of living with schizophrenia. When MindFrame was used with the HCPs consistently for more than a month, it could provide them with the power to keep up their medication, to keep a step ahead of their illness, and to get appropriate help based on their needs. This empowered them to stay on track with their illness, thus in control of it. It was also reported that MindFrame could fuel the fear of restraint and illness exacerbation, thereby disempowering some from feeling certain and secure. CONCLUSIONS The findings demonstrate that young adults diagnosed with schizophrenia are amenable to use a smartphone app to monitor their health, manage their medication, and stay alert of the early signs of illness exacerbation. This may empower them to stay on track with their illness, thus in control of it. This indicates the potential of smartphone-based care being capable of aiding this specific population to more confidently manage their new life situation. The potentially disempowering aspect of MindFrame accentuates a need for further research to understand the best uptake and the limitations of smartphone-based schizophrenia care of young adults.
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Affiliation(s)
- Malene Terp
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke Jørgensen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte Schantz Laursen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Mainz
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department for Community Mental Health, Haifa University, Haifa, Israel
| | - Charlotte D Bjørnes
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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