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Harvey C, Zirnsak TM, Brasier C, Ennals P, Fletcher J, Hamilton B, Killaspy H, McKenzie P, Kennedy H, Brophy L. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Front Psychiatry 2023; 14:1259944. [PMID: 37779607 PMCID: PMC10539575 DOI: 10.3389/fpsyt.2023.1259944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs. Method We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience. Results Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central. Conclusion Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Peter McKenzie
- The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia
| | - Hamilton Kennedy
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
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Hilton C, Jones S, Akers N, Panagaki K, Sellwood W. Self-Report Measures Assessing Aspects of Personal Recovery in Relatives and Other Informal Carers of Those With Psychosis: A Systematic Review. Front Psychol 2022; 13:926981. [PMID: 35911034 PMCID: PMC9335122 DOI: 10.3389/fpsyg.2022.926981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Providing long-term care for a family member with psychosis can cause significant distress for informal carers due to the trauma of seeing their loved one in crisis, dealing with the difficult symptoms of psychosis and the burden of providing care. An important aspect of carers' adjustment can be construed as their personal recovery in relation to having a relative affected by psychosis. Self-report measures are increasingly used to assess personal recovery in service users, but less is known about the utility of such tools for carers. Aims This review aimed to identify all self-report measures assessing aspects of carers' personal recovery, and to quality appraise them. Methods Academic Search Ultimate, CINAHL, MEDLINE, PsychINFO and PubMed were searched for articles that reported the development of self-report measures created for carers of those with psychosis. Studies were appraised using the Consensus-based Standards for the Selection of health status Measurement INstruments (COSMIN) checklist. A Levels of Evidence synthesis provided overall quality scores for each measure. Results The search identified 3,154 articles for initial screening. From a total of 322 full text articles, 95 self-report measures were identified with a final 10 measures included for the quality assessment showing varying levels of psychometric rigor. Conclusions The results show that no single self-report measure is currently available for use to comprehensively assess personal recovery for carers, highlighting the need for further research in this area and the development of a new measure.
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Affiliation(s)
- Claire Hilton
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
- *Correspondence: Claire Hilton
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Nadia Akers
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Katerina Panagaki
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - William Sellwood
- Clinical Psychology, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Wang HY, Ren L, Li T, Pu L, Huang X, Wang S, Song C, Liang Z. The impact of anxiety on the cognitive function of informal Parkinson's disease caregiver: Evidence from task-based and resting-state fNIRS. Front Psychiatry 2022; 13:960953. [PMID: 36159948 PMCID: PMC9492928 DOI: 10.3389/fpsyt.2022.960953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Informal Parkinson's disease (PD) caregivers are considered to experience high levels of caregiver burden, negatively affecting the health of caregivers. However, few studies explored the relationship between anxiety in caregiver burden and cognitive function in informal PD caregivers. Although, no study has even investigated the neural mechanisms underlying this connection. This study aimed to conduct comprehensive cognitive and clinical assessments and evaluate brain activity from task-based state and resting-state using functional near-infrared spectroscopy (fNIRS). A total of ten informal PD caregivers and 15 matched, healthy, non-caregivers were recruited. Comprehensive cognitive and clinical assessments were conducted to evaluate five cognitive domains and mental states. Neural activity induced by verbal fluency task (VFT) and brain connectivity during resting state were monitored, and their correlations with the neuropsychological and clinical tests were explored. Our results showed that compared to non-caregiver, an informal PD caregiver exhibited no difference in most cognitive domains of function but performed better in attentional function, along with higher levels of anxiety. Decreased activation over prefrontal regions during VFT and hypo-connectivity within the frontoparietal network (FPN) and between default mode network (DMN) and FPN in the resting state were confirmed in this study as a result of the negative effects of anxiety on the brain. Furthermore, Spearman's correlation found that neural activity in FPN during task-based state and resting state was negatively correlated with the severity of anxiety. These findings indicate that despite normal or even better cognitive function, informal PD caregivers have impaired brain function, and this deficit in neural activity was related to anxiety.
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Affiliation(s)
- Hai-Yang Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lu Ren
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Li
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanlan Pu
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaofeng Huang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Song Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chunli Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhanhua Liang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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Labrum T. Persons with serious mental illness help relatives: rates and correlates of assistance. J Ment Health 2020; 29:328-335. [PMID: 32208791 DOI: 10.1080/09638237.2020.1739246] [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] [Indexed: 10/24/2022]
Abstract
Background: Scant research has focused on assistance provided by persons with serious mental illness (SMI) to relatives.Aims: The objectives of the present study are to (1) describe and compare rates of assistance provided by persons with SMI to relatives and vice versa and (2) examine the extent to which factors are associated with assistance provided by persons with SMI.Methods: A cross-sectional survey design was employed. In 2014 and 2015, 573 adults with a relative with SMI completed an online survey. Multivariate logistic regression was computed.Results: Although persons with SMI were more likely to receive than provide assistance, 61% and 37% of persons with SMI provided relatives with assistance with activities of daily living (ADL) and financial assistance, respectively. Relationship type, co-residence and frequency of in-person contact were associated with providing assistance with ADL and financial assistance. Disability status and regular alcohol use were associated with assistance with ADL. Income was related to financial assistance.Conclusions: It is critical that researchers and practitioners acknowledge the help persons with SMI provide to relatives. Implications for research and practice are addressed.
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Affiliation(s)
- Travis Labrum
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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