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Powell T, Glozier N, Conn K, Einboden R, Buus N, Caldwell P, Milton A. The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers. BMC Psychiatry 2024; 24:350. [PMID: 38730333 PMCID: PMC11088060 DOI: 10.1186/s12888-024-05758-4] [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: 09/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.
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Affiliation(s)
- Tacita Powell
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia
| | - Katrina Conn
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- Department of Education, NSW, Sydney, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Canada
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- School of Nursing, Western Sydney University, Camperdown, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Patrick Caldwell
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia.
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Brown K, Parry S. How do people with first episode psychosis experience therapeutic relationships with mental health practitioners? A narrative review. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2160487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Katrina Brown
- Faculty of Health and Medicine, Lancaster University, Lancaster
| | - Sarah Parry
- Faculty of Health and Medicine, Lancaster University, Lancaster
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Milton A, Powell T, Conn K, Einboden R, Buus N, Glozier N. Experiences of service transitions in Australian early intervention psychosis services: a qualitative study with young people and their supporters. BMC Psychiatry 2022; 22:788. [PMID: 36514052 PMCID: PMC9749227 DOI: 10.1186/s12888-022-04413-0] [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: 02/28/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. RESULTS The analysis identified four major service-related transitions in a YP's journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. CONCLUSION Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.
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Affiliation(s)
- Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW, 2050, Camperdown, Australia. .,The University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia.
| | - Tacita Powell
- Adolescent Court and Community Team Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Katrina Conn
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.461941.f0000 0001 0703 8464NSW Department of Education, Sydney, Australia
| | - Rochelle Einboden
- grid.28046.380000 0001 2182 2255Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada ,grid.1013.30000 0004 1936 834XSusan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Niels Buus
- grid.1002.30000 0004 1936 7857School of Nursing and Midwifery, Monash University, Clayton, Australia ,grid.10825.3e0000 0001 0728 0170Department Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nicholas Glozier
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
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Le PD, Choe K, Burrone MS, Bello I, Velasco P, Arratia T, Tal D, Mascayano F, Jorquera MJ, Schilling S, Ramírez J, Arancibia D, Fader K, Conover S, Susser E, Dixon L, Alvarado R, Yang LH, Cabassa LJ. Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process. FRONTIERS IN HEALTH SERVICES 2022; 2:958743. [PMID: 36925802 PMCID: PMC10012675 DOI: 10.3389/frhs.2022.958743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/10/2022] [Indexed: 05/31/2023]
Abstract
Background In 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile. Methods A qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack. Results Participants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model. Conclusion OnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile.
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Affiliation(s)
- PhuongThao D. Le
- School of Global Public Health, New York University, New York, NY, United States
| | - Karen Choe
- School of Global Public Health, New York University, New York, NY, United States
| | | | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, United States
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Tamara Arratia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Danielle Tal
- Department of Clinical Psychology, Teachers College Columbia University, New York, NY, United States
| | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - María José Jorquera
- Departamento de Atención Primaria y Salud Familiar, Universidad de Chile, Santiago, Chile
| | - Sara Schilling
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Ramírez
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Diego Arancibia
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Kim Fader
- New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Conover
- Silberman School of Social Work, Hunter College, New York, NY, United States
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, United States
- Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Leopoldo J. Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, MO, United States
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Jiménez JD, Guillén-Guzmán E, Oliva V, Ballesteros-Urpi A, Pardo-Hernandez H. Theoretical approaches to the engagement with patients in case-management programmes and assertive outreach teams: A systematic review of the literature. J Psychiatr Ment Health Nurs 2022; 29:647-658. [PMID: 35384145 DOI: 10.1111/jpm.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: It is generally accepted that all interventions carried out by mental health nurses involve engagement with the patient; this engagement is a process that is gradually constructed and is not immediate. In Spain during last decade, nurses working in assertive outreach teams have gradually replaced the traditional institutional setting in favour of environments that are more familiar to the patient. In contrast, when patients and nurses interact outside institutional settings, a new approach and skillset is required in order to adapt to the new environment. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We have systematically identified and assessed the available evidence on how nurses work in assertive outreach team programmes. The therapeutic link is not just assistance; it is actually a construct, which is established between nurse and patient, with the aim of favouring, fostering and strengthening the therapeutic relationship. Only a few studies have discussed the nurse-patient therapeutic link in assertive outreach services. However, it seems important that nurses use a standardized language, that is, a language promoted as a model of correct use and used for functions of greater prestige, especially in public administration and teaching, to integrate it into the theoretical framework. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With the synthesis that we present, we hope that it promote a more consistent use of the engagement concept in research on this topic. In turn, this will enhance staff support and training and will foster evidence-based practice. The conceptualization of nursing language and its use by professionals helps to improve practice and the lack of a theoretical framework with a nurse perspective. It is necessary to establish a consensus between mental health nurses around the engagement' meaning in the programmes of assertive outreach teams. ABSTRACT: Introduction During last decade in Spain, nurses working in assertive outreach programmes have replaced the traditional institutional setting in favour of the patient's own environment. Engagement with patients requires a different skillset when the axis of the nurse-patient interaction is the patient's own environment. The engagement alone could be associated with the innate concept of patient's care and the helping relationship. However, in the individualized care models, the engagement seems to be an instrument with its own characteristics for the purpose of providing mental health care. Aim/Question To systematically identify and assess the empirical evidence on the relationships and engagement between patients with mental illness (schizophrenia, psychotic disorders, schizoaffective disorders, mood disorders and disorders of adult personality) and nursing mental health nurses. Method Systematic literature review based on PRISMA guidance. Results We identified and reviewed seven primary research studies. Following the analytic processes, three themes emerged: existence of different engagement levels, training needs and skills in the creation and consolidation of the engagement, and engagement as process. Discussion The engagement of nurse and patient is understood as a process that incorporates different stages. Whilst it is established, the engagement is subject to positive and negative influences. For the creation of the engagement and its maintenance specialized skills, knowledge and personal attributes (resilience, psychosocial skills, compressive knowledge of mental health illnesses, capacity to build effective relationships, adaptability and problem-solving) are necessary, but the main focus is on context where it develops, selected by the patient himself, for example, his home. Implications for Practice Administrators may have questions about appropriate hiring practices for assertive outreach teams since certain skills are necessary to obtain un engagement process, and staff training should be considered a key issue to provide specific skills for enhancing engagement and the therapeutic relationship. Conclusion The engagement must be understood as a long-term process. For the creation of the engagement and its maintenance, specialized skills, knowledge and personal attributes are necessary.
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Affiliation(s)
- Jorge D Jiménez
- Instituto de Neuropsiquiatría y Adicciones (INAD), Consorci Mar Parc de Salut de Barcelona (PSMar), Barcelona, Spain
| | - Elías Guillén-Guzmán
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Barcelona, Spain
| | - Víctor Oliva
- Instituto de Neuropsiquiatría y Adicciones (INAD), Consorci Mar Parc de Salut de Barcelona (PSMar), Barcelona, Spain
| | - Anna Ballesteros-Urpi
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Lim J, McCombe G, Harrold A, Brown K, Clarke M, Hanlon D, Hennessy L, O'Brien S, Lyne J, Corcoran C, McGorry P, Cullen W. The role of key workers in improving physical health in first episode psychosis: A scoping review. Early Interv Psychiatry 2021; 15:16-33. [PMID: 32134195 DOI: 10.1111/eip.12937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/01/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
AIM Studies have demonstrated that a majority of the decline in health status and functioning emerges during the first few years following the onset of psychosis. This knowledge led to the development of specialized early intervention services (EIS) targeting patients experiencing their first episode of psychosis (FEP). The central component of EIS is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. The aim of this scoping review was to examine how key workers can enhance the physical health outcomes in people with FEP by addressing the factors associated with increased mortality in this population. METHODS The scoping review framework comprised a five-stage process developed by Arksey and O'Malley. The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RESULTS A total of 27 studies conducted across 10 countries were analysed. These studies discussed the various ways in which key workers can mediate enhancements in the various factors contributing to the increased mortality rates in FEP patients. CONCLUSIONS A broad range of key worker-mediated outcomes was identified, which were broadly classified into three themes: influences on lifestyle, influences on effects of psychosis and influences on organizational barriers. Our findings suggest that key workers primarily mediated the amelioration of psychosis-induced effects and the reduction of organizational barriers. Further trials of key worker interventions to enhance physical health outcomes in this cohort are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | - John Lyne
- Royal College of Surgeons in Ireland, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
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Vojtila L, Ashfaq I, Ampofo A, Dawson D, Selby P. Engaging a person with lived experience of mental illness in a collaborative care model feasibility study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:5. [PMID: 33419484 PMCID: PMC7796603 DOI: 10.1186/s40900-020-00247-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/20/2020] [Indexed: 05/26/2023]
Abstract
Researchers have explored different types of treatment to help people with a mental illness with other problems they might be experiencing, such as their health condition and quality of life. Care models that involve many different health care providers working together to provide complete physical and mental health care are becoming popular. There has been a push from the research community to understand the value of including people with lived experience in such programs. While research suggests that people with lived experience may help a patient's treatment, there is little evidence on including them in a team based program. This paper describes how our research team included a person with lived experience of psychosis in both the research and care process. We list some guiding principles we used to work through some of the common challenges that are mentioned in research. Lastly, experiences from the research team, lessons learned, and a personal statement from the person with lived experience (AA) are provided to help future researchers and people with lived experience collaborate in research and healthcare. Background In our current healthcare system, people with a mental illness experience poorer physical health and early mortality in part due to the inconsistent collaboration between primary care and specialized mental health care. In efforts to bridge this gap, hospitals and primary care settings have begun to take an integrated approach to care by implementing collaborative care models to treat a variety of conditions in the past decade. The collaborative care model addresses common barriers to treatment, such as geographical distance and lack of individualized, evidence-based, measurement-based treatment. Person(s) with lived experience (PWLE) are regarded as 'experts by experience' in the scope of their first-hand experience with a diagnosis or health condition. Research suggests that including PWLE in a patient's care and treatment has significant contributions to the patient's treatment and overall outcome. However, there is minimal evidence of including PWLE in collaborative care models. This paper describes the inclusion of a PWLE in a research study and collaborative care team for youth with early psychosis. Aims To discuss the active involvement of a PWLE on the research and collaborative care team and to describe the research team's experiences and perspectives to facilitate future collaborations. Method This paper describes the inclusion of a PWLE on our research team. We provide a selective review of the literature on several global initiatives of including PWLE in different facets of the healthcare system. Additionally, we outline multiple challenges of involving PWLE in research and service delivery. Examples are provided on how recruitment and involvement was facilitated, with the guidance of several principles. Lastly, we have included a narrative note from the PWLE included in our study, who is also a contributing author to this paper (AA), where she comments on her experience in the research study. Conclusion Including PWLE in active roles in research studies and collaborative care teams can enhance the experience of the researchers, collaborative care team members, and PWLE. We showcase our method to empower other researchers and service providers to continue to seek guidance from PWLE to provide more comprehensive, collaborative care with better health outcomes for the patient, and a more satisfying care experience for the provider.
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Affiliation(s)
- Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Augustina Ampofo
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Danielle Dawson
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Peter Selby
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada.
- Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Family and Community Medicine; Department of Psychiatry; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Henderson P, Fisher NR, Ball J, Sellwood W. Mental health practitioner experiences of engaging with service users in community mental health settings: A systematic review and thematic synthesis of qualitative evidence. J Psychiatr Ment Health Nurs 2020; 27:807-820. [PMID: 32171046 DOI: 10.1111/jpm.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. ABSTRACT: Introduction Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals' experiences and understanding of effective engagement have been published. Aim This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners' experiences of engagement in community mental health settings was conducted. Results Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualized person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings.
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Affiliation(s)
- Paul Henderson
- Division of Health Research, Lancaster University, Lancaster, UK.,Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Judith Ball
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
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9
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Leanza L, Studerus E, Mackintosh AJ, Beck K, Seiler L, Andreou C, Riecher-Rössler A. Predictors of study drop-out and service disengagement in patients at clinical high risk for psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:539-548. [PMID: 31646355 DOI: 10.1007/s00127-019-01796-6] [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: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Study drop-out during follow-up and service disengagement frequently occur in patients at clinical high risk for psychosis (CHR-P). However, little is known about their predictors. Therefore, we aimed to analyze the rate and reasons for drop-out and service disengagement in CHR-P patients and investigate their sociodemographic and clinical predictors. METHODS Data from 200 patients of the prospective Früherkennung von Psychosen (FePsy) study were analyzed with competing risks survival models, considering drop-out and transition to psychosis as competing events. To investigate whether symptoms changed immediately before drop-out, t tests were applied. RESULTS Thirty-six percent of patients dropped out within 5 years. Almost all drop-outs also disengaged from our service. Hence, study drop-out was used as a proxy for service disengagement. Patients with more severe baseline disorganized symptoms and a late inclusion into the study were significantly more likely to disengage. Immediately before disengagement, there was significant improvement in negative symptoms only. CONCLUSION A considerable proportion of CHR-P patients disengaged from our clinical study and service. Patients who were included during a later study period with more assessments disengaged more often, which might have been due to more frequent invitations to follow-up assessments and thereby increasing participation burden. Hence, our study provides a cautionary note on high-frequency follow-up assessments. Larger-scale studies evaluating predictors on multiple domains would help to further elucidate drop-out and disengagement.
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Affiliation(s)
- Letizia Leanza
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Erich Studerus
- Division of Personality and Developmental Psychology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Amatya J Mackintosh
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Leonie Seiler
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Hospital, University of Basel, Basel, Switzerland
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10
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D'Arcey J, Collaton J, Kozloff N, Voineskos AN, Kidd SA, Foussias G. The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. JMIR Ment Health 2020; 7:e16993. [PMID: 32238334 PMCID: PMC7163420 DOI: 10.2196/16993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. OBJECTIVE This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. METHODS Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. RESULTS Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. CONCLUSIONS Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
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Affiliation(s)
- Jessica D'Arcey
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - Joanna Collaton
- Department of Clinical Psychology, University of Guelph, Guelph, ON, Canada
| | - Nicole Kozloff
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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11
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Stasiulis E, Gibson BE, Webster F, Boydell KM. Resisting governance and the production of trust in early psychosis intervention. Soc Sci Med 2020; 253:112948. [PMID: 32244151 DOI: 10.1016/j.socscimed.2020.112948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 01/17/2023]
Abstract
Trust is vital in mental healthcare where uncertainty and risk prevail and where relationship building is central to effective service delivery. Despite its significance, research on trust, particularly among multi-disciplinary healthcare teams and between service providers and users is limited and explored only tangentially within early psychosis intervention (EPI) programs. An institutional ethnographic approach is used to examine how trust within an EPI setting is produced and operates. Drawing on participant observation, textual analysis of clinic documents and in-depth interviews with 27 participants (staff, young people and family members), our analysis outlines how the clinic manager's and staff's resistance to hospital rulings that impeded EPI policy principles were part of the extended sequence of activities that produced trust. These acts of resistance, alongside the clinic manager's reflective leadership practices, cultivated spaces for staff to take risks, share their ideas and build consensus - culminating in staff-designed protocols that produced trust among one another, and between service providers and young people and their families. Drawing from Brown and Calnan's framework of "vicious" and "virtuous" cycles of (dis)trust, we highlight how management and staff responses to vulnerability and uncertainty generated trust through their communication practices and knowledge sharing. We also suggest that protocols to manage the risk of medication non-adherence and treatment dis-engagement among young people contained regulatory functions, pointing to the complex interplay of trust, control and risk. Study implications suggest shifting the emphasis from risk management and quality governance as an organizing framework in mental health to a framework based on trust.
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Affiliation(s)
- Elaine Stasiulis
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada; Institute of Medical Science, University of Toronto, 1 King's Circle, Toronto, Ontario, M5S 3K1, Canada.
| | - Barbara E Gibson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario, M4G 1R8, Canada; Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Fiona Webster
- Arthur Labatt Family School of Nursing, Western University, FIMS and Nursing Building, London, Ontario, N6A 5B9, Canada
| | - Katherine M Boydell
- Black Dog Institute, Hospital Road, Randwick, New South Wales, NSW 2031, Australia; Institute of Medical Science, University of Toronto, 1 King's Circle, Toronto, Ontario, M5S 3K1, Canada
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12
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Loughlin M, Bucci S, Brooks J, Berry K. Service users' and carers' experiences of engaging with early intervention services: A meta-synthesis review. Early Interv Psychiatry 2020; 14:26-36. [PMID: 30912274 DOI: 10.1111/eip.12803] [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: 06/02/2018] [Revised: 01/14/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS. METHODS Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool. RESULTS Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed. CONCLUSIONS The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings.
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Affiliation(s)
- Matthew Loughlin
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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13
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis. BMC Psychiatry 2019; 19:312. [PMID: 31651268 PMCID: PMC6814013 DOI: 10.1186/s12888-019-2315-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation. METHODS Qualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis. RESULTS Case-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics). CONCLUSION This study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples' recovery from first-episode psychosis and increase case-manager job satisfaction.
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Affiliation(s)
- Rachel M. Tindall
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- 0000 0001 2179 088Xgrid.1008.9Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E. Hamilton
- 0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
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14
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Kim DJ, Brown E, Reynolds S, Geros H, Sizer H, Tindall R, McGorry P, O'Donoghue B. The rates and determinants of disengagement and subsequent re-engagement in young people with first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:945-953. [PMID: 30923838 DOI: 10.1007/s00127-019-01698-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND A core component of treatment provided by early intervention for psychosis (EI) services is ensuring individuals remain successfully engaged with the service. This ensures they can receive the care they may need at this critical early stage of illness. Unfortunately, rates of disengagement are high in individuals with a first episode of psychosis (FEP), representing a major barrier to effective treatment. This study aimed to ascertain the rates and determinants of disengagement and subsequent re-engagement of young people with FEP in a well-established EI service in Melbourne, Australia. METHOD This cohort study involved all young people, aged 15-24, who presented to the Early Psychosis Prevention and Intervention Centre (EPPIC) service with FEP between 1st January 2011 and 1st September 2014. Data were collected retrospectively from clinical files and electronic records. Cox regression analysis was used to identify determinants of disengagement and re-engagement. RESULTS A total of 707 young people presented with FEP during the study period, of which complete data were available for 700. Over half of the cohort (56.3%, N = 394) disengaged at least once during their treatment period, however, the majority of these individuals (85.5%, N = 337) subsequently re-engaged following the initial episode of disengagement. Of those who disengaged from the service, 54 never re-engaged, representing 7.6% of the total cohort. Not being in employment, education or training, not having a family history of psychosis in second degree relatives and using cannabis were found to be significant predictors of disengagement. No significant predictors of re-engagement were identified. CONCLUSION In this study, the rate of disengagement in young people with first-episode psychosis was higher than found previously. Encouragingly, rates of re-engagement were also high. The concept of disengagement from services might be more complex than previously thought with individuals disengaging and re-engaging a number of times during their episode of care. What prompts individuals to re-engage with services needs to be better understood.
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Affiliation(s)
- Da Jung Kim
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Ellie Brown
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Deakin University, IMPACT Strategic Research Centre, School of Medicine, Geelong, 3220, Australia
| | - Siobhan Reynolds
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Hellen Geros
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Holly Sizer
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Rachel Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. .,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.
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15
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Hayes C, Simmons M, Palmer VJ, Hamilton B, Simons C, Hopwood M. The unheard voice of the clinician: Perspectives on the key features of an adolescent inpatient model of care. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:129-138. [PMID: 31209987 DOI: 10.1111/jcap.12242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023]
Abstract
PROBLEM Little has been reported from clinicians about the operations, interventions, and outcomes of inpatient units and how these comprise models of care in such units. The aim of this study was to explore an inpatient model of care in operation at the study site by defining key features of the model from the perspectives of clinicians. METHODS Semi-structured face to face interviews were conducted with ten clinicians working in a private inpatient unit in Melbourne, Australia. Interview data were analyzed using thematic analysis. FINDINGS Analysis resulted in the identification of three thematic features relating to containment, engagement, and therapy. These included (a) an environment conducive to containment, (b) adolescent engagement through shared experiences, and (c) dialectical behavior therapy embedded culture. CONCLUSIONS The findings provide insights into often unheard clinician perspectives on what the key features of an adolescent inpatient model of care are. These features relate to the interventions that are currently offered on the unit and ways of working as informed by philosophies and practices. These findings should be used to improve clinical services and inform research aiming to articulate exemplary adolescent inpatient models of care. Furthermore, the findings provide guidance and practical information to commissioners, clinicians, and policy makers implementing models of care.
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Affiliation(s)
- Claire Hayes
- Department of Psychiatry, The Albert Road Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magenta Simmons
- Orygen Youth Health, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria J Palmer
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christine Simons
- Department of Psychiatry, The Albert Road Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The Albert Road Clinic, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Myers N, Sood A, Fox KE, Wright G, Compton MT. Decision Making About Pathways Through Care for Racially and Ethnically Diverse Young Adults With Early Psychosis. Psychiatr Serv 2019; 70:184-190. [PMID: 30554560 PMCID: PMC6397098 DOI: 10.1176/appi.ps.201700459] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study elicited factors that shaped treatment decision making for young adults and their key supporters after an initial hospitalization for psychosis to generate hypotheses about how to improve service engagement. METHODS This prospective, longitudinal, ethnographic study (using home visits, interviews, and hospital-based fieldwork) asked what mattered to 18 young adults primarily from racial-ethnic minority groups and 19 of their self-identified key supporters (N=37) as they made decisions about treatment during the 12-week critical period after an initial hospitalization for psychosis. The analytical approach used inductive coding and constructivist grounded theory methods to analyze interview transcripts and field notes from home visits and generate hypotheses about key factors that seemed to affect treatment decision making. Factors were ranked in order of frequency across all participants (overall, young adults only, and key supporters only). RESULTS Among the 37 total participants (young adults and key supporters), more than two-thirds were concerned with getting back to normal, the insufficient mental health care on offer, police involvement in their pathway to care, feeling worse, and needing help with repairing strained relationships. More than one-half were concerned with how young adults would be able to live independently in the future, paying for mental health care, distrusting mental health diagnoses, managing social pressure to use substances, feeling disempowered by hospitalization experiences, and managing transportation challenges. CONCLUSIONS To better engage young adults with early psychosis in care, including those from racial-ethnic minority groups, there is a need to design services that address the specific concerns of their everyday lives in the context of the initial hospitalization and posthospitalization period.
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Affiliation(s)
- Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, Texas
- University of Texas Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | - Anubha Sood
- University of Texas Southwestern Medical School, Department of Psychiatry, Dallas, Texas
| | - Katherine E. Fox
- Southern Methodist University, Department of Anthropology, Dallas, Texas
| | | | - Michael T. Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
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17
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Pietrini F, Albert U, Ballerini A, Calò P, Maina G, Pinna F, Vaggi M, Boggian I, Fontana M, Moro C, Carpiniello B. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1045-1060. [PMID: 31118640 PMCID: PMC6503342 DOI: 10.2147/ndt.s199048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a chronic syndrome involving different clinical dimensions, and causes significant disability with a negative impact on the quality of life of patients and their caregivers. Current guidelines for the treatment of schizophrenia focus on maximizing a patient's adaptive functioning and quality of life in a recovery-oriented approach that encourages active collaboration among patients, caregivers, and mental health professionals to design and manage a customized and comprehensive care plan. In the present study, a panel of experts (psychiatrists, psychologists, nurse, and social worker) gathered to review and explore the need for contemporary use of second-generation antipsychotic long-acting injectables (SGA LAIs) in "recovery-oriented" and "patient-centered" care of schizophrenia. Starting from the available data and from sharing personal attitudes and experiences, the panel selected three clinical dimensions considered useful in characterizing each patient: phase of disease, adherence to treatment, and level of functioning. For each clinical dimension, perspectives of patients and caregivers with regard to needs, expectations, and personal experiences were reviewed and the role of SGA LAIs in achieving shared goals examined. The experts concluded that from today's modern perspectives, SGA-LAIs may play an important role in breaking the spiral of desocialization and functional decline in schizophrenia, thus favoring the recovery process.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Marco Vaggi
- Department of Mental Health and Drug Addiction ASL 3 Genoa, Azienda Sanitaria 3 Genovese, Genoa, Italy
| | - Ileana Boggian
- Department of Mental Health, Azienda Ulss 9 Scaligera, Legnago, Italy
| | - Maria Fontana
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Cesare Moro
- Department of Mental Health and Addictions, ASST Bergamo Ovest, Treviglio, Italy
| | - Bernardo Carpiniello
- Psychiatric Clinical Unit, University Hospital of Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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18
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Maddigan J, LeDrew K, Hogan K, Le Navenec CL. Challenges to recovery following early psychosis: Nursing implications of recovery rate and timing. Arch Psychiatr Nurs 2018; 32:836-844. [PMID: 30454625 DOI: 10.1016/j.apnu.2018.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/30/2018] [Accepted: 06/02/2018] [Indexed: 12/21/2022]
Abstract
Early intervention in first episode psychosis is based on an indicated prevention approach that has early illness identification and timely recovery as primary goals. Nurses are instrumental in helping individuals and families achieve both aims. To better understand recovery following a first episode, a prospective cohort of 260 individuals participating in a three-year early intervention program was monitored for achievement of recovery outcomes. Two outcome measures were used to examine the recovery rate and timing of the cohort: (1) partial recovery was comprised of two criteria: (a) symptom control (psychosis and mania), and (b) daily functioning, and 2) comprehensive recovery was measured by three criteria: (a) symptom control; (b) daily functioning; and, (c) quality of life. Survival analysis, including the Kaplan-Meier statistic, and Cox hazard regression were used to examine the cohort's rate and timing for both measures. One hundred and seventy-four individuals attained partial recovery with half (51.1%) reaching the target within nine months. Comprehensive recovery was achieved by 59 individuals (22.7%), primarily in year two and three of treatment. Issues impacting quality of life delayed recovery for the majority of program participants. The gap between psychosis remission and satisfaction/fulfillment with one's everyday life is troubling, but could be improved with stronger nursing support and influence. Sharing the recovery experience with individuals and families that supports their life goals and the discovery of meaning, hope and purpose in the face of illness is the work of nurses. Suggestions for strengthening nursing's impact are considered.
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Affiliation(s)
| | - Kellie LeDrew
- Memorial University of Newfoundland, Canada; Eastern Regional Health Authority, Newfoundland, Canada
| | - Kevin Hogan
- Eastern Regional Health Authority, Newfoundland, Canada
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19
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Lecardeur L, Meunier-Cussac S, Dollfus S. Mobile Intensive Care Unit: A case management team dedicated to early psychosis in France. Early Interv Psychiatry 2018; 12:995-999. [PMID: 29717820 DOI: 10.1111/eip.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/19/2018] [Accepted: 03/13/2018] [Indexed: 12/23/2022]
Abstract
AIM To present the activities of a Mobile Intensive Care Unit in France. METHODS We summarize participant recruitment as well as the diagnostic procedures and therapeutic interventions offered to individuals with an at-risk mental state or first-episode psychosis (FEP). RESULTS Since its inception in 2010, 266 individuals from 16 to 30 years old living in an area of 120 000 citizens have been recruited by the Mobile Intensive Care Unit. Patients are evaluated by clinical and neuropsychological assessments, and therapeutic interventions include medication, individual case management and both individual and group cognitive behavioural therapy. Diagnostic assessments are also provided for the patients outside of our geographic area. CONCLUSIONS The Mobile Intensive Care Unit is a functional unit enabling young adults with a high-risk mental state or FEP to receive high standard of care and mobile management over 2 years, aimed at diminishing the risk of transition to chronic disease and decreasing functional impairment.
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Affiliation(s)
- Laurent Lecardeur
- UNICAEN, Normandie University, Caen, France.,Caen University Hospital, Adult Psychiatric Unit, Mobile Intensive Care Unit, Caen, France.,UNICAEN, Medical School, Normandie University, Caen, France
| | - Sophie Meunier-Cussac
- Caen University Hospital, Adult Psychiatric Unit, Mobile Intensive Care Unit, Caen, France
| | - Sonia Dollfus
- UNICAEN, Normandie University, Caen, France.,Caen University Hospital, Adult Psychiatric Unit, Mobile Intensive Care Unit, Caen, France.,UNICAEN, Medical School, Normandie University, Caen, France
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20
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Tindall RM, Simmons MB, Allott K, Hamilton BE. Essential ingredients of engagement when working alongside people after their first episode of psychosis: A qualitative meta-synthesis. Early Interv Psychiatry 2018; 12:784-795. [PMID: 29624917 DOI: 10.1111/eip.12566] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 12/08/2017] [Accepted: 02/04/2018] [Indexed: 11/26/2022]
Abstract
AIM Early intervention services (EISs) for first-episode psychosis (FEP) have been established internationally, however, service disengagement is a recurrent concern resulting in unplanned treatment cessation. The implications of this are far-reaching due to the financial and personal costs associated with untreated symptoms. The aim of this meta-synthesis was to collect, interpret and synthesize qualitative research about how engagement is experienced within EISs for FEP. METHODS A systematic search was conducted in PsycINFO, Ovid MEDLINE and Ovid Emcare from date of conception to November 2016. Following initial screening, 91 abstracts and 13 full texts were reviewed for eligibility. Nine studies were then critically appraised using the CASP tool for qualitative studies, data were systematically extracted and results were synthesized using constant comparison and reciprocal translational analysis. RESULTS Nine qualitative studies explored engagement with EISs, from the perspectives of service users and their caregivers. No studies were found from the perspectives of clinicians or services. All 9 studies employed an inductive methodology, within an interpretivist epistemology. Five main themes were identified: experiences of finding help; factors promoting engagement; the therapeutic relationship; the role of caregivers in supporting engagement; and factors impacting ongoing engagement. CONCLUSIONS There is a critical need to stimulate discussion around this multifaceted phenomenon, including a continued focus on the roles of key stakeholders and clinical models that may further facilitate collaboration in treatment plans and recovery.
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Affiliation(s)
- Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magenta B Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget E Hamilton
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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21
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. Engagement at entry to an early intervention service for first episode psychosis: an exploratory study of young people and caregivers. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2018. [DOI: 10.1080/17522439.2018.1502341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E Hamilton
- Department of Nursing, The University of Melbourne, Melbourne, Australia
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22
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Becker KD, Buckingham SL, Rith-Najarian L, Kline ER. The Common Elements of treatment engagement for clinically high-risk youth and youth with first-episode psychosis. Early Interv Psychiatry 2016; 10:455-467. [PMID: 26486257 DOI: 10.1111/eip.12283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/21/2015] [Indexed: 11/30/2022]
Abstract
AIM Without treatment, clinically high-risk (CHR) youth or youth with first-episode psychosis (FEP) have increased risk for significant complications from their illness; yet, treatment engagement among these youth is critically low. The purpose of this study was to examine engagement efforts with CHR/FEP youth to stimulate new ideas that might facilitate participation in services for this population. METHODS A literature review using distillation methods identified engagement practices reported in two bodies of literature. The first body of literature (i.e. 'CHR/FEP engagement') included 13 studies employing qualitative designs to explore consumer perspectives about treatment engagement practices in samples of CHR/FEP youth and their families. The second body of research (i.e. 'CHR/FEP RCTs') included 18 randomized controlled trials (RCTs) testing treatments for CHR/FEP youth and their families. Engagement practice frequencies were compared with the frequency of these practices within effective engagement interventions, as tested in 40 RCTs within the broader child and adolescent mental health literature (i.e. 'CAMH engagement'). RESULTS Treatment attrition and attendance were the most frequent engagement outcomes measured in the CHR/FEP RCTs. There were notable efforts described in the CHR/FEP RCTs towards engaging youth and families, yet CHR/FEP RCTs reportedly included only a small proportion of engagement practices described in either the CHR/FEP or CAMH engagement literatures. CONCLUSION Results suggest there might be practices available to complement current efforts at engaging CHR/FEP youth in treatment, and that increased attention to the measurement of engagement outcomes could provide important information regarding engagement in a population with low treatment engagement rates.
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Affiliation(s)
- Kimberly D Becker
- Division of Child & Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
| | - Sara L Buckingham
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Leslie Rith-Najarian
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Emily R Kline
- Department of Psychiatry, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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23
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Niimura J, Tanoue M, Nakanishi M. Challenges following discharge from acute psychiatric inpatient care in Japan: patients' perspectives. J Psychiatr Ment Health Nurs 2016; 23:576-584. [PMID: 27624838 DOI: 10.1111/jpm.12341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: A lack of transitional care covering the period from psychiatric hospital discharge to community mental health care can increase the likelihood of illness recurrence or readmission of discharged patients. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The participants expressed the view that discontinuity between inpatient and community life was a post-discharge challenge after being involuntarily admitted to a psychiatric emergency ward. These challenges arose from the dissatisfaction with inpatient treatment, inability to coordinate post-discharge life WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Patients should be able to disclose their feelings about their own experiences in inpatient care settings and the current challenges in community care settings in an open manner. An advocate should be appointed in acute psychiatric inpatient care settings to reflect patients' own feelings and individual needs to transitional care without bias to inpatient and community care providers. ABSTRACT Introduction Psychiatric care in Japan usually comprises inpatient care provided during lengthy hospital stays. Recently, policies for shortening psychiatric hospital stays have been aggressively pursued. However, appropriate transitional care is not always provided for acute psychiatric inpatient care. Aim We elucidated patients' challenges immediately after hospital discharge following acute psychiatric inpatient care to clarify how to improve inpatient care and post-discharge follow-ups. Method This study utilized a qualitative descriptive study design and incorporated patient interviews. Participants comprised 18 patients who experienced involuntary admission following a diagnosis of schizophrenia spectrum disorder. Inductive qualitative content analysis was used to create codes and categories from interview transcripts. Findings The core category of post-discharge challenges that emerged was 'separating life as an inpatient from community life'. This comprised two subcategories: 'dissatisfaction with the inpatient care received' and 'lack of abilities to coordinate lifestyle following discharge'. Discussion Patients should be able to disclose their feelings about their experiences in inpatient care settings and the current challenges in community care settings openly. Implications for practice Advocate (e.g. peer staff) should be appointed in acute psychiatric inpatient care settings to reflect patients' feelings and individual needs to transitional care without bias to inpatient and community care providers.
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Affiliation(s)
- J Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - M Tanoue
- Mental Health and Psychiatric Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - M Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Casey D, Brown L, Gajwani R, Islam Z, Jasani R, Parsons H, Tah P, Birchwood M, Singh SP. Predictors of engagement in first-episode psychosis. Schizophr Res 2016; 175:204-208. [PMID: 27132495 DOI: 10.1016/j.schres.2016.04.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/19/2022]
Abstract
Engagement with psychiatric services is critical for ensuring successful outcomes in patients experiencing a first episode of psychosis (FEP). However, it is not known how sociodemographic factors and patient beliefs about the causes of mental illness affect engagement. This study explored predictors of engagement in a cohort of 103 FEP patients presenting to an early-intervention service. Beliefs that mental illness is caused by social stress or thinking odd thoughts predicted higher engagement scores. Patients with no qualifications were found to have higher engagement scores than those educated to a higher level. Ethnicity, gender, age and socioeconomic factors were not significantly correlated with engagement scores. Duration of untreated illness (DUI) significantly predicted higher engagement scores, but only for values >1220days. Duration of untreated psychosis (DUP) was not a significant predictor of patient engagement scores. Patient beliefs about the causes of mental illness are an important factor to be taken into consideration and may represent a target of interventions to increase engagement in FEP.
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Affiliation(s)
- Daniel Casey
- James Paget University Hospital, Lowestoft Rd., Gorleston NR31 6LA, UK.
| | - Luke Brown
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G3 8SJ
| | - Zoebia Islam
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Rubina Jasani
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Helen Parsons
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Priya Tah
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Max Birchwood
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
| | - Swaran P Singh
- Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK
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