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Høgås M, Elstad TA, Ness O, Alsaker S. Picturing healthcare: a photovoice study of how healthcare is experienced by service users in a mental-health low threshold service. BMC Health Serv Res 2022; 22:714. [PMID: 35637494 PMCID: PMC9153114 DOI: 10.1186/s12913-022-08013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background A recent policy change dictates that all mental healthcare in Norway must be referred and documented in the medical record of the service users. This has not been the case within low threshold mental health services, which is services without referrals, social arenas where healthcare professionals are available and where service users themselves can choose to attend based on their self-reported needs. This challenges the idea of “healthcare” being a medical term as opposed to experienced and expressed by the service user. A new healthcare understanding that includes the service users’ voices are thus needed, and the aim of this study is to explore how service users within low threshold services, understand, describe, and experience healthcare. Methods The present study has used the photovoice approach to explore how four service users perceive and experience healthcare in a low threshold context. The chosen photovoice method enabled service users to reflect upon and communicate their experiences first visually by individual pictures and thereafter reflective texts emerged through seven workshops. A qualitative thematic analysis was performed based on the pictures, notes and audiotaped material from the workshops. Results The analysis found three main themes showing how healthcare is experienced: availability of people, availability of places and availability of activities. This is illustrated through the following sub-themes: First, common community, good relations and fellowship, second, flexible and easily accessible support, which includes the opportunity to spend time and to try things out in a safe environment, and third, facilitation and motivation for participation and activity, given the opportunity to have a meaningful role and be seen as a resourceful human being. Conclusions A new understanding of healthcare is needed in the context of recovery-oriented low threshold services, as today`s largely medical understanding of healthcare is challenging to connect to a relational, recovery-oriented understanding of healthcare. As healthcare are to be documented in service users medical record, further research should explore how to document healthcare based on a new or extended, relational understanding of healthcare.
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Affiliation(s)
- Mariell Høgås
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Toril Anne Elstad
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ottar Ness
- Department of Education and Lifelong Learning, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sissel Alsaker
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Walker ER, Fukuda J, McMonigle M, Nguyen J, Druss BG. A Qualitative Study of Barriers and Facilitators to Transitions From the Emergency Department to Outpatient Mental Health Care. Psychiatr Serv 2021; 72:1311-1319. [PMID: 33887957 DOI: 10.1176/appi.ps.202000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People with psychiatric disorders are among the most frequent users of emergency departments (EDs). The transition of care from the ED to outpatient mental health treatment may be important for continuity of care; however, little is known about the barriers and facilitators that patients experience in transitions to and engagement in outpatient mental health care. In this qualitative study, the authors examined the perspectives of patients and providers on these barriers and facilitators at the patient, provider, and health care system levels. METHODS The authors (trained interviewers) conducted 30 semistructured interviews with patients and 15 interviews with 13 mental health providers. Data were analyzed by using thematic analysis. RESULTS Patients and providers discussed similar barriers and facilitators to patient transitions and engagement in care. Patients with psychiatric disorders experienced barriers and facilitators at multiple levels when engaging in mental health care after discharge from the ED. Patient-level themes included openness to treatment and logistical challenges. Provider-level themes focused on the connection between patients and providers and on establishing and maintaining contact. Themes at the health care system level were coordination between the ED and outpatient clinics, managing appointments, and health care resources. CONCLUSIONS Key factors that influence transitions of care from the ED to outpatient treatment include patients' complex health and life circumstances, the establishment of a relationship with providers built on trust and compassion, and the level of coordination between care settings.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Julia Fukuda
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Megan McMonigle
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Julie Nguyen
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Department of Behavioral, Social, and Health Education Sciences (Walker, Fukuda, McMonigle), and Department of Health Policy and Management (Nguyen, Druss), Rollins School of Public Health, Emory University, Atlanta
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Chiang VCL, Chien WT, Wan MC, Cheung SYH. Walking with the illness and life: Experience of the community life of people previously under the services of an integrated community mental health service. J Psychiatr Ment Health Nurs 2020; 27:728-741. [PMID: 32249981 DOI: 10.1111/jpm.12632] [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: 06/01/2019] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There have been some studies on the experience and community life of mental health clients receiving integrated community mental health service (ICMHS). Evaluation of ICMHS suggests that the service could have positive clinical and social outcomes, but the results are inconclusive. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Research studies have focused on clients and/or staff of the ICMHS, while in this study, the experiences and perspectives of family members are also explored. More comprehensive knowledge about the work for, and community life of, people previously under the services of ICMHS is added to the existing knowledge. This study found that with "timely support" and "family presence," people who had received the services of ICMHS continued to engage in more social activities ("expanding social networks"), had "better family relationships," were "letting go" of thinking too much and more able to relax, and had "better self-efficacy and self-caring" in the community. Professional contact after ICMHS through continuous conversations (e.g. home visits and follow-up calls) and social activities are essential for both clients and their families to carry on living with the illness. Timely support, family presence, support to family members in the community and better social networks are key experiences of ICMHS clients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Although the ICMHS' resources are limited, better promotion is urgently needed for the public to realize the services and to support mental health clients. Mental health professionals may develop practice models through exploratory and confirmatory factors analyses of the themes identified from this study as the outcome measures. The cost-effectiveness of services and relapse rates over time should also be evaluated for future practice development. Further studies for practice on the difference that family support can make to the community life of former ICMHS clients are warranted. This may be achieved through research designs that compare people with, and without, family members. ABSTRACT: Introduction More comprehensive understanding, from the experiences and multiple perspectives of the clients, families and staff, about the community life of former clients of the integrated community mental health service (ICMHS) is scarce. Aim To explore the community life experiences of people after their discharge from the ICMHS. Method A qualitative approach with an interpretative phenomenological analysis was utilized for this study. Data were collected through individual semi-structured interviews of 37 participants, including people discharged from an Integrated Community Centre of Mental Wellness, their family members and staff members. Results Six themes emerged from the analysis: "timely support," "family presence," "better family relationships," "expanding social networks," "letting go" and "better self-efficacy and self-care," under the main theme of "walking with the illness and life." Discussion Over and after the ICHMS, with timely support and family presence, there was a positive trend in the experiences of clients in expanding social networks, having better family relationships, letting go of thinking too much and being more able to relax, and improving self-efficacy and self-caring. Implications for practice The study provides a more comprehensive understanding of the experiences of clients, family and staff about the community life of people post-ICMHS, providing insights and clearer directions for research and practice development.
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Affiliation(s)
- Vico Chung Lim Chiang
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ming Chi Wan
- New Life Psychiatric Rehabilitation Association, Hong Kong, Hong Kong
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Guvenc NC, Oner H. Views of patient relatives and health professionals about the reasons of the patients enrolled in the community mental health center to discontinue or irregularly continue the center. Int J Soc Psychiatry 2020; 66:707-723. [PMID: 32567444 DOI: 10.1177/0020764020931875] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the study was to determine the views of patient relatives and health professionals about the reasons of patients enrolled in the community mental health center to discontinue or irregularly continue the center. METHODS This study is qualitative and phenomenological. The study group consisted of 17 patient relatives and eight health professionals according to the maximum variation sampling method. In the study, the data were collected using the personal information form in semi-structured interviews. The data were analyzed with the descriptive (thematic) method in the MAXQDA 2018 package program. RESULTS In line with the research findings, themes and codes were determined based on the statements of patient relatives and health professionals. For patient relatives, the themes were determined as disease symptoms, disease effect/coping difficulties, misbeliefs-fears, problems about the center, and social and economic causes. For health professionals, the themes were determined as reasons for not coming to the community mental health center, problems related to center health professionals, level/severity of the disease and treatment compliance, socio-economic conditions and problems experienced by health professionals. CONCLUSION It can be said that the views of patient relatives and health professionals about the discontinuity of patients to the center were similar. It was seen that the problems regarding factors such as disease severity, disease effects, knowledge and beliefs of the family, stigma, functionality and promotion of the center were effective in patient's continuity to the center. In line with the research findings, it was recommended to improve the quality of the activities in the center to increase the number of patients enrolled in the community mental health center and their continuity, develop training programs that also involve health professionals to increase the quality of service, and increase the cooperation with patient relatives.
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Affiliation(s)
- Nur Ceren Guvenc
- Department of Mental Health and Diseases Nursing, Faculty of Nursing, Adnan Menderes University, Aydin, Turkey
| | - Hatice Oner
- Department of Mental Health and Diseases Nursing, Faculty of Nursing, Adnan Menderes University, Aydin, Turkey
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Xiao L, Gao Y, Zhang L, Sun X, Zeng K. Perspectives of Individuals With Mental Illness on Community Mental Health Services in China: A Qualitative Exploration. J Psychosoc Nurs Ment Health Serv 2017; 55:30-37. [PMID: 28671239 DOI: 10.3928/02793695-20170619-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
Abstract
Little is known about the perspectives of individuals with mental illness on community mental health services (CMHS) in China. The current study aimed to explore these perspectives. Semi-structured interviews were completed with a purposive sample of 25 individuals with mental illness recruited from three communities in Guangzhou City, China. The Colaizzi method was used for data analysis. Three main themes were identified: (a) patients' perceptions of CMHS, (b) patients' barriers to accessing CMHS, and (c) patients' expectations of CMHS. The identified issues should be taken into consideration in improving CMHS. CMHS staff, including nurses, should make patients more aware of CMHS. To increase CMHS use and make it more responsive to patients' expectations, staff should try to resolve patients' stigma and desire to return to society. [Journal of Psychosocial Nursing and Mental Health Services, 55(7), 30-37.].
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Nieminen I, Kaunonen M. Professionals' views on mental health service users' education: challenges and support. J Psychiatr Ment Health Nurs 2017; 24:57-68. [PMID: 28090750 DOI: 10.1111/jpm.12355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mental health service users (MHSUs) may experience disruptions in their education. However, education has been shown to have a positive influence on their recovery, potentially offering them broader employment opportunities. The literature suggests that providing support for MHSUs in their educational efforts may be beneficial and is wished for by the service users themselves. However, there is a lack of mental health professionals' views on the topic in the setting of a community mental health centre. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: In the perception of mental health professionals, the predominance of disease in the life of MHSUs and their marginalization may form barriers to their success in education. Professionals can support MHSUs in their educational efforts by strengthening the MHSUs' internal resources and creating a supportive environment with professional expertise available. A service user-centred education might further help MHSUs to achieve their educational goals. Our findings confirm previous knowledge of a recovery-oriented approach to supporting MHSUs' education. This study explored the topic from the professionals' perspective in the context of community mental health centres, which is a fresh view in the research literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest which types of support professionals perceive to be required for MHSUs to advance their studies. Knowledge of adequate forms of support can be applied in the mental health nursing practice to develop support measures for service users to advance in their studies. All levels of the community mental health centres should be aware of and adopt a recovery-oriented approach. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and the more active involvement of MHSUs in the design of their own rehabilitation process. ABSTRACT Introduction Studies show the importance of providing support for mental health service users' (MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process.
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Affiliation(s)
- I Nieminen
- Doctoral student, Nursing Science, School of Health Sciences, University of Tampere, Finland
| | - M Kaunonen
- Professor, Nursing Science, School of Health Sciences, University of Tampere, General Administration Pirkanmaa Hospital District, Finland
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Abstract
A hermeneutic phenomenological analysis reveals the complexity of bipolar disorder. Operating at biological, psychological, and social levels this phenomenon creates dilemmas and people must account for their choices in a moral order. Two participants suffer from the condition, whereas a third is employed to deliver mental health treatment. Three themes are identified showing that all the participants struggle to feel they are competent and consistent decision makers. They feel exposed, fearing that others will impose interpretations on their behavior. They resist the imposition of a medical model, wanting to believe that choices are personal and related to life experiences. This person-centered interpretation is favored because it offers the potential for learning, for achieving autonomy, and growth. By attending to the interpersonal aspects of emotion and subjectivity, this analysis challenges the idea that autonomy can be undermined by a disease process in a simple manner. It is suggested that mental health care systems need to deliver services in which the personal and interpersonal aspects of recovery are adequately managed.
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Wilson RL. Mental health recovery and quilting: evaluation of a grass-roots project in a small, rural, Australian Christian church. Issues Ment Health Nurs 2014; 35:292-8. [PMID: 24702214 DOI: 10.3109/01612840.2014.886089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A small project in a rural community church setting was undertaken to promote mental health recovery for one person and to develop a positive conversation about mental health amongst the wider group. Social capital within the group of people was successfully harnessed so that a warm and supportive recovery environment might be fostered within the broader community. The goals of the project were to reduce mental health stigma and to foster recovery. This was achieved as a mental health nurse, quilt maker, and a team of sewers came together to produce a quilt as a tangible expression of care and support for both the quilt recipient and each other. This project, as a case study, demonstrates how a church faith community and mental health care can be combined and yield positive outcomes. This article outlines how the project proceeded and presents the results of a post-project evaluation survey.
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Affiliation(s)
- Rhonda Lynne Wilson
- University of New England, School of Health, University of New England, Armidale, New South Wales, Australia
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Happell B, Hoey W, J Gaskin C. The characteristics of consumers receiving case management in the community: a review of literature. Issues Ment Health Nurs 2012; 33:145-8. [PMID: 22364425 DOI: 10.3109/01612840.2011.627107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, and School of Nursing and Midwifery, CQ University Australia, Rockhampton, Queensland, Australia.
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