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Tham SS, Solomon P. Family Involvement in Routine Services for Individuals With Severe Mental Illness: Scoping Review of Barriers and Strategies. Psychiatr Serv 2024:appips20230452. [PMID: 38938096 DOI: 10.1176/appi.ps.20230452] [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: 06/29/2024]
Abstract
OBJECTIVE The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment. METHODS Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used. RESULTS Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies. CONCLUSIONS A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.
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Affiliation(s)
- Suzanne S Tham
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia
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Piché G, Villatte A, Clément MÈ, Morin MH, Maybery D, Reupert A, Richard-Devantoy S, Fournier-Marceau M. Predictors of family-focused practices among mental health workers in Quebec. Front Psychiatry 2024; 15:1380001. [PMID: 38803674 PMCID: PMC11128615 DOI: 10.3389/fpsyt.2024.1380001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Context Engaging family members in the ongoing care of individuals with mental illness is a practice known to bolster the client's recovery journey and enhance the overall wellbeing of both children and families involved. Despite its potential benefits, there remains a dearth of understanding surrounding the implementation of family-focused practices (FFP) by mental health professionals serving adults, as well as the factors that could either promote or hinder such practices. This knowledge gap is particularly pronounced within North American settings. Goal The goal of this study was to identify potential hindering and enabling factors of FFP used in adult mental health services. Methods A sample of 512 professionals working with adult mental health clients, from all regions of Quebec, Canada, with a variety of disciplinary backgrounds and working in different work settings, completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Multinominal logistic regression analysis was performed to assess the impact of several factors - organizational, professional, and personal - on the degree of family-based practices of mental health workers. Results and discussion Findings of this study show that the strongest predictors for the adoption of higher FFP levels among adult mental health professionals in Quebec, are being employed on a full-time basis, perceiving a higher level of skills, knowledge, and confidence toward FFP, and having a supportive workplace environment. Results underscore the need to address both organizational and worker-related aspects to effectively promote better FFP in mental health services.
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Affiliation(s)
- Geneviève Piché
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
- Centre de Recherche Universitaire Sur les Jeunes et les Familles (CRUJEF), Québec, QC, Canada
- Réseau de recherche en santé des populations du Québec (RRSPQ), Montréal, QC, Canada
| | - Aude Villatte
- Centre de Recherche Universitaire Sur les Jeunes et les Familles (CRUJEF), Québec, QC, Canada
- Unité de Formation et de Recherches (UFR) de Psychologie, Université Toulouse Jean Jaurès, Laboratoire Psychologie de la Socialisation - Développement et Travail (PSDT), Toulouse, France
| | - Marie-Ève Clément
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Marie-Hélène Morin
- Département de travail social, Université du Québec à Rimouski, Rimouski, QC, Canada
| | - Darryl Maybery
- Department of Rural and Indigenous Health, Monash University, Melbourne, VIC, Australia
| | - Andrea Reupert
- School of Educational Psychology and Counseling, Monash University, Melbourne, VIC, Australia
| | - Stéphane Richard-Devantoy
- Department of Psychiatry and Douglas Mental Health University Institute, McGill Group for Suicide Studies, McGill University, Montréal, QC, Canada
| | - Marianne Fournier-Marceau
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
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Moitra E, Park HS, Guthrie KM, Johnson JE, Peters G, Wittler E, Price LH, Gaudiano BA. Stakeholder perspectives on adjunctive mHealth services during transitions of care for patients with schizophrenia-spectrum disorders. J Ment Health 2024; 33:211-217. [PMID: 35484975 PMCID: PMC9616963 DOI: 10.1080/09638237.2022.2069693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A growing body of research focuses on developing and testing interventions that leverage mental health-related mobile health (mHealth) services for patients with schizophrenia and other schizophrenia-spectrum disorders. Yet, most formative research has focused on patient perspectives, with little attention paid to clinical stakeholders. AIMS This qualitative study aimed to explore clinical stakeholders' (i.e., administrative supervisors, support staff, and clinicians) perspectives on what might help or hinder the use of mHealth, particularly when patients transition from inpatient to outpatient care. METHODS In-depth individual qualitative interviews were conducted with 18 stakeholders from inpatient and outpatient psychiatric settings. RESULTS Four key themes were identified: (a) adherence challenges; (b) role of mobile technology in patient care; (c) clinical professionals' receptiveness to adjunctive mHealth services; and, (d) costs related to implementation of mHealth services. CONCLUSIONS Overall, stakeholders agree with extant data showing that supportive networks are important in facilitating patients' return to the community following hospitalization. Stakeholders welcome mHealth services but suggest they should be appropriately tailored to the population, both in terms of usability and connection to ongoing traditional treatments. Demonstration of added value will likely facilitate wider implementation of mHealth services in the care of patients with schizophrenia and other schizophrenia-spectrum disorders.
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Affiliation(s)
- Ethan Moitra
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hyun Seon Park
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Kate M. Guthrie
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Behavioral & Preventive Medicine, The Miriam Hospital, Providence RI, USA
| | - Jennifer E. Johnson
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Gloria Peters
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Ellen Wittler
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Lawrence H. Price
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Psychosocial Research Program, Butler Hospital, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Linderborg C, Grant A, Weimand BM, Falkov AF, Östman M. Experiences of clinicians and managers in the implementation of a family focused model in child and adult psychiatry. Front Psychiatry 2024; 15:1360375. [PMID: 38563021 PMCID: PMC10982353 DOI: 10.3389/fpsyt.2024.1360375] [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: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction This paper describes the process of implementing a family focused model, The Family Model, in child and adolescent and adult mental health services in Sweden. Additionally, it describes a service development project carried out in both services within a defined geographical area of Region Stockholm. The Family Model is a communication tool designed to assist clinicians in both services to have family focused conversations with their patients and relatives. Internationally, the needs of individuals experiencing mental health challenges (parents, children and young people) and their close relatives are now well recognized, but barriers to family focused practice nevertheless persist. The aim of this study was to better understand clinicians` experiences in implementing The Family Model in both services. Methods Three preplanned focus group interviews were carried out with 14 clinicians and managers across both services and the data were analyzed in accordance with methods of Naturalistic inquiry. Result Findings suggest that The Family Model has utility in both services. The Naturalistic inquiry analyses revealed three main themes: individual, relational and organizational aspects with a total of 10 sub-themes of how the models influence the participants. Furthermore, analyses on a meta understanding level explored that participants underwent a developmental journey in learning about and using The Family Model in practice which was expressed through three themes: "Useful for burdened families", "Influencing prevention", and "To integrate this would be fantastic". Conclusions The Family Model, when adapted for the Swedish context, is a useful tool for assisting experienced clinicians to engage in family focused practice in both child and adolescent and adult mental health services. The Family Model highlights different aspects in everyday clinical services that were of special interest for clinicians, families, and the system. Future research could explore families' perspectives of the utility of the model.
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Affiliation(s)
- Camilla Linderborg
- Faculty of Health, Social and Welfare Studies, USN- University of South Eastern Norway, Drammen, Norway
- Child and Adolescent Psychiatry, Stockholm Regional Council, Stockholm, Sweden
| | - Anne Grant
- School of Nursing and Midwifery, Queens University Belfast, Belfast, United Kingdom
| | - Bente Margrethe Weimand
- Faculty of Health, Social and Welfare Studies, USN- University of South Eastern Norway, Drammen, Norway
- Faculty of Health and Social Sciences Mental Health and Addiction Services, Department for Research and Development, Akershus University Hospital, Oslo, Norway
| | - Adrian Farrel Falkov
- Department of Child and Youth Mental Health, Royal North Shore Hospital, Northern Sydney Health District, Sydney, NSW, Australia
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Moran N, Naughton-Doe R, Wilberforce M, Wakeman E, Webber M. Supporting unpaid carers around hospital leave for people detained under the Mental Health Act (1983) in England: carer and practitioner perspectives. BMC Psychiatry 2024; 24:160. [PMID: 38395842 PMCID: PMC10885509 DOI: 10.1186/s12888-024-05602-9] [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: 09/06/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND When an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers' instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave. METHODS Semi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis. RESULTS Three themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers. CONCLUSION Implications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a 'S.17 Standard', a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers.
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Affiliation(s)
- Nicola Moran
- School for Business and Society, University of York, YO10 5DD, York, England.
| | - Ruth Naughton-Doe
- School for Business and Society, University of York, YO10 5DD, York, England
| | - Mark Wilberforce
- School for Business and Society, University of York, YO10 5DD, York, England
| | - Emma Wakeman
- St Andrew's Healthcare, Billing Road, NN1 5DG, Northampton, England
| | - Martin Webber
- School for Business and Society, University of York, YO10 5DD, York, England
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Vaswani-Bye A, McCain C, Blank JM, Tennison ME, Kopelovich SL. A Thematic Analysis Investigating the Inaugural Psychosis REACH Family Ambassador Peer Training Program. Neuropsychiatr Dis Treat 2024; 20:233-245. [PMID: 38348058 PMCID: PMC10860596 DOI: 10.2147/ndt.s432255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/15/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose Caregivers of loved ones with psychosis are tasked with navigating a barren care landscape for their loved ones and for themselves. The dearth of resources they face has a negative impact on outcomes for caregivers and their loved ones. The Psychosis REACH program, based on principles from Cognitive Behavioral Therapy for psychosis was developed as a community-based resource for families to address this care gap. A role for family peers called the Psychosis REACH Family Ambassadors (pRFAs) was developed to reinforce skill learning for caregivers by utilizing a task-sharing approach. This qualitative study sought to better understand pRFAs' experiences in the inaugural training cohort of this program. Patients and Methods Eleven pRFAs participated in semi-structured interviews with research coordinators via teleconference. Questions assessed the quality of the training, challenges and facilitators experienced in their role, and ways in which the program could be improved and expanded. Using thematic analysis, members of the research team coded interviews individually, discussed codes until consensus was reached, and iteratively developed themes based on codes that clustered based on meaning or content. Results This process identified 5 key themes: The development of hope and recovery, the development of solidarity networks, the challenges of navigating boundaries, preferred pedagogical strategies, and the need for more support. Conclusion Overall, the themes developed from this qualitative analysis demonstrate the value and feasibility of developing a caregiver peer network of pRFAs trained in recovery-oriented care and CBTp-informed skills to support other caregivers. Additionally, they highlight the challenges associated with being in the role of a pRFA and further efforts needed to align training content and learning management systems to the needs of pRFA trainees. These findings highlight the importance of expanding access to family peer training programs for the wellbeing of caregivers and loved ones with psychosis alike.
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Affiliation(s)
- Akansha Vaswani-Bye
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Chris McCain
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer M Blank
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Mackenzie E Tennison
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Shimange ME, Shilubane HN. Perspectives of Hospitalized Mental Health Care Users Concerning the Involvement of Family Members in Their Care: A Qualitative Study. NURSING REPORTS 2023; 13:1684-1694. [PMID: 38133115 PMCID: PMC10871100 DOI: 10.3390/nursrep13040139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
The value of families and professionals in mental health care is well understood. Patient perspectives appear to have gotten less attention to date. This study investigated the perspectives of hospitalized mental health care users on the involvement of family members in their care using a qualitative phenomenological design. The participants with lived experience of family members being involved in their care were chosen using non-probability, purposive sampling. Individual interviews were carried out with the assistance of a voice recorder and observation notes. Because of data saturation, only fifteen people were interviewed. The interviews were transcribed verbatim and analyzed using Colaizzi's method. It started with reading and reviewing the transcript to extract key statements about the phenomenon. The meaning was then determined by carefully studying the primary significant statements and phrases. The established meanings were then organized into themes and subthemes. The three themes that emerged from the data analysis are as follows: a wide variation in patients' perspectives when family members remind them of their medicine, unpredictable visitation by family members, and a lack of support from family members. There were also the following five sub-themes: not visiting mental health care users in the hospital causes uncertainty about their future, mental health care users were concerned by fewer visits from relatives, friends were perceived as a contributory factor to no or limited visitation by family members, disappointment by a lack of financial support, and perceived lack of emotional support from family members. There is a need for family members to visit mental health care users to remove uncertainty about their future. Healthcare providers should listen to mental health care users to identify the challenges they are faced with, and hospital policies tailored to enhancing the involvement of family members should be formulated.
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Affiliation(s)
| | - Hilda N. Shilubane
- Department of Advanced Nursing Science, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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Hsiao CY, Lu HL, Chiu CK, Tsai YF. Factors associated with attitudes of mental health nurses towards the importance of families in mental health nursing care. Int J Ment Health Nurs 2023; 32:1429-1438. [PMID: 37332262 DOI: 10.1111/inm.13187] [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: 01/16/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
Family involvement in mental healthcare is a key ingredient in the recovery of patients with mental illness. Research on the attitudes of mental health nurses regarding family involvement in mental healthcare remains limited. This study aimed to examine factors that affect the attitudes of mental health nurses towards the importance of family involvement in mental health nursing care. A descriptive, correlational study with a cross-sectional design was conducted with 162 mental health nurses at two psychiatric hospitals in Taiwan. Descriptive statistics, independent t-tests, one-way analysis of variance, and stepwise multiple linear regression analyses were applied to analyse data. Mental health nurses generally demonstrated positive attitudes towards incorporating families into nursing care. Older age, more clinical experiences in mental healthcare, and workplace (such as working in chronic psychiatric inpatient wards) were found to be key factors for mental health nurses' attitudes. Particularly, greater competence in working with families and job satisfaction were the most significant factors associated with positive attitudes of mental health nurses towards involving families as important in nursing care. Insight into correlates of mental health nurses' attitudes towards the importance of focusing on families in care is pivotal for targeted interventions to improve nurses' attitudes towards families and, thus, implement family engagement in mental healthcare practices.
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Affiliation(s)
- Chiu-Yueh Hsiao
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China
- Department of Psychiatry, Chang Gung Memorial Hospital, Tao-Yuan City, Taiwan, Republic of China
| | - Huei-Lan Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, Republic of China
| | - Chin-Kuai Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Tao-Yuan City, Taiwan, Republic of China
| | - Yun-Fang Tsai
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan City, Taiwan, Republic of China
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan City, Taiwan, Republic of China
- Department of Psychiatry, Chang Gung Memorial Hospital in Keelung, Keelung City, Taiwan, Republic of China
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9
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Eckardt JP. Family caregivers: never underestimate the power of hope. Nord J Psychiatry 2023; 77:624-626. [PMID: 36803377 DOI: 10.1080/08039488.2023.2178672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
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Vasava T, Majhi G, Muralidhar D, Kumar D. Factors Associated with Family Retention or Involvement in Treatment of Persons with Severe Mental Illness: A Scoping Review. Indian J Psychol Med 2023; 45:331-337. [PMID: 37483579 PMCID: PMC10357914 DOI: 10.1177/02537176231164647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Objective A scoping review was conducted to detect the factors that affect family retention (FR) or involvement (FI) in the treatment of persons with severe mental illness (PwSMI) and to understand the gaps in this research area. Design We included studies that described factors associated with FR/FI in the treatment of persons with PwSMI. English language articles available in full text, published until June 2022, were included. The literature search was carried out in four major electronic databases, such as PubMed, Scopus, ProQuest, and EBSCOhost, for 6 months from January 2022 to June 2022, which yielded 5442 articles, of which six (four primary studies and two secondary studies) were considered for the final scoping review as per the inclusion criteria. Results Five major categories of factors were identified: (a) family level, (b) professional level, (c) mental health system level, (d) related to characteristics of the patient and illness, and (e) related to the external environment. Most studies described barriers to FI, while only a few elaborated on facilitators for FI/FR. Systemic and family-level factors were the major contributors to the barrier to FI and FR in the treatment of people with PwSMI. Conclusion There is a dearth of literature in the field of FR/FI in the treatment of people with schizophrenia. More research is required so that holistic interventions can be designed and provided.
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Affiliation(s)
- Tejas Vasava
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Gobinda Majhi
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - D. Muralidhar
- Dept. of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Devvarta Kumar
- Dept. of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
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Stavnes K, Ruud T, Benth JŠ, Hanssen-Bauer K, Solantaus T, Hilsen M, Skogøy BE, Kallander EK, Kufås E, Weimand BM. Norwegian health personnel's contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study. BMC Health Serv Res 2023; 23:649. [PMID: 37330496 DOI: 10.1186/s12913-023-09607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/26/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients' children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients' children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in five health trusts in Norway. METHOD We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression. RESULTS The health personnel contacted/referred children to different services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive efforts. The service most often referred to was the child welfare service. CONCLUSION The results indicate a change in contacts/referrals for children from their parents' health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more referrals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.
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Affiliation(s)
- Kristin Stavnes
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, 8092, Bodø, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, Kløveråsveien 1, 8076, Bodø, Norway.
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
| | - Tytti Solantaus
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marit Hilsen
- Regional Centre for Child and Adolescent Mental Health, RBUP Øst Og Sør, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Bjørg Eva Skogøy
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, 8092, Bodø, Norway
- Nordland Research Institute, Postboks 1490, 8049, Bodø, Norway
| | | | - Elin Kufås
- Vestre Viken Hospital Trust, Drammen, Norway
| | - Bente M Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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12
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Hestmark L, Romøren M, Hansson KM, Heiervang KS, Pedersen R. Clinicians' perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study. Front Psychiatry 2023; 14:1175557. [PMID: 37293406 PMCID: PMC10244542 DOI: 10.3389/fpsyt.2023.1175557] [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: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Abstract
Background Family involvement in mental health care ranges from basic practices to complex interventions such as Family psychoeducation, the latter being a well-documented treatment for psychotic disorders. The aim of this study was to explore clinicians' perceptions of the benefits and disadvantages of family involvement, including possible mediating factors and processes. Methods Nested in a randomised trial, which purpose was to implement Basic family involvement and support and Family psychoeducation in Norwegian community mental health centres during 2019-2020, this qualitative study is based on eight focus groups with implementation teams and five focus groups with ordinary clinicians. Using a purposive sampling strategy and semi-structured interview guides, focus groups were audio-recorded, transcribed verbatim, and analysed with reflexive thematic analysis. Results Four main themes were identified as perceived benefits: (1) Family psychoeducation-a concrete framework, (2) Reducing conflict and stress, (3) A triadic understanding, and (4) Being on the same team. Themes 2-4 formed an interconnected triad of mutually reinforcing elements and were further linked to three important clinician-facilitated sub-themes: a space for relatives' experiences, emotions and needs; a space for patients and relatives to discuss sensitive topics and an open line of communication between clinician and relative. Although far less frequent, three main themes were identified as perceived disadvantages or challenges: (1) Family psychoeducation-occasional poor model fit or difficulties following the framework, (2) Getting more involved than usual, and (3) Relatives as a potentially negative influence-important nonetheless. Conclusions The findings contribute to the understanding of the beneficial processes and outcomes of family involvement, as well as the critical role of the clinician in achieving these and possible challenges. They could also be used to inform future quantitative research on mediating factors and implementation efforts.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health and Social Sciences, Center for Mental Health and Substance Abuse, University of South-Eastern Norway, Drammen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Hestmark L, Romøren M, Heiervang KS, Hansson KM, Ruud T, Šaltytė Benth J, Norheim I, Weimand B, Pedersen R. Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:520-533. [PMID: 36797515 PMCID: PMC9934504 DOI: 10.1007/s10488-023-01255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12-14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.Trial Registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318, Oslo, Norway.
| | - Maria Romøren
- Centre for Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo , Oslo, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Lier, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
- Faculty of Health Sciences, OsloMet Oslo Metropolitan University, Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Postbox 1130, Blindern, 0318, Oslo, Norway
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Hem MH, Molewijk B, Weimand B, Pedersen R. Patients with severe mental illness and the ethical challenges related to confidentiality during family involvement: A scoping review. Front Public Health 2023; 10:960815. [PMID: 36711422 PMCID: PMC9877517 DOI: 10.3389/fpubh.2022.960815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Background Despite evidence on the significant potential value of family involvement during the treatment of patients with severe mental illness, research has shown that family involvement is largely underused. The duty of confidentiality is reported to be a key barrier to family involvement. To develop more insight into this barrier, this scoping review focuses on the following question: What are the reported ethical challenges related to confidentiality when involving family in the treatment of patients with severe mental illness? Methods A systematic search into primary studies was conducted using the following databases: Medline (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), and Web of Science core collection (Clarivate). The PICO (Population, Intervention, Comparison, Outcome) scheme and qualitative content analysis were used to make the ethical challenges more explicit. Results Twelve studies-both qualitative and quantitative-were included. We identified the following main categories of ethical challenges: (1) the best interest of family members vs. confidentiality, (2) the patient's best interest vs. the right to confidentiality, (3) patient trust and alliance as a reason not to involve the relatives or not to share information, and (4) using confidentiality as a smokescreen. We also identified several subcategories and illustrative and concrete examples of ethical challenges. Conclusions Through a systematic examination, we discovered various types of ethical challenges related to confidentiality when involving the family in the treatment of patients with severe mental illness. However, research on these ethical challenges and the constituents of these challenges remains limited and often implicit. An ethical analysis will create knowledge which may facilitate a more balanced and nuanced approach to respecting the principle of confidentiality while also considering other moral principles. The duty of confidentiality does not always have to be a major barrier to family involvement; this insight and using this ethical analysis in the training of healthcare professionals may benefit the patient, the family, and the services.
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Affiliation(s)
- Marit Helene Hem
- Norwegian University of Science and Technology (NTNU) Social Research, Trondheim, Norway,Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bert Molewijk
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway,Department Ethics, Law and Humanities, Amsterdam University Medical Centre (UMC) and Vrije Universiteit, Amsterdam, Netherlands
| | - Bente Weimand
- University of South-Eastern Norway, Faculty of Health and Social Sciences, Drammen, Norway,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway,*Correspondence: Reidar Pedersen ✉
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Mihailov E, Provoost V, Wangmo T. Acceptable objectives of empirical research in bioethics: a qualitative exploration of researchers' views. BMC Med Ethics 2022; 23:140. [PMID: 36575520 PMCID: PMC9794471 DOI: 10.1186/s12910-022-00845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This is the first qualitative study to investigate how researchers, who do empirical work in bioethics, relate to objectives of empirical research in bioethics (ERiB). We explore reasons that make some objectives more acceptable, while others are deemed less acceptable. METHODS Using qualitative exploratory study design, we interviewed bioethics researchers, who were selected to represent different types of scholars working in the field. The interview data of 25 participants were analyzed in this paper using thematic analysis. RESULTS From the eight objectives presented to the study participants, understanding the context of a bioethical issue and identifying ethical issues in practice received unanimous agreement. Participants also supported other objectives of ERiB but with varying degrees of agreement. The most contested objectives were striving to draw normative recommendations and developing and justifying moral principles. The is-ought gap was not considered an obstacle to ERiB, but rather a warning sign to critically reflect on the normative implications of empirical results. CONCLUSIONS Our results show that the most contested objectives are also the more ambitious ones, whereas the least contested ones focus on producing empirical results. The potential of empirical research to be useful for bioethics was mostly based on the reasoning pattern that empirical data can provide a testing ground for elements of normative theory. Even though empirical research can inform many parts of bioethical inquiry, normative expertise is recommended to guide ERiB. The acceptability of ambitious objectives for ERiB boils down to finding firm ground for the integration of empirical facts in normative inquiry.
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Affiliation(s)
- Emilian Mihailov
- grid.5100.40000 0001 2322 497XFaculty of Philosophy, University of Bucharest, Bucharest, Romania
| | - Veerle Provoost
- grid.5342.00000 0001 2069 7798Bioethics Institute Ghent, University of Ghent, Ghent, Belgium
| | - Tenzin Wangmo
- grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
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The duty of confidentiality during family involvement: ethical challenges and possible solutions in the treatment of persons with psychotic disorders. BMC Psychiatry 2022; 22:812. [PMID: 36539741 PMCID: PMC9764492 DOI: 10.1186/s12888-022-04461-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Family involvement during severe mental illness is still poorly implemented, contrary to evidence-based recommendations. Confidentiality issues are among the most prominent barriers, with mental health professionals facing complex ethical, legal, and practical challenges. However, research focusing on this barrier is very sparse. Nested within a cluster-randomised trial to implement guidelines on family involvement for persons with psychotic disorders in community mental health centres, the aim of this sub-study was to explore ethical challenges related to the duty of confidentiality as experienced by mental health professionals, and to explore key measures that might contribute to improving the handling of such challenges. METHODS In total 75 participants participated in 21 semi-structured focus groups, including implementation team members at the initial and late phase of the intervention period and clinicians who were not on the implementation teams, at late phase of implementation. We used purposive sampling and manifest content analysis to explore participants' experiences and change processes. RESULTS Ethical challenges related to the duty of confidentiality included 1) Uncertainty in how to apply the legislation, 2) Patient autonomy versus a less strict interpretation of the duty of confidentiality, 3) Patient alliance and beneficence versus a less strict interpretation of the duty of confidentiality, 4) How to deal with uncertainty regarding what relatives know about the patients' illness, and 5) Relatives' interests versus the duty of confidentiality. Measures to facilitate better handling of the duty of confidentiality included 1) Training and practice in family involvement, and 2) Standardisation of family involvement practices. CONCLUSION When health professionals gained competence in and positive experiences with family involvement, this led to vital changes in how they interpreted and practiced the duty of confidentiality in their ethical reasoning and in clinical practice. Especially, the need to provide sufficient information to the patients about family involvement became evident during the study. To improve the handling of confidentiality issues, professionals should receive training in family involvement and confidentiality statutes followed by practice. Furthermore, family involvement should be standardised, and confidentiality guidelines should be implemented in the mental health services. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.
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Marshall P, Jones S, Gooding P, Robinson H, Lobban F. Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15192. [PMID: 36429907 PMCID: PMC9690796 DOI: 10.3390/ijerph192215192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. METHODS A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. RESULTS Three themes were generated. "Suicide as the ultimate threat" highlights fears emerging from carers' difficulties with understanding and managing suicidal behaviour. "Bouncing from one crisis to another" reflects carers' experiences of recurring crises and the challenges of relying on emergency healthcare support. "It definitely needs to be easier to get help" emphasises carers' desires to be acknowledged by healthcare professionals and included in support offered to service users. CONCLUSIONS Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers' needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.
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Affiliation(s)
- Paul Marshall
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
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Hansson KM, Romøren M, Pedersen R, Weimand B, Hestmark L, Norheim I, Ruud T, Hymer IS, Heiervang KS. Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres - a nested qualitative study. BMC Health Serv Res 2022; 22:1153. [PMID: 36096844 PMCID: PMC9469513 DOI: 10.1186/s12913-022-08489-y] [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: 02/10/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders. Methods We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis. Results Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals. Conclusions Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families. Trial registration ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08489-y.
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Affiliation(s)
| | - Maria Romøren
- Centre for Medical Ethics, University of Oslo, Postbox 1130 Blindern, 0318, Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Postbox 1130 Blindern, 0318, Oslo, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway.,Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Faculty of Health Sciences, OsloMet Oslo Metropolitan University, Oslo, Norway
| | - Lars Hestmark
- Centre for Medical Ethics, University of Oslo, Postbox 1130 Blindern, 0318, Oslo, Norway
| | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inger Stølan Hymer
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, University of Oslo, Postbox 1130 Blindern, 0318, Oslo, Norway.,Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway.,Center for Mental Health and Substance Abuse, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Cameron SLA, Tchernegovski P, Maybery D. Mental health service users' experiences and perspectives of family involvement in their care: a systematic literature review. J Ment Health 2022; 32:699-715. [PMID: 35808821 DOI: 10.1080/09638237.2022.2091760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: The importance of engaging families in mental health care is recognised and endorsed by governments worldwide, however service users' perspectives of family involvement are not well understood.Aims: This study sought to summarise the literature regarding how service users view the involvement of family in their engagement with services and care.Methods: A search was conducted within the following databases for manuscripts published in the last 10 years: PsycINFO, CINAHLPlus, PubMed and Scopus. Of the 4251 eligible papers 17 met the inclusion criteria for review and were subjected to quality appraisal using the RATS (relevance, appropriateness, transparency, soundness) qualitative research review guidelines.Results: Thematic analysis identified four primary themes: family involvement can be positive and negative; barriers to family involvement; family involvement is variable; and communication and collaboration among stakeholders.Conclusions: Identifying the barriers to family involvement and heterogeneity among service users' views were key findings of this review. Despite the widely reported benefits of including families in mental health care it does not always occur. A clearer and more nuanced understanding of service users' needs and preferences for family involvement is required.
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Affiliation(s)
- Sarah L A Cameron
- School of Educational Psychology and Counselling, Monash University, Clayton, Australia
| | - Phillip Tchernegovski
- School of Educational Psychology and Counselling, Monash University, Clayton, Australia
| | - Darryl Maybery
- School of Rural Health, Monash University, Warragul, Australia
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Hasselberg N, Klevan TG, Weimand B, Uverud GM, Holgersen KH, Siqveland J, Ruud T. Similarities and differences between service users' and carers' experiences of crisis resolution teams in Norway: a survey. BMC Psychiatry 2022; 22:266. [PMID: 35421950 PMCID: PMC9011940 DOI: 10.1186/s12888-022-03928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution team (CRT) care in adult mental health services is intended to provide accessible and flexible short-term, intensive crisis intervention to service users experiencing a mental health crisis and involve their carers (next of kin). Research on users' and especially carers' experiences with CRT care is scarce and is mostly qualitative in nature. METHODS Altogether, 111 service users and 86 carers from 28 Norwegian CRTs were interviewed with The Service User and Carer Structured Interviews of the CORE Crisis Resolution Team Fidelity Scale Version 2. Their experiences with different aspects of CRT care were reported with descriptive statistics, and differences between service users' and carers' experiences were analyzed with the Mann-Whitney U Test. RESULTS The service users and carers reported that the CRT care mostly reflected their needs and what they wanted. The experiences of service users and carers were mostly similar, except for significant differences in received information and how the termination of CRT care appeared. Both groups experienced the organization of the CRT care as accessible, with continuity, reliability, and flexibility, but without a high intensity of care. Both groups found the content of the CRT care supportive, sensitive, with a choice of treatment type and a range of interventions beyond medication, but a lack of written treatment plans and discharge plans. Carers were rarely involved in discharge meetings. Regarding the role of CRTs within the care system, both groups agreed upon the lack of facilitation of early discharge from inpatient wards and lack of home treatment, but both groups confirmed some collaboration with other mental health services. CONCLUSION Service users and carers found that the CRTs were accessible, reliable, flexible, supportive, sensitive, and provided a range of interventions beyond medication. Limitations were lack of a high intensity of care, limited written treatment and discharge plans, limited provision of home treatment, and lack of gatekeeping of acute beds. Both groups experienced the CRT care as mostly similar, but with significant differences regarding involvement in care planning and discharge preparation.
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Affiliation(s)
- Nina Hasselberg
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Trude Gøril Klevan
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Katrine Høyer Holgersen
- Nidelv Community Mental Health Center, Clinic of Mental Health, St Olavs hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Siqveland
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Center for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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21
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Eckardt JP. Barriers to WHO Mental Health Action Plan updates to expand family and caregiver involvement in mental healthcare. Gen Psychiatr 2022; 35:e100784. [PMID: 35372788 PMCID: PMC8921906 DOI: 10.1136/gpsych-2022-100784] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
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22
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Eckardt JP. Comment on: Family engagement as part of managing patients with mental illness in primary care. Singapore Med J 2022; 62:561. [PMID: 35001128 DOI: 10.11622/smedj.2021205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Rowaert S, De Pau M, De Meyer F, Nicaise P, Vander Laenen F, Vanderplasschen W. Voices to be heard: Understanding family perspectives in forensic care trajectories. Front Psychiatry 2022; 13:1022490. [PMID: 36590630 PMCID: PMC9798123 DOI: 10.3389/fpsyt.2022.1022490] [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: 08/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION De-institutionalization of psychiatric care has greatly increased the role of family members in the recovery pathways of Persons labeled as Not Criminally Responsible (PNCR). However, the role of family members in supporting PNCR in forensic psychiatric care remains understudied. Scarce evidence indicates that PNCR have to deal with stigma and endure specific burdens (i.e., symptom-specific, financial, social, and emotional). Recovery-focused research showed that recovery in both persons with a severe mental illness and family members develop in parallel with each other and are characterized by similar helpful principles (e.g., hope and coping skills). As such, the recovery pathways of PNCR often goes hand in hand with the recovery pathway of their family members. During the family recovery process, family members often experience not being listened to or being empowered by professionals or not being involved in the decision-making process in the care trajectory of their relative. Therefore, the aim of this study is to capture how family members experience the care trajectories of their relatives, more specifically by looking at family recovery aspects and personal advocacy of family members. METHODS Semi-structured interviews were conducted with 21 family members of PNCR from 14 families. A thematic analysis confirms that family members suffer from stigma and worry significantly about the future of their relative. RESULTS Regarding the care trajectory of PNCR, family members experienced barriers in multiple domains while trying to support their relative: involvement in care and information sharing, visiting procedures, transitions between wards, and the psychiatric and judicial reporting by professionals. In addition, family members emphasized the importance of (social) support for themselves during the forensic psychiatric care trajectories and of a shared partnership. DISCUSSION These findings tie in with procedural justice theory as a precondition for family support and family recovery within forensic psychiatric care.
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Affiliation(s)
- Sara Rowaert
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Marjolein De Pau
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy (IRCP), Ghent University, Ghent, Belgium
| | - Florian De Meyer
- Department of Special Needs Education, Ghent University, Ghent, Belgium
| | - Pablo Nicaise
- Faculty of Public Health, Institute of Health and Society (IRSS), Catholic University of Louvain, Brussels, Belgium
| | - Freya Vander Laenen
- Department of Criminology, Criminal Law and Social Law, Institute for International Research on Criminal Policy (IRCP), Ghent University, Ghent, Belgium
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Maybery D, Jaffe IC, Cuff R, Duncan Z, Grant A, Kennelly M, Ruud T, Skogoy BE, Weimand B, Reupert A. Mental health service engagement with family and carers: what practices are fundamental? BMC Health Serv Res 2021; 21:1073. [PMID: 34627245 PMCID: PMC8502279 DOI: 10.1186/s12913-021-07104-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Substantial and important benefits flow to all stakeholders, including the service user, when mental health services meaningfully engage with carers and family members. Government policies around the world clearly supports inclusiveness however health service engagement with family and carers remains sporadic, possibly because how best to engage is unclear. A synthesis of currently used surveys, relevant research and audit tools indicates seven core ways that families and carers might be engaged by health services. This study sought to confirm, from the perspective of family and carers, the importance of these seven health service engagement practices. METHODS In a mixed method online survey, 134 family members and carers were asked what they received and what they wanted from mental health services. Participants also quantified the importance of each of the seven core practices on a 0-100 point likert scale. RESULTS Almost 250 verbatim responses were deductively matched against the seven themes, with additional unaligned responses inductively categorised. The findings triangulate with multiple diverse literatures to confirm seven fundamental engagement practices that carers and family want from health services. Conceptually, the seven practices are represented by two broad overarching practice themes of (i) meeting the needs of the family member and (ii) addressing the needs of the service user. CONCLUSION Policy, clinical practice, training and future research might encompass the seven core practices along with consideration of the intertwined relationship of family, carers and the service user suggested by the two broader concepts.
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Affiliation(s)
| | | | - Rose Cuff
- Satellite Foundation, Melbourne, Australia
| | | | | | | | - Torleif Ruud
- Akershus University Hospital, Nordbyhagen, Norway
| | | | - Bente Weimand
- University of South-Eastern Norway, Notodden, Norway
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25
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Vandewalle J, Debyser B, Deproost E, Verhaeghe S. Family expectations of inpatient mental health services for adults with suicidal ideation: a qualitative study. Int J Ment Health Nurs 2021; 30:1136-1148. [PMID: 33817944 DOI: 10.1111/inm.12864] [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] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub-elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery-oriented mental health services that allow meaningful family involvement.
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Affiliation(s)
- Joeri Vandewalle
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Psychiatric Centre Sint-Amandus, Beernem, Belgium
| | - Bart Debyser
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy, Clinic Sint-Jozef, Pittem, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy, Clinic Sint-Jozef, Pittem, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
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de Waardt DA, Meijnckens D, Wierdsma AI, Widdershoven GAM, Mulder CL. Dutch Mental Health Patients' and Significant Others' Perspectives on Compulsory Treatment at Home: One Size Does Not Fit All. J Patient Exp 2021; 8:23743735211033100. [PMID: 34435087 PMCID: PMC8381458 DOI: 10.1177/23743735211033100] [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] [Indexed: 11/15/2022] Open
Abstract
On January 1, 2020, the Compulsory Mental Health Care Act took effect in the Netherlands. It contains provisions for compulsory community treatment (CCT) and compulsory treatment at home (CTH). In this study, we collected the opinions of patients and their significant others on CTH and on their preferences regarding compulsory care in their homes. Patients and their significant others were involved in the experience-based co-design of a purpose-built online questionnaire. This questionnaire was completed by 624 patients and 531 significant others. Sixty-one percent of the patients and 62% of the significant others did not want compulsory treatment to take place at home but in hospital or elsewhere. Patients' and significant others' opinion showed few differences, except with regard to the involvement of the significant others in CTH. As the respective views of patients and significant others were mixed, we recommend that crisis plans and compulsory treatment plans should be individually tailored to the needs and wishes of patients and their significant others regarding CTH.
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Affiliation(s)
- DA de Waardt
- Department of Psychiatry, ETZ Hospital (Elisabeth-TweeSteden
Ziekenhuis), Tilburg, the Netherlands
| | | | - AI Wierdsma
- Department of Psychiatry, Erasmus MC, University Medical Center,
Rotterdam, the Netherlands
| | - GAM Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University
Medical Centers, VU University Amsterdam, the Netherlands
| | - CL Mulder
- Parnassia Psychiatric Institute, Rotterdam, the Netherlands
- Department of Psychiatry, Epidemiological and Social Psychiatric
Research institute (ESPRi), Erasmus MC, Rotterdam, the Netherlands
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Hestmark L, Heiervang KS, Pedersen R, Hansson KM, Ruud T, Romøren M. Family involvement practices for persons with psychotic disorders in community mental health centres - a cross-sectional fidelity-based study. BMC Psychiatry 2021; 21:285. [PMID: 34078306 PMCID: PMC8170939 DOI: 10.1186/s12888-021-03300-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement. METHODS We employed three fidelity scales, with 12-14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales. RESULTS The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale. CONCLUSIONS The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway.
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
| | | | - Torleif Ruud
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
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28
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Moen ØL, Aass LK, Schröder A, Skundberg-Kletthagen H. Young adults suffering from mental illness: Evaluation of the family-centred support conversation intervention from the perspective of mental healthcare professionals. J Clin Nurs 2021; 30:2886-2896. [PMID: 33942942 DOI: 10.1111/jocn.15795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore how mental healthcare professionals' experience and evaluate the use of Family-Centred Support Conversation Intervention. BACKGROUND Mental health professionals working in the community mental health service provide treatment, care and support to young adults suffering from mental illness. Young adults suffering from mental illness are dependent on other family members and live close to the family. The Family-Centred Support Conversation promotes healing and alleviates the suffering of the family. DESIGN AND METHODS A qualitative explorative design was used. Individual interviews with health professionals (n = 13) were conducted in Norway and analysed using a phenomenographic approach. The COREQ checklist was used. RESULTS Three descriptive categories emerged: A new tool in the toolbox, the family as a conversational partner and Implementing the intervention, with seven conceptions. The mental health professionals had no previous routine for family support. The conversations helped them to structure the involvement of family members. Having the family as a conversational partner together with the patients was considered both somewhat new and rewarding but also challenging. The mental health professionals described a need to adjust the intervention. CONCLUSIONS The Family-Centred Support Conversation was described as a complement to care, as usual, structuring the involvement of families. The knowledge exchange between the families and the mental health professionals may create a context of changing beliefs, strengths and resources. RELEVANCE TO CLINICAL PRACTICE Clinical practice is challenged to work on establishing a mindset; whereby, the family is regarded as a resource with important skills and life experience. The family should be offered individualised support and follow-up, and FCSC may be a relevant intervention.
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Affiliation(s)
- Øyfrid Larsen Moen
- Faculty of Medicine and Health Sciences, Institute of Health sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Lisbeth Kjelsrud Aass
- Faculty of Medicine and Health Sciences, Institute of Health sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Agneta Schröder
- Faculty of Medicine and Health Sciences, Institute of Health sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Hege Skundberg-Kletthagen
- Faculty of Medicine and Health Sciences, Institute of Health sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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29
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Svendsen ML, Ellegaard T, Jeppesen KA, Riiskjær E, Nielsen BK. Family involvement and patient-experienced improvement and satisfaction with care: a nationwide cross-sectional study in Danish psychiatric hospitals. BMC Psychiatry 2021; 21:190. [PMID: 33849472 PMCID: PMC8042926 DOI: 10.1186/s12888-021-03179-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised controlled trials suggest that family therapy has a positive effect on the course of depression, schizophrenia and anorexia nervosa. However, it is largely unknown whether a positive link also exists between caregiver involvement and patient outcome in everyday psychiatric hospital care, using information reported directly from patients, i.e. patient-reported experience measures (PREM), and their caregivers. The objective of this study is to examine whether caregiver-reported involvement is associated with PREM regarding patient improvement and overall satisfaction with care. METHODS Using data from the National Survey of Psychiatric Patient Experiences 2018, we conducted a nationwide cross-sectional study in Danish psychiatric hospitals including patients and their caregivers who had been in contact with the hospital (n = 940 patients, n = 1008 caregivers). A unique patient identifier on the two distinct questionnaires for the patient and their caregiver enabled unambiguous linkage of data. In relation to PREM, five aspects of caregiver involvement were analysed using logistic regression with adjustment for patient age, sex and diagnosis. RESULTS We consistently find that high caregiver-reported involvement is statistically significantly associated with high patient-reported improvement and overall satisfaction with care with odds ratios (OR) ranging from 1.69 (95% confidence interval (CI) 0.95-2.99) to 4.09 (95% CI 2.48-6.76). This applies to the following aspects of caregiver-reported involvement: support for the patient-caregiver relationship, caregiver information, consideration for caregiver experiences and the involvement of caregivers in decision making. No statistically significant association is observed regarding whether caregivers talk to the staff about their expectations for the hospital contact. CONCLUSION This nationwide study implies that caregiver involvement focusing on the patient-caregiver relationship is positively associated with patient improvement and overall satisfaction with care in everyday psychiatric hospital care.
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Affiliation(s)
| | - Trine Ellegaard
- Aarhus University Hospital, Psychiatry, Psychosis Research Unit, Palle Juul-Jensens Boulevard 175, 8200, Aarhus, Denmark
- The Research Centre for Patient Involvement, Aarhus University & the Central Denmark Region, Bartholins Allé 2, 8000, Aarhus, Denmark
| | | | - Erik Riiskjær
- DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus, Denmark
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30
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Jones N, Basaraba C, Piscitelli S, Jewell T, Nossel I, Bello I, Mascayano F, Scodes J, Marino L, Wall M, Dixon LB. Clients' Preferences for Family Involvement and Subsequent Family Contact Patterns Within OnTrackNY Early Psychosis Services. Psychiatr Serv 2021; 72:399-407. [PMID: 33530730 DOI: 10.1176/appi.ps.202000241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about clients' preferences for family involvement and subsequent family contact in naturalistic, community-based coordinated specialty care (CSC) settings. The study's primary goal was to characterize clients' preferences and longitudinal patterns of family contact with providers across the OnTrackNY network in New York. METHODS Clinical administrative data collected at 3-month intervals and spanning 21 OnTrackNY CSC sites were used to analyze the preferences of 761 clients at baseline (unconditional involvement, conditional involvement, or no involvement) and patterns of family contact with program staff (always, sometimes, never, or early discharge) and their correlates during the initial 12-month service period. Data from clients discharged before 12 months were included for comparison. RESULTS At baseline, most clients requested some form of family involvement (unconditional, 59%; conditional, 35%; and none, 6%). Within each 3-month assessment period, rates of family contact ranged from 73% to 84%. Variables associated with both client preferences and contact patterns included baseline insurance status, housing status, race, frequency of family contact, and employment. Clients' preferences for no or conditional family involvement were associated with higher rates of early discharge (i.e., before 1 year). CONCLUSIONS Structuring family involvement around clients' preferences did not appear to negatively affect family contact, and for some clients, it seemed to bolster such contact. Additional mixed-methods research is needed to deepen the understanding of the contexts and reasoning underlying both client preferences for family involvement and subsequent levels of family contact.
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Affiliation(s)
- Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Cale Basaraba
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Sarah Piscitelli
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Thomas Jewell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Ilana Nossel
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Iruma Bello
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Franco Mascayano
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Jennifer Scodes
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Leslie Marino
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Melanie Wall
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
| | - Lisa B Dixon
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript
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Hestmark L, Romøren M, Heiervang KS, Weimand B, Ruud T, Norvoll R, Hansson KM, Norheim I, Aas E, Landeweer EGM, Pedersen R. Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial. BMC Health Serv Res 2020; 20:934. [PMID: 33036605 PMCID: PMC7547488 DOI: 10.1186/s12913-020-05792-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process. METHODS The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis. DISCUSSION This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.
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Affiliation(s)
- Lars Hestmark
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway.
| | - Maria Romøren
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
| | - Kristin Sverdvik Heiervang
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
| | - Bente Weimand
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- School of Nursing and Midwifery, Queens University, Belfast, Northern Ireland
| | - Torleif Ruud
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | | | - Irene Norheim
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Lier, Norway
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Elisabeth Geke Marjan Landeweer
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway
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Powell C, Bedi S, Nath S, Potts L, Trevillion K, Howard L. Mothers' experiences of acute perinatal mental health services in England and Wales: a qualitative analysis. J Reprod Infant Psychol 2020; 40:155-167. [PMID: 32883099 DOI: 10.1080/02646838.2020.1814225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND/OBJECTIVE Perinatal mental health services are a current NHS priority and services are being increased for women. There is limited research on mothers' perspectives of these services and most research focuses on mother and baby units (MBUs). This study explored women's views of their experiences of generic wards, MBUs and crisis resolution teams. METHODS A qualitative thematic analysis was conducted on written feedback on a service-user-designed questionnaire. One hundred and thirty-nine women recruited across 42 mental health trusts made comments. RESULTS Two key themes were identified: support networks and staff authority. Support networks included subthemes relating to families, peers and staff. The theme of staff authority incorporated subthemes about communication, confidence in staff and service-user autonomy. All themes contributed to whether mothers felt safe in these services. Mothers reported the benefits of positive, non-coercive relationships with family and staff for their recovery. The findings highlight that the challenges women face in perinatal settings reflect the literature on general psychiatric services, particularly around coercion. CONCLUSIONS Specific implications for mothers accessing perinatal mental health services: 1) integrated mental health care and support with babies; 2) support with separation from babies for mothers in acute wards; 3) improvement of women's relationships with social services across all services.
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Affiliation(s)
- Claire Powell
- Section of Women's Mental Health, King's College London, London, UK.,Institute of Child Health, University College London, London, UK
| | - Simran Bedi
- Section of Women's Mental Health, King's College London, London, UK
| | - Selina Nath
- Section of Women's Mental Health, King's College London, London, UK.,Institute of Child Health, University College London, London, UK
| | - Laura Potts
- Section of Women's Mental Health, King's College London, London, UK
| | - Kylee Trevillion
- Section of Women's Mental Health, King's College London, London, UK
| | - Louise Howard
- Section of Women's Mental Health, King's College London, London, UK
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Skundberg-Kletthagen H, Gonzalez MT, Schröder A, Moen ØL. Mental Health Professionals' Experiences with Applying a Family-Centred Care Focus in Their Clinical Work. Issues Ment Health Nurs 2020; 41:815-823. [PMID: 32401564 DOI: 10.1080/01612840.2020.1731028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Family members play vital roles in supporting their young adults with mental health challenges, implying that professionals are challenged to apply a Family-Centred Care approach (FCC) in community mental health services. By applying a qualitative phenomengraphic approach, this study aimed to explore and describe professionals' experiences of applying a FCC approach. Based on data from 13 individual interviews, the descriptive categories were: Mutual understanding, Facing dilemmas and Dealing with barriers. Despite the professionals' expressed desires to involve the family, individual treatment and follow-up seemed to characterize their daily clinical practice, often due to the young adults' own wishes.
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Affiliation(s)
- Hege Skundberg-Kletthagen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Marianne Thorsen Gonzalez
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Notodden, Norway
| | - Agneta Schröder
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Øyfrid Larsen Moen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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34
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Dirik A, Kaselionyte J, Giacco D, Priebe S. Defining what a 'carer' is and the role they play in in-patient mental healthcare: A focus group study with patients, carers and clinicians. BJPsych Open 2020; 6:e89. [PMID: 32807255 PMCID: PMC7453793 DOI: 10.1192/bjo.2020.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The value of carer involvement has been extensively researched and promoted. However, the field lacks exploration of conceptual issues, which might help to explain why there are widespread difficulties in putting policy into practice in this area, as implementation rates remain low internationally. AIMS This qualitative study explored patients', carers' and clinicians' perspectives on the role of carers in mental healthcare, particularly with regards to in-patient settings. METHOD Sixteen focus groups were conducted with patients, carers and clinicians who have current or previous experience of in-patient settings. A thematic analysis was conducted on the transcripts, exploring two key domains: (a) what a 'carer' is, and (b) how the 'carer' role is described within the context of the hospital environment. RESULTS Participants diverged in their opinions of what the 'carer' role entails, and the perceived helpfulness of it. Issues unique to the in-patient setting were identified, such as the role of the hospital environment in enabling or being a barrier to carer involvement. These differing perspectives and contextual factors had an impact on the position of carers in the hospital setting, as they could be viewed as helpful, a hindrance or as passive visitors, depending on the perspectives of clinicians. CONCLUSIONS More clarity and agreement is needed between patients, carers and clinicians in terms of how the 'carer' role is defined. This has the potential to improve carers' experience of involvement in hospital settings.
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Affiliation(s)
- Aysegul Dirik
- Unit for Social & Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, UK
| | - Justina Kaselionyte
- Unit for Social & Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, UK
| | - Domenico Giacco
- Unit for Social & Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, UK
| | - Stefan Priebe
- Unit for Social & Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, UK
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35
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Barr KR, Jewell M, Townsend ML, Grenyer BFS. Living with personality disorder and seeking mental health treatment: patients and family members reflect on their experiences. Borderline Personal Disord Emot Dysregul 2020; 7:21. [PMID: 32944249 PMCID: PMC7487914 DOI: 10.1186/s40479-020-00136-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite effective treatments for personality disorders being developed, consumers and carers often report negative experiences of mental health services, including challenges accessing these treatments. METHODS This qualitative study used separate focus groups to compare the unique perspectives of consumer and carers, and to investigate how to improve services for individuals with personality disorders. Reflexive thematic analysis was used to analyze the data. RESULTS Both consumers and carers (N = 15) discussed the value of providing appropriate information to consumers when they are diagnosed with personality disorder. Consumers and carers described the importance of creating a safe environment for consumers when they present to the emergency department. Both groups discussed experiencing positive and negative treatment from mental health professionals, and suggested that professionals should be trained to understand personality disorder. Limited accessibility and quality of services, and offering peer support to consumers were also described by consumers and carers. Consumers and carers also had perspectives which were unique to their group. Consumers identified the importance of psychological treatment, having a strong therapeutic relationship with a mental health professional, and the benefit of long term psychotherapy with the same professional. Broadening the scope of psychotherapies including creative, animal-assisted, and physical therapies was recommended by consumers. Carers described the importance of assessing for personality disorder and intervening early. Involvement in the assessment, diagnosis, and intervention process was important to carers. The desire to be recognized and supported by mental health professionals was discussed by carers. CONCLUSIONS This research contributes to the concern that consumers with personality disorder and their carers experience stigma and low quality care within mental health services. In line with these findings, we recommend guidelines for health professionals who work with consumers with personality disorder.
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Affiliation(s)
- Karlen R Barr
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Mahlie Jewell
- Project Air Strategy Consumer and Carer Advisory Committee, Wollongong, NSW Australia
| | - Michelle L Townsend
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW 2522 Australia
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36
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Littlewood DL, Quinlivan L, Graney J, Appleby L, Turnbull P, Webb RT, Kapur N. Learning from clinicians' views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study. BMC Psychiatry 2019; 19:346. [PMID: 31694598 PMCID: PMC6836656 DOI: 10.1186/s12888-019-2336-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/23/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Suicide and non-fatal self-harm represent key patient safety events in mental healthcare services. However, additional important learning can also be derived by highlighting examples of optimal practice that help to keep patients safe. In this study, we aimed to explore clinicians' views of what constitutes good practice in mental healthcare services in the context of suicide prevention. METHODS Data were extracted from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) database, a consecutive case series study of suicide by people in contact with mental healthcare services. A large national sample of clinicians' responses was analysed with a hybrid thematic analysis. RESULTS Responses (n = 2331) were submitted by clinicians across 62 mental healthcare providers. The following five themes illustrated good practice that helps to: 1) promote safer environments, 2) develop stronger relationships with patients and families, 3) provide timely access to tailored and appropriate care, 4) facilitate seamless transitions, and 5) establish a sufficiently skilled, resourced and supported staff team. CONCLUSION This study highlighted clinicians' views on key elements of good practice in mental health services. Respondents included practice specific to mental health services that focus on enhancing patient safety via prevention of self-harm and suicide. Clinicians possess important understanding of optimal practice but there are few opportunities to share such insight on a broader scale. A further challenge is to implement optimal practice into routine, daily care to improve patient safety and reduce suicide risk.
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Affiliation(s)
- Donna L. Littlewood
- 0000000121662407grid.5379.8NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Leah Quinlivan
- 0000000121662407grid.5379.8NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Jane Graney
- 0000000121662407grid.5379.8National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Louis Appleby
- 0000000121662407grid.5379.8National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Pauline Turnbull
- 0000000121662407grid.5379.8National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Roger T. Webb
- 0000000121662407grid.5379.8NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Navneet Kapur
- 0000000121662407grid.5379.8NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK ,0000000121662407grid.5379.8National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, Manchester, UK ,0000 0004 0430 6955grid.450837.dGreater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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37
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Martinsen EH, Weimand B, Norvoll R. Does coercion matter? Supporting young next-of-kin in mental health care. Nurs Ethics 2019; 27:1270-1281. [PMID: 31500502 DOI: 10.1177/0969733019871681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coercion can cause harm to both the patient and the patient's family. Few studies have examined how the coercive treatment of a close relative might affect young next-of-kin. RESEARCH QUESTIONS We aimed to investigate the views and experiences of health professionals being responsible for supporting young next-of-kin to patients in mental health care (children-responsible staff) in relation to the needs of these young next-of-kin in coercive situations and to identify ethical challenges. RESEARCH DESIGN We conducted a qualitative study based on semistructured, focus group interviews and an individual interview. PARTICIPANTS AND RESEARCH CONTEXT We held three focus group interviews with six to seven children-responsible staff in each group (a total of 20 participants) and one individual interview with a family therapist. The participants were recruited from three hospital trusts in the eastern part of Norway. ETHICAL CONSIDERATIONS The study was approved by the National Data Protection Official for Research and based on informed consent and confidentiality. FINDINGS Coercion was not a theme among the participants in relation to their work with young next-of-kin, and there was much uncertainty related to whether these young people need special support to deal with the coercive treatment of their close relative. Despite the uncertainty, the study indicated a need for more information and emotional support among the youth. DISCUSSION Few studies have addressed the potential impact of coercive treatment of a close family member on young next-of-kin. The findings were consistent with existing research but highlighted disagreement and uncertainty among the children-responsible staff about to what extent the young next-of-kin should visit and whether they should enter the ward unit or not. We identified ethical challenges for the children-responsible staff related to the principle of not inflicting harm (nonmaleficence). CONCLUSION From the perspective of children-responsible staff, it appears that the coercive treatment of a close family member entails a need for extra support of young relatives both in relation to information and the facilitation of visits, but more systematic knowledge about these issues is needed.
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Affiliation(s)
| | - Bente Weimand
- Oslo Metropolitan University, Norway.,Akershus University Hospital, Norway.,Queens University Belfast, Northern Ireland, UK
| | - Reidun Norvoll
- Oslo Metropolitan University, Norway.,University of Oslo, Norway
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38
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Marynowski-Traczyk D, Broadbent M, Kinner SA, FitzGerald G, Heffernan E, Johnston A, Young JT, Keijzers G, Scuffham P, Bosley E, Martin-Khan M, Zhang P, Crilly J. Mental health presentations to the emergency department: A perspective on the involvement of social support networks. Australas Emerg Care 2019; 22:162-167. [PMID: 31300299 DOI: 10.1016/j.auec.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022]
Abstract
The involvement of families, carers and significant others (i.e. social support networks) has a positive corollary for a person experiencing mental health problems. Accordingly, in Australia involvement of social support networks within mental health services is endorsed in national health policy and service guidelines. Despite the endorsement, this is yet to be fully realised in all areas that provide mental health services, including emergency departments. Social support networks are integral in the provision of mental health consumers' care. Supporting the involvement of social support networks in the emergency department can provide healthcare services with opportunities for enhanced and cost-effective care, contributing to improved outcomes for consumers. An overview of some of the barriers and facilitators of social support network involvement is provided. The intention of this paper is to encourage reflection and dialogue on this important area of mental health service provision and support the evolution of a new paradigm of research into social support network involvement in the emergency department.
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Affiliation(s)
- Donna Marynowski-Traczyk
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia.
| | - Marc Broadbent
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, QLD, Australia
| | - Stuart A Kinner
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Queensland, Mater Research Institute-UQ, QLD, Australia; Griffith University, Griffith Criminology Institute, QLD, Australia; Monash University, School of Public Health and Preventive Medicine, VIC, Australia
| | - Gerard FitzGerald
- Queensland University of Technology, School of Public Health and Social Work, QLD, Australia
| | - Ed Heffernan
- Queensland Forensic Mental Health Service, Queensland Health, QLD, Australia
| | - Amy Johnston
- University of Queensland, School of Nursing, Midwifery and Social Work, QLD, Australia; Department of Emergency Medicine, Princess Alexandra Hospital, QLD, Australia
| | - Jesse T Young
- Murdoch Children's Research Institute, Centre for Adolescent Health, VIC, Australia; University of Melbourne, Melbourne School of Population and Global Health, VIC, Australia; University of Western Australia, School of Population and Global Health, WA, Australia; Curtin University, National Drug Research Institute, WA, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast Health, QLD, Australia; Bond University, School of Medicine, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Paul Scuffham
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Griffith University, School of Medicine, QLD, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Information Support, Research and Evaluation, QLD, Australia
| | - Melinda Martin-Khan
- University of Queensland, Centre for Health Services Research, QLD, Australia
| | - Ping Zhang
- Griffith University, Menzies Health Institute Queensland, QLD, Australia
| | - Julia Crilly
- Griffith University, Menzies Health Institute Queensland, QLD, Australia; Department of Emergency Medicine, Gold Coast Health, QLD, Australia
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Foster K, Goodyear M, Grant A, Weimand B, Nicholson J. Family-focused practice with EASE: A practice framework for strengthening recovery when mental health consumers are parents. Int J Ment Health Nurs 2019; 28:351-360. [PMID: 30191650 DOI: 10.1111/inm.12535] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
This paper provides a framework for essential family-focused practices (EASE: Engage, Assess, Support, Educate) for clinicians to support parents with mental illness in the context of their family. The framework is underpinned by relational recovery as the parent/consumer's recovery is considered within the context of their relationships, including the relationship between clinician and parent/consumer. The central aim is to strengthen nurses' and other clinicians' capacity to address key psychosocial needs of parents and to strengthen relational recovery in families where parents have mental illness. The EASE framework is a theory and evidence-informed family practice approach to relational recovery within healthcare provision. The EASE practice components are defined and illustrated with practice exemplars that operationalize the framework within adult service settings. Potential applications and outcomes of using EASE are also described. The framework is intended as a practical guide for working with parents and families in inpatient and community mental health settings and may also be relevant for clinicians in a range of contexts including child welfare and primary health care.
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Affiliation(s)
- Kim Foster
- Australian Catholic University and NorthWestern Mental Health, Victoria, Australia
| | - Melinda Goodyear
- School of Rural Health, Monash University, Victoria, Australia.,Parenting Research Centre, East Melbourne, Victoria, Australia
| | - Anne Grant
- School of Nursing and Midwifery, Queens University, Belfast, Northern Ireland
| | - Bente Weimand
- Mental Health Division, Akershus University Hospital, Research and Development, Lørenskog, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Joanne Nicholson
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Skärsäter I, Keogh B, Doyle L, Ellilä H, Jormfeldt H, Lahti M, Higgins A, Meade O, Sitvast J, Stickley T, Kilkku N. Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: A critical review of the literature. Nurse Educ Pract 2018; 32:138-146. [PMID: 30007849 DOI: 10.1016/j.nepr.2018.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/18/2018] [Accepted: 07/06/2018] [Indexed: 01/21/2023]
Abstract
Involving and supporting the family members and caregivers of people with mental illness is essential to high-quality mental health services. However, literature suggests that there is a lack of engagement between family members and mental health nurses (MHNs). Lack of knowledge among MHNs is often cited as one of the main reasons for this lack of engagement. The aim of this review was to explore the knowledge, skills and attitudes that are required by MHNs to enable to them to work more effectively with families affected by mental illness. A literature based critical review was used to access and review 35 papers in order to extract concepts that could inform the design of eLearning materials to assist MHNs advance their knowledge in this area. Two overarching themes were identified; 'Mental health problems and the family' and 'Working with the family'. From these themes, the knowledge, skills and attitudes required to work more effectively with families are described. The findings from this review provide a descriptive account of the knowledge skills and attitudes that are required for effective family work. In addition, the review provides an empirical foundation for education programmes in the area.
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Affiliation(s)
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Heikki Ellilä
- University of Applied Science Turku, Ruiskatu 8, 20810, Turku, Finland
| | | | - Mari Lahti
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Agnes Higgins
- Halmstad University, Box 823, SE 301 18, Halmstad, Sweden
| | - Oonagh Meade
- School of Psychology, National University of Ireland, Galway, Ireland.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ, Utrecht, The Netherlands
| | - Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, UK
| | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520, Tampere, Finland
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Families in Assertive Community Treatment (ACT) Teams in Norway: A Cross-Sectional Study on Relatives' Experiences of Involvement and Alienation. Community Ment Health J 2018; 54:686-697. [PMID: 29127565 DOI: 10.1007/s10597-017-0207-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
International research shows that relatives of people with mental illness are rarely involved by mental health services. Assertive Community Treatment (ACT) has been recently implemented in Norway. The experience of relatives of ACT users is largely unknown. The aim of this study was to explore relatives' experience with ACT-teams in Norway. Data were collected using the family involvement and alienation questionnaire, consisting of experiences of approach, and alienation from the provision of professional care. 38 Relatives participated in this study. A majority experienced a positive approach (openness, confirmation, and cooperation) from the ACT teams, which also was considered better compared to previous services. They considered openness and cooperation as essential aspects from the professionals. Almost half did not feel alienated (powerlessness and social isolation). Higher level of being approached positively was significantly associated with lower level of feeling alienated. The knowledge of what constituted relatives' positive experiences with the ACT teams should be transferred into practice regarding how to form a positive alliance with relatives.
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