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Schamschula M, Paul JL. Deconstructing stigmatising narratives: a qualitative analysis of contrast devices in interviews with mothers with a mental illness. BMC Psychol 2024; 12:433. [PMID: 39123219 PMCID: PMC11316300 DOI: 10.1186/s40359-024-01933-0] [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: 02/02/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND In the context of stigma and mental health research, limited empirical studies examine stigma through the positioning of individuals within interview contexts. This study addresses this gap by investigating the positioning processes in interviews with mothers with a mental illness, with a specific focus on the use of contrast devices as a strategy identified through analysis. By analysing how mothers position themselves through contrast devices and to which discourses they refer, this study provides insights into how stigmatising discourses are evident in the narratives of mothers with a mental illness. METHODS This study is based on 20 semi-narrative interviews with mothers with a mental illness who participated in the Village Project (a pilot project co-created for children of parents with mental illness in Tyrol, Austria). Our analysis focuses on identifying stigmatising discourses related to motherhood and mental illness by examining the use of contrast devices in their accounts. RESULTS The analysis shows insights into mothers' efforts to distance themselves from labels such as 'bad mother', 'not normal/crazy women' and 'weak person'. These positions often carry a gendered dimension, with motherhood emerging as a central position. Our study highlights the challenges mothers with a mental illness face in navigating societal norms and expectations related to motherhood during research interviews. CONCLUSION The research contributes to a deeper understanding of mental health stigma in the context of motherhood, emphasising the importance of considering gendered dynamics and societal expectations in mental health research.
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Affiliation(s)
- Monika Schamschula
- Department of Sociology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, University Hospital for Psychiatry I, Innsbruck, Austria
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Jean Lillian Paul
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, Medical University of Innsbruck, University Hospital for Psychiatry I, Innsbruck, Austria.
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.
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Allchin B, Albermann K, Blake-Holmes K, Gatsou L, Hine R, van Doesum K, Nicholson J. Sustaining efforts to improve family well-being with parents with mental ill health and substance (mis)use. Front Psychiatry 2024; 15:1376409. [PMID: 38596628 PMCID: PMC11003303 DOI: 10.3389/fpsyt.2024.1376409] [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: 01/25/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Research conducted over the past 30 years has developed an extensive body of knowledge on families where parents experience mental ill health and/or substance (mis)use, and interventions that are effective in improving their outcomes. A more recent focus has also explored the importance and nuance of implementation. This perspective article reflects on the concept and practice of sustainability within this body of work and considers underlying assumptions in the field about the goal and direction of interventions that make clarity about sustainability difficult. We identify challenges for understanding sustainability, relating to how and who defines it, what is measured and the impact of context. We conclude by considering how we might be better able to plan and design for sustainability within this field.
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Affiliation(s)
- Becca Allchin
- Mental Health Program, Eastern Health, Melbourne, VIC, Australia
- School of Rural Health, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Kurt Albermann
- Social Pediatric Center, Cantonal Hospital, Winterthur, Switzerland
| | - Kate Blake-Holmes
- School of Social Work, Faculty of Social Sciences, University of East Anglia, Norwich, United Kingdom
| | - Lina Gatsou
- Institute of Health, Health Policy and Social Care Research, De Montfort University, Leicester, United Kingdom
- Child and Adolescent Mental Health Services, Leicestershire Partnership NHS (National Health Service) Trust, Leicester, United Kingdom
| | - Rochelle Hine
- Monash Rural Health, Monash University, Warragul, VIC, Australia
| | - Karin van Doesum
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, Netherlands
- Community Mental Health Service, Department Impluz Prevention, Dimence-groep, Deventer, Netherlands
| | - Joanne Nicholson
- The Heller School, Institute for Behavioral Health, Brandeis University, Waltham, MA, United States
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Szota K, Christiansen H, Aarons GA, Ehrhart MG, Fischer A, Rosner R, Steil R, Barke A. Climate for evidence-based mental health care implementation in Germany: psychometric investigation of the Implementation Climate Scale (ICS). Sci Rep 2023; 13:5311. [PMID: 37002318 PMCID: PMC10066389 DOI: 10.1038/s41598-023-32282-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees' perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79-.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p < .001). Results for the German ICS confirm good psychometric properties including validity.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, P.O. Box 161390, Orlando, FL, 32816-1390, USA
| | - Anne Fischer
- Department of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
| | - Regina Steil
- Department of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany
| | - Antonia Barke
- Division of Clinical Psychology and Psychological Intervention, Institute of Psychology, University of Duisburg-Essen, Universitätsstr. 2, S06 S03 B24, 45141, Essen, Germany
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Zechmeister-Koss I, Aufhammer S, Bachler H, Bauer A, Bechter P, Buchheim A, Christiansen H, Fischer M, Franz M, Fuchs M, Goodyear M, Gruber N, Hofer A, Hölzle L, Juen E, Papanthimou F, Prokop M, Paul JL. Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. Int J Ment Health Nurs 2023; 32:223-235. [PMID: 36226745 DOI: 10.1111/inm.13078] [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] [Accepted: 09/18/2022] [Indexed: 01/14/2023]
Abstract
Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well-structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants.
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Affiliation(s)
| | | | | | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Hanna Christiansen
- Institut für Klinische Kinder- und Jugendpsychologie, Philipps-University, Marburg, Germany
| | - Maria Fischer
- Hilfe für Angehörige Psychisch Erkrankter Menschen in Tirol, Innsbruck, Austria
| | - Marianne Franz
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Fuchs
- Medical University Innsbruck, Innsbruck, Austria.,Abteilung für Kinder- und Jugendpsychiatrie, Tirol Kliniken GmbH, Hall in Tirol, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia.,Emerging Minds, Hilton, South Australia, Australia
| | - Nadja Gruber
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Laura Hölzle
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Juen
- Kinder- und Jugendhilfe, Landeck, Austria
| | | | - Mathias Prokop
- Univ. Klinik für Psychiatrie, Landeskrankenhaus-Universitätskliniken Innsbruck Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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Romsbotn S, Eftedal I, Vaag JR. A Work Environment Under Pressure: Psychosocial Job Demands and Resources Among Saturation Divers. Front Public Health 2022; 10:765197. [PMID: 35570940 PMCID: PMC9095950 DOI: 10.3389/fpubh.2022.765197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Saturation divers work and live under high physiological and social demands for weeks on end. Even though physiological research has contributed insights to the work conditions of saturation divers, research on the qualities of the divers' psychosocial work environment is lacking. This study aimed to explore which job demands and resources are viewed as characteristic among saturation divers working within an isolated and confined environment. Based on data from 6 in-depth semi-structured interviews, template analysis was applied to map unique characteristics. By using the theoretical framework of the job demands-resources model, we found that the work environment in saturation diving was characterized by shifting demands and big contrasts, requiring adaptability in each individual diver. One major demand described by the informants was an unpredictable future, somewhat due to the changes in the oil and gas industry. Another important demand was the conflict between family and work/leisure when committing to work for extended periods in isolated environments. The monotony that characterizes the work environment is a challenge that must be managed. High wages, periods of leisure, and a prestigious job provide external motivation, while personal resources such as mental endurance and flexibility, a willingness to learn, and keeping up small personal routines, may benefit the divers' mental health. This is also affected by the quality of team climate-with features such as being sociable and considerate, having a dark sense of humor and having trust in one another.
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Affiliation(s)
- Siri Romsbotn
- Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid Eftedal
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Jonas Rennemo Vaag
- Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Social Sciences, Nord University, Bodø, Norway
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Goodyear MJ, Allchin B, Burn M, von Doussa H, Reupert A, Tchernegovski P, Sheen J, Cuff R, Obradovic A, Solantaus T, Maybery D. Promoting Self-Determination in Parents With Mental Illness in Adult Mental Health Settings. JOURNAL OF FAMILY NURSING 2022; 28:129-141. [PMID: 35094587 DOI: 10.1177/10748407211067308] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article reports a strengths-based intervention to support parents with mental illness and their children in adult mental health settings: "Let's Talk About Children" (LTC) intervention. A qualitative methodology was adopted with parent participants receiving LTC in adult mental health and family services. The benefits for parents receiving LTC were described through in-depth interviews with 25 parents following the delivery of the program. Interview data identified an impact on parental self-regulation-mainly through a change in a sense of agency as a parent-and skill building, once a clearer picture of their child's everyday life was understood. This study outlines the benefits of talking with parents about the strengths and vulnerabilities of their children during routine mental health treatment. The role for self-determination of parents in preventive interventions for children is an important consideration for mental health recovery, and it also helps to break the cycle of transgenerational mental illness within families.
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Affiliation(s)
- Melinda J Goodyear
- Monash University, Clayton, Victoria, Australia
- Emerging Minds, Hilton, South Australia, Australia
| | - Becca Allchin
- Monash University, Clayton, Victoria, Australia
- Eastern Health, Box Hill, Victoria, Australia
| | | | - Henry von Doussa
- Monash University, Clayton, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Jade Sheen
- Deakin University, Burwood, Victoria, Australia
| | - Rose Cuff
- Satellite Foundation, North Melbourne, Victoria, Australia
| | - Angela Obradovic
- Northern Area Mental Health Service, Parkville, Victoria, Australia
| | - Tytti Solantaus
- Finnish National Institute for Health and Welfare, Helsinki, Finland
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Goodyear M, Zechmeister-Koss I, Bauer A, Christiansen H, Glatz-Grugger M, Paul JL. Development of an Evidence-Informed and Codesigned Model of Support for Children of Parents With a Mental Illness- "It Takes a Village" Approach. Front Psychiatry 2022; 12:806884. [PMID: 35173638 PMCID: PMC8841827 DOI: 10.3389/fpsyt.2021.806884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
Providing support to parents and their children to help address the cycle of intergenerational impacts of mental illness and reduce the negative consequences for children is a key focus of selective prevention approaches in public mental health. However, a key issue for children of parents with a mental illness is the lack of access to early intervention and prevention support when needed. They are not easily identifiable (until presenting with significant mental health issues of their own) and not easily accessing the necessary support that address the complex interplay of parental mental illness within families. There are significant barriers to the early identification of these children, particularly for mental health care. Furthermore, there is a lack of collaborative care that might enhance identification as well as offer services and support for these families. The "It takes a Village" project seeks to improve mental health outcomes for children through the co-development, implementation and evaluation of an approach to collaborative practice concerned with the identification of families where a parent has a mental illness, and establishing a service model to promote child-focused support networks in Austria. Here we describe the development of service delivery approach for the "It takes a Village" project that aims to improve identification and support of these children within enhancements of the existing service systems and informal supports. The paper describes the use of codesign and other implementation strategies, applied to a research setting, with the aim of impacting the sustainability of workforce reform to achieve lasting social impact. Results highlight the steps involved in translating evidence-based components, local practice wisdom and lived experience into the "It takes a Village" practice model for Tyrol, Austria. We highlight through this paper how regional context-specific solutions are essential in the redesign of care models that meet the complex needs of children of parents with a mental illness. Service system and policy formation with local and experienced stakeholders are also vital to ensure the solutions are implementation-ready, particularly when introducing new practice models that rely on organizational change and new ways of practice with vulnerable families. This also creates a solid foundation for the evaluation of the "It take a Village" approach for children of parents with a mental illness in Austria.
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Affiliation(s)
- Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, VIC, Australia
- Emerging Minds, National Workforce Centre for Child Mental Health, Hilton, SA, Australia
| | | | - Annette Bauer
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Hanna Christiansen
- Department of Psychology, Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Martina Glatz-Grugger
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Szota K, Thielemann JFB, Christiansen H, Rye M, Aarons GA, Barke A. Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D). Health Res Policy Syst 2021; 19:90. [PMID: 34078387 PMCID: PMC8173815 DOI: 10.1186/s12961-021-00736-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/12/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The implementation of evidence-based practice (EBP) in mental health care confers many benefits to patients, and research into factors facilitating the implementation of EBP is needed. As an important factor affecting the implementation of EBP, service providers' attitudes toward EBP emerged. The Evidence-Based Practice Attitude Scale (EBPAS-36) is an instrument with good psychometric characteristics that measures positive and ambivalent attitudes toward EBP. However, a German version is missing. The present study therefore aims to provide a validated German translation of the EBPAS-36. METHODS The scale was translated and back-translated as recommended by standard procedures. German psychotherapists were recruited to participate in an online survey. They provided demographic and professional information, completed the EBPAS-36, the Implementation Climate Scale (ICS) and the Intention Scale for Providers (ISP). Standard item and reliability analyses were conducted. Construct validity was evaluated with exploratory (EFA) and confirmatory factor analyses (CFA) in two subsamples (random split). Convergent validity was tested by predicting a high positive correlation of the EBPAS-36D with two scores of attitudes of the ISP and an interest in EBP score. It was tested whether the EBPAS-36D predicts the intention to use EBP. RESULTS N = 599 psychotherapists participated in the study. The item analyses showed a mean item difficulty of pi = 0.64, a mean inter-item correlation of r = 0.18, and a mean item-total correlation of ritc = 0.40. The internal consistency was very good for the total scale (α = 0.89) and ranged from adequate to very good for the subscales (0.65-0.89), indicating high reliability. The original factor structure showed an acceptable model fit (RMSEA = 0.064 (90% CI = 0.059-0.068); SRMR = 0.0922; AIC = 1400.77), confirming the 12-factor structure of the EBPAS-36. However, a second-order factor structure derived by the EFA had an even better model fit (RMSEA = 0.057 (90% CI = 0.052-0.062); SRMR = 0.0822; AIC = 1274.56). When the EBPAS-36D was entered in a hierarchical regression model with the criterion Intention to use EBP, the EBPAS-36D contributed significantly to the prediction (Change in R2 = 0.28, p < 0.001) over and above gender, age and participants' report of ever having worked in a university context. CONCLUSIONS The present study confirms good psychometric properties and validity of a German version of the EBPAS-36 in a sample of psychotherapists.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
| | - Jonathan F B Thielemann
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Marte Rye
- Faculty of Health Sciences, UiT The Arctic University of Norway, Regional Centre for Child and Youth Mental Health and Child Welfare, 9037, Tromsø, Norway
| | - Gregory A Aarons
- Department of Psychiatry, University of California, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Antonia Barke
- Department of Clinical and Biological Psychology, Catholic University of Eichstätt-Ingolstadt, Levelingstr. 7, 85049, Ingolstadt, Germany
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[Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:443-462. [PMID: 32886045 DOI: 10.13109/prkk.2020.69.5.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supporting Children of Parents With a Mental Illness: State of Research and Two Practice Approaches and Claims for the Government Children of parents with a mental illness (COPMI) are at an increased risk to develop (severe) mental disorders (SMI) themselves. Estimates for Germany result in about 25 % of COPMI. This is thus a large and high risk group. On the other hand, prevention programs for COPMI are still scarce, especially in Germany, and central features of the transgenerational transmission of mental disorders have not been studied in conjunction to shed light on potential transmission mechanisms. The current article presents two current research projects on COPMI focusing on preventive approaches. The BMBF funded project "Children of Parents with a Mental Illness At Risk Evaluation" (COMPARE) targets parents of children aged 1.5 to 16 years of age. Parents need to fulfil a current DSM-5 based diagnosis of a mental disorder and then receive either 25-45 sessions gold standard cognitive behavioural therapy (CBT) or CBT plus 10 sessions Positive Parenting Program (PPP) to test the effects of parental therapy on the children and whether an additional parent training results in incremental effects above and beyond CBT alone. The project "The Village" is a model project in the region Tyrol, Austria, targeting the improved identification and collaborative care of COPMI.
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Zechmeister-Koss I, Tüchler H, Goodyear M, Lund IO, Paul JL. Reaching families where a parent has a mental disorder: Using big data to plan early interventions. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2020; 34:39-47. [PMID: 31741296 DOI: 10.1007/s40211-019-00323-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Children who grow up with a parent who has a mental health problem (25%) are at increased risk of developing (health) problems themselves. One approach to reach those children for early intervention supports is through their parents seeking treatment within the adult mental healthcare system. We aimed to gain information on the users of adult mental health services in Tyrol, Austria in order to understand more about the identification of these families to provide support. METHODS We descriptively analysed administrative claims data from the Tyrolean health insurance. Uptake of mental health services (hospital inpatient and day-care services, rehabilitation, outpatient psychiatrist and psychotherapy services), prescription medication and sick leave in persons aged 19-64 in 2017 were analysed. RESULTS The vast majority (82%) of an overall number of 49,494 patients were prescribed medication for their mental health issues. Half of them only received medication as their form of treatment. A quarter had contacted an outpatient psychiatrist and 13% received psychotherapy. Five percent were treated in psychiatric inpatient or day-care. The median length of hospital stay was 15 days. More women than men used mental health benefits. CONCLUSIONS Most parents may be reached via the general practitioner (via drug prescriptions) and low numbers were found accessing services in a psychiatric hospital. The latter may, however, have higher needs for support given their greater acuity of illness. How to get into contact with their children requires thoughtful and sensitive preparation, given the stigmatisation of accessing support for mental health issues. Administrative data are a useful source for planning such early intervention strategies.
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Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria.
| | - Heinz Tüchler
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University Melbourne, Wellington, 3800, Clayton, Victoria, Australia
| | - Ingunn Olea Lund
- The Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213, Oslo, Norway
| | - Jean Lillian Paul
- Tirol Kliniken GmbH, Mental Health Research Group Programme, The Village, Ludwig Boltzmann Gesellschaft, MedUni Innsbruck, Schöpfstraße 23a, 6020, Innsbruck, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Zechmeister-Koss I, Goodyear M, Tüchler H, Paul JL. Supporting children who have a parent with a mental illness in Tyrol: a situational analysis for informing co-development and implementation of practice changes. BMC Health Serv Res 2020; 20:326. [PMID: 32306960 PMCID: PMC7168853 DOI: 10.1186/s12913-020-05184-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A research project, which aims to improve the situation of children of parents with a mental illness (COPMI) is currently underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge regarding the Tyrolean societal and service provision context. METHODS We collected qualitative (17 interviews among stakeholder and people with lived experience) and quantitative data (e.g. health insurance data) regarding overall societal characteristics, epidemiology of mental illness, currently existing services, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along eight external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate. RESULTS We identified that there is awareness of potential challenges related to COPMIs at both a professional and planning level. Additionally, there is a lack of installed support processes and standards to meet these children's needs across Tyrol. A variety of services are available both for unwell parents, as well as for families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health, differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs. CONCLUSIONS The societal structures and the current services provide a rich resource for improving identification and support of COPMIs, however considerable coordination and behaviour change efforts will be required due to the fragmentation of the system and professional cultures. The insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in the local organizations.
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Affiliation(s)
- Ingrid Zechmeister-Koss
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University Melbourne, Wellington Rd, Clayton, Victoria, 3800, Australia
| | - Heinz Tüchler
- Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090, Vienna, Austria
| | - Jean Lillian Paul
- Mental Health Research Group Programme, The Village, Ludwig Boltzmann Gesellschaft, c/o MedUni Innsbruck, Tirol Kliniken GmbH, Schöpfstraße 23a, 6020, Innsbruck, Austria.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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