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de Beer CRM, Nooteboom LA, van Domburgh L, de Vreugd M, Schoones JW, Vermeiren RRJM. A systematic review exploring youth peer support for young people with mental health problems. Eur Child Adolesc Psychiatry 2024; 33:2471-2484. [PMID: 36495354 PMCID: PMC11272732 DOI: 10.1007/s00787-022-02120-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
Youth peer support workers (YPSWs) are young adults with lived experience of mental illness during childhood or adolescence who support young people receiving treatment in mental health services. The contributions made by YPSWs are a promising development to facilitate consumer-centered and recovery-oriented care. Although the youth peer support workforce is expanding rapidly, structurally embedding YPSWs in practice is challenging. To overcome these challenges and thereby improve care for young people, insight into YPSW roles, barriers and facilitators for implementing and pursuing youth peer support (YPS) is a necessity. This systematic review examined the published literature to identify existing knowledge on YPSW roles in treatment settings, and the barriers and facilitators for implementing and pursuing YPS in practice. A total of 24 studies from a variety of youth serving contexts were included in this review. Thematic synthesis resulted in six YPSW roles and five themes with barriers and facilitators. The roles included the: engagement role, emotional support role, navigating and planning role, advocacy role, research role and the educational role. The themes explored the needs of YPSWs, experiences of YPSWs, relationships between service users and YPSWs, the collaboration process between YPSWs and non-peer staff, and organizational readiness. This review underlines that YPSWs likely are a valuable addition to numerous youth treatment contexts. Overall, the implementation of YPSWs is a multifaceted operation that requires careful planning. We recommend services to set clear and realistic expectations for YPSWs, to consider potential power imbalances between YPSWs and non-peer staff, to provide adequate resources to pursue YPS, and to approach the implementation of YPSWs with a growth mindset.
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Affiliation(s)
- C R M de Beer
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
| | - L A Nooteboom
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Domburgh
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
- iHUB, Rotterdam, The Netherlands
| | - M de Vreugd
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Directorate of Research Policy (Formerly: Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | - R R J M Vermeiren
- LUMC Curium, Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Youz, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Kabukye JK, Namagembe R, Nakku J, Kiberu V, Sjölinder M, Nilsson S, Wamala-Larsson C. Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e53976. [PMID: 38843515 PMCID: PMC11190627 DOI: 10.2196/53976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Rosemary Namagembe
- Hutchinson Centre Research Institute of Uganda, Uganda Cancer Institute, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Vincent Kiberu
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Susanne Nilsson
- Unit for Integrated Product Development and Design, Department of Machine Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Caroline Wamala-Larsson
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Haun MH, Girit S, Goldfarb Y, Kalha J, Korde P, Kwebiiha E, Moran G, Mtei R, Niwemuhwezi J, Nixdorf R, Nugent L, Puschner B, Ramesh M, Ryan GK, Slade M, Charles A, Krumm S. Mental health workers' perspectives on the implementation of a peer support intervention in five countries: qualitative findings from the UPSIDES study. BMJ Open 2024; 14:e081963. [PMID: 38749688 PMCID: PMC11097849 DOI: 10.1136/bmjopen-2023-081963] [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: 11/14/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE The introduction of peer support in mental health teams creates opportunities and challenges for both peer and non-peer staff. However, the majority of research on mental health workers' (MHWs) experiences with peer support comes from high-income countries. Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) is an international multicentre study, which aims at scaling up peer support for people with severe mental illness in Europe, Asia and Africa. This study investigates MHWs experiences with UPSIDES peer support. DESIGN Six focus groups with MHWs were conducted approximately 18 months after the implementation of the UPSIDES peer support intervention. Transcripts were analysed with a descriptive approach using thematic content analysis. SETTING Qualitative data were collected in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel) and Pune (India). PARTICIPANTS 25 MHWs (19 females and 6 males) from UPSIDES study sites in the UPSIDES Trial (ISRCTN26008944) participated. FINDINGS Five overarching themes were identified in MHWs' discussions: MHWs valued peer support workers (PSWs) for sharing their lived experiences with service users (theme 1), gained trust in peer support over time (theme 2) and provided support to them (theme 3). Participants from lower-resource study sites reported additional benefits, including reduced workload. PSWs extending their roles beyond what MHWs perceived as appropriate was described as a challenge (theme 4). Perceptions about PSWs varied based on previous peer support experience, ranging from considering PSWs as equal team members to viewing them as service users (theme 5). CONCLUSIONS Considering local context is essential in order to understand MHWs' views on the cooperation with PSWs. Especially in settings with less prior experience of peer support, implementers should make extra effort to promote interaction between MHWs and PSWs. In order to better understand the determinants of successful implementation of peer support in diverse settings, further research should investigate the impact of contextual factors (eg, resource availability and cultural values). TRIAL REGISTRATION NUMBER ISRCTN26008944.
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Affiliation(s)
| | - Selina Girit
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Yael Goldfarb
- Department of Social Work, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Eric Kwebiiha
- Butabika National Referral Hospital, Kampala, Uganda
| | - Galia Moran
- Department of Social Work, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Rachel Mtei
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jackline Niwemuhwezi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Nugent
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Lawn S, Shelby-James T, Manger S, Byrne L, Fuss B, Isaac V, Kaambwa B, Ullah S, Rattray M, Gye B, Kaine C, Phegan C, Harris G, Worley P. Evaluation of lived experience Peer Support intervention for mental health service consumers in Primary Care (PS-PC): study protocol for a stepped-wedge cluster randomised controlled trial. Trials 2024; 25:319. [PMID: 38745299 PMCID: PMC11094922 DOI: 10.1186/s13063-024-08165-y] [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: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. METHODS This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. DISCUSSION This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.
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Affiliation(s)
- Sharon Lawn
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Tania Shelby-James
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Sam Manger
- Lifestyle Medicine, James Cook University, James Cook University LPO, 150 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Louise Byrne
- School of Management, RMIT, GPO Box 2476, Melbourne, VIC, 3001, Australia
| | - Belinda Fuss
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Vivian Isaac
- Faculty of Science and Health, Charles Sturt University, Albury, NSW, 2640, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Megan Rattray
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Bill Gye
- Community Mental Health Australia, PO Box 668, Rozelle, NSW, 2039, Australia
| | - Christine Kaine
- Lived Experience Australia, PO Box 96, 5048, Brighton, Australia
| | - Caroline Phegan
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Geoff Harris
- Mental Health Coalition of South Australia, Suite 2/195 North Terrace, Adelaide, SA, 5000, Australia
| | - Paul Worley
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Ben-Dor IA, Kraus E, Goldfarb Y, Grayzman A, Puschner B, Moran GS. Perspectives and Experiences of Stakeholders on Self-Disclosure of Peers in Mental Health Services. Community Ment Health J 2024:10.1007/s10597-024-01287-2. [PMID: 38730076 DOI: 10.1007/s10597-024-01287-2] [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: 07/18/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
With the movement towards recovery-oriented mental health (MH) services, individuals with MH lived-experience are increasingly employed as peer providers (peers). Peers are unique in that they bring knowledge from experience and eye-level connection to service users that enhance the quality of services and humanize MH systems' culture. In Israel, hundreds of peers are employed in various roles and settings across the MH system. However, peer integration into MH services faces challenges. One issue involves the use of self-disclosure (SD) in MH services which varies with explicitness across roles and settings. This study sought to understand perspectives and experiences regarding peers' SD (use & sharing of knowledge from experience) among different stakeholders in MH health services. Six focus groups and 4 semi-structured interviews (N = 42) were conducted as a part of a larger international project (UPSIDES; ERC Horizon 2020, Moran et al., Trials 21:371, 2020). Data was transcribed verbatim and analyzed using thematic analysis. Four categories and 7 themes were identified regarding current perspectives and experiences with peers' SD in MH organizations: (i) Restrained or cautious organizational approach to SD; (ii) Attitudes of peers to SD approach; (iii) The influence of designated peer roles on SD; and (iv) Unwarranted SD of peers working in traditional roles. The findings reveal that peers' SD in MH services is a complex process. Organizational approaches were often controlling of non-designated peers' SD practices; participants had diverse attitudes for and against peers' SD; SD occurred according to personal preferences, specific peer role and the director's approach to peers' SD; Conflictual SD dilemmas emerged in relation to service users and staff. SD sometimes occurs unwarrantely due to ill mental health. The presence of peer-designated roles positively impacts peers' SD. We interpret the current mix of views and general conduct of peer SD practice in statutory MH services as related to three aspects: 1. The presence of a traditional therapeutic SD model vs. a peer SD model - with the former currently being dominant. 2. Insufficient proficiency and skill development in peers' SD. 3. Stigmatic notions about peer SD among service users and staff. Together, these aspects interrelate and sometimes create a negative cycle create tension and confusion.A need to develop professionalism of peer SD in statutory services is highlighted alongside enhancing staff and service user acknowledgement of the value of peer SD. Developing peer-designated roles can positively impacts peer SD in MH statutory services. Training, support, and organizational interventions are required to further support for peer-oriented SD and the enhancement of a person-centered and recovery orientation of MH services.
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Affiliation(s)
- Inbar Adler Ben-Dor
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel.
| | - Eran Kraus
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
| | - Yael Goldfarb
- The Academic College of Tel Aviv Yaffo, Tel Aviv-Yaffo, Israel
| | - Alina Grayzman
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Galia S Moran
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben GurionUniversity of the Negev, Be'er Sheva, Israel
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Hanlon C, Roberts T, Misganaw E, Malla A, Cohen A, Shibre T, Fekadu W, Teferra S, Kebede D, Mulushoa A, Girma Z, Tsehay M, Kiross D, Lund C, Fekadu A, Morgan C, Alem A. Studying the context of psychoses to improve outcomes in Ethiopia (SCOPE): Protocol paper. PLoS One 2024; 19:e0293232. [PMID: 38722946 PMCID: PMC11081395 DOI: 10.1371/journal.pone.0293232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Global evidence on psychosis is dominated by studies conducted in Western, high-income countries. The objectives of the Study of Context Of Psychoses to improve outcomes in Ethiopia (SCOPE) are (1) to generate rigorous evidence of psychosis experience, epidemiology and impacts in Ethiopia that will illuminate aetiological understanding and (2) inform development and testing of interventions for earlier identification and improved first contact care that are scalable, inclusive of difficult-to-reach populations and optimise recovery. METHODS The setting is sub-cities of Addis Ababa and rural districts in south-central Ethiopia covering 1.1 million people and including rural, urban and homeless populations. SCOPE comprises (1) formative work to understand care pathways and community resources (resource mapping); examine family context and communication (ethnography); develop valid measures of family communication and personal recovery; and establish platforms for community engagement and involvement of people with lived experience; (2a) a population-based incidence study, (2b) a case-control study and (2c) a cohort study with 12 months follow-up involving 440 people with psychosis (390 rural/Addis Ababa; 50 who are homeless), 390 relatives and 390 controls. We will test hypotheses about incidence rates in rural vs. urban populations and men vs. women; potential aetiological role of khat (a commonly chewed plant with amphetamine-like properties) and traumatic exposures in psychosis; determine profiles of needs at first contact and predictors of outcome; (3) participatory workshops to develop programme theory and inform co-development of interventions, and (4) evaluation of the impact of early identification strategies on engagement with care (interrupted time series study). Findings will inform development of (5) a protocol for (5a) a feasibility cluster randomised controlled trial of interventions for people with recent-onset psychosis in rural settings and (5b) two uncontrolled pilot studies to test acceptability, feasibility of co-developed interventions in urban and homeless populations.
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Affiliation(s)
- Charlotte Hanlon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tessa Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Eleni Misganaw
- Mental Health Service User Association, Addis Ababa, Ethiopia
| | - Ashok Malla
- Department of Psychiatry and Douglas Mental Health Institute, McGill University, Montreal, Canada
| | - Alex Cohen
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Wubalem Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Derege Kebede
- Department of Preventive Medicine, School of Public Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiyam Mulushoa
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zerihun Girma
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonnen Tsehay
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessalegn Kiross
- Victoria University of Wellington, School of Nursing, Midwifery and Health Practice, Wellington, New Zealand
| | - Crick Lund
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Abebaw Fekadu
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Craig Morgan
- ESRC Centre for Society & Mental Health, King’s College London, London, United Kingdom
| | - Atalay Alem
- Department of Psychiatry and WHO Collaborating Centre in Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hiltensperger R, Ryan G, Ben-Dor IA, Charles A, Epple E, Kalha J, Korde P, Kotera Y, Mpango R, Moran G, Mueller-Stierlin AS, Nixdorf R, Ramesh M, Shamba D, Slade M, Puschner B, Nakku J. Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach. BMC Health Serv Res 2024; 24:480. [PMID: 38637776 PMCID: PMC11027518 DOI: 10.1186/s12913-024-10990-5] [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: 02/08/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. METHODS One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. RESULTS The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. CONCLUSIONS UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. TRIAL REGISTRATION ISRCTN26008944 (Registration Date: 30/10/2019).
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Affiliation(s)
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Epple
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mary Ramesh
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Donat Shamba
- Department of Health Systems Impact Evaluation and Policy, Ifakara Health Institute, Dar Es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Health and Community Participation Division, Nord University, Namsos, Norway
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
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Nixdorf R, Kotera Y, Baillie D, Garber Epstein P, Hall C, Hiltensperger R, Korde P, Moran G, Mpango R, Nakku J, Puschner B, Ramesh M, Repper J, Shamba D, Slade M, Kalha J, Mahlke C. Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries. PLoS One 2024; 19:e0298315. [PMID: 38408108 PMCID: PMC10896522 DOI: 10.1371/journal.pone.0298315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.
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Affiliation(s)
- Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dave Baillie
- East London NHS Foundation Trust, London, United Kingdom
| | - Paula Garber Epstein
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, United Kingdom
| | | | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Haun M, Adler Ben-Dor I, Hall C, Kalha J, Korde P, Moran G, Müller-Stierlin AS, Niwemuhwezi J, Nixdorf R, Puschner B, Ramesh M, Charles A, Krumm S. Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study. BMC Health Serv Res 2024; 24:159. [PMID: 38302955 PMCID: PMC10835950 DOI: 10.1186/s12913-024-10543-w] [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: 06/28/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR). METHOD 6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis. RESULTS Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting). CONCLUSIONS This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.
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Affiliation(s)
- Maria Haun
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, UK
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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10
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Soronen K. Acting as a Mental Health Expert by Experience and Its Impact on Social Identity. Community Ment Health J 2024; 60:179-190. [PMID: 37976006 PMCID: PMC10799801 DOI: 10.1007/s10597-023-01207-w] [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: 04/20/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
This study was conducted to examine the construction of social identity among mental health experts by experience working in Finnish municipal mental healthcare services. The construction of social identity is approached as an ongoing lifelong process that is significantly affected by lived experiences with mental health problems and recovery from them. The research data consist of focus group discussions, and the analysis is based on a thematic design that is initially material-driven. As a result, four categories are formed to describe the effect of acting as an expert by experience on social identity and the importance of the issue. Experts by experience have to consider profound questions about their identity and future in their new life situation. The individual meanings of acting as an expert by experience are considered particularly important. The support provided by group members builds confidence in one's chances of success and thereby supports the development of social identity. Social identities of experts by experience are partially built in encounters with professionals representing the mental health care system. This creates opportunities for new roles for those who act as experts by experience.
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Affiliation(s)
- Kari Soronen
- Faculty of Social Sciences, University of Lapland, Rovaniemi, Finland.
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11
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Ostrow L, Cook JA, Salzer MS, Pelot M, Burke-Miller JK. Employment of Certified Peer Specialists in Mental Health Professional Shortage Areas. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:134-143. [PMID: 37962714 DOI: 10.1007/s10488-023-01318-2] [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] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The current demand for mental health services is exacerbated by an ongoing shortage of behavioral health care providers in the United States. The Health Resources and Services Administration has identified 5,833 Mental Health Professional Shortage Areas (MHPSAs), many of which are rural, and could be served by Certified Peer Specialists (CPSs). This paper examines the relationship between CPS employment and MHPSA residency. Data are from a 2020 survey of 572 CPS certified in one of four states. Random effects logistic regression models were used to test the relationship between MHPSA residence and employment outcomes. Of 166 unique counties identified by participant zip codes, 47 were characterized as being MHPSAs with 14% of participants residing in one of these counties. A higher proportion of those living in MHPSAs were employed in peer support jobs (rather than other job types or unemployed) compared to those living in non-MHPSAs (68% vs. 54%, p = .020). MHPSA residential status was not a significant predictor of employment status (OR = 1.14, p = .728) but was significantly associated with greater likelihood of employment in peer support compared to other jobs, both for the entire sample (OR = 2.13, p = .026), and among those currently employed (OR = 2.90, p = .032). The greater likelihood of working in peer support among those residing in MHPSAs suggests that CPSs may leverage their credential to address shortages. As a result, peer support may become a more necessary part of the traditional service array. Policies that enable CPS to practice in MHPSAs should be encouraged.
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Affiliation(s)
- Laysha Ostrow
- Live & Learn, Inc, 785 Quintana Road, Suite 219, Morro Bay, CA, 93442, USA.
| | - Judith A Cook
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60607, USA
| | - Mark S Salzer
- Department of Social and Behavioral Sciences, Temple University, 1801 N Broad St, Philadelphia, PA, 19122, USA
| | - Morgan Pelot
- Live & Learn, Inc, 785 Quintana Road, Suite 219, Morro Bay, CA, 93442, USA
| | - Jane K Burke-Miller
- Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1200 W Harrison St, Chicago, IL, 60607, USA
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12
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Goldfarb Y, Grayzman A, Meir LG, Grundman SH, Rabinian M, Lachman M, Epstein PG, Ben-Dor IA, Naaman A, Puschner B, Moran GS. UPSIDES Mental Health Peer Support in Face of the COVID-19 Pandemic: Actions and Insights. Community Ment Health J 2024; 60:5-13. [PMID: 36508063 PMCID: PMC9743118 DOI: 10.1007/s10597-022-01030-9] [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: 01/30/2022] [Accepted: 09/12/2022] [Indexed: 12/14/2022]
Abstract
The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19.
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Affiliation(s)
- Yael Goldfarb
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Alina Grayzman
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Lion Gai Meir
- Enosh the Israeli Mental Health Association, Kfar Saba, Israel
| | | | | | - Max Lachman
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Adi Naaman
- Mental Health Department, Ministry of Health, Jerusalem, Israel
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Galia S Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel.
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13
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Markström U, Näslund H, Schön UK, Rosenberg D, Bejerholm U, Gustavsson A, Jansson M, Argentzell E, Grim K, Engdahl P, Nouf F, Lilliehorn S, Svedberg P. Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol. Front Psychiatry 2023; 14:1282700. [PMID: 37900294 PMCID: PMC10601639 DOI: 10.3389/fpsyt.2023.1282700] [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: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.
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Affiliation(s)
| | - Hilda Näslund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | | | | | - Mårten Jansson
- The Swedish Partnership for Mental Health, NSPH, Stockholm, Sweden
| | | | - Katarina Grim
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Patrik Engdahl
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Faten Nouf
- Department of Social Work, Umeå University, Umeå, Sweden
| | | | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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14
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Ramesh M, Charles A, Grayzman A, Hiltensperger R, Kalha J, Kulkarni A, Mahlke C, Moran GS, Mpango R, Mueller-Stierlin AS, Nixdorf R, Ryan GK, Shamba D, Slade M. Societal and organisational influences on implementation of mental health peer support work in low-income and high-income settings: a qualitative focus group study. BMJ Open 2023; 13:e058724. [PMID: 37612104 PMCID: PMC10450133 DOI: 10.1136/bmjopen-2021-058724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/17/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES Despite the established evidence base for mental health peer support work, widespread implementation remains a challenge. This study aimed to explore societal and organisational influences on the implementation of peer support work in low-income and high-income settings. DESIGN Study sites conducted two focus groups in local languages at each site, using a topic guide based on a conceptual framework describing eight peer support worker (PSW) principles and five implementation issues. Transcripts were translated into English and an inductive thematic analysis was conducted to characterise implementation influences. SETTING The study took place in two tertiary and three secondary mental healthcare sites as part of the Using Peer Support in Developing Empowering Mental Health Services (UPSIDES) study, comprising three high-income sites (Hamburg and Ulm, Germany; Be'er Sheva, Israel) and two low-income sites (Dar es Salaam, Tanzania; Kampala, Uganda) chosen for diversity both in region and in experience of peer support work. PARTICIPANTS 12 focus groups were conducted (including a total of 86 participants), across sites in Ulm (n=2), Hamburg (n=2), Dar es Salaam (n=2), Be'er Sheva (n=2) and Kampala (n=4). Three individual interviews were also done in Kampala. All participants met the inclusion criteria: aged over 18 years; actual or potential PSW or mental health clinician or hospital/community manager or regional/national policy-maker; and able to give informed consent. RESULTS Six themes relating to implementation influences were identified: community and staff attitudes, resource availability, organisational culture, role definition, training and support and peer support network. CONCLUSIONS This is the first multicountry study to explore societal attitudes and organisational culture influences on the implementation of peer support. Addressing community-level discrimination and developing a recovery orientation in mental health systems can contribute to effective implementation of peer support work. The relationship between societal stigma about mental health and resource allocation decisions warrants future investigation. TRIAL REGISTRATION NUMBER ISRCTN26008944.
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Affiliation(s)
- Mary Ramesh
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alina Grayzman
- Department of Social Work, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer Sheva, Southern, Israel
| | | | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Arti Kulkarni
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Galia S Moran
- Department of Social Work, Ben-Gurion University of the Negev, Southern Israel, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- Department of Mental Health, School of Health Sciences, Soroti University, Soroti, Uganda
| | | | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Grace Kathryn Ryan
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donat Shamba
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, University of Nottingham, Nottingham, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Postbox 474, 7801 Namsos, Norway
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15
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Haregu T, Aziz Z, Cao Y, Sathish T, Thankappan KR, Panniyammakal J, Absetz P, Mathews E, Balachandran S, Fisher EB, Oldenburg B. A peer support program results in greater health benefits for peer leaders than other participants: evidence from the Kerala diabetes prevention program. BMC Public Health 2023; 23:1175. [PMID: 37337201 PMCID: PMC10278268 DOI: 10.1186/s12889-023-16049-0] [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: 08/01/2022] [Accepted: 06/03/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Peer support programs are promising approaches to diabetes prevention. However, there is still limited evidence on the health benefits of peer support programs for lay peer leaders. PURPOSE To examine whether a peer support program designed for diabetes prevention resulted in greater improvements in health behaviors and outcomes for peer leaders as compared to other participants. METHODS 51 lay peer leaders and 437 participants from the Kerala Diabetes Prevention Program were included. Data were collected at baseline, 12 months, and 24 months. We compared behavioral, clinical, biochemical, and health-related quality of life parameters between peer leaders and their peers at the three time-points. RESULTS After 12 months, peer leaders showed significant improvements in leisure time physical activity (+ 17.7% vs. + 3.4%, P = 0.001) and health-related quality of life (0.0 vs. + 0.1, P = 0.004); and a significant reduction in alcohol use (-13.6% vs. -6.6%, P = 0.012) and 2-hour plasma glucose (-4.1 vs. + 9.9, P = 0.006), as compared to participants. After 24 months, relative to baseline, peer leaders had significant improvements in fruit and vegetable intake (+ 34.5% vs. + 26.5%, P = 0.017) and leisure time physical activity (+ 7.9% vs. -0.9%, P = 0.009); and a greater reduction in alcohol use (-13.6% vs. -4.9%, P = 0.008), and waist-to-hip ratio (-0.04 vs. -0.02, P = 0.014), as compared to participants. However, only the changes in fruit and vegetable intake and waist-to-hip ratio were maintained between 12 and 24 months. CONCLUSION Being a peer leader in a diabetes prevention program was associated with greater health benefits during and after the intervention period. Further studies are needed to examine the long-term sustainability of these benefits.
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Affiliation(s)
- Tilahun Haregu
- Baker Heart and Diabetes Institute, Melbourne, Australia.
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia.
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Zahra Aziz
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Yingting Cao
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | | | | | - Jeemon Panniyammakal
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute of Medical Science and Technology, Kerala, India
| | - Pilvikki Absetz
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | | | - Edwin B Fisher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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16
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Omigbodun OO, Ryan GK, Fasoranti B, Chibanda D, Esliker R, Sefasi A, Kakuma R, Shakespeare T, Eaton J. Reprioritising global mental health: psychoses in sub-Saharan Africa. Int J Ment Health Syst 2023; 17:6. [PMID: 36978186 PMCID: PMC10043866 DOI: 10.1186/s13033-023-00574-x] [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: 07/15/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Arthur Kleinman's 2009 Lancet commentary described global mental health as a "moral failure of humanity", asserting that priorities should be based not on the epidemiological and utilitarian economic arguments that tend to favour common mental health conditions like mild to moderate depression and anxiety, but rather on the human rights of those in the most vulnerable situations and the suffering that they experience. Yet more than a decade later, people with severe mental health conditions like psychoses are still being left behind. Here, we add to Kleinman's appeal a critical review of the literature on psychoses in sub-Saharan Africa, highlighting contradictions between local evidence and global narratives surrounding the burden of disease, the outcomes of schizophrenia, and the economic costs of mental health conditions. We identify numerous instances where the lack of regionally representative data and other methodological shortcomings undermine the conclusions of international research carried out to inform decision-making. Our findings point to the need not only for more research on psychoses in sub-Saharan Africa, but also for more representation and leadership in the conduct of research and in international priority-setting more broadly-especially by people with lived experience from diverse backgrounds. This paper aims to encourage debate about how this chronically under-resourced field, as part of wider conversations in global mental health, can be reprioritised.
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Affiliation(s)
- O O Omigbodun
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - G K Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK.
| | - B Fasoranti
- Department of Psychiatry and Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, 200212, Oyo State, Nigeria
| | - D Chibanda
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - R Esliker
- Mental Health Department, University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone
| | - A Sefasi
- Department of Mental Health, Kamuzu University of Health Sciences, P/Bag 360, Blantyre, Malawi
| | - R Kakuma
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
| | - T Shakespeare
- Department of Population Health, London School of Hygiene and Tropical Medicine, International Centre for Evidence in Disability, Keppel Street, London, WC1E 7HT, UK
| | - J Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, Keppel Street, London, WC1E 7HT, UK
- CBM Global Disability Inclusion, Dr.-Werner-Freyberg-Straβe 7, 69514, Laudenbach, Germany
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17
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Girit S, Müller-Stierlin AS, Hiltensperger R, Wenzel L, Lohner M, Mahlke C, Nixdorf R, Puschner B. [Successful Implementation of Peer Support for People with Severe Mental Illness in Germany: a Theory of Change Approach]. Psychother Psychosom Med Psychol 2023; 73:70-77. [PMID: 35793668 DOI: 10.1055/a-1827-4040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Peer support is an established intervention in which people with mental illness receive support by trained peer support workers who have already overcome a mental health crisis. The implementation of peer support is complex due to interacting factors and can be achieved through the participatory Theory of Change method. Aim of this study is to develop a cross-site Theory of Change for the sustainable implementation of UPSIDES peer support in Germany. METHODS Based on site-specific Theories of Change workshops from Ulm and Hamburg in which 47 participants took part, a cross-site Theory of Change was designed and verified in three follow-up workshops with 12 participants. Participants' professional and experiential backgrounds were diverse, including peer support workers, hospital directors and managers, mental health professionals (psychiatrists, psychotherapists, nurses), and researchers. RESULTS The first pathway of the cross-site Theory of Change focuses on the training of peer support workers, whereas the second pathway emphasizes recognition and integration by mental health institutions and professionals. The third pathway specifies the building of a cross-professional care network to integrate various peer support services. Procedures to approach prospective peer clients are depicted in the fourth pathway. The fifth path addresses the clarification of the role description of peer support workers and the implementation in other institutions through cooperation. DISCUSSION Many of the identified implementation steps have been validated in comparable studies. The development of this Theory of Change by bringing together multiple perspectives of key stakeholders is an important basis for the sustainable implementation of UPSIDES peer support. Furthermore, it may serve as a blueprint for the implementation of similar interventions to advance scaling-up of evidence-based user-led and recovery-oriented interventions. CONCLUSION The Theory of Change approach is a well-accepted and feasible method, which can be recommended for the implementation of complex interventions such as UPSIDES peer support.
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Affiliation(s)
- Selina Girit
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | | | - Ramona Hiltensperger
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Lisa Wenzel
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Manfred Lohner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
| | - Candelaria Mahlke
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- AG sozialpsychiatrische und partizipative Forschung, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Günzburg, Germany
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18
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Eiroa-Orosa FJ, Sánchez-Moscona C. Implementing the figure of peer support workers in mental health: an international perspective from the context of its implementation in Catalonia. Salud Colect 2023; 19:e4252. [PMID: 37311138 DOI: 10.18294/sc.2023.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
In the context of debates surrounding the training of mental health peer support workers and their incorporation into the Catalan Health System, this article presents a literature review complemented by interviews carried out between 2020 and 2021 with both international and Spanish experts. Based on the information obtained, content analysis of elements of their training and integration within the health system was performed. German-speaking countries offer the most homogeneous training and recruitment programs. In the case of English- and French-speaking countries, non-profit or third sector organizations are usually in charge of training programs and recruitment. Various experiences with training programs exist in the Ibero-American world, although they are not recognized as professional qualifications. Recommendations are offered for the development of this figure in Catalonia, which include advancing towards professional training with recognition as health care providers, as well as contracting options from both socio-health or health care providers or from third sector entities.
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Affiliation(s)
- Francisco José Eiroa-Orosa
- Doctor en Psicología Clínica y Psiquiatría. Investigador Ramón y Cajal, Sección de Personalidad, Evaluación y Tratamiento Psicológico, Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
| | - Cecilia Sánchez-Moscona
- Magíster en Psicología General Sanitaria. Sección de Personalidad, Evaluación y Tratamiento Psicológico; Departamento de Psicología Clínica y Psicobiología, Universidad de Barcelona. Integrante, Grupo de Investigación en Salud Mental en Primera Persona, Federación Veus, Barcelona, España
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19
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Hare-Duke L, Charles A, Slade M, Rennick-Egglestone S, Dys A, Bijdevaate D. Systematic review and citation content analysis of the CHIME framework for mental health recovery processes: recommendations for developing influential conceptual frameworks. JOURNAL OF RECOVERY IN MENTAL HEALTH 2023; 6:38-44. [PMID: 36926313 PMCID: PMC7614322 DOI: 10.33137/jrmh.v6i1.38556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To identify design features of the CHIME conceptual framework of mental health recovery which are associated with high rates of citation. RESEARCH DESIGN AND METHODS Systematic review of all citations of the Connectedness, Hope, Identity, Meaning, and Empowerment (CHIME) framework of mental health recovery. Papers citing CHIME were screened and extracted from three citation databases. Citation content analysis was used to investigate associations between nine CHIME design features. Citations were investigated across six forms of visibility: all citations; Anglophone vs non-Anglophone; academic vs non-academic; academic discipline; professional group; and clinical population. RESULTS There were 915 eligible documents identified. Six CHIME framework design features met predefined thresholds for high levels of influence: (i) using a systematic review methodology for development, (ii) adopting a memorable acronym, (iii) having disaggregable components, and being unaligned to a (iv) particular discipline (i.e., transdisciplinary), (v) professional group, or (vi) diagnostic population. Documents from Anglophone countries were more likely to cite CHIME with reference to trans-professional (χ2=3.96, df=1, p=0.05) and ethnicity sub-group analysis (p=0.039) design features than non-Anglophone documents. Non-academic documents were more likely to cite the acronym design feature than academic papers (χ2=5.73, df=1, p=0.01). Public Health-related publications were more likely to cite CHIME within a trans-diagnostic framework (χ2=16.39, df=1, p<0.001) than other disciplines. CONCLUSIONS The influence and impact of conceptual frameworks for recovery are increased when the framework is underpinned by a systematic review, includes disaggregable components which can be summarized using a memorable acronym, and when the framework is transdisciplinary, trans-professional, and trans-diagnostic.
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Affiliation(s)
- Laurie Hare-Duke
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Nord University, Faculty of Nursing and Health Sciences, Health and Community Participation Devision, Namsos, Norway
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ada Dys
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Daan Bijdevaate
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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20
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Krumm S, Haun M, Hiller S, Charles A, Kalha J, Niwemuhwezi J, Nixdorf R, Puschner B, Ryan G, Shamba D, Epstein PG, Moran G. Mental health workers' perspectives on peer support in high-, middle- and low income settings: a focus group study. BMC Psychiatry 2022; 22:604. [PMID: 36088330 PMCID: PMC9464408 DOI: 10.1186/s12888-022-04206-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers' attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings. METHODS Six focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis. RESULTS Participants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers' views on peer support workers' roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment. CONCLUSIONS Mental health workers' attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers' roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany.
| | - Maria Haun
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Selina Hiller
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Ashleigh Charles
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jasmine Kalha
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Jackie Niwemuhwezi
- grid.461309.90000 0004 0414 2591Butabika National Referral Hospital, Kampala, Uganda
| | - Rebecca Nixdorf
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Grace Ryan
- grid.8991.90000 0004 0425 469XCentre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- grid.414543.30000 0000 9144 642XDepartment of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Paula Garber Epstein
- grid.12136.370000 0004 1937 0546Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Galia Moran
- grid.7489.20000 0004 1937 0511Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
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21
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Ibrahim N, Selim A, Ng F, Kasaby M, Ali AM, Eweida R, Almakki D, Elaagib A, Slade M. Experiences of peer support workers supporting individuals with substance use disorders in Egypt: phenomenological analysis. BMC Health Serv Res 2022; 22:1012. [PMID: 35941645 PMCID: PMC9361559 DOI: 10.1186/s12913-022-08393-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Background Peer support work for substance use disorders is widely implemented in high-income countries. More research is still needed to understand its applicability in settings which have proportionately low budgets allocated to mental health. Peer Support Workers are individuals who managed to achieve recovery from substance use disorders and help people remain engaged in their recovery and prevent relapse through shared understanding. Aim To investigate the experience of peer support workers providing recovery support to people with substance use disorders in Egypt. Methods A qualitative phenomenological design was used in which 17 adults working as peer support workers for substance use disorders were recruited by means of purposive and snowball sampling. A semi-structured interview with participants was conducted by phone or video-call. Interviews were transcribed and thematically analysed based on descriptive phenomenology. Results Three superordinate themes were identified: role responsibility, Peer Support Workers’ need for organizational and stakeholders’ support, and challenges to the role integrity. Conclusion and recommendations The findings indicate the need for national and governmental support to peer support workers engaged with people with substance use disorders in Egypt and educating families and the public about the role of peer support workers in substance use disorders.
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Affiliation(s)
- Nashwa Ibrahim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt.
| | - Abeer Selim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt.,College of Nursing, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Muhamed Kasaby
- Center for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, 21527, Egypt
| | - Rasha Eweida
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, 21527, Egypt
| | | | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK.,Nord University, Postboks 474, 7801, Namsos, Norway
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22
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Analisa S, Catharine J, Sarah B, Peter B, Jan O. A Qualitative Study Exploring the Support Needs of Newly Qualified Nurses and their Experiences of an Online Peer Support Intervention. Contemp Nurse 2022; 58:343-354. [PMID: 35899488 DOI: 10.1080/10376178.2022.2107036] [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: 11/03/2022]
Abstract
BACKGROUND In the transitional period following registration, newly qualified nurses may feel socially isolated and easily overwhelmed by increases in accountability, workplace pressures and the psychological demands of the role. Such experiences place them at risk of burnout and leaving the profession. AIMS To explore newly qualified nurses' support needs and their experiences of an online peer support intervention. METHOD Eighteen newly qualified nurses participated in online peer support groups. After 3 months participants took part in interviews exploring their support needs and experiences of the groups. Eight one-to one interviews were conducted between October 2019 and January 2020. Qualitative thematic analysis was used. FINDINGS Two themes identified were; "The Support needs of newly qualified nurses" with two subthemes, "The role of the newly qualified nurse" and "Unmet support needs"; "The online experience" with three subthemes, "Barriers to participation", "Anticipated benefits" and "Unmet expectations". CONCLUSION Our findings suggested that there is insufficient support for newly qualified nurses. The newly qualified nurses wanted to use online support to help manage their stress. However, the organisation of online peer support needs careful consideration to ensure participation can be beneficial. IMPACT STATEMENT Online support requires careful design and clear support from employing organisations to promote improved transition experiences. Further research should focus on evaluating adjusted online support interventions.
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Affiliation(s)
- Smythe Analisa
- Birmingham and Solihull Mental Health Foundation Trust and Royal Wolverhampton NHS Trust.
| | | | - Bicknell Sarah
- Clinical Studies Officer, Birmingham and Solihull Mental Health Foundation Trust;
| | - Bentham Peter
- Consultant Psychiatrist, Birmingham and Solihull Mental Health Foundation Trust
| | - Oyebode Jan
- Professor PhD - Professor of Dementia Care, University of Bradford
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23
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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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24
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Alexopoulos P, Roukas D, Efkarpidis A, Konstantopoulou G, Soldatos R, Karaivazoglou K, Kontogianni E, Assimakopoulos K, Iliou T, Εconomou P, Gourzis P, Politis A. Hospital workforce mental reaction to the pandemic in a low COVID-19 burden setting: a cross-sectional clinical study. Eur Arch Psychiatry Clin Neurosci 2022; 272:95-105. [PMID: 33904979 PMCID: PMC8078092 DOI: 10.1007/s00406-021-01262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
Τhe COVID-19 pandemic has mental health implications for both healthcare workforces and general population, particularly in regions heavily hit by the crisis. Τhe study aimed (i) to investigate anxiety- and depression severity differences between staff of a COVID-19 treatment unit (N = 84) and a hospital without such a unit (N = 55) in comparison to participants of a convenience general population online survey (N = 240) and (ii) to explore relations between such symptoms and hospital staff reaction to COVID-19 in a low COVID-19 burden setting. Anxiety was studied with the Generalized Anxiety Disorder 7-Item in hospital workforces and with the Hospital Anxiety Depression Scale (HADS) in online survey participants. Depression symptoms were assessed with the Patient Health Questionnaire-9 in hospital employees and the HADS in the online survey sample. Symptoms were classified as absent/minimal, borderline abnormal or indicating clinical caseness. Staff reaction to COVID-19 was tapped with a 9-item-questionnaire and the 22-item Impact of Event Scale-revised (IES-R). Proper tests for differences and stepwise ordered logistic regression models were employed. Anxiety- and depression severity was higher in hospital workforces than in online survey participants (P < 0.05). Anxiety was more severe in frontline- compared to backstage employees (P < 0.001) was inversely correlated with age (P = 0.011) and positively with avoidance (P = 0.028). Both anxiety and depression symptoms related to intrusion symptoms (P < 0.001). Regarding the relatively long data collection period, an inverse association between crisis duration and depression symptoms was detected (P = 0.025). These observations point to the urgent need for distress-mitigating interventions for hospital workforces even in low COVID-19 burden settings.
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Affiliation(s)
- Panagiotis Alexopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece.
- Department of Psychiatry and Psychotherapy, Klinikum Rechts Der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany.
| | - Dimitrios Roukas
- Department of Psychiatry, 417 Army Equity Fund Hospital (NIMTS) Hospital, Athens, Greece
| | - Apostolos Efkarpidis
- Nursing Services Department, General Hospital of Syros "Vardakeio and Proio", Ermoupolis, Greece
| | - Georgia Konstantopoulou
- Special Office for Health Consulting Services and Faculty of Education and Social Work, School of Humanities and Social Sciences, University of Patras, Patras, Greece
| | - Rigas Soldatos
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Karaivazoglou
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Evagellia Kontogianni
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Assimakopoulos
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Theodoros Iliou
- Medical Informatics Laboratory, Faculty of Medicine, School of Health Sciences, Democritus University of Thrace, Alexandroupolis, Greece
| | - Polychronis Εconomou
- Department of Civil Engineering (Statistics), University of Patras, Patras, Greece
| | - Philippos Gourzis
- Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Patras University General Hospital, University of Patras, Patras, Greece
| | - Antonios Politis
- First Department of Psychiatry, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry, Johns Hopkins Medical School, Baltimore, MD, USA
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25
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Mirbahaeddin E, Chreim S. A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:596-612. [PMID: 35018509 PMCID: PMC8751663 DOI: 10.1007/s10488-021-01186-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 01/22/2023]
Abstract
With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.
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Affiliation(s)
- Elmira Mirbahaeddin
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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26
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Sims S, Hepsipa Omega Juliet S, Joseph J, Gopal S, Raghavan V, Venkatraman L, Padmavati R. Acceptability of Peer Support for People With Schizophrenia in Chennai, India: A Cross Sectional Study Amongst People With Lived Experience, Caregivers, and Mental Health Professionals. Front Psychiatry 2022; 13:797427. [PMID: 35370806 PMCID: PMC8965369 DOI: 10.3389/fpsyt.2022.797427] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Establishing structured peer support in mental health, particularly for people with schizophrenia, as a psychosocial intervention is early in low and middle-income countries like India. Before implementing and understanding the effectiveness of peer support service and which mode of peer support delivery will be suitable for our culture, our study aimed to understand if peer support would be accepted by the different participants like persons with schizophrenia, caregivers and mental health professionals in a tertiary care center in Chennai, India. METHODS The study was conducted at the outpatient department (OPD) of a tertiary psychiatric care facility in Chennai, India. A cross-sectional study method was used. Consecutive persons diagnosed with schizophrenia and caregivers of persons with schizophrenia, who attended the outpatient department, and mental health professionals within and outside the facility who met the inclusion and exclusion criteria participated in the study. A structured questionnaire purposefully developed for the study was administered to the different study participants. Descriptive statistics were used to analyze the data. Categorical variables were expressed as frequency and percentages, while the continuous variables were expressed as mean and standard deviation. RESULTS A total of 155 participants (52 persons with schizophrenia, 50 caregivers and 53 mental health professionals) completed the survey. The majority of the participants (90.4% of persons with schizophrenia, 86% caregivers and all mental health professionals) welcomed peer support interventions. The participants wanted peers to help persons with schizophrenia achieve personal goals to enhance their mental health and day to day living with an emphasis on independent living and interpersonal and social relationships and help them achieve medication and treatment-related goals toward recovery. Understanding the role of a peer support volunteer and transitioning from a "person with schizophrenia" to a "peer support volunteer" by persons with schizophrenia was thought most challenging. CONCLUSION The results highlight the potential acceptability of peer support across several stakeholders in the care of schizophrenia in a low and middle-income country context. The results may guide the implementation of a peer support volunteer programme as an essential mechanism of delivering psychosocial interventions for persons with schizophrenia.
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Affiliation(s)
- Sonia Sims
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - S Hepsipa Omega Juliet
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Jainey Joseph
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Subhashini Gopal
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Vijaya Raghavan
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Lakshmi Venkatraman
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
| | - Ramachandran Padmavati
- Department of Psychosocial Rehabilitation, Schizophrenia Research Foundation, Chennai, India
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Interventions for adolescents and adults with psychosis in Africa: a systematic review and narrative synthesis. Glob Ment Health (Camb) 2022; 9:223-240. [PMID: 36618745 PMCID: PMC9806991 DOI: 10.1017/gmh.2022.25] [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: 02/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Global Burden of Disease attributable to psychotic disorders in African countries is high and has increased sharply in recent years. Yet, there is a scarcity of evidence on effective, appropriate and acceptable interventions for schizophrenia and other psychotic disorders on the continent. METHODS We carried out a systematic review and narrative synthesis of peer-reviewed literature evaluating the impact of non-pharmacological interventions for adolescents and adults (10-65 years) in African countries. Two reviewers independently double-screened all articles and performed data extraction and quality appraisal using standardized tools. RESULTS Of the 8529 unique texts returned by our search, 12 studies were identified for inclusion, from seven countries: Egypt, Ethiopia, Ghana, Kenya, Nigeria, South Africa and Sudan. They evaluated a range of interventions with one or more clinical, psychological or psychosocial, education or awareness or traditional or faith-based components, and were delivered by either mental health specialists or non-specialist health workers. Ten of the 12 included studies reported significant, positive effects on a range of outcomes (including functioning, symptoms and stigma). Nearly half of the interventions were based out of health facilities. Based on quality appraisals, confidence in these studies' findings is only rated low to medium. CONCLUSION Further research is needed to develop and evaluate interventions that meet the diverse needs of people with psychosis, within and beyond the health sector.
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Le PD, Agrest M, Mascayano F, Dev S, Kankan T, Dishy G, Tapia-Muñoz T, Tapia E, Toso-Salman J, Pratt C, Alves-Nishioka S, Schilling S, Jorquera MJ, Castro-Valdez J, Geffner N, Price LN, Conover S, Valencia E, Yang LH, Alvarado R, Susser ES. Understanding Users' Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile. Community Ment Health J 2022; 58:111-120. [PMID: 33646493 PMCID: PMC8408283 DOI: 10.1007/s10597-021-00800-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/08/2021] [Indexed: 01/03/2023]
Abstract
This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.
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Affiliation(s)
- PhuongThao D Le
- School of Global Public Health, New York University, New York, USA.
| | | | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Saloni Dev
- Teachers College, Columbia University, New York, NY, USA
| | - Tanvi Kankan
- Teachers College, Columbia University, New York, NY, USA
| | | | - Thamara Tapia-Muñoz
- Department of Behavioural Science and Health, University College London, London, UK
| | - Eric Tapia
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Charissa Pratt
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Sara Schilling
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - María José Jorquera
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | | | - LeShawndra N Price
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Sarah Conover
- Center for the Advancement of Critical Time Intervention, Silberman School of Social Work, Hunter College, City University of New York, New York, NY, USA
| | - Eliecer Valencia
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lawrence H Yang
- School of Global Public Health, New York University, New York, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
- Teachers College, Columbia University, New York, NY, USA
| | - Rubén Alvarado
- School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Ezra S Susser
- New York State Psychiatric Institute, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Hyun MS, Kim H, Nam KA, Kim SY. Experience of Peer Support Work among People with Mental Illness in the Community: A Grounded Theory Approach. J Korean Acad Nurs 2022; 52:187-201. [DOI: 10.4040/jkan.21208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Myung Sun Hyun
- College of Nursing, Ajou University, Suwon, Korea
- Research Institute of Nursing Science, Ajou University, Suwon, Korea
| | - Hyunlye Kim
- Department of Nursing, Chosun University, Gwangju, Korea
| | - Kyoung A Nam
- School of Nursing · Research Institute of Nursing Science, Hallym University, Chuncheon, Korea
| | - Su Young Kim
- College of Nursing, Ajou University, Suwon, Korea
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Gühne U, Richter D, Breilmann J, Täumer E, Falkai P, Kilian R, Allgöwer A, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Kösters M, Riedel-Heller SG. [Peer Support: Utilization and Benefit in Severe Mental Illness - Results from an Observational, Cross-Sectional Study]. Psychother Psychosom Med Psychol 2021; 71:499-507. [PMID: 34872153 DOI: 10.1055/a-1667-9966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Peer support is playing an increasing role in the treatment of severely mentally ill people. International findings are available on its effectiveness. However, little is known about knowledge, use and benefit assessment in Germany. This paper addresses this question and presents results from an observational study with 10 participating clinics in southern Germany. METHODS As part of the observational cross-sectional study with people with severe mental illness (IMPPETUS, N=359), sociodemographic and illness- and treatment-associated data were collected by trained study staff between March 2019 and September 2019. Binary logistic regression was used to analyse a possible association with peer support use. RESULTS 38% (N=138) of respondents reported knowledge about the possibility of peer support; 15% (N=55) affirmed its use. Use of peer support varied across sites (between 6.5 and 37.5%) and was associated with household income. Significantly less frequent use of peer support was among those with high versus low household income (OR=0.20 [95% CI: 0.06-0.68], p=0.01). Of respondents with peer support use (N=55), 78% reported perceiving peer support to be helpful or highly helpful. DISCUSSION Peer support not only proves to be effective under study conditions with regard to various outcomes, but is also assessed as beneficial under routine conditions in a defined care region by the majority of users. However, only a few respondents knew and used the possibility of peer support. CONCLUSION In order to implement peer support more strongly, information about this kind of service should be provided more effectively and a dialogue about successful implementation experiences should be initiated on a regional level.
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Affiliation(s)
- Uta Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
| | - Daniel Richter
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland.,Institut für Qualitätssicherung und Transparenz im Gesundheitswesen (IQTIQ), Berlin, Deutschland
| | - Johanna Breilmann
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Esther Täumer
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Peter Falkai
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, München, Deutschland
| | - Reinhold Kilian
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Andreas Allgöwer
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - Klemens Ajayi
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Jessica Baumgärtner
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Augsburg, Universität Augsburg, Deutschland
| | - Peter Brieger
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Karel Frasch
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland.,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Donauwörth, Deutschland
| | - Stephan Heres
- Kbo-Isar-Amper-Klinikum, Region München, Deutschland
| | - Markus Jäger
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland.,Fachkrankenhaus für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kempten, Deutschland
| | - Andreas Küthmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Memmingen, Deutschland
| | - Albert Putzhammer
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus Kaufbeuren, Deutschland
| | | | | | - Thomas Becker
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Markus Kösters
- Klinik für Psychiatrie und Psychotherapie II am Bezirkskrankenhaus Günzburg, Universität Ulm, Günzburg, Deutschland
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Deutschland
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Peer Support in Behavioral Health care: why it can work in the Latinx context. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2021. [DOI: 10.33881/2027-1786.rip.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Las personas de origenes latinoamericanos son menos propensas a comprometerse con el cuidado de salud mental y la participación en servicios de salud mental, comparado a otros grupos raciales y étnicos. Las bajas tasas de participación en servicios de salud mental en parte de la comunidad Latinx en los Estados Unidos (EE. UU.) se puede atribuir parcialmente alfuncionamiento de los sistemas de cuidado, los cuales no son sensibles a la cultura Latinx o al español como lengua. Las Investigaciones han demostrado que intervenciones centradas en la cultura, que promueven los valores culturales de la comunidad Latinx, informan una mayor participación y satisfacción en el tratamiento y los servicios de salud mental. Un enfoque efectivo, informado por la cultura, que puede mejorar la participación de la comunidad Latinx en servicios de salud mental es el apoyo de compañerxs. En el enfoque de apoyo de pares, se contrata a personas con experiencias vividas en salud mental y adicciones como compañeros de apoyo para ayudar a quienes han vivido experiencias similares. Los estudios de investigación que miden la efectividad de los enfoques de apoyo entre pares han mostrado mejoras en las vidas de quienes reciben el apoyo, ayudando con el sentido de esperanza, calidad de vida, y bienestar. Los resultados también han demostrado disminución de hospitalizaciones, visitas a la sala de emergencia y menor uso de sustancias y participación en actividades criminales. El apoyo entre compañerxs en el contexto Latinx parece un ajuste natural dados sus valores colectivos compartidos (p. ej., simpatía, personalismo, respeto, confianza, familismo). Este articulo discute como los valores de apoyo entre compañerxs se relacionan con los valores colectivistas; y como se pueden infundir más los valores Latinx en el entrenamiento, desarrollo y supervisión de los compañerxs de apoyo para mejorar el cuidado de salud mental informado por la cultura.
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Charles A, Nixdorf R, Ibrahim N, Meir LG, Mpango RS, Ngakongwa F, Nudds H, Pathare S, Ryan G, Repper J, Wharrad H, Wolf P, Slade M, Mahlke C. Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation. JMIR Ment Health 2021; 8:e25528. [PMID: 34042603 PMCID: PMC8193486 DOI: 10.2196/25528] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/15/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. OBJECTIVE The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. METHODS A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. RESULTS The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). CONCLUSIONS The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.
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Affiliation(s)
- Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Masoura, Egypt
| | - Lion Gai Meir
- Department of Social Work, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Richard S Mpango
- Butabika National Referral Hospital, Butabika, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Fileuka Ngakongwa
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Hannah Nudds
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Heather Wharrad
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Philip Wolf
- Department of Psychiatry II, Ulm University II, Ulm, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Odrovakavula L, Mohammadnezhad M, Khan S. A Survey on Wellness and Its Predictors Amongst Fiji High School Students. Front Public Health 2021; 9:671197. [PMID: 34041220 PMCID: PMC8141803 DOI: 10.3389/fpubh.2021.671197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Adolescent population face a number of health concerns which calls for objective and comprehensive assessment of their wellness during their critical development phase. This study aimed to determine adolescent wellness and its predictors amongst adolescents in secondary schools in Fiji. Methods: This quantitative cross sectional study was conducted in four purposively selected schools in Suva and the greater Suva area, Fiji, between August and September, 2019. Students of Fijian nationality, enrolled into years 11-13 in the selected schools were purposively selected. A structured self-administered questionnaire was used to collect data on four dimensions of wellness including physical, emotional, social, and spiritual. Spearman's Rho correlation was conducted to test for associations. Descriptive and inferential statistical tests were applied to analyze the data by the SPSS software version 25. A p-value < 0.05 was considered significant. Results: A total of 350 students participated in the study. Mean raw scores for wellness dimensions were as follows: physical = 51 (out of 60), psychological = 63 (out of 80), social = 42 (out of 50), and spiritual = 34 (out of 40). For overall wellness, two significant differences were observed: students of Fijian Itaukei descent (193.68 ± 14.2) and participants with a family income of $40,000-50,000 (199.08 ± 12.60) (p = 0.04) had a higher overall wellness score. There were three significant differences observed for psychological wellness dimension; Fijians of Indian descent (64.68 ± 9.30), participants enrolled into year 13 (64.68 ± 9.30) and those with a family income of $40,000-50,000 had higher psychological score. For social wellness, a significant difference was observed: Itaukei participants had higher scores (43.34 ± 4.42) when compared to other ethnic groups (p < 0.05). In terms of spiritual wellness, a significant difference was observed for ethnicity: Itaukei participants had a higher mean score (35.59 ± 4.26) when compared to other ethnic groups (p < 0.05). Strong correlations were observed for all dimensions of wellness. Conclusions: Findings of this study highlighted different factors affecting adolescents' wellness in Fiji. It is recommended that health education and awareness program be carried out for developing adolescent wellness by considering these factors. It is also recommended that parental and family support are provided to adolescents.
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Affiliation(s)
| | | | - Sabiha Khan
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji
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Ametaj AA, Smith AM, Valentine SE. A Stakeholder-Engaged Process for Adapting an Evidence-Based Intervention for Posttraumatic Stress Disorder for Peer Delivery. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:793-809. [PMID: 33813717 DOI: 10.1007/s10488-021-01129-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Peer providers represent a growing sector of the U.S. workforce, yet guidance is needed on best practices for adapting behavioral health interventions for peer delivery. METHODS We utilized the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME; Wiltsey Stirman et al. 2013, 2019) to describe how we systematically adapted Skills Training in Affective and Interpersonal Regulation (STAIR) for posttraumatic stress disorder (PTSD) for peer delivery. Our process was iterative and relied on engagement of multiple stakeholders, including a work group of organizational leaders (N = 5), peer interventionists (N = 4), intervention experts (N = 2), and trial participants (N = 18). The FRAME was used to guide rapid coding across multiple data sources, including researcher field notes, meeting minutes, and intervention manual documents, and content analysis of semi-structured interviews with peer interventionists and trial participants. RESULTS Phase 1 (pre-trial) focused on modifications for fit with the local context and peer model. Key modifications focused on improving intervention design and packaging, removing clinical and stigmatizing language, and addressing peer interventionist training gaps. We used a hybrid approach to delivery, whereby we integrated peer model principles (self-disclosure, mutuality) into a directive approach. Phase 2 (trial) included reactive fidelity-consistent adaptations, such as additional educational resources. Phase 3 (post-trial) focused on adaptations to support roll-out of the intervention at the peer organization (e.g., group format). CONCLUSION Our stakeholder-engaged process may serve as a helpful exemplar to others tailoring interventions for peer delivery. Future research is needed to understand the role of stakeholder engagement and adaptation in implementation success.
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Affiliation(s)
- Amantia A Ametaj
- Department of Epidemiology, Harvard Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Ash M Smith
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA
| | - Sarah E Valentine
- Department of Psychiatry, Boston Medical Center, 720 Harrison Ave, Suite 1150, Boston, MA, 02118, USA. .,Department of Psychiatry, Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA.
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Haun M, Nixdorf R, Heuer DI, Wagner M, Bilmayer S, Mahlke DC, Puschner PDB. UPSIDES Peer-Begleitung – Gemeinsam Krisen
bewältigen. DAS GESUNDHEITSWESEN 2021. [PMCID: PMC8390294 DOI: 10.1055/a-1395-1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Im Rahmen von Peer-Begleitung (engl. peer support) erhält eine Person mit einer psychischen Erkrankung Unterstützung von einer Person, die selbst Erfahrung mit Krisen und/oder psychiatrischen Diagnosen gemacht und damit einen guten Umgang gefunden hat. „Peer-Begleiter/innen helfen als Betroffene Betroffenen“, erklärt Stefan Bilmayer, UPSIDES Peer-Begleiter am deutschen Standort Ulm/Günzburg.
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Sanchez-Moscona C, Eiroa-Orosa FJ. Training mental health peer support training facilitators: a qualitative, participatory evaluation. Int J Ment Health Nurs 2021; 30:261-273. [PMID: 32893476 DOI: 10.1111/inm.12781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 12/01/2022]
Abstract
The facilitator's training for peer support workers in mental health course was a recovery-based initiative addressed to professionalize peer support in Catalonia, Spain. Our aim was to elicit participants' motivations, significant learnings, and opinions regarding the training programme. A qualitative approach was used through content and thematic analyses of the course contents and participation narratives. The motivations to attend the course were helping others, learning, and supporting the implementation of the peer support profession. Participants learnt concepts on pedagogy, peer support, and recovery. The key resulting themes were organization and moderation; peer support's role, skills, functions, and values; language; health system knowledge; and types of support. The course programme seems appropriate in preparing people who have lived experience of mental health problems as facilitators of future peer support training courses. The present analysis identifies the participants' vision regarding their learning needs. It aims to serve as a guide for similar train-the-trainers courses.
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Affiliation(s)
- Cecilia Sanchez-Moscona
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, Barcelona, Catalonia, Spain
| | - Francisco José Eiroa-Orosa
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,First-Person Research Group, Veus, Catalan Federation of 1st Person Mental Health Organisations, Barcelona, Catalonia, Spain.,Yale Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, USA
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Suresh R, Alam A, Karkossa Z. Using Peer Support to Strengthen Mental Health During the COVID-19 Pandemic: A Review. Front Psychiatry 2021; 12:714181. [PMID: 34322045 PMCID: PMC8310946 DOI: 10.3389/fpsyt.2021.714181] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The coronavirus (COVID-19) pandemic has had a significant impact on society's overall mental health. Measures such as mandated lockdowns and physical distancing have contributed to higher levels of anxiety, depression, and other metrics indicating worsening mental health. Peer support, which is peer-to-peer provided social and emotional support, is an underutilized and effective mental health resource that can potentially be used to ameliorate mental health during these times. Objective: This review aims to summarize the toll that this pandemic has had on society's mental health as found in peer-reviewed literature from October 2019 to March 2021, as well as suggest the utility of peer support to address these needs. Methods: References for this review were chosen through searches of PubMed, Web of Science, and Google Scholar for articles published between October 2019 and March 2021 that used the terms: "coronavirus," "COVID-19," "mental health," "anxiety," "depression," "isolation," "mental health resources," "peer support," "online mental health resources," and "healthcare workers." Articles resulting from these searches and relevant references cited in those articles were reviewed. Articles published in English, French and Italian were included. Results: This pandemic has ubiquitously worsened the mental health of populations across the world. Peer support has been demonstrated to yield generally positive effects on the mental health of a wide variety of recipients, and it can be provided through numerous accessible mediums. Conclusions: Peer support can overall be beneficial for improving mental health during the COVID-19 pandemic and may be an effective tool should similar events arise in the future, although the presence of a few conflicting studies suggests the need for additional research.
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Affiliation(s)
- Rahul Suresh
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, Montreal, QC, Canada.,Peer Support Centre, McGill University, Montreal, QC, Canada
| | - Armaghan Alam
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zoe Karkossa
- Peer Support Centre, McGill University, Montreal, QC, Canada
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Rezaie L, Phillips D. Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:752-762. [PMID: 32277722 DOI: 10.1111/jpm.12634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A search of common databases indicates the absence of any research focused on the needs of Iranian women diagnosed with severe mental illness post-discharge from an inpatient setting. Moreover, there is a lacuna of information about the unique experiences and needs of persons diagnosed with severe mental illness living in non-Western communities (esp. Middle Eastern communities). WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This study examined interviews of women diagnosed with severe mental illness receiving treatment at an Iranian inpatient hospital. Three categories of post-discharge needs emerged: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings highlight the need for systemic changes to current care models. Broadly, families should be incorporated into care to improve outcomes and decrease stigma. Regarding mental health nursing, results highlighted the need for additional nursing and occupational therapy interventions to empower families and patients. Nursing practitioners can aid in preparing these patients for employment and public health initiatives to decrease stigma and improve access to care. ABSTRACT: Introduction Understanding the post-discharge needs of patients diagnosed with severe mental illness is critical for improving treatment outcomes. Aim The aim of the present study was to determine the unique post-discharge needs of Iranian women diagnosed with severe mental illness. Method Conventional content analysis was utilized to analyse data gathered via focus group interviews conducted within the psychiatric inpatient unit at Farabi hospital located in Kermanshah, Iran. Participants (N = 42; M age = 40; SD = 6.3 years) had been diagnosed with a severe mental illness, had a history of at least two psychiatric hospitalizations and were awaiting discharge following significant symptom improvement. Results Content analysis extracted three categories of post-discharge needs: support, skill acquisition and information. Support consisted of family, social and health system subcategories. Skill acquisition was comprised of social skills, work skills and self-management skills. Lastly, information distinguished between illness-related information and women's health information. Discussion/Implications for practice Analysis of interview data highlighted the general need for adopting a family-system approach to reduce stigma, increase knowledge and foster skill acquisition. Regarding mental health nursing, results highlighted the unique role of nurses and their capacity to pre-emptively address needs such as aiding in employment. Lastly, findings are contrasted against Western care models.
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Affiliation(s)
- Leeba Rezaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - David Phillips
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
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Lyons M, Evison P, Berrios R, Castro S, Brooks H. The lived experience of psychosis in Nicaragua: a qualitative examination of the views of service users. J Ment Health 2020; 31:50-57. [PMID: 33179559 DOI: 10.1080/09638237.2020.1844871] [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: 01/31/2023]
Abstract
BACKGROUND The experience of psychosis is individual and influenced by a complex intersection of identity, thought processes, perceptions and culture. Little is known about the lived experience of psychosis in Nicaragua. AIM To explore the subjective experience of psychosis in Nicaragua from the perspectives of service users. METHODS Focus groups with 28 service users with experience of psychosis. A qualitative analysis using both inductive and deductive approaches was used to analyse these data. RESULTS Participants mostly attributed the onset of psychosis to external factors such as physical or psychological trauma and highlighted the impact of long-term conflict in the area. Whilst medication was generally viewed positively where this was available participants foregrounded lay and community support networks and engagement in valued activities in their narratives about the management of psychosis. Religious and magical forces were salient in participants' accounts of causal pathways, wider Nicaraguan culture and management practices. Stigma, social exclusion and limited access to formal health services and psychological interventions in particular were the major barriers reported to recovery from psychosis. CONCLUSION Our findings point to the potential utility of culturally adapted psychological interventions in Nicaragua as well as the value of lay and community workforces in delivering such interventions.
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Affiliation(s)
- Minna Lyons
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Patrick Evison
- School of Psychology, University of Liverpool, Liverpool, UK
| | | | | | - Helen Brooks
- Department of Health Services Research, Institute of Population Health, University of Liverpool, Liverpool, UK
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Mpango R, Kalha J, Shamba D, Ramesh M, Ngakongwa F, Kulkarni A, Korde P, Nakku J, Ryan GK. Challenges to peer support in low- and middle-income countries during COVID-19. Global Health 2020; 16:90. [PMID: 32977816 PMCID: PMC7517058 DOI: 10.1186/s12992-020-00622-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A recent editorial urged those working in global mental health to "change the conversation" on coronavirus disease (Covid-19) by putting more focus on the needs of people with severe mental health conditions. UPSIDES (Using Peer Support In Developing Empowering mental health Services) is a six-country consortium carrying out implementation research on peer support for people with severe mental health conditions in high- (Germany, Israel), lower middle- (India) and low-income (Tanzania, Uganda) settings. This commentary briefly outlines some of the key challenges faced by UPSIDES sites in low- and middle-income countries as a result of Covid-19, sharing early lessons that may also apply to other services seeking to address the needs of people with severe mental health conditions in similar contexts. CHALLENGES AND LESSONS LEARNED The key take-away from experiences in India, Tanzania and Uganda is that inequalities in terms of access to mobile technologies, as well as to secure employment and benefits, put peer support workers in particularly vulnerable situations precisely when they and their peers are also at their most isolated. Establishing more resilient peer support services requires attention to the already precarious situation of people with severe mental health conditions in low-resource settings, even before a crisis like Covid-19 occurs. While it is essential to maintain contact with peer support workers and peers to whatever extent is possible remotely, alternatives to face-to-face delivery of psychosocial interventions are not always straightforward to implement and can make it more difficult to observe individuals' reactions, talk about emotional issues and offer appropriate support. CONCLUSIONS In environments where mental health care was already heavily medicalized and mostly limited to medications issued by psychiatric institutions, Covid-19 threatens burgeoning efforts to pursue a more holistic and person-centered model of care for people with severe mental health conditions. As countries emerge from lockdown, those working in global mental health will need to redouble their efforts not only to make up for lost time and help individuals cope with the added stressors of Covid-19 in their communities, but also to regain lost ground in mental health care reform and in broader conversations about mental health in low-resource settings.
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Affiliation(s)
- Richard Mpango
- Research and Training Section, Butabika National Referral Hospital, Kampala, Uganda
- Mental Health Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Mental Health Department, School of Health Sciences, Soroti University, Arapai, Uganda
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Pune, India
| | - Donat Shamba
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fileuka Ngakongwa
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Arti Kulkarni
- Centre for Mental Health Law and Policy, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Pune, India
| | - Juliet Nakku
- Psychiatry, Butabika National Referral Hospital, Kampala, Uganda
| | - Grace K Ryan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Abstract
Severe mental health disparities exist in the United States, with reduced access to community-based care and poorer recovery outcomes associated with people of color, women, and lesbian, gay, bisexual, or transgender individuals. One strategy to reduce these disparities is to incorporate the perspectives of mental health consumers and their families into care planning and delivery. Successful integration of personal experience with evidence-based interventions can help reduce stigma and improve retention in care. To leverage public policy to reduce mental health disparities, New York City has launched ThriveNYC, the nation's largest municipal-level investment in mental health.
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Burn E, Chevalier A, Leverton M, Priebe S. Patient and befriender experiences of participating in a befriending programme for adults with psychosis: a qualitative study. BMC Psychiatry 2020; 20:368. [PMID: 32664892 PMCID: PMC7359239 DOI: 10.1186/s12888-020-02776-w] [Citation(s) in RCA: 7] [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: 12/12/2019] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Befriending is a popular form of volunteering in healthcare, and research suggests that it can be beneficial for people with mental illness. This study aimed to explore the experiences of a large sample of volunteer befrienders and patients who participated in the VOLUME trial, testing the efficacy of a structured befriending programme for individuals with psychosis. This is the first study to explore the specific challenges and benefits of befriending in both volunteers and patients in this population within the same programme. METHODS A series of in-depth semi-structured interviews were conducted with 34 volunteer befrienders and 28 participating patients. All participants who had taken part in at least one befriending session were invited to be interviewed about their experiences with the aim of including a wide range of views, including those who were more or less engaged with the befriending programme. The data were analysed using Thematic Analysis. RESULTS Four broad themes were developed from the analysis of the befriender and patient interviews which, although were largely discrete, captured the overall experiences of participating in the befriending programme: 1) Bridging the gap, 2) A genuine relationship that developed over time, 3) A big commitment, and 4) A flexible approach. CONCLUSIONS These results further support that, befriending programmes for individuals with psychosis can be a worthwhile experience for both befrienders and patients. However, participation also requires perseverance and flexibility from both sides. Different factors, such as incorporating participant preferences for frequency of meetings, have to be considered in the development and management of a befriending programme in order to provide effective support to both befrienders and patients.
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Affiliation(s)
- Erin Burn
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK. .,East London NHS Foundation Trust, London, UK.
| | - Agnes Chevalier
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, London, UK
| | - Monica Leverton
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, London, UK
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Moran GS, Kalha J, Mueller-Stierlin AS, Kilian R, Krumm S, Slade M, Charles A, Mahlke C, Nixdorf R, Basangwa D, Nakku J, Mpango R, Ryan G, Shamba D, Ramesh M, Ngakongwa F, Grayzman A, Pathare S, Mayer B, Puschner B. Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT). Trials 2020; 21:371. [PMID: 32357903 PMCID: PMC7195705 DOI: 10.1186/s13063-020-4177-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/17/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change). METHODS UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support. DISCUSSION The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right. TRIAL REGISTRATION ISRCTN, ISRCTN26008944. Registered on 30 October 2019.
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Affiliation(s)
- Galia S. Moran
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Candelaria Mahlke
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
| | | | - Grace Ryan
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Alina Grayzman
- The Charlotte B. and Jack J. Spitzer Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Benjamin Mayer
- Institute for Medical Biometry and Epidemiology, Ulm University, Ulm, Germany
| | - Bernd Puschner
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
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Ibrahim N, Thompson D, Nixdorf R, Kalha J, Mpango R, Moran G, Mueller-Stierlin A, Ryan G, Mahlke C, Shamba D, Puschner B, Repper J, Slade M. A systematic review of influences on implementation of peer support work for adults with mental health problems. Soc Psychiatry Psychiatr Epidemiol 2020; 55:285-293. [PMID: 31177310 DOI: 10.1007/s00127-019-01739-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/03/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. METHODS Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). RESULTS The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. CONCLUSION The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.
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Affiliation(s)
- Nashwa Ibrahim
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.,Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Dean Thompson
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
| | - Rebecca Nixdorf
- Department of Psychiatry, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | | | - Galia Moran
- Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Grace Ryan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Julie Repper
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK.
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Michel L, Nguyen LT, Nguyen AK, Ekwaru JP, Laureillard D, Nagot N, Phan O, Khuat OTH. Exposure to HIV risks among young people who use drugs (YPUD) in three cities in Vietnam: time to develop targeted interventions. Harm Reduct J 2020; 17:13. [PMID: 32093700 PMCID: PMC7038548 DOI: 10.1186/s12954-020-00357-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction The aim of this study is to identify the profiles of young people who use drugs (YPUD) and their exposure to HIV risks in the 3 main cities of Vietnam, Haiphong, Hanoi, and Ho Chi Minh City (HCMC), in order to design a community-based intervention to prevent HIV. Methods A survey using respondent-driven sampling (RDS) was conducted among YPUD aged 16–24. Participants were eligible if they reported drug use, confirmed by a urine test. After obtaining informed consent, they were screened for HIV/HCV and assessed using face-to-face questionnaires and self-report. A cluster analysis was conducted, taking into account risk behaviors and confirmed HIV-positive status. Results Seven hundred and three YPUD aged 16–24 were recruited between October 2016 and February 2017, 584 of whom were included in the final analysis. Median age was 21 (17.7, 23.0); 79% were male, 18% female, and 2% transgender. Methamphetamines use was reported by 77%, followed by cannabis (51%) and heroin (17%); polydrug use was common; 15% had “ever” injected drugs. HIV prevalence was 7%. Among all participants, 48% reported non-consistent condom use and 1% reported needle/syringe sharing during the previous month. Four distinct profiles of HIV risk behaviors were identified: The high multiple-risk group mixed unsafe drug use with unsafe sexual practices and had higher prevalence of HIV; the second group practiced high-risk sex with non-consistent condom combined with methamphetamine use; the third group was a moderate-risk group with limited unsafe sexual practices; and the fourth was considered at “low-risk” as reportedly, most never had sex and never injected. The highest risk group included more female YPUD, living in HCMC, who used heroin and had unsafe sex with their regular partners. The second high-risk group included most of the MSM and all transgender people and frequently reported mental health disorders. Conclusions The profiles of YPUD who are at risk of HIV vary according to age, location, and population group. Injecting YPUD are the most exposed to risk and need immediate attention. Sexual exposure to HIV is very common. Mental health is a major concern. Interventions need to be integrated in a differentiated but holistic approach.
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Affiliation(s)
- Laurent Michel
- CESP/Inserm 1018, Centre Pierre Nicole, French Red Cross, Paris, France
| | - Linh T Nguyen
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam
| | - An K Nguyen
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam
| | - John P Ekwaru
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Didier Laureillard
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, Inserm, Etablissement Français du Sang, University of Montpellier, Montpellier, France
| | - Olivier Phan
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Oanh T H Khuat
- Supporting Community Development Initiative, 240 Mai Anh Tuan Street, Thanh Cong Ward, Ba Dinh District, Ha Noi, Vietnam.
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Tse S, Yuen WWY, Murray G, Davidson L, Lai Q, Kan A. Combining technical and expert-by-experience knowledge in the quest for personal recovery from bipolar disorder: a qualitative study. BMC Psychiatry 2019; 19:368. [PMID: 31771532 PMCID: PMC6878707 DOI: 10.1186/s12888-019-2357-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Knowledge construction is a form of communication in which people can work individually or collaboratively. Peer support services have been adopted by the public psychiatric and social welfare service as a regular form of intervention since 2015 in Hong Kong. Peer-based services can help people with bipolar disorder (BD) deal with the implications of the diagnosis, the way in which individuals with BD receive treatment, and the lifestyle changes that take place as a result of the diagnosis. Through a qualitative paradigm, this study aims to examine how individuals with BD use technical and expert-by-experience knowledge. METHODS A total of 32 clients of mental health services were recruited from hospitals, Integrated Community Centers for Mental Wellness, and non-governmental organizations. They participated in semi-structured individual interviews. All interviews were recorded, transcribed verbatim, and analyzed using thematic analysis with the aid of NVivo. The findings were verified by peer researchers. RESULTS Three main themes are presented in this article, including how clients made sense of the knowledge provided by mental health professionals and peer support workers (PSWs), critical perspectives about peer support services, and the way in which the services are more than knowledge transfer alone. Participants generally indicated that knowledge sharing revolved around three experiences: mood changes, medications, and sense of hope. Nevertheless, an empathic understanding of the clients' experience was more important than the sharing of knowledge. Some clients perceived medication as the chief means to recovery, so PSWs were not useful for them. However, PSW role models had an effect beyond mere knowledge transmission, as they could promote clients' pursuit of functional recovery goals. CONCLUSIONS The present study has improved our understanding of knowledge sharing between clients with BD and health professionals or PSWs, which should take place in an empathic and hope-instilling manner. It has also emphasized the value of the presence of a role model who can speak convincingly with clients to facilitate recovery. The present findings can be used to improve the care of people with BD by generating important guidance with regard to enhancing the knowledge exchange between clients and health practitioners.
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Affiliation(s)
- Samson Tse
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
| | - Winnie W. Y. Yuen
- 0000000121742757grid.194645.bDepartment of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China ,Current address: Department of Counselling and Psychology, Shue Yan University, Hong Kong, China
| | - Greg Murray
- 0000 0004 0409 2862grid.1027.4Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Larry Davidson
- 0000000419368710grid.47100.32Yale Program for Recovery and Community Health, Yale University, New Haven, USA
| | - Queenie Lai
- 0000000121742757grid.194645.bDepartment of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Alice Kan
- 0000000121742757grid.194645.bDepartment of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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