SOCIAL ROLE VALORIZATION IN COMMUNITY MENTAL HEALTH HOUSING: DOES IT CONTRIBUTE TO THE COMMUNITY INTEGRATION AND LIFE SATISFACTION OF PEOPLE WITH PSYCHIATRIC DISABILITIES?

Despite its importance as a theory in the development of programs for populations with disabilities, social role valorization (SRV) has received relatively little attention in community mental health research. We present findings of a study that examined the relationship of housing‐related SRV to community integration and global life satisfaction of persons with psychiatric disabilities. The housing environments and associated supports of a group of 73 persons with psychiatric disabilities living in a mid‐sized city were assessed using the PASSING rating system on the extent that their housing environments facilitated SRV. In addition, in‐person interviews were conducted to determine the levels of physical integration, psychological integration, social integration, and life satisfaction of study participants. Results showed SRV contributing directly to all three types of community integration. Psychological integration was found to mediate the relationship between SRV and life satisfaction. Implications of the findings are discussed.     

Integrated dual disorders treatment

Mental health programs are increasingly combining evidence‐based practices to provide comprehensive services. Individuals with complex services needs, such as those dually diagnosed with mental illness and substance use disorders, are at high risk for numerous negative outcomes and may benefit from such comprehensive programs. This report describes the process and outcomes of a program that formally integrated assertive community treatment, supported housing, and integrated dual disorders treatment for a sample of clients with dual diagnoses. Over a 2‐year period, this pilot program targeted 14 clients with 12 clients successfully transitioned out of a state hospital into the community. Results showed large reductions in hospitalization, homelessness, and incarceration, and increases in employment and later stages of treatment for substance abuse. This study demonstrates the potential of such an integrated program and points to areas for further research in housing services. © 2009 Wiley Periodicals, Inc.     

Longitudinal assessment of family support among homeless mentally ill participants in a supported housing program

Although strengthening the family relations of individuals with severe mental illness has been identified as an important objective for community-based case management programs, little is known about the impact of such programs on patterns of family relations over time. This study assesses longitudinally the family support of a large sample of homeless mentally ill individuals participating in a supported housing program. The program randomly assigned participants to one of four experimental conditions created by varying the level of access to independent housing and the intensity of case management services provided. Substantial improvements were found during the 3-year follow-up period for frequency of family interaction, perceived availability, and satisfaction with family. Regression analyses were used to model factors correlated with change. Improvement in support was not associated with housing or case management conditions. Increased levels of family support were associated with housing status and mental health status. Clients in stable independent and community housing showed greater improvement than a group of clients living in an unstable housing environment. Substantial gains in family relations also occurred among a subgroup who did not achieve housing stability, but received family housing assistance during follow-up. The lack of relationship between the experimental intervention and change in support is discussed. © 1998 John Wiley & Sons, Inc.     

Assessing residential segregation among medicaid recipients with psychiatric disability in Philadelphia

This study assesses the extent of residential segregation among 15,246 people diagnosed with psychiatric disabilities and receiving Medicaid (MA) in Philadelphia, and an identically sized group of MA recipients serving as matched controls. Results indicate that overall levels of residential segregation among this group were modest at their most extreme, were not markedly different from a control group of Medicaid recipients without any record of treatment for severe mental illness, and were substantially reduced after taking poverty into account. There were, however, localized areas in Philadelphia that showed distinct concentrations of persons with psychiatric disability, suggesting there may be a subgroup that is more at‐risk for living in areas with elevated concentrations of persons with serious psychiatric disability. © 2007 Wiley Periodicals, Inc.     

CONCEPTUALIZING SOCIAL INTEGRATION AMONG FORMERLY HOMELESS ADULTS WITH SEVERE MENTAL ILLNESS

The multiple dimensions of social integration among formerly homeless adults with severe mental illness have not been well‐studied. Previous studies have focused on clinical measures or narrow components of social integration. We used a multisite study of chronically homeless adults who were provided housing to (a) identify the main factors related to social integration, (b) examine the association between clinical symptoms and social integration, and (c) examine whether social integration is associated with life satisfaction. A factor analysis identified six components of social integration: housing, community participation, civic activities, religious faith, social support, and treatment support. Social integration was found to be largely independent of clinical symptoms and had only a weak association with life satisfaction. These findings suggest supported housing programs needed to focus on improving client outcomes in several domains of social integration regardless of symptoms and that additional efforts are needed to improve life satisfaction among clients.     

Duration of homeless spells among severely mentally ill individuals: A survival analysis

The major objective of this study was to identify predictors of the duration of homeless spells among persons with severe mental illness (SMI). This was the first study to incorporate time-varying covariates into the survival analysis model predicting the length of homeless spells. The sample consisted of 215 individuals who had participated in two experiments evaluating the effectiveness of various treatment programs for homeless individuals. Persons who received assertive community treatment exited homelessness sooner than individuals who received brokered case management, outpatient treatment, or services from a drop-in center. More assistance in finding and maintaining housing were especially predictive of shorter homeless spells. Inclusion of variables which varied over time in the model (e.g., income and frequency of service contacts) reduced the impact of many of the demographic variables in the model. This survival analysis demonstrated that the efforts of human service agencies to assist homeless mentally ill individuals do make a difference. In general, persons who received more services exited homelessness sooner. © 1998 John Wiley & Sons, Inc.     

Social Support, Health and Satisfaction among the Elderly with Chronic Conditions in Taiwan

This study examines possible relationships between perceived social support, physical and mental health, satisfaction towards hospital services, and satisfaction towards life-asa-whole, among the community elderly with chronic conditions. A sample of 172 Chinese elderly living in a metropolitan Taiwanese city were home-interviewed. Results indicated that (a) the elderly perceived good social support, and tangible support was the most important aspect; (b) the elderly did not perceive great impact of illness(es) upon their life, and both physical and mental health were satisfactory; (c) the elderly were generally satisfied with both the hospital services and life-as-a-whole; (d) apart from health and illness factors, social support appeared to have profound and pervasive protective effects on adjustment and satisfaction of the elderly.     

“There goes the fear”: feelings of safety at home and in the neighborhood: The role of personal,social, and service factors

Safety has been shown to be an important contributor to mental well‐being and is often identified as a key element of sustainable communities. Drawing on the fear of crime literature this study investigates the determinants of feelings of indoor and outdoor safety for people living in deprived areas, using both cross‐sectional and longitudinal samples from household surveys in 15 communities in Glasgow. Across the different models social cohesion, satisfaction with services, and perceived empowerment emerge as the most robust predictors of feeling very safe indoors and outside. Our findings suggest useful extensions to several theoretical models of the fear of crime: The vulnerability hypothesis should include social vulnerability more generally; environmental models should focus on local amenities and services as well as on disorder; and social–psychological models should consider not only informal social control but also resident empowerment in relation to housing and neighborhood issues.     

The development and internal consistency of the satisfaction with Antipsychotic Medication Scale

BACKGROUND: Satisfaction with antipsychotic medication is an important outcome variable. To date, there is a lack of a well-established measure to quantify patient satisfaction with psychiatric medication. This paper describes the development, dimensionality, reliability and validity of the Satisfaction with Antipsychotic Medication (SWAM) scale. METHOD: Clinical and academic experts devised a 33-item Likert scale satisfaction questionnaire. Following a pilot study in a sample of 69 people with schizophrenia, 315 people with schizophrenia on the caseload of local mental health services in three London boroughs completed the questionnaire. The dimensionality, internal consistency and validity of the devised instrument were assessed. RESULTS: Reliability of the SWAM scale was good for subscales and total scores. The alpha coefficient for the two subscales: treatment acceptability and medication insight were 0.92 and 0.84 respectively. The a coefficient for the SWAM scale total score was 0.91 and ranged from 0.92 to 0.90. CONCLUSION: Testing of the psychometric properties of the SWAM scale demonstrate that it is a reliable instrument for measuring patient satisfaction with antipsychotic medication. The measure could be used in routine clinical practice in mental health services to assess patient satisfaction with psychiatric medication.     

Exploratory cluster randomised controlled trial of shared care development for long-term mental illness.

BACKGROUND: Primary care clinicians have a considerable amount of contact with patients suffering from long-term mental illness. The United Kingdom's National Health Service now requires general practices to contribute more systematically to care for this group of patients. AIMS: To determine the effects of Mental Health Link, a facilitation-based quality improvement programme designed to improve communication between the teams and systems of care within general practice. Design of study: Exploratory cluster randomised controlled trial. SETTING: Twenty-three urban general practices and associated community mental health teams. METHOD: Practices were randomised to service development as usual or to the Mental Health Link programme. Questionnaires and an audit of notes assessed 335 patients' satisfaction, unmet need, mental health status, processes of mental and physical care, and general practitioners' satisfaction with services and beliefs about service development. Service use and intervention costs were also measured. RESULTS: There were no significant differences in patients' perception of their unmet need, satisfaction or general health. Intervention patients had fewer psychiatric relapses than control patients (mean = 0.39 versus 0.71, respectively, P = 0.02) but there were no differences in documented processes of care. Intervention practitioners were more satisfied and services improved significantly for intervention practices. There was an additional mean direct cost of pound 63 per patient with long-term mental illness for the intervention compared with the control. CONCLUSION: Significant differences were seen in relapse rates and practitioner satisfaction. Improvements in service development did not translate into documented improvements in care. This could be explained by the intervention working via the improvements in informal shared care developed through better link working. This type of facilitated intervention tailored to context has the potential to improve care and interface working.     

Measuring perceived procedural justice and coercion among persons with mental illness in police encounters: the Police Contact Experience Scale

Despite increased recent attention to improving the quality of encounters between police officers and people with serious mental illness, there are no measures available for assessing how consumers perceive their interactions with police officers. Drawing upon conceptual frameworks developed within social psychology, this study reports the development and testing of a new measure, the Police Contact Experience Scale (PCES), which yields indicators of procedural justice and coercion as evaluated by persons with mental illness in relation to specific encounters with the police. The PCES was administered to 154 individuals with mental illness that had police contact within the prior 12 months. Rasch rating scale analysis supported construct validity of a 10‐item procedural justice and a 5‐item coercion scale. Correlational analysis supported convergent validity for both scales. © 2010 Wiley Periodicals, Inc.     

HOUSING CHRONICALLY HOMELESS VETERANS: EVALUATING THE EFFICACY OF A HOUSING FIRST APPROACH TO HUD‐VASH

Rapidly placing homeless Veterans with severe mental illness into permanent housing is one important goal of the U.S. Department of Housing and Urban Development‐Veterans Affairs Supportive Housing (HUD‐VASH) program; however, no research has tested whether an explicit organizational alignment of this goal with revised practices could improve outcomes. A demonstration project initiated in 2010 to reform housing placement practices in a metropolitan area enabled researchers to compare an explicit “Housing First” program—offering immediate permanent housing without requiring treatment compliance, abstinence, or “housing readiness”—with a treatment‐first program for 177 homeless Veterans. The Housing First initiative successfully reduced time to housing placement, from 223 to 35 days, housing retention rates were significantly higher among Housing First tenants, and emergency room use declined significantly among the Housing First cohort. The results suggest that a national Housing First model for the VA would be associated with improved outcomes for Veterans experiencing homelessness.     

Television and attitudes toward mental health issues: Cultivation analysis and the third‐person effect

A television content analysis and survey of 419 community respondents supports the hypothesis that media stereotypes affect public attitudes toward mental health issues. A content analysis of network, prime‐time television demonstrates that portrayals are violent, false, and negative. The mentally disordered are portrayed as 10 times more likely to be a violent criminal than nonmentally disordered television characters. A survey demonstrates that as television viewing increases so does the belief among viewers that locating mental health services in residential neighborhoods will endanger the residents. Viewers who watch television news are less likely to support living next to someone who is mentally ill. The survey also tests the third‐person effect, and finds that viewers believe television portrayals of mental illness affect others more than themselves. © 2007 Wiley Periodicals, Inc.     

Quality of life in individuals with serious mental illness and type 2 diabetes

Diabetes is a pervasive metabolic disease that disproportionately affects persons with serious mental illness. The authors studied the effect of diabetes on quality of life in a sample of 369 adult outpatients with schizophrenia or major mood disorder, 201 of whom had type 2 diabetes. Patients with diabetes reported greater impairment in both physical and mental-health quality of life than those without diabetes. The diabetes patients also reported less satisfaction with health but not with other life domains. Medical providers need to be attentive to the burden of disease experienced by patients with both serious mental illness and diabetes.     

Housing stability among homeless individuals with serious mental illness participating in housing first programs

This article presents findings from an exploratory study of three programs using the Housing First approach to provide permanent supportive housing for single, homeless adults with serious mental illness and often co‐occurring substance‐related disorders. This approach provides direct, or nearly direct, access to housing that is intended to be permanent without requiring sobriety or psychiatric treatment. Findings from the three programs examined for this study indicate that the Housing First approach may help the hardest‐to‐serve chronically homeless population achieve housing stability. Of the 80 participants tracked over 12 months, 84% remained enrolled in the Housing First program for 1 year following program entry. One half of those spent every night in their Housing First unit, while the others spent some time in other living environments. © 2009 Wiley Periodicals, Inc.     

Older peoples' attitudes to mental illness

Despite the prevalence of mental health problems in later life, older people markedly underutilize mental health services. A greater awareness of factors influencing older peoples' attitudes to mental illness may therefore improve awareness and treatment of mental disorders in this population. A mixed methodology approach was used to explore and compare older peoples' attitudes to mental illness in a sample of clinical and non‐clinical participants. Results indicated that, similar to younger people, older people endorsed a range of positive and negative attitudes to mental illness. However, when attitudes to mental illness were considered within the context of ageing and experience a more complex pattern of results emerged. Although negative attitudes to mental illness were associated with negative attitudes to ageing across the entire sample, clinical participants (and those with prior experience of mental illness) reported more positive attitudes to mental illness and more negative attitudes to ageing than non‐clinical participants, for whom the reverse was true. Attitudes were also differentially related to health behaviour outcomes. Results suggest that attitudes to mental illness and ageing may be linked and mediated by personal experience and capacity for psychological self‐regulation in the face of age‐associated adversity. Copyright © 2009 John Wiley & Sons, Ltd.     

Feelings of professional fulfilment and exhaustion in mental health personnel: the importance of organisational and individual factors

BACKGROUND: Mental health personnel are at high risk for mental illness, burnout and suicide. Previous studies of this group of professionals have indicated the importance of organisational factors in explaining burnout, or exhaustion, and work satisfaction. This study looks more systematically at the contribution of organisational and individual factors to work-related exhaustion and to professional fulfillment, an expanded version of job satisfaction. METHODS: A cross-sectional study of 1, 051 psychiatrists and mental health nurses in the city of Stockholm was carried out by postal questionnaire with a previously validated instrument. Multiple and logistic regressions were used to identify predictors of exhaustion and professional fulfillment. RESULTS: Organisational characteristics were found to be more important than individual characteristics in predicting exhaustion and professional fulfillment in mental health professionals. CONCLUSIONS: The results indicate that the psychosocial work environment and well-being of mental health professionals can be improved by concentrating on organisational factors such as efficiency, personal development and goal quality.     

中国精神卫生服务及其政策:对1949-2009年的回顾与未来10年的展望

目的:对中国1949-2009年精神卫生服务提供模式和相关政策进行了系统回顾,分析不同发展阶段的特征,为我国精神卫生改革提供借鉴。方法:通过检索电子期刊数据库和我国卫生部官方网站等数据库并配合相应的手工检索,纳入收集整理与精神疾病流行病学、精神卫生服务提供、精神卫生服务利用、精神卫生政策和规划高度相关的资料。访谈国内外从事精神卫生服务工作的多名知名专家和主管领导,对其访谈内容记录、录音,进行归纳、分析、总结。结果:共纳入216篇文献,213人参与访谈。研究显示,60年来中国精神卫生资源和服务模式的演变经历了快速发展、稳步发展和改革等三个阶段;中国精神卫生服务体系在60年间发生了巨变化,但仍存在资源短缺、精神病治疗率较低、普通人群和医务人员精神卫生知识匮乏、社会对精神病人的偏见严重等现状;60年间,中国精神卫生服务政策也经历了巨大的变化,正向着建立以社区精神卫生服务为主的综合服务网络方向前进。结论:我国应继续强化社区卫生服务,提高精神卫生服务的公平性和可及性。     

Treatment Considerations for HIV-Infected Individuals with Severe Mental Illness

There has been a general recognition of a syndemic that includes HIV/AIDS and serve mental illnesses including schizophrenia, major depression, bipolar disorder, post-traumatic stress disorder, and others. The pathophysiology and direction of effects between severe mental illness and HIV infection is less clear however, and relatively little work has been done on prevention and treatment for people with these complex, co-occurring conditions. Here we present the most recent work that has been published on HIV and mental illness. Further, we describe the need for better treatments for “triply diagnosed persons”; those with HIV, mental illness, and substance abuse and dependence. Finally, we describe the potential drug-drug interactions between psychotropic medications and anti-retrovirals, and the need for better treatment guidelines in this area. We describe one example of an individually tailored intervention for persons with serious mental illness and HIV (PATH+) that shows that integrated community-based treatments using advanced practice nurses (APNs) as health navigators can be successful in improving health-related quality of life and reducing the burden of disease in these persons.     

Meeting the Mental Health Needs of Older Adults in Primary Care: How Do We Get the Job Done?

Most elderly persons in the United States with mental health problems such as depression receive no attention or care. Those who receive treatment generally do so in primary care settings, where disorders like depression have a hard time competing with other common and chronic medical problems. Typically, mental illnesses are under-recognized and under-treated in elderly persons attending primary care clinics. The experience of the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study is briefly described, indicating that depression, for example, can be treated successfully in primary care elderly using the type of multidisciplinary collaborative care model advocated by Speer and Schneider (2003 ; this issue). The challenge now facing all of us is to create a consumer- and family-driven demand for good mental health services in geriatric clinics and a political consensus to reimburse such services fairly. Recent improvement in Medicare reimbursement for mental health services to victims of Alzheimer's dementia provides a basis for hope.