Recruitment and retention issues for occupational therapists in mental health: Balancing the pull and the push

Background/aim: Recruitment and retention issues for mental health occupational therapists have been the subject of significant concern for many years. This paper describes recruitment and retention issues as reported by mental health occupational therapists employed by a large Area Health Service in metropolitan Sydney. Method: Thirty‐eight mental health occupational therapists (response rate 84%) completed a survey in the first half of 2008. Key themes investigated were: overall satisfaction; attractive elements of positions; positive aspects of positions; constraints of positions; factors associated with leaving positions; supervision; professional development; career pathways; and interest in and access to management positions. Results: Key elements that kept respondents in positions included the nature of the work, being in a supportive team and the opportunity to use occupational therapy skills. Elements that prompted people to consider leaving positions were the desire for new and different types of work, a desire to work closer to home, insufficient time or high workloads, feeling ‘bored’ or ‘stale’, organisational change or juggling multiple demands, working in unsupportive or dysfunctional teams and family or other personal factors. Conclusions: The results supported the development of a ‘push and pull’ conceptualisation of recruitment and retention issues, including job‐related (intrinsic) and non‐job‐related (extrinsic) issues. This conceptualisation allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.     

The Cost‐Effectiveness of Independent Housing for the Chronically Mentally Ill: Do Housing and Neighborhood Features Matter?

OBJECTIVE: To determine the effects of housing and neighborhood features on residential instability and the costs of mental health services for individuals with chronic mental illness (CMI). DATA SOURCES: Medicaid and service provider data on the mental health service utilization of 670 individuals with CMI between 1988 and 1993 were combined with primary data on housing attributes and costs, as well as census data on neighborhood characteristics. Study participants were living in independent housing units developed under the Robert Wood Johnson Foundation Program on Chronic Mental Illness in four of nine demonstration cities between 1988 and 1993. STUDY DESIGN: Participants were assigned on a first-come, first-served basis to housing units as they became available for occupancy after renovation by the housing providers. Multivariate statistical models are used to examine the relationship between features of the residential environment and three outcomes that were measured during the participant's occupancy in a study property: residential instability, community-based service costs, and hospital-based service costs. To assess cost-effectiveness, the mental health care cost savings associated with some residential features are compared with the cost of providing housing with these features. DATA COLLECTION/EXTRACTION METHODS: Health service utilization data were obtained from Medicaid and from state and local departments of mental health. Non-mental-health services, substance abuse services, and pharmaceuticals were screened out. PRINCIPAL FINDINGS: Study participants living in newer and properly maintained buildings had lower mental health care costs and residential instability. Buildings with a richer set of amenity features, neighborhoods with no outward signs of physical deterioration, and neighborhoods with newer housing stock were also associated with reduced mental health care costs. Study participants were more residentially stable in buildings with fewer units and where a greater proportion of tenants were other individuals with CMI. Mental health care costs and residential instability tend to be reduced in neighborhoods with many nonresidential land uses and a higher proportion of renters. Mixed-race neighborhoods are associated with reduced probability of mental health hospitalization, but they also are associated with much higher hospitalization costs if hospitalized. The degree of income mixing in the neighborhood has no effect. CONCLUSIONS: Several of the key findings are consistent with theoretical expectations that higher-quality housing and neighborhoods lead to better mental health outcomes among individuals with CMI. The mental health care cost savings associated with these favorable features far outweigh the costs of developing and operating properties with them. Support for the hypothesis that "diverse-disorganized" neighborhoods are more accepting of individuals with CMI and, hence, associated with better mental health outcomes, is mixed.     

Promoting mental health and emotional well‐being among children and youth: a role for community child health?

‘Teenage suicides double as the future crumbles’ with collapse of the economy in Argentina ( Arie 2002 ). Schizophrenia ‘linked to racism’, a study reveals among ethnic minorities in London ( Boydell et al. 2001 ). The promotion of emotional well‐being focuses on improving environments (social, physical, economic) that affect emotional well‐being and enhancing the ‘coping’ capacity of communities as well as individuals ( Wood & Wise 1997 ). What improvements in the ‘environment’ are required, and how does one ‘enhance coping’ in order to promote emotional well‐being? What is the role of those working in community child health in promoting mental health and emotional well‐being? Most of the research on the determinants of the health and well‐being of populations have focused on physical health problems, particularly mortality and life expectancy ( Marmot & Wilkinson 1999 ). There is less research on the ‘upstream’ (socioeconomic) determinants of mental health problems, and even less on emotional well‐being and enhancing ‘coping’ or promoting resilience. Examples of upstream determinants of mental health problems include good evidence linking the prevalence of mental health problems of children and young people to income, educational status and family structure ( Sawyer et al. 2001 ). Male youth suicide has been linked to such upstream determinants as relative unemployment rates. Suicide has increased with increasing ratio of youth to overall unemployment rates ( Morrell et al. 2001 ). A significantly higher risk of suicide in Australia over the past century was shown to be associated with conservative governments compared with social democratic government tenures ( Page et al. 2002 ).     

Canadian community mental health workers’ perceived priorities for supportive housing services in northern and rural contexts

A relationship between mental health and supportive housing has been established, yet there exist enduring challenges in meeting the supportive housing needs of people with severe mental health problems. Furthermore, not all stakeholder viewpoints of supportive housing services are well documented in the research literature, and research has tended to focus on supportive housing provision in large, urban centres. Potentially, distinct challenges and opportunities associated with the provision of supportive housing services in smaller urban and rural communities that define the greater geographical terrain of Canada and other jurisdictions are less developed. This study describes community mental health service workers’ priorities for supportive housing services. Using Q methodology, 39 statements about supportive housing services, developed from a mixed‐methods parent study, were sorted by 58 service providers working in four communities in northern Ontario, Canada. Data used in this study were collected in 2010. Q analysis was used to identify correlations between service workers who held similar and different viewpoints concerning service priorities. The results yielded four discrete viewpoints about priorities for delivery of supportive housing services including: a functional system, service efficiency, individualised services and promotion of social inclusion. Common across these viewpoints was the need for concrete deliverables inclusive of financial supports and timely access to adequate housing. These findings have the potential to inform the development of housing policy in regions of low population density which address both system and individual variables.     

Children of mothers with mental ilness: attachment,emotional and behavioural problems

This study describes the pattern of emotional and behavioural difficulties of children whose mothers have mental illness, and explores the relationship between children’s behavioural and emotional difficulties and maternal perceptions of attachment. Thirteen mothers previously admitted to psychiatric hospital for mental illness completed a measure of their own symptoms (Brief Symptom Inventory), their children’s emotional and behavioural problems (Strengths and Difficulties Questionnaire (SDQ)), and attachment security (Parent/Child Reunion Inventory) (n?=?21). Mean scores for child SDQ profiles were found to be within the ‘normal’ range, although (on some indices) mothers reported more ‘case’ scores for their children, than would be expected from standardized norms. It was found that there were significant positive correlations between ‘insecurity’ scores and all problem scales of the SDQ. Best predictors from the Parent/Child Reunion Inventory factors for each SDQ scale are reported and discussed.     

Music and health. Phenomenological investigation of a medical humanity

In response to the tendency for music to be under-represented in the discourse of medical humanities, we framed the question ‘how can music heal?’ We answered it by exploring the lived experiences of musicians with lay or professional interests in health. Two medical students and a medically qualified educationalist, all musicians, conducted a co-operative inquiry with a professional musician interested in health. All researchers and six respondents kept audio or written diaries. Three respondents were interviewed in depth. A medical school head (and experienced musician) critiqued the phenomenological analysis of respondents’ accounts of music, health, and its relationship with undergraduate medical education. Respondents experienced music as promoting health, even in seriously diseased people. Music affected people’s identity and emotions. Through the medium of structure and harmony, it provided a means of self-expression that adapted to whatever condition people were in. Music was a communication medium, which could make people feel less isolated. Immersion in music could change negative states of mind to more positive ones. A transport metaphor was commonly used; music ‘taking people to better places’. Exercising control by becoming physically involved in music enhanced diseased people’s self-esteem. Music was able to bring the spiritual, mental, and physical elements of their lives into balance, to the benefit of their wellbeing. Music could help medical students appreciate holistically that the state of health of people who are either well or diseased can be enhanced by a ‘non-technical’ intervention.     

Psychiatric morbidity and people’s experience of and response to social problems involving rights

Psychiatric morbidity has been shown to be associated with the increased reporting of a range of social problems involving legal rights (‘rights problems’). Using a validated measure of psychiatric morbidity, this paper explores the relationship between psychiatric morbidity and rights problems and discusses the implications for the delivery of health and legal services. New representative national survey data from the English and Welsh Civil and Social Justice Survey (CSJS) surveyed 3040 adults in 2007 to explore the relationship between GHQ‐12 scores and the self reported incidence of and behaviour surrounding, rights problems. It was found that the prevalence of rights problems increased with psychiatric morbidity, as did the experience of multiple problems. It was also found the likelihood of inaction in the face of problems increased with psychiatric morbidity, while the likelihood of choosing to resolve problems without help decreased. Where advice was obtained, psychiatric morbidity was associated with a greater tendency to obtain a combination of ‘legal’ and ‘general’ support, rather than ‘legal’ advice alone. The results suggest that integrated and ‘outreach’ services are of particular importance to the effective support of those facing mental illness.     

Americans’ Health Priorities During the COVID-19 Pandemic

ObjectivesThis study aimed to examine how Americans’ opinions of the seriousness of various health-related problems have changed over time and to quantify the public’s preferences for research prioritization.MethodsWe conducted a survey that asked respondents to rate the seriousness of 80 health-related problems on a 4-point Likert scale (“very serious problem,” “somewhat serious problem,” “not too serious of a problem,” or “not a problem at all”). Results were compared with past surveys from 2001 and 2013 that examined the same set of health-related problems (with the exception of COVID-19). The survey also included best-worst scaling questions that asked respondents to select, from 20 health problems, those they considered most and least important for research funding. Respondents were recruited from the KnowledgePanel, a nationally representative sample of American households.ResultsA total of 768 adults completed the survey between September 3, 2020, and September 14, 2020. The health-related problems that Americans consider to be “very serious” generally align with the leading causes of death and noncommunicable diseases such as heart disease, diabetes, and mental health; nevertheless, several social determinants of health are also identified. COVID-19 was an unsurprising top priority, whereas cancer remains the highest and a persistent priority for research funding.ConclusionsAmericans consider a diverse set of health-related problems to be “very serious,” with recognition of social determinants of health rising. Our findings offer guidance as to the disease areas for which the public would value further public and private investment in treatment innovations.     

Tracking change in psychological distress among homeless adults: an examination of the effect of housing status

Although research has documented the endemic nature of psychological distress among homeless people, little is known about the variation of and change in distress when psychiatric disabilities and housing status are considered. Using longitudinal data from a homeless sample, the author examined the pattern of distress across three groups--people with serious mental illness (SMI), people with drug or alcohol problem, and people with neither diagnosis. Distress symptoms were most pervasive and persistent among people with SMI. The effect of housing status on distress differed across the three groups and was statistically significant for people with no psychiatric diagnosis.     

Patients' opinions of the use of psychiatric case-finding questionnaires in general practice

Background The common mental disorders of depression and anxiety often remain undetected in general practice. Psychiatric screening instruments have been recommended to assist detection. Aim To assess patients' attitudes towards the use of psychiatric screening questionnaires for common mental disorders within general practice. Design Twenty focus groups comprising 127 patients were conducted in Wales, UK. The groups were distinguished by age, sex and locality. Results The majority of respondents felt that the use of a screening questionnaire was acceptable and would be willing to complete one within a general practice setting. However, a number of individuals expressed concern about the validity of the kinds of questions asked and the usefulness of the instrument in practice. Respondents also discussed their concerns relating to issues of confidentiality and the doctor's response to the assessment. Conclusion The study indicates that lay beliefs towards mental illness, particularly relating to perceived stigma, will continue to pose problems for the routine use of psychiatric case‐finding questionnaires within general practice.     

Partnerships to promote mental health of NSW farmers: the New South Wales Farmers Blueprint for Mental Health

Objective: To describe the process and outcome of development of a framework for planning and implementation of a range of interventions aimed at improving the mental health and wellbeing of farmers and farm families in New South Wales (NSW). Design: In response to a major drought in New South Wales (NSW), key agencies were invited to participate in a longer-term collaborative program aimed at improving the mental health and well-being of the people on NSW farms. These agencies became the NSW Farmers Mental Health Network. Setting: The Australian National Action Plan for Promotion, Prevention & Early Intervention for Mental Health 2000 proposed a population health approach base encompassing the range of risk and protective factors that determine mental health at the individual, family and community and society levels. It incorporated three traditional areas of health activity into programs aimed at achieving improved mental health for the Australian population – mental health promotion, prevention activities and early intervention. Although the farming population was not identified as a priority population, research has identified this population to be at high risk of suicide, and of having difficulty in coping with the range of pressures associated with life and work in this industry. Participants: Participants were agencies providing services across rural NSW in the fields of farmer and country women's organisations, financial counselling services, government departments of primary industries and health, mental health advisory and support services, charitable organisations and others. Results: The NSW Farmers Blueprint for Mental Health ( http://www.aghealth.org.au/blueprint ) was developed to be ‘a simplified summary of key issues that need to be addressed, and the major actions that we can be confident will be effective in achieving our purpose’. It has identified ‘steps’ along ‘pathways to breakdown’ from the range of known mental health and suicide risk factors that are relevant to the NSW farming population, and 23 areas of current and potential action that would contribute to improving mental health, as key steps along ‘pathways to health’. For each of the areas of action there is described the rationale and basis for action, and the lead agency or individual who has accepted responsibility for coordinating and reporting further activity to the Network. Conclusion: It is suggested that the NSW Farm Blueprint and the activities being implemented by the NSW Farmers Mental Health Network partners represent a model for implementation of a mental health promotion in identified at-risk Australian populations.     

Correlates of Mental Health Among Latino Farmworkers in North Carolina

Purpose : Latino farmworkers are a vulnerable population who confront multiple threats to their mental health. Informed by the stress‐process model of psychiatric disorder, the goal of this paper is to determine primary and context‐specific stressors of poor mental health among Latino farmworkers. Methods : Structured interview data were obtained from farmworkers (N = 69) in 6 counties in eastern and western North Carolina. Findings: Results indicated that a substantial number of farmworkers have poor mental health, as indicated by elevated depressive symptoms (52.2%) and anxiety (16.4%). Results also indicated that each mental health outcome had different predictors. Conclusion: Addressing the mental health issues of farmworkers requires a comprehensive, multifaceted approach.     

Studies regarding supported housing and the built environment for people with mental health problems: A mixed-methods literature review

Places where people live are important for their personal and social lives. This is also the case for people with mental health problems living in supported housing. To summarise the existing knowledge, we conducted a systematic review of 13 studies with different methodologies regarding the built environment in supported housing and examined their findings in a thematic analysis.The built environment of supported housing involves three important and interrelated themes: well-being, social identity and privacy. If overregulated by professionals or located in problematic neighbourhoods or buildings, the settings could be an obstacle to recovery. If understood as meaningful places with scope for control by the tenants or with amenities nearby, the settings could aid recovery.     

Needs of homeless people coping with psychiatric problems: findings from an innovative advocacy project

In this article the authors report on the self-perceived needs of 40 homeless people who are coping with psychiatric problems. These people were among 207 with psychiatric problems participating in an innovative advocacy project based outside the formal mental health system. Compared with domiciled participants, the homeless participants had more accentuated and somewhat different major daily living needs in the areas of income and benefits, housing, legal services, employment, and health care. On the basis of these findings, the authors draw implications for social work practice with homeless people coping with psychiatric problems.     

Case management in mental health services:the role of community mental health support teams

The progressive reduction in the numbers of hospital places available for people with mental health problems has led to an increasing demand on community support services. One response has been the development within social services departments of community mental health support teams, which employ largely unqualified staff who offer support to people with longer term mental health needs. The paper examines to what extent the practice of one authority's support teams reflects an appropriate ‘case management’ style of service, as developed in the USA to address the needs of long-term community patients. Key features of this approach are identified, and used as the basis of analysis of the support teams' practice in relation to 214 cases. It is concluded that a ‘case management’ model can be appropriate for work involving unqualified staff, provided that the service structure as a whole enables access to other skills as appropriate. Two specific risks are identified: firstly that the service is developed because of cost rather than appropriateness; and secondly that the service can rapidly become silted up with increasing numbers of people who need service of indefinite duration.     

Tackling the needs of the homeless: a controlled trial of health advocacy

The objective of the present study was to assess the effectiveness of a health advocate's casework with homeless people in a primary care setting in terms of improvements in health‐related quality of life (QoL). The impact of the health advocacy intervention was assessed in a quasi‐experimental, three‐armed controlled trial. Homeless people moving into hostels or other temporary accommodation in the Liverpool 8 area of the UK and patients registering at an inner‐city health centre as temporary residents were allocated in alternating periods to health advocacy (with or without outreach registration) or ‘usual care’ over a total intake period of 3 years. Health‐related QoL outcomes were assessed using three independent self‐report measures: the Life Fulfilment Scale; the Delighted–Terrible Faces Scale; and the Nottingham Health Profile. Out of the 326 homeless people who were given baseline questionnaires at registration, 222 (68%) returned usable questionnaires. Out of these individuals, 171 (77.0%) were traceable at follow‐up, and 117 (68.4%) follow‐up questionnaires were returned. The majority of respondents (n = 117) were women (72%) who were under 30 years of age (74%), white British (91%), and single (63%) or separated (23%), many of whom were living with their children (41%) in either women's refuges (30%) or family hostels (25%). Improvements in health‐related QoL were greatest in people recruited and supported by a health advocate early in their stay in temporary housing, in comparison with those in the control group given ‘usual care’ at the health centre. The model of streamlined care for patients with complex psycho‐social needs is shown to be a worthwhile and effective option for primary healthcare providers.     

Mental health and social security: the case of the Incapacity Benefit in Northern Ireland

Although mental illness affects people from all income levels, a significant proportion of discharged psychiatric patients rely heavily on the benefit system. Therefore, changes in benefit entitlement are of great concern to these people who already find this system difficult to use. In the summer of 1995, using both focus groups and individual interviews, the views of 35 individuals with mental health problems and of five organizations involved in advocacy work were sought on the introduction of the Incapacity Benefit. These views raised serious questions about the extent to which the benefit system meets the needs of claimants with mental health problems, on the relevance of the models of disability used in sickness benefits, and on the impact of the Incapacity Benefit and the Job Seeker's Allowance on people with mental health problems and confirmed the need for further research.