Moving Beyond Routines in Teaching and Learning: Releasing the Educative Potential of Published Eating Disorder Memoirs

Learning from the lived experience of disordered eating is vital for contemporary mental health practitioners. While mental health practitioners need to understand the psycho-biological issues that impact the person and family with an eating disorder, there is much about this complex condition that eludes and escapes a bio-medical perspective. Use of an aesthetic lens on the issue can illuminate various challenges, tensions and insights that people with disordered eating experience along the journey of their ill-health and on to their recovery, but which often remain unstated in the clinical context. Scholars within the creative arts discipline are experts in making judgements about the quality of artworks they encounter and have highly developed aesthetic knowing. Yet, the central skills and knowledges embodied in creative arts activity are not widely utilized outside that sphere. This article reports on how aesthetics can be applied to sensitize mental health practitioners to appreciate the lived experience of a mental health challenge such as an eating disorder. Such mental health practitioners play an important role in the health service, yet the widespread diffusion of the bio-medical model into mental health, once characterized for its equal emphasis on the psycho-social-cultural, has led to criticisms of an over-focus on illness identification, at the expense of accommodating the meanings of subjective and unique experiences of mental health, struggle and recovery. Using Kate Grenville's typology of the elements of effective creative writing, we show how these elements contribute to the aesthetic power and impact of particular eating disorder memoirs.     

The effect of work on people with severe mental illness in Taiwan using a stress-social support model: an exploratory study

Satisfaction with quality of life is one aspect of a positive and successful life, and this remains true in the rehabilitation of people with severe mental illness. This study explores the meaning and impact of work on people with severe mental illness in Taiwan and, specifically, the value of encouraging people with severe mental illness to work to enhance their quality of life. We apply stress-social support theory (a Western model) to examine daily life and work stressors in an Eastern cultural environment (Taiwan). We use multiple regression models to analyze predictive factors for their effect on life quality. There are five categories: socio-demographic characteristics, mental illness history, current work status variables (as controls), stress variable and social support variable. Unlike Western studies, current work status, in itself, did not lead to better satisfaction with quality of life, but the stress-social support model did. The implications for rehabilitation success are discussed.     

Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review

Title. Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: systematic review. Aim. This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background. Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources. Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods. Results from studies using meta‐analysis, randomized and non‐randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results. Fifty‐four studies were included: one systematic review with meta‐analysis, 30 randomized controlled trials and 23 non‐experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long‐term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion. These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups.     

High expressed emotion: precipitating relapse in substance misuse disorders

There is a considerable body of evidence on the effect of high expressed emotion on individuals suffering severe mental illnesses; there is also considerable work on those people suffering the dual diagnosis of severe mental illness and substance use disorders. However, in the latter, the majority of studies appear to concentrate on the mental illness aspect of the condition. Literature searches identified that there were few scholarly articles on how expressed emotion affects relapse in those people with a substance use disorder, and yet there is a great deal of evidence regarding the disruption substance use can have on a family and on the individual. This article intends to provide an evaluation on the reasons why high expressed emotion should be addressed in substance use disorder and suggests that, if the benefits of reducing high expressed emotion in these disorders are as significant as in severe mental illness, then there is a sound basis for the increased use of family interventions in substance use disorders.     

Development of an instrument to measure self-efficacy for social participation of people with mental illness

Promoting social participation is consistent with the principles of psychiatric rehabilitation of people with severe mental illness, but lack of self-efficacy in social participation is a major barrier to the community integration of these people. The purpose of this study was to develop an instrument in the form of a mental illness scale (self-efficacy for social participation [SESP]) to measure self-efficacy in social participation among Japanese people and to evaluate the scale's reliability and validity. Devised from a content analysis of interviews with 12 patients regarding their participation in socialization programs, the scale consisted of 37 items. The scale's validity and reliability were tested in a total of 340 community-dwelling individuals with severe mental illness. The final scale consisted of four dimensions with 27 items. Internal consistency of the overall SESP-27 was excellent (α = .96). The scale demonstrated adequate criterion and construct validity and was psychometrically sound. The scale may offer clinicians a tool for planning how to help individuals with mental illness boost their self-efficacy in social participation and community integration.     

Family‐focused recovery: Perspectives from individuals with a mental illness

Family members often provide significant support and care to their relative who has a mental illness. Nonetheless, how family members might be part of an individual's mental health recovery journey is rarely considered. The aim of this study was to investigate how those with a mental illness define ‘family’ and the role of family (if any) in their recovery journey. A qualitative approach was used. Purposive sampling and snowballing were used to recruit and conduct semi‐structured interviews with 12 people who have been diagnosed with a severe mental illness. Participants defined family in various ways with some being very inclusive and others more selective. There was acknowledgement that family contributed to the individual's recovery in a myriad of ways, although the need for boundaries was stressed. While no participants suggested that their family might become active treatment facilitators, they did want clinicians to support them in talking to their family about their mental illness. A multifaceted approach is needed to promote family‐focused recovery practice. The needs of different family members and the needs of the family as a group should be considered concurrently alongside the individual's needs in their recovery plan. Individual and relational components of recovery should be embedded in policy and clinical practice.     

Attitudes towards people with mental illness: a cross-sectional study among nursing staff in psychiatric and somatic care

Stigma and discrimination have been identified as important obstacles to the integration of people with mental illness in society. In efforts to reduce stigma and discrimination, health professionals play an important role as they have frequent contact with and responsibility for treatment and rehabilitation of consumers. The aim of the present study was to investigate attitudes towards mental illness and people with mental illness among nursing staff working in psychiatric or somatic care. The sample consisted of 120 registered or assistant nurses who were interviewed about intimacy with mental illness and attitudes about seven different mental illnesses. The results showed that nursing staff in somatic care, to a higher degree than nursing staff in mental health, reported more negative attitudes with regard to people with schizophrenia as being more dangerous and unpredictable. In contrast, professional experience, intimacy with mental illness and type of care organization were found to be more associated with attitudes to specific mental illnesses concerning the prospect of improvement with treatment and the prospect of recovery. In conclusion, attitudes among nursing staff are in several respects comparable with public opinions about mental illness and mentally ill persons. In order to elucidate if negative attitudes about dangerousness and unpredictability of persons with specific mental illnesses are associated with realistic experiences or with prejudices further studies with a qualitative design are suggested.     

Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes

Lack of participation in the open labour market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe. Vocational rehabilitation through individual placement and support (IPS) has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden. The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified. This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.     

Beliefs towards mental illness in Turkish physiotherapy students

Abstract

Mental health is a new area of specialization for physiotherapists. However, they usually meet patients with psychiatric co-morbidities secondary to other chronic diseases. It is important to explore the beliefs of future physiotherapists regarding mental illness in order to implement effective strategies to avoid possible stigmatizing attitudes that may interfere with the rehabilitation process. Moreover, the psychiatric field should be introduced to physiotherapists as a clinical and research area. Therefore, we aimed to question the beliefs of physiotherapy students regarding mental illness using the Beliefs towards Mental Illness Scale in two different universities in Turkey. The total score of 524 students was 46.5?±?14.5 out of 105 while the Dangerousness Subscale score was 21.2?±?5.8/40; Incurability and Poor Social and Interpersonal Skills Subscale score was 24.2?±?9.3/55 and Shame Subscale score was 1.1?±?1.9/10. Students who had a relationship with an individual having a mental problem and students who had consulted a psychiatrist/psychologist for any mental problem showed more positive beliefs. Future physiotherapists should be informed and trained regarding people with mental illness both to avoid stigma and to be aware of this area in physiotherapy settings. Therefore, it is important to implement new curricula for schools providing physiotherapy education including courses, lectures and clinical practices in the psychiatry field.     

A narrative framework for understanding experiences of people with severe mental illnesses

This article discusses the value of a narrative approach to understand the experiences of people with severe mental illnesses and the systems around them, and the importance of narrative in the patient-practitioner relationship. These are important concepts in the shift to recovery-oriented systems. People lead storied lives which provide coherence and meaning, but that story has the potential to be change. Both consumers and practitioners have stories, and it is the shared decision-making between them that can lead to recovery. Narratives can be illness narratives, initiated by an illness and the search for meaning in it, or counterstories which are inherently political. The article identifies a Framework for Understanding Stories as a means for listening to and understanding stories at multiple levels. It can be useful for nurses to understand complexity and multilevel aspects of an individual's experience. Although people tell their own individual stories, they compose them by adapting narrative types, which a culture makes available. Programs tells a story and provide an important context for both consumers and practitioners. Dominant societal narratives provide an overall context which can be empowering or disempowering for programs, consumers and practitioners. Thus, as the recovery paradigm has become more prominent, people with mental illnesses have increasingly talked and written about recovery.     

Consumer perspectives on recovery: A focus on housing following discharge from hospital

Housing is a critical element in recovery from mental illness. Without suitable housing, people have little chance of maintaining other resources in their lives, such as supportive social relationships and meaningful activities. This study investigated consumers' perspectives on the recovery needs of people who are living with a mental illness, especially those who might need supported accommodation as part of their reintegration into the community. Good quality housing is a critical element in recovery for people living with a mental illness. Findings indicate that when people become unwell, they can destroy resources in their lives, such as housing and friendships. A lack of financial stability can be a problem and exacerbate other difficulties. Having a mental illness means living with loss, stigma, and loneliness, but having someone who understands contributes significantly to recovery. The literature suggests that ‘recovery’ can relate to the relief of symptoms or from the stigma of the illness, recovering from the effects of treatment, from the lack of opportunities, and from the destructive aspects of mental illness. Findings from this study support these aspects, but also that recovery seems to be more. After spending time with the participants, the authors concluded that recovery also means the recovery of a life that includes supportive friends, living in a community in which at least some people ‘understand’, and of recovering a life that includes activities that give that life meaning. Consumers can make a significant contribution to our understanding of mental illness and recovery.     

The impact of volunteering in mental health settings on nursing students' attitudes

Nursing faculties are working to improve students’ attitudes towards mental illness and people with severe mental illness, given the repercussions a lack of knowledge and negative attitudes may have on the quality of care. Complementing undergraduate programmes with volunteering activities affords students the opportunity to interact with people with a severe mental illness, and allow them to develop positive attitudes and overcome prejudice. Aim: to explore and deepen in nursing students attitudes prior to and following volunteering on an Acute Mental Health Inpatient Unit. By means of mixed methods approach, students were assessed at two time points by questionnaires including “Community Attitudes to Mental Illness” and “Semantic Differential”, and by testimonies gathered from interviews. Positives changes in attitudes were identified and monitored over time capturing a destigmatizing tendency. The participation in educational strategies such as volunteering in Acute Mental Health Inpatient Unit, complementary to undergraduate programmes and clinical placements in mental health, allows nursing students to develop more diversified and positive attitudes towards mental illness and people with severe mental illness. The impact of an interventional education strategy is not as powerful in nursing students as it might be in students of other non-healthcare oriented university degrees due to their baseline attitudes.     

Mental health nurses establishing psychosocial interventions within acute inpatient settings

Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be ‘at high risk’ of harm. Subsequently, recovery‐based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems.     

Experience of stigma among family members of people with severe mental illness: A qualitative systematic review

Family members of people with severe mental illness are subjected to stigmatization, and a better understanding of their experience of stigma is important for developing anti‐stigma interventions to reduce the related adverse consequences. This review aimed to systematically identify, evaluate, and synthesize existing findings from qualitative studies regarding the experience of stigma among family members of people with severe mental illness. A systematic literature search for primary studies was conducted in PubMed, EMBASE, Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations and Theses (PQDT), SinoMed (China), Chinese Citation Database (CNKI), and Wanfang Data (China) until March 2019. Findings from the included qualitative studies were extracted and aggregated using meta‐synthesis, guided by the Joanna Briggs Methodology for Qualitative Systematic Reviews. The results revealed that family members experienced stigma and suffered from various negative consequences related to it. Five major categories were identified in 20 studies: ‘negative public images of mental illness’, ‘structural discrimination against mental illness’, ‘stigma encountered in everyday life’, ‘psychological distress associated with stigmatization’, and ‘coping with stigma’. The study contributes to our understanding of the stigma experienced by family members of people with severe mental illness. It is suggested that culturally appropriate multi‐level interventions targeting the general public, health professionals, communities, and family members need to be developed to reduce the harmful influence of associated family stigma.     

Psychosocial interventions for people with a milder dementing illness: a systematic review

INTRODUCTION: Over the last three decades, interest has grown in the use of psychosocial interventions for people with dementia. Empirical studies and systematic reviews have been undertaken on a range of such interventions to examine their effectiveness. However, little account has been taken of the appropriateness of psychosocial interventions for people in different stages of the illness. This raises important questions about the degree to which the research evidence can be generalized for people in the milder and the more severe stages of dementia. This systematic review was undertaken therefore to investigate the effectiveness of psychosocial interventions for people with a milder dementing illness. METHODS: A comprehensive search was undertaken using all the major health care databases, as well as various grey literature sources. For studies to be included in the review, they must have investigated the effect of one or more psychosocial intervention on people with a milder dementing illness, employing a controlled trial design, and measuring outcomes such as cognitive ability, communication, functional performance and well-being. Identified studies were critically appraised, and where suitable for inclusion, data were extracted. RESULTS: Four studies met the final inclusion criteria for the review, and covered three psychosocial interventions: reality orientation, procedural memory stimulation and counselling. No evidence was found for the effectiveness of counselling and procedural memory stimulation on the outcome measures used. However, some evidence was found that reality orientation is effective in improving cognitive ability, with a demonstrable long-term gain using follow-up data. CONCLUSIONS: The review provides some evidence for the use of reality orientation for people in the milder stages of dementia. However, due to the small sample sizes in all the included studies, more research is needed into the effectiveness of psychosocial interventions for this client group. Implications for nursing practice are discussed, and recommendations for future research are set out.     

Interdependence of stroke survivors' recovery and their relatives' attitudes and health: a contribution to investigating the causal effects

PURPOSE: One goal of the study was to test specific hypotheses concerning the interdependence of the stroke survivors' recovery and their caregiving partners' attitudes and health. The other aim was to find an applicable method for investigating causal effects on the rehabilitation of chronically sick persons in longitudinal studies with medium-sized samples. METHOD: The recovery of 81 stroke survivors regarding the physical and mental functioning in everyday life and their caregiving partners' health and attitudes were assessed twice, once after the patients left the hospital and again one year later. We applied the structure equation modeling and the cross-lagged partial correlation analysis (CLPC) for testing causal effects. RESULTS: Particularly stroke victims' cognitive and emotional recovery seems to be influenced by psychosocial factors such as the caregiving partners' acceptance of a post-stroke life-situation. In contrast to this, the research suggests that the patients' recovery regarding physical functioning is not substantially affected by the partners, rather the patients' difficulties with motor functioning influence their partners' health. CONCLUSIONS: Caregivers merit attention as part of rehabilitation interventions. We recommend the CLPC for investigating causal effects in the complex interdependence of chronically sick persons' convalescence and their family members' health and state of mind in medium-sized samples.     

Social and existential alienation experienced by people with long-term mental illness

The aim of this study was to explore how people suffering from long-term mental illness and who live in the community experience their daily lives. The study was based on an ethnographic framework involving participant observations with 23 individuals from two rehabilitation centres and interviews with six women and two men. The observational notes and interviews were recorded, transcribed into the data and analysed based on the phases of hermeneutic interpretation. The process consisted of identifying tentative interpretations that highlighted various impediments that prevent people with long-term mental illness from having an active life. The impediments can also be interpreted as a form of alienation, an interpersonal phenomenon and a consequence due to of the lack of social acceptance towards mental illness. The participants expressed concern about the future and lack of hope. Viewing themselves as being 'odd' is not a symptom of mental illness, but rather evidence of experiencing existential and social alienation not only as a consequence of other people's reactions but also their own negative attitudes towards mental illness and effects of their cognitive dysfunction.     

The compatibility of psychosocial interventions (PSI) and assertive outreach: a survey of managers and PSI-trained staff working in UK assertive outreach teams

In recent years, there has been an increased emphasis on providing psychosocial interventions (PSI) and assertive outreach (AO) for people with severe and enduring mental illness living in the UK. This paper presents the findings of a telephone survey conducted with managers and PSI-trained staff working for AO teams in the Northwest of England. The aim of the study was to gain an insight into staff attitudes regarding the compatibility of PSI and AO. The survey also gathered more general information about the nature of the AO teams and the number of PSI-trained staff working within them. The results indicate that, although PSI-trained staff believe that PSI and AO are compatible, AO is not immune to the barriers to PSI implementation that exist in other service areas. There also appears to be a question regarding the extent to which teams are maintaining fidelity to the original AO model that was outlined by Stein and Test.     

Dissemination of supported employment in Department of Veterans Affairs

The dissemination of complex innovative practices is one of the major challenges of mental health service organizations. Although substantial progress has been made in the development of evidence-based practices for people with severe mental illness, development of approaches for the large-scale dissemination of such practices has lagged. In 2004, the Veterans Health Administration began a national dissemination effort of supported employment (SE). Concomitant with the clinical initiative, a research project was funded to study the factors that promote successful program implementation through an evaluation of the effectiveness and cost-effectiveness of two levels of training in the evidence-based practice of SE. This article reviews the dissemination effort and associated research project. This initiative represents the largest dissemination effort of any psychosocial rehabilitation model to date in any single healthcare system in the United States. We review the dissemination plan, including development of a mentor-trainer system at two intensity levels, regular on-site and telephone training and supervision, ongoing fidelity evaluation, and national outcomes monitoring with a Web-based data collection system.