Support in the community for people with dementia and their carers: a comparative outcome study of specialist mental health service interventions

BACKGROUND: This study aimed to evaluate outcomes for carers receiving the Admiral Nurse Service, a specialist mental health nursing service for carers of people with dementia. In contrast to many community mental health teams, it works primarily with the caregiver, focuses exclusively on dementia and offers continuing involvement, throughout the caregiving career, including emotional support, provision of information and coordination of practical support. METHOD: 104 carers of people with dementia who were interviewed as soon as possible after being referred to a number of Admiral Nurse (AN) services or conventional services in neighbouring areas, and who were re-interviewed eight months later, form the sample (43 AN; 61 comparison). RESULTS: There were no significant differences between groups, controlling for initial score, on the primary outcome measure at follow-up, the 28-item General Health Questionnaire (GHQ) or its sub-scales, apart from anxiety and insomnia, where outcome was better for the AN group (p = 0.038). Follow-up GHQ scores were associated with ratings of past and current relationship quality. There were no differences in survival in the community between the groups. CONCLUSION: Both conventional and AN services are associated with lower distress scores over an eight-month period. Outcome for people with dementia (in terms of institutional placement) is no worse in the AN group, despite the carer focus. Some support is provided for a model of dementia-specialist service which engages with the caregiver and continues involvement for as long as is required, rather than simply carrying out an assessment and referring the person back to social services or primary care.     

Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions

OBJECTIVE: There is a lack of consensus on the identification of seriously mentally ill patients (SMI). This study investigates the external and predictive validity of an operationalized definition for the severity and persistency of mental illness applied to a sample of service users attending a community mental health service. METHOD: The definition is based on the fulfilment of dysfunction (GAF < or = 50) and illness duration (> or = 2 yrs) criteria. The study was conducted with a two-year longitudinal design. External and predictive validity of the SMI definition were assessed against the diagnosis of psychosis. RESULTS: Our data show evidence for an overall high predictive and external validity of the SMI definition and high sensitivity in predicting those with high burden of mental illness. CONCLUSIONS: In order to identify people with high levels of psychiatric burden, the SMI working definition seems to be more useful than that simply based on diagnostic criteria.     

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Dual diagnosis: HIV and mental illness, a population-based study

This is a cross-sectional, population-based (n = 378,710) study using hospital discharge abstract data to determine the relative risk associated with having a dual diagnosis of mental illness and HIV/AIDS. The analysis addresses issues of gender, race, and age, as well as types of mental illness. Persons with a mental illness are 1.44 times more likely to have HIV/AIDS. Women are at increased risk of being dually diagnosed. There are no risk differences by race. Those with a specific diagnosis of substance abuse or a depressive disorder are more likely to have a diagnosis of HIV/AIDS.     

Commentary on "Community mental health care for women with severe mental illness who are parents" - The tragedy of missed opportunities: of missed opportunities: What providers can do

Women and men who meet criteria for psychiatric disorder are likely to be parents. Many go undiagnosed and untreated, putting themselves and their children at risk of poor outcomes. Adults with mental illness may fear disclosing their status as parents; providers may not ask. Practices can be modified to promote the well being of parents with mental illness and their children.     

Poverty and mental health: a qualitative study of residential care facility tenants

The impact of poverty on daily living was assessed for twenty-two mental health consumers using qualitative in-depth interviews. Consumers reported considerable difficulty meeting basic needs, such as clothing, shoes and personal care items. A majority reported running out of money before the end of each month. Respondents used strategies including careful budgeting, borrowing and employment to cope with poverty. Analysis indicated that the poverty experienced by respondents worked directly against participation in meaningful activities and their ability to build and sustain social relationships. Moreover, poverty directly contributed to stigma experienced by respondents. Findings suggest that a failure to recognize poverty as a key mental health policy issue will continue to constrain efforts to facilitate consumer empowerment and social integration.     

Effect of perceived stigmatisation on the quality of life among ageing female family carers: a comparison of carers of adults with intellectual disability and carers of adults with mental illness

Background   Little account has been taken of quality of life (QoL) among family carers of adults with an intellectual disability (ID) and family carers of adults with a mental illness (MI), particularly the female ageing carers' perceived stigma. We explore whether there are differences in the significant predictors of female ageing family carers' QoL between family carers of adults with ID and family carers of adults with MI and aim to examine the effect of these differences in stigma on carer QoL between the two groups.
Methods   A structural survey interview was administered to 350 female family carers supporting persons with ID and 66 female carers supporting persons with MI; the carers were aged 55 years and older, and the interviews were carried between July 2006 and April 2007 at the carers' homes in a county in Taiwan. The survey package contained standardised scales to measure the carer's stigma, social support, QoL and health as well as adult and carer socio-demographic data.
Results   The results highlight that in both groups the ageing female family carers' health and social support were strongly associated with the level of their QoL even though there was also a strong effect of carers' perceived stigma on their QoL. Contrary to previous findings, ageing female family carers of adults with MI had a higher level of QoL compared with the carers of adults with ID. Hierarchical regressions show a stronger effect of perceived stigma on the carer QoL among the family carers of adults with MI than among the carers of adults with ID.
Conclusions   This study suggests that attempts to improve these female older family carers' health and social support must include their lifelong unmet needs in terms of how to cope with the perceived stigma associated with their position.     

Mental health issues for lesbian,gay, bisexual and transgender people: a qualitative study

International research clearly demonstrates that lesbian, gay, bisexual men and women and transgender (LGBT) people experience poorer mental health than heterosexual people. Despite this robust evidence, one important gap in New Zealand is an understanding of the mental health issues of this group. A qualitative research project was commissioned to address this. Data from interviews with 17 key informants and a qualitative online survey completed by 124 LGBT people were thematically analysed. An overarching theme of macro-social environment was identified, along with two other themes: social acceptance and connection experienced by LGBT individuals and the provision of mental health services and other support. These themes were pertinent across the LGBT groupings, but at times in uneven and different ways. In order to develop useful mental health policy and service provision for LGBT people, greater account of social explanations for poor mental health is indicated, along with appropriate mental health service provision.     

Associations of health insurance coverage,mental health problems,and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health

Objective: To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities.

Methods: This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use.

Results: The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use.

Conclusions: Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.     

Development of a specialized psychiatric service for people with learning disabilities and mental health problems: report of a project from Kwai Chung Hospital,Hong Kong

With the promotion of the concepts of normalization and integration, the mental health needs of people with learning disabilities are increasingly being recognized in Hong Kong. The present paper describes the development of a specialized psychiatric unit in Kwai Chung Hospital that was designed to provide mental health care for people with learning disabilities. A hospital‐based system with multidisciplinary input and strong community linkage was adopted to suit the local situation, and this was funded almost entirely by redistributing existing resources. Since the service came into operation, the responses received from patients, carers and other service providers in the community have been highly favourable. This project is important because it signifies a major step forward in the health care of people with learning disabilities in Hong Kong.     

Social factors of sickness absences and ways of coping: a qualitative study of men and women with mental and musculoskeletal diagnoses,Norway

The rate of sickness absence is a serious problem in Norway and Scandinavia as a whole. Musculoskeletal problems are a heterogeneous category, covering a spectrum from a broken back and diffuse muscle pains. Mental diagnoses constitute generally about 25–30% of the total number of the long-term sickness absences. It is thus important to document scientifically how and why participation in nature–culture–health (NaCuHeal) activities may prove beneficial for individuals with long-term illnesses. The purpose of our project is to focus on and to discuss how social factors influence sickness absence. There were two aims of this study: (a) to explore and reveal the absentees' own experiences and perceptions of sickness absence in daily life and (b) to explore and reveal the absentees' own perceptions and experiences of various coping strategies while being on sickness absence. Qualitative method through a pragmatic synthesis of elements of ethnography and grounded theory were used. The sample from the county of Oppland, Norway (n = 30), had a mental or a musculoskeletal diagnosis in accordance with the ICPC-2 medical classification system. In this study, men and women understand and interpret their health situation differently; most men in this sample have become ill due to work-related factors, and for women it seems to be the combined impact of domestic responsibilities and job strain, the so-called double exposure. Health-promoting nature and culture activities refuel their energy levels, which in turn help them to sustain their social network. A combination of various social activities seemed also to be beneficial as long as these activities could be personally chosen within their own time and space. This notion highlights the importance of a lay perspective on the illness experience and its connections to coping strategies. Combined with discussion of sickness absence as a phenomenon, we believe that our findings can contribute to a wider understanding of sickness absence, the complexity behind the outbreak of long-term illnesses and ways of coping in everyday life. This research may add important knowledge and insight, hence increase awareness and understanding of NaCuHeal benefits among health personnel and rehabilitation.