Oral health problems and support as experienced by people with severe mental illness living in community‐based subsidised housing – a qualitative study

The purpose of this study was to explore how persons with severe mental illness (SMI) experience oral health problems (especially dry mouth), and weigh the support they received in this regard from professionals and staff at community‐based congregate housing through a controlled intervention programme. Oral health problems and dry mouth are found in association with apathy and indifference, cognitive deficits, and long‐term medication with psycho‐pharmacological drugs. The present study describes the results from one part of a longitudinal intervention programme, which sought effective ways of mitigating dry mouth through increased support with oral health problems. This part consists of 67 informal interviews with ten participants in two community‐based urban housing projects between November 2006 and June 2007, with a follow‐up session in December 2007. Content analysis of the results yielded five categories: The shame of having poor dental health, history of dental care, experiences of self‐care, handling of oral health problems, and experiences of staff support. Poor oral health caused shame and limited participation in social activities. Participants avoided oral health issues by such circumventions as denial of a tooth ache or dental infections, or postponing oral problems with the hope that they would die away. Offers of support were frequently resisted because of unsatisfactory prior encounters with dental professionals and staff. Our findings suggest that self‐care needs to be facilitated in an unobtrusive manner with minimal staff involvement, and clients should be referred to dental care providers experienced in treating people with SMI.     

Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review

Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing-related independent variables and health-related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Twenty-nine studies met the suitability criteria, of which 14 reported healthcare utilisation outcomes; 12 examined mental status outcomes; and 9 reported quality-of-life outcomes. The findings of the review suggest that there is good evidence that housing interventions benefit the homeless population; however more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasising longitudinal designs that focus on participant retention and by implementing matched control groups or randomised interventions to strengthen internal validity. Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimises harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.     

Outcome assessments used in studies examining the effect of prescribed exercise interventions for people living with severe mental illness,a scoping review

BackgroundExercise interventions are increasingly incorporated in the management of severe mental illness; however, best practice screening and outcome monitoring for this unique population are yet to be established. This review aims to explore assessment measures reported in publications of exercise interventions in severe mental illness.MethodsA scoping review was implemented with a structured search of Embase, PubMed, Medline, PsychINFO, Scopus, and SportDiscus using terms related to severe mental illness, exercise, and health. Studies were included if they incorporated an exercise intervention for people with severe mental illness and measured physical and/or mental health outcomes. Studies were analysed for population, assessment measures, and methodological quality.Results1832 studies were identified and following screening and full text review 38 studies involving 2854 participants were included for analysis, primarily psychotic (n = 13), depressive disorder (n = 9) and mixed severe mental illness populations (n = 13). The most frequently reported health domains and assessment measures used included body composition (weight and body mass index), symptom severity, cardiorespiratory fitness (volume of oxygen consumption), cardiometabolic health (blood pressure and metabolic blood sampling), and quality of life. Methodological quality varied with 13 determined as good, 12 fair, and 13 poor.ConclusionThe review identified domains and assessment tools frequently reported in the exercise and severe mental illness literature. However, given the heterogeneity and scarcity of the research, along with lack of reporting of sufficient detail, best-practice clinical recommendations are still limited. There remains a need to establish best practice assessment and monitoring procedures within exercise interventions in severe mental illness.     

Developing a worker role: Stories of four people with mental illness

Background and Aims:  Work plays an important role in adults' well-being, irrespective of health status. Vocational rehabilitation can enable people with mental illness to return to open employment. A narrative approach was used to explore how individuals with a mental illness made sense of their work-related experiences.
Methods and Results:  Four Clubhouse members in open employment for at least 6 months completed in-depth, semistructured interviews, from which narratives were created to reveal events, significant persons and actions that assisted these individuals to resume work. Woven into the participants' stories were four 'impelling forces' contributing to a sense-of-self as a worker. These impelling forces were: support from significant others, the personal meaning of work, experiences within the Clubhouse programme, and the ongoing struggle with illness. Implications for occupational therapy practice are discussed.
Conclusion:  The findings of this study urge occupational therapists and others to provide opportunities to provide on-going support to people with a mental illness who seek paid employment.     

A new patient focused index for measuring quality of life in persons with severe and persistent mental illness

The quality of life in persons with severe and persistent mental illness is often poor. Most treatment programmes have the goal of increasing quality of life. Unfortunately, existing methods to assess qualtiy of life are cumbersome and oriented towards research rather than clinical settings. This study describes preliminary steps in the development, testing and application of a new patient focused index for measuring quality of life in persons with severe mental illness. The Quality of Life Index for Mental Health (QLI-MH) differs from existing instruments in that it is based on an easy to use, self-administered questionnaire that assesses nine separate domains that together encompass quality of life. Each domain can be individually weighted depending on its relative importance to the patient. Different parts of the instrument solicit information from the patient, the primary clinician and, when available, the family. The instrument and its scoring system address limitations of previous approaches to quality of life measurement.     

Food skills assessment tools for people with a mental illness

The present review defines food skills assessment tools and explores reasons for assessing food skills. The purpose of the present review was to consider tools appropriate for assessing food skills in people with a mental illness. Six assessment tools met the selection criteria: (i) the Rabideau Kitchen Evaluation, Revised; (ii) the Moss Kitchen Assessment; (iii) the Kitchen Task Assessment; (iv) the Functional Needs Assessment Program for Chronic Psychiatric Patients (Nutritional Management Program); (v) the Routine Task Inventory; and (vi) Assessment of Motor and Process Skills, 2nd edition. Each assessment tool was reviewed for criteria including strengths and weaknesses, the original target population, psychometric properties, scoring system and training requirements for the interviewer. The review concluded that food skills in people with a mental illness can be measured in many different ways; therefore, the precise reason for making the assessment should be established prior to selection of the assessment tool to ensure the most suitable method of assessment is chosen.     

Impact of a population‐wide mental health promotion campaign on people with a diagnosed mental illness or recent mental health problem

Objectives : To determine the impact of the Act‐Belong‐Commit mental health promotion campaign on people with a diagnosed mental illness or who had sought professional help for a mental health problem in the previous 12 months. Method : In 2013 and 2014, 1,200 adults in Western Australia were interviewed by telephone. The questionnaire measured campaign reach, impact on beliefs about mental health and mental illness and behavioural impact. Results : Campaign impact on changing the way respondents thought about mental health was significantly higher among those with a mental illness or who had sought help (41.4% vs 24.2%; p<0.001), as was doing something for their mental health as a result of their exposure to the campaign (20.5% vs 8.7%; p<0.001). Conclusions : The campaign appears to empower people with a mental illness or who recently sought help to take steps of their own to enhance their mental health.     

The dietitians challenge: the implementation of nutritional advice for people with diabetes*

The evidence base for current nutritional recommendations has been extensively reviewed on behalf of the European Association for the Study of Diabetes (EASD) 1998 and the American Diabetes Association (ADA) 2002. The nutrition Sub‐Committee of Diabetes UK is in general agreement with those recommendations. This paper provides consensus‐based recommendations that emphasize the practical implementation of nutritional advice for people with diabetes, and describe the provision of dietetic services required to provide the information. Important changes from previous Diabetes UK (previously British Diabetic Association Diabet. Med. 9 , 189) recommendations include greater flexibility in the proportions of energy derived from carbohydrate and monounsaturated fat, further liberalization in the consumption of sucrose, more active promotion of foods with a low glycaemic index, and greater emphasis on the provision of nutritional advice in the context of wider lifestyle changes, particularly physical activity. Monounsaturated fats are now promoted as the main source of dietary fat because of their lower susceptibility to lipid peroxidation – and consequent lower atherogenic potential. Consumption of sucrose for patients who are not overweight can be increased up to 10% of daily energy derived from carbohydrate provided that this is eaten in the context of a healthy diet and distributed throughout the day. The role of the dietitian is outlined in facilitating lifestyle changes and evidence is presented for the effectiveness of advice provided by trained dietitians. The increasing evidence for the importance of good metabolic control and the growing requirement for measures to prevent Type 2 diabetes in an increasingly obese population will require major expansion of dietetic services if the standards in National Service Frameworks are to be successfully implemented at local level.     

Two-year outcomes of fee-for-service and capitated medicaid programs for people with severe mental illness

OBJECTIVE: To examine the effects of two models of capitation on the clinical outcomes of Medicaid beneficiaries in the state of Colorado. DATA SOURCE: A large sample of adult, Medicaid beneficiaries with severe mental illness drawn from regions where capitation contracts were (1) awarded to local community mental health agencies (direct capitation), (2) awarded to a joint venture between local community mental health agencies and a large, private managed behavioral health organization, and (3) not awarded and care continued to be reimbursed on a fee-for-service basis. STUDY DESIGN: The three samples were compared on treatment outcomes assessed over 2 years (total n = 591). DATA COLLECTION METHODS: Study participants were interviewed by trained, clinical interviewers using a standardized protocol consisting of the GAF, BPRS, QOLI, and CAGE. PRINCIPAL FINDINGS: Outcomes were comparable across most outcome measures. When outcome diffrences were evident, they tended to favor the capitation samples. CONCLUSIONS: Medicaid capitation in Colorado does not appear to have negatively affected the outcomes of people with severe mental illness during the first 2 years of the program. Furthermore, the type of capitation model was unrelated to outcomes in this study.     

Registering concern: the case of primary care registers for people with severe and enduring mental illness

As the focus of mental health care has shifted from the hospital to the community, so the importance of effectively targeting resources on those with the greatest need has become paramount. One approach to identifying and targeting people deemed to have severe and enduring mental health problems is the establishment of mental health case registers at primary care level. This paper raises a number of conceptual issues associated with these registers and, on the basis of the available literature, offers suggestions to guide those who are contemplating their introduction.     

A review of mental health literacy in Singapore

ABSTRACT

Mental health is a major concern throughout the world. The lifetime prevalence of mental health problems in Singapore for those aged 18 years and above was reported to be 12%. However, studies on mental health literacy are relatively scarce in Singapore. The aim of this paper is to provide a topical review of local studies on mental health literacy, people’s knowledge of, and attitude toward mental illness, and beliefs about mental health treatment. A narrative review of studies on mental health literacy in Singapore covering the period from 1995 to 2016 highlights the findings from various local studies about attitudes toward mental illness, belief about the causes, and help-seeking behavior. Findings revealed that many lay people are unable to recognize different types of mental disorders. Negative attitudes toward mental illness that hinders individuals from seeking professional treatment, and help-seeking, are the common themes that emerge from the findings. Health professionals have differing views about the causes and treatment of mental disorders. Findings also revealed that treatment seeking and attitudes and beliefs toward mental illness are related to mental health literacy. Implications for promoting mental health literacy are provided.     

Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis

An expansive body of research has investigated the experiences and adverse consequences of internalized stigma for people with mental illness. This article provides a systematic review and meta-analysis of the extant research regarding the empirical relationship between internalized stigma and a range of sociodemographic, psychosocial, and psychiatric variables for people who live with mental illness. An exhaustive review of the research literature was performed on all articles published in English that assessed a statistical relationship between internalized stigma and at least one other variable for adults who live with mental illness. In total, 127 articles met the inclusion criteria for systematic review, of which, data from 45 articles were extracted for meta-analyses. None of the sociodemographic variables that were included in the study were consistently or strongly correlated with levels of internalized stigma. The review uncovered a striking and robust negative relationship between internalized stigma and a range of psychosocial variables (e.g., hope, self-esteem, and empowerment). Regarding psychiatric variables, internalized stigma was positively associated with psychiatric symptom severity and negatively associated with treatment adherence. The review draws attention to the lack of longitudinal research in this area of study which has inhibited the clinical relevance of findings related to internalized stigma. The study also highlights the need for greater attention on disentangling the true nature of the relationship between internalized stigma and other psychosocial variables.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.     

重性精神疾病患者家庭儿童发展的研究现况

父母患有重性精神疾病的儿童是一个很大的群体,他们具有和常人不同的遗传基础和环境因素,是精神问题的高风险人群。但是,由于一些保护性因素的存在,仍然有许多儿童并未出现不利后果。儿童青少年不利结果常常是父母精神疾病与各种因素相互作用的结果,其影响机制是多层面的,包括广泛的气质性/遗传性与心理社会因素。已有的证据表明,针对父母有精神疾病的儿童进行干预能降低罹患风险。本文通过梳理文献,综述了国内外研究成果,提出了现有研究的局限及未来基于中国文化背景下的研究主题。