Adults With Mild Intellectual Disabilities’ Experiences of Mental Health Problems: A Qualitative Study Using Interpretative Phenomenological Analysis

Research addressing people with intellectual disabilities’ experiences of mental health problems has mainly focused on the perspectives of family members or professionals, or has been driven by service evaluation. Few studies have sought the views of people with intellectual disabilities about their own mental health experiences. This study explored the experiences of eight adult participants with mild intellectual disabilities who self-identified as having experienced anxiety, depression, and/or psychosis. Participants completed semi-structured interviews and data was analyzed using interpretative phenomenological analysis (IPA). Four superordinate themes emerged: distress, fear and isolation; damaging impact of relationships and people; negative view of self; and the challenge of “getting my sparkle back.” The themes identified in the participants’ accounts of their mental health experiences are discussed in relation to clinical and research implications.     

Impact of services,met needs,and service empowerment on consumer outcomes

The current study examined service characteristics, needs, and outcomes of consumers with severe mental disabilities served in a public mental health setting. The study utilized a longitudinal design with three yearly waves of measurement. Data were obtained from consumer interviews and case manager questionnaires. A model specifying relationships between service characteristics, needs, and outcomes was tested using structural equation modeling. This model incorporated service-related variables pertaining to service amounts, service empowerment, and needs in order to gain a better understanding of factors that mediate service effects and account for mental health outcomes. The model focused on consumers' perspectives, in order to highlight the importance of consumers' opinions about their mental health services and needs. The results suggested that consumers' perceptions that their needs are met were related to better symptomatology and quality of life outcomes. In addition, consumers' perceptions that they had some say in service-related decisions had an indirect effect on mental health outcomes by increasing the likelihood that needs were met according to consumers' perspectives. Results were mixed with regard to the effects of these variables on level of functioning outcomes. Service amount was unrelated to mental health outcomes. Furthermore, service amount was unrelated to consumers' perceptions of needs, suggesting that consumers' views regarding met and unmet needs may not be included sufficiently in decision-making surrounding the provision of services.     

Mental Health Provider Attitudes Toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS)

Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. METHODS: Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. RESULTS: Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. CONCLUSIONS: Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts.     

What carers of family members with mental illness say,think and do about their relative's smoking and the implications for health promotion and service delivery: a qualitative study

Few researchers have explored family carers’ perspectives of smoking by their family members with mental illness, despite smoking rates remaining high for people with mental illness. In-depth qualitative interviews with twelve South Australian family carers explored their experiences and views of providing care for people with mental illness who smoke. Data were analysed thematically. Around the central theme of the caring role within the context of mental illness and smoking, were three interrelated themes: (1) responsibility; (2) accommodation; and, (3) dissonance. Carers struggled physically, philosophically and emotionally with perceived responsibilities involving their family member's smoking. They felt isolated and asserted as there was limited support from service providers to assist them. Carers are important agents within the person's immediate environment who could potentially help them to improve their smoking cessation success. Community services aiming to support smoking cessation support for this population need to incorporate the role of family carers.     

Legislative policy to support children of parents with a mental illness: revolution or evolution?

In 2014, a Mental Health Act was introduced in Victoria, Australia which mandated clinicians to recognize and support consumers’ children. Interviews were conducted with 11 clinical adult mental health professionals about their views and experiences of the introduction of the Act and its impact on their practices. Interviews revealed that sections of the Act relating to consumers’ children were not promoted within organizations and did not result in revolutionary practice change. Instead, practice development staff within organizations were viewed as the main drivers of practices to support consumers’ children. Suggestions are made for enhancing the impact of legislation to promote practice change.     

Practitioner Attitudes Toward Evidence-based Practice: Themes and Challenges

Abstract The widespread successful implementation of evidence-based practices (EBPs) into community mental health settings will require a thorough understanding of practitioner attitudes toward these approaches. This study reports on the results of two community mental health practitioner focus groups investigating attitudes toward EBPs, perceived challenges to implementing EBPs, and recommendations for researchers interested in facilitating EBP use in community settings. The participants were child and adolescent mental health professionals (N=19) from two community mental health centers. The focus groups were taped, transcribed and coded for themes. Major themes included concerns regarding the applicability of some research supporting EBPs, a desire for a greater emphasis on the therapeutic relationship, and the need for flexibility within treatment protocols. Themes are discussed within the context of the recent movement toward implementing EBPs in community settings and recent research related to focus group themes.     

Adoption of Evidence-Based Practices in Community Mental Health: A Mixed-Method Study of Practitioner Experience

This mixed method study examined practitioners as they adopted four evidence-based practices (EBPs) in a community mental health center. In-depth semi-structured interviews; a measure of EBPs attitudes; and a final focus-group were used over a 2-year study period to assess 14 mental health practitioners on one immersion team. The framework for data collection was adapted from organizational theories that view culture and climate as mediating factors. Analysis of practitioner themes demonstrated that there were facilitating and impeding factors in the adoption process. Practitioners reported positive changes in their individual competency but two years was inadequate for training on four EBPs. Involvement of agency administration and consistent supervision were regarded by practitioners as crucial to successful adoption of EBPs.     

Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children’s Mental Health Services: A Discrete Choice Conjoint Experiment

Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children’s mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.     

Mental health literacy,treatment preferences,and barriers in Salvadorian parents

Parents are pivotal in accessing treatment for their children, yet we know little about youth mental health literacy in parents. This is particularly the case in developing countries such as El Salvador, where good parent mental health literacy about children’s psychological problems may play a pivotal role in being able to navigate treatment access in an already underfunded and poorly resourced system. This study examined parent mental health literacy about child anxiety disorders in El Salvador; parent perceptions and preferences for treatment-seeking; and perceived barriers to accessing mental health treatment. Parents (N?=?271) of youth aged 4–17 in El Salvador answered questions about three vignettes depicting different childhood anxiety disorders. The majority of parents did not recognize specific youth anxiety disorders. Less than 5% of parents identified the vignettes as a mental health problem, most commonly attributing symptoms to personal weakness or stress. Parents endorsed generally positive views about seeking treatment, preferring non-pharmacological mental health treatments, informal support from grandparents and religious leaders, and handling the problem personally. The most common barriers to treatment-seeking were related to cost and service availability. Improving parent mental health literacy may assist with treatment-seeking. Results have implications for mental health policy decisions and service implementation in El Salvador.     

Implementing evidence-based practices for people with severe mental illness

Persons with severe mental illnesses (SMI) often lack access to effective treatments. The authors describe the Implementing Evidence-Based Practices (EBPs) Project, designed to increase access for people with SMI to empirically supported interventions. The EBP Project aims to improve access through development of standardized implementation packages, created in collaboration with different stakeholders, including clinicians, consumers, family members, clinical supervisors, program leaders, and mental health authorities. The background and philosophy of the EBP Project are described, including the six EBPs identified for initial package development: collaborative psychopharmacology, assertive community treatment, family psychoeducation, supported employment, illness management and recovery skills, and integrated dual disorders treatment. The components of the implementation packages are described as well as the planned phases of the project. Improving access to EBPs for consumers with SMI may enhance outcomes in a cost-effective manner, helping them pursue their personal recovery goals with the support of professionals, family, and friends.     

Public Mental Health Care Utilization by Older Adults

The present study examined the extent to which older adults began public mental health treatment throughout Texas in 1999, the types of services they used, and how they compared on demographic and clinical variables to younger consumers. Notwithstanding recent policy and related developments, older adults were found to use public mental health services at substantially low rates, as in past decades. Significantly, older consumers tended to be relatively healthy and independent. Among younger and, even more so, older consumers, there were relatively high proportions of rural residents and minorities, groups previously found to be unlikely to utilize private mental health services. Overall, the findings urge that greater attention be devoted to public mental health outreach and service delivery with the elderly, and raise the question of what role the public mental health system should have in nursing homes and other long-term care settings.     

‘The challenges of sharing information when a young person is experiencing severe emotional difficulties’: implications for schools and CAMHS

Background

Supporting the education of children and young people with complex emotional mental health difficulties requires schools to have knowledge of their needs. Exchanging information about less visible mental health difficulties is, however, known to be complex. Exploring the perceptions of young people experiencing problems can explicate some of this complexity and identify solutions. Yet their views are rarely given credence in this context.

Methods

The findings were derived from a broader qualitative study exploring the school experiences of young people, aged 14–16 years, identified by CAMHS as having severe emotional difficulties. Their parents’ and teachers’ perceptions were also explored. Data were collected via semistructured interviews and analysed using thematic analysis.

Results

Findings demonstrated that young people experiencing emotional difficulties need to feel safe about exchanging private information pertaining to their mental health. Teachers having a basic knowledge of mental health promoted their safety as this ensured confidentiality. Participants reported that CAMHS practitioners needed to be more proactive regarding the practicalities of exchanging information.

Conclusions

Arguably, teachers need to have basic knowledge of mental health and schools need clearer mental health confidentiality guidance. CAMHS also have responsibility in identifying more information exchange mechanisms and young service users and parents can play a part in this.     

The need for trauma assessment and related clinical services in a state-funded mental health system

Previous data show that trauma is highly prevalent in public sector consumers and is associated with severe mental illness and high service use costs. Despite this, evidence suggests that trauma victims tend to go unrecognized and to receive inadequate mental health services. We surveyed all facilities (6 inpatient, 17 outpatient) within the South Carolina Department of Mental Health about their current services for trauma victims. Results indicate that most public mental health facilities do not routinely evaluate trauma history in an adequate manner or provide specialized trauma-related services. Implications and future directions are addressed, including the current trauma initiatives of many state-funded systems.     

A multi-perspective survey of mental health consumer needs

Conclusions There is extensive evidence that perspectives on mental health consumer needs vary widely between consumers and other stakeholders-administrators, practitioners, and family members. Traditional methods of determining mental health consumer needs, based on professional input only, have inhibited program development. While progress has been achieved when shared goals have been identified, it has also been inhibited by a lack of known areas of consensus between stakeholder groups.Surveys provide a cost-effective step toward documenting shared views from stakeholders who have the greatest stake in influencing the size and direction of the mental health service system. Identifying shared views is necessary to coordinate stakeholder efforts. The most encouraging result of the surveys is that there are many areas of consensus and thus the potential exists for the stakeholders to coordinate their efforts toward shared goals to better meet important consumer needs by prioritizing services, improving practitioner training, and coordinating advocacy.     

Mental health of primary family caregivers with children with intellectual disability who receive a home care programme

Background The aims of the present study were to describe the change in mental health over time in a group of family caregivers with a child with intellectual disability (ID) and to explore the effect of a home care service on the psychological well‐being of the caregiver. Methods The authors identified children with ID who received home care services in the southern part of Taiwan. A total of 46 primary family caregivers (age range = 21–65 years) were recruited for the present study. The study design was a quasi‐experimental follow‐up analysis. The children with ID and their families regularly received home‐based care. The 12‐item version of the Chinese Health Questionnaire (CHQ) was used to evaluate the subjects’ mental health at three time points: (1) baseline, (2) 3 months and (3) 9 months. The validity and reliability of the CHQ have been tested in Taiwan. The Generalized Estimating Equation was used to conduct longitudinal data analyses. Results The authors found that the family caregivers showed a significant improvement in their mental health by month 9. Conclusions The preliminary findings of this study accredit the effect of home care services and suggest that home care services are necessary for family caregivers.     

Beneficence vs. Obligation: Challenges of the Americans with Disabilities Act for Consumer Employment in Mental Health Services

Involvement of mental health service consumers in the provision of mental health services is a growing model in community mental health. It is, however, a complicated issue, made ever more so by the passage of the Americans with Disabilities Act. In this ethnographic case study, we seek to explore the changes one social services agency has made to adjust to the requirements of the ADA and the impact of these changes on their consumer employees. Our results indicate potential for positive progress as a result of the ADA, but also unexpected pitfalls as organizational cultures change as well.     

A Survey of Mental Health Consumers' and Family Members' Involvement in Advocacy

As the service delivery system is redesigned,the involvement of consumers and family members inmental health policy-making is essential. Advocacy is away for them to have an impact on policy ordecision-making. To determine the extent of their participationin advocacy efforts, consumers and family members weresurveyed by other consumers and family members abouttheir involvement in advocacy and mental healthcare reform. Although more family than consumersreported receiving mental healthcare reform information,both groups had difficulty understanding thisinformation. Consumers were more likely to have received information from a mental health professionalwhile family were more likely to have receivedinformation from an advocacy group. Lack of economicresources and communication problems were the most often cited barriers to advocacy for consumers.Strategies are suggested for how to increase involvementof consumers and family in advocacy efforts. Thelimitations of conducting a state-wide study withconsumers and family as data collectors isdiscussed.     

Associations among acculturation stress,mental health literacy,and mental health of married immigrant women in Korea

Approximately one in 12 marriages in Korea is an international marriage between a Korean man and a foreign woman. Women immigrating by international marriage have often reported that they experience difficulties adapting to their Korean family and culture. This study was conducted to provide basic information for developing mental health programs for immigrant women in Korea by investigating their acculturation stress, mental health literacy, and mental health. A sample of 209 immigrant women completed scales measuring these three constructs, which correlation analyses revealed to be significantly interrelated. Immigrant women’s acculturation stress was significantly related to number of marriages, husbands’ number of marriages, original country, reason for marriage, and occupation. Mental health was significantly associated with women’s original country, reason for marriage, education, and house income. Mental health literacy was significantly related to nationality. This research provides an important evidence base for developing multicultural education, services, and programs.     

Attitudes toward mental health services: Age-group differences in Korean American adults

The present study examined the attitudes toward mental health services held by younger (aged 20–45, n = 209) and older (aged 60 and older, n = 462) groups of Korean Americans. Following Andersen's (1968; A behavioral model of families’ use of health service, Center for Health Administration Studies) behavioral health model, predisposing (age, gender, marital status and education), need (anxiety and depressive symptoms) and enabling (acculturation, health insurance coverage and personal experience and beliefs) variables were considered. In the mean-level assessment, younger and older adults were found to hold a similar level of positive attitudes toward mental health services. In the multivariate analysis, culture-influenced beliefs were shown to have a substantial contribution to the model of attitudes toward mental health services in both age groups. The belief that depression is a medical condition was found to be a common predictor of positive attitudes across the groups. In the older adult sample, more negative attitudes were observed among those who believed that depression is a sign of personal weakness and that having a mentally ill family member brings shame to the whole family. Our findings show that older adults are not only more subject to cultural misconceptions and stigma related to mental disorders, but also their attitudes toward service use are negatively influenced by the cultural stigma. The findings provide important implications for interventions targeted to improve access to mental health care among minority populations. Based on the similarities and differences found between young and old, both general and age-specific strategies need to be developed in order to increase effectiveness of these programs.