Promoting mental health through multidisciplinary care: service users' experience in Ireland

Irish mental health policy identifies that mental health services should be provided in local communities by community mental health teams where several health professionals play a key role. In Ireland, recent reports indicate that the number of fully staffed multidisciplinary teams is low with potential negative consequences for the breadth and quality of care provided to service users. Limited research has been conducted from the perspective of service users. This research sought to examine service users' experiences of receiving multidisciplinary care in the community. Ten community mental health services nationally were surveyed comprising a sample of 97 service users. The results indicated that participants did not have access to the multidisciplinarity advocated in European policy and there was overreliance on the medical model of treatment. Furthermore, the results indicated that participants had little involvement in making decisions about their treatment care.     

From Principles to Practice: A Study of Implementation of Supported Housing for Psychiatric Consumers

In the post-deinstitutionalization era, supported housing has emerged as a housing and service approach considered most conducive to the goal of consumer empowerment and community integration. Although prior research found beneficial effects of supported housing, little empirical work has been done on identifying the gaps between the principles and practice of supported housing. Using multiple data sources on 27 supported independent living (SIL) programs for psychiatric consumers in a large metropolitan community, this paper examines the extent to which these programs are implemented in accordance with supported housing. Findings suggest consistency with as well as deviation from the supported housing approach in regard to consumer choice, typical and normalized housing, resource accessibility, consumer control and provision of individualized and flexible support. This study suggests methods for assessing housing programs for psychiatric consumers along these domains. Implications for the development of housing programs that promote consumer empowerment and community integration are discussed.     

Housing for people with mental illness: update of a report to the President's New Freedom Commission

A significant barrier to participation in community life for people with serious mental illness is the lack of decent, safe, affordable, and integrated housing of their choice linked with supportive services. The nation's affordable housing and mental health systems have historically failed to address consumers' housing needs and choices. The lack of housing has resulted in disproportionately high rates of homelessness and chronic homelessness. The author summarizes these issues, which were examined by the Subcommittee on Housing and Homelessness of the President's New Freedom Commission, and discusses the subcommittee's recommendations to end chronic homelessness among people with mental illness, expand access to affordable housing resources for consumers, and promote evidence-based practices. There has been uneven progress nationwide in ameliorating the widespread and multidimensional housing and homelessness problems that were exposed in the subcommittee's paper. The permanent supportive housing model, including "housing first" approaches, has proven effective in preventing and ending homelessness among consumers, but efforts to expand the supply are hampered by significant reductions in federal funds for housing. State and local mental health systems are also struggling to re-configure service system resources to better address housing and homelessness issues. Apparent reductions in chronic homelessness will be short-lived unless affordable housing policies and mental health services are reoriented to both prevent and end homelessness for people with mental illness.     

Demonstrating Translational Research for Mental Health Services: An Example from Stigma Research

In seeking to understand how the goal of providing efficient and effective mental health services can best be attained, services researchers have developed principles and methods that distinguish it from other research approaches. In 2000, the National Institute of Mental Health called for translational research paradigms that seek to expand the conceptual and methodological base of mental health services with knowledge gained from basic behavioral sciences such as cognitive, developmental, and social psychology. The goal of this paper is to enter the discussion of what is translational research by illustrating a services research program of the Chicago Consortium for Stigma Research on mental illness stigma. Our research strives to explain the prejudice and discrimination that some landlords and employers show toward people with mental illness in terms of basic research from social psychology and contextual sociology. We end the paper with a discussion of the implications of this research approach for the very practical issues of trying to change mental illness stigma.     

Creating an innovative youth mental health service in the United Kingdom: The Norfolk Youth Service

Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and “youth‐friendly” service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social‐recovery oriented, evidence‐based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth‐oriented.     

Permanent and stable housing for individuals living with a mental illness in the community: a paradigm shift in attitude for mental health nurses

The provision of appropriate housing for individuals with a mental illness has been recognized by a number of researchers as a means to enhance effectiveness of treatment and rehabilitation services, to maintain treatment gains, and to decrease community opposition to deinstitutionalization. Whether community-based services, which are now meant to be the focus of treatment, are successful or not is crucially related to the nature and availability of accommodation. This paper argues a case for change in the current philosophical basis of, and services provided by, mental health professionals and agencies that are charged with the responsibility of meeting the housing needs of consumers of mental health services. This change, it is contended, needs to be to an approach that is more flexible, more supportive of the consumer, and in which the consumers are empowered to make decisions and choices about their housing needs.     

A participatory benchmarking strategy for describing and improving supportive housing

This paper describes a participatory research project conducted to document good practice in the delivery of supportive housing programs. Stakeholders in a local mental health housing system in Toronto, Ontario worked collaboratively to develop 40 service benchmarks for supportive housing programs and to recommend practices for achieving these benchmarks. The findings are discussed in terms of their implications for the delivery of supportive housing and strategies for improving these programs.     

Community Integration in the Early Phase of Housing Among Homeless Persons Diagnosed with Severe Mental Illness: Successes and Challenges

The present investigation used qualitative methods to explore the response to housing and experience of community integration of formerly homeless individuals diagnosed with severe mental illness recently housed in both independent and staffed residential settings. Findings indicate that entering into housing after a long period of homelessness is associated with improvements in community integration for most individuals diagnosed with severe mental illness. However, for a meaningful minority, the adaptation to housing may also be associated with challenges that can complicate the integration process. Implications of findings are discussed in the context of how best to tailor programs to meet the complex needs of persons diagnosed with severe mental illness and to maximize community integration.     

Recovery from schizophrenia and the role of evidence-based psychosocial interventions

Recovery is the new vision for mental health services, in which two definitions of recovery dominate. Firstly, recovery is an outcome; research suggests that many people with serious mental illness learn to cope with their disabilities so they can achieve major life goals related to independent living. Secondly, recovery is a process; it reintroduces such important values as hope, empowerment and goal orientation into the service system. Both definitions have data that support its assertions, suggesting that an integration of the two offers the most complete and effective picture of recovery. Psychosocial interventions integrated with psychopharmacological strategies have been shown to most effectively help individuals recover. Effective interventions are those that are evidence based and include, illness management, supported employment, assertive community treatment, services to families and dually diagnosed services.     

Epidemiologic data and planning mental health services

The Epidemiologic Catchment Area Program (ECA) is the most comprehensive community and institutionalized epidemiologic data base currently available for mental health service planning. In this report, the authors compare the ECA with a previous community survey used to plan mental health services--the Stirling County Study--in terms of conceptual framework, research design, results and implementation of service planning. Familiarity with the Stirling County Study can inform users of ECA data regarding the strengths and weaknesses of the ECA data for health services research.     

Promoting Healthy Organizational Partnerships and Collaboration Between Consumer-run and Community Mental Health Agencies

Community mental health agencies (CMHAs) and consumer-run agencies (CRAs) both provide critically important services to persons with severe psychiatric disabilities. Emerging research has begun to support the effectiveness of the CRA approach, a newer service delivery mechanism. However, collaboration between the two service systems, when it occurs, is often problematic. This article briefly identifies the core features of CRAs, discusses their potential for collaboration with CMHAs, and suggests ways to promote healthy organizational partnerships between the two based upon the model proposed by Gidron and Hasenfeld [(1994) Nonprofit Management & Leadership, 5(2), 159–172]. Salient collaboration theories are reviewed and barriers to collaboration are discussed. Finally, implications for mental health practice and future research directions are identified.John Q. Hodges, Ph.D., is assistant professor of social work at the University of Missouri, Columbia. His research interests include mental health consumer-run services, consumer perspectives on the mental health service system, homelessness, and severe mental illness.Eric R. Hardiman is assistant professor of social welfare at the University at Albany, State University of New York. His research interests include mental health service utilization, consumer-operated services, peer support, and psychiatric recovery.     

Assertive community treatment in the Netherlands: a randomized controlled trial

OBJECTIVE: Assertive community treatment is rapidly implemented by many European mental health services, but recently the evidence base has been questioned. Positive results of randomized trials in the USA were not replicated in the UK. The question is whether the UK findings are representative for other European countries with modern mental health services. METHOD: Open randomized controlled trial of long-term severely mentally ill patients [Health of the Nation Outcome Scales (HoNOS) total score >or=15], assigned to assertive community treatment (n = 59) or to standard community mental health care (n = 59). Primary outcome: sustained contact; housing stability and admission days. This trial is registered as an International Standard Randomized Clinical Trial, number ISRCTN 11281756. RESULTS: Assertive community treatment was significantly better in sustaining contact with patients, but not in reducing admission days. No differences in housing stability, psychopathology, social functioning or quality of life were found. CONCLUSION: The results are in agreement with UK studies. However, the sustained contact potential of assertive community treatment is important, as too many patients are lost in standard care.     

A partnership model of early intervention in psychosis programme--a Canadian experience

Aim: To describe how a new partnership model of early intervention in psychosis, early intervention in psychosis (EIP) programme delivery in Canada attracted the interest of the community and acquired government funding. Methods: The process by which a few individuals used a conceptual framework of integrated, collaborative, flexible and recovery focused principles to engage community partners and attract government funding is described. Results: The establishment of a small EIP programme and its expansion to a regional programme serving an area of 20 000 square kilometers and a population of approximately 500 000 people were achieved. A programme specific logic prototype was developed. A synergy of public, private and academic services emerged with an infrastructure for ongoing cohesiveness and productivity. Annual clinic visits increased from 641 in 2002 to 1904 in 2007 and annual new patients enrollments grew from 46 to 128 within the same period. Staffing grew from an interdisciplinary staff of 1.5 full‐time equivalent (FTE) to the current 10.0 FTE. Conclusions: A carefully orchestrated programme organization that is inclusive rather than exclusive can produce a balance of evidence‐based best practices in client focused service, community mental health integration and academic productivity.     

Barriers to Providing Effective Mental Health Services to Asian Americans

Using the research framework recommended by L. Rogler, R. Malgady, and D. Rodriguez (1989), the current paper examines the barriers to providing effective mental health services to Asian Americans. Beginning with the recognition that Asian Americans consists of numerous heterogeneous subgroups, the issue of the stereotype of Asian Americans as the model minority was also discussed. The primary focus of the paper is on Stages 2, 3, and 4 within the Rogler et al. (1989) model and the identification and discussion of cultural factors that hinder the delivery of mental health services to Asian Americans. The paper is therefore organized into these three sections: (a) help-seeking or mental health service utilization, (b) evaluation of mental health problems, and (c) psychotherapeutic services. In each of the sections, not only are the barriers to delivery of effective mental health services discussed but so are the research and methodological problems as well as some directions for future research. This critical review of the literature has been prepared with the goal of serving as a blueprint for us to pursue rigorous but relevant research to identify and reduce these cultural barriers to providing effective mental health services to Asian Americans.     

Introducing a Recovery Education Centre for Adults Experiencing Mental Health Challenges and Housing Instability in a Large Urban Setting

The Supporting Transitions and Recovery (STAR) Learning Centre is a Recovery Education Centre designed to support housing tenure and community integration among people experiencing mental health challenges and housing instability in a large urban setting. Grounded in principles of emancipatory adult education, and user involvement in program design and delivery, the Recovery Education Centre supports student empowerment, and strengthens key domains of individual vulnerability to homelessness. The Centre can complement traditional mental health services and foster service provider reflexivity, confronting individual and institutional discrimination towards this population.     

Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing

The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient’s ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO.     

Suicide in the homeless within 12 months of contact with mental health services

Background Suicide prevention is a health service priority. Homeless mental health patients present a challenge to services because of their complex health and social needs. Aims To establish the numbers of homeless patients in contact with services who die by suicide; to describe their suicide methods and their social and clinical characteristics including aspects of clinical care. Method A national clinical survey based on a 4-year (1996–2000) sample of people in England and Wales who died by suicide. Detailed data were collected on those who had been in contact with mental health services in the year before death. Results A total of 131 individuals who died by suicide were reported to have been homeless at the time of death—3% of all suicides by psychiatric patients, over 30 per year. Hanging was the most common cause of death. The most frequent diagnosis was schizophrenia. Around half were in-patients at the time of death. Social and clinical risk factors for suicide were common, including drug and alcohol misuse, and recent suicidal ideas and behaviour. Despite this, their clinical care was characterised by disengagement from services as a result of missed contacts, self-discharge, lack of follow-up and lack of key worker. Conclusions In order to reduce the number of deaths by suicide in those who are homeless and mentally ill, improvements in in-patient safety and engagement in the community are needed. This may be achieved through assertive community treatment, dual diagnosis services, and dedicated community mental health teams.     

Consumer and Family Views on Evidence-Based Practices and Adult Mental Health Services

Evidence-based practice (EBP) is an important construct in mental health services. Though much has been written about them, there is little in the literature that fully explores consumers’ and family members’ views regarding EBPs. Using a focus group methodology, this study asked the question “What are consumers’ and family member’s views of EBPs within the larger context of their mental health service needs and their experiences with the mental health service system?” Results indicate that consumers and families have limited knowledge of EBPs, are generally supportive of EBPs, but have questions and concerns that are grounded in systemic and contextual considerations.     

Impact of chronically street homeless tenants in congregate supportive housing

New initiatives to house chronically street homeless (CSH) adults have led to increasing proportions of this population living in congregate supportive housing, but little is known about the impact of this shift on supportive housing programs. The present multisite, mixed-methods study examined service utilization and lease compliance among 52 chronically street homeless and 46 long-term shelter stayer (LTSS) adults during their first 12?months in congregate supportive housing. Quantitative analysis of administrative data revealed that CSH tenants used significantly more service resources than LTSS tenants, including more advocacy, escorting, and psychiatric treatment and more assistance with financial, housing, and mental and physical health issues. The 2 groups did not differ significantly on measures of lease compliance. Qualitative focus groups with CSH tenants, service provider staff, and property management staff all indicated that existing supportive housing services are suitable for this population, although some adjustments, additional resources, or both, may be indicated.     

Clinical characteristics of community forensic mental health services

OBJECTIVE: Community forensic mental health teams are a new service within the widening range of specialized community mental health services. The characteristics of these novel services are poorly defined. Two commonly described service models in the United Kingdom are the integrated model (forensic specialists working within community mental health teams) and the parallel model (forensic specialists working on a separate specialist team). The study reported here aimed to establish clear definitions of these service models. METHODS: A literature review and a focus group of ten service professionals were conducted to identify candidate characteristics of services in community forensic mental health teams. A total of 31 characteristics were identified and used to prepare the first-round questionnaire for the two rounds of a modified Delphi consultation, which is an expert opinion and consensus method, with a multidisciplinary panel of 32 mental health professionals experienced in community forensic work. RESULTS: Twenty-nine staff (91 percent) completed the two rounds of consultation. Thirteen service characteristics differentiated the integrated and parallel models. Key characteristics of parallel teams included having their own team base, separate referral meetings, a specialist management line, specialist supervision, protected funding, forensic psychology, good links with criminal justice systems, and capped caseloads. Integrated teams were distinguished by their close links with community mental health services and acceptance of more referrals from primary care. CONCLUSIONS: Integrated and parallel models of community forensic mental health teams differ on many service characteristics. Defining these characteristics will help in researching the pros and cons of each model in the treatment and risk management of mentally ill offenders in the community.