Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection

This study describes persons with serious mental illness and comorbid HIV infection and examines the effect of co-location of mental health and HIV care on satisfaction, service utilization, and appropriateness of care. One hundred and eighteen subjects completed interviews and gave blood samples; medical records were abstracted. Most reported few barriers to care and satisfaction with mental health and HIV treatment. Co-location of mental health and HIV care did not influence satisfaction with care, utilization of services, or appropriateness of care. This report challenges the notion that persons with serious mental illnesses receive inadequate health care and that they have minimal capacity for illness management. These subjects may be benefiting from increased funding for, and attention to, persons with HIV infection.     

A Service System Planning Model for Individuals With Serious Mental Illness

An institutional-based care system in mental health has been replaced by a network of community-based services with different levels of structure and support. This poses both an opportunity and a challenge to provide appropriate and effective care to persons with serious mental illnesses. This paper describes a simulation-based approach for mental health system planning, focused on hospital and residential service components that can be used as a decision support tool. A key feature of this approach is the ability to represent the current service configuration of psychiatric care and the client flow pattern within that framework. The strength of the simulation model is to help mental health service managers and planners visualize the interconnected nature of client flow in their mental health system and understand possible impacts of changes in arrival rates, service times, and bed capacity on overall system performance. The planning model will assist state mental health agencies to respond to requirements of the Olmstead decision to ensure that individuals with serious mental illness receive care in the least restrictive setting. Future plans for refining the model and its application to other service systems is discussed.     

Utilization of Public Mental Health Services by Adults with Serious Mental Illness

Public mental health (MH) services were examined for non-elderly adults with serious mental illness (SMI) using a database combining information from Medicaid, MH, and substance abuse agencies in three states. These data show that between 23% and 39% of those with SMI received MH services only through Medicaid. Relative use of community versus state hospitals for delivery of psychiatric inpatient care varied across the three states. However, state hospitals accounted for a large proportion of total inpatient days, due to high mean annual days of care. In two states, Medicaid paid for fewer psychiatric inpatient days than expected.     

Measuring Personal Loss Among Adults Coping with Serious Mental Illness

Psychometric properties of a brief self-report measure of personal loss for adults coping with psychiatric disability are examined. The Personal Loss from Mental Illness Scale (PLMI) is a 20-item measure that assesses overall perceptions and four interrelated aspects of personal loss from mental illness. Using a sample of 158 adults with serious mental illness, the PLMI was found to have a meaningful factor structure, good internal consistency and high test–retest reliability. Construct validity is evidenced by positive correlations between personal loss scores, number of psychiatric hospitalizations, self-reports of loneliness, psychological symptoms, and problems with alcohol. PLMI scores were unrelated to scores on a personal growth measure and negatively correlated with scores on a positive well-being scale. Implications of the PLMI for research on coping, adaptation and recovery from serious mental illness are discussed.This research was supported by a grant from the Ohio Department of Mental Health (99.1144) awarded to the first author. We extend our appreciation to participants in the research and to the graduate students who served as interviewers for the study.     

Treating Difficult Cases in a Psychoeducational Family Support Group for Serious Mental Illness

Research findings on family psychoeducation as evidence-based treatment for serious mental illnesses and benefits for families of peer-led family education groups are presented. Because major psychiatric disorders frequently are long term with episodic crises, caregivers have ongoing needs for support to enhance time-limited interventions. This article describes a continuous psychoeducational family support group that gives prolonged assistance and also helps problem families who reject family therapy. Three case examples are given of such families and the contributions of the group in effecting change. It is suggested that mental health systems incorporate psychoeducational support groups for family caregivers in standard practice.     

Assessing Delayed Effects of a Multi-Site System Intervention for Homeless Persons with Serious Mental Illness

ACCESS demonstration sites were followed for an additional two years beyond the scheduled four-year evaluation to assess whether any delayed effects had occurred in system and project integration. For system integration, findings indicate that there was a sharp increase between Wave 3 (1998) and Wave 4 (2000), but experimental and comparison sites had identical trends. For project integration, experimental sites at Wave 4 sustained the high level of integration achieved at Wave 3, but the comparison sites achieved the same level as the experimental sites at Wave 4, through an abrupt increase in their scores. The absence of delayed effects is likely due to diffusion of the interventions to comparison sites both in the latter stages of the demonstration and immediately afterwards. Further, aggressive lobbying on the part of ACCESS program managers to generate local and state support to sustain their services following the termination of federal funding, had an integrating effect thereby creating linkages among comparison site agencies. Implications of these findings for policy and further research are highlighted.     

Intervention Programs for Children of Parents with a Mental Illness: A Critical Review

There is widespread acknowledgement that children in families affected by parental mental illness are at risk for a range of poor life outcomes. There is also a growing number of interventions to meet the needs of this group of young people. This review evaluates the quality of the existing evidence for such intervention programs. Five hundred and twenty articles were reviewed, and twenty-six studies were judged to be relevant. The majority of the studies were randomised trials (n=8) and pre-post interventions with no comparison or control groups (n=8). None of the studies measured cost-effectiveness or included consumer or carer consultation, and few outlined the theoretical basis for the development of the intervention program. Seven studies were rated as methodologically strong, four as of moderate quality and fifteen as methodologically weak. This data provides very limited evidence of program effectiveness as determined by well-being or illness outcomes for the child. Practitioners should use a recognised theory in developing intervention programs, link program components to identified risk factors for this target group, select intervention components from across the public health spectrum and incorporate greater intersectoral collaboration. Future programs should be rigorously evaluated and widely disseminated, with long-term follow-up of participants.     

Self-stigma in Serious Mental Illness: A Systematic Review of Frequency,Correlates, and Consequences

Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma—including from mental health providers—predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.     

Religion and Spirituality in the Lives of People with Serious Mental Illness

Although there is a fair sized literature documenting the relationship of religiousness and spirituality with health and well-being, far fewer studies have examined this phenomenon for people with serious mental illness. In this research, religiousness is defined as participation in an institutionalized doctrine while spirituality is framed as an individual pursuit of meaning outside the world of immediate experience. In this study, 1,824 people with serious mental illness completed self-report measures of religiousness and spirituality. They also completed measures of three health outcome domains: self-perceived well-being, psychiatric symptoms, and life goal achievement. Results showed that both religiousness and spirituality were significantly associated with proxies of well being and symptoms, but not of goal achievement. Implications of these findings for enhancing the lives of people with psychiatric disability are discussed.     

Hepatitis C Services and Individuals with Serious Mental Illness

Although individuals with serious mental illness have been shown to be at increased risk for hepatitis C viral (HCV) infection, there is growing concern regarding limited dissemination of recommended HCV related services to this population. This paper presents rates of receipt of HCV prevention services among a cohort of seriously mentally ill adults and reports rates of recommended follow-up care among the subset who tested HCV positive in a pilot study. Previous HCV screening was low and indicated medical follow-up among those who tested positive was also limited. Results stress the need for increased screening and counseling and delivery of preventive and follow-up medical services.     

Applying the Readiness to Change Model to Implementation of Family Intervention for Serious Mental Illness

Family intervention for serious mental illness is known to be highly efficacious in reducing patient relapse, improving social functioning, enhancing caregivers knowledge of mental illness, and ultimately reducing overall costs of care. However, very few families receive services. The reasons for this gap between empirical findings and program implementation are complex and not yet fully understood. Prochaska and DiClementes Readiness to Change Model provides a helpful structure for understanding key issues for the four relevant stakeholders (patients, family members, clinicians and administrators). Staging each stakeholder group and applying corresponding interventions (processes of change) are useful in a sites implementation of family services.     

Physical Wellness and Employment Status Among Adults with Serious Mental Illness

This study examined whether concurrent medical status contributes to employment outcomes among those with psychiatric disabilities. Thirty-five percent (n = 70) of the 200 participants reported being currently employed. Sixty-three percent (n = 127) reported one or more co-occurring medical conditions; thirty-six percent (n = 71) reported two or more, and twenty-one percent (n = 41) reported three or more co-occurring medical conditions. Individuals with higher self-ratings of physical health functioning were more likely to be employed. Neither the number of co-occurring medical conditions nor any specific medical condition was related to employment status. Recommendations to enhance existing models of supported employment programs with physical health and wellness promotion components are offered.     

Updates and Five-year Evaluation of the S.A.F.E. Program: A Family Psychoeducational Program for Serious Mental Illness

This brief report reviews recent updates to the S.A.F.E. Program, a family psychoeducational intervention for serious mental illness created in the Veterans Affairs (VA) system. The improvements and significant content additions to the curriculum are outlined. Further, positive five-year program evaluation data are described, including high levels of participant retention and satisfaction. Program attendance is positively correlated with understanding of mental illness, awareness of VA resources, and ability to engage in self-care activities—and inversely correlated with caregiver distress. This data lays the groundwork for a randomized clinical trial and raises questions about the necessity of diagnostic-specific family programming.Michelle D. Sherman is affiliated with the Oklahoma City VA Medical Center, South Central Mental Illness Research, Education and Clinical Center (MIRECC). He is also affiliated with the Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center.     

Pathways to Psychiatry Care among Children with Mental Health Problems

Many children with mental health problems in Egypt, as in many other countries, do not receive the help they need. Investigating the pathways of care is crucial for the early detection and treatment of these children. This study examined referral patterns and the duration of untreated psychiatric illness of 350 children attending two urban clinical settings in Egypt. Diagnoses were made using the Kiddie Schedule for Affective Disorder and Schizophrenia for School-aged children present and lifetime (K-SADS-PL), Child behavior checklist (CBCL,) and the Stanford-Binet Intelligence Scale. For 46.3%, the most distressing symptom was behavioral problems. A delay in seeking psychiatric help was found. positive family history, and lower socioeconomic class were associated with delays in psychiatric consultation. For 39.7% of patients, the first contact was with a psychiatrist. Most children were referred by relatives. Awareness programs are needed to increase knowledge about and to decrease the duration of untreated illness.     

Outcome from a Community-based Smoking Cessation Program for Persons with Serious Mental Illness

Six and 12-month outcomes are reported on 79 mentally ill persons attending either a 4- or 8-session community-based smoking cessation group. Quit rates at post, 3-, 6-, and 12-month follow-ups were 16, 19, 16, and 19%, respectively, with no significant effect of program length. These success rates are comparable to outcomes reported following group-based treatment with mentally healthy smokers. The majority of quitters used nicotine replacement therapy. Psychotropic medication dosages did not vary over time in quitters or non-quitters. No reductions in smoking were observed among non-quitters. Quitting smoking had no untoward effects on symptoms of mental illness or general functioning.