Improving mental health service responses to domestic violence and abuse

Abstract

Domestic violence and abuse is a considerable international public health problem, which is associated with mental disorders in both women and men. Nevertheless, victimization and perpetration remain undetected by mental health services. This paper reviews the evidence on mental health service responses to domestic violence, including identifying, referring, and providing care for people experiencing or perpetrating violence. The review highlights the need for mental health services to improve rates of identification and responses to domestic violence and abuse, through the provision of specific training on domestic violence and abuse, the implementation of clear information sharing protocols and evidence-based interventions, and the establishment of care referral pathways. This review also highlights the need for further research into mental health service users who perpetrate domestic violence and abuse.     

Experience of child welfare services and long-term adult mental health outcomes: a scoping review

Purpose

This is the first comprehensive review of empirical research that investigated the association between receipt of child welfare services and adult mental health outcomes. The review summarised the results of studies about mental health outcomes of adults with a history of child welfare involvement.

Methods

A scoping review methodology was used to search five electronic databases (MEDLINE, EMBASE, PsychINFO, IBSS, Social Policy and Practice). Studies were included if they examined any child welfare exposure (including receipt of services while remaining at home/being placed in care) and adult mental health status.

Results

In total 4591 records were retrieved, of which 55 met the eligibility criteria. Overall, receipt of child welfare services was associated with an increased risk of adult mental ill-health, suicide attempt and completed suicide. Results regarding potential moderating factors, such as gender and care-related experiences, were mixed. Relatively few studies investigated the reasons for requiring child welfare services, the experience of abuse or neglect or the adult outcomes of child welfare service users who remained in their own homes. Mental ill-health was defined and measured heterogeneously and details about the nature and type of welfare service utilisation were lacking.

Conclusion

There is a need for detailed, longitudinal studies to better understand the relative contribution of pre-existing adversity versus experiences during and after exposure to child welfare services on adult mental health outcomes. More standardised measures of mental ill-health and greater detail from authors on specific care exposure are also needed.

     

Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

Worldwide, growing concern with young people’s mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11–30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes—initiating contact with mental health services; characteristics of services’ response; and youths’ and carers’ appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths’ pathways to them. It underlines the need for grounding reform in youths’ and carers’ perspectives and needs.

     

Art therapists with experience of mental distress: Implications for art therapy training and practice

ABSTRACT

As part of its ongoing work to support and value the contributions to art therapy from service users, the British Association of Art Therapists (BAAT) conducted a survey of art therapists with dual experience as professionals and mental health service users. The survey aimed to establish if art therapists disclosed their experiences as service users when applying to train, during their art therapy training and/or when qualified. Participants (N?=?20) were also surveyed on their motivation for disclosure or non-disclosure, their experiences of the process and the quality of responses they met. They were additionally asked whether their experiences of mental health services had impacted on the quality of their art therapy practice and if so, how. The findings from this small sample suggest that disclosure was not easy. Reported responses to participants’ disclosures were mixed, with many experiencing both helpful and unhelpful responses. Emotional support appeared to be important for helping people both to normalise and to contain current distress. Another finding concerns self-reported increased empathy for service users. Awareness and management of one’s own limitations was another reported gain, since reflecting on oneself and one’s life was usually enforced through the ‘breakdown’, hospitalisation or disruption of career path.     

EPA guidance on building trust in mental health services

PurposeTo advance mental health care use by developing recommendations to increase trust from the general public and patients, those who have been in contact with services, those who have never been in contact and those who care for their families in the mental health care system.MethodsWe performed a systematic literature search and the retrieved documents were evaluated by two independent reviewers. Evidence tables were generated and recommendations were developed in an expert and stakeholder consensus process.ResultsWe developed five recommendations which may increase trust in mental health care services and advance mental health care service utilization.DiscussionTrust is a mutual, complex, multidimensional and dynamic interrelationship of a multitude of factors. Its components may vary between individuals and over time. They may include, among others, age, place of residence, ethnicity, culture, experiences as a service user, and type of disorder. For mental health care services, issues of knowledge about mental health services, confidentiality, continuity of treatment, dignity, safety and avoidance of stigma and coercion are central elements to increase trust.ConclusionEvidence-based recommendations to increase mutual trust of service users and psychiatrists have been developed and may help to increase mental health care service utilization.     

Risk of violence among patients in psychiatric treatment: results from a national census

Background: Adverse media coverage of isolated incidents affects the public perception of the risk of violent behavior among people with mental illness. However, the risk of violence is studied most frequently among inpatients, which falsely exaggerates the prevalence of people with mental illness because the majority of individuals receive treatment as outpatients.

Aim: To estimate the prevalence of the risk of violence among inpatients and outpatients in psychiatric treatment, as well as the associations with gender, age, socio-economic status and co-morbid substance use disorders in all major diagnostic categories.

Methods: We conducted a national census of patients in specialist mental health services in Norway, which included 65% of all inpatients (N?=?2,358) and 60% of all outpatients (N?=?23,124).

Results: The prevalence of the risk of violence was 32% among inpatients and 8% among outpatients, where 80% of the patients in specialist mental health services were outpatients. If we weight the prevalence rates accordingly, less than 2% of the patients in specialist mental health services had a high risk of violent behavior.

Conclusions: The stigma attached to those with mental illness is not consistent with the absence or low to modest risk of violent behavior in 98% of the patient group. Substance use disorders must be given priority in the treatment of all patient groups. Mental health care in general and interventions that target violent behavior in particular should address the problems and needs of these patients better, especially those who are unemployed, have a low level of education and have a background of being a refugee or an immigrant.     

Carers' experiences of accessing and navigating mental health care for older people in a rural area in Australia

Objectives: Mental health care for older people is primarily delivered in the community and is largely dependent on informal carers. Mental health policy encourages partnerships between carers and service providers to facilitate service access, coordination and positive experience of care. However, carers often lack information and support from services, with the potential for carer burden, and negative impacts on their own health and capacity to fulfil caring tasks. This paper explores rural carers' experiences of accessing care from a range of services for older people with mental health problems.

Method: The Pathways Interview Schedule was used to facilitate 9 in-depth care journey interviews with 11 carers of older people with a mental health problem. Interviews explored their journeys to and through mental health, aged care, primary care and social care services. Framework analysis was used to explore carers' experiences and perceptions of care with a focus on access enablers and barriers.

Results: Carers had a significant role in navigating services and operationalising care for their relative. Enablers to accessing care included carer knowledge and workers actively involving carers in planning. Barriers included carer mental health literacy, consumer and carer readiness for services, and worker misinterpretation of confidentiality and privacy laws.

Conclusion: Carers should be considered key partners in mental health care planning that crosses service sectors. For this to occur, changes are required at the worker level, including increased communication between mental health workers and carers, and the service level, involving training for staff in interpreting confidentiality and privacy policy.     

How much does mental health discrimination cost: valuing experienced discrimination in relation to healthcare care costs and community participation

Aims.This study builds on existing research on the prevalence and consequences of mental illness discrimination by investigating and quantifying the relationships between experienced discrimination and costs of healthcare and leisure activities/social participation among secondary mental health service users in England.Methods.We use data from the Mental Illness-Related Investigations on Discrimination (MIRIAD) study (n = 202) and a subsample of the Viewpoint study (n = 190). We examine experiences of discrimination due to mental illness in the domains of personal relationships, community activities, and health care, and how such experienced discrimination relates to patterns of service use and engagement in leisure activities.Results.Our findings show that the cost of health services used for individuals who reported previous experiences of discrimination in a healthcare setting was almost twice as high as for those who did not report any discrimination during the last 12 months (Relative Risk: 1.73; 95% Confidence Interval (CI): 1.39, 2.17) and this was maintained after controlling for symptoms and functioning. Experienced discrimination in healthcare (Relative Risk: 0.83; 95% CI: 0.81, 0.84) or in relationships (Relative Risk: 0.89; 95% CI: 0.87, 0.91), however, was associated with lower participation in, and hence lower costs of, leisure activities. Individuals who reported any discrimination in a healthcare setting had, on average, £434 higher costs associated with health service use while reported discrimination in the community was associated with increased leisure costs of £32.Conclusions.These findings make an important initial step towards understanding the magnitude of the costs of mental health-related discrimination.Key words: Health economics, mental health services, mental illness, stigma     

Complex Caring Trajectories in Community Mental Health: Contingencies, Divisions of Labor and Care Coordination

The concept of ‘trajectory’ refers to the unfolding of individual service users’ health and illness experiences, the organization of health and social care work surrounding them and the impact this work has on people involved. Using qualitative data from a study completed in two sites in Wales we first reveal the complex character of trajectories encountered in the community mental health field. We show how these can be shaped by features peculiar to mental ill-health per se, and by features with organizational origins. We then use our data to lay bare true divisions of labor. Mental health professionals featured prominently in our study. We also reveal relatively invisible contributions made by professionals on the periphery, support workers, unpaid lay carers and service users. In examining the significance of our findings we identify particular lessons for mental health practitioners, managers and policymakers sharing concerns for the coordination of care.     

Participation in mental healthcare: a qualitative meta-synthesis

Background

Facilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care.

Methods

Electronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs.

Results

The synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy.

Conclusions

This meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.

     

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.     

Profile of children investigated for sexual abuse: association with psychopathology symptoms and services

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates children's psychological symptoms and child welfare service (CWS) patterns to understand how children's needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to children's needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed.     

Intimate Partner Violence,Cumulative Violence Exposure,and Mental Health Service Use

Intimate partner violence (IPV) leaves victims with serious mental healthconsequences; some victims do not seek help even though they suffer from adverse mental health symptoms. Victims’ use of mental health services seems to be affected by sociocultural factors and their history of experiences with violence. This study used the collaborative psychiatric epidemiology surveys to examine the effects of cumulative violence on IPV victims’ mental health service use. The results showed that victims’ mental health needs were the most prominent predictor of their use of mental health services, and that cumulative violence exposure also predicted mental health service use.     

Common mental disorders and use of general health services: a review of the literature on population-based studies

OBJECTIVE: To review population-based studies on the association between common mental disorders and the use of general (non-mental) health care services. METHOD: Literature search in Medline and PsychLit databases. Only studies with a prospective design and correction for somatic morbidity were included for review. RESULTS: On the most general level of outcomes considered and in the majority of studies, mental disorders were associated with higher service use. This general tendency is not consistently reflected in the use of specific health care services, but is materialized in different patterns of out-patient and in-patient service utilization, which vary from study to study. Findings for the elderly were less clear-cut than for other age groups. CONCLUSION: Mental disorders are related to higher general health care service use on a global, aggregated level. These associations are not specific for certain types of services.     

A systematic review of factors associated with service user satisfaction with psychiatric inpatient services

BackgroundSatisfaction is seen as an indicator of the quality of mental health services and has been related to outcomes and compliance with treatment. The current review seeks to examine the factors relating to satisfaction with inpatient services.MethodA search was conducted of PsycInfo, Web of Science, Cinahl, Embase and Medline databases. Screening resulted in 32 papers being included in the review. Papers were subject to quality assessment using the Mixed Methods Appraisal Tool (MMAT).ResultsReview of the included papers suggested factors relating to satisfaction could be broadly classified as either service user or service/ward related. Service user related factors included findings that satisfaction was higher when service users were admitted voluntarily. Service related factors included findings that satisfaction was negatively associated with experiences of coercion and positively associated with being on an open ward.ConclusionIt appears that coercion has a key role in ratings of satisfaction. Additionally, service users reported an impact of staff relationships, and the ward environment. Satisfaction is associated with a range of factors, an awareness of which will allow for the development of quality services that meet the needs of service users.     

Practitioner relationships and quality of care for low-income persons with serious mental illness

OBJECTIVE: Though central to experiences of mental health care for persons with serious mental illness, relationships with practitioners have been underemphasized in recent quality-of-care research. This qualitative study described concepts of good care in relationships with psychiatrists, therapists, and case managers from the perspectives of low-income persons with psychiatric disabilities. METHODS: In-person, semistructured interviews were conducted with 51 adult Medicaid enrollees with psychiatric disabilities and diagnoses of schizophrenia. Grounded theory techniques were used to analyze the data. RESULTS: Eight categories representing service users' priorities for care in practitioner relationships resulted from the analysis: getting "extra things," looking for common ground, feeling known, the importance of talk, feeling like "somebody," practitioner availability, practitioner flexibility, and opportunities for input into treatment. CONCLUSIONS: Quantitative and illness-centered formulations may miss much of what low-income service users with serious mental illness value in their relationships with practitioners. The opportunity to counter feelings of vulnerability and alienation with a sense of connection that is based on shared humanness may be a high priority for services for this group. Practitioner relationships that help service users feel cared about and connected to the social world address suffering in mental illness and are thus essential to the meaning of good care.     

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

Background Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London. Method A two‐round Delphi process was utilised. White British and Black or Black British service users from a specialist community‐based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale. Results Twenty‐four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication. Conclusions People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.     

Child and adolescent mental health in South Africa

Mental health problems in childhood and adolescence pose a major threat to public health. Epidemiological studies in high, middle and low income countries indicate that approximately one in five children and adolescents suffer from a mental disorder. In many instances these persist into adulthood. In South Africa, HIV infection, substance use, and exposure to violence increase vulnerability to mental disorders. Child and adolescent mental health services play a key role in reducing the burden of mental disorders in childhood and later in adulthood. This paper focuses on service needs for children and adolescents in South Africa. It commences with a discussion of the prevalence of child and adolescent psychiatric disorders after which the legal and policy context of child and adolescent psychiatric services is described. A framework for child and adolescent mental health service provision is presented, following which steps for reducing the extent of unmet service need are considered. The paper concludes with a call to scale up child and adolescent mental health services in South Africa, based on the stark realities of unmet need and the constitutional rights of children and adolescents to appropriate mental health care.