Understanding Users’ Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users’ perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system’s incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

     

Social support network and continuity of care: an ego-network study of psychiatric service users

Purpose

For severely mentally ill (SMI) users, continuity of care requires consistency between the supports provided by the members of their social support network. However, we know little about their network cohesion and its association with continuity of care. We set out to investigate this association and hypothesised that it would depend on the severity of the user’s situation and on his/her living arrangements.

Methods

We conducted face-to-face interviews with 380 SMI users recruited in outpatient and inpatient mental health services in three areas in Belgium. Data regarding users’ social networks were collected using an ego-network mapping technique and analysed with social network analysis. The cohesion indicators were density (frequency of connections between network members), centralisation (having a small number of central people), and egobetweenness (the user’s centrality in his/her own network). Participants’ perception of continuity of care was measured by the Alberta Continuity of Services Scale.

Results

Results show that cohesion indicators were associated with continuity of care only for users with high-severity problems, regardless of their living arrangements. The numbers of network members, professionals, and services in the network were all negatively associated with continuity of care for all the users.

Conclusions

Satisfactory continuity of care requires fewer professionals or services in a user’s network and a dense network for users with the most severe problems. This implies that those providing care must not only be able to increase cohesion within a network, but also to adapt their interventions to support the transition to a different, individualised network structure when severity decreases.

     

Relationships Between Early Maladaptive Schemas and Smartphone Addiction: the Moderating Role of Mindfulness

This study investigated the relationships between early maladaptive schemas (EMSs) and smartphone addiction. The study further investigated the moderating role of mindfulness in the relationship between EMSs and smartphone addiction. The study employed a SEM-based multi-group analysis using data collected from 660 mobile users in Turkey. Results indicated that none of the EMSs were significantly associated with smartphone addiction for average users. On the other hand, certain EMSs were significantly associated with smartphone addiction for intermittent and addicted users. The schemas of social isolation/mistrust, approval seeking, and abandonment were positively associated with smartphone addiction for intermittent users, whereas approval seeking and entitlement/insufficient self-control were positively associated with smartphone addiction for addicted users. The findings implied that those who have higher score on the EMSs were more likely to become addicted to smartphones. The results further indicated that mindfulness significantly moderated these relationships, suggesting that as mindfulness increases, the number of schemas related to smartphone addiction decreases.

     

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.     

Peer Support Formation and the Promotion of Recovery Among People Using Psychiatric Day Care in Japan

The present study aimed to clarify the process of peer support formation and the promotion of recovery in people using psychiatric day care. From January to March 2014, semi-structured interviews were conducted with 18 participants with mental illness living in the community in Japan. The qualitative data were analyzed using a modified grounded theory approach. The results described a two-stage process: (1) awareness of peers with similar disability and distress and (2) formation and utilization of peer support. These results suggest that adjusting the environment and engaging in activities assisting others are useful for facilitating peer support and promoting the recovery of users in psychiatric day care.

     

A qualitative study exploring personal recovery meaning and the potential influence of clinical recovery status on this meaning 20 years after a first-episode psychosis

Purpose

Long-term data on recovery conceptualisation in psychotic illness are needed to support mental health services to organise themselves according to recovery-oriented frameworks. To our knowledge, no previous research has investigated how first-episode psychosis (FEP) service users (sampled across psychotic illness type) perceive recovery beyond 5 years after diagnosis. We aimed to explore personal recovery meaning with individuals 20 years after their FEP and examine the potential influence of clinical recovery status on how they defined recovery (i.e. personal recovery).

Methods

Twenty participants were purposefully sampled from an epidemiologically representative FEP incidence cohort. At 20-year follow-up, semi-structured interviews were conducted with 10 cohort members who met full ‘functional recovery criteria’ (Clinically Recovered Group) and 10 who did not (Not Clinically Recovered Group). A thematic analysis was performed to develop shared themes and group-specific sub-themes to capture agreement and divergence between groups.

Results

Five shared themes were produced: pursuing balance in conflict, generating meaning in life, experiencing a dynamic personal relationship with time, redressing inequality while managing added challenges/vulnerability, and directing life from resilience to flourishing. The five group-specific sub-themes developed illuminate differences in the meaning ascribed to personal recovery by each group.

Conclusion

Findings emphasise the role of time in how personal recovery is conceptualised by service users and identify ways clinical recovery may influence personal recovery meaning in FEP at mid-later life. Mental health services failing to consider temporal changes in meaning-making and discounting clinical recovery risk ignoring key factors affecting personal recovery.

     

Legal Justice and Mental Health

Background. Recovery is a journey not only of personal change but also of social reengagement. It underlines the essence of social environments that are supportive to the recovery of people with ongoing mental health issues. The process of recovery also affects other actors, and likewise these actors exert their influence on the recovery of their family member or friend.

Objective. Since 2009, we have been studying whether the decision-making model called family group conferencing (FGC) helps mental health clients increase their self-reliance. The essence of FGC is that individuals who experience problems have the opportunity to develop a plan together with people from their social network. Clients in mental health have to deal with different forms of disempowerment, especially when they are threatened with compulsory measures. It is an aim to help them regain ownership over their problems as well as over the potential solutions.

Method. From 2011 to 2013, we evaluated 41 family group conferences that were organized for clients in a public mental health care setting in the north of the Netherlands. Each conference was analyzed in a qualitative case study framework.

Results. This article highlights two case portraits. It gives insight into how ownership was restored and what this meant regarding clients’ recovery process.

Conclusion. FGC seems a promising tool to shift the attention from disorders and inabilities to capacities and the rediscovery of social resources.     

Easier Said Than Done: The Challenge to Teach “Personal Recovery” to Mental Health Professionals Through a Short,Targeted and Structured Training Programme

This study assesses the effectiveness of our short Personal Recovery Training Program (PRTP) for mental health professionals. Fifty-two healthcare professionals from Italian mental health services and forty students in psychiatric rehabilitation completed the Recovery Knowledge Inventory (RKI) pre- and post-training, divided into two groups: the PRTP (N?=?45) and the Family Psychoeducational Training Program (FPTP; N?=?47). Participants’ understanding of personal recovery improved more significantly for those in the PRTP than for those in the FPTP group in two domains, “Roles and responsibilities” and “Non-linearity of the recovery process”; the FPTP group showed a significant improvement in the “Role of self-definition and peers in recovery” domain. Two consumers were involved in the PRTP and represented a resource to help participants understand the personal recovery process. Our findings indicate that a brief PRTP supported by consumers can improve staff and students' recovery orientation. The translation of the training into clinical practice remains unevaluated.

     

Social networks among users of mental health day care--predictors of social contacts and confiding relationships

AbstractBackground The social networks of people with mental illness have received much attention, but users of day care services have rarely been considered.Methods Users of day hospitals and day centres were surveyed cross-sectionally. Demographic and illness factors were tested for associations with network size, while intrinsic relationship factors were tested for association with confiding in a network member.Results There was some evidence that a longer duration of contact with services, more unmet needs, working, living in supported accommodation and needing help with psychotic symptoms were associated with having a larger network, while a longer duration of contact was associated with having more confidantes. Day centre users confided in people who were more likely to be friends or neighbours than professionals, and who were more likely to be the same sex.Conclusion For people in day care, the stereotype that people with longer-term mental health problems are socially isolated is contradicted by this study. The limited role of professionals in providing confiding relationships is striking.     

‘First and foremost a human being…’: user perspectives on mental health services from 50 mentally disordered offenders

Abstract

Background: This is the first study of this kind in a Danish context. Knowledge and research on user perspectives is rather limited in Danish as well as Nordic psychiatry.

Aims: The aim of the study was to create new knowledge on patient and user perspectives and how mentally disordered offenders perceive their hopes and expectancies as well as their interactions with staff in mental health services. Furthermore, the aim was to establish what constitutes helpful care and treatment seen from a user perspective, and how the users themselves look at and perceive their sentences and how, according to them, the overall aim to prevent future crime can be fulfilled.

Method: The study is based on 50 semi-structured qualitative research interviews. Main themes and patterns were condensed and synthesized in a qualitative analysis.

Results: The study has provided useful knowledge of service users’ experiences with nursing, treatment and rehabilitation practices. As part of the interviews, patients were asked to contribute with advice on how to improve practices within mental health services. There are remarkable similarities between the answers, and central points were reiterated from interview to interview: The importance of mental health staff acting with respect and empathy in their interaction with patients, improved communication between patients and professionals involved in clinical pathways, responsiveness and shared decision-making when adjusting medical treatment as well as a greater variety of activities offered within inpatient units.

Conclusion: When asked what it is like to be a forensic patient, the informants underline that despite severe mental illness, social marginalization as well as various criminal records they are still, first and foremost, human beings. However, they often feel dehumanized and monstrous.     

Examining the utilisation and usefulness of social support for mothers with young children with autism spectrum disorder

ABSTRACT

Background Social support has been described as a vital resource for families with children with disability. Although the benefits of social support have been described, little is known about the utilisation patterns in families of young children with autism spectrum disorder (ASD).

Method In a community sample of 78 American families with children (2–6 years) with ASD, this study examined the utilisation and usefulness of social support. Child, family, and service variables related to social support were explored.

Results Mothers of children with ASD reported using a combination of formal and informal supports, and these were perceived to be helpful. Sociodemographic variables, child behaviour problems, satisfaction with the autism diagnostic process, and access to information about ASD predicted social support utilisation.

Conclusion Social support utilisation varies as a function of different child, family, and service variables. Understanding these variables may help professionals guide families in access to and use of social support.     

How service users and carers understand,perceive, rephrase,and communicate about “depressive episode” and “schizophrenia” diagnoses: an international participatory research

Background

For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process.

Aims

The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences.

Method

An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication.

Results

Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of “depressive episode” mostly came from the concept itself, that of “schizophrenia” was largely based on its social impact and stigmatization associated with “mental illness”.

When rephrasing “depressive episode”, a majority kept the root “depress*”, and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on “schizophrenia”. Finally, when communicating, no one used the phrase “depressive episode”. Some participants used words based on “depress”, but no one mentioned “episode”. Very few used “schizophrenia”.

Conclusion

Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.

     

The crisis in psychiatry: A public health perspective

Abstract

The role and responsibilities of psychiatry and psychiatrists have changed significantly in recent decades as a consequence of changes in society. The target of psychiatrists has moved from the treatment of specific mental disorders to the management of a wide range of psychological conditions. Following these changes, a public health approach has been claimed as necessary for psychiatric practice and research, given the current ongoing crisis in mental health. If we want to promote a public health approach, the following actions should be responsibly taken by modern mental health professionals: (1) the identification of causes of mental disorders, (2) the refinement of diagnoses, (3) the social inclusion of patients, (4) the involvement of users and carers in mental health research and practice, and (5) the improvement of psychiatric treatments and services. This crisis should represent a stimulus for all psychiatrists and a reconceptualization of psychiatry as public health is not in question.     

“Everything is so relaxed and personal” – The construction of helpful relationships in individual placement and support

The relationship with professionals is an important factor in relation to the outcome of interventions directed to persons with severe mental problems. However, the current knowledge regarding the development of helpful relationships within Individual Placement and Support (IPS) services is limited. The aim of the study was to investigate how participants in IPS services described their relationship with their IPS coach. The article is based on interviews from a Swedish government evaluation of IPS services, thematically analyzed. The results showed that the relationship with the coach is central for the participants’ success in the service. The main theme, “something different - as a human being” highlighted that the conditions for the relationship are different within IPS as compared to traditional services. The other themes were “here and now action,” “closer to wish-fulfilment – impact on the self,” and “from role to person.” The principles of IPS parallel the results from research about helpful relationships and offers good preconditions for the occurrence of such relationships. This can represent a bridge between evidence based methods and research on helpful relationships, and should be possible to implement in the development of evidence based methods as well as of treatment as usual.     

The Therapeutic Intent of the New Zealand Mental Health Review Tribunal

The New Zealand Mental Health Review Tribunal states that therapeutic intentions guide its decision-making process. The review body reports that it endeavours to make positive comments and promote therapeutic relationships (Review Tribunal, 2004). We undertook a thematic analysis of the 95 cases of the Review Tribunal from 1 July 2003 to 30 June 2004 to discern whether these intentions are communicated within the written decisions. We also inquired through content analysis whether other therapeutic efforts are apparent in the decisions. There was ample evidence of the desired pro-therapeutic intent. Furthermore, we found evidence of other therapeutic approaches involving the incorporation of consumers' perspectives, the Tribunal's giving of advice and the Tribunal actively challenging some professional participants' decisions regarding treatment. Finally, we noted that the Tribunal takes particular account of the cultural and religious affiliation of some people during proceedings, which may have pro-therapeutic effects. However, we believe some well-intended statements could be perceived as coercive or demeaning with unintended repercussions upon service users. International scholarship indicates some scepticism by health professionals regarding whether therapeutic benefits flow from administrative review hearings (Grundell, 2005). Our research indicates some constructive aspects of the New Zealand review process based on the Tribunal's commitment to therapeutic processes. There remains a lack of evaluative research to determine the benefit of the good intentions initiated by the Review Tribunal.     

Perceived helpfulness of treatment for social anxiety disorder: findings from the WHO World Mental Health Surveys

Purpose

To investigate the prevalence and predictors of perceived helpfulness of treatment in persons with a history of DSM-IV social anxiety disorder (SAD), using a worldwide population-based sample.

Methods

The World Health Organization World Mental Health Surveys is a coordinated series of community epidemiological surveys of non-institutionalized adults; 27 surveys in 24 countries (16 in high-income; 11 in low/middle-income countries; N = 117,856) included people with a lifetime history of treated SAD.

Results

In respondents with lifetime SAD, approximately one in five ever obtained treatment. Among these (n = 1322), cumulative probability of receiving treatment they regarded as helpful after seeing up to seven professionals was 92.2%. However, only 30.2% persisted this long, resulting in 65.1% ever receiving treatment perceived as helpful. Perceiving treatment as helpful was more common in female respondents, those currently married, more highly educated, and treated in non-formal health-care settings. Persistence in seeking treatment for SAD was higher among those with shorter delays in seeking treatment, in those receiving medication from a mental health specialist, and those with more than two lifetime anxiety disorders.

Conclusions

The vast majority of individuals with SAD do not receive any treatment. Among those who do, the probability that people treated for SAD obtain treatment they consider helpful increases considerably if they persisted in help-seeking after earlier unhelpful treatments.

     

Exploring Stigmatizing Attitudes Among Community Mental Health Clinicians Working with Clients Who Have a Dual Diagnosis

Illicit drug use, alcohol use and mental health problems frequently co-occur and are some of the most stigmatised health conditions. This can include stigma from those providing care, although stigmatization by mental health professionals towards dual-diagnosis clients is poorly understood. This study aimed to examine whether clinicians in community managed mental health organisations hold attitudes and beliefs that could be considered stigmatising towards clients with a dual diagnosis (ddx). Using an online survey, mental health clinicians (n = 32) were presented with three vignettes depicting a person with (1) schizophrenia, (2) schizophrenia and alcohol dependence and (3) schizophrenia and methamphetamine use, and two scales measuring stigmatising attitudes. Scores across the vignettes were compared to assess attitudes towards dual diagnosis compared to mental illness. Mental health clinicians' responses suggested greater stigma and a desire for greater social distance towards the methamphetamine case (but not the alcohol case) relative to the schizophrenia alone case. Rates of belief in full recovery were relatively low for all vignettes. It is recommended that training to address negative atttiudes and beliefs towards illicit drug users is implemented in mental health settings.

     

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Purpose

Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels.

Methods

A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically.

Results

The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention.

Conclusions

Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.