Exploring Lived Experiences of Persons with Severe Mental Illness: A Review of the Literature

This paper describes a literature review concerning the use of phenomenology to explore the experiences of persons with severe mental illness. Data from 35 publications were abstracted and summarized. The congruence between philosophical underpinnings and methods are critiqued. Findings of individual studies are summarized and reveal desires for normalcy, social relationships, meaningful activities, and opportunities for involvement and participation in treatment. The experience of suffering demonstrated the grave effect of severe mental illness on the individual's life experience. Utilization of phenomenology as a philosophy and methodology can guide the development of interventions that honor individual experience and meaning.     

Managing Weight in Persons Living with Severe Mental Illness in Community Settings: A Review of Strategies Used in Community Interventions

Although several published reviews have summarized the results of behavioral weight management interventions for persons with severe mental illness, little attention has been paid to the interventions themselves, despite the breadth of intervention strategies that have been examined in published trials. This study identified and systematically described 16 behavioral weight management interventions for community-dwelling persons with severe mental illness. Intervention content and delivery features that were considered included (a) approach to weight management; (b) theoretical constructs targeted to achieve behavior change; (c) diet, exercise, and/or self-regulation skills; (d) instructional strategies; and (e) intervention format including duration, intensity, and setting. Findings revealed modest, but sustained, weight loss. Individual and societal resources to address obesity among persons living with severe mental illness are limited. Further research is needed to identify the most effective and the most parsimonious interventions.     

A Literature Review on the Experience of Long-Term Mental Illness

Purpose: To illuminate long-term experiences of mental illness from both research and autobiographical accounts. Design: A literature review of English-language papers, 1950–2014, relating to the experience of long-term mental illness indexed in AgeInfo, AMED, ASSIA, British Nursing Index (BNI), CINAHL, MEDLINE, PsycEXTRA, and PsychINFO. Findings: Twenty-five research papers and nine autobiographic accounts met the review criteria. Thematic analysis revealed nine themes: fear, explanation seeking, stigma, disability, coping strategies, control, support, change and learning, and life history. Specific gaps of note relate to age differences, acknowledgement of longevity of mental illnesses, and different cultural perspectives. Research Implications: There is an absence of longitudinal studies focused on experiences of long-term mental illness. The considerable length-of-time implicated in the experiences suggests that more individual life experience rather than illness focused studies are needed, enabling a holistic understanding. This includes studies from cultures other than the Western world. Greater transparency is needed in justifying age inclusions or passive exclusion of older peoples' perspectives. Practical Implications: Knowledge of long-term mental illness experiences is of great importance to mental health practitioners. Evidence-based services cannot be provided if we do not have an holistic understanding of long-term mental illness. Social Implications: This review questions our ability to provide effective support for those experiencing long-term mental illness, in particular older people and different cultural perspectives. Originality/Value: There appear to be no literature reviews that focus on the individual experience of long-term mental illness. It highlights the surprisingly small number of research studies available to inform mental health practitioners.     

Support Interventions for Family Members of Adults with Mental Illness: A Narrative Literature Review

The aim of this review was to describe research related to support interventions for adult family members of people with mental illness and the significance that support may have. The results indicate the importance of flexible and individualized forms of support from both professionals and people with personal experience as a family member of someone with mental illness. In many cases, the intervention studies revealed that family members’ burden decreased, their knowledge of the disease and treatment increased, and their ability to cope with the situation was improved. The results highlight the importance of support both from professionals and peers.     

Mental Illness in Homeless Families

The article discusses the factors influencing mental illness in homeless families. High rates of domestic violence, substance abuse, depression, and poverty are identified as contributing factors. Social isolation and rejection by peers are commonly seen in children of homeless families. Nurse practitioners who provide health promotion, risk reduction strategies, and disease management in the community should adapt care interventions to take into account these contributing factors. Guidelines established by the National Health Care for the Homeless Council are used to adapt care for the unique needs of a homeless family at risk of or currently experiencing mental health issues.     

Childhood Parental Mental Illness: Living with Fear and Mistrust

This paper presents one major theme of findings from a doctorate study. The study used a narrative enquiry approach, to gather parenting narratives of adult children of parents with mental illness. A Partnership Model for a Reflexive Narrative for Participant and Researcher (Partnership Model) was used to invite participants into the study, while encouraging a space for reflection for both the adult children and researcher. In total, 13 adult children participants constructed their narratives of living with childhood parental mental illness, alongside their current parenting role. Their stories reflected childhood experiences of fear and emergence of mistrust of others, particularly their parent with mental illness. For some participants, fear and mistrust continued into adulthood. Many adult children reported their childhood experiences of feeling lonely and isolated. They felt unable to disclose their experiences of parental mental illness to others. In addition, participants were unable to access information about their parent's condition, leaving them feeling unprepared and unskilled, despite their childhood desire to help their parent. This furthermore, compounded their sense of fear and isolation. Early identification of children and families experiencing mental illness is important to facilitate dialogue, psychoeducation and support. Social and health professionals have an important opportunity to enhance the social integration and support for families experiencing parental mental illness, to reduce long-standing fear, isolation and mistrust.     

Educating for Wellness: A Wellness Education Group Intervention for Adults with Chronic Severe Mental Illness Living in the Community

Chronic severe mental illness (CSMI) is a common disorder in the United States associated with numerous adverse health effects. Health promotion educational interventions can be beneficial. The purpose of this project was to implement and evaluate a community-based educational program for adults with CSMI. Analyses of quantitative and qualitative data showed overall satisfaction with the program and achievement of some specific consumer health modifications. Three primary areas of interest and benefit included socialization and support, education and information, and motivation to change. The Wellness Education Group Intervention (WEGI) can serve as a model for wellness education with adults in similar communities.     

重性精神疾病患者的家庭负担调查

目的探讨重性精神疾病患者的疾病家庭负担。方法采用疾病家庭负担量表(FBS),对148 例符合ICD-10 诊断标准的精神分裂症和双相障碍患者的照顾者进行评定。结果精神分裂症和双相障碍患者的疾病家庭负担普遍存在,涉及多个维度。各维度影响达中度以上的分别为家庭关系(51%)、家庭娱乐活动(50%)、家庭日常活动(45%)、经济负担(43%)、家庭成员心理健康(36%)、家庭成员身体健康(32%)。年轻、自费及无个人收入患者的疾病家庭负担更重。结论提示需制定综合的心理社会干预措施,有效减轻照顾者的家庭负担。     

Social Activities in Elderly Patients with Severe Mental Illness

Mental hospitals offer their patients many different kinds of social activities/facilities. One-hundred-and-twenty-seven patients in the long-term care unit at a mental hospital were included in the study. They were divided into three subgroups on the basis of diagnosis: dementia disorder (n = 65), chronic psychotic disorder (n = 38), and chronic non-psychotic disorder (n = 24). An inventory was made of all possible activities/facilities offered to the patients by the mental hospital, with the objective of ascertaining whether participation in social activities/facilities discriminated between the three diagnostic groups. Sixteen activities/facilities were obtained from an inventory by nurses. Stepwise discriminant analysis identified length of stay in hospital, age and the social activities/facilities that separated the three diagnostic groups. The discriminant function analysis showed that participation in social activities, together with length of stay and age, discriminated very well between the demented and the chronic psychotic groups. The discriminant analysis also indicated that patients with chronic psychotic disorder were distinguishable by their frequent participation in social activities, long stay in hospital, and low age. The results obtained can be used when the social activities/facilities in a community care setting are being planned for the various diagnostic groups.     

惠州市重性精神疾病患者社区规范化管理效果分析

目的 探讨重性精神疾病社区规范化管理治疗模式对重性精神病患者防治效果的影响.方法 对8 606例重性精神病患者采取规范化管理治疗,内容包括建立重性精神疾病管理治疗工作的组织领导机构,健全重性精神疾病患者管理治疗技术网络,组织各类相关人员培训,开展重性精神疾病社区规范化管理治疗等.比较开展规范化管理治疗前后重性精神患者防治效果.结果 开展规范化管理治疗后,重性精神疾病患者的显好率、社会参与率、服药依从性分别从14.66%、31.55%、25.97%提高至86.40%、91.79%、73.30%(P<0.01);规范化管理的患者肇事肇祸率从3.07%下降至0.55%(P<0.01).结论 重性精神疾病社区规范化管理提高了重性精神疾病患者的防治效果.     

Goal Setting Among People Living with Mental Illness: A Qualitative Analysis of Recovery Camp

People living with mental illness (consumers) often experience difficulty in achieving life goals, particularly those important for their recovery. An innovative approach to address consumers' goals for recovery can be found in the form of therapeutic recreation (TR) initiatives. Recovery Camp is a five-day TR program, bringing together people with a serious mental illness, undergraduate health students, and staff members. This article aims to examine the types of goals set by consumers in the context of Recovery Camp, and to what extent the self-identified goals were attained. The consumers (n = 27) were invited to set goals that they wished to achieve during the week. On the final day of Recovery Camp, each participant rated the degree to which they felt that each of their goals was achieved or not. The goals were themed using content analysis, revealing four key themes: connectedness, developing healthy habits, challenging oneself, and recovery. All goals were, to some extent, attained. The results suggest people with a mental illness are able to both set and evaluate the self-identified goals in the context of a TR initiative. A collaborative recovery approach indicates that goal planning should be undertaken in direct consultation with the consumer.     

Perceptions of Barriers to Physical Health Care for People with Serious Mental Illness: A Review of the International Literature

Premature death and poorer access to quality care for physical health concerns is common for people diagnosed with serious mental illness (SMI). However, there is lack of clarity regarding the nature of barriers encountered at different points in the physical health care process, and the level of consistency of these barriers both among countries, and between consumers with SMI and health care staff. The current narrative review integrates views of consumers and health care staff on barriers to physical health care. It involved a search of CINAHL, Proquest, and Web of Science, for peer-reviewed papers published between 2005 and June 2012, for studies of perceptions of barriers to physical health care, published in English. Despite variations in health care systems among countries, there is agreement between consumers and health care staff that division between physical and mental health care and stigma of mental illness act as barriers to all phases of the physical health care process. This uniformity is grounds for international policy development (in general public health and within mental health nursing) for reforms that improve the physical health care, quality of life, and longevity of people with serious mental illness.     

Healthy Amistad: Improving the Health of People with Severe Mental Illness

Here, we report evaluation results of implementing a health promotion program for individuals with serious mental illnesses. Healthy Amistad aimed to address four behaviors: physical inactivity, nutrition choices, smoking, and seeking access to health care. The evaluation employed a mixed-method study design to assess changes in the health of individuals in the program. Process measures assessed the implementation of the program. A pre-post examination was used to compare data associated with behaviors. Data sources included the 2008 and 2009 annual surveys, clinical data, interviews for staff, interviews with members, and an on-site observation. Participants were staff and members of Amistad. Those involved with the Peer Patient Navigator lost weight; new physically active activities were being offered. A new salad bar and healthier menu was offered in the Amistad cafeteria. Interviews revealed that 11 members lost a total of 150 pounds. The percentage reporting visits to an emergency room more than once in the last 6 months decreased from 58% to 37%, the percentage calling the crisis line less often increased from 75% to 86%, and the percentage reporting that they had become more satisfied with their life since joining Amistad improved from 76% to 88%. Individuals with serious mental illnesses are benefiting from programs that focus on the mitigation of disease states manifested from issues with physical inactivity, nutrition, smoking, and health access. Evaluation of the Healthy Amistad program has shown a positive influence.     

Engaging Persons with Severe Persistent Mental Illness into Primary Care

Persons with severe and persistent mental illness (SPMI) consistently experience inadequate primary health care. Very little is known about what promotes primary care (PC) engagement by persons with SPMI. That gap was addressed by a recently published qualitative study that described the social process of engagement in PC from the perspective of those with SPMI. This article describes the clinical implications of the findings from the qualitative study. Categories of engagement are described, and clinical practice implications based on these categories aim to promote engagement in PC with this population.     

Clinical Placements in Mental Health: A Literature Review

Gaining experience in clinical mental health settings is central to the education of health practitioners. To facilitate the ongoing development of knowledge and practice in this area, we performed a review of the literature on clinical placements in mental health settings. Searches in Academic Search Complete, CINAHL, Medline and PsycINFO databases returned 244 records, of which 36 met the selection criteria for this review. Five additional papers were obtained through scanning the reference lists of those papers included from the initial search. The evidence suggests that clinical placements may have multiple benefits (e.g. improving students’ skills, knowledge, attitudes towards people with mental health issues and confidence, as well as reducing their fears and anxieties about working in mental health). The location and structure of placements may affect outcomes, with mental health placements in non-mental health settings appearing to have minimal impact on key outcomes. The availability of clinical placements in mental health settings varies considerably among education providers, with some students completing their training without undertaking such structured clinical experiences. Students have generally reported that their placements in mental health settings have been positive and valuable experiences, but have raised concerns about the amount of support they received from education providers and healthcare staff. Several strategies have been shown to enhance clinical placement experiences (e.g. providing students with adequate preparation in the classroom, implementing learning contracts and providing clinical supervision). Educators and healthcare staff need to work together for the betterment of student learning and the healthcare professions.