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Individuals with mental health challenges are at particularly high risk of experiencing negative outcomes (e.g., worsening of mental health, increased risk of mortality) due to the coronavirus disease (COVID-19) pandemic. Peer specialists may have the benefit of several protective factors, including higher levels of social support and better illness self-management skills that buffer against negative effects of the pandemic. In this study, we compared the differences in the impact of COVID-19 on those trained as peer specialists (e.g., certified peer specialists, recovery coaches) to those not trained in this role.Participants with self-reported mental health and/or substance use challenges completed an online survey to collect information on their experiences during COVID-19 (Epidemic-Pandemic Impacts Inventory [EPII]), loneliness (3-item Loneliness Scale), and access to and satisfaction with mental health support. Respondents self-identified as peer specialists or not.One hundred seventy-three U.S. resident participants from 23 states were included in the final analysis: 109 were peer specialists and 64 were nonpeer specialists. Those who were trained as peer specialists reported fewer negative outcomes during the pandemic, including less disruption in employment, less loneliness, and less worsening of mental health, while reporting more positive attitudes in the face of difficulties. Peer specialists were also likely to report more access to and satisfaction with mental health services.Possibly as a function of their role, peer specialists reported better mental health outcomes during COVID-19, providing key, empirical evidence to support the benefits of helping others. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Limited research has been conducted on the long-term course of employment in people with severe mental illnesses (SMI) in developing countries such as India. To inform the development of culturally appropriate vocational services in India we prospectively evaluated work status, perceived benefits, and problems related to work in employed participants, and interest in work, barriers to work, and desired job supports among unemployed participants over a 1-year period.We conducted semistructured interviews with 150 individuals with SMI (90% schizophrenia-schizoaffective) receiving psychiatric outpatient services at a public hospital in an urban district in India at baseline and followed up 1 year later. One-hundred-and-seven participants (71.3%) completed the follow-up interviews.Work status (employed/unemployed) was consistent in 90.7% of participants, with 43.9% working at baseline and 49.5% working at follow-up. Participants who were working in the same job at both assessments were consistent in identifying several work-related problems (e.g., stress) as well as benefits (e.g., money). Interest in work among unemployed participants was consistent, with 78.8% interested at both assessments. Participants who were unemployed but interested in work consistently identified work barriers (e.g., cognitive difficulties) and desired job supports (e.g., assistance with job finding).Unemployment rates are moderately high and stable in people with SMI, with most unemployed participants consistently interested in working and desiring job supports. These findings, together with stable employment rates in working participants, suggest that supported employment developed for the Indian context could improve employment in people with SMI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Work is one of the most valued social rules in modern society, contributing to a person's sense of economic well-being, self-esteem, personal identity, and social status. Conversely, the inability to work or sustain employment due to a psychiatric condition is the primary factor in determining eligibility for disability benefits, such as Social Security Disability Income or Social Security Supplemental Income. Just as work is valued strongly by society, it is also important to people with serious mental illness. In this editorial, we contemplate why we cannot "do the right thing" and fully fund supported employment for persons with serious mental illness. (PsycINFO Database Record

The year 2010 saw passage of an historic piece of legislation in Public Law 111-148, entitled the Patient Protection and Affordable Care Act or ACA (2010). Since that time, the ACA has contributed to a number of improvements to the U.S. health care system including a large decrease in the number of uninsured individuals, substantially expanded access to health care services, and relief of the burden of uncompensated care provided by hospitals and other health care organizations (Jost, 2015). Various analyses of the law's impact on people with mental illnesses suggest that there have been both positive and negative outcomes from the first five years of ACA implementation. In this editorial, we reflect on these impacts as well as their current and future effects on the field of psychiatric rehabilitation. (PsycINFO Database Record

This article serves as an introduction to the special issue on the topic of cognitive remediation. The papers comprising this special issue make important contributions to the cognitive remediation field by testing the efficacy of cognitive programs on unique symptom targets of serious mental illness, evaluating novel cognitive program enhancements, demonstrating the feasibility and promise of incorporating cognitive programs into everyday practice, and engaging new populations into cognitive programs. Together, these papers show that cognitive remediation is an important and increasingly common component of comprehensive psychiatric rehabilitation programs that can increase the effectiveness of these programs at helping participants make progress toward and achieve their personal goals. (PsycINFO Database Record

Objective Posttraumatic stress disorder (PTSD) is common in people with a serious mental illness, but it is often not diagnosed or treated. Recent progress has been made in developing and validating interventions for PTSD in this population, but dropout from treatment can be problematic. The present study evaluated the feasibility and clinical outcomes of a Brief program (three sessions) for the treatment of PTSD in persons with a serious mental illness. Method An open clinical trial was conducted to evaluate the Brief program, which comprises three individual weekly sessions and includes education about trauma and PTSD, as well as instruction in breathing retraining for the self-management of anxiety. Eighteen predominantly minority persons with serious mental illness and PTSD were enrolled in the Brief program and assessed at baseline, 1-month posttreatment, and 3-month follow-up. Results Acceptability and tolerability of the program were high, with 15 of 18 (83%) study participants completing all three sessions. Interview-based and self-report assessments indicated significant reductions in PTSD symptoms, depression, and other symptoms at posttreatment, with treatment gains maintained at the 3-month follow-up. Conclusion and implication for practice The results suggest the Brief program may be clinically beneficial to persons with serious mental illnesses and PTSD and indicate that more rigorous research is needed to evaluate the program.

The authors of this editorial discuss whether or not the value of exercise is being underestimated for wellness. One response to these alarming findings has been to develop or adapt illness self-management programs specifically targeting frequently co-occurring physical disorders in this population, such as diabetes, hypertension, and coronary artery disease. Preliminary evidence from controlled studies suggests promise for these approaches. Consistent across the different studies of medical comorbidity has been the finding that cardiovascular disease is the most common cause of death in persons with a serious mental illness. This has underscored the importance of routine screening for cardiovascular risk factors in this population. It has also led to an increased focus on addressing common modifiable risk factors, with particular attention to smoking cessation and weight loss programs to address obesity. Increasing activity level through regular exercise is a common ingredient of lifestyle interventions targeting weight loss. However, the benefits of exercise may not be limited to its role in weight loss programs. Furthermore, the benefits of exercise alone for weight loss may be limited, suggesting the need to consider exercise within the broader context of quality of life improvement.

Objective Most research on the Illness Management and Recovery (IMR) program for people with severe mental illnesses has focused on individuals with stable symptoms living in the community, with less attention to persons being treated in an inpatient setting. We evaluated the feasibility and effects of an IMR program adapted for individuals with schizophrenia who were awaiting discharge into the community. Method A randomized controlled trial was conducted at 2 hospitals in Taiwan to compare the adapted IMR program with treatment as usual (TAU). Ninety-seven individuals with schizophrenia were randomized to the adapted IMR program or TAU. Four outcome indicators including illness-management knowledge, attitudes toward medication, insight, and symptoms were assessed at baseline, posttreatment, and at a 1-month follow-up following discharge from the hospital. Results Participants in the adapted IMR group showed significantly greater improvements at posttreatment and 1-month follow-up in illness-management knowledge, attitudes toward medication, insight, and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) than individuals in the TAU group. There were no significant differences between the 2 groups on other subscales of the BPRS. Conclusions and implications for practice This is the first controlled evaluation of a version of the IMR program in an East Asian culture, and the first to evaluate it in an acute care inpatient setting. Our findings support the feasibility and potential benefits of implementing an adapted IMR program, focused on the prevention of relapses and rehospitalizations, during the discharge period of an inpatient treatment stay to prepare individuals to reenter the community.

Objective Effective monitoring and treatment are needed to address the elevated rates of medical comorbidity among individuals with serious mental illnesses. This study examined the feasibility and potential effectiveness of an automated telehealth intervention, supported by nurse health-care management, among adults with serious mental illnesses and chronic medical conditions. Methods We conducted a single-arm pilot trial with 70 individuals with serious mental illnesses and chronic medical conditions who were medically unstable (determined by treatment team or defined as multiple emergency room visits/hospitalizations within the past year). The telehealth intervention was delivered for 6 months with feasibility and acceptability as the primary outcomes. Measures of illness management self-efficacy, psychiatric symptoms, subjective health status, health indicators, and service use were also collected at baseline and at 6 months. Results Most individuals (n = 62; 89%) participated in at least 70% of the telehealth sessions. Participation was associated with improvements in self-efficacy for managing depression and diastolic blood pressure. Almost all participants (n = 68; 98%) rated their understanding of their medical condition as "much better" or "somewhat better" postintervention. Among a subgroup of individuals with diabetes, decreases in fasting blood glucose were achieved, and among those with diabetes and major depression or bipolar disorder there were reductions in urgent care and primary care visits. Conclusions and implications for practice These results demonstrate the feasibility and acceptability of automated telehealth supported by a nurse care manager and the potential effectiveness of this technology in improving self-management of psychiatric symptoms and chronic health conditions among these high-risk individuals.

OBJECTIVE There is a lack of research on social support for health behavior change among persons with serious mental illness who face disproportionate morbidity and premature death due to cardiovascular disease. This study examined social contact and the demographic, health and clinical characteristics associated with perceived social support for diet and exercise among persons living with serious mental illness enrolled in a healthy lifestyle intervention. METHOD Baseline data from two ongoing studies of the In SHAPE healthy lifestyle intervention for persons with serious mental illness were included in this analysis (N = 158). Cross-sectional analyses examined social contact and correlates of both negative and positive experiences of social support for diet and exercise. Multiple linear regression was used to assess the relationship between demographic characteristics, symptoms, health, and social support. RESULTS The majority (80.3%) of participants reported face-to-face contact at least twice monthly with a family member or friend. Readiness to change physical activity was associated with greater criticism from family for exercise behaviors, r(64) = .29, p < .05. Depressive symptoms (β = .30, p < .01) were significantly associated with more unhealthy family eating environments while controlling for the amount of family contact (β = .27, p < .01), while readiness to change dietary portion size (β = .34, p < .01) was associated with encouragement for healthy eating from friends. CONCLUSION AND IMPLICATIONS FOR PRACTICE Participants had regular contact with significant others who were a source of both positive and negative support for healthy eating and exercise. Engaging natural supports in supporting healthy behaviors may help persons with serious mental illness initiate and maintain lifestyle change.

Objective To explore mental health consumer and provider responses to a computerized version of the Illness Management and Recovery (IMR) program. Method Semistructured interviews were conducted to gather data from 6 providers and 12 consumers who participated in a computerized prototype of the IMR program. An inductive-consensus-based approach was used to analyze the interview responses. Results Qualitative analysis revealed consumers perceived various personal benefits and ease of use afforded by the new technology platform. Consumers also highly valued provider assistance and offered several suggestions to improve the program. The largest perceived barriers to future implementation were lack of computer skills and access to computers. Similarly, IMR providers commented on its ease and convenience, and the reduction of time intensive material preparation. Providers also expressed that the use of technology creates more options for the consumer to access treatment. Conclusions and implications for practice The technology was acceptable, easy to use, and well-liked by consumers and providers. Clinician assistance with technology was viewed as helpful to get clients started with the program, as lack of computer skills and access to computers was a concern. Access to materials between sessions appears to be desired; however, given perceived barriers of computer skills and computer access, additional supports may be needed for consumers to achieve full benefits of a computerized version of IMR.

As psychiatric rehabilitation practitioners, we have solid evidence that our field's services are effective in helping people become employed, participate in social and civic life, avoid restrictive and coercive psychiatric treatment, and thrive in stable and secure community residences. Yet, hundreds of thousands of people with psychiatric disabilities do not do these things. So we must ask ourselves, to what extent is this due to their location outside the financial mainstream, and if it is, what we can do as a field to address poverty among those we serve? This editorial addresses this question: Is recovery possible outside of the financial mainstream? (PsycINFO Database Record

Two articles in the current issue of the Psychiatric Rehabilitation Journal bring into focus the important question of the importance of work, and in particular meaningful employment, in people with a serious mental illness. Gewurtz, Cott, Rush, and Kirsh (see record 2012-34112-003) present findings from a change in policy in Canada for the funding of vocational services for people with a serious mental illness from a fee-for-service model to an outcomes-based model, with reimbursement based on successful competitive job placement and retention, irrespective of job type and consumer preference. The results indicated increased rates of competitive work, mainly in entry-level jobs, but they also raised questions as to whether the narrow focus on job attainment may have been at the cost of less career development and ultimately less meaningful work for the consumers. Baksheev, Allott, Jackson, McGorry, and Killackey (see record 2012-34112-002) found that a combined supported employment and education program for people with a first episode of psychosis led to higher rates of employment and class completion than usual services. The analysis presented in this report showed that no individual consumer characteristics other than program assignment (supported employment and education vs. usual services) predicted vocational or educational outcomes. The findings underscore the potency of supported employment, and suggest that combining it with educational services may be fruitful for people who have recently experienced an episode of psychosis. These findings raise several questions that will be touched on in this editorial, including: Why are career development and supported education important? What have we learned about supported education? What are the current gaps in our knowledge about supported education?

As the authors complete the 2017 publication cycle of Psychiatric Rehabilitation Journal and their term as editors draws to a close, they take the opportunity to welcome the new leadership of PRJ, to thank the many people who have contributed to its success, and to reflect on the importance of the journal's focus and scope to the field. They are pleased to welcome Dr. Sandra ("Sandy") Resnick as the new editor of PRJ, who will begin her incoming term by accepting new manuscripts starting January 1, 2018. In her role as Editor, Dr. Resnick hopes to further increase PRJ's accessibility to both practitioners and policymakers, while maintaining the high-quality of original research submissions that have led to widely cited articles in the field. (PsycINFO Database Record

This study explored the role of work in the recovery of employed and unemployed persons with psychiatric disabilities. Fourteen persons with psychiatric disabilities participated in semi-structured interviews. Content analysis revealed that the experience of recovery was based on six major dimensions: self-definition, empowerment, connections to others, meaning of work, vocational future, and meaning of recovery. Differences in these six dimensions led to the identification of three profiles of recovery: recovery as uncertain, recovery as a self-empowering experience, and recovery as a challenging experience. Each profile described a specific context in which participation in work or avoidance of work can be understood and vocational interventions can be designed.

This editorial reviews the challenges of treating people who first experience a psychotic episode, and the core elements of effective programs for these individuals. It then describe the NIMH Recovery After Initial Schizophrenia Episode (RAISE) initiative, and other related developments in the U.S., and their implications for psychiatric rehabilitation practitioners.

Objective Despite the large number of Latinos living in the United States, little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population. This article presents a secondary analysis of a randomized, controlled trial comparing supported employment with 2 other vocational rehabilitation programs in 3 ethnic/racial groups of participants with severe mental illness: Latinos, non-Latino African Americans, and non-Latino Whites. Method The data were drawn from a previously published randomized, controlled trial comparing supported employment with standard vocational rehabilitation services and a psychosocial clubhouse program in persons with severe mental illness (Mueser et al., 2004), including 64 Latinos, 91 non-Latino African Americans, and 43 non-Latino Whites. Comparisons were made between the 3 groups at baseline on demographic characteristics, clinical and psychosocial functioning, and quality of life. Within each ethnic/racial group, competitive employment and all paid employment outcomes were compared between the 3 vocational rehabilitation programs over the 2-year study period. Results At baseline, the Latino participants had lower levels of education and disability income, were less likely to have worked competitively over the previous 5 years, had more severe symptoms, and worse psychosocial functioning than the non-Latino African American or non-Latino White participants. Latinos randomized to supported employment had better competitive and all-paid work outcomes than those assigned to either standard services or the psychosocial clubhouse program, similar to the non-Latino consumers. Rates of competitive work for consumers in supported employment were comparable across all 3 racial/ethnic groups. Discussion Supported employment is effective at improving competitive work in Latinos with severe mental illness. Efforts should be made to increase access to supported employment in the growing population of Latinos with severe mental illness.

Despite many challenges, recent developments in the field of psychiatric rehabilitation offer opportunities for an increased focus on serving parents with psychiatric disabilities and their children. One such trend is the growth of psychosocial rehabilitation (PSR) programs that serve children and youth. The new Certificate in Children's Psychiatric Rehabilitation program offers practitioners education and training to meet the needs of children and families. Another opportunity can be found in the recent growth of family services in PSR programs for veterans with serious mental health problems. The Veterans Administration's new Psychosocial Rehabilitation and Recovery Services model explicitly includes family members in supporting veterans and acknowledges the need to deliver direct services to their spouses, children, and parents. A third relevant trend is the emergence of a new generation of recovery-oriented PSR services for mothers and fathers. Opportunities for enhanced services are provided in particular by self-help, peer support programs for parents with lived experience.

OBJECTIVE Engaging persons with co-occurring disorders in substance use treatment presents a significant challenge for public mental health service providers. Standardized, user-friendly guidelines may have great benefit for community mental health outreach staff working with individuals with co-occurring disorders. The purpose of this study is to describe the impact of a brief, structured goal development curriculum ("Fresh Start") on clinicians' motivational interviewing skills and to assess clinician and consumer satisfaction with the curriculum. METHOD Four clinicians, each working with 3-4 consumer participants, were assessed with the Yale Adherence and Competency Scale prior to and during use of Fresh Start to determine improvements in motivational interviewing and goal setting. Consumer participants were assessed in brief qualitative interviews to assess satisfaction. Chart-review of routinely collected substance use data was used to assess reductions in use. RESULTS Clinicians demonstrated high ratings in relational motivational interviewing skills at baseline which were maintained at study conclusion. Clinicians had lower technical motivational interviewing skills at baseline and made modest improvements in motivational interviewing techniques targeting increasing change talk. Fresh Start participants completed an average of 10 sessions (SD = 2.35). Among the 16 consumers who volunteered to participate in using the Fresh Start curriculum, 12 finished the program and 9 decided to reduce use and composed a sobriety plan. CONCLUSIONS AND IMPLICATION FOR PRACTICE High rates of completion indicate acceptability of the curriculum and feasibility for implementing the program in a community setting. Short, goal-setting interventions are needed and under proper conditions may be teachable in vivo.

The active involvement of consumers with a serious mental illness as partners in their own treatment and the facilitation of illness self-management strategies are hallmarks of recovery-oriented services. The articles in this special issue are evidence of the explosion in the development, evaluation, adaptation, and implementation of programs aimed at improving the ability of consumers to manage psychiatric, medical, and substance use disorders in collaboration with others. Illness self-management is a critical ingredient to consumers taking control over their own lives and fostering genuine collaboration with professionals in their treatment.

TOPIC A growing research literature indicates that cognitive enhancement (CE) interventions for people with schizophrenia can improve cognitive functioning and may benefit psychosocial functioning (e.g., competitive employment, quality of social relationships). Debate continues regarding the strength of evidence for CE and related policy implications, such as the appropriateness of funding CE services. PURPOSE This paper summarizes and updates a meeting of experts and stakeholders convened in 2008 by the New York Office of Mental Health to review evidence on the impact of CE for people with schizophrenia and other serious mental illnesses, and addresses whether the evidence base for CE interventions is sufficient to warrant funding. SOURCES USED Specific recommendations based on the extant literature are provided regarding the structure and components of CE programs that should be present in order to improve cognitive and psychosocial outcomes and therefore merit consideration of funding. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These recommendations may serve as a starting point in developing standards for CE programs. Establishing evidence-based practice standards for implementing CE interventions for people with serious mental illnesses may facilitate dissemination of programs that have the greatest potential for improving individuals' functional outcomes while minimizing incremental costs associated with providing CE services. Important open questions include how the performance of CE programs should be monitored and which individuals might be expected to benefit from CE as evidenced by improved functioning in their everyday lives.

Trauma can affect anyone's life. However, some people are more likely than others to have experienced trauma in their lives and are more sensitive to its effects. In particular, people with a serious mental illness tend to have been exposed to high levels of trauma, both before and after the onset of their mental illness, and not surprisingly they have higher rates of PTSD than in the general population. Just as there is a need to educate the general public about PTSD and its treatment, mental health professionals and service users would benefit from learning similar information and understanding that there is realistic hope for developing a worthwhile and rewarding life after recovery from trauma and PTSD.

People with psychiatric disabilities often face complex financial situations that make them unable to exercise choice in how their financial resources are allocated to needs including health care, housing, education, leisure pursuits, and other important life activities. One avenue to address these barriers is by helping people increase their financial literacy or knowledge of how to manage and budget their money effectively, accumulate assets, and reduce or deal with debt. However, our field has not focused sufficient attention on improving the financial literacy of the people we serve. Unfortunately, people with mental illness are significantly less likely to have any savings than those without mental illness. This makes them excellent candidates for state and federal programs that help low-income individuals accumulate savings that are exempt from asset limits for all federal means-tested programs. Growing out of these efforts, a field known as "asset-based welfare" has evolved to understand the role of assets in the promotion of individual and collective welfare. In an uncertain economy, the time is right for the field of psychiatric rehabilitation to expand its focus to include community and economic development activities that promote financial security.

The readership of Psychiatric Rehabilitation Journal is broad and not limited to a single profession; however, in this opinion piece, as the Journal moves under the umbrella of publications operated by the American Psychological Association, we focus on the need to engage one profession, clinical psychology, more fully in working with individuals with a serious mental illness. Many of the arguments provided below also have clear relevance to other professions, and may have implications for increasing their involvement in work with this population. In this opinion piece, we call attention to the insufficient training and lack of investment and involvement in the treatment of serious mental illness of one mental health profession, clinical psychology.

OBJECTIVES The purpose of this study was to explore the amount of family contact among older persons with serious mental illnesses (SMI), and to examine its relationship to health and mental health. METHODS An analysis of baseline data was conducted from a treatment study including 180 adults age 50 and older. The amount of family contact was examined with descriptive statistics. Differences in health and mental health were examined between participants with low, moderate, or high levels of family contact. Analyses also compared these groups on health and mental health functioning, controlling for psychiatric symptoms and the number and severity of medical diseases, respectively. RESULTS Over three-quarters of respondents (77.8%) reported speaking on the phone with a relative and two-thirds (67.2%) reported seeing a relative at least once during the past month. Older adults who lived with a family member had more severe mood symptoms and poorer mental health functioning. Those who lived with family or had moderate levels of family contact had more comorbid diseases and more disease severity than those with less family contact. These relationships remained significant after controlling for medical conditions or psychiatric symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The majority of older persons have regular family contact and those with the highest levels of family contact appear to have more compromised physical and mental health. Study findings provide new knowledge for practitioners regarding the importance of using family interventions to target physical health and mental illness management for older consumers who may need assistance to access medical care and treatment. Further research on the role of families in psychiatric and physical health management will provide a foundation for family interventions aimed at supporting community living among older adults.

Objective Cognitive remediation programs aimed at improving role functioning have been implemented in a variety of different mental health treatment settings, but not in psychosocial clubhouses. This study sought to determine the feasibility and preliminary outcomes of providing a cognitive remediation program (the Thinking Skills for Work program), developed and previously implemented in supported employment programs at mental health agencies, in a psychosocial club-house. Methods Twenty-three members with a history of difficulties getting or keeping jobs, who were participating in a supported employment program at a psychosocial clubhouse, were enrolled in the Thinking Skills for Work program. A neurocognitive battery was administered at baseline and 3 months later after completion of the computer cognitive training component of the program. Hours of competitive work were tracked for the 2 years before enrollment and 2 years following enrollment. Other work-related activities (school, volunteer) were also tracked for 2 years following enrollment. Results Twenty-one members (91%) completed 6 or more computer cognitive training sessions. Participants demonstrated significant improvements on neurocognitive measures of processing speed, verbal learning and memory, and executive functions. Sixty percent of the members obtained a competitive job during the 2-year follow-up, and 74% were involved in some type of work-related activity. Participants worked significantly more competitive hours over the 2 years after joining the Thinking Skills for Work program than before. Conclusions The findings support the feasibility and promise of implementing the Thinking Skills for Work program in the context of supported employment provided at psychosocial clubhouses.

Medication nonadherence in people with schizophrenia and other serious mental illnesses (SMI) is multidetermined and has been consistently associated with relapse and rehospitalization, but little is known about the prevalence and correlates of nonadherence in older people with SMI. This study evaluated the interrelationships between different measures of medication adherence (including pill counts, self-report, informant report, and attitudes toward medications), and their associations with demographic characteristics, and clinical, functional, skill, and cognitive measures in a group of 72 older people with SMI living in the community. Pill counts of adherence to psychotropic medications were highly correlated with pill counts for nonpsychiatric medications. However, pill counts were weakly correlated with self-report and informant ratings, which tended to overestimate adherence. Lower medication adherence was associated with: mood disorder (compared to schizophrenia), lack of supervision, fewer prescription medications, less insight, more severe negative symptoms, and worse community functioning. Among individuals with little or no supervision of their medications, higher adherence was related to better performance on the Medication Management Administration Assessment (MMAA) role-play, which was highly correlated with several domains of cognitive functioning, suggesting that the MMAA may be a more ecologically valid measure of cognitive functioning related to medication adherence. This study highlights the importance of using multiple measures for the assessment of medication adherence in older people with SMI, including pill counts, and suggests that interventions are needed to improve adherence in this population.

The effects of yoga on mood were examined in 13 psychiatric inpatients at New Hampshire Hospital. Participants completed the Profile of Mood States (POMS) prior to and following participation in a yoga class. Analyses indicated that participants reported significant improvements on all five of the negative emotion factors on the POMS, including tension-anxiety, depression-dejection, anger-hostility, fatigue-inertia, and confusion-bewilderment. There was no significant change on the sixth POMS factor, vigor-activity. Improvements in mood were not related to gender or diagnosis. The results suggest that yoga was associated with improved mood, and may be a useful way of reducing stress during inpatient psychiatric treatment.