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Background: Knowledge about the illness and treatment is important for treatment adherence and positive outcomes in patients with severe mental illnesses (SMIs) and their caregivers. The current study aimed at comparing the knowledge of the patients with SMI and their caregivers, and its relationship with their sociodemographic characteristics. Methodology: A cross-sectional, observational study conducted in the outpatient department of a tertiary care general hospital and comprised 50 dyads of patients with SMIs and their caregivers. Information was collected by a semi-structured questionnaire. Comparison of knowledge between groups was performed using the Chi-square test, and the relationship of knowledge with their sociodemographic variables was analyzed using logistic regression test. Results: There was a lack of knowledge among participating dyads for most of the illness- and treatment-related variables. A significant difference was observed between the two groups in regard to their knowledge about the name of the illness, how medical comorbidity and comorbid substance use affect psychiatric illness, brand name of the medicine, adverse effect, duration of treatment, role of investigation in diagnosis and treatment, and psychosocial rehabilitation (P < 0.001). The difference in knowledge was also observed regarding the formulation of medicine other than tablets and mechanism of its action (P < 0.05). Dyads with higher socioeconomic status had more knowledge about some but not all aspects of their illness. Conclusion: The patients and their caregivers lacked knowledge about many important illnesses-related variables. It is important to psychoeducate in routine clinical practice.

Objective: The resource group method intends to promote patients' agency and self-management and to organize meaningful partnerships between patients and their informal and formal support systems. The aim of this study was to enhance the understanding of interpersonal dynamics that arise within resource groups for people with severe mental illness. Insight into these unfolding processes would enable improved implementation of the resource group method so that it contributes to establishing a positive social environment, which can lead to more enduring recovery.Methodology: We performed a narrative analysis of transcripts and field notes obtained in a longitudinal, qualitative study on the resource group method. The stories of four different resource groups were reconstructed and analyzed in depth. Data included a total of 36 interviews (with patients, significant others, and mental health professionals) and 18 observations of resource group meetings.Results: The degree to which the resource group method actually contributes to recovery was based on the extent to which the existing roles of and patterns between the patient and his/her resource group members were altered. Breaking through old patterns of inequality and the joint search for a new balance in relationships proved to be crucial processes for establishing an empowering resource group. The four cases showed that it takes time, patience, and small steps back and forth to overcome the struggles and fears related to finding new ways of relating to each other. An honest and reflective atmosphere in which all participants are encouraged to participate and be curious about themselves and each other is essential for changes in interpersonal dynamics to emerge. Such changes pave the way for individuals with SMI to find their own voices and pursue their unique recovery journeys.Conclusions: The functioning of the resource group and the ability of the involved members to respond in new ways are important when working toward the patient's recovery goals. The resource group method should therefore not be considered an intervention to organize informal support for the patient, but a platform to expose and adjust the functioning of the patient's social network as a whole.

Background Interpersonal trauma and post-traumatic stress disorder (PTSD) in patients with severe mental illness (SMI) negatively affect illness course. Narrative exposure therapy (NET) is effective in vulnerable patient groups, but its efficacy and applicability has not been studied in out-patients with SMI. Aims We aimed to evaluate the efficacy and applicability of NET in SMI on changes in PTSD, dissociation, SMI symptoms, care needs, quality of life, global functioning and care consumption. Method The study had a single-group, pre-test–post-test, repeated-measures design and was registered in The Netherlands National Trial Register (identifier TR571). Primary outcomes were assessed at pre-treatment (T0), 1 month post-treatment (T1) and 7 months’ follow-up (T2), with a structured interview for PTSD and dissociation screening. Secondary outcomes followed routinely SMI measurements and medical data. Mixed models were used for data analysis. Results The majority of the 23 participants was female (82%). Mean age was 49.9 years (s.d. 9.8) and mean PTSD duration was 24.1 years (s.d. 14.5). Mean PTSD severity decreased from 37.9 at T0 to 31.9 at T1 (−6.0 difference, 95%CI −10.0 to −2.0), and decreased further to 24.5 at T2 (−13.4 difference, 95%CI −17.4 to −9.4). Dissociation, SMI symptoms, duration of contacts, and medication decreased; global functioning increased; and quality of life and perceived needs did not change. Eleven participants were in remission for PTSD at T2, of which five were also in remission for major depression. Conclusions NET appeared efficacious and applicable to out-patients with SMI and PTSD, and was well tolerated.

AbstractBackgroundAdministrators and policymakers are increasingly interested in individual placement and support (IPS) as a way of helping people with severe mental illness (SMI) obtain employment or education. It is thus important to investigate the cost-effectiveness to secure that resources are being used properly.MethodsIn a randomized clinical trial, 720 people diagnosed with SMI were allocated into three groups; (a) IPS, (b) IPS supplemented with cognitive remediation a social skills training (IPSE), and (c) Service as usual (SAU). Health care costs, municipal social care costs, and labor market service costs were extracted from nationwide registers and combined with data on use of IPS services. Cost-utility and cost-effectiveness analyses were conducted with two primary outcomes: quality-adjusted life years (QALY) and hours in employment. Incremental cost-effectiveness ratios (ICER) were computed for both QALY, using participant’s responses to the EQ-5D questionnaire, and for hours in employment.ResultsBoth IPS and IPSE were less costly, and more effective than SAU. Overall, there was a statistically significant cost difference of €9,543 when comparing IPS with SAU and €7,288 when comparing IPSE with SAU. ICER’s did generally not render statistically significant results. However, there was a tendency toward the IPS and IPSE interventions being dominant, that is, cheaper with greater effect in health-related quality of life and hours in employment or education compared to usual care.ConclusionIndividual placement support with and without a supplement of cognitive remediation tends to be cost saving and more effective compared to SAU.

AbstractBackgroundSymptoms may be more useful prognostic markers for mental illness than diagnoses. We sought to investigate symptom domains in women with pre-existing severe mental illness (SMI; psychotic and bipolar disorder) as predictors of relapse risk during the perinatal period.MethodsData were obtained from electronic health records of 399 pregnant women with SMI diagnoses from a large south London mental healthcare provider. Symptoms within six domains characteristically associated with SMI (positive, negative, disorganization, mania, depression, and catatonia) recorded in clinical notes 2 years before pregnancy were identified with natural language processing algorithms to extract data from text, and associations investigated with hospitalization during pregnancy and 3 months postpartum.ResultsSeventy-six women (19%) relapsed during pregnancy and 107 (27%) relapsed postpartum. After adjusting for covariates, disorganization symptoms showed a positive association at borderline significance with relapse during pregnancy (adjusted odds ratio [aOR] = 1.36; 95% confidence interval [CI] = 0.99–1.87 per unit increase in number of symptoms) and depressive symptoms negatively with relapse postpartum (0.78; 0.62–0.98). Restricting the sample to women with at least one recorded symptom in any given domain, higher disorganization (1.84; 1.22–2.76), positive (1.50; 1.07–2.11), and manic (1.48; 1.03–2.11) symptoms were associated with relapse during pregnancy, and disorganization (1.54; 1.08–2.20) symptom domains were associated with relapse postpartum.ConclusionsPositive, disorganization, and manic symptoms recorded in the 2 years before pregnancy were associated with increased risk of relapse during pregnancy and postpartum. The characterization of routine health records from text fields is relatively transferrable and could help inform predictive risk modelling.

Introduction Mental health problems increase the risk for unstable career paths and often lead to early transition to disability pensions. Individual Placement and Support (IPS) is an evidence-based program integrated into psychiatric care helping individuals with serious mental illness to find competitive employment. It comprises personalized job search as well as individual in-work support for both the employee and the employer. Objectives The Finnish Individual Placement and Support Evaluation Study (2020-2023) aims at investigating the implementation, feasibility as well as perceived benefits and outcomes of the IPS program implemented for the first time broadly in Finland. The present study focuses on the changes observed among program participants in employment status and psychosocial well-being during the 6- and 12-months follow-ups. Methods Both quantitative and qualitative data from different stakeholders have been and will be collected. The data collection will be finished at the end of 2022. The presentation focuses on findings from interviews (n=31) and from questionnaire data collected among program participants at baseline and at 6- and 12-months follow-ups. The total sample will comprise approximately 300 program participants (18−64 years of age) diagnosed with a severe mental illness. Results Findings on changes in employment status as well as in psychosocial well-being (self-rated health and work ability, mental distress, positive mental health, self-esteem, satisfaction with life, social inclusion, and perceived social support) will be discussed at the congress. The preliminary findings of the study show that about half of the program participants have succeeded in getting employed at least once during the follow-up. However, becoming employed does not always result in increased psychosocial well-being. Work-related stress, meaningless or unsuitable job, problems at the workplace community or fear of being stigmatized may contribute toward decreased psychosocial well-being. Conclusions Meaningful work can play an important role in the process of recovery from mental illness. However, individuals with severe mental health problems need support with the working life related concerns and stress especially at the beginning of employment. Disclosure of Interest None Declared

Introduction In Italy, subjects with severe mental illness (SMI) considered “in danger of posing a threat to others” are hospitalized into structures known as “REMS–Residenze per l’Esecuzione delle Misure di Sicurezza”, designed to provide rehabilitating programs. There are also specialized forensic teams to support Community Mental Health Centers (CMHC) in helping patients who committed crimes. A better characterization of clinical and real-world functioning of forensic patients represents a topic of clinical interest (Caruso R et al. Curr Psychiatry Rep 2021; 7 29; Barlati et al. Eur Arch Psychiatry Clin Neurosci 2022, in press; Fazel et al. Br J Psychiatry. 213 609-614). Objectives Aims were to compare clinical and psychosocial functioning characteristics in three cohorts of SMI patients. Methods A total of 29 patients hospitalized in REMS facilities were included into this study; starting from this first group an equal number of individuals matched for sex, age, and diagnosis were included in other two groups of outpatients cared for by the forensic team and of non-forensic outpatients treated by CMHC. Clinical severity was measured through the Clinical Global Impression scale – Severity (CGI-S) and real-world functioning was measured through the Personal and Social Performance scale (PSP). Analyses included Chi-Square test for categorical variables and Kruskall-Wallis test for continuous variables with Mann-Withney U test for post/hoc comparisons. P values < 0.05 were considered significant. Results Significant between-groups differences emerged regarding psychosocial functioning (p=0.013): that was more compromised in the REMS group (mean:34.0) when compared to the forensic team subjects (mean:41.3) and to the subjects in the CMHC group (mean:47.7). Results concerning clinical severity point in the opposite direction: more severe symptoms were observed in the CMHC group (mean:4.7) compared to the REMS group (mean: 4.3) and the forensic outpatients (mean:3.5). The difference in the CGI-S mean scores is significant for the forensic outpatients when compared to the REMS group (p=0.011) and to the CMHC group (p

Introduction The COVID-19 pandemic has disrupted mental healthcare delivery in many countries. The restricted access to psychiatric services and double disasters (pandemic and earthquakes) coincided in Croatia, potentially placing people with severe mental illness (SMI) in a very vulnerable position. Objectives The aim of this study was to examine the changes in substance use in people with SMI in the first and the second COVID-19 wave and co-occurring earthquakes. The secondary aim was to explore whether the type of treatment (community mental health teams (CMHT) vs. treatment as usual) influenced those changes. Methods This study was nested within the RECOVER-E project (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE, Horizon 2020 research and innovation programme, grant agreement No 779362). The study involved 90 participants with SMI assessed at two time points: in May/June 2020 (during the first COVID-19 wave and after Zagreb earthquake) and in December 2020/January 2021 (during the second COVID-19 wave and after Petrinja earthquake). The changes in the use of psychoactive substances (alcohol, cannabis, other drugs, sedatives) were assessed using self-reported survey. Results The increase in tobacco smoking behavior and the use of sedatives was observed in both COVID-19 waves in people with SMI. No increase was reported in cannabis and other drugs use, while less than 5% of participants reported increase in alcohol consumption. Not receiving CMHT service predicted the increase in sedative use. Conclusions Ensuring accessible mental health care provided by CMHT is recommended for counteracting the negative effect of external stressors (such as pandemic and co-occurring earthquakes) on the increased substance use among people with SMI. Disclosure of Interest S. Levaj Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., S. Medved Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., J. Gerlach: None Declared, L. Shields-Zeeman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., F. Bolinski Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Bradaš Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., Z. Madžarac Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362., I. Rojnić Palavra: None Declared, M. Rojnić Kuzman Grant / Research support from: Project RECOVER-E - European Union’s Horizon 2020 research and innovation programme; Grant Agreement No 779362.

Introduction The COVID-19 pandemic has disproportionately affected patients with severe mental illness (SMI), a vulnerable population with high morbidity and mortality. A UK-based study found reduced vaccination rates in patients with SMI; they therefore need to be prioritised for prevention and disease management. Objectives The objectives were to determine risk factors for vaccine hesitancy, and how best to manage those in patients with SMI, as well as whether our intervention of calling patients for their vaccines had a positive outcome. Methods Following approval from the Lambeth Directorate of South London and Maudsley (SLaM) NHS Foundation Trust, we investigated COVID-19 vaccination rates inpatients with SMI from a psychosis community service in South London (n=236). Dates of first and second doses were recorded through audit; reasons for refusal of vaccination were noted. Patients were encouraged to take the vaccine. A re-audit was performed after allowing three months. Chi-squared statistical analysis was performed to determine the value of our intervention. Results Before the intervention, 143 patients (60.6%) received at least one vaccine. 24 patients (10.2%) received one dose, and 77 (32.8%) were yet to receive any. There was no statistical significance (p=0.1509) between the number of patients who received a vaccine before and after intervention, with 33.1% of patients still remaining unvaccinated. Image: Image 2: Image 3: Conclusions There is limited research on perceptions of receiving vaccines in patients with SMI, despite their cost-effectiveness in disease prevention. Even after intervention, 33.1% of patients remained unvaccinated, compared to 6.6% nationally. A lack of knowledge and recommendations from care teams are reasons for hesitancy. Misinformation, conspiracy theories and propaganda can drive people towards refusal. Patients with SMI typically have disadvantages of healthcare inequality, lower levels of education and access to inaccurate information. Patients and their healthcare team should be knowledgeable about vaccine efficacy and side effects. Studies have shown low uptake in the Black/African/Caribbean ethnic group (49.3%, table 3). Reasons include general mistrust in institutions and access barriers. For minority communities, vaccination sites in community centres or places of worship have proven to be effective, providing familiarity. Patients taking clozapine may have a weaker immune system due to myelosuppression. 24.3% of our patients take this, with many unsure of interactions or side effects. Poorer prognosis means a focussed approach is needed. Vaccine hesitancy is complex and requires targeted, tailor-made strategies, with consideration for patients who may lack capacity. It is evident from our results that calling patients alone may not be effective. A future multi-modal approach may be necessary to address poor vaccine uptake and opens up avenues to further explore vaccine hesitancy. Disclosure of Interest None Declared

Abstract Background Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England. Methods We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis. Results Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, −786;31) to £599 (−1,321;−156) (in 2020–2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [−0.03;0.05] to 0.01 QALY, [−0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving. Conclusion Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.

Abstract Introduction Resource-oriented interventions can be a low-cost option to improve care for patients with severe mental illnesses in low-resource settings. From 2018 to 2021 we conducted three randomized controlled trials testing resource-oriented interventions in Bosnia and Herzegovina (B&H), i.e. befriending through volunteers, multi-family groups, and improving patient-clinician meetings using the DIALOG+ intervention. All interventions were applied over 6 months and showed significant benefits for patients’ quality of life, social functioning, and symptom levels. In this study, we explore whether patient experiences point to common processes in these interventions. Methods In-depth semi-structured interviews were conducted with 15 patients from each intervention, resulting in a total sample of 45 patients. Patients were purposively selected at the end of the interventions including patients with different levels of engagement and different outcomes. Interviews explored the experiences of patients and were audio-recorded, transcribed, and analysed using the thematic analysis framework proposed by Braun and Clark. Results Three broad themes captured the overall experiences of patients receiving resource-oriented interventions: An increased confidence and agency in the treatment process; A new and unexpected experience in treatment; Concerns about the sustainability of the interventions. Conclusions The findings suggest that the three interventions – although focusing on different relationships of the patients – lead to similar beneficial experiences. In addition to being novel in the context of the mental health care system in B&H, they empower patients to take a more active and confident role in treatment. Whilst strengthening patients’ agency in their treatment may be seen as a value in itself, it may also help to achieve significantly improved treatment outcomes. This shows promise for the implementation of these interventions in other low-resource countries with similar settings.

Background: Among Family-Based Services for the treatment of severe mental illnesses, multi-family models gained particular attention, given the potential usefulness of mutual feed-back, motivation and encouragement among families.Methods: The Psychodynamic Multi-Family Group Model has been proposed since 1997 in some Community Mental Health Services in Rome. Since 2011 multifamily groups are held weekly in all the six Districts of the Department of Mental Health that serves a population of more than one million people, and data have been collected since 2015 in three Districts. A total of 794 individuals attended the meetings in the period 2015–2019.Results: Eighty-six percent of those who started, attended more than one meeting. The mean of occurrences of participation among patients was 18.6, among mothers 25.6 and among fathers 21.6. The 794 participants belonged to 439 family units, among which 180 comprised only the patient, 76 only parent(s) or other close person(s), and 183 comprised parent(s) or close person(s) with the patient. Patients participating alone were older than those of families who participated as a whole. Families including the patient showed the longest duration of attendance and the highest prevalence of a diagnosis of schizophrenia in the index patient. Families who had been attending the multifamily groups since a long time maintained a high rate of attendance.Conclusions: Multifamily groups represent a setting where patients can meet with other people and professionals in a free still structured way, and with not strictly therapeutic objectives. The high number of patients who attended alone suggests that such participation corresponds to a self-perceived need of open and free setting facilitating sharing of problems and solutions. The good tenure of the interventions, the high participation, and the feasibility in the long-term suggest that multifamily groups can be implemented in the mental health services of a large city, are sustainable over many years, and can represent a valuable resource for many patients and families.

Neuropsychological abilities may underlie successful performance of everyday functioning and social skills. We aimed to determine the strongest neuropsychological predictors of performance-based functional capacity and social skills performance across the spectrum of severe mental illness (SMI). Unemployed outpatients with SMI (schizophrenia, bipolar disorder, or major depression; n = 151) were administered neuropsychological (expanded MATRICS Consensus Cognitive Battery), functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B), and social skills (Social Skills Performance Assessment; SSPA) assessments. Bivariate correlations between neuropsychological performance and UPSA-B and SSPA total scores showed that most neuropsychological tests were significantly associated with each performance-based measure. Forward entry stepwise regression analyses were conducted entering education, diagnosis, symptom severity, and neuropsychological performance as predictors of functional capacity and social skills. Diagnosis, working memory, sustained attention, and category and letter fluency emerged as significant predictors of functional capacity, in a model that explained 43% of the variance. Negative symptoms, sustained attention, and letter fluency were significant predictors of social skill performance, in a model explaining 35% of the variance. Functional capacity is positively associated with neuropsychological functioning, but diagnosis remains strongly influential, with mood disorder participants outperforming those with psychosis. Social skill performance appears to be positively associated with sustained attention and verbal fluency regardless of diagnosis; however, negative symptom severity strongly predicts social skills performance. Improving neuropsychological functioning may improve psychosocial functioning in people with SMI.

Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups.Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models.Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups.Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.

Introduction: There is an increasing emphasis on recovery-oriented care in the design and delivery of mental health services. Research has demonstrated that recovery-oriented services are understood differently depending on the stakeholders involved. Variations in interpretations of recovery lead to challenges in creating systematically organized environments that deliver a consistent recovery-oriented approach to care. The existing evidence on recovery-oriented practice is scattered and difficult to apply. Through this systematic scoping study, we aim to identify and map the essential elements that contribute to recovery outcomes for persons living with severe mental illness.Methods: We used the Arksey & O'Malley framework as our guiding approach. Seven key databases (MEDLINE, PubMed, CINAHL/EBSCO, EMBASE, ProQuest, PsycINFO, and Google Scholar) were searched using index terms and keywords relating to recovery and severe mental illness. To be included, studies had to be peer-reviewed, published after 1988, had persons with severe mental illness as the focal population, and have used recovery in the context of mental health. The search was conducted in August 2018 and last updated in February 2020.Results: Out of 4,496 sources identified, sixty (n = 60) sources were included that met all of the selection criteria. Three major elements of recovery that emerged from the synthesis (n = 60) include relationships, sense of meaning, and participation. Some sources (n = 20) highlighted specific elements such as hope, resilience, self-efficacy, spirituality, social support, empowerment, race/ethnicity etc. and their association with the processes underpinning recovery.Discussion: The findings of this study enable mental health professionals to incorporate the identified key elements into strategic interventions to facilitate recovery for clients with severe mental illness, and thereby facilitate recovery-oriented practice. The review also documents important gaps in knowledge related to the elements of recovery and identifies a critical need for future studies to address this issue.

Objective: The resource group method for people with severe mental illness might provide a useful framework to facilitate patient's empowerment and systematically engage significant others. However, no research has explored the perspectives and experiences of patients and their significant others. This is crucial for better adjustment to the needs of the people using the method. The aim of this study was to develop a useful framework for a deeper understanding of the resource group method and its outcomes.Method: The study used a longitudinal, qualitative multiple case-study design based on grounded theory methodology. During a period of 2 years, the developments and processes in eight resource groups were explored by conducting a total of 74 interviews (e.g., with patients, significant others, and mental health professionals) and 26 observations of resource group meetings.Results: Analysis showed that a well-functioning resource group set the stage for five processes to unfold: (i) experience of support; (ii) acknowledgment of significant others; (iii) activation; (iv) openness; and (v) integration. These processes facilitated recovery both in terms of an arousing curiosity within the patient as well as increasing reciprocity and equality in their social relations. In addition, the method emphasized the uniqueness of each recovery journey, thereby providing a framework to shape recovery-oriented care. The analysis also revealed three hindering factors: (i) embedding and implementation issues; (ii) predominant network; and (iii) tensions inherent in the resource group setting.Conclusion: Working according to the resource group method involves that the person's recovery work becomes a social process that takes place in relation to the social environment and everyday life in which it is important to acknowledge and integrate the needs of significant others in treatment and care. This study provides a first step toward a multidimensional comprehension of the resource group method, the working mechanisms and its influence on recovery for people with severe mental illness.

AimsThis study explores how well the World Health Organization Disability Assessment Schedule (WHODAS 2.0) assesses problems with psychosocial functioning in patients with severe mental illness (SMI). Further, we assessed the relationships between psychosocial functioning and psychopathology, medication side effects, treatment setting, and quality of life.MethodsWe performed an observational, cross-sectional study on the island of Curaçao to assess psychosocial functioning in 77 patients with SMI; they mainly had psychotic disorders. We interviewed their healthcare providers using the proxy version of the WHODAS 2.0. In addition, patients were examined for psychiatric symptoms, medication side effects (including drug-induced movement disorders), and quality of life. Associations were examined with Spearman's rank correlation (ρ).ResultsDifficulties in psychosocial functioning were reported by patients with SMI in the WHODAS 2.0 domains of understanding and communicating [mean (M)=34.5, standard deviation (SD)=18.6), participation in society (M=25.5, SD=15.6), and getting along with people (M=24.1, SD=16.1)]. Notably, outpatients had more problems participating in society than inpatients (M=33.6, SD=18.5 versus M=23.2, SD=14.1, p=0.03). A positive correlation was observed between drug-induced parkinsonism and the WHODAS 2.0 total score (ρ =0.30; p=0.02), as well as with various subscales, getting around, and household activities.ConclusionThe proxy version of the WHODAS 2.0 is clinically useful for patients with severe mental illness. The highest scores on the WHODAS 2.0 were found in domains related to interactions with other people and to participation in society. Inpatient status appeared to aid participation in society; this might be due to living in the sheltered clinic environment and its associated daily activities. We further found that drug-induced parkinsonism was associated with a broad spectrum of psychosocial disabilities.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT02713672; retrospectively registered in February 2016

This article explores the link between spirituality/religiosity and mental health from a clinical and neuroscience perspective, taking into account the advancements in neuroimaging. Specifically, it examines how spirituality influences the treatment of mental illness, emphasizing the importance of neuronal networks in cognitive and emotional processes, with a focus on the default mode network (DMN) of the brain. The discussion explores the role of spirituality/religiosity in managing mental disorders and how alterations in the DMN may provide insight into the impact of spirituality/religiosity on mental health. By also discussing spiritual and non-spiritual meditation, as well as spiritual experiences facilitated by the use of psychedelics in psychiatry and the associated brain networks, we aim to elaborate on the importance and limitations of spirituality within psychiatry. [ABSTRACT FROM AUTHOR]

Abstract Background The stigmatization of mental illness is currently considered to be one of the most important issues facing caregivers of severely mentally ill individuals. There is a dearth of information about the prevalence and associated factors of perceived stigma among caregivers of people with severe mental illness in the study area. Objective To assess the prevalence and associated factors of perceived stigma among non-professional caregivers of people with severe mental illness, Bahir Dar, northwest Ethiopia. Method Institutional based cross-sectional study was conducted from May to June, 2016 at Felege Hiwot Referral Hospital among 495 caregivers of people with the severe mental illness. Pre-tested structured family interview schedule questionnaire was used. Binary logistic regression was applied to identify factors associated with perceived stigma and interpreted using odds ratio with 95% confidence interval. Statistical significance was considered at p value

Background: In the Netherlands only a comparatively low percentage (18-19%) of persons with severe mental illness (SMI) are in paid employment. The problem consists not only of finding a job but also of holding it down., Aim: To develop guidelines that will ensure that patients with SMI have the best possible access to paid employment and that the drop-out rate for this group is as low as possible., Method: We reviewed the literature systematically and reviewed the results revealed by focus groups and case studies., Results: There is strong evidence that the integrated approach 'Individual Placement and Support' is effective in keeping people in employment. There are indications that self-management strategies and programmes and assessment instruments are also effective in this regard., Conclusion: The guidelines recommend that persons with SMI should be given continuing support so they can remain in paid employment. More research is needed into how effective self-management programmes and assessment instruments can be in keeping this group of persons in employment. Collaborations between various sectors also needs to be further investigated.

Introduction Studies in adult psychiatric patients consistently call attention to premature mortality and its association with metabolic syndrome. However, the utility of the metabolic syndrome construct is controversial in older adults in the general population, since literature shows that some components, such as obesity, can be protective against mortality. In older adults with mental illness, only one study explored the relation between metabolic syndrome and mortality and found no association. Objectives To examine whether metabolic syndrome or any of its components predicted mortality in a cohort of older adults with psychiatric disorders, and to determine if this association differs across diagnostic groups. Methods We used a multicentric prospective design to follow, over 5 years, a cohort that included 634 in– and outpatients with schizophrenia, bipolar or major depressive disorder (MDD). Metabolic syndrome was assessed at baseline following NCEP-ATPIII criteria. Cause of death was categorized as cardiovascular disorder (CVD) mortality, non-CVD disease-related mortality, suicide and accident. Results We found no significant association between metabolic syndrome or any of its components with all-cause, CVD and non-CVD mortality. However, an association with increased all-cause and disease-related mortality was found in the subpopulation of older adults with MDD, even after adjustment for age, sex and smoking status (p=0.032 and p=0.036, respectively). A significant interaction was found between metabolic syndrome and psychiatric diagnoses indicating that in participants with MDD, metabolic syndrome had a significantly greater effect on all-cause mortality (p=0.025) and on disease-related mortality (p=0.008) than in participants with either bipolar disorder or schizophrenia. Conclusions In older adults with psychiatric illness, our findings do not support an association between metabolic syndrome and increased mortality, in contrast with the literature findings on their younger counterparts. We discuss several possible explanations, including a survival bias, a lack of sensitivity of the used cut-offs and a ceiling effect of metabolic syndrome on mortality in this very high-risk population. The lack of a ceiling effect in the depressive subgroup, because of a less marked premature mortality, could explain the positive association, in contrast with bipolar disorder or schizophrenia subgroups. Disclosure of Interest None Declared

Introduction Different mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models. Objectives To explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain. Methods 21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis. Results Healthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome. Conclusions Innovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges. Disclosure of Interest None Declared

Introduction A descriptive study is presented on three cases in which the adjustment of antipsychotic treatment has led to an improvement in the patients’ quality of life. Objectives The objective is the description of the process of treatment optimization in elderly people, with the secondary improvement in the quality of life. Methods These are three female patients, with an average age of 73 years, institutionalized in the ORPEA Puerta de Hierro Specialized Mental Health Center for the Elderly. Two of them have a diagnosis of paranoid schizophrenia, and the third has a diagnosis of delusional disorder. The average age at the onset of symptoms was 21 years old. All three were receiving treatment with biweekly zuclopenthixol, 200mg DMD together with haloperidol at a mean dose of 7.5mg of haloperidol. For the extrapyramidal side effects presented they were on treatment with biperiden 4mg DMD. In addition to psychopathological examinations and subjective impressions, previous and current status were compared with the Barthel Scale, GDS and family satisfaction scale. Results The treatment of the three patients was modified, in a period of three months, replacing the treatment with zuclopenthixol 200mg DMD to paliperidone extended release 150mg every 21 days, as well as with oral paliperidone, at an average dose of 10mg DMD. Also, biperiden treatment could be completely withdrawn and the dose of haloperidol could be reduced to 2.25mg. In addition to the reduction of polypharmacy doses, an overall improvement is observed in relation to psychotic symptoms, without presenting exacerbations and improvement in the control of chronic psychotic symptoms. Likewise, they have improved at the affective level, presenting less negative symptoms, improvement of the affective flattening, being more resonant in the interaction with peers and with increased participation in joint activities. On the other hand, at a cognitive level, a significant improvement has been observed. Conclusions First generation antipsychotics produce a high rate of side effects, such as prolactin increase, affective blunting and extrapyramidal symptoms. In contrast, second-generation antipsychotics, in addition, act as 5HT2A antagonists, thus reducing the rates of unwanted effects. Some studies have shown that paliperidone increases prolactin to a lesser extent than risperidone and causes fewer extrapyramidal and cognitive effects. Furthermore, because of its safety profile, paliperiona may be a first-choice strategy in psychosis in the elderly, even in its intramuscular extended-release form in nonadherent patients. In conclusion, the elderly are a vulnerable population and to a greater extent when they suffer from a severe mental disorder. The aim of any treatment must be directed not only to control positive symptoms, but also to slow down the deterioration of the disease itself, as well as to improve quality of life and functionality. Disclosure of Interest None Declared

Current health care systems do not sufficiently address contributors, also known as modifiable behavior factors, to severe mental illnesses (SMI). Instead treatment is focused on decreasing symptom-experience rather than reducing the detrimental effect of biological predisposition and behavioral influences on illness. Health care services and patients alike call for a more comprehensive, individual approach to mental health care, especially for people with SMI. A Syndemics framework has been previously used to identify ecological and social contributors to an HIV epidemic in the 1990s, and the same framework is transferable to mental health research to identify the relationship between contributing factors and the outcomes of SMI. Using this approach, a holistic insight into mental illness experience could inform more effective health care strategies that lessen the burden of disease on people with SMI. In this review, the components of a Syndemic framework, the scientific contributions to the topic so far, and the possible future of mental health research under the implementation of a Syndemic framework approach are examined.

BackgroundLittle is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development.AimsThis study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China.MethodTwo mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses.ResultsThe proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015.ConclusionsThis study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.

Abstract Machine learning (ML), one aspect of artificial intelligence (AI), involves computer algorithms that train themselves. They have been widely applied in the healthcare domain. However, many trained ML algorithms operate as ‘black boxes’, producing a prediction from input data without a clear explanation of their workings. Non-transparent predictions are of limited utility in many clinical domains, where decisions must be justifiable. Here, we apply class-contrastive counterfactual reasoning to ML to demonstrate how specific changes in inputs lead to different predictions of mortality in people with severe mental illness (SMI), a major public health challenge. We produce predictions accompanied by visual and textual explanations as to how the prediction would have differed given specific changes to the input. We apply it to routinely collected data from a mental health secondary care provider in patients with schizophrenia. Using a data structuring framework informed by clinical knowledge, we captured information on physical health, mental health, and social predisposing factors. We then trained an ML algorithm and other statistical learning techniques to predict the risk of death. The ML algorithm predicted mortality with an area under receiver operating characteristic curve (AUROC) of 0.80 (95% confidence intervals [0.78, 0.82]). We used class-contrastive analysis to produce explanations for the model predictions. We outline the scenarios in which class-contrastive analysis is likely to be successful in producing explanations for model predictions. Our aim is not to advocate for a particular model but show an application of the class-contrastive analysis technique to electronic healthcare record data for a disease of public health significance. In patients with schizophrenia, our work suggests that use or prescription of medications like antidepressants was associated with lower risk of death. Abuse of alcohol/drugs and a diagnosis of delirium were associated with higher risk of death. Our ML models highlight the role of co-morbidities in determining mortality in patients with schizophrenia and the need to manage co-morbidities in these patients. We hope that some of these bio-social factors can be targeted therapeutically by either patient-level or service-level interventions. Our approach combines clinical knowledge, health data, and statistical learning, to make predictions interpretable to clinicians using class-contrastive reasoning. This is a step towards interpretable AI in the management of patients with schizophrenia and potentially other diseases.

PurposePeople with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting.DesignSingle arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention.MethodPeople with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise.ResultsForty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks.ConclusionsA brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors.Clinical Trial RegistrationThe trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)—U1111-1211-4009.

Abstract Background Patients with severe mental illness (SMI), such as schizophrenia or bipolar disorders, are more frequently affected by metabolic syndrome and cardiovascular (CV) diseases than the general population, with a significant reduction in life expectancy. Beyond metabolic syndrome, quantifying the risk of CV morbidity in the long-term may help clinicians to put in place preventive strategies. In this study, we assessed 10-year CV risk in patients with SMI and healthy individuals using an algorithm validated on the Italian general population. Methods Patients aged 35–69 years diagnosed with SMI were consecutively recruited from psychiatric acute care units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Patients’ data were compared with those from the general population. The 10-year CV risk was log-transformed, and multivariable linear regression was used to estimate mean ratios, adjusting for age, and education. Results Three hundred patients and 3,052 controls were included in the analysis. Among men, the 10-year CV risk score was very similar between patients with SMI and the general population (mean ratio [MR]: 1.02; 95%CI 0.77–1.37), whereas a 39% increase in 10-year CV risk was observed in women with SMI compared to the general population (MR: 1.39; 95%CI 1.16–1.66). Conclusions In our study, women with SMI were consistently more at risk than the general population counterpart, even at younger age.

AbstractBackground.Policies addressing the physical health of people with mental disorders have historically focused on those with severe mental illness (SMI), giving less prominence to the more prevalent common mental disorders (CMDs). Little is known about the comparative physical health outcomes of these patient groups. We aimed to first compare the: (a) number of past-year chronic physical conditions and (b) recent physical health service utilization between CMDs vs. SMI, and secondly compare these outcomes between people with CMDs vs. people without mental disorders.Methods.We analyzed cross-sectional data from the third Adult Psychiatric Morbidity Survey, a representative sample of the English population. We determined the presence of physical conditions and health service utilization by self-report and performed logistic regression models to examine associations of these outcomes between participant groups.Results.Past-year physical conditions were reported by the majority of participants (CMDs, n = 815, 62.1%; SMI = 27, 63.1%) with no variation in the adjusted odds of at least one physical condition between diagnoses (odds ratio [OR] = 0.96, 95% confidence intervals [CI] 0.42–1.98, p = 0.784). People with CMDs were significantly more likely to be recently hospitalized relative to with those with SMI (OR = 6.33, 95% CI 5.50–9.01, p < 0.05). Having a CMD was associated with significantly higher odds of past-year physical conditions and recent health service utilization (all p < 0.001) compared with the general population.Conclusions.People with CMDs experience excess physical health morbidities in a similar pattern to those found among people with SMI, while their somatic hospitalization rates are even more elevated. Findings highlight the importance of recalibrating existing public health strategies to bring equity to the physical health needs of this patient group.

AbstractBackground.While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization.Methods.DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol.Results.Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization.Conclusions.Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.

This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified.

ObjectiveThis study assessed differences in diabetes prevalence based on race-ethnicity among people with severe mental illnesses.MethodsThis retrospective cohort study examined diabetes prevalence in 2009 among California Medicaid enrollees with severe mental illness who were screened for diabetes (N=19,364). Poisson regression assessed differences in diabetes prevalence by race-ethnicity. The sample was standardized to the U.S.PopulationResultsThe overall prevalence of diabetes was 32.0%. The adjusted prevalence for all minority groups with severe mental illness, except for Asians, was significantly higher than for whites (1.21-1.28 adjusted prevalence ratios). With inverse probability weighting to reduce selection bias captured by measured factors, estimated prevalence of diabetes among screened participants was 27.3%.ConclusionsThe prevalence of diabetes in minority groups with severe mental illness was significantly higher than among whites with severe mental illness. Mental health administrators should implement universal diabetes screening with specific outreach efforts targeting minority populations with severe mental illness.

ObjectiveThis study aimed to determine cervical cancer screening rates among women with severe mental illness.MethodsCalifornia Medicaid administrative records (2010-2011) for 31,308 women with severe mental illness were examined. Participants received specialty mental health services and were not dually eligible for Medicare. Poisson models assessed association between selected predictors and cervical cancer screening.ResultsOverall, 20.2% of women with severe mental illness received cervical cancer screening during the one-year period. Compared with white women, Asian women (adjusted risk ratio [ARR]=1.23), black women (ARR=1.10), and Hispanic women (ARR=1.11) (p

ObjectiveThis research aimed to characterize HIV testing rates among Medicaid recipients with severe mental illness who received public specialty mental health services.MethodsThis retrospective cohort study examined California Medicaid records from October 1, 2010, to September 30, 2011 (N=56,895). Study participants were between age 18 and 67, utilized specialty mental health care services, were prescribed antipsychotic medications, and were not dually eligible for Medicare. Adjusted Poisson regression models were used to estimate the overall effects of predictor variables on HIV testing prevalence.ResultsDuring the study period, 6.7% of people with severe mental illness received HIV testing. Men were 32% less likely to be tested for HIV than women (p

Abstract Background People with severe mental illness (SMI) are more likely to experience criminal victimization than other community members. In addition, (self-) stigma and perceived discrimination are highly prevalent in this group. These adversities in the social context often have major adverse effects on the rehabilitation and recovery of these persons. Current practice, however, lacks instruments to address these issues. As a reaction, the Victoria intervention was developed and pilot-tested with client representatives, professionals, trainers and researchers. The Victoria intervention is a method for community mental health care workers to expand their awareness of this topic and support them in assessing victimization and incorporate appropriate services, including trauma screening and rehabilitation services, in their health care planning. For clients, the Victoria intervention aims to increase their awareness, active management of possible victimization risks and promote safe social participation. As a new intervention, little is known about its use in real practice and its effects on client outcomes. Methods/design To determine the feasibility and effectiveness of this intervention, a process evaluation and a first cluster randomized controlled trial (RCT) will be carried out. Outpatients from eight Flexible Assertive Community Treatment (F-ACT) teams from two mental health care (MHC) organizations in the Netherlands are included in the study. Teams in the intervention group will receive three half-day training sessions, and bi-monthly supervision meetings for 18 months. Teams in the control group provide care as usual. For the process evaluation, a multi-method design is used. To assess effects on client outcomes, clients will be interviewed about their experiences on victimization and societal participation using validated questionnaires at baseline, and after 9 and 18 months. Discussion This study is the first to evaluate an intervention aiming at recognition of victimization, (self-) stigma and perceived discrimination, and targeting outpatients’ insights into possible risks and coping skills to tackle these risks to enhance safe societal participation. Results of this study may validate the Victoria intervention as a practice to better manage risk for adversities related to societal participation. Trial registration Dutch Trial Register (NTR): 5585, date of registration: 11–01-2016.

Abstract Background Peer support services for patients with severe mental illness (SMI) originated from Western countries and have become increasingly popular during the past twenty years. The aim of this paper is to describe a peer service model and its implementation in China, including the model’s feasibility and sustainability. Methods A peer support service was developed in four Chinese communities. Implementation, feasibility and sustainability were assessed across five domains: Service process, service contents, peer training and supervision, service satisfaction, and service perceived benefit. Results Service process: 214 peer support activities were held between July 2013 and June 2016. No adverse events occurred during three years. Each activity ranged from 40 to 120 min; most were conducted in a community rehabilitation center or community health care center. Service content: Activities focused on eight primary topics—daily life skills, social skills, knowledge of mental disorders, entertainment, fine motor skill practice, personal perceptions, healthy life style support, emotional support. Peer training and supervision: Intensive training was provided for all peers before they started to provide services. Regular supervision and continued training were provided thereafter; online supervision supplemented face to face meetings. Service satisfaction: Nineteen consumers (79.2%) (χ2(1) = 12.76, p

Background Lifestyle interventions can improve health-related outcomes for people with severe mental illness (SMI), but few studies evaluate this potential in everyday settings. After a successful approach in routine inpatient mental healthcare (MULTI), we sought to replicate this multidisciplinary lifestyle-enhancing support in people with SMI living in sheltered housing (MULTI_sh). Aims To evaluate the effectiveness and implementation of MULTI_sh (trial registration: NCT03157557). Method In an effectiveness-implementation hybrid cluster-randomised controlled trial, six municipalities with sheltered housing facilities in The Netherlands were randomly assigned to MULTI_sh (n = 3) or treatment as usual (TAU, n = 3). After 12 months, we evaluated effects on metabolic health, sedentary behaviour/physical activity (ActiGraph GT3X+), quality of life (EuroQol 5D, WHOQoL-Bref) and psychopathology (Brief Psychiatric Rating Scale Expanded Version) using multiple regression, adjusting for baseline values and municipalities (intention to treat and per protocol). In addition, implementation fidelity and barriers/facilitators were evaluated (Measurement Instrument for Determinants of Innovation). Results Of 177 eligible patients, 74 (42%) could be included in the analyses. Health outcomes did not substantially improve with MULTI_sh (n = 45) compared with TAU (n = 29). MULTI_sh was not implemented as intended. Most patients and all healthcare professionals believed that patients’ lifestyle should be part of treatment, but implementation was primarily (in)directly hindered by organisational factors (e.g. staff shortages, complexity of participation, lack of time and difficulty getting patients involved). Conclusions MULTI_sh was not implemented as intended and no clinical health improvements were found. Organisations are decisive in the success or failure of the implementation of lifestyle interventions for people with SMI. More intensive implementation strategies on this level are warranted in sheltered housing.

BackgroundNo randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article reports on a prospective, direct comparison of the designs of two parallel studies in this field.MethodsA two-centre, parallel-group non-inferiority effectiveness study was conducted at two locations in Switzerland using identical instruments and clinical hypotheses. One centre applied an RCT design and the other an observational study (OS) design with propensity score methods (ClinicalTrials.gov: NCT03815604). The comparability of the two study centres was investigated in terms of participants, procedures, and outcomes. The primary outcome was social inclusion and the secondary outcomes were quality of life and psychiatric symptoms.ResultsThe study included 141 participants (RCT: n = 58; OS: n = 83). Within one year, 27% study dropouts occurred (RCT: 34%; OS: 22%). A similar balance of sample characteristics was achieved in the RCT and the OS using propensity score methods (inverse probability of treatment weighting). After one year, ISH was non-inferior to the control condition regarding social inclusion (mean differences [95% CI]) in the RCT (6.28 [–0.08 to 13.35]) and the OS (2.24 [–2.30 to 6.77]) and showed no significant differences in quality of life (RCT: 0.12 [–0.52 to 0.75]; OS: 0.16 [–0.26 to 0.58]) and symptoms (RCT: –0.18 [–0.75 to 0.40]; OS: 0.21 [–0.17 to 0.60]) in both study centres. However, strong and persistent preferences for ISH in the RCT control group reduced participants’ willingness to participate. Because of several limitations in the RCT, the results of the RCT and the OS are not comparable.ConclusionParticipants were comparable in both study sites. However, there were significant problems in conducting the RCT because of strong preferences for ISH. The OS with propensity score methods provided results of more stable groups of participants and revealed balanced samples and valid outcome analysis. Our results do not support further investment in RCTs in this field.

Persons with severe mental illness have a 10-to-20-year shorter life span than the general public. Excess morbidity and mortality in this patient population has been described as a major public health challenge worldwide. Despite robust extant literature on the role of exercise in reducing morbidity and mortality, especially from cardiovascular disease and diabetes (highly prevalent in this patient population), Very few clinical programs or clinical research projects currently exist to implement and study the effects of exercise on decreasing morbidity and mortality in this highly vulnerable patient population. Given the global lack of trained mental health providers, the need to integrate healthcare providers from different disciplines, such as nurses, physical therapists, occupational therapists, physician assistants, cannot be overstated. This mini-review will provide an historic perspective and current data supporting the need to establish exercise, and other Lifestyle Psychiatry interventions, as a key component of treatment for all patients with serious mental illness.

Objective: To determine whether an elective course on mental health could reduce pharmacy students' social distance toward people with severe mental illness., Design: Course activities included assigned readings, class discussions, student presentations, review of video and other media for examples of social distance, presentations by patients with mental illness, and visits to hospitalized patients in a variety of psychiatric settings., Assessment: The Social Distance Scale (SDS) was administered at the beginning and end of the semester to students enrolled in the elective and to a comparator group of students not enrolled in the course. Pharmacy students who did not complete the elective had significantly higher SDS scores than students who completed the elective (18.7 vs. 15.6, p < 0.001). Students enrolled in the course had lower precourse SDS scores, were more likely than their peers to have a personal association with mental illness, and had a decrease in precourse to postcourse scores., Conclusion: A course designed to reduce stigma towards the mentally ill can reduce pharmacy students' social distance.

Objective: The aim of this study was to assess psychiatrists' Hepatitis C virus (HCV)-related knowledge and behaviour practices., Method: A self-report survey was completed by doctors working at an urban psychiatric hospital in Australia., Results: Doctors working in psychiatry underestimated the prevalence of HCV infection for their patients and less than one-third felt well informed about HCV. Overall, there was good knowledge regarding HCV acquisition epidemiology but knowledge of management was poor., Conclusion: Improving knowledge about HCV, especially current management, may facilitate better health care for patients with severe mental illness.

Abstract Background Schizophrenia spectrum disorders (SSD) are severe, persistent mental illnesses resulting in considerable disability and premature mortality. Emerging evidence suggests that diet may be a modifiable risk factor in mental illness; however, use of nutritional counselling as a component of psychiatric clinical practice is limited. The objective of this project is the design and evaluate a worksheet and clinician guide for use in facilitating nutritional counseling in the context of existing mental health care. Methods The worksheet and clinician guide were developed based on the results of a recent scoping review on the relationship between diet and mental health symptoms among individuals with SSD. A feedback process involved a focus group with psychiatrists and interviews with individuals with lived experience with psychosis. Participants were asked a series of structured and open-ended questions. Interviews were transcribed and data units were allocated to categories from an existing framework. The comments were used to guide modifications to the worksheet and clinician guide. A brief interview with all participants was completed to gather feedback on the final version. Results Five psychiatrist participants and six participants with lived experience completed interviews. Participants provided positive comments related to the worksheet design, complexity and inclusion of interactive components. A novel theme emerged relating to the lack of nutritional counselling in psychiatric training and clinical practice. Many constructive comments were provided which resulted in meaningful revisions and improvements to the worksheet and clinician guide design and content. All participants were satisfied with the final versions. Conclusions A worksheet and clinician guide designed to facilitate nutritional counselling with individuals with SSD was found to be acceptable to all participants following a process of feedback and revision. Further research and dissemination efforts aimed at increasing the use of nutritional counselling in psychiatric practice are warranted.

Abstract Background People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI. Methods Adults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p

Abstract Background People with severe mental disorders (SMDs) are associated with increased risk of infectious disease including human immunodeficiency virus infection (HIV) and hepatitis viruses, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and other types of hepatitis viruses because of high-risk behaviors compared to the general population. The prevalence of HIV in people with SMDs is higher in females than in males. Unlike HIV, the prevalence of HBV and HCV is higher in males than in females. This study aimed to carry out a systematic review and meta-analysis to determine the prevalence and estimated gender difference in the risk of HIV, HBV, and HCV in people with SMD. Methods Literature search was performed using the electronic databases PubMed, EMBASE, and Scopus. Publications were screened according to predefined inclusion criteria. A qualitative and quantitative analysis was undertaken for this systematic review. Eighteen materials published from 1993 to 2017 were included in the qualitative and quantitative analysis. Random-effect model was used to calculate weighted prevalence, odds ratio (OR), and corresponding 95% confidence interval (CI). Results 12,290 citations were identified and 18 articles including 11,175 participants were included. The results of our meta-analysis show that the prevalence of HIV, HBV, and HCV in people with SMD was 7.59% (95% CI 4.82–11.75), 15.63% (95% CI 7.19–30.69), and 7.21% (95% CI 4.44–11.50), respectively. The prevalence of HIV was higher in women (8.25%) than men (7.04%), but the prevalence of HBV and HCV was higher in men than women (18.91% versus 12.02% and 9.16% versus 5.43% for HBV and HCV in men versus women, respectively). A meta-analysis of included studies demonstrated a significantly increased risk of HBV (OR 1.72; 95% CI 1.17–2.53) and HCV (OR 2.01; 95% CI 1.16–3.20) infections in men compared to women in people with SMD. However, no significant association was observed between gender and HIV. The funnel plot and Egger’s regression tests provided no evidence of substantial publication bias in the prevalence and gender difference in association for HIV, HBV, and HCV in people with SMD. Conclusions In our review, the prevalence of HIV, HBV, and HCV was high. The prevalence of HBV is significantly higher than HIV and HCV. There was a significantly increased risk of HBV and HCV infections in men compared to women. No significant association was observed between gender and HIV. People with SMDs warrant greater emphasis in efforts to identify and treat HIV, HBV and HCV.

The aim of this study is to describe the psychosocial interventions for individuals with severe mental illness and/or their families in Turkey, and evaluate their results. Turkish Psychiatry Index, Turkish Medline, Council of Higher Education National Thesis Center, Google Scholar, and TR Index databases were searched to identify the studies conducted with individuals with severe mental illness and/or their families between 2000 and 2019. As a result of the search, 2404 studies were obtained in total, and 36 of them were selected to be evaluated. 16 of the studies examined are published research articles, 10 are PhD theses, 6 are master’s theses, and 4 are medical dissertation. While the majority of the psychosocial intervention programs (47.2%) are psychoeducation studies, 11 (30.5%) are original skill trainings and 8 (22.2%) are problem- or symptom-oriented studies. The average number of samples of intervention programs mostly practiced by nurses is 30.5, and the average intervention period is 10.5 sessions. The results reveal that the positive effects of the applied programs on the areas such as social functionality, treatment compliance and quality of life for individuals with severe mental illness; and subjective burden, coping strategies, emotional expression and family functionality for caregivers. It is extremely important for individuals with severe mental illness and their families to extend these programs, which currently seem to be implemented in a limited way in Turkey, and to make them a part of routine clinical practice.

BackgroundThere is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands.DesignA modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed.ResultsOverall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff's motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention.ConclusionsThis study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.

Introduction Personal Health Budget (PHB) has been provided to consumers with severe mental illness within a policy shift toward a person-tailored mental healthcare treatment based on individual unmet needs. PHB is an amount of money to support patient’s health and wellbeing needs, which is planned and agreed between patients and their local NHS team. It is not new money, but it may mean spending money differently so that patients can get the care that they need. However, evidence of beneficial effects of PHB is still scarce. Objectives The aim of this study was to provide preliminary data on clinical and social benefits of adding PHB to a standard pharmacotherapy in patients with severe mental illness across a 24-month follow-up period. Methods 137 individuals with severe mental illness (aged 18–50 years) were recruited in one of the adult mental health services of an Italian Department of Mental Health. They completed the Global Assessment of Functioning scale, the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale. Friedman’s test for repeated measure was used to assess the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also performed. Results A significant decrease in all GAF scale, HoNOS and BPRS scores along the 24 months of follow-up was observed. Regression analysis results specifically showed a relevant association between a PHB multiaxial intervention and the longitudinal reduction in BPRS ‘Negative Symptoms’ and HoNOS ‘Social Problems’ subscores. Conclusions Our findings support the useful implementation of a PHB approach for severe mental illness patients within the Italian mental health service network. Disclosure No significant relationships.

Introduction The COVID-19 pandemic has a huge impact on the provision of mental health care. Particularly the limitations of face-to-face contacts and the access to treatment facilities can be expected to have significant negative effects on the practice of psychiatric treatment and outcomes. To date the extent and the severity of these effects in people with severe mental illnesses are rarely investigated in Germany. Objectives We investigated the impact of the COVID-19 pandemic on mental health and service use of people with severe mental illness in Germany. Methods As part of a pragmatic randomized trial on the effectiveness of an integrated community mental health care program that started immediately after the first COVID-19 wave in June 2020, 1000 people with severe mental illness from different regions in Germany have been asked for the effects of the COVID-19 pandemic on their mental health care and on their general living conditions. Multivariate regression models were computed to estimate the effects of the patients’ COVID-19 experiences on the outcome parameters empowerment (EPAS), psychosocial impairment (HoNOS) and unmet needs (CAN). Results Using prospective data in a large sample of people with mental illness, we will be able to examine the extent to which the pandemic has affected participants’ mental health, their social lives, but also the use of mental health care services. Conclusions The data will help to examine the impact of the pandemic on people with severe mental illness in a comprehensive way and will provide evidence where immediate action is needed to reduce further burdens and inequities. Disclosure No significant relationships.

BackgroundTwo OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services.MethodWe employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China).ResultsMedian risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72).ConclusionBoth OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.