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Introduction: Individuals with serious mental illness often have persistent and disruptive symptoms. These can profoundly affect their children's lives, exposing them to adverse social and psychological conditions. Such conditions can result in traumatic lived experiences during childhood, which can carry over into adulthood, influencing their self‐perceptions and shaping their attitudes toward themselves and society. To gain insights into this phenomenon, this study explored the lived experiences of adults who grew up with a parent with serious mental illness and their perceptions of their lives in adulthood. Design: This study used an interpretive phenomenological design. Methods: Participants were invited to voluntarily participate in the study through a call posted on social media. Semi‐structured interviews were conducted with 30 adults (age range, 20–55 years) who grew up with a parent with serious mental illness. The interviews were recorded and transcribed, and inductive thematic analysis was used to identify main and overarching themes. Results: The overarching theme of transition from childhood survival to adulthood survival emerged and included four main themes: (1) a traumatic childhood, (2) perceived control, (3) resilience and general self‐efficacy, and (4) adult quality of life. A traumatic childhood consisted of experiences of neglect and abuse, while participants used perceived control to achieve personal growth, self‐care, and care of others. Resilience and general self‐efficacy emerged during the transition to adulthood and helped participants further their social status and strengthen family bonds. Lastly, adult quality of life was described as being disturbed by feelings of loneliness and being burdensome, stemming from an inherent tendency to rely solely on themselves, leading to trust issues and mental health complications. Therefore, these adults found it difficult to reach out and get help or treatment for their concerns, as they initially did not want to appear dysfunctional or in need. Conclusion: This study has illuminated the lived experiences of a specific, vulnerable population that has not been intentionally explored until now. To delve into these experiences, we employed a distinctive qualitative approach, merging the interpretive phenomenological perspective with an inductive thematic analysis. This allowed for rich insight with a relatively large group of participants and enabled an in‐depth exploration within this methodological framework. Consequently, this study constitutes a notable contribution to the extant body of knowledge, exploring the intricacies of personal growth and its impact on participants' quality of life. It uncovers the essence of resilience and general self‐efficacy, revealing how these elements intertwine with the negative results observed. However, the study findings emphasize the need for healthcare professionals, including nurses and other caregivers, to be mindful of the long‐lasting effects of the adverse experiences of children of patients with serious mental illness. Prioritizing active clinical assessment and implementing tailored interventions to address such children's specific needs and difficulties across different developmental stages is imperative. Such comprehensive and targeted approaches are crucial in providing appropriate support and promoting the well‐being of these individuals. Clinical Relevance: Enhanced clinical attention in holistic psychiatric care is crucial for individuals and their relatives, especially children. Comprehensive assessments of children and adults raised by seriously mentally ill parents can enable tailored and preventive interventions, positively impacting overall quality of life. [ABSTRACT FROM AUTHOR]

The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19. [ABSTRACT FROM AUTHOR]

Psychiatrists' beliefs and behaviors regarding smoking cessation promotion among people with serious mental illness (PWSMI) have been cited as a barrier for PWSMI achieving successful abstinence. A mixed methods approach was employed to evaluate beliefs and practices of psychiatrists affiliated with a large HMO in Israel regarding smoking cessation among PWSMI. Fifty psychiatrists (43% response rate) completed a telephone survey and thirty psychiatrists interviewed using a semi-structured questionnaire. Most of the psychiatrists (84%) saw smoking cessation promotion as part of their role, but in-depth interviews revealed that only a third were routinely pro-active, with over half believing that few PWSMI are willing or capable of quitting smoking. Most of the study population felt that an attempt to quit smoking would not adversely affect their patients' mental health status, but many raised concerns regarding the safety of smoking cessation medications (SCM) amongst PWSMI. Factors associated with pro-active practice were knowledge regarding services and SCM, characteristics of patient caseload (proportion low-functioning) and psychiatrist's smoking behavior. Psychiatrist-targeted interventions highlighting safety of SCM and promoting referral to smoking cessation services are indicated. Offering PWSMI-specific harm reduction as a first step to abstinence may offer psychiatrists an acceptable treatment alternative for the low-functioning patient. [ABSTRACT FROM AUTHOR]

Background: People with severe mental disorders have higher mortality rates and more chronic physical conditions than the general population. Recent reforms in the Israeli mental health system included reducing the number of psychiatric hospital beds ("Structural Reform"), establishing community- based rehabilitation services ("Rehabilitation Reform"), and the transfer of governmental responsibility to the Health Maintenance Organizations (HMOs) ("Insurance Reform"). We examined how these changes have impacted the physical health of people with severe mental illness as reflected in acute care hospitalizations. Methods: Data from the National Psychiatric Case Register were linked with data from the National Hospital Discharges Database for 2000–2019. Acute care discharges from public hospitals were identified for people who had a psychiatric hospitalization with a diagnosis of severe mental illness (SMI, ICD-10 codes F10-F69 or F90-F99) within the preceding 5 years. The discharge rate of SMI patients was compared to that of the total population by age, diagnosis group, and period of hospitalization. Total and age-standardized discharge ratios (SDR) were calculated, using indirect standardization. Results: The SDR for total acute care hospitalizations showed that discharge rates in 2016–2019 were 2.7 times higher for the SMI population than expected from the total population. The highest SDR was for external causes (5.7), followed by respiratory diseases (4.4), infectious diseases (3.9), skin diseases (3.7) and diabetes (3.3). The lowest SDR was for cancer (1.6). The total discharge rate ratio was lowest at ages 65–74 (2.2) and highest at ages 45–54 (3.2). The SDR was lowest for females at ages 25–34 (2.1) and for males at ages 18–24 (2.3). SDRs increased over the study period for all diagnoses. This increasing trend slowed at the end of the period, and between 2012–2015 and 2016–2019 there was a small decrease for skin and liver diseases, the SDR was stable for cancer and the increase was smaller for respiratory, infectious and circulatory diseases and diabetes. Conclusion: This study showed higher hospitalization rates in people with SMI compared to the total population. These differences increased between 2000 and 2019 following the opening of alternative services in the community, possibly due to a higher likelihood of psychiatric hospitalization only for those with more severe mental disease. We recommend that general practitioners and mental health professionals in the community be made aware of the essential importance of good physical healthcare, and collaborate on health promotion and disease prevention in the SMI population. [ABSTRACT FROM AUTHOR]

Objective: The literature on the experience of mental health providers (MHPs) working with people with serious mental illness (SMI) in community-based mental health programs related to sex, sexuality, and intimacy is scarce. The purpose of the present study was to explore the situations, thoughts, feelings, dilemmas, and challenges experienced by MHPs around these issues. Method: Semistructured interviews were conducted with 13 MHPs working with people with SMI in six different community mental health programs in Israel. Results: Four main themes emerged: (a) lack of professional training and skill sets to discuss clients' sexuality and intimacy issues, (b) ambivalence regarding the status and appropriateness of sexual relationships and intimacy as recovery-related goals, (c) discomfort discussing sexuality as a barrier to shared decision making and person-centered care, and (d) distinct programmatic and structural barriers to discussing and addressing needs and preferences related to sexuality and intimacy. Discussion: The study highlights challenges experienced by MHPs working with people with SMI when confronted with sexual activities, relationships, and intimacy issues raised by service users. The development and implementation of trainings and resources designed to bolster MHPs' skill sets addressing sexuality and intimacy should be a priority for the field of psychiatric rehabilitation. Conclusions and Implications for Practice: MHPs who work with people with SMI in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHPs to respond effectively to these complex situations and associated challenges. Impact and Implications: Mental health providers (MHPs) who work with people with serious mental illness (SMI) in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHP to respond effectively to these complex situations and associated challenges. [ABSTRACT FROM AUTHOR]

Smoking prevalence is threefold higher among people with serious mental illness (PWSMI) than in the general population, yet smoking cessation rates for PWSMI are lower. Numerous reasons have been posited as to why tobacco use is higher and abstinence rates are lower among PWSMI. This study explores smoking cessation perceptions and experiences among PWSMI and people without serious mental illness (SMI). Participants in this cross-sectional study were recruited from among members of a large health maintenance organization (HMO) in Israel who had registered for or commenced a smoking cessation program in 2015 through 2017. The sample comprised 208 PWSMI and a matched sample of people without SMI (N = 428). Telephone surveys were used to collect information about smoking status and smoking/cessation history, use of smoking cessation programs and aids (prescription medications, nicotine replacement therapy, electronic cigarettes), motivation and intention to quit, self-efficacy (to quit), smoking cessation outcome expectancies, physician support to quit, barriers and facilitators for those who had not quit, and reinforcements/challenges for those who had quit. Of those without SMI, 27% quit smoking compared to 20% of PWSMI (p =.051). Irrespective of mental health status, the most significant predictor of abstinence was the use of smoking cessation prescription medications. Family physicians were significantly less likely to inquire about motivation to quit, refer to smoking cessation programs, or prescribe smoking cessation medications for PWSMI than for people without SMI. Beyond these factors, no differences were noted between respondents with and without SMI regarding motivation to quit, intention to quit, and abstinence self-efficacy. PWSMI who had not quit were more likely to be concerned about how quitting might affect their functioning and how they would pass the time without cigarettes. PWSMI have similar levels of motivation and intention to quit smoking as those without SMI. However, they are disadvantaged by the reduced support received from their family physicians and lower cessation medication usage. Efforts to promote the implementation of smoking cessation treatment guidelines will help promote smoking abstinence among PWSMI. [ABSTRACT FROM AUTHOR]

Background: Despite the high prevalence of smoking amongst people with serious mental illness (SMI), referral rates to smoking cessation programs (SCPs) are low. Mental health workers reticence to refer to SCPs has been attributed, in part, to their belief that quitting will have a deleterious effect on their patients' mental health status. Objectives: This study's objective was to determine if participating in a smoking cessation program had an adverse effect on mental health status among people with SMI, measured here by a change in hospitalization occurrence or psychiatric medication utilization. People with SMI who had participated in at least one SCP session in a large health maintenance organization (n = 403) were compared to an age-gender-diagnosis matched sample of SMI smokers (1,209) who had never participated. Results: No change in psychiatric hospitalization occurrence pre- versus post-SCP participation was found among participants (Pre:7.2% vs. Post:5.2, p = 0.2) or nonparticipants (Pre:7.0% vs. Post:6.0%, p = 0.2). Mean defined daily dose (DDD) for anti-psychotic, mood stabilizer, anti-depressant and anxiolytic medications also did not change over time for participants and nonparticipants. However, participants who did not complete the SCP and didn't quit had a 0.35 higher mean DDD for anti-psychotic medications compared with participants who had completed the SCP or quit, and with nonparticipants (p = 0.006), and were the only group to exhibit an increase in mean antipsychotic DDD over time (Pre:1.42, Post:1.63). SCP participation was not associated with hospitalization occurrence or psychiatric medication utilization. Conclusions/Importance: Smoking cessation should be encouraged, with close monitoring during the quit process. [ABSTRACT FROM AUTHOR]

Refusal to take psychiatric medication as prescribed is often considered negative, harmful, and even reflective of a sign of one's illness. However, recent research from diverse sources has challenged this axiom. The current study investigated the reasons, processes, experiences, and perceived impacts of medication discontinuation. The study was carried out using the narrative approach to life stories method. Participants were 12 women and 9 men who had discontinued their prescribed medication following psychiatric hospitalization. Four main themes were revealed in the data analysis: (a) the experience with medication, (b) the process of discontinuing medication, (c) elements that helped achieve successful medication discontinuation, and (d) the perceived impact of medication discontinuation. Our findings challenge the widespread notion that discontinuing psychiatric medication is necessarily negative and suggest that, for some, it is a legitimate and meaningful life choice. [ABSTRACT FROM AUTHOR]

The current cross-sectional study investigated and compared the associations between insight, self-stigma, and family burden among Jewish and Arab mothers of an adult son or daughter with serious mental illness (SMI) in Israel. A total of 162 Israeli mothers of a person with SMI participated in the study; 95 were Jewish (58.6%), and 67 were Arab (41.4%). Insight, self-stigma, and family burden scales were administered. Jewish mothers reported higher levels of insight into their son’s or daughter’s illness and reported greater family burden compared to Arab mothers. No significant differences in self-stigma scores were found between Jewish and Arab mothers. The pattern of associations between insight, self-stigma, and burden differed between Jewish and Arab mothers. Self-stigma was found to mediate the relationship between insight and burden among Jewish mothers but not among Arab mothers. Ethno-national affiliation should be taken into consideration regarding how family members conceptualize and experience mental illness, as this might affect care. [ABSTRACT FROM AUTHOR]

This study compares the levels and predictors of paternal warmth and involvement of 69 fathers with serious mental illness (SMI) and 69 matched non-clinical (NC) fathers in Israel. Findings show that the NC fathers were more involved with their children, whereas the SMI fathers reported more warmth and perceived their children as less difficult. The interactions that were found in the regression analyses highlight the differences between the two groups. Among the SMI fathers, but not the NC fathers, higher paternal self-efficacy was associated with increased father involvement, and lower family support was associated with decreased warmth. [ABSTRACT FROM AUTHOR]

Objective: Illness Management and Recovery (IMR) is a widely used evidence-based standardized psychosocial intervention. Little is known, however, about the impact of practitioner professional background on the consumer outcome. The current study aims to examine the delivery impact of practitioners who were mental health professionals, peer providers, or paraprofessionals on fidelity and consumer outcome in IMR. Method: Study participants were 252 persons with serious mental illness receiving psychiatric rehabilitation services in the community who received IMR (n = 210) or treatment as usual (TAU; n = 42). Study participants completed IMR groups that were delivered by either mental health professionals (n = 126), peer providers (n = 43), or paraprofessionals (n = 41). Study participants in the treatment group completed the Illness Management and Recovery scale before starting and after completing the IMR program; participants in the control group completed the same scale twice in similar time intervals. Fidelity ratings were made. Results: Regardless of practitioner background, consumers who received the IMR intervention demonstrated significant improvement compared to the control group. Post hoc analyses showed no statistically significant difference on consumer outcome regardless of whether the practitioner was a professional, paraprofessional, or a peer provider. All three IMR groups had good fidelity scores. Conclusions and Implications for Practice: The results demonstrate that IMR can be implemented with good fidelity and generate positive outcomes when delivered by practitioners who receive sufficient training and supervision regardless of their professional background. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this research is to test and apply a model of the disparities and variations in serious mental illness (SMI) to estimating prevalence in local areas throughout Israel. Methods: This study employs a secondary analysis of data from the 2003/2004 Israel National Health Survey of 4859 adults aged 21 and over from the household population of legal residents and citizens. It uses small area estimation methods (SAE), specifically to: (i) estimate and test a multivariate logistic model of disparities in the risk of serious mental illness; (ii) use the foregoing model for computing estimates, using census data, for local areas; (iii) validate these estimates against the rate of psychiatric hospitalizations. Results: The model uses standard demographic and socioeconomic variables to successfully predict 92.5% of respondents’ statuses as SMI, with a sensitivity of 26.9%, specificity of 95.9%, and an AUC index of .797. The resulting estimates of the percentage of adults with an SMI in the 16 subdistricts ranged between 3.7% and 7.7%, with a national mean of 5.0%. The estimates have a partial correlation of .63 with rates of psychiatric hospitalization in Jewish localities, but elevated rates have not been validated in Arab localities. Conclusion: The use of small area estimation methods demonstrated the capacity for deriving local prevalence rates of serious mental illness, ones that can be validated against psychiatric hospitalization for the majority population group in Israel. [Copyright &y& Elsevier]