40 results on '"Community-based mental health"'
Search Results
2. Clinical practices, challenges, and job satisfaction of occupational therapists working in Community Mental Health Centers in Turkey.
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Ercan Doğu, Selma, Özkan, Esma, and Kars, Sinem
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TEAMS in the workplace ,CAREGIVERS ,SAMPLE size (Statistics) ,CROSS-sectional method ,WORK ,SURVEYS ,JOB satisfaction ,PSYCHOSOCIAL factors ,EXPERIENTIAL learning ,SCALE analysis (Psychology) ,DESCRIPTIVE statistics ,MEDICAL practice ,INDUSTRIAL hygiene ,SOCIODEMOGRAPHIC factors ,OCCUPATIONAL therapists - Abstract
Introduction: Occupational therapists have been involved in Community Mental Health Centers (CMHCs) since 2016 in Turkey. To the best of our knowledge, no data about occupational therapists' practices in CMHCs is available in the extant research literature. Therefore, this study aimed to investigate the clinical practices, challenges, and job satisfaction of occupational therapists working for CMHCs in Turkey. Method: We conducted a cross-sectional survey study in which 28 volunteer occupational therapists working in CMHCs participated. The participants filled out the Sociodemographic and Professional Experience Information Form and the Job Satisfaction Scale. Results: Occupational therapists were experienced practitioners implementing various occupational therapist practices in community mental health and they were generally satisfied with their job. The challenges facing Occupational therapists were communicating with caregivers, motivating the client, enabling the client to perform occupational participation. Collaborative teamwork and participation in training about community mental health were found as the important factors contributing to occupational therapist professionals' job satisfaction. Conclusion: Investigating the professional behaviors of Occupational therapists, an emerging health profession in Turkey, is important for the development of the profession. The education and supervision specially adapted for community mental health and the supportive teamwork seem to be significant for the job satisfaction of community mental health Occupational therapists. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Stigma, occupational injustice, and individualization of systemic issues: current issues faced by community dwelling adults with serious mental illnesses.
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Solaru, Adeola A. and Mendonca, Rochelle J.
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COGNITION disorders , *HUMAN rights , *HEALTH services accessibility , *RIGHT to work (Human rights) , *COMMUNITIES , *SOCIAL stigma , *SLEEP disorders , *INDEPENDENT living , *AUTONOMY (Psychology) , *QUALITY of life , *MENTAL illness , *ADULTS - Abstract
Serious Mental Illness (SMI) is a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. As of 2019, it is estimated that 13.1 million adults aged 18 or older are living with an SMI in the United States. Community-dwelling adults with SMI have identified many benefits that help with carrying out needed activities in the community but also face many barriers such as (internalized) stigma, occupational injustice, and individualization of systemic issues. It is imperative for practitioners to understand how these barriers impact participation and create better ways to understand and center the voices of this population in assessment and intervention and work to address barriers at both an individual and systems level. [ABSTRACT FROM AUTHOR]
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- 2023
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4. Recent Developments in Community-Based Mental Health Care in Japan: A Narrative Review
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Jun Iwatani, Junichiro Ito, Yukiko Taguchi, and Tsuyoshi Akiyama
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community-based mental health ,assertive community treatment ,compulsory treatment ,home-visit nursing care ,physical complication ,Psychiatry ,RC435-571 ,Psychology ,BF1-990 - Abstract
BACKGROUND: Since the 1950s, mental health care in Japan has been hospital-centered. A set of legislative initiatives were undertaken in 1995, emphasizing the importance of community-based mental health care. However, despite these attempts to develop a community-based mental health care system, the rate of inpatient-based treatment has remained high and the shift from hospital-centered care to community-based has still not fully materialized. AIM: This study aims to conduct a review of the available literature on the development of community-based mental health care in Japan between 2010 and 2020. METHODS: We conducted a standardized literature search in the electronic database Igaku Chuo Zasshi, aiming to identify original studies published between 2010 and 2020 that explored community mental health care in Japan. The included studies outcomes were categorized as performance surveys, service user reports, service provider reports, and educational activities. A descriptive-analytical method was implemented in the current review. RESULTS: A total of 25 studies were examined. Six studies reported surveys assessing the performance of community-based mental health care on the assertive community treatment (ACT), compulsory treatment, home-visit nursing care, physical complications, and a welfare medicine collaboration on a remote islands. Four studies investigated the perspectives of service users or their families on home-visit nursing care, social participation, community program, and legislative revision. Ten studies focused on social withdrawal, service providers perspectives on local population needs, supporting skills, care programs, and the professional growth of psychiatric social workers. Five studies focused on educational approaches for future healthcare professionals and efforts to improve mental health literacy among adolescents. CONCLUSION: This paper provided the first comprehensive review of Japans community-based mental health care. Between 2010 and 2020, community mental health care in Japan evolved in many directions, with the understanding that various needs should be met. Home-visit nursing care and ACT can be considered as the most thoroughly investigated and better developed. Research that adopt rigorous methodologies such as randomized controlled trials is required if the goal is to achieve solid conclusions.
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- 2022
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5. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis
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Corianna E. Sichel and Elizabeth H. Connors
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Measurement-feedback system ,Measurement-based care ,Implementation outcomes ,Determinants of practice ,Clinician characteristics ,Community-based mental health ,Medicine (General) ,R5-920 - Abstract
Abstract Background Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. Methods Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants’ ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians’ responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). Results We identified two classes of clinicians: “Higher MFS” and “Lower MFS,” and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. Conclusion This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.
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- 2022
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6. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities
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Maria Lindström, Lars Lindholm, and Per Liv
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ELR intervention ,Community-based mental health ,Severe mental illness ,Health equity ,Collaboration ,Occupational therapy ,Medicine (General) ,R5-920 - Abstract
Abstract Background People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model—a person-centred activity- and recovery-oriented intervention—has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness. Methods The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff. Discussion This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness. Trial registration ClinicalTrials.gov NCT05056415. Registered on 24 September 2021.
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- 2022
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7. Study protocol for a pragmatic cluster RCT on the effect and cost-effectiveness of Everyday Life Rehabilitation versus treatment as usual for persons with severe psychiatric disability living in sheltered or supported housing facilities.
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Lindström, Maria, Lindholm, Lars, and Liv, Per
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MENTAL illness , *DISABILITIES , *GOAL Attainment Scaling , *RESEARCH protocols , *EVERYDAY life , *CITIES & towns - Abstract
Background: People with severe psychiatric disabilities and impaired autonomy, living in sheltered or supported housing facilities, often lead sedentary, solitary lives indoors and have significantly poorer health than others in the population. Meaningful everyday activities are important for the recovery towards an enrichening, agentic, social, and hopeful everyday life. The Everyday Life Rehabilitation (ELR) model-a person-centred activity- and recovery-oriented intervention-has shown positive outcomes in feasibility studies, and thus a randomised controlled trial (RCT) is required to establish the effectiveness of ELR, along with calculations of cost-effectiveness.Methods: The ELR-RCT is a pragmatic, two-parallel-armed cluster RCT evaluating the effect and cost-effectiveness of using ELR from two measurement points over 6 months (pre-post intervention) and in three waves over 3 years. The primary outcome is recovering quality of life (ReQoL) at 6 months, and the secondary outcome is self-perceived recovery and daily functioning (RAS-DS) at 6 months. Additionally, Goal Attainment Scaling (GAS) will be used for the intervention group. Power analysis has been conducted for primary outcome measure. The first wave will include an internal pilot, to be evaluated after 6 months, used as basis for decisions on updating the required sample size and any other need for adaptations before continuing with the full-scale RCT in the second and third wave. All municipalities within a geographic area in northern Sweden, with a minimum of one sheltered or supported housing facility for people with severe psychiatric or neuropsychiatric disability, including access to occupational therapy, will be enrolled. Participants will be block-randomised to receive ELR plus treatment as usual (TAU) or TAU alone for a control period. The control group will thereafter receive delayed ELR. Occupational therapists and housing staff will receive an educational package, manuals, and tools, as well as reflections with colleagues during the intervention period. Housing managers will receive questions for monthly follow-up and coaching with staff.Discussion: This is a protocol for both an internal pilot and full trial of the first RCT study using the ELR intervention model in sheltered or supported housing facilities, evaluating the effects together with cost-effectiveness.Trial Registration: ClinicalTrials.gov NCT05056415. Registered on 24 September 2021. [ABSTRACT FROM AUTHOR]- Published
- 2022
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8. Community-Based Mental Health Challenges and Implications: Examining Factors Influencing Distress and Help-Seeking Behaviors among Korean American Church Leaders and Members in Greater Los Angeles.
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Baek K, Bell C, Montgomery SB, Ortiz L, Kumar A, and Alemi Q
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- Humans, Female, Male, Middle Aged, Los Angeles, Adult, Help-Seeking Behavior, Aged, Depression psychology, Anxiety psychology, Stress, Psychological psychology, Asian psychology, Asian statistics & numerical data, Mental Health
- Abstract
There is limited research on the factors that impact mental distress among Korean American (KA) church leaders even though their unique social situation can create many barriers to seeking mental health assistance. This study compared factors impacting mental distress and help-seeking behaviors between KA church leaders (CLs) and church members (CMs) in the greater Los Angeles area. The respondents ( N = 243) were mostly female, married, educated, first-generation immigrants with a mean age of 47.9 years ( SD = 19.7). The Hopkins Symptoms Checklist 10 was used to measure anxiety and depression. Hierarchal linear regressions showed that health status exerted the strongest effect on both anxiety and depression among CLs and CMs. Beyond health status, education (only for depression), informal resource use, and resiliency impacted mental distress scores for CLs. Only resiliency and religious coping predicted depression scores among CMs. To effectively reach this population, community-based organizations and behavioral health specialists should consider collaborating with churches to promote and provide essential mental health support. Our findings also highlight that the needs of church leaders (CLs) and church members (CMs) differ, which should guide the development of culturally tailored interventions that build on the resilience of both groups.
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- 2024
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9. Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review
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Jan Manuel Heijdra Suasnabar and Bethany Hipple Walters
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Community-based mental health ,Mental health ,Community psychiatry ,Implementation ,Substance use disorder ,Psychosocial ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Mental health and substance use disorders (SUDs) are the world’s leading cause of years lived with disability; in low-and-middle income countries (LIMCs), the treatment gap for SUDs is at least 75%. LMICs face significant structural, resource, political, and sociocultural barriers to scale-up SUD services in community settings. Aim This article aims to identify and describe the different types and characteristics of psychosocial community-based SUD interventions in LMICs, and describe what context-specific factors (policy, resource, sociocultural) may influence such interventions in their design, implementation, and/or outcomes. Methods A narrative literature review was conducted to identify and discuss community-based SUD intervention studies from LMICs. Articles were identified via a search for abstracts on the MEDLINE, Academic Search Complete, and PsycINFO databases. A preliminary synthesis of findings was developed, which included a description of the study characteristics (such as setting, intervention, population, target SUD, etc.); thereafter, a thematic analysis was conducted to describe the themes related to the aims of this review. Results Fifteen intervention studies were included out of 908 abstracts screened. The characteristics of the included interventions varied considerably. Most of the psychosocial interventions were brief interventions. Approximately two thirds of the interventions were delivered by trained lay healthcare workers. Nearly half of the interventions targeted SUDs in addition to other health priorities (HIV, tuberculosis, intimate partner violence). All of the interventions were implemented in middle income countries (i.e. none in low-income countries). The political, resource, and/or sociocultural factors that influenced the interventions are discussed, although findings were significantly limited across studies. Conclusion Despite this review’s limitations, its findings present relevant considerations for future SUD intervention developers, researchers, and decision-makers with regards to planning, implementing and adapting community-based SUD interventions.
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- 2020
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10. Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana
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Naomi Gyamfi, Eric Badu, Wisdom Kwadwo Mprah, and Isaac Mensah
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Community-based mental health ,Expectations ,Ghana ,Personal recovery journey ,Recovery services ,Rehabilitation ,Psychiatry ,RC435-571 - Abstract
Abstract Background In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers’ and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. Methods A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. Results The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers’ and MHPs expectation concerning the recovery journey. Conclusion The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.
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- 2020
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11. Belonging home: capabilities, belonging and mental health recovery in low resourced settings.
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Cappo, David, Mutamba, Brian, and Verity, Fiona
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MIDDLE-income countries , *CONVALESCENCE , *DEINSTITUTIONALIZATION , *MENTAL health , *MEDICAL protocols , *REHABILITATION of people with mental illness , *INDEPENDENT living , *LOW-income countries , *MENTAL illness , *PSYCHIATRIC hospitals , *DISCHARGE planning - Abstract
There are significant barriers to the development of a 'balanced model' of mental health in low-income countries. These include gaps in the evidence base on effective responses to severe mental health issues and what works in the transition from hospital to home, and a low public investment in primary and community care. These limitations were the drivers for the formation of the non-government organization, YouBelong Uganda (YBU), which works to contribute to the implementation of a community-based model of mental health care in Uganda. This paper overviews an intervention protocol developed by YBU, which is a combined model of parallel engagement with the national mental hospital in Kampala, Uganda, movement of 'ready for discharge' patients back to their families and communities, and community development. The YBU programme is theoretically underpinned by a capabilities approach together with practical application of a concept of 'belonging'. It is an experiment in implementation with hopes that it may be a positive step towards the development of an effective model in Uganda, which may be applicable in other countries. Finally, we discuss the value in joining ideas from social work, sociology, philosophy, public health and psychiatry into a community mental health 'belonging framework'. [ABSTRACT FROM AUTHOR]
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- 2021
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12. The association between a free medicine program and functioning in people with schizophrenia: a cross-sectional study in Liuyang, China
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Wenjie Gong, Chao Zhang, Dong (Roman) Xu, Shuiyuan Xiao, Yu Yu, and Eric D. Caine
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Free medication program ,686 Program ,Medication adherence ,Community-based mental health ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background Persons with schizophrenia frequently discontinue or avoid medications. Under a national community-based mental health program many places in China have started to provide free medications to people with severe mental health disorders in their communities. In the free medication program (FMP) in Liuyang, China, peripatetic psychiatrists prescribed and dispensed antipsychotic medications free of charge at regular intervals and places convenient for all patients through the primary health care system since 2006. Our study aims to test whether adherence to this FMP improves the functioning of people with schizophrenia. Methods The research was conducted in Liuyang, a rural county in central China. Data were obtained from three sources: an ad-hoc survey and the program’s management system in 2013 and in-home interviews in 2014 in Liuyang. We conducted a cross-sectional propensity-score based analysis of the “dose” effect of FMP participation on their level of functioning, using medication refill adherence as a proxy for the participatory intensity in the program. Results Only 50.9% of 2,332 participants came for all refills in 2012. Higher refill adherence was associated with slightly worse functional outcomes. The main reasons for refill non-adherence were “unwilling to take medication or only took medication when unwell” (23.6%), “forgot or missed the appointment” (20.6%) and “hospitalized” (20.1%). Conclusions The FMP program in Liuyang seemed to have successfully removed barriers in cost and access. However, better refill adherence was not associated with better functional outcomes in this study, which might have been the result of reverse causation. To improve the effectiveness of the FMP, patient-centered measures should be considered.
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- 2020
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13. Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana.
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Gyamfi, Naomi, Badu, Eric, Mprah, Wisdom Kwadwo, and Mensah, Isaac
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MENTAL health personnel , *CUSTOMER services , *MONETARY incentives , *SOCIAL integration , *THEMATIC analysis - Abstract
Background: In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. Methods: A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. Results: The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey. Conclusion: The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs. [ABSTRACT FROM AUTHOR]
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- 2020
- Full Text
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14. Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot.
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Ravitz, Paula, Berkhout, Suze, Lawson, Andrea, Kay, Tatjana, and Meikle, Susan
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EVIDENCE-based psychiatry , *PSYCHOTHERAPY , *MENTAL illness treatment , *MIXED methods research , *THERAPEUTICS , *EMPATHY , *MEDICAL case management , *PROFESSIONAL practice , *PILOT projects , *COUNSELING , *SOCIAL services case management , *MOTIVATIONAL interviewing , *EVIDENCE-based medicine , *ORGANIZATIONAL change , *COMMUNITY mental health service administration , *COMMUNITY mental health services - Abstract
Objectives: Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices.Methods: Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences.Results: Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05).Conclusions: This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2019
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15. Trauma and Acculturative Stress
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Rettger, John P., Kletter, Hilit, Carrion, Victor, Patel, Sita, editor, and Reicherter, Daryn, editor
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- 2016
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16. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis
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Sichel, Corianna E. and Connors, Elizabeth H.
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- 2022
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17. The Center for Youth Wellness: A Community-Based Approach to Holistic Health Care in San Francisco
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Walker, Suzanne E., Carrion, Victor G., Roberts, Laura Weiss, editor, Reicherter, Daryn, editor, Adelsheim, Steven, editor, and Joshi, Shashank V., editor
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- 2015
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18. Adventure therapy and its impact on the functioning of youth in a community setting.
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Vankanegan, Christie, Tucker, Anita R., Mcmillion, Patrick, Gass, Michael, and Spencer, Lynette
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ADVENTURE therapy , *ANALYSIS of variance , *COMMUNITY health services , *CRITICAL thinking , *GROUP psychotherapy , *INTERPERSONAL relations , *LIFE skills , *NONPROFIT organizations , *QUESTIONNAIRES , *RESEARCH funding , *SEX distribution , *SOCIAL problems , *PSYCHOLOGICAL stress , *TIME , *TRANSGENDER people , *TREATMENT effectiveness , *REPEATED measures design , *DESCRIPTIVE statistics ,MEDICAL care for teenagers - Abstract
The purpose of this article is to explore the impact of one type of activity-based group work, adventure therapy (AT) group practice, on youth in a community-based mental health setting. Using data collected from Adventure Works, a nonprofit outdoor behavioral healthcare and adventure therapy counseling center, this article explores treatment outcomes to identify the effectiveness of adventure therapy group interventions. AT has been identified as an effective intervention within wilderness and residential settings, but little research exists focusing on adventure therapy in a community setting. Data collected shows positive outcomes for youth participating in adventure-based group therapy. Research and practice implications are discussed. [ABSTRACT FROM AUTHOR]
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- 2019
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19. Feasibility of Training Frontline Therapists in Prolonged Exposure: A Randomized Controlled Pilot Study of Treatment of Complex Trauma in Diverse Victims of Crime and Violence.
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Ghafoori, Bita, Hansen, Marissa C., Garibay, Erika, and Korosteleva, Olga
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The study aims were to determine whether prolonged exposure (PE) improved mental health and was feasible to implement by frontline clinicians in a culturally diverse sample with complex trauma. Seventy-one individuals were randomly assigned to PE or person-centered therapy (PCT). Outcome measures were administered at baseline and sessions 3, 6, 9, and 12. Mixed modeling was used to regress outcome measures on time, treatment group, and number of visits. Individuals who received PE showed significant moderate association with decline in reported posttraumatic stress disorder (PTSD) symptoms as noted by the PTSD Checklist for DSM-5 (p = 0.05) compared with PCT. Results indicated improved scores on all measures at each follow-up time point compared with baseline (p ≤ 0.01). PE was feasible, shown by positive recruitment and ability of clinicians to effectively implement and maintain treatment fidelity. Findings suggest that PE can be effective for treating complex trauma when used by clinicians in community settings. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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20. New and Ongoing Users.
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Kim, HyunSoo, Kim, Seok-Joo, Williams, Thomas G., and Garrity, John F.
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ANALYSIS of variance , *CHI-squared test , *COMMUNITY mental health services for teenagers , *FACTORIAL experiment designs , *LIFE skills , *LONGITUDINAL method , *RESEARCH methodology , *EVALUATION of medical care , *PSYCHOLOGICAL tests , *RESEARCH funding , *T-test (Statistics) , *REPEATED measures design , *SEVERITY of illness index - Abstract
There is growing recognition that to maximize service impacts, first-time users of community mental health services require treatment approaches different from those for experienced users. This study examines differences between new and ongoing service users in their sociodemographic and clinical characteristics, how episodes of the treatment status (new vs. ongoing) interact with problem severity and the level of functioning at the baseline and three-month follow-up; and the role of the service quantity, satisfaction, and hopefulness in predicting service outcomes for children. The results of mixed factorial ANOVAs reveal significant interactions between new/ongoing treatment conditions and problem severity as well as functioning across time periods. New users showed higher problem severity at the baseline than at T2 in comparison with ongoing users. In addition, new users showed lower functioning scores at the baseline than at T2 in comparison with ongoing users. Hopefulness predicted problem severity for new and ongoing users, and service satisfaction predicted problem severity only for ongoing users. In terms of functional outcomes, gender, diagnosis, the number of providers, and hopefulness were predictors for new users, and hopefulness was a predictor for ongoing users. The results suggest a need for using different treatment approaches for new versus ongoing users. [ABSTRACT FROM AUTHOR]
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- 2015
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21. Current practices in community treatment of the mentally ill in Ontario, Canada: learning opportunities for improving Ghana's mental health system.
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Mfoafo-M'Carthy, Magnus and Sottie, Cynthia Akorfa
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The article discusses the history of the mental health care system in Ghana, its Mental Health Act (ACT 846), and efforts to improve its mental health care system, and the authors present the argument of need for political will to ensure the success of Mental Health Act. Topics discussed include authors arguing that implementing a community-based mental health system similar to Ontario's mandated outpatient treatment or Community Treatent Orders (CTOs) to help improve mental health system.
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- 2015
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22. Community-based psychosocial substance use disorder interventions in low-and-middle-income countries: a narrative literature review
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Heijdra Suasnabar, Jan Manuel and Hipple Walters, Bethany
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- 2020
- Full Text
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23. Interrelationships Among Physical Health, Health-Related, and Psychosocial Characteristics of Persons Receiving Integrated Care in Community Mental Health Settings.
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Lemieux, Catherine M., Richards, Kristin N., Hunter, Dana R., and Kasofsky, Jan
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INTEGRATED health care delivery , *COMMUNITY mental health services , *HEALTH equity , *MENTAL illness treatment , *MEDICAL care of people with mental illness , *COMORBIDITY , *THERAPEUTICS - Abstract
Integrated primary and behavioral health care (PBHC) programs in community mental health (CMH) settings seek to address the health disparities and excess mortality of persons with serious mental illness (SMI) and comorbid medical disorders. The current cross-sectional, descriptive study utilized an integrated health data set to examine interrelationships among physical health, health-related, and psychosocial characteristics of 125 clients receiving integrated PBHC services in a CMH setting. Using baseline data collected by nurse care managers, researchers sought to develop a comprehensive, person-centered profile of adults in CMH agencies. Results showed that participants reported fair overall health, with mean scores on four of eight health indicators in the at-risk range. Disparities on some measures emerged for women, African Americans, and clients with a family history of cardiometabolic disorders. Participants reported moderate levels of functioning and psychological distress and moderately high levels of social connectedness. Approximately 27% of the variance in overall health was explained by five predictors in the model. Blood glucose levels and daily functioning were the strongest predictors of health status. Results are consistent with research on comorbidity that emphasizes the multidimensionality of health. Future social work research should employ multivariate approaches to identify disparities and clarify treatment needs of diverse CMH clients. [ABSTRACT FROM PUBLISHER]
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- 2015
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24. Recent Developments in Community-Based Mental Health Care in Japan: A Narrative Review.
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Iwatani J, Ito J, Taguchi Y, and Akiyama T
- Abstract
Background: Since the 1950s, mental health care in Japan has been hospital-centered. A set of legislative initiatives were undertaken in 1995, emphasizing the importance of community-based mental health care. However, despite these attempts to develop a community-based mental health care system, the rate of inpatient-based treatment has remained high and the shift from hospital-centered care to community-based has still not fully materialized., Aim: This study aims to conduct a review of the available literature on the development of community-based mental health care in Japan between 2010 and 2020., Methods: We conducted a standardized literature search in the electronic database Igaku Chuo Zasshi, aiming to identify original studies published between 2010 and 2020 that explored community mental health care in Japan. The included studies' outcomes were categorized as performance surveys, service user reports, service provider reports, and educational activities. A descriptive-analytical method was implemented in the current review., Results: A total of 25 studies were examined. Six studies reported surveys assessing the performance of community-based mental health care on the assertive community treatment (ACT), compulsory treatment, home-visit nursing care, physical complications, and a welfare medicine collaboration on a remote islands. Four studies investigated the perspectives of service users or their families on home-visit nursing care, social participation, community program, and legislative revision. Ten studies focused on social withdrawal, service providers perspectives on local population needs, supporting skills, care programs, and the professional growth of psychiatric social workers. Five studies focused on educational approaches for future healthcare professionals and efforts to improve mental health literacy among adolescents., Conclusion: This paper provided the first comprehensive review of Japan's community-based mental health care. Between 2010 and 2020, community mental health care in Japan evolved in many directions, with the understanding that various needs should be met. Home-visit nursing care and ACT can be considered as the most thoroughly investigated and better developed. Research that adopt rigorous methodologies such as randomized controlled trials is required if the goal is to achieve solid conclusions., Competing Interests: Conflict of Interest: The authors declare no conflicts of interest., (© Authors, 2022.)
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- 2022
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25. Belonging home: capabilities, belonging and mental health recovery in low resourced settings
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Fiona Verity, Brian Mutamba, and David Cappo
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medicine.medical_specialty ,family ,Health (social science) ,Evidence-based practice ,deinstitutionalization ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Psychiatric hospital ,AcademicSubjects/MED00860 ,Uganda ,030212 general & internal medicine ,Sociology ,community-based mental health ,belonging ,Community development ,Government ,Social work ,business.industry ,Public health ,Public Health, Environmental and Occupational Health ,Original Articles ,Public relations ,Mental health ,030227 psychiatry ,Intervention (law) ,Mental Health ,Mental Health Recovery ,business - Abstract
There are significant barriers to the development of a ‘balanced model’ of mental health in low-income countries. These include gaps in the evidence base on effective responses to severe mental health issues and what works in the transition from hospital to home, and a low public investment in primary and community care. These limitations were the drivers for the formation of the non-government organization, YouBelong Uganda (YBU), which works to contribute to the implementation of a community-based model of mental health care in Uganda. This paper overviews an intervention protocol developed by YBU, which is a combined model of parallel engagement with the national mental hospital in Kampala, Uganda, movement of ‘ready for discharge’ patients back to their families and communities, and community development. The YBU programme is theoretically underpinned by a capabilities approach together with practical application of a concept of ‘belonging’. It is an experiment in implementation with hopes that it may be a positive step towards the development of an effective model in Uganda, which may be applicable in other countries. Finally, we discuss the value in joining ideas from social work, sociology, philosophy, public health and psychiatry into a community mental health ‘belonging framework’.
- Published
- 2020
26. The Use of Adventure Therapy in Community-Based Mental Health: Decreases in Problem Severity Among Youth Clients.
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Tucker, Anita, Javorski, Steve, Tracy, Julie, and Beale, Bobbi
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- *
ADVENTURE therapy , *ANALYSIS of variance , *ATTENTION-deficit hyperactivity disorder , *CHI-squared test , *COMMUNITY health services , *CONFIDENCE intervals , *EPIDEMIOLOGY , *RESEARCH methodology , *HEALTH outcome assessment , *RESEARCH , *SCALES (Weighing instruments) , *STATISTICS , *T-test (Statistics) , *DATA analysis , *MULTIPLE regression analysis , *TREATMENT effectiveness , *PRE-tests & post-tests , *SEVERITY of illness index , *DATA analysis software , *ADOLESCENCE - Abstract
Background: There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need. Objective: Using a sample of 1,135 youth from a community-based mental health center, this study addressed the following questions: (1) Is AT an effective treatment modality for youth compared to traditional counseling? (2) How do changes in problem severity associated with participation in AT-based interventions compare with those associated with traditional counseling across gender, age, primary diagnosis, and race? (3) What are the predictors of changes in problem severity in clients? Methods: In this exploratory non-equivalent groups quasi-experimental design study, pre- and post- mean scores of problem severity as reported by youth's primary clinician were compared by type of treatment and client characteristics. Treatment and client characteristics were used as predictors of changes in problem severity. Findings: Participants in AT had significant reported mean decreases in problem severity larger than those of clients not involved in counseling with an adventure component with larger decreases in female and African American clients. AT and psychological counseling were found to be significant predictors of decreases in problem severity; however, length of counseling, not length of AT, was a significant predictor. Discussion: These findings suggest that community-based AT may be a viable treatment for youth in community settings; yet these findings should be interpreted with caution due to several study limitations. [ABSTRACT FROM AUTHOR]
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- 2013
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27. Ethnic Similarity, Therapist Adherence, and Long-Term Multisystemic Therapy Outcomes.
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Chapman, Jason E. and Schoenwald, Sonja K.
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- *
BEHAVIOR disorders , *SOCIAL disabilities , *CAREGIVERS , *CHILD Behavior Checklist , *COMMUNITY mental health services for teenagers , *LEGAL compliance , *CONFIDENCE intervals , *CRIME , *ETHNIC groups , *FAMILY psychotherapy , *JUVENILE delinquency , *LONGITUDINAL method , *EVALUATION of medical care , *MEDICAL protocols , *MINORITIES , *PROFESSIONS , *PSYCHOTHERAPISTS , *RESEARCH funding , *T-test (Statistics) , *CRISIS intervention (Mental health services) , *REPEATED measures design , *ADOLESCENCE , *THERAPEUTICS - Abstract
The current study investigated relations among ethnic similarity in caregiver-therapist pairs of youth participating in Multisystemic Therapy, therapist adherence, and youth long-term behavioral and criminal outcomes. Participants were 1,979 youth and families treated by 429 therapists across provider organizations in 45 sites. Relations were found, independently, and in the presence of ethnic similarity, between adherence and reductions in youth externalizing and internalizing behavior problems 1-year posttreatment and youth criminal charges 4 years posttreatment. Relations between ethnic similarity and outcomes were found only for reductions in youth externalizing behavior problems and not when adherence was included in the model. Adherence ratings were higher, however, in ethnically similar caregiver-therapist pairs, and evidence was found that this increased adherence predicted slightly better outcomes for youth. Implications for further research and clinical practice are considered. [ABSTRACT FROM AUTHOR]
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- 2011
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28. Trauma and Humanitarian Translation in Liberia: The Tale of Open Mole.
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Abramowitz, Sharon Alane
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TRAUMATISM , *MENTAL illness , *MENTAL health , *PSYCHOLOGICAL distress , *HUMANITARIAN assistance - Abstract
The focus of this paper is the intercultural process through which Open Mole and trauma-related mental illnesses are brought together in the postconflict mental health encounter. In this paper, I explore the historical dimension of this process by reviewing the history of Open Mole, and the ways in which it has been interpreted, acted on, and objectified by external observers over the last half-century. Moving into Liberia’s recent war and postconflict period, I examine the process by which Open Mole is transformed from a culture-bound disorder into a local idiom of trauma, and how it has become a gateway diagnosis of PTSD-related mental illnesses, and consider how it is produced as an objectified experience of psychiatric disorder in clinical humanitarian contexts. By studying how Open Mole is transformed in the humanitarian encounter, I address the structure and teleology of the humanitarian encounter and challenge some of the foundational assumptions about cultural sensitivity and community-based mental health care in postconflict settings that are prevalent in scholarship and practice today. [ABSTRACT FROM AUTHOR]
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- 2010
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29. Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing.
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O'Brien, Ann-Marie, Farrell, Susan J., and Faulkner, Sylvie
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- *
MENTAL health services , *COMMUNITY health services , *ENVIRONMENTAL health , *PUBLIC health , *PSYCHOTHERAPY patients - Abstract
The purpose of this paper is to examine the association of community treatment orders (CTO) with community engagement and housing arrangements for one population of psychiatric patients in Ontario, Canada. Socio demographic characteristics and health service utilization information were collected for each patient placed on a CTO during a 3 year period. Information was collected for each of the 84 patients when a CTO was first issued and then updated to reflect both the patient’s ongoing involvement with the legislation and related clinical outcomes. A significant increase in the number of community services and a shift to supportive housing arrangements was found for patients following issuance of a CTO. [ABSTRACT FROM AUTHOR]
- Published
- 2009
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30. Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy.
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Preti, A., Rucci, P., Santone, G., Picardi, A., Miglio, R., Bracco, R., Norcio, B., and De Girolamo, G.
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- *
PSYCHOTHERAPY patients , *INPATIENT care , *MENTAL illness treatment -- Evaluation , *PSYCHIATRIC hospital patients , *PSYCHIATRIC hospital admission & discharge - Abstract
BackgroundA proper understanding of patterns of care represents a crucial step in improving clinical decision making and enhancing service provision. Only a few studies, however, have explored global patterns of psychiatric admissions nationwide, and none have been undertaken in Italy.MethodSociodemographic, clinical and treatment-related information was collected for 1577 patients admitted to 130 public and 36 private in-patient facilities in Italy during an index period in the year 2004. All patients were also rated using the 24-item Brief Psychiatric Rating Scale (BPRS) and the Personal and Social Performance (PSP) rating scales.ResultsNon-affective psychoses (36%) were the most common diagnoses and accounted to a large extent for compulsory admissions. Private facilities were more likely to admit patients with organic mental disorders and substance abuse/dependence and less likely to admit patients with non-affective psychoses. Overall, 77.8% of patients had been receiving treatment by a mental health professional in the month prior to admission. In 54% of cases, the admission was solicited by patients' family members. The main factors preceding admission were impairment in work or social functioning, social withdrawal, and conflict with family members. Agitation, delusions and/or hallucinations, and the presence of multiple problems were associated with compulsory admissions, whereas depressive and anxiety symptoms were associated with voluntary admissions.ConclusionsIn a mixed, public–private psychiatric care system, like the Italian one, public and private facilities admit patients with widely different clinical characteristics and needs. Family support represents an important resource for most patients, and interventions specifically addressed to relieving family burden are warranted. [ABSTRACT FROM PUBLISHER]
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- 2009
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31. Use and Predictors of Out-of-Home Placements Within Systems of Care.
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Farmer, Elizabeth M. Z., Mustillo, Sarah, Burns, Barbara J., and Holden, E. Wayne
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- *
CHILD psychology , *MENTAL health , *COMMUNITY health services , *CHILD mental health services , *MENTAL health services , *PUBLIC health , *MEDICAL care - Abstract
This article examines out-of-home placements for youth with mental health problems in community-based systems of care. Longitudinal data come from the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. One third of youth residing at home when they enrolled in the system of care were placed out of home during the 2-year follow-up period. As expected, youth who were placed out of home displayed more problems, fewer strengths, and more risk factors than youth who remained at home. However, results suggested few differences between youth placed in foster care and those placed in more restrictive settings. In addition, there was increased placement instability for Hispanic and older youth. Findings suggest that out-of-home placements remain a common component in systems of care. This suggests the immediate need for additional work on effectiveness of these settings for youth within systems of care. [ABSTRACT FROM AUTHOR]
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- 2008
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32. Some reflections on social workers' perspectives on mental health services in two cities—Sydney, Australia and Budapest, Hungary.
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Weber, Zita and Bugarszki, Zsolt
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MENTAL health services , *MEDICAL care , *SOCIAL workers , *SOCIAL services , *SMALL groups - Abstract
The opportunity to explore social workers' reflections on their practice in the mental health arena in the two cities, Sydney and Budapest, followed earlier collaboration in 2003 by the two authors on research in Budapest regarding the nature of out-patient mental health services. Historical and political narratives have shaped these cities differently and we were interested in exploring how those grand narratives had affected the nature of social workers' perspectives on their work. In this article, the authors attempt to summarize the important elements that emerged from the narratives shared in conversations with 10 social workers, five in Budapest and five in Sydney. It must be pointed out that at the time of these conversations, there were only a total of eight social workers employed in the mental health field in Budapest. There is no intention on the authors' part to generalize from the narratives generated from this small group. However, we offer our observations on the reflections of these social workers as a starting point for an understanding of orientations to practice. [ABSTRACT FROM AUTHOR]
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- 2007
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33. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings
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Mandell, David S., Walrath, Christine M., Manteuffel, Brigitte, Sgro, Gina, and Pinto-Martin, Jennifer A.
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- *
CHILD mental health services , *PEDIATRICS , *CHILD psychology , *MENTAL health , *DEVELOPMENTAL disabilities - Abstract
Abstract: Objective: To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. Methods: Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. Results: Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. Conclusion: Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed. [Copyright &y& Elsevier]
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- 2005
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34. The association between a free medicine program and functioning in people with schizophrenia: a cross-sectional study in Liuyang, China
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Chao Zhang, Wenjie Gong, Yu Yu, Eric D. Caine, Shuiyuan Xiao, and Dong Xu
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medicine.medical_specialty ,Mental health program ,Cross-sectional study ,lcsh:Medicine ,Psychiatry and Psychology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Free medication program ,030212 general & internal medicine ,Association (psychology) ,China ,Psychiatry ,Medication adherence ,business.industry ,General Neuroscience ,lcsh:R ,General Medicine ,medicine.disease ,Mental health ,686 Program ,Test (assessment) ,Community-based mental health ,Schizophrenia ,Antipsychotic Medications ,Public Health ,General Agricultural and Biological Sciences ,business ,030217 neurology & neurosurgery - Abstract
Background Persons with schizophrenia frequently discontinue or avoid medications. Under a national community-based mental health program many places in China have started to provide free medications to people with severe mental health disorders in their communities. In the free medication program (FMP) in Liuyang, China, peripatetic psychiatrists prescribed and dispensed antipsychotic medications free of charge at regular intervals and places convenient for all patients through the primary health care system since 2006. Our study aims to test whether adherence to this FMP improves the functioning of people with schizophrenia. Methods The research was conducted in Liuyang, a rural county in central China. Data were obtained from three sources: an ad-hoc survey and the program’s management system in 2013 and in-home interviews in 2014 in Liuyang. We conducted a cross-sectional propensity-score based analysis of the “dose” effect of FMP participation on their level of functioning, using medication refill adherence as a proxy for the participatory intensity in the program. Results Only 50.9% of 2,332 participants came for all refills in 2012. Higher refill adherence was associated with slightly worse functional outcomes. The main reasons for refill non-adherence were “unwilling to take medication or only took medication when unwell” (23.6%), “forgot or missed the appointment” (20.6%) and “hospitalized” (20.1%). Conclusions The FMP program in Liuyang seemed to have successfully removed barriers in cost and access. However, better refill adherence was not associated with better functional outcomes in this study, which might have been the result of reverse causation. To improve the effectiveness of the FMP, patient-centered measures should be considered.
- Published
- 2019
35. The association between a free medicine program and functioning in people with schizophrenia: a cross-sectional study in Liuyang, China.
- Author
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Gong W, Zhang C, Xu DR, Xiao S, Yu Y, and Caine ED
- Abstract
Background: Persons with schizophrenia frequently discontinue or avoid medications. Under a national community-based mental health program many places in China have started to provide free medications to people with severe mental health disorders in their communities. In the free medication program (FMP) in Liuyang, China, peripatetic psychiatrists prescribed and dispensed antipsychotic medications free of charge at regular intervals and places convenient for all patients through the primary health care system since 2006. Our study aims to test whether adherence to this FMP improves the functioning of people with schizophrenia., Methods: The research was conducted in Liuyang, a rural county in central China. Data were obtained from three sources: an ad-hoc survey and the program's management system in 2013 and in-home interviews in 2014 in Liuyang. We conducted a cross-sectional propensity-score based analysis of the "dose" effect of FMP participation on their level of functioning, using medication refill adherence as a proxy for the participatory intensity in the program., Results: Only 50.9% of 2,332 participants came for all refills in 2012. Higher refill adherence was associated with slightly worse functional outcomes. The main reasons for refill non-adherence were "unwilling to take medication or only took medication when unwell" (23.6%), "forgot or missed the appointment" (20.6%) and "hospitalized" (20.1%)., Conclusions: The FMP program in Liuyang seemed to have successfully removed barriers in cost and access. However, better refill adherence was not associated with better functional outcomes in this study, which might have been the result of reverse causation. To improve the effectiveness of the FMP, patient-centered measures should be considered., Competing Interests: The authors declare that they have no competing interests., (© 2020 Gong et al.)
- Published
- 2020
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- View/download PDF
36. Community Treatment Orders: Beyond Hospital Utilization Rates Examining the Association of Community Treatment Orders with Community Engagement and Supportive Housing
- Author
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O’Brien, Ann-Marie, Farrell, Susan J., and Faulkner, Sylvie
- Published
- 2009
- Full Text
- View/download PDF
37. Balanced on the Horns of a Dilemma: Observations on Work with Chronic Depression
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Sarasohn, M. Kim
- Published
- 2004
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38. Public beliefs and attitudes towards depression in Italy: a national survey
- Author
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Piergiorgio Argentero, Giuseppe Tibaldi, Paola Rucci, Rocco Luigi Picci, Carmine Munizza, Alessandro Coppo, Massimo Di Giannantonio, Munizza C, Argentero P, Coppo A, Tibaldi G, Di Giannantonio M, Picci RL, and Rucci P
- Subjects
Male ,Health Knowledge, Attitudes, Practice ,Social stigma ,Epidemiology ,Social Stigma ,Culture ,Psychological intervention ,lcsh:Medicine ,Social and Behavioral Sciences ,Public opinion ,Depression ,community-based mental health ,treatment ,Sociology ,Surveys and Questionnaires ,Psychology ,Medicine ,lcsh:Science ,media_common ,Multidisciplinary ,PERSONAL BELIEFS ,Middle Aged ,DEPRESSION ,PREVALENCE ,Telephone survey ,Mental Health ,Italy ,Female ,Public Health ,Behavioral and Social Aspects of Health ,Research Article ,Adult ,medicine.medical_specialty ,Social Psychology ,Clinical Research Design ,media_common.quotation_subject ,MEDLINE ,Humans ,survey ,Psychiatry ,Aged ,Behavior ,Cultural Characteristics ,Survey Research ,business.industry ,Addiction ,lcsh:R ,Primary care physician ,STIGMA ,Mental health ,Social Epidemiology ,Public Opinion ,lcsh:Q ,business - Abstract
Background: Previous studies have shown that attitudes towards depression may be influenced by country-specific social and cultural factors. A survey was carried out to collect beliefs on and attitudes toward depression in Italy, which has an established community-based mental health system. Methods: A telephone survey was carried out in a probabilistic sample aged $15 years. A 20-item questionnaire was administered to explore knowledge of depression, stigma, causal beliefs, treatment preference, and help-seeking attitudes. Results: Of the 1001 participants, 98% were aware of depression, and 62% had experienced it, either directly or indirectly. A widespread belief (75%) was that people suffering from depression should avoid talking about their problem. A minority of the sample viewed depression as a condition that should be managed without recourse to external help or a ‘‘socially dangerous’’ illness. Among perceived causes of depression, most respondents mentioned life stressors or physical strains. Psychologists were often indicated as an adequate source of professional help. Half of the sample believed that depression should be pharmacologically treated, but drugs were often seen as addictive. Referring to a primary care physician (PCP) was considered embarrassing; furthermore, many people thought that PCPs are too busy to treat patients suffering from depression. Conclusions: Our findings indicate that depression is seen as a reaction to significant life events that should be overcome with the support of significant others or the help of health professionals (mainly psychologists). However, there are still barriers to the disclosure of depressive symptoms to PCPs, and concerns about the addictive effect of antidepressants. In the presence of a gap between people’s beliefs and what health professionals consider appropriate for the treatment of depression, a ‘‘shared decision making’’ approach to treatment selection should be adopted taking into account the patients’ preference for psychological interventions to ensure active compliance with effective treatments.
- Published
- 2013
39. Accessibility and pathways to psychiatric care in a community-based mental health system
- Author
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Graham Thornicroft, Francesco Amaddeo, Michele Tansella, and F Zambello
- Subjects
Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Social Psychology ,Referral ,Adolescent ,Epidemiology ,Poison control ,Context (language use) ,Suicide prevention ,Occupational safety and health ,Health Services Accessibility ,Organisation and utilisation ,Services' accessibility ,Community-based mental health ,Mental health service ,Pathways to care ,Sleep Initiation and Maintenance Disorders ,Medicine ,Psychiatric hospital ,Humans ,Psychiatry ,Somatoform Disorders ,Referral and Consultation ,Aged ,business.industry ,Public health ,Mental Disorders ,Middle Aged ,Mental health ,Community Mental Health Services ,Psychiatry and Mental health ,Italy ,Utilization Review ,Female ,business ,Family Practice - Abstract
Background The careful analysis of pathways to specialist mental health care, within the context of community-based services, is important because it allows a detailed understanding of the inter-relationship between the component parts of the whole system of care. Moreover, it permits a comparison of service functioning to made over time, and is one way to operationalise the measurement of accessibility to services. The aims of this study are to describe: (i) the pathways followed by patients with new episodes of care to community-based mental health services, (ii) the time intervals from onset of the problem to first contact with services, and then to onward referral to specialist care (accessibility), and (iii) to explore the short-term costs associated with different pathways. Methods Using data from the South-Verona Psychiatric Case Register, all new patients referred to any of the facilities which are part of the South-Verona Community Psychiatric Service (CPS) over a 6-month period (November 1999 – May 2000) were eligible to enter the study. Patients were interviewed by telephone using the Italian translation of the WHO Encounter Form. The costs of care provided in the 3 months following the index contact were assessed for all patients. Results The most common route to mental health services is via a GP (40 %), followed by a referral from a hospital doctor (26 %) and self-referral (23 %). The median interval from onset to direct contact with the South-Verona CPS (12 weeks) was shorter than the intervals from onset to direct contact with other service providers (the median interval for contact with GPs and hospital doctors was 24 weeks). The intervals varied considerably from 1 week (for attempted suicide), to 1.5 years (for disturbed behaviour). The results of backward regression modelling revealed a significant relationship between patients' characteristics and community costs or total psychiatric costs (44 % and 53 % of the variance explained respectively). Conclusion When the results are compared with a directly comparable earlier study in South-Verona, it is apparent that between 1991 and 1999 an increasing proportion of patients with insomnia and somatic disorders presented first to GPs, while a decreasing proportion of patients over the years sought care directly from specialist care. An increase in the role of local GPs as gatekeepers has, therefore, emerged. A prompt assessment by the South-Verona CPS of the patients' presenting problems was also confirmed, and this can be explained by the ‘drop-in’ approach at the Mental Health Centre, where patients can seek specialist care directly, without previously attending GPs. This method of measuring time intervals along pathways is proposed as a way to operationalise accessibility to services in future.
- Published
- 2002
40. Reducing Mental Health Emergency Services for Children Served Through California’s Full Service Partnerships
- Author
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Cordell, Katharan D. and Snowden, Lonnie R.
- Published
- 2017
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