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BACKGROUND: Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI. METHODS: Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10). RESULTS: Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources. CONCLUSIONS: Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants recovery journey.

BackgroundThere has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare-as well as co-located sites providing both-sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic.MethodsWe interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis.ResultsCommonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices.ConclusionsThough COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.

Background: Health institutions advocate for psychosocial and recovery-oriented interventions alongside pharmacological treatment for severe mental illness. Participatory arts interventions appear promising in promoting personal recovery by fostering connectedness, hope, renegotiation of identity, meaning-making, and empowerment. Despite encouraging findings, however, the evidence base remains thin. Further, results from cognitive literature studies suggest possible impact on parameters of clinical recovery, but this has not been studied in clinical contexts. We developed REWRITALIZE, a structured, recovery-oriented, fifteen-session creative writing group intervention led by a professional author alongside a mental health professional. Participants engage with literary forms, write on them, share their texts, and partake in reflective discussions within a supportive, non-stigmatising environment, designed to promote self-expression, playful experimentation, agency, recognition, participatory meaning-making, renegotiation of identity and social engagement. The aim of this project is to evaluate REWRITALIZE for persons with severe mental illness through a randomised controlled trial (RCT) focusing on personal recovery outcomes. Additionally, an embedded pilot RCT will explore additional outcomes i.e., clinical recovery for a subgroup with schizophrenia spectrum disorders. Methods: The RCT is an investigator-initiated, randomised, two-arm, assessor-blinded, multi-center, waiting-list superiority trial involving 300 participants (age > 18) from six psychiatric centers in regions Capital and Zealand in Denmark, randomised to receive either the creative writing intervention combined with standard treatment or standard treatment alone. Assessments will be conducted before and after the intervention and at six months post intervention. The primary outcome is personal recovery at the end of intervention measured with the questionnaire of the process of recovery. Secondary outcomes include other measures of personal recovery, self-efficacy, mentalising, and quality of life. The pilot RCT, integrated within the RCT, will focus on 70 of the participants aged 18–35 with schizophrenia spectrum disorders, evaluating exploratory measures related to perspective-taking, social cognition, cognitive function, psychosocial functioning, and symptom pressure. Discussion: This is the first RCT for creative writing groups. It assesses whether REWRITALIZE, as adjunct to standard mental healthcare, is more effective for personal recovery than standard care. If successful, it would provide evidence for the efficacy of REWRITALIZE, potentially enabling its implementation across mental health centers in Denmark. Trial registration: Privacy (data protection agency): p-2023–14655. Danish National Center for Ethics: 2313949. Clinicaltrials.gov: NCT06251908. Registration date 02.02.2024. [ABSTRACT FROM AUTHOR]

Living Well, Living Longer (The Program) is an integrated care strategy to improve the physical health of people living with severe mental illness within a public mental health service. The significant life expectancy gap experienced by this cohort is largely attributed to higher rates of cardiovascular disease and modifiable risk factors. The Program addresses this by guiding people through the four stages of screening, detection, treatment initiation, and ongoing management of coexisting chronic health conditions. The Program adopted an integrated care approach to ensure the provision of appropriate and coordinated care across hospital and primary care services. Key care pathways include a cardiometabolic health assessment clinic, shared care with general practitioners, oral health services partnership and employment of peer support workers, dietitians, exercise physiologists, and smoking cessation to provide targeted community support and interventions. There has been strong engagement with the care pathways introduced since The Program's inception in 2013 and evaluation is currently underway to consider the impact on cardiometabolic health outcomes for participants. Critical to The Program's effectiveness has been engagement with lived experience expertise, multidisciplinary collaboration, and strong executive support. However, significant challenges persist amid an Australian public health crisis characterised by reducing rates of free primary healthcare access for people living with severe mental illness and enduring communication challenges between primary and secondary health services. With the implementation of MyMedicare and the imminent Single Digital Patient Record across NSW Health, we stand at a critical juncture. It is imperative to establish robust systems to enhance care for this vulnerable population. What is known about the topic? People living with severe mental illness experience a 20-year reduced life expectancy due to a combination of modifiable lifestyle factors and increased rates of chronic disease. What does this paper add? This paper describes the Living Well, Living Longer integrated care program, which introduces various strategies to address this problem. What are the implications for practitioners? Living Well, Living Longer demonstrates that with strong executive support, multidisciplinary collaboration, and engagement with lived experience expertise, effective care pathways can be implemented to improve the health of people living with severe mental illness. [ABSTRACT FROM AUTHOR]

Background: Severe mental illness (SMI) has been associated with reduced bone density and increased risk of fractures, although some studies have shown inconsistent results. Aim: To examine the association between SMI and recorded diagnosis of osteoporosis and fragility fracture in people aged ≥50 years. Design and setting: Population-based cohort study set in UK primary care. Method: Anonymised primary care data (IQVIA Medical Research Database) were used. Patients with a diagnosis of SMI aged 50–99 years (2000–2018) were matched to individuals without SMI. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Analyses were stratified by sex and age, accounting for social deprivation, year, smoking, alcohol, and body mass index. Results: In total, 444 480 people were included (SMI n = 50 006; unexposed n = 394 474). In men, diagnosis of SMI increased the likelihood of an osteoporosis diagnosis, with differences mainly observed among the youngest (aged 50–54 years: HR 2.12, 95% CI = 1.61 to 2.79) and the oldest (aged 85–99 years: HR 2.15, 95% CI = 1.05 to 4.37), and SMI increased the risk of fragility fractures across all ages. In women, SMI increased the risk of an osteoporosis diagnosis only in those aged 50–54 years (HR 1.16, 95% CI = 1.01 to 1.34), but increased the risk of fragility fractures across all ages. There were more than twice as many men with SMI with fragility fracture records than with an osteoporosis diagnosis: fragility fracture:osteoporosis = 2.10, compared with fragility fracture:osteoporosis = 1.89 in men without SMI. The fragility fracture:osteoporosis ratio was 1.56 in women with SMI versus 1.11 in women without SMI. Conclusion: SMI is associated with an increased likelihood of fragility fractures and osteoporosis underdiagnosis. Interventions should be considered to mitigate the increased risk of fractures in people with SMI. [ABSTRACT FROM AUTHOR]

High rates of cardiometabolic disease and poor physical health outcomes contribute to significant premature mortality in people living with severe mental illness (PLWSMI). Lifestyle interventions such as exercise are known to improve both physical and mental health outcomes, however the best way to deliver exercise programs for PLWSMI remains a challenge. This paper uses a pragmatic program evaluation of a co-delivered low-cost community-based exercise program implemented over a 6-month period. Of 46 referrals in the first half of 2023 to the SLHD Gym and Swim program, 13 gave consent to participate in standardised measures and qualitative interviews. Findings revealed an increase in average hours of sport/exercise, improvements in confidence to exercise independently and within group settings, as well as achievement of individualised goals. The success of the program was in part due to the co-facilitation between peer support workers and exercise physiologists, community connection and the established partnership between the public health service and the local government council. Results offer evidence to adopt and implement accessible and low-cost exercise opportunities in the community external to health services to address barriers of attendance for PLWSMI. [ABSTRACT FROM AUTHOR]

Background: Severe mental illness results in an enormous social and economic burden on affected individuals, their families, and communities, especially in developing countries, such as Ethiopia. Objective: The aim of this study was to assess the level of depression among caregivers of patients with severe mental illness in Debre Tabor Town, Northwest Ethiopia in 2023. Methods: This institution-based explanatory mixed study was conducted at Debre Tabor Compressive Specialized Hospitals between September 30 to October 30, 2023. A systematic random sampling technique was used to select 260 study participants, and a public health questionnaire was used to assess depression. Epicollect5 was used to collect data, which were then exported to the SPSS-25 for analysis. Variables with a p -value <0.25 were considered candidates for the multivariate logistic regression analysis. The odds ratios with a 95% confidence interval were used to determine the strength of the association. An in-depth interview was conducted with 11 participants, selected using purposive sampling. Results: The prevalence of depression was 31.3% (95% CI = 29.7–38.6). The multivariate analysis showed that being female (AOD = 2.43, CI = 1.42–7.23), divorced/widowed (AOD = 1.8, CI = 1.32–6.34), poor social support (AOD = 2.2, CI = 1.9–5.87), and perceived stigma (AOD = 2.33, CI = 0.24–13.22) were positively associated with depression. The qualitative results suggest that being female, illiterate, severity of the illness, poor social support, and stigma were factors for depression. Conclusions and recommendations: The prevalence of depression was high among caregivers of patients with severe mental illness. Female sex, being divorced or widowed, being illiterate, poor social support, and perceived stigma were the contributing factors. This implies that a greater focus on caregivers and the government increases mental health literacy and mental health community services. [ABSTRACT FROM AUTHOR]

Studies have shown a high prevalence of trauma and PTSD among patients with severe mental illness, but relatively few studies have examined the outcomes of PTSD treatment for this patient group. The aim of this case-series was to assess the feasibility of a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) intervention for PTSD in people with psychosis. The study examined the possibilities and obstacles when treating this population within clinical settings. Patients were selected from four community mental health centers and were screened for traumatic experiences and symptoms of PTSD. A small group of eligible participants (n=7) received manualized TF-CBT adapted for patients with psychosis. Experienced therapists received training and supervision in the intervention. Symptoms of PTSD and psychosis were assessed at baseline and post-treatment along with quality of life, level of functioning, alliance, life events, engagement, suicidal ideation and adverse events. Treatment fidelity and the different combinations of treatment modules were monitored in regard to implementation. Three cases were selected as illustrative of the different treatment courses when implementing the TF-CBT intervention within this population. Detailed case descriptions were based on quantitative ratings and the therapists' experiences with the therapy. Results from the case series highlighted issues regarding toleration of treatment, large variation in psychopathology and the task of matching treatment needs with appropriate therapeutic techniques. The complexity of the patient group may affect treatment and clinical research studies. Lessons learned from this case series can contribute to the future development implementation and evaluation of trauma treatment for patients with psychosis. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aim Method Results Discussion Implications for Practice A crucial long‐term care resource for individuals with severe mental illness (SMI) in Taiwan is provided by psychiatric nursing homes. Given the higher incidence of physical illnesses and accidents among individuals with SMI, ensuring patient safety is an important aspect of quality care. However, there is limited literature exploring how the staff provides safe care for individuals with SMI.Investigates how the staff in a psychiatric nursing home managed residents' activities to mitigate risks and reduce physical injuries.Using a qualitative approach and drawing from Foucault's concept of ‘disciplinary power’, data were collected from field observations and staff interviews.Three themes emerged: (1) a gaze for efficiency, where checklists, timetables and spatial arrangements were used to efficiently manage residents' bodies; (2) controlling the deviant body, which entailed procedures to monitor and prevent risk behaviours and bodily signs through broad safety measures and (3) your body, my business, which described the reduced autonomy of residents over their behaviours as the responsibility largely shifted to the staff.The predominant risk management framework, driven by safety considerations, comprises residents' autonomy and undermines compassionate caring.Risk management should actively involve both staff and residents in decision‐making. [ABSTRACT FROM AUTHOR]

About 40 years after the reforms leading to the closure of psychiatric hospitals (Ospedale Psichiatrico [OP]) in Italy in favor of a widespread model with a strong rehabilitation emphasis, Italy has chosen to close High Security Hospitals as well (Ospedale Psichiatrico Giudiziario [OPG]). The new forensic treatment model is expected to be more respectful of the person, including the perpetrators of violent crimes, and aims to be less stigmatizing and more rehabilitative. Despite the favorable premises of the reform (Law n. 81/2014), Italian psychiatrists are now obliged to answer calls to give evidence on strictly legal issues such as the social dangerousness of the mentally ill offender drawing on evidence or paradigms that many believe do not belong to medical knowledge. Psychiatrists must now learn to communicate about the relationship between psychiatry and society as required by law. This public expression engages with the cultural climate of society. Otherwise, the risk is of increasing the level of complexity leading to real misunderstandings that paradoxically may feed the stigma. The Italian reform provides an opportunity for reflection on some issues concerning psychiatric action, on how the public perceives the mentally ill and their psychiatrists, on the relationship between psychiatry and the world of law, on clinical methodologies for structured professional judgment, on public communication regarding severe mental illness, and the risk that psychiatrists may inadvertently be blamed for conveying an unwelcome message about mental illness and social dangerousness—we have called this social sensitivity against psychiatrists "hermanoia," blaming the messenger. The authors do not provide certain solutions but propose good practices. [ABSTRACT FROM AUTHOR]

Background: Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams. Methods: Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment. Results: After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team's fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start. Conclusions: ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Aim Method Results Implications for Practice Conclusion Somatic comorbidity is the main cause of reduced life expectancy in patients with substance use disorders (SUDs).This study aims to investigate somatic health challenges in patients with SUDs using the USS. Patient self‐management of somatic health and quality of life were also assessed.In our study, a stratified random sample of 136 clients who received treatment at a specialist addiction facility was drawn to investigate their physical health and lifestyle behaviours using the Utrecht Somatic Screening 2.0 (USS 2.0). The sample included three subgroups, that is, patients receiving outpatient treatment through Flexible Assertive Community Treatment (FACT), Heroin‐Assisted Treatment (HAT) and Opioid Replacement Therapy (ORT). Pain, self‐management and quality of life were also measured. Descriptive statistics were used to analyse the data.The findings indicate that many patients experience a large number of somatic health problems, including pain and exhaustion. The most prevalent conditions in this study are cardiovascular disease (25%) and COPD (20%), underweight and poor oral health. Tobacco smoking is prevalent among 88% of patients. Fifty percent of the patients expressed a need for support in managing their physical health.Somatic health care and lifestyle promotion should be tailored to the specific characteristics of patients.Patients with SUDs suffer from poor physical health and show unhealthy lifestyle behaviours, which demand the promotion of tailored somatic health. [ABSTRACT FROM AUTHOR]

Background: Meaning in Life (MiL) represents a key variable in mental health models of personal recovery. There is a need for straightforward and concise instruments to assess this construct quantitatively in individuals diagnosed with severe mental illness (SMI). Objective: The aim of the present study was to test the psychometric properties of the Purpose in Life Test-Short Form (PIL-SF), a brief self-report measuring the presence of MiL, in a sample of individuals with SMI. Methods: The participants were 41 adults (21 women, 51.8% and 20 men, 48.2%) aged 18 to 65 years (M = 50.05; SD = 10.73) with a diagnosis of SMI (schizophrenia, 61%; bipolar disorder, 26.8%; borderline personality disorder, 7.3%; and major depression, 4.9%) and clinically stable. The PIL-SF, Satisfaction with Life Scale (SWLS), Oxford Happiness Questionnaire—6 Item (OHQ-6), Engagement in Meaningful Activities Survey (EMAS), and Seeking of Noetic Goals—8 Item (SONG-8) were used. Descriptive analysis, estimation of the internal consistency, and Confirmatory Factor Analysis of the PIL-SF were conducted. Furthermore, correlations between the PIL-SF, SWLS, OHQ-6, EMAS, and SONG-8 were calculated. Results: The PIL-SF showed acceptable internal consistency (ω = 0.81) and an excellent fit as a unidimensional scale (CFI = 1.000, TLI = 1.070, RMSEA = 0.000, SRMR = 0.021), confirming its factorial structure. Regarding construct validity, correlations between the PIL-SF and the SWLS (ρ = 0.54, p < 0.001), the OHQ-6 (ρ = 0.52, p < 0.001), and EMAS (ρ = 0.44, p < 0.005) were positive and significant, whereas the correlations between the PIL-SF and the SONG-8NfM (ρ = −0.35, p < 0.025) were negative and significant. Conclusions: The Spanish version of the PIL-SF appears to be a reliable and valid instrument to measure the presence of MiL in adults with SMI. [ABSTRACT FROM AUTHOR]

Aim: To explore the distributed impact of severe mental health conditions (SMHCs) among people with lived experience of SMHCs, their family members, and community members. Methods: We conducted in-depth interviews with family key informants of people with SMHCs (n = 32), people with SMHCs (schizophrenia, bipolar disorder, and major depression) (n = 10), and community members (n = 6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMHCs. Interviews were conducted in Amharic and were audiotaped. We conducted a thematic analysis. Results: We identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat. Family members reported stress and hopelessness; some also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed, leading to unmet expectations: being left alone to care for children, unable to go to school or dropping out early. The study participants with SMHCs also spoke about the impacts of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which sometimes led to selling assets, debt, unemployment, forced migration, and food insecurity. Community members emphasised the economic burden and danger related to the aggressive behavior of the person with SMHCs, while the person with the illness and their family members blamed the community for the stigma and discrimination they experienced. Conclusion: SMHCs have profound consequences for the person with the illness, their family members, and the community. Future interventions for SMHCs should consider household-level interventions to address economic and care needs and mitigate the intergenerational impact. The community should be considered as a resource as well as a target for intervention. [ABSTRACT FROM AUTHOR]

Background: There is wide variation in premature mortality rates in adults with severe mental illness (SMI) across London, with Tower Hamlets (a highly deprived and ethnically diverse area) scoring the highest. Objective: To identify examples of best practice and co‐design recommendations for improving physical health checks and follow‐up care amongst people with SMI in Tower Hamlets. Methods: Data were collected through online questionnaires (using SMI physical health best practice checklists), one‐on‐one interviews (n = 7) and focus groups (n = 3) with general practices, secondary mental health services, commissioners and leads of community services and public health programmes, experts by experience and community, voluntary and social enterprise organisations in Tower Hamlets. Data were analysed using deductive and inductive thematic analysis. Results: Twenty‐two participants representing 15 general practices (out of 32), secondary mental health services, commissioners and public health leads completed the online questionnaires. Twenty‐one participants took part in interviews and focus groups. Examples of best practice included cleaning and validating the SMI register regularly by general practices, knowing the number of patients who had been offered and/or received physical health checks, having clear pathways to community and specialist care services, using various communication methods and having a key performance indicator (KPI) for tailored smoking cessation services for people with SMI. Recommendations included adopting evidence‐informed frameworks for risk stratification and utilising the wider primary care workforce with specific training to follow up on results, offer interventions and support navigating pathways and taking up follow‐up care. Incentivising schemes were needed to deliver additional physical health check components such as oral health, cancer screening, Covid‐19 vaccination and sexual health checks. Including KPIs in other community services' specifications with reference to SMI people was warranted. Further engagement with experts by experience and staff training were needed. Conclusion: The present initiative identified best practice examples and co‐designed recommendations for improving physical health checks and follow‐up care in deprived and ethnically diverse people with SMI. Patient or Public Contribution: This initiative was supported by three experts with experience, and two community organisations, who were involved in data curation and interpretation, development of recommendations and/or dissemination activities including writing this manuscript. [ABSTRACT FROM AUTHOR]

Aim: To test the feasibility of a participatory design intervention aimed at reducing the risk of cardio-vascular disease among patients suffering from alcohol use disorder (AUD) or severe mental illness (SMI). Methods: The intervention was developed by patients from the Community Mental Health Center and the Alcohol Treatment Facility in Odense, Denmark, and consisted of eight modules (health interviews, screening and treatment, introduction, diet/alcohol, physical activity, smoking, health app, and sleep problems). The intervention was tested using pre- and post-measurements of selected variables, patients' intervention attendance, and interviews and dialogue workshops at the end of the study. Results: A total of 21 out of 42 eligible patients from the Alcohol Treatment Facility and two out of 443 eligible patients from the Community Mental Health Center accepted participation in the study. The two patients from the Community Mental Health Center were not included in the analyses due to General Data Protection Regulation (GDPR). All patients accepted being screened for risk factors at inclusion, and the majority enrolled in at least one of the subsequent modules. The study indicated that the patients followed recommendations from their GPs. Conclusions: There is a great need for focus on cardio-vascular disease in patients with SMI and those with AUD. Results indicate that the intervention is feasible for patients with AUD, but due to inclusion of too few patients with SMI, nothing can be concluded for this patient group. Patients and staff in the Alcohol Treatment Facility agreed that the intervention has future perspectives. [ABSTRACT FROM AUTHOR]

Individuals with severe mental illness and substance use disorders face complex barriers to achieving physical health. This study aims to explore the barriers and facilitators of primary care access among an Assertive Community Treatment (ACT) team. Semi-structured qualitative interviews were conducted with 14 clients and 7 clinicians from an ACT team at a community mental health center in Connecticut. Data analysis followed a grounded theory approach, with codes and themes emerging iteratively during the interview process. The study identified multifaceted barriers to accessing primary care, including economic challenges, homelessness, and the prioritization of mental health and substance use symptoms over healthcare. The conceptual framework consists of nine dominant themes: clients' attitudes, knowledge, mental health, and motivations ("Client-Level Barriers and Facilitators"); ACT team-directed care coordination and relationship-building as well as primary care provider communication ("Provider-Level Barriers and Facilitators"); and clients' experiences with medical care and socioeconomic status ("Systemic-Level Barriers and Facilitators"). This research provides valuable insights into the various barriers faced by ACT clients in accessing primary care. Improving primary care access for individuals with severe mental illness and substance use disorders is crucial for reducing health disparities in this vulnerable population. [ABSTRACT FROM AUTHOR]

Racial disparities in diagnosis, treatment, and outcome have been well-established for people with schizophrenia. While cognitive remediation treatments have been shown to produce mild to moderate improvements in cognition for people with schizophrenia, few studies have examined racial/ethnic differences in treatment response. This study employed a secondary analysis of data from two randomized, single-blind controlled trials (N = 119) investigating the efficacy of two forms of cognitive training, to explore potential racial/ethnic differences in targeted outcomes. Given the extant literature, we predicted that racial/ethnic minorities would (1) drop out of the study at higher rates, (2) display greater levels of functional and cognitive impairment prior to treatment, and (3) display lower levels of improvement in cognitive and functioning outcomes following treatment. Our study revealed largely negative findings: white vs. non-white groups showed similar treatment drop-out rates, similar levels of cognitive impairment and symptom severity at study baseline and showed similar responses to cognitive training, with the exception of working memory in which participants' racial/ethnic minority status predicted significantly greater improvement in response to cognitive training. These findings suggest that cognitive remediation treatments are effective at addressing cognitive deficits in racial/ethnic minorities and supports cognitive remediation as a treatment which may help address racial/ethnic disparities in cognition. Given the scant research literature, future analyses should look at race as a potential mediator of treatment in a variety of evidence-based psychosocial treatments. [ABSTRACT FROM AUTHOR]

Objective: The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment. Methods: Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used. Results: Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies. Conclusions: A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance. [ABSTRACT FROM AUTHOR]

Objective: Weight gain can harm health and be socially stigmatizing. We sought to determine whether weight gain during the inpatient stay, as collateral damage related to lockdown, was more in patients admitted during the lockdown in the first pandemic year than in those admitted during the same period in the immediately preceding year. To our knowledge, this has not been previously investigated. Methods: We extracted from medical record weight data during two similar 4-month periods (April–July) in 2019 and 2020. We examined the impact of the ward restrictions during the pandemic lockdown on weight gain using multivariable regression analysis, adjusting for potential confounding variables selected a priori : age, sex, baseline weight, metabolic syndrome or antipsychotic load, and duration of inpatient stay. Results: There were 59 patients, almost all with schizophrenia spectrum disorders. Patients admitted in 2019 (n = 27) were significantly more likely to consume alcohol or use illicit substances, but otherwise did not differ much from those admitted in 2020 (n = 32). Weight gain during inpatient stay was not statistically significant for 2019 (+1.85 kg; P = 0.22), 2020 (+0.74 kg; P = 0.26), or for the 2 years combined (+1.25 kg; P = 0.10). Finally, weight gain during inpatient stay did not differ between 2019 and 2020 (P = 0.83). In the regression analysis, the year of admission was not significantly associated with change in weight during inpatient stay (beta, −0.11; P = 0.43). Conclusions: Our findings validate our ward strategies to reduce the risk of weight gain during lockdown in inpatients with severe mental illness. [ABSTRACT FROM AUTHOR]

Abstract Background Health institutions advocate for psychosocial and recovery-oriented interventions alongside pharmacological treatment for severe mental illness. Participatory arts interventions appear promising in promoting personal recovery by fostering connectedness, hope, renegotiation of identity, meaning-making, and empowerment. Despite encouraging findings, however, the evidence base remains thin. Further, results from cognitive literature studies suggest possible impact on parameters of clinical recovery, but this has not been studied in clinical contexts. We developed REWRITALIZE, a structured, recovery-oriented, fifteen-session creative writing group intervention led by a professional author alongside a mental health professional. Participants engage with literary forms, write on them, share their texts, and partake in reflective discussions within a supportive, non-stigmatising environment, designed to promote self-expression, playful experimentation, agency, recognition, participatory meaning-making, renegotiation of identity and social engagement. The aim of this project is to evaluate REWRITALIZE for persons with severe mental illness through a randomised controlled trial (RCT) focusing on personal recovery outcomes. Additionally, an embedded pilot RCT will explore additional outcomes i.e., clinical recovery for a subgroup with schizophrenia spectrum disorders. Methods The RCT is an investigator-initiated, randomised, two-arm, assessor-blinded, multi-center, waiting-list superiority trial involving 300 participants (age > 18) from six psychiatric centers in regions Capital and Zealand in Denmark, randomised to receive either the creative writing intervention combined with standard treatment or standard treatment alone. Assessments will be conducted before and after the intervention and at six months post intervention. The primary outcome is personal recovery at the end of intervention measured with the questionnaire of the process of recovery. Secondary outcomes include other measures of personal recovery, self-efficacy, mentalising, and quality of life. The pilot RCT, integrated within the RCT, will focus on 70 of the participants aged 18–35 with schizophrenia spectrum disorders, evaluating exploratory measures related to perspective-taking, social cognition, cognitive function, psychosocial functioning, and symptom pressure. Discussion This is the first RCT for creative writing groups. It assesses whether REWRITALIZE, as adjunct to standard mental healthcare, is more effective for personal recovery than standard care. If successful, it would provide evidence for the efficacy of REWRITALIZE, potentially enabling its implementation across mental health centers in Denmark. Trial registration Privacy (data protection agency): p-2023–14655. Danish National Center for Ethics: 2313949. Clinicaltrials.gov: NCT06251908. Registration date 02.02.2024.

Objective: Weight gain can harm health and be socially stigmatizing. We sought to determine whether weight gain during the inpatient stay, as collateral damage related to lockdown, was more in patients admitted during the lockdown in the first pandemic year than in those admitted during the same period in the immediately preceding year. To our knowledge, this has not been previously investigated. Methods: We extracted from medical record weight data during two similar 4-month periods (April–July) in 2019 and 2020. We examined the impact of the ward restrictions during the pandemic lockdown on weight gain using multivariable regression analysis, adjusting for potential confounding variables selected a priori: age, sex, baseline weight, metabolic syndrome or antipsychotic load, and duration of inpatient stay. Results: There were 59 patients, almost all with schizophrenia spectrum disorders. Patients admitted in 2019 (n = 27) were significantly more likely to consume alcohol or use illicit substances, but otherwise did not differ much from those admitted in 2020 (n = 32). Weight gain during inpatient stay was not statistically significant for 2019 (+1.85 kg; P = 0.22), 2020 (+0.74 kg; P = 0.26), or for the 2 years combined (+1.25 kg; P = 0.10). Finally, weight gain during inpatient stay did not differ between 2019 and 2020 (P = 0.83). In the regression analysis, the year of admission was not significantly associated with change in weight during inpatient stay (beta, −0.11; P = 0.43). Conclusions: Our findings validate our ward strategies to reduce the risk of weight gain during lockdown in inpatients with severe mental illness.

Abstract High rates of cardiometabolic disease and poor physical health outcomes contribute to significant premature mortality in people living with severe mental illness (PLWSMI). Lifestyle interventions such as exercise are known to improve both physical and mental health outcomes, however the best way to deliver exercise programs for PLWSMI remains a challenge. This paper uses a pragmatic program evaluation of a co-delivered low-cost community-based exercise program implemented over a 6-month period. Of 46 referrals in the first half of 2023 to the SLHD Gym and Swim program, 13 gave consent to participate in standardised measures and qualitative interviews. Findings revealed an increase in average hours of sport/exercise, improvements in confidence to exercise independently and within group settings, as well as achievement of individualised goals. The success of the program was in part due to the co-facilitation between peer support workers and exercise physiologists, community connection and the established partnership between the public health service and the local government council. Results offer evidence to adopt and implement accessible and low-cost exercise opportunities in the community external to health services to address barriers of attendance for PLWSMI.

Abstract Background Recovery from severe mental illness, including psychosis has been described as a personal and unique process, but it rarely is a journey undertaken without profound influences of significant others (family, mental health professionals). Diverging perspectives between persons with severe mental illness, family and professionals are frequent during the recovery process, notably in psychotic disorders. We aimed to explore processes of collaboration during recovery, to inform recovery supporting practices. Methods Current qualitative study had a participatory design and was set within long-term mental healthcare for severe mental illness. We conducted semi-structured interviews and focus groups with persons with severe mental illness (most had a history of psychosis), family and professionals on their mutual contact during recovery. Using reflexive thematic analysis, we developed themes representing processes of collaboration during recovery. Results We described roles persons with severe mental illness, family and professionals attribute to each other in mutually influential terms of unconditional and meaningful contact (which takes time to establish) and problem-oriented aspects. Secondly, experienced differences over problem definition, “needing help” and consequently over the role parties attribute to one another, may result in negative interactions, in the area of having expectations; (not) informing; (not) having agency to change; experiencing (dis)agreement or struggle. Conclusions unconditional, meaningful contact and knowing each other’s perspective are important to fruitful interaction in a triad when perspectives on mental health problems diverge. Relationally centered and process oriented care with continuity of family and professionals involved are needed to advance recovery in severe mental illness, especially psychosis.

Abstract Background People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. Methods In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group’s needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one’s daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). Discussion This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. Trial registration : ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Abstract Background Assertive Community Treatment (ACT) teams have become a part of mental health services for people with severe mental illness in many high-income countries. Studies in several countries have investigated the outcomes of ACT, and knowledge is also needed about outcomes of ACT teams in Norway. Our aims were to study clinical outcomes of ACT, how the outcomes were associated with characteristics of patients and treatment, and whether they differed across ACT teams. Methods Our explorative, prospective, pre–post multicenter study involved 142 patients who received ACT for two years from the first 12 ACT teams established in urban and rural areas of Norway. There was no control group. The primary outcome was change in clinician-rated psychiatric symptoms. Secondary outcomes were clinician-rated change in functioning and engagement and change in community tenure compared with 2 years prior to ACT. We measured fidelity to the ACT model using the Tool for Measurement of Assertive Community Treatment. We performed linear mixed-effects modeling to analyze outcomes and their associations with characteristics of patients and treatment. Results After two years, psychiatric symptoms were significantly reduced with a small effect size. Negative symptoms, anxiety and depression, and agitation and mania had significant reductions, while positive symptoms had nonsignificant changes. Functioning, engagement, and community tenure all significantly increased with small effect sizes. Age, difficulty to engage, problematic use of alcohol, frequent previous use of inpatient services, total number of sessions, and team’s fidelity to the ACT model were associated with different groups of symptoms. Less improvement in functioning was associated with team fidelity and number of sessions. Change in engagement was not associated with any predictors. Increased community tenure was greater for younger patients and patients who were on community treatment orders at treatment start. Conclusions ACT for two years led to significant positive outcomes with small effect sizes for psychiatric symptoms, functioning, engagement, and community tenure. The outcomes were associated with some potential predictors, and some team-level variance emerged. Positive significant outcomes after two years indicate that larger improvements may be achieved from longer-term treatments by ACT teams.

Abstract Background Participation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the “International Classification of Functioning, Disability and Health (ICF)” framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings. Methods The PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures. Results The final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect. Conclusion The development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning. Trial registration The study Implementation of Guidelines for the Treatment of Psychoses was registered retrospectively on 31 August 2017 at ClinicalTrials.gov (NCT03271242).

Abstract Aim To explore the distributed impact of severe mental health conditions (SMHCs) among people with lived experience of SMHCs, their family members, and community members. Methods We conducted in-depth interviews with family key informants of people with SMHCs (n = 32), people with SMHCs (schizophrenia, bipolar disorder, and major depression) (n = 10), and community members (n = 6) in rural Ethiopia. The study was nested within a long-standing population-based cohort of people with SMHCs. Interviews were conducted in Amharic and were audiotaped. We conducted a thematic analysis. Results We identified four themes: stress and physical tolls, lost expectations, social disruption, and economic threat. Family members reported stress and hopelessness; some also tried to harm themselves. Family members reported that their relationships with each other and with the wider community were disrupted significantly. Spouses and children did not get the support they needed, leading to unmet expectations: being left alone to care for children, unable to go to school or dropping out early. The study participants with SMHCs also spoke about the impacts of their illness on other family members and the community which appeared to be a source of shame and self-isolation. Both the family and the community respondents reported the economic effect of the illness which sometimes led to selling assets, debt, unemployment, forced migration, and food insecurity. Community members emphasised the economic burden and danger related to the aggressive behavior of the person with SMHCs, while the person with the illness and their family members blamed the community for the stigma and discrimination they experienced. Conclusion SMHCs have profound consequences for the person with the illness, their family members, and the community. Future interventions for SMHCs should consider household-level interventions to address economic and care needs and mitigate the intergenerational impact. The community should be considered as a resource as well as a target for intervention.

Abstract Background Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants’ social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI. Methods Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants’ social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10). Results Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources. Conclusions Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants’ recovery journey.

Abstract Background Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users. Methods A cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis. Results The four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1–0.5), Guangzhou (B = 0.2; 95%CI: 0.1–0.3), and Shenzhen (B = 0.3; 95%CI: 0.1–0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5). Conclusions There have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients’ utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

Aims and method Research regarding quitting cannabis use often excludes patients with severe mental illness (SMI). We investigated facilitating and impeding factors in SMI patients and their advice to others, using semi-structured interviews with 12 SMI-patients, who were daily cannabis users for ≥12 months and had fully stopped using for ≥6 months. Results Seeking distraction, social contacts in personal environment, avoiding temptation and support from professionals were facilitating factors in stopping. Impeding factors were withdrawal symptoms, user environment, experiencing stress and user's routine. Advice to other patients included to just do it, seek support from others, quit ‘cold turkey’ and acknowledge that cannabis use is a problem. Advice to mental health professionals is to discuss cannabis use from the start of treatment. Clinical implications It is important to inform patients that cannabis use has negative consequences and limits the effects of treatment. Do not judge cannabis use or force the patient to stop.

AbstractThe landscape of mental health care in the community in England is changing in response to the Mental Health Community Transformation (NHS England 2019). An increased number of people with severe mental illness will be seen solely in primary care. Currently little is known about how people with severe mental illness are supported in primary care and the preparedness of primary care teams to respond to these changes. This article will highlight key literature on severe mental illness in primary care and areas for future research. [ABSTRACT FROM AUTHOR]

AbstractIn this paper, the author examines the role that psychotherapy documentation plays in community mental health: documentation’s bureaucratic/administrative functions, its foundation in the science of psychiatry, and the impact it has on the clinical situation. His critique of documentation language uses ideas drawn from Samuel Beckett’s 1951 novel Molloy, which deals with the weakness and absurdity of language as a means to express what is often unnamable. Likewise, he draws on Hanna Segal’s idea of symbol formation to offer a psychodynamic explanation for the way language is employed in documenting treatment in community settings, especially the treatment of those with severe mental illness. The author argues that the essence of psychotherapy and what it addresses cannot be captured by the style of documentation imposed on medical/agency settings. He uses his own personal story and a case study to show how the documentation requirements became a source of distress and negatively impacted the treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Severe mental illnesses (SMIs) represent a significant public health challenge with substantial personal, economic and societal burdens. Despite treatment advances, recovery outcomes for SMI patients remain variable. This study aimed to investigate the influence of personal and psychosocial factors on recovery among SMI patients in community health settings. This cross‐sectional study was conducted in 23 community health service centres in Nanjing, China. We recruited 924 participants diagnosed with SMIs, using a random sampling method. The relationships between individual, psychosocial factors and patients' recovery status were analysed by multiple linear regression. The mediation effect of medication adherence was further tested by the Sobel test with bootstrapping. The mean score of the Morningside Rehabilitation Status Scale (MRSS) of 924 patients with SMIs was 49.82 ± 41.52. The main influencing personal factors of recovery status were age, marital status, education, average annual income and duration of illness. Patients who were accepted by their families tended to have better recovery outcomes, while stigma and social impairment may hinder recovery. Medication adherence played a mediating role between psychosocial factors and recovery status. This study highlights the crucial role of psychosocial factors in the treatment and recovery of SMI patients. Furthermore, medication adherence emerged as a mediating factor. Implementing targeted interventions and policies addressing identified psychosocial barriers can offer promising avenues for improving recovery outcomes for SMI patients in community settings. [ABSTRACT FROM AUTHOR]

Introduction: Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT. Method: Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation. Results: Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge. Conclusions: This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices. [ABSTRACT FROM AUTHOR]

The MacArthur Admission Experience Survey was developed to evaluate perceived coercion in psychiatric inpatients and comprises of three subscales: “Perceived coercion”, “Negative pressures” and “Voice”. The present study aims to evaluate the psychometric properties of a Romanian language version of the AES (R-AES) and to identify predictors for higher perceived coercion. We developed the R-AES using a translation/back-translation procedure and administered it to 137 patients admitted to the “Profesor Doctor Alexandru Obregia” psychiatric hospital in Bucharest, Romania. Discriminatory power was evaluated by comparing the scores of voluntarily and involuntarily admitted patients. The R-AES showed satisfactory internal consistency (Crohnbach’s alpha = 0.92). Principal components analysis disclosed a three-factor solution explaining 69.1% of variance. Factor components roughly corresponded to the original subscales. Higher scores were associated with involuntary admission, objective coercive measures, younger age, frequent past hospitalisations, treatment non-compliance, psychosis, mania, greater disease severity, aggression, and presentation by police or ambulance. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England. Methods: This mixed‐methods cross‐sectional study took place between March and October 2022. Participants were adults with self‐reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis. Results: In total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18–75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p < 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071–19.924, p = 0.04). Conclusion: The prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population. [ABSTRACT FROM AUTHOR]

Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases and three Chinese databases to identify relevant studies from December 2020 to December 2023 to compare the risk of COVID-19-related outcomes for SMI patients to those without SMI after vaccination. Random effects meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CI). Subgroup analysis, sensitivity analysis, and publication bias analysis were conducted with R software 4.3.0. A total of 11 observational studies were included. Compared with controls, SMI patients were associated with a slightly increased risk of infection (pooled OR = 1.10, 95% CI, 1.03–1.17, I2 = 43.4%), while showing a 2-fold higher risk of hospitalization (pooled OR = 2.66, 95% CI, 1.13–6.22, I2 = 99.6%), even after both groups have received COVID-19 vaccines. Limited evidence suggests a higher mortality risk among SMI patients compared to controls post vaccination, but the findings did not reach statistical significance. SMI patients remain at increased risk compared to their peers in COVID-19-related outcomes even after vaccination. Vaccination appears an effective approach to prevent severe COVID-19 illness in SMI patients, and actions should be taken by healthcare providers to improve vaccination coverage in these vulnerable groups. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusion\nPRISMA/PROSPEROAssertive outreach (AO) is a systematic approach to engage vulnerable patients with serious mental illness.This review aims to provide a comprehensive analysis of engagement strategies in relation to principles of the AO model to clarify effective components of AO, better understand engagement in an AO context, and consider encompassing change mechanisms.A systematic mixed-methods review was completed from 1806 to December 2022 (no pre-registration). Articles meeting the inclusion criteria were rated for methodological quality using the JBI scales and thematic synthesis using a meta-aggregative approach. Reporting was according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.Eighteen articles met the inclusion criteria. The literature was defined by three main themes: definition and perspectives of engagement; key principles of AO in relation to engagement; and additional principles and strategies enhancing engagement.Despite the heterogeneity in defining engagement, the relationship between AO professionals and patients emerged as crucial in the process of engagement. Subsequently, the four key principles of AO emerged as central to promoting engagement. Finally, we identified a number of additional principles that are considered crucial in the engagement process in AO. The review concludes with recommendations for future research and the implementation of AO in routine clinical care.The reporting of this review is conducted following the PRISMA guidance and not registered at PROSPERO because completed reviews cannot be registered. [ABSTRACT FROM AUTHOR]

Aims and method Research regarding quitting cannabis use often excludes patients with severe mental illness (SMI). We investigated facilitating and impeding factors in SMI patients and their advice to others, using semi-structured interviews with 12 SMI-patients, who were daily cannabis users for ≥12 months and had fully stopped using for ≥6 months. Results Seeking distraction, social contacts in personal environment, avoiding temptation and support from professionals were facilitating factors in stopping. Impeding factors were withdrawal symptoms, user environment, experiencing stress and user's routine. Advice to other patients included to just do it, seek support from others, quit 'cold turkey' and acknowledge that cannabis use is a problem. Advice to mental health professionals is to discuss cannabis use from the start of treatment. Clinical implications It is important to inform patients that cannabis use has negative consequences and limits the effects of treatment. Do not judge cannabis use or force the patient to stop. [ABSTRACT FROM AUTHOR]

Background: Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population. Aims: We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group. Methods: We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564). Results: After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments. Conclusions: We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined whether social support contributes to better consequences among chronic patients with severe mental illnesses (SMI) in their community recovery stage and whether self-stigma would be a mechanism through which social support impacts psychiatric symptoms and personal and social functioning. Aims: This study aimed to examine prospective associations of social support with long-term self-stigma, psychiatric symptoms, and personal and social functioning, and to investigate whether self-stigma would mediate the associations of social support with psychiatric symptoms and personal and social functioning among patients with SMI. Methods: A total of 312 persons with SMI (schizophrenia and bipolar disorder) in their community recovery stage participated in the study. Social support, self-stigma, psychiatric symptoms, and personal and social functioning were evaluated at baseline. The follow-up assessment was conducted at 6 months with the baseline measures except for social support. Hierarchical linear regression and mediation analysis were performed. Results: The results showed that baseline social support predicted decreases in stigma (β = −.115, p =.029) and psychiatric symptoms (β = −.193, p <.001), and increases in personal and social functioning (β =.134, p =.008) over 6 months, after adjusting for relevant covariates. Stigma at 6 months partially mediated the association between baseline social support and 6-month psychiatric symptoms (indirect effect: β = −.043, CI [−0.074, −0.018]). Stigma and psychiatric symptoms at 6 months together mediated the association between baseline social support and 6-month personal and social functioning (indirect effect: β =.084, 95% CI [0.029, 0.143]). Conclusion: It is necessary to provide comprehensive social support services and stigma reduction interventions at the community level to improve the prognosis of SMI. [ABSTRACT FROM AUTHOR]

An increasing number of older people with severe mental illness (SMI) poses additional challenges to healthcare and social services. This scoping review aimed to investigate the life situation of older people living with severe mental illness and identify the research gaps in the existing literature. The current review followed the methodological framework for conducting scoping reviews by Arksey and O'Malley, consisting of five main stages: (1) identifying the research question (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising, and reporting the results. An optional sixth stage, a consultation exercise, has also been used in this study: The scoping review was conducted in accordance with the PRISMA extension for scoping reviews PRISMA‐ScR, and the databases PsychINFO Scopus, Cinahl, Web of Science and PubMed were used. A total of 24 studies were included in the review. The thematic analysis focused on: (1) the perspective of older people with SMI, (2) the perspective of healthcare professionals supporting older people with SMI, and (3) the perspective of informal carers supporting older people with SMI. The results describe the life situation of older people living with SMI, especially in relation to the older peoples' experiences of suffering and well‐being. The staff and the informal carers need adequate knowledge to provide support to the older people with SMI. To gain greater knowledge about the life situation and support needed by older people with SMI, we strongly advocate additional research focusing on their own experiences. [ABSTRACT FROM AUTHOR]

Locating specialized mental healthcare services in the neighborhood of people with severe mental illnesses (SMI) has been suggested as a way of improving treatment outcomes by increasing patient engagement and integration with the local care landscape. The current mixed methods study aimed to examine patient experience and treatment outcomes in three Flexible Assertive Community Treatment (FACT) teams that relocated to the neighborhood they served, compared to seven teams that continued to provide FACT as usual from a central office. Routine Outcome Measurement (ROM) and care use data were analyzed to compare change in treatment outcomes for patients in place-based FACT (n = 255) and FACT as usual (n = 833). Additionally, retrospective in-depth interviews were conducted with twenty patients about their experience with place-based FACT. Quantitative analysis showed mental health admission days decreased more in place-based than FACT as usual, although this difference was small. Both groups showed improved quality of life, psychosocial functioning, and symptomatic remission rates, and decreased unmet and overall needs for care. There was no change over time in met needs for care, employment, and daily activities. Qualitative analysis showed that patients experienced place-based FACT as more accessible, a better safety net, a more personal approach, better integrated with other forms of care, involving their social network, and embedded in their neighborhood and daily environment. This study showed that location and integration matter to patients, and the long term impact of place-based FACT on treatment outcomes should be explored. [ABSTRACT FROM AUTHOR]

Abdominal pain frequently leads to emergency department (ED) visits, with non-specific abdominal pain (NSAP) being a common diagnosis. Patients with severe mental illness (SMI) face higher risks due to atypical disease presentations and elevated comorbidity rates. Studies show that patients with both SMI and NSAP have increased ED revisit rates and delayed diagnoses. This study examines ED management, unscheduled ED revisit rates, and short-term adverse outcomes in patients with both SMI and NSAP using data from the Chang Gung Research Database from 01 January 2007, to 31 December 2017. Diagnoses were confirmed through the International Classification of Diseases (ICD) codes and medical records, with a 1:3 matching ratio for the non-SMI group using a Greedy algorithm. The outcomes assessed were ED management, 72-hour unscheduled ED revisits, and 7-day adverse events. From seven hospitals, 233,671 patients were initially included over 11 years; 98,722 were excluded, leaving 134,949 for analysis. The SMI group showed higher comorbidity rates, more frequent 72-hour unscheduled ED revisits, and greater use of analgesics but were less likely to receive laboratory tests or CT scans. Non-SMI patients were more likely to be admitted to the hospital and receive invasive procedures within 7 days after index discharge. There were no significant differences in intensive care unit (ICU) admissions, abdominal surgery, or inhospital mortality between the groups. This study indicates that while patients with SMI and NSAP have higher 72-hour ED revisit rates, they do not experience higher shortterm adverse outcomes. Although NSAP is generally safe for all patients, the higher unscheduled revisit rate highlights the need for tailored healthcare interventions to reduce health disparities in this vulnerable group. Future efforts should focus on strategies to improve healthcare for individuals with SMI and NSAP. [ABSTRACT FROM AUTHOR]

Background: Outcomes of bariatric surgery (BS) in patients with schizophrenia are poorly understood. We aimed to analyze the effects of BS in patients with schizophrenia (SZ) or schizoaffective disorder (SZA). Methods: This was a multicenter, retrospective case-control study in patients with SZ or SZA who had undergone BS in seven public referral hospitals in Spain. Controls without psychiatric comorbidity were selected in a 1:4 ratio. Detailed clinical and biochemical data were collected preoperatively and at 12, 24, 36, 48, and 60 months after BS. Results: Twenty patients with SZ (n = 15; 75%) or SZA (n = 5; 25%) and 80 matched controls were studied. There were no differences between patients and controls concerning the evolution of the percentage of total weight loss. The remission rate of the main comorbidities was similar between groups except for hypertension, which was lower in patients with a psychotic disorder from year 3. There were no mortalities within 30 days of surgery in either group. The psychiatric medication burden did not change during follow-up. Conclusions: BS is safe and effective in carefully selected patients with SZ. The course of the psychiatric disease does not seem to be worsened by the procedure. [ABSTRACT FROM AUTHOR]

Objective: Personal recovery refers to a person's pursuit of a full, meaningful life despite the potentially debilitating impact of a mental illness. An evidence base describing personal recovery among people at risk for developing a mental illness is lacking, limiting the potential for mental health services to support personal recovery. To address this gap, the authors synthesized the extant research describing personal recovery among people at risk for developing a mental illness. Methods: A systematic search of several literature databases (MEDLINE, Embase, APA PsycInfo, Web of Science Core Collection, and Cochrane Library) was conducted to retrieve qualitative and case studies and first-person accounts. The Joanna Briggs Institute guidelines for systematic reviews were followed. Included studies reported on participants at variable risk for developing a schizophrenia spectrum, bipolar, major depressive, or borderline personality disorder. Articles were retrieved through a librarian-assisted search and through use of additional strategies (e.g., expert consultation). Abstracts were screened by the research team, and themes were developed by using thematic synthesis. Results: The 36 included articles were synthesized, and six themes were generated: difficulties and challenges; establishing an understanding of, and finding ways to cope with, one's mental health challenges; reestablishing a sense of agency and personhood; receiving support from people and services, as well as restoring relationships; reestablishing hope, meaning, and purpose; and overcoming stigma and destigmatizing mental illness in others. Conclusions: These findings provide a conceptual foundation that can guide future research on personal recovery and clinical interventions that foster it among people at risk for mental illness. [ABSTRACT FROM AUTHOR]

Background Studies investigating parenthood and how it affects long-term outcomes are lacking among individuals with schizophrenia spectrum disorders. This study aimed to examine the life of participants 20 years after their first diagnosis with a special focus on parenthood, clinical illness course, and family-related outcomes. Methods Among 578 individuals diagnosed with first-episode schizophrenia spectrum disorder between 1998 and 2000, a sample of 174 participants was reassessed at the 20-year follow-up. We compared symptom severity, remission, clinical recovery, and global functioning between 75 parents and 99 non-parents. Also, family functioning scored on the family assessment device, and the children's mental health was reported. We collected longitudinal data on psychiatric admission, supported housing, and work status via the Danish registers. Results Participants with offspring had significantly lower psychotic (mean (s.d.) of 0.89 (1.46) v. 1.37 (1.44), p = 0.031) negative (mean [ s.d. ] of 1.13 [1.16] v. 1.91 [1.07], p < 0.001) and disorganized symptom scores (mean [ s.d. ] of 0.46 [0.80] v. 0.85 [0.95], p = 0.005) and more were in remission (59.5% v. 22.4%, p < 0.001) and in clinical recovery (29.7% v. 11.1%, p = 0.002) compared to non-parents. When investigating global functioning over 20 years, individuals becoming parents after their first diagnosis scored higher than individuals becoming parents before their first diagnosis and non-parents. Regarding family-related outcomes, 28.6% reported unhealthy family functioning, and 10% of the children experienced daily life difficulties. Conclusions Overall, parents have more favorable long-term outcomes than non-parents. Still, parents experience possible challenges regarding family functioning, and a minority of their children face difficulties in daily life. [ABSTRACT FROM AUTHOR]