Community-based Mental Health Center Research Articles

Suicide as slow death: Towards a haunted sociology of suicide

Sociological research on suicide has tended to favour functionalist approaches, and quantitative methods. This article argues for an alternative engagement – drawing on interpretive paradigms, and inspired by ‘live’ methodologies, we make an argument for a haunted sociology of suicide. This approach, informed by Avery Gordon’s haunted sociological imagination and Lauren Berlant’s concept of slow death, works between the structural realities of inequalities in suicide rates and the more (in)tangible affects of suicide as they are lived. These theoretical engagements are illustrated through an empirical study which used collaborative, arts-based discussion groups about suicide. The groups were held with 14 people, all affected in different ways by suicide, and attending a community-based mental health centre in a semi-rural location in Scotland, UK. A narrative-informed analysis of data generated through these groups shows the creative potential of both arts-based methodologies, and interpretive sociologies, in deepening understanding of how inequalities in rates of suicide may be experienced and made sense of. We illustrate this via two related metaphors (‘the point’ and ‘the edge’) which recurred in the data. Our analysis underlines the vital relevance of sociology to suicide studies – and the urgent need for diverse sociological engagement and action on this topic.

The moderating effect of cognitive function on the association between social support and depressive symptoms among community-dwelling older adults: Cross-sectional and longitudinal analyses

BackgroundThe moderating effect of cognitive function on the association between social support and late-life depressive symptoms has not been thoroughly investigated. Identifying cognitive function as a possible moderator of this association might help plan community-based interventions for late-life depressive symptoms. MethodsParticipants were community-dwelling older adults who visited a community-based mental health center. The ENRICHD Social Support Instrument and the Montgomery-Asberg Depression Rating Scale were used to evaluate social support and depressive symptoms, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Data from 1088 and 506 participants were included in the cross-sectional and longitudinal analyses, respectively. Multiple linear regression analysis was performed to assess the effects of social support on depressive symptoms and the possible moderating effect of cognition. ResultsAfter adjusting for possible confounders, greater social support at baseline was associated with fewer depressive symptoms in both cross-sectional (estimate = −0.25 standard error [SE] = 0.03, P < 0.001) and longitudinal analyses (estimate = −0.11, SE = 0.05, P = 0.014). Moreover, the association between social support and depressive symptoms was significantly moderated by cognitive function (P for interaction < 0.001 for cross-sectional analysis, and P for interaction = 0.011 for longitudinal analysis). LimitationsThe tool for assessing social support was self-reported. There may have been a selection bias in the study sample. ConclusionsGreater social support was associated with fewer late-life depressive symptoms in both analyses. However, social support may have less benefits for alleviating depressive symptoms in older adults with cognitive decline.

Factors influencing the successful connection of deliberate self-injury patients to community-based mental health centers.

The emergency department (ED) is a good place to start preventing actions for suicide attempters. As a preventive factor, early intervention, follow-up management, and connection with community-based mental health care are important. We aimed to determine which factors were important for a successful connection to community-based mental health care services. This study was conducted at two tertiary teaching hospitals from January 2018 to December 2020. There were 1016 deliberate self-harm patients who received the four weeks of follow-up intervention. There were 166 patients in the connected group and 850 patients in the non-connected group. In the logistic regression analysis for the successful connection to community-based mental health care, married patients had an odds ratio (OR) 1.627 (95% CI 0.960-2.758), 1.314 OR (95% CI 0.619-2.790) of separated patients and 5.317 OR (CI 1.864-15.168) of widowed patients compared to single patients. And face-to-face follow-up management had 2.630 OR (95% CI 1.815-3.811) to the successful connection rate to community-based mental healthcare compared to the patients in non-face-to-face management. When deliberately self-injured patients who visited the ED received short-term follow-up intervention after emergency treatment, face-to-face follow-up intervention had a higher connection rate to community-based mental healthcare centers than non-face-to-face follow-up intervention. In the future, for deliberate self-harm patients who visit the ED, the ED staff should manage deliberate self-harm through early detection and face-to-face follow-up intervention, and other methods that can compensate for face-to-face follow-up intervention.

The Health and Health Needs of People under Community Supervision

Americans under community supervision experience high rates of chronic disease, mental illness, and substance use disorders but have poor access to high-quality preventive care and treatment. Pervasive barriers to healthcare and health insurance reinforce poor health, as do restrictions to evidence-based addiction treatment. We propose that community supervision agencies transfer management of the health of supervised individuals to an expanded community-based healthcare system and that they abandon practices at odds with the science of addiction medicine (e.g. prohibitions on medications to treat addiction, and revocation of community release for addiction relapse). Further, we argue that correctional systems should prioritize health of those under supervision by standardizing health-related protocols, including basic needs resources in discharge planning, and leveraging the skills of individuals with lived experiences in the correctional system. If implemented, the success of our recommendations would require expansion of community-based primary care, mental health, and addiction treatment centers.

Dropout from evidence-based trauma treatment in a community mental health clinic serving victims of interpersonal violence.

Trauma-focused psychotherapies are increasingly offered in community-based mental health centers, but little is known about treatment dropout in these settings. The current study explored dropout at different stages of treatment in a treatment-seeking sample of 1,186 adults who experienced interpersonal violence and were offered trauma-focused and non-trauma-focused therapies. A total of 31.6% of participants dropped out before treatment initiation, 28.0% dropped out after treatment initiation and completed a mean of 4.02 (SD = 2.41) sessions, and 40.4% completed a full course of PTSD treatment. Being unemployed, p < .001, and scoring lower on measures of environment factors, p = .045, were significant predictors of pretreatment dropout. Being female, p < .001; Latinx, p = .032; and scoring higher on a measure of social relationships, p = .024, were independent predictors of postinitiation dropout. Individuals who completed nine sessions of treatment displayed significantly lower levels of posttraumatic stress disorder, depression, and anxiety symptoms. The present study provides preliminary evidence that survivors of interpersonal violence who seek therapy tend to drop out early during treatment, and most who complete treatment attain symptom reduction.

Adapting the multilevel model for estimation of the reliable change index (RCI) with multiple timepoints and multiple sources of error.

ObjectiveOne of the primary tools in the assessment of individual‐level patient outcomes is Jacobson and Truax, (1991’s) Reliable Change Index (RCI). Recent efforts to optimize the RCI have revolved around three issues: (a) extending the RCI beyond two timepoints, (b) estimating the RCI using scale scores from item response theory or factor analysis and (c) estimation of person‐ and time‐specific standard errors of measurement.MethodWe present an adaptation of a two‐stage procedure, a measurement error‐corrected multilevel model, as a tool for RCI estimation (with accompanying Statistical Analysis System syntax). Using DASS‐21 data from a community‐based mental health center (N = 379), we illustrate the potential for the model as unifying framework for simultaneously addressing all three limitations in modeling individual‐level RCI estimates.ResultsCompared to the optimal‐fitting RCI model (moderated nonlinear factor analysis scoring with measurement error correction), an RCI model that uses DASS‐21 total scores produced errors in RCI inferences in 50.8% of patients; this was largely driven by overestimation of the proportion of patients with statistically significant improvement.ConclusionEstimation of the RCI can now be enhanced by the use of latent variables, person‐ and time‐specific measurement errors, and multiple timepoints.

Evaluating the Performance of Community Mental Health Centers in Iran: Strengths and Challenges

Objectives: This study aims to evaluate the performance of Community-based Mental Health Centers (CMHCs) in Iran and identifying the strengths and challenges in the provision of mental health services. Methods: This is a qualitative study, conducted using 36 individual interviews and 13 focus group discussions. Content analysis was performed and data were categorized. The findings were presented in terms of the needs for program implementation, achieving the expected goals and outcomes, and the findings of program evaluation. First, the points related to the provision of infrastructure and setting up the centers were mentioned, and then, the features, strengths and challenges facing the program were discussed. Results: Significant successes were achieved in providing infrastructure and implementing the community-based mental health program. Challenges in the implementation of this program included the barriers to attracting more general physicians and the impact of culture and attitudes in each city on the effectiveness of the program. Conclusion: To improve the performance of CMHCs, more attention should be paid to psychiatry and mental health educational programs in the general medicine curriculum, public education about the mental health and providing solutions for better implementation of the program.

Community Mental Health Care in Serbia: Development and Perspectives.

Community mental health care was developed in Serbia in 1982 at the Belgrade Institute of mental health. Treatment was provided through the primary health care system, with each health centre having its own mental health care team. However, in the process of psychiatric reform and deinstitutionalization, dedicated community centres had to be established, in accordance with the National Strategy for the Development of Mental Health Care. The first community-based mental health centre opened in the southern area of Serbia in 2005 and subsequently, other centres were established. The centres are organized independently of psychiatric hospitals and are located in local, self-government units, providing psychosocial treatment and the continuation of mental health care. In relation to the ongoing reform of psychiatry in the country, there are positive and negative issues. There are 41.41 beds per 100,000 of the population in psychiatric hospitals and 18.33 beds per 100,000 of the population in the psychiatric departments of general hospitals. Day hospitals, established throughout the country, provide patients with good quality care. Mental health care professionals are educated to a high standard and integrative, person-centred treatment is applied in most services. However, the level of stigma directed towards those with mental illness is still high and constitutes a barrier to treatment. Well-developed screening and early detection programmes to identify persons requiring mental health care are lacking, as are the records of patients with mental disorders. The future goal is to further reduce the number of beds in psychiatric hospitals, establish new community mental health care services throughout the country and ensure the prevention of mental disorders, as well as mental health promotion.

Community Mental Health Care in Serbia: Development and Perspectives

Community mental health care was developed in Serbia in 1982 at the Belgrade Institute of mental health. Treatment was provided through the primary health care system, with each health centre having its own mental health care team. However, in the process of psychiatric reform and deinstitutionalization, dedicated community centres had to be established, in accordance with the National Strategy for the Development of Mental Health Care. The first community-based mental health centre opened in the southern area of Serbia in 2005 and subsequently, other centres were established. The centres are organized independently of psychiatric hospitals and are located in local, self-government units, providing psychosocial treatment and the continuation of mental health care. In relation to the ongoing reform of psychiatry in the country, there are positive and negative issues. There are 41.41 beds per 100,000 of the population in psychiatric hospitals and 18.33 beds per 100,000 of the population in the psychiatric departments of general hospitals. Day hospitals, established throughout the country, provide patients with good quality care. Mental health care professionals are educated to a high standard and integrative, person-centred treatment is applied in most services. However, the level of stigma directed towards those with mental illness is still high and constitutes a barrier to treatment. Well-developed screening and early detection programmes to identify persons requiring mental health care are lacking, as are the records of patients with mental disorders. The future goal is to further reduce the number of beds in psychiatric hospitals, establish new community mental health care services throughout the country and ensure the prevention of mental disorders, as well as mental health promotion.

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study

BackgroundThe integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs.MethodsThis study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case.ResultsThe health impacts are calculated in terms of healthy life years gained for 2020–2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018.ConclusionsMental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.

Optimization of community-based mental health services: a systematic review

PurposeThis paper aims to review the literature of community-based mental health services (CMHS) optimization in Malaysia that focus on the aspects of perceived challenges or barriers and facilitating factors for community-based mental health centre (CMHC).Design/methodology/approachRelevant peer-reviewed literature was identified and being reviewed in three databases and one local journal.FindingsNine studies were eligible for inclusion and the extracted data were summarized into a narrative review. The evidence provided for what constituting an optimal implementation of CMHS in Malaysia appeared lacking. However, there are adequate recommendations and suggestions on the component of facilitating factors; on how to increase service user’s engagement towards the improvement of mental health systems.Research limitations/implicationsResearch in the literature had focussed on the optimization aspects from the perspective of the service user. Additionally, this had been discussed through the lens of a variety of mental health systems and not specifically on the community-based perspectives.Originality/valueThis current systematic review provides valuable and important evidence that further explorations of the existing experiences of the mental health care professionals in delivering CMHS in Malaysia CMHC. The review serves as the foundation for future research to explain the local explanatory framework on what are the best practise models for local CMHS.

Effectiveness of Acceptance and Commitment Therapy for Patients with Psychosis Being Monitored at a Community Mental Health Center: A Six-Month Follow-up Study.

This study aimed to examine the long-term efficacy of a short-term acceptance and commitment therapy-based (ACT) group psychotherapy on patients with psychosis in a community mental health center (CMHC). A total of 6 group-based ACT sessions were applied to 16 people diagnosed with psychotic disorders who met the inclusion criteria. They were evaluated at the start of, end of, and 6 months after the therapy using the acceptance and action questionnaire, the psychotic symptom rating scales, and the quality-of-life scale. At the end of the 6 session group therapy and 6-month follow-up, a statistically significant decrease was found in patients' psychotic symptoms and experiential avoidance as well as a statistically significant increase in their quality of life (P < .001). According to the results, ACT can be said to be an effective method for managing psychotic symptoms, reducing experiential avoidance, and improving the quality of life in patients diagnosed with psychotic disorders in CMHCs.

An Exploration of Facilitators and Challenges to Young Adult Engagement in a Community-Based Program for Mental Health Promotion

Adolescence and young adulthood can be particularly daunting for those with mental health concerns. In one Canadian city, a community-based drop-in psychosocial mental health center (Center) was designed specifically for youth who self-identified as struggling with mental health issues. The purpose of this study was to identify the features of the program that promoted or discouraged engagement. Narrative inquiry was used to guide the project. One-on-one interviews were conducted with 10 Center users. Four major categories were identified: (a) Reasons for Coming: Motivated to Work on Goals; (b) Facilitators of Engagement and Beyond; (c) Challenges to Engagement; and (d) Benefits of Engaging: Finding My Way. These categories were further delineated into themes. All participants had experienced trauma, and the Center assisted them in their coping. The researchers believe that to aid recovery, agencies working with this population need to use trauma-informed and healing-centered engagement.

Doctor-Diagnosed Arthritis and Self-Reported Physical Health Function Among Middle-Aged and Older Adults With Serious Mental Illness

Arthritis is one of the most common chronic conditions in aging adults, with both physical and mental health issues and consequences. However, there is insufficient arthritis research among aging adults with serious mental illness (SMI). This study examined rates of doctor-diagnosed arthritis and its cross-sectional associations with self-reported physical health function among adults aged 50 years and older with SMI. Community-based mental health center participants (n = 176) reported clinical and sociodemographic data (e.g., physical health function, sex), whereas diagnostic information (i.e., arthritis, psychiatric, and medical diagnoses) was retrieved from medical records. Arthritis prevalence was high (43.8%) and had an independent, negative association with physical health function. Findings suggest that arthritis evaluations and intervention services need to be prioritized in middle-aged and older adults with SMI. Future research should focus on further testing arthritis self-management programs and other nonpharmacological psychosocial approaches for arthritis in aging adults with SMI.

Utilization of professional mental health services according to recognition rate of mental health centers

BackgroundDespite the positive effect of community-based mental health centers, the utilization of professional mental health services appears to be low. Therefore, we analyzed the relationship between regional recognition of mental health centers and utilization of professional mental health services. MethodsWe used data from the Community Health Survey (2014) and e-provincial indicators. Only those living in Seoul, who responded that they were either feeling a lot of stress or depression, were included in the study. Multiple logistic regression analysis using generalized estimating equations was performed to examine both individual- and regional-level variables associated with utilization of professional mental health services. ResultsAmong the 7338 participants who reported depression or stress, 646 (8.8%) had consulted a mental health professional for their symptoms. A higher recognition rate of mental health centers was associated with more utilization of professional mental health services (odds ratio [OR]=1.05, 95% confidence interval [CI]=1.03–1.07). ConclusionsAccessibility to professional mental health services could be improved depending on the general population's recognition and attitudes toward mental health centers. Therefore, health policy-makers need to plan appropriate strategies for changing the perception of mental health services and informing the public about both the benefits and functions of mental health centers.

Integrated Healthcare in a Community-Based Mental Health Center: A Longitudinal Study of Metabolic Risk Reduction

ABSTRACTPeople living with serious mental illness (SMI) are at increased risk for metabolically related disease. This study aimed to examine the impact of a collaborative care intervention that targeted metabolically related health risk in adults diagnosed with SMI in a community mental health center. Markers of physical health were collected from a sample of 169 adults served by a federally funded integrated healthcare project. At the six-month follow-up, significant decreases in weight, cholesterol, and cigarette use were found. These findings highlight the important role social work practitioners hold for improving the health status of persons living with SMI.

The effects of an Audio Visual Assisted Therapy Aid for Refractory auditory hallucinations (AVATAR therapy): study protocol for a randomised controlled trial.

BackgroundPsychological interventions which adopt an explicitly interpersonal approach are a recent development in the treatment of distressing voices. AVATAR therapy is one such approach which creates a direct dialogue between a voice-hearer and a computerised representation of their persecutory voice (the avatar) through which the person may be supported to gain a sense of greater power and control. The main objective of the trial is to test the clinical efficacy of this therapy to reduce the frequency and severity of auditory verbal hallucinations (AVH). Secondary objectives of the study are to explore explanatory mechanisms of action and potential moderators, to carry out a qualitative evaluation of participants’ experience and to conduct an economic evaluation.Methods/DesignThe AVATAR randomised clinical trial will independently randomise 142 participants to receive either 7 sessions of AVATAR therapy or supportive counselling (SC). The study population will be individuals with schizophrenia spectrum and other psychotic disorders who report hearing persistent distressing voices, for more than 12 months, which are unresponsive or only partially responsive to antipsychotic medication. The main hypotheses are that, compared to SC, AVATAR therapy will reduce the frequency and severity of AVH and will also reduce the reported omnipotence and malevolence of these voices. Assessments will occur at 0 weeks (baseline), 12 weeks (post-intervention) and 24 weeks (follow-up), and will be carried out by blinded assessors. Both interventions will be delivered in a community-based mental health centre. Therapy competence and adherence will be monitored in both groups. Statistical analysis will follow the intention-to-treat principle and data will be analysed using a mixed (random) effects model at each post treatment time point separately. A formal mediation and moderator analysis using contemporary causal inference methods will be conducted as a secondary analysis. The trial is funded by the Welcome Trust (WT).DiscussionAVATAR therapy showed promising effects in a pilot study, but the efficacy of the approach needs to be examined in a larger randomised clinical trial before wider dissemination and implementation in mental health services.Trial registrationCurrent Controlled Trials ISRCTN: 65314790, registration date: 27 March 2013.

Implementation and Evaluation of an Evidence-Based Treatment of Disruptive Behaviour within a Children's Mental Health Program

Abstract: This practice note details the synchronous implementation and developmental evaluation of a novel model of care that integrates an evidence-based treatment of children with disruptive behaviour within a community-based children's mental health centre in Canada. The overall objective of the project was to evaluate the impact and viability of the integrated program. A multidisciplinary team used a “knowledge to action” framework to guide implementation activities and a developmental evaluation approach to support learning and innovation, as well as measure program success. Key insights and lessons learned with regards to building staff capacity and appreciation for evaluation, balancing clinical and evaluation practices, and sustaining evaluation procedures are discussed. Suggestions for future similar efforts within a children's mental health context are provided.

Evaluation of a Youth with Sexual Behavior Problems (YSBP) Outpatient Treatment Program

Sexual behavior problems usually involve intimidation or force and can be harmful. Evidence-based practices for youth with sexual behavior problems (YSBP) are needed. This study involved a program evaluation at an urban community mental health program for YSBP which incorporated cognitive-behavioral therapy methods. Secondary data was collected from case files of 28 male youthful offenders, ages 11–17, from an urban community-based mental health center. Results suggest that there were significant improvements in youth psychosocial functioning and parenting stress, and significant decreases in parent–child dysfunctional interaction. However, there was no significant change in Sexual Interests, Attitudes, and Behaviors. Although there were several limitations to the evaluation, improvements in critical areas such as psychosocial functioning, parenting and parent–child relations are promising. Suggestions to improve the program are discussed along with future research that is needed.

Measuring Mental Health Recovery: An Application of Rasch Modeling to the Consumer Recovery Measure.

As the need for recovery-oriented outcomes increases, it is critical to understand how numeric recovery scores are developed. In the current article, the modern Rasch modeling techniques were applied to establish numeric scores of consumers’ perceptions of recovery. A sample of 1,973 adult consumers at a community-based mental health center (57.5% male; average age of 47 years old) completed the 15-item Consumer Recovery Measure. A confirmatory factor analysis revealed the unidimensional nature of the Consumer Recovery Measure and provided construct validity evidence. The Rasch analysis displayed that the items produced acceptable model fit, reliability, and identified the difficulty of the items. The conclusion emphasizes the value of Rasch modeling regarding the measurement of recovery and its relevance to consumer-derived assessments in the clinical decision-making process.