Community Mental Health Center Research Articles

Informal caregivers compared with users and health workers on well-being and respect for human rights in mental health care services.

This study aimed to measure differences among informal caregivers, users, and mental healthcare workers (MHW) regarding job/organizational satisfaction and perceptions of respect for rights in the mental health services of one region of Italy. A sample of 100 caregivers, 240 MHW, and 200 users completed the "Well-Being at Work and Respect for Human Rights Questionnaire" (WWRR) in community mental health centers in Sardinia. Caregivers reported higher satisfaction toward MHW on perceiving respect for human rights among users (5.2 ± 1.0 vs 5.1 ± 1.1, p < 0.0001) and health professionals (5.3 ± 0.8 vs 4.5 ± 1.3, p < 0.0001) and organization well-being (5.1 ± 1.2 vs 3.9 ± 1.3, p < 0.0001); toward users about respect of rights of MHW (5.3 ± 0.8 vs 4.9 ± 1.2, p < 0.0001) and both toward users and MHW on dissatisfaction on resources (p < 0.0001). Caregivers strongly highlighted insufficient resources for services. Despite caregiver satisfaction, resource deficiencies signal a critical juncture in Italian mental health care. Continued cuts in healthcare spending, especially in mental health, raise concerns for future outcomes.

An evaluation of the process of measuring outcomes of a cognitive stimulation therapy group

The evaluation took place in an NHS Older People’s Mental Health community service in the east of England. One intervention provided by these teams is a Cognitive Stimulation Therapy (CST) group, an evidence-based therapy for people with dementia. This evaluation was completed in the context of procedural changes following the Covid-19 pandemic. CST groups moved from face-to-face to online delivery, and there were changes in the clinical systems used across the service. These changes led to inconsistencies in how outcome measures were administered and how data was gathered and stored across the teams. The aim was to recommend improvements to the procedures for evaluating the CST groups, namely, the use of outcome measures. Data on processes was acquired from professionals and quantitative data was procured from the clinical records system. A literature review was carried out to summarise the most recent evidence on outcome measures used to evaluate the CST intervention. This resulted in descriptive data about the inconsistencies across teams in evaluating the CST group. Findings focused on descriptive data and recommendations were shared with the service about the most efficacious process and outcome measure to evaluate the CST group.

Conditionally Discharged Restricted Patients in a General Adult Community Mental Health Setting

AbstractLittle is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study, the authors evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures. Supervision in the community is time‐ and resource‐intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training and joint working opportunity with forensic services to ensure safe quality care.

Single case experiment evaluating the effectiveness of an adapted cognitive behavioural therapy intervention for an older adult with a fear of falling

Aim:A single case experiment was carried out for a 77-year-old woman who was referred to the older adult community mental health team for support with anxiety related to a fear of falling.Method:An AB design was implemented, using an adapted cognitive behavioural therapy graded exposure intervention to target her anxiety and fear of falling.Results:There was an overall reduction in the client’s anxiety and an increase in her activity levels.Conclusion:The adapted intervention resulted in decreased anxiety, psychological distress, and a fear of falling and an increase in the frequency of her walking.Consent:The client was provided with information about the purpose of the write up for this case study. She kindly provided informed written consent for the case study to be published within an academic journal. Some demographic details have been amended to protect her identity.

Exploring clinicians’ experience of using Behavioural Family Therapy within an older adult community mental health service

This service evaluation summarises the experience of staff offering Behavioural Family Therapy (BFT) in a community mental health setting for older people. Semi-structured interviews were conducted to gather staff views and a Template Analysis was used to summarise feedback. This evaluation indicates that BFT were seen as beneficial to Older Adults (OA) across a range of mental health problems and adaptations were needed to support this patient group and their families.

Phase-Based Care in Community Mental Health: A Cost-Effective Innovation Using Algorithms, Rating Scales and Treatment Teams for Depression Management.

This retrospective, observational report describes an innovative quality improvement process, Phase-based Care (PBC), that eliminated wait times and achieved positive clinical outcomes in a community mental health center's (CMHC) mood disorder clinic without adding staff. PBC accomplishes this by eliminating the ingrained cultural practice of routinely scheduling stable patients at rote intervals of 1-3months, regardless of clinical need or medical necessity. Based on four organizational transformations and using mathematical algorithms developed for this process, PBC re-allocates therapy and medical resources away from routinely scheduled appointments and front-loads those resources to patients in an acute phase of illness. To maintain wellness for patients in recovery, lower frequency and intensity approaches are used. This report describes the development of the PBC methodology focusing on the Rapid Recovery Clinic (RRC) comprised of 182 patients with a primary diagnosis of a mood disorder, the largest of the 14 PBC clinics created. Over an 18-month period, wait times were reduced from several months to less than one week and recovery rates, meaning no longer in an acute phase, were 63% and 78% at weeks 6 and 12, respectively for patients who engaged in the program.

Effective provider communication for personal agency in mental health recovery: A cross-sectional study on Japanese users' perspectives.

INTRODUCTION: Recovery-oriented practice in community-based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures. This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness. A cross-sectional study was conducted among community-dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self-management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery. Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision-making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency. In recovery-oriented practice, prioritizing users' emotional experiences during decision-making and supporting their self-determination in their unique recovery journeys is crucial. Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery-oriented practice.

Reducing disparities in behavioral health treatment in pediatric primary care: a randomized controlled trial comparing Partnering to Achieve School Success (PASS) to usual ADHD care for children ages 5 to 11 – study protocol

BackgroundIntegrating behavioral health services into pediatric primary care can improve access to care, especially for children marginalized by poverty and racial/ethnic minority status. In primary care, a common presenting concern is attention-deficit/hyperactivity disorder (ADHD). Services in primary care for marginalized children with ADHD typically include medication alone; therapy to improve skills and build relationships is less available. This study evaluates the effectiveness of a behavioral intervention offered through primary care for marginalized families coping with ADHD (Partnering to Achieve School Success, PASS) compared to treatment as usual (TAU).MethodThree hundred participants will be randomly assigned to PASS or TAU. Participants include children ages 5 to 11 who have ADHD and are from economically marginalized families. PASS is a personalized, enhanced behavioral intervention that includes evidence-based behavior therapy strategies and enhancements to promote family engagement, increase caregiver distress tolerance, and provide team-based care to improve academic and behavioral functioning. TAU includes services offered by primary care providers and referral for integrated behavioral health or community mental health services. Outcomes will be assessed at mid-treatment (8 weeks after baseline), post-treatment (16 weeks), and follow-up (32 weeks) using parent- and teacher-report measures of service use, child academic, behavioral, and social functioning, parenting practices, family empowerment, and team-based care. Mixed effects models will examine between-group differences at post-treatment and follow-up. Analyses will examine the mediating role of parenting practices, family empowerment, and team-based care. Subgroup analyses will examine differential effects of intervention by child clinical characteristics and socioeconomic factors.DiscussionThis study is unique in targeting a population of children with ADHD marginalized by low socioeconomic resources and examining an intervention designed to address the challenges of families coping with chronic stress related to poverty.Trial registrationThis study was registered on clinicaltrials.gov (NCT04082234) on September 5, 2019, prior to enrollment of the first participant. The current version of the protocol and IRB approval date is October 4, 2023. Results will be submitted to ClinicalTrials.gov no later than 30 days prior to the due date for the submission of the draft of the final research report to the Patient-Centered Outcomes Research Institute.

Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers

BackgroundResearch demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth.MethodsUsing survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training).ResultsWilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD.ConclusionsThese results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.

Epidemiological aspects of individuals with mental disorders in the referral system: the experience of a Community Mental Health Center in the northeast of Iran

BackgroundCommunity Mental Health Centers (CMHCs) offer affordable mental health services in a less stigmatized environment, in a domiciliary setting. This study aimed to shed light on the epidemiological factors of patients attending CMHCs of Mashhad, their referral status, and treatment.MethodsThis study was conducted over the medical records of patients seen by psychiatrists between January 2014 and December 2021 in Mashhad's CMHC, the northeast of Iran. A detailed questionnaire was used to extract data from medical records about the epidemiological characteristics, diagnosed mental illnesses, referral status, and how often they visited the psychiatrist. The association between epidemiological findings and patient referral (referral system or self-referral) as well as the association between epidemiological findings and the number of psychiatric revisits were examined using the Chi-square test.ResultsOut of 662 patients, 472 (71%) were female and 190 (29%) were male, with an average age of 29 years. Among the 475 adult patients, 367 (77.3%) were married, with the majority being homemakers (56.4%). Major Depression Disorder (MDD) (32%) and Generalized Anxiety Disorder (GAD) (18.3%) were the most prevalent mental health conditions among patients. The majority of patients (74.9%) were referred to the CMHC of Mashhad from Primary Healthcare centers (PHCs) and psychiatric hospitals. Furthermore, female gender and patients with lower level of education were associated with more referral through from referral system. Of note, 431 patients (65.1%) did not return for a second visit, the ratio of treatment dropout was higher for patients with lower education levels.ConclusionsReferral system should be more practical in Iran to enhance health services in CMHCs. It is recommended that PHCs undergo certain modifications to enhance the referral process for patients with mental health conditions, focusing on common mental disorders and individuals with low socioeconomic level.

The cycle of acceptance: mental health professionals’ experience of workplace violence in a UK community mental health team

PurposeViolence and aggression against mental health professionals is a global concern with well-documented consequences. In the UK, mental health care is increasingly delivered in the community, yet little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient settings. This study aimed to explore how mental health professionals in a UK community mental health team (CMHT) perceive, experience and cope with WPV.Design/methodology/approachFace-to-face semi-structured interviews were conducted with ten multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative phenomenological analysis.FindingsThree interconnected themes emerged. WPV was accepted as inevitable: participants carried on working despite its impact, and feeling unheard by management they gave up on change, perpetuating the perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and occupational health improved coping. Stigma and ideas of professional responsibility were barriers to access.Originality/valueTo mitigate against the negative consequences of WPV, CMHTs could offer peer support initiatives, improve communication and availability of organisational resources and involve staff in post-incident decision-making. Recommendations are made to shift the attitude of acceptance of WPV and encourage help-seeking.

Patterns of Mental Health Service Utilisation: A Population-Based Linkage of Over 17 Years of Health Administrative Records.

A cross-sectoral partnership was formed in 2021 in support of the recommendations in an audit on access to state-funded mental health services. In this first paper, we aimed to describe the demographic and service utilisation of adults with a mental health diagnosis in the Western Australian state-funded health system from 2005 to 2021. Inpatient, emergency department, specialised (ambulatory) community mental health service, and death records were linked in individuals aged ≥ 18 years with a mental health diagnosis in Western Australia. Altogether, 392,238 individuals with at least one mental health service contact between 1st January 2005 and 31st December 2021 were included for analysis. Females, Aboriginal and/or Torres Strait Islander people, and those who lived outside major cities or in the most disadvantaged areas were more likely to access state-funded mental health services. While the number of individuals who accessed community mental health services increased over time (from 28,769 in 2005 to 50,690 in 2021), the percentage increase relative to 2005 was notably greater for emergency department attendances (127% for emergency department; 76% for community; and 63% for inpatient). Conditions that contributed to the increase for emergency department were mainly alcohol disorder, reaction to severe stress and adjustment disorders, and anxiety disorders. Sex differences were observed between conditions. The pattern of access increased for emergency department and the community plus emergency department combination. This study confirmed that the patterns of access of state-funded mental health services have changed markedly over time and the potential drivers underlying these changes warrant further investigation.

Clinical decision-making before discharge in hospitalized persons with schizophrenia: a Spanish Delphi expert consensus.

The care of people with schizophrenia (PWS) is usually provided in an outpatient setting by community mental health teams. However, PWS frequently require inpatient treatment because of a wide array of clinical, personal and/or social situations. Unfortunately, to our knowledge, there are no guidelines available to help psychiatrists in the decision-making process on hospital discharge for PWS. The aim of this project was to develop an expert consensus on discharge criteria for PWS after their stay in an acute inpatient psychiatric unit. Using a modified Delphi method a group of 42 psychiatrists throughout Spain evaluated four areas of interest regarding this issue: clinical symptomatology, treatment-related factors, follow-up health care units after discharge, and physical health and monitoring. After two rounds, among the 64 statements, a consensus was reached for 59 (92.2%) statements. In three (17.7%) of the 17 statements on 'clinical symptomatology' and 2 (13.3%) of the 15 statements on 'follow-up health care units after discharge', a consensus was not reached; in contrast, a consensus was reached for all statements concerning 'treatment-related factors' and those concerning 'physical health and monitoring'. The consensus results highlight the importance for discharge of the control of symptoms rather than their suppression during admission and of tolerability in the selection of anantipsychotic. Although there is a lack of relevant data for guiding the discharge of PWS after hospitalization in an acute inpatient psychiatric unit, we expect that this consensus based on expert opinion may help clinicians to take appropriate decisions.

Utility of the Leadership and Organizational Change for Implementation-Systems Level (LOCI-SL) strategy for a statewide substance use treatment implementation effort

IntroductionMulti-level and cross-context implementation strategies are needed to support health systems, healthcare delivery organizations, and providers to adopt evidence-based practice (EBP) for substance use disorder (SUD) treatment. However, misalignment between state oversight agencies and healthcare organizations about which services to prioritize and which outcomes are reasonable to expect can hinder implementation success and widespread access to high-quality care. This study investigated the utility of the Leadership and Organizational Change for Implementation-System Level (LOCI-SL) strategy for supporting statewide EBP implementation for SUD treatment. MethodsNine community mental health centers (CMHCs) contracted by a state agency participated in a combined motivational-enhancement therapy and cognitive behavioral therapy (MET/CBT) implementation effort. Five of the CMHCs also received the LOCI-SL strategy to obtain ongoing implementation support. We conducted 21 individual interviews and three small group interviews with 30 participants across CMHCs and state health agencies to investigate the utility of LOCI-SL in supporting their EBP implementation efforts. Deductive thematic analysis was guided by the Exploration, Preparation, Implementation, Sustainment Framework. ResultsFive themes described CMHCs' LOCI-SL and broader contextual experiences implementing EBPs: (1) LOCI-SL supported executives in Preparation phase activities that holistically considered organizational needs and capacity to implement and sustain EBPs; (2) LOCI-SL facilitated trust and communication processes across Preparation, Implementation, and Sustainment phases to improve EBP uptake; (3) LOCI-SL increased CMHCs' use of implementation climate strengthening activities throughout the Implementation phase; (4) state contracts did not emphasize quality and thus were not sufficient bridging factors to enforce EBP fidelity during Implementation; and, (5) limited funding and low Medicaid reimbursement rates hindered EBP use throughout the Implementation and Sustainment phases. ConclusionsLOCI-SL was viewed as a favorable and useful implementation strategy for supporting statewide adoption of EBPs. However, outer context barriers, including limited financial investments in the treatment system, impeded implementation and sustainment efforts. While previous research suggests that contracts are viable alignment-promoting bridging factors, this study demonstrates the importance of articulating implementation outcome expectations to aid state-contracted organizations in achieving EBP implementation success. This study also highlights the need for multi-level implementation strategies to effectively align implementation expectations between outer- and inner-context entities.

Why do Stayers Stay? Perceptions of White and Black Long-Term Employees in a Community Mental Health Center

Why do Stayers Stay? Perceptions of White and Black Long-Term Employees in a Community Mental Health Center

Nursing Students' Attitudes toward Working in Mental Health Facilities in Saudi Arabia: A Cross-Sectional Study.

(1) Background: There is a global demand for more psychiatric nurses, with nursing students' attitudes toward mental illness and working in mental health facilities playing a pivotal role in their career choices. This study aims to evaluate attitudes toward working in mental health facilities among undergraduate nursing students in Saudi Arabia, both before and after exposure to psychiatry courses, and examine their relationship with perceptions of mental illness. (2) Methods: A quantitative descriptive and correlational cross-sectional design was employed. Nursing students' attitudes toward working in mental health facilities were assessed using the Attitude Toward Psychiatry 18 (ATP-18) questionnaire and the Beliefs Toward Mental Illness (BMI) scale. (3) Results: No significant relationship has been found between the frequency of negative views of both ATP-18 and BMI, and exposure to the psychiatry course. However, nurses who completed the psychiatry course held more positive views towards psychiatrists and found psychiatric patients less demanding, were less likely to view psychological disorders as dangerous, more confident in trusting mentally ill colleagues, and felt less embarrassed by the term "psychological disorder" compared to those who had not taken the course. (4) Conclusion: Based on our findings, it is evident that exposure to psychiatric courses and training enhances the potential of nursing students to contribute effectively to the psychiatric field. Therefore, integrating mental health and illness community services training into nursing education programs can play a pivotal role in raising awareness and attracting students who may hold negative attitudes towards individuals with mental illness.

Barriers to mental health service utilization among Arab society in Israel: Perspectives from service providers

This study attempted to identify the barriers to the utilization of mental health services among the Arab society in Israel, as perceived by professionals working with this population. Twenty-seven therapists from community mental health services participated in structured in-depth interviews with at least 5 years of experience. Five main types of barriers to the utilization of mental health services were discovered: barriers related to attitudes and perceptions regarding mental disorders and their treatment, low literacy in the field of mental health, exposure and stigma, family characteristics and cultural values, and instrumental barriers. Flexibility and sensitivity to the socio-cultural context of the target population while allocating resources to create equality in access to mental health care may increase the utilization of mental health services in a traditional society such as the Arab society in Israel.

Risk prevalence, readiness and confidence to change lifestyle risk factors among clients of community mental health services.

People with mental health conditions have high rates of chronic physical diseases, partially attributable to lifestyle risks factors. This study examined risk prevalence among community mental health service clients, their readiness and confidence to change, and associations with participant characteristics. Cross-sectional survey of adult clients from 12 community mental health services across 3 local health districts in New South Wales, Australia, collected from 2021 to 2022. Participants (n = 486) completed a telephone interview determining five risk factors, and readiness and confidence to change these. Multiple binary logistic regression models determined associations between readiness and confidence (for each risk), and participant characteristics (demographics and diagnosis). Participants most commonly reported a diagnosis of schizophrenia (36.7%) or depression (21.1%). Risk factors were prevalent: ranging from 26% (harmful alcohol use) to 97% (poor nutrition). High readiness was greatest for smoking (68%), weight (66%) and physical inactivity (63%), while confidence was highest for changing alcohol use (67%). Two significant associations were identified; females were more likely than males to have high readiness to change nutrition (odds ratio = 1.14, confidence interval = [1.13, 2.34], p = 0.0092), with males more likely to have high confidence to change physical activity (odds ratio = 0.91, confidence interval = [0.45, 0.99], p = 0.0109). Many participants were ready and confident to change risk factors. Gender influenced readiness to change nutrition and physical activity confidence. Training to upskill mental health clinicians in provision of preventive care that builds confidence and readiness levels may aid in supporting positive behaviour change.

Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory.

Research on psychiatric deinstitutionalization has neglected that reforms in this field are nested in a health system that has undergone financial reforms. This subordination could introduce incentives that are misaligned with new mental health policies. According to Chile's National Mental Health Plan, this would be the case in the Community Mental Health Centers (CMHC). The goal is to understand how the CMHCpayment mechanism is a potential incentive for community mental health. A mixed quantitative-qualitative convergent study using grounded theory. We collected administrative production data between 2010 and 2020. Following the payment mechanism theory, we interviewed 25 payers, providers, and user experts. We integrated the results through selective coding. This article presents the relevant results of mixed selective integration. Seven payment mechanisms implemented heterogeneously in the country's CMHC are recognized. They respond to three schemes subject to rate limits and prospective public budget. They differ in the payment unit. They are associated with implementing the community mental health model negatively affecting users, the services provided, the human resources available, and the governance adopted. Governance, management, and payment unit conditions favoring the community mental health model are identified. A disjointed set of heterogeneously implemented payment schemes negatively affects the community mental health model. Formulating an explicit financing policy for mental health that is complementary to existing policies is necessary and possible.

Over-Referred and Badly Served – Patient Journeys in Attention Deficit Hyperactivity Disorder at a Community Mental Health Team

Over-Referred and Badly Served – Patient Journeys in Attention Deficit Hyperactivity Disorder at a Community Mental Health Team