Community-based Mental Health Research Articles

30 years of youth system of care lessons learned – a qualitative study of Hawaiʻi’s partnership with the Substance Abuse and Mental Health Services Administration

BackgroundThe Hawaiʻi State Department of Health, Child and Adolescent Mental Health Division (CAMHD) has maintained a longstanding partnership with Substance Abuse and Mental Health Services Administration (SAMHSA) to enhance capacity and quality of community-based mental health services. The current study explored CAMHD’s history of SAMHSA system of care (SOC) awards and identified common themes, lessons learned, and recommendations for future funding.MethodsEmploying a two-phase qualitative approach, the study first conducted content analysis on seven final project reports, identifying themes and lessons learned based on SOC values and principles. Subsequently, interviews were conducted with 11 system leaders in grant projects and SOC award projects within the state. All data from project reports and interview transcripts were independently coded and analyzed using rapid qualitative analysis techniques.ResultsContent validation and interview coding unveiled two content themes, interagency collaboration and youth and family voice, as areas that required long-term and consistent efforts across multiple projects. In addition, two general process themes, connection and continuity, emerged as essential approaches to system improvement work. The first emphasizes the importance of fostering connections in family, community, and culture, as well as within workforce members and child-serving agencies. The second highlights the importance of nurturing continuity throughout the system, from interagency collaboration to individual treatment.ConclusionsThe study provides deeper understanding of system of care evaluations, offering guidance to enhance and innovate youth mental health systems. The findings suggest that aligning state policies with federal guidelines and implementing longer funding mechanisms may alleviate administrative burdens.

From multilevel to trans-level interventions: A critical next step for creating sustainable social change to improve mental health.

Eliminating mental health disparities requires simultaneously addressing numerous determinants of health, including social inequities. Although emphasis on multilevel change is growing, interventions typically involve separate efforts or people focusing on each level. We propose a trans-level conceptual model for mental health intervention that simultaneously facilitates change across multiple intersecting levels with four guiding principles: (1) emphasis on structural change; (2) involvement of people experiencing health and social inequities in achieving structural change by addressing the necessary preconditions of access to resources for basic needs, community membership and belonging, and knowledge or information to participate in social change efforts; (3) valuing and building on the expertise and strengths of individuals, families, and communities experiencing health inequities; and (4) dismantling unequal power dynamics of helping relationships through a focus on mutual learning and support and cocreation of change. Tracing the trajectory of a 23-year community-based mental health intervention partnership (the Refugee and Immigrant Well-Being Project), we illustrate the trans-level intervention model and describe its impact on individual mental health and sustainable change at multiple levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A microcosting approach for planning and implementing community-based mental health prevention program: what does it cost?

BackgroundEstimating program costs when planning community-based mental health programs can be burdensome. Our aim was to retrospectively document the cost for the first year of planning and implementing Healthy Minds Healthy Communities (HMHC), a mental health promotion and prevention multi-level intervention initiative. This Program is among the first to use the Community Initiated Care (CIC) model in the US and is aimed at building community resilience and the capacity for communities to provide mental health support, particularly among those disproportionately impacted by COVID-19. Our objective is to share our methods for costing a program targeting 10 zip codes that are ethnically and linguistically diverse and provide an example for estimating the cost of a mental health prevention and promotion programs consisting of multiple evidence-based interventions.MethodsWe used a semi-structured interview process to collect cost data through the first year of program planning, start-up and initial implementation from key staff. We calculated costs for each activity, grouped them by major project categories, and identified the cost drivers of each category. We further validated cost estimates through extensive literature review. The cost analysis was done from the provider’s perspective, which included the implementing agency and its community partners. We delineated costs that were in-kind contributions to the program by other agency, and community partners. Sensitivity analyses were conducted to estimate uncertainty around parameters.ResultsFor the first year of the development and implementation of the program, (funded through program and in-kind) is estimated at $1,382,669 (2022 US$). The costs for the three main activity domains for this project are: project management $135,822, community engagement $364,216 and design and execution $756,934. Overall, the cost drivers for the first year of this intervention were: hiring and onboarding staff, in-person community building/learning sessions, communications and marketing, and intervention delivery.ConclusionImplementation of community-based mental health promotion and prevention programs, when utilizing a participatory approach, requires a significant amount of upfront investment in program planning and development. A large proportion of this investment tends to be human capital input. Developing partnerships is a successful strategy for defraying costs.

Connections between specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder and primary substance use

Purpose This study aims to use the database of consumers referred to the dual diagnosis shared care service to examine those connections. The Eastern Dual Diagnosis Service, based in Melbourne, Australia, has established a database of consumers with co-occurring mental health disorders and problematic substance use. An examination of mental health and substance-use information obtained over a two-year period in the delivery of dual diagnosis shared care to consumers of mental health services is supporting an improved understanding of substance use and the connections to specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder. Design/methodology/approach This research uses a quantitative approach to review the prevalence of primary substance use and mental health diagnoses for consumers referred to as dual diagnosis shared care. Reviewed are referrals from adult mental health community and rehabilitation teams operating within a mental health and well-being program between January 2019 and December 2020 inclusive. Findings Of the 387 clients referred to the specialist dual diagnosis shared care, methamphetamine, alcohol and cannabis are associated with 89.4% of the primary mental health diagnosis (PMHD). The most common PMHDs are schizophrenia, schizoaffective disorder and bipolar disorder. The most common PMHD and substance-use connection was schizophrenia and methamphetamine. Nicotine was reported to be used by 84% of consumers and often occurred in addition to another problematic primary substance. Originality/value Improved dual diagnosis data collection from a community-based clinical mental health service is increasing understanding of the mental health and substance-use relationship. This is now providing clarity on routes of investigation into co-occurring mental health and problematic substance-use trends and guiding improved integrated treatments within a contemporary mental health setting.

Identifying internalizing transdiagnostic profiles through motivational and cognitive control systems: Relations with symptoms, functionality, and quality of life

BackgroundThe diversity of patients' symptomatology among people seeking treatment on community-based mental health services poses significant challenges to traditional models of care. Recent approaches favor identifying transdiagnostic factors that allow a better understanding of patient heterogeneity and designing more effective and quality interventions. This study examines the heterogeneity of patients with internalizing symptoms based on profiles identified with cognitive and motivational control variables. Differences between these profiles on dimensional measures of psychopathology and quality of life are examined. Methods263 patients were selected by non-probabilistic sampling procedures on mental health services in the province of Huelva (Spain). A latent class analysis on the standardized scale scores of The Behavioral Inhibition/Behavioral Activation System Scales and the Effortful Control Scale of the Adult Temperament Questionnaire Short-Form was conducted. Profiles were compared on the scores of the Inventory of Depression and Anxiety Symptoms-II, the WHO Disability Assessment Schedule II, and the Health Assessment Questionnaire SF-36. ResultsThe four latent profile solution is the one that showed the best fit indicators and substantive interpretability, with a kappa of 0.94 in the cross-validation procedure with 75% of the sample. No sex differences were found between the profiles (χ32 5.17, p = .160). Profiles #1 and #3, both characterized by an imbalance between low activation and high inhibition, had lower well-being, lower functionality, and quality of life. When comparing profile #2 (featuring the highest inhibitory control) lower scores on most internalizing scales are observed, specially claustrophobia, social anxiety, panic mania. Profile #4 (low control, high activation, and high inhibition) showed greater scores on both mania and euphoria and lower scores on emotional role. ConclusionsWe identified four distinctive profiles that had overly increased behavioral inhibition (as expected in internalizing disorders) and differed in the degree of imbalance between inhibition and activation systems, and between motivational systems and top-down cognitive control. The profile characterized by high activation and reduced cognitive (inhibitory) control was the one showing greater mood-related symptoms and lower levels of quality of life. These profiles could be generated by treatment providers to guide clinical management in an evidence-based manner.

The transition towards community-based mental health care in the European Union: Current realities and prospects

The shift of mental health care from mental institutions to community-based services has been implemented differentially throughout the EU. However, because a comprehensive overview of the current mental health provision in member states is lacking, it is challenging to compare services across nations. This study investigates the extent of implementation of community-based mental health services within the EU using data collected from the WHO Mental Health Atlas. Results show that, although great cross-country variation exists in the implementation of community-based services, mental hospitals remain the prominent model of care in most countries. A few countries endorsed a balanced care model, with the co-occurrence of community services and mental hospitals. However, missing data, low quality of data and different service definitions hamper the possibility of a thorough analysis of the status on deinstitutionalization. Although policies on the closing and downsizing of mental institutions have been endorsed by the EU, the strong presence of mental hospitals slows down the shift towards community-based mental health care. This study highlights the need for an international consensus on definitions and a harmonization of indicators on mental health services. Together with the commitment of member states to improve the quality of data reporting, leadership must emerge to ensure quality monitoring of mental health-related data, which will help advance research, policies and practices.

Experiences of managers and staff working in community-based mental health with people ageing with severe mental health problems.

Existing research shows that older people with severe mental health problems need different forms of support in daily life and in the community to lead an active and meaningful life. A common form of support for people with severe mental health problems in Sweden is attendance at community-based day centres (DCs). However, knowledge of staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs is scarce. The aim was to explore DC staff and managers' experiences of how people ageing with severe mental health problems are supported in DCs during the retirement process. Telephone interviews were conducted with managers in 27 municipalities in southern Sweden. In addition, focus groups were held with personnel from a total of nine different DCs. The material was analysed using content analysis. The results showed that older people who receive support in community-based mental health care were viewed as a neglected group with complex needs, and the informants (managers and staff) had few policies to guide them when providing support. This made the informants desire more knowledge about best practices to support the target group. One theme emerged, Minding the gap between ideal and reality while working with a neglected group with complex needs, with three categories: Reasoning around unmet needs, Navigating in a muddled organisation, and Wishing for an enriched service. Together with previous research, the results can contribute to increase awareness about an overlooked group at risk of being neglected and the pitfalls that impact the possibility to guide this target group in their recovery journey. Further research focusing on the target group's own experience of their everyday life situations is also needed.

Spiritual and Community-Based Mental Health Services for Children with Special Needs in Islamic Boarding School

This study focuses on enhancing the care and educational support for children with special needs, particularly in rural areas where their families often lack adequate support. Recognizing the vital roles of communities and governments, the research seeks to create an inclusive education and mental health service model that incorporates spirituality and community engagement. A qualitative research method was used to achieve this, involving 19 managers and caregivers of children with special needs. Through interviews, participant observations, and three focus group discussions, data were collected using the free association technique and analyzed via thematic analysis. This analysis highlighted four key themes: the development of spiritual and community-based mental health services, the application of these approaches in service delivery, the care strategies for children with special needs, and the evaluation methods and psychological interventions rooted in indigenous psychology. The goal is to establish a mental health service model for rural settings that can be adapted for broader application in other regions.

Perceptions of the acceptability and effectiveness of a localised lifestyle medicine initiative to improve mental health – the lift project

ABSTRACT Objective Evaluate survey respondents’ perceptions concerning the acceptability and effectiveness of a localised, community-based mental health program. Method Avondale University and Lake Macquarie City Council partnered to implement an online, lifestyle-based program for all Council residents during a COVID-19 lockdown period. The University and Council promoted the program through established networks, resulting in 2390 registrations representing 4041 participants. Researchers invited registered users to respond to a post-program survey assessing their perceptions concerning program satisfaction, mental health benefits, and self-efficacy for managing mental health. Qualitative questions probed respondents’ likes and dislikes and were analysed thematically. Results Response rates were low, 6% (138/2390) of registered participants completed the post-program survey. Of the 138 responses, 99% indicated they would recommend the program to others, and 94% believed they gained skills to manage their mental well-being into the future. Themes generated from the qualitative data indicated that respondents liked the video content and delivery style, community camaraderie, personal empowerment, and easy accessibility. Some respondents found online accessibility problematic, disliked the delivery style, and experienced technical difficulties. Discussion The findings from a limited number of respondents indicate that a localised, community-based lifestyle program may offer a replicable model that is acceptable and effective in improving perceived mental health and self-efficacy in managing mental well-being. Survey respondents valued the practical content, community togetherness and emphasis on self-empowerment.

Transcending technology boundaries and maintaining sense of community in virtual mental health peer support: a qualitative study with service providers and users

BackgroundThis qualitative study explores the experiences of peer support workers (PSWs) and service users (or peers) during transition from in-person to virtual mental health services. During and following the COVID-19 pandemic, the need for accessible and community-based mental health support has become increasingly important. This research aims to understand how technological factors act as bridges and boundaries to mental health peer support services. In addition, the study explores whether and how a sense of community can be built or maintained among PSWs and peers in a virtual space when connections are mediated by technology. This research fills a gap in the literature by incorporating the perspectives of service users and underscores the potential of virtual peer support beyond pandemic conditions.MethodsData collection was conducted from a community organization that offers mental health peer support services. Semi-structured interviews were conducted with 13 employees and 27 service users. Thematic analysis was employed to identify key themes and synthesize a comprehensive understanding.ResultsThe findings highlight the mental health peer support needs that were met through virtual services, the manifestation of technology-based boundaries and the steps taken to remove some of these boundaries, and the strategies employed by the organization and its members to establish and maintain a sense of community in a virtual environment marked by physical distancing and technology-mediated interrelations. The findings also reveal the importance of providing hybrid services consisting of a mixture of in person and virtual mental health support to reach a broad spectrum of service users.ConclusionsThe study contributes to the ongoing efforts to enhance community mental health services and support in the virtual realm. It shows the importance of virtual peer support in situations where in-person support is not accessible. A hybrid model combining virtual and in-person mental health support services is recommended for better accessibility to mental health support services. Moreover, the importance of organizational support and of equitable resource allocation to overcome service boundaries are discussed.

Racial and ethnic disparities in access to community-based perinatal mental health programs: results from a cross-sectional survey

BackgroundPerinatal mental health is a major public health problem that disproportionately affects people from racial and ethnic minority groups. Community-based perinatal mental health programs, such as peer support groups, are essential tools for the prevention and treatment of perinatal depression. Yet, little is known about racial and ethnic disparities in accessibility and utilization of community-based perinatal mental health programs.MethodsWe conducted a cross-sectional study using an online survey with program administrators representing perinatal mental health community-based services and support programs throughout New Jersey. Descriptive analysis and mapping software was used to analyze the data.ResultsThirty-three program administrators completed the survey. Results showed substantial racial and ethnic disparities in availability and utilization of community-based programs. In the majority of programs, Black, Hispanic, and Asian individuals made up less than 10% of total annual participants and less than 10% of facilitators. There were also geographic disparities in program accessibility and language availability across counties. Program administrators identified mental health stigma, lack of support from family, fear of disclosure of mental health challenges, social determinants, lack of language-concordant options in programs, and limited awareness of programs in the community as significant barriers to participation of racial and ethnic minorities. Strategies to address barriers included adding language options, improving program outreach, and increasing diversity of facilitators.ConclusionsThis study provides new evidence on racial and ethnic disparities in access to community-based perinatal mental health programs. Efforts to build the resources and capacities of community-based programs to identify equity gaps, increase diversity of staff, and address barriers to participation is critical to reducing racial and ethnic inequities in perinatal mental health.

Protocol of the study: Multilevel community-based mental health intervention to address structural inequities and adverse disparate consequences of COVID-19 pandemic on Latinx Immigrants and African refugees.

The NIMH-funded Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees study aims to advance the science of multilevel interventions to reduce the disparate, adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic that are a result of complex interactions between underlying structural inequities and barriers to health care. The study tests three nested levels of intervention: 1) an efficacious 4-month advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes enacted in response to the pandemic. This community-based participatory research (CBPR) study builds on long-standing collaboration with five CBOs. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as-usual CBO involvement or the RIWP intervention and a comparison group comprised of a random sample of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months tests the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, access to resources, English proficiency, cultural connectedness). The study also tests the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions. This paper reports on the theoretical basis, design, qualitative and quantitative analysis plan, and power for the study.

From despair to hope: tackling Balochistan's suicide crisis with sustainable solutions

Balochistan, Pakistan's largest province, faces a concerning rise in self-harm and suicide, exacerbated by socioeconomic challenges, political instability and events such as climate change and recent suicide bombings. Despite the alarming suicide mortality rate, it remains a neglected public health issue. This perspective paper highlights the need for a comprehensive approach, including suicide prevention initiatives, community-based mental health services, education and research. We also suggest establishing a suicide prevention task force, inclusion of life skills and mental health education in school and undergraduate curricula, conducting research into self-harm, and fostering empathetic media reporting. Additionally, suggestions for sustainable economic change include job creation, development of marketable skills and interest-free microfinance initiatives to empower the community economically.

IJCM_389A: A community based cross-sectional study on perception, attitude, and stigma towards mental illness among the rural community in Mangalore

Introduction: Mental disorder is a behavioral pattern which causes either suffering or poor ability to function in ordinary life. According to WHO health report 2022, 970 million people suffer from mental illness globally. 80% people with mental illness live in low and middle-income countries, which is a matter of concern for India being the most populated country in the world. This study aims to assess the attitude and perception of people towards mental illness and to identify the presence of stigma towards mental illness in the community. Methodology: This cross-sectional study was conducted among 320 individuals aged above 18 years from Jeppinamogaru, Boloor, Shiv Nagar and Neermarga of Mangalore. Data was collected using a pretested semi-structured questionnaire of the CAMI scale rates a total of 40 items on a 5-point Likert scale (1 = strongly agree to 5 = strongly disagree) and analyzed using SPSS version 25. Results were expressed as proportions using appropriate tables and graphs. P< 0.05 was considered as statistically significant. Results: Out of 320 individuals assessed, 73.1% were females, with 50% aged over 45 years. The lower middle class constituted 35.3%, while only 0.6% belonged to the lower class. Awareness of mental illnesses was low, with only 42 individuals (13%) are knowledgeable. Most relied on behavior to identify mental illness, and 54.1% favored hospital treatment. 31.6% believed mental illness was genetically inherited as it is running through families. Medium stigma was prevalent across all domains of the CAMI scale, with the least stigma observed among the upper class. Conclusions: The study revealed low to medium level of stigma toward mental illness among lower and upper middle-class SEC individuals, alongside insufficient knowledge about mental health issues. Addressing these gaps, necessitates community awareness campaigns, enhanced education in schools, and increased accessibility to community-based mental health services and health camps.

Shanghai Community-Based Schizophrenia Cohort (SCS): a protocol for establishing a longitudinal cohort and research database of patients with schizophrenia receiving community-based mental health treatment

IntroductionDrivers for remission, relapse and violence-related behaviour among patients with schizophrenia are the most complicated issue.Methods and analysisThis study aims to recruit a longitudinal cohort of patients with schizophrenia. Two...

Patterns of help-seeking behavior among people with mental illness in Ethiopia: a systematic review and meta-analysis.

Despite the availability of evidence-based and effective treatments, significant numbers of people living with mental illness do not receive treatment or do not seek help from providers of formal modern treatment. Although numerous primary studies have been conducted on patterns of help-seeking behavior among individuals with mental illness with respect to modern therapy, the evidence has not been aggregated nationwide. Therefore, the aim of this review was to investigate pooled data on patterns of help-seeking behavior among individuals with mental illness in Ethiopia. All available primary studies were searched via the Google Scholar, HINARI, and PubMed databases from June 22 to December 20, 2023; 912 articles were identified. Sixteen articles were included in the final review; data from them were extracted to an Excel spreadsheet and exported to Stata version 17 for analysis. The search terms used were: "Pattern of help-seeking behavior'' OR "Pattern of treatment-seeking behavior" OR "Health care-seeking behavior" OR "Help-seeking intention" OR "Help-seeking preferences" OR "Perceived need" OR "Pathways to psychiatric care", AND "Common mental disorders" OR "Mental illness" OR "Mental health problems" OR "Depression", AND "Predictors" OR "Determinate factors" OR "Associated factors", AND "Ethiopia". The quality of the studies included was critically appraised using the modified The Joanna Briggs Institute (JBI) Joanna Briggs Institute quality assessment tool, adapted for observational studies. During critical appraisal, disagreements between the two authors conducting the assessment were resolved by the involvement of a third author. Effect sizes were pooled using the random effects model, and the presence of publication bias was detected based on asymmetry of the funnel plot and a statistically significant result of Egger's test (p<0.05). The pooled rate of positive help-seeking behavior with respect to modern treatment among people living with mental illness was 42.21% (95% CI: 29.29, 55.12; I2 = 99.37%, P=0.00). Factors significantly associated with a positive pattern of help-seeking behavior were: having a secondary education or above (AOR=5.47, 95% CI: 2.33, 12.86); believing that mental illness requires treatment (AOR=2.76, 95% CI: 2.02, 3.78); having strong social support (AOR=2.00, 95% CI: 1.64, 2.44); having a family history of mental illness (AOR=2.68, 95% CI: 1.38, 3.97); having awareness of the availability of treatment (AOR=2.92, 95% CI: 1.56, 5.46); having previously engaged in positive help-seeking behavior (AOR=3.28, 95% CI: 1.63, 6.60); having comorbid disorders (AOR=4.25, 95% CI: 1.69, 10.66); not using alcohol (AOR=3.29, 95% CI: 1.73, 6.27); and the perceived severity of mental illness (AOR=2.54, 95% CI: 1.490, 4.33). The majority of people with mental illness in Ethiopia exhibited a poor pattern of help-seeking behavior with respect to modern treatment. Therefore, mobilization of the community should be encouraged via regular public awareness campaigns regarding mental illness and the availability of evidence-based and effective modern treatment in Ethiopia. Moreover, the design of effective community-based mental health interventions is recommended in order to improve public attitudes and rates of help-seeking behavior in relation to mental health problems.

Australian men's help-seeking pathways for anxiety

Globally, there has been a substantial increase in the number of men being diagnosed with anxiety disorders. Despite this, men's mental health research often focusses on uncovering why men don't, rather than why they do, seek help. Within this context, men's help-seeking pathways for anxiety are poorly understood. This study mapped the help-seeking pathways of 419 Australian-based men for anxiety. Respondents 16 to 77 years-old (M = 40.92 years, SD = 15.36) reported multiple instances of help-seeking (n = 321, 77%) elaborating on their drivers for help-seeking via an open-text qualitative survey. Thematic analysis of men's responses was used to generate three themes, first detailing common tipping points of men's anxiety (namely relationship issues and work stress), and second, the reclusive causes and consequences of men's anxiety (burdensome symptoms and unmet expectations). These two themes converged into a third theme of help-seeking where defeatist (i.e., resigned abandonment self-management strategies) or defiant (proactive motivation in reaction to new events) motivations propelled men into either assisted or solitary help-seeking pathways. The current study findings afford important insights about the drivers that lead men to seek help for anxiety across the life course. Interventions targeting men's help-seeking for anxiety should accentuate the potential benefits of community-based mental health treatment within the context of men's social connectedness. Such interventions would also benefit from leveraging positive masculine ideals including strength, emotional-control and competition which can be both a barrier to, and driver for, help-seeking in the context of men's anxiety.

Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders’ perspectives in Bangladesh

IntroductionBangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services.MethodsFour stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised.ResultStakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery.ConclusionThe peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.

"I Think Peer Support Helps to Demystify People Who Have Mental Health Issues and Helps to Remove That Stigma": Exploring the Defining Characteristics and Related Challenges of Youth Peer Support Through Participatory Research.

Despite the emerging body of literature on the benefits of youth peer support, there is also evidence that peer support can have unintended negative impacts on peers themselves. It is important to explore what aspects of the peer role contribute to these difficulties in order to mitigate risks. This paper uses a participatory approach to examine the unique attributes of youth peer practice and the related challenges. We conducted semi-structured interviews and focus groups with both peer and non-peer staff from a community-based youth mental health program that provides peer support services (N = 29). Thematic analyses were completed using QSR NVivo. Analyses capture the defining features and related challenges of the peer support role (self-disclosure, boundaries, role confusion and dynamic recovery), and risk factors that affect peers (stigma, exposure to harm and burnout). This paper contributes to the literature on peer support as well as youth participatory evaluation. The findings will be useful to support the development of improved organizational contexts for peer practice and more effective peer support programming.

Psychiatric disorders in childhood cancer survivors: A retrospective matched cohort study of inpatient hospitalisations and community-based mental health services utilisation in Western Australia.

We examined the impact of long-term mental health outcomes on healthcare services utilisation among childhood cancer survivors in Western Australia using linked hospitalisations and community-based mental healthcare records from 1987 to 2019. The study cohort included 2977 childhood cancer survivors diagnosed with cancer at age < 18 years in Western Australia from 1982 to 2014 and a matched non-cancer control group of 24,994 individuals. Adjusted hazard ratios of recurrent events were estimated using the Andersen-Gill model. The cumulative burden of events over time was assessed using the method of mean cumulative count. The annual percentage change in events was estimated using the negative binomial regression model. The results showed higher community-based service contacts (rate/100 person-years: 30.2, 95% confidence interval = [29.7-30.7] vs 22.8, 95% confidence interval = [22.6-22.9]) and hospitalisations (rate/1000 person-years: 14.8, 95% confidence interval = [13.6-16.0] vs 12.7, 95% confidence interval = [12.3-13.1]) in childhood cancer survivors compared to the control group. Childhood cancer survivors had a significantly higher risk of any event (adjusted hazard ratio = 1.5, 95% confidence interval = [1.1-2.0]). The cumulative burden of events increased with time since diagnosis and across age groups. The annual percentage change for hospitalisations and service contacts significantly increased over time (p < 0.05). Substance abuse was the leading cause of hospitalisations, while mood/affective and anxiety disorders were common causes of service contacts. Risk factors associated with increased service events included cancer diagnosis at age < 5 years, leukaemia diagnosis, high socioeconomic deprivation, and an attained age of < 18 years. The elevated utilisation of healthcare services observed among childhood cancer survivors emphasises the need for periodic assessment of psychiatric disorders, particularly in high-risk survivors, to facilitate early management and optimise healthcare resources.