Community-based Psychosocial Treatments Research Articles

The role of moral explanations and structural inequalities in experiences of mental illness stigma in Northern Minas Gerais, Brazil.

The process of stigmatization within different cultural contexts has long been viewed as essential in understanding the course and outcomes of mental illness. However, little research has examined which cultural constructs and categories are used to explain mental illness, and how they contribute to the way people with mental illness experience stigma and social exclusion, as well as how these beliefs affect healthcare practices. This study examines meanings ascribed to mental illness and experiences of stigma among four groups in urban settings of Minas Gerais, Brazil: persons with mental illness; their families; members of the lay public; and health professionals working at an alternative community-based psychosocial treatment service or a local university hospital. Qualitative methods, including semi-structured interviews and participant observation, were conducted with a purposive sample of 72 participants. Data were analyzed through content analysis. The findings suggest that stigma and discrimination are intrinsically rooted in a systemic process of social exclusion generated by meanings ascribed to mental illness and the structural vulnerabilities of the mental healthcare system. The findings further suggest that structural inequality is a powerful factor behind lay concepts of mental illness and that this is particularly harmful because it reinforces personal blame attributions instead of addressing the hidden structural forces that contribute to mental illness. The study highlights the subtle interrelations between cultural beliefs and structural vulnerabilities that should be addressed in mental health policy in order to diminish the effects of stigma on people with mental illnesses.

Community-Based Psychosocial Treatment Has an Impact on Social Processing and Functional Outcome in Schizophrenia.

Schizophrenic patients have serious impairments in social cognition, which often persists after significant reduction in clinical symptoms. Community-based psychosocial treatments aim to recover social functioning for mentally ill individuals. Our aim was to examine prospective changes in social cognition and functional outcomes in two groups of schizophrenic patients involved in two forms of community-based psychosocial treatments namely case management (CM) and community-based club (CC) compared to a matched, treatment as usual (TAU) group of patients. We hypothesized that CC and CM groups would exhibit better functional and social cognitive outcomes after a 6-month long psychosocial treatment period. Seventy-five patients participated either in CC, CM or TAU. Both CC and CM took part in community-based psychosocial treatment programs including trainings, such as communication and assertiveness trainings. In addition, CC provided group therapeutic treatments and a continuously available day care where patients had the possibility to participate in various social interactions. All participants were in remission, and on maintenance antipsychotic treatment. Participants were assessed on all study variables at two time points: baseline and after 6 months with a battery of questionnaires that examined affective face perception, affective prosody perception, pragmatic language comprehension and ToM. Our results showed that functional outcomes improved significantly in the CC as well as in the CM groups, in contrast to the TAU group. While analyzing summary scores of social cognition, it was found that only the CC group increased its performance in social cognition. In addition, a significant between-group difference in social cognitive function was found after 6 months between the three groups, with the CC group performing best. When investigating associations between changes in social cognition and changes in functional outcomes during a 6-month long treatment period, we found significant correlations between the two variables both in the CC and in the CM groups. Based on our results, we suggest that a rich interpersonal network and social support have highly beneficial effects on social cognition and we would like to emphasize the necessity of offering community-based psychosocial treatments beside antipsychotic medications as early as possible as a crucial part of the complex therapy of schizophrenia.

A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation

Nonepisodic irritability is a common and impairing problem, leading to the development of the diagnoses severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD). No psychosocial therapies have been formally evaluated for either, with medication being the most common treatment. This study examined the feasibility and efficacy of a joint parent-child intervention for SMD. A total of 68 participants aged 7 to 12 years with attention-deficit/hyperactivity disorder (ADHD) and SMD were randomly assigned to the 11-week therapy or community-based psychosocial treatment. All participants were first stabilized on psychostimulant medication by study physicians. Of the participants, 56 still manifested impairing SMD symptoms and entered the therapy phase. Masked evaluators assessed participants at baseline, midpoint, and endpoint, with therapy participants reassessed 6 weeks later. All but 2 therapy participants attended the majority of sessions (n = 29), with families reporting high levels of satisfaction. The primary outcome of change in mood symptoms using the Mood Severity Index (MSI) did not reach significance except in the subset attending the majority of sessions (effect size = 0.53). Therapy was associated with significantly greater improvement in parent-rated irritability (effect size = 0.63). Treatment effects for irritability but not MSI diminished after therapy stopped. Little impact on ADHD symptoms was seen. Results may not be generalizable to youth with SMD and comorbidities different from those seen in this sample of children with ADHD, and are limited by the lack of a gold standard for measuring change in SMD symptoms. While failing to significantly improve mood symptoms versus community treatment, the integrative therapy was found to be a feasible and efficacious treatment for irritability in participants with SMD and ADHD. Group-Based Behavioral Therapy Combined With Stimulant Medication for Treating Children With Attention Deficit Hyperactivity Disorder and Impaired Mood; http://clinicaltrials.gov/; NCT00632619.

Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized, Controlled Trial

This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7-11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34-1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6% of observed intervals at posttreatment, compared to 25% of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted.

Mental Illness, Law, and a Public Health Law Research Agenda

Mental illness is a significant global public health issue. Disorders such as schizophrenia, bipolar disorder, and major depression put an enormous strain on afflicted individuals, their caregivers and communities. Yet, in some respects, acceptance of mental illness as a key part of the broader field of public health has developed only recently. Legal and policy responses to mental illness have shifted gradually over the last half century, away from the axis of involuntary institutional care and protection of individual rights, and towards an emphasis on ensuring access to community-based treatment and services – promoting autonomy and social inclusion within an ethos of recovery. A confluence of forces – deinstitutionalization, changing constitutional norms, advances in pharmacotherapies and community-based psychosocial treatments, and reform in the organization and financing of mental health services – has dramatically altered the landscape in which individuals today experience serious mental disorders and seek to recover from them. At the same time, public misperceptions, negative attitudes, and discriminatory behavior toward people with mental illness largely remain. And in fact, people with serious mental illnesses often do not receive the treatment they need and many become involved with the criminal justice system. What is the emerging role of law and policy in addressing the complex problems around mental illness from a public health perspective, and what is the agenda for research to inform those efforts? As part of a series of Theory, Practice and Evidence papers commissioned by the National Program Office for Public Health Law Research, this paper reviews the current evidence base on the relationship between law and mental health and offers a research agenda that situates mental health within an explicit public health framework. The paper begins by placing mental health law in its historical context, discussing the events and assumptions that in some measure continue to shape public policy and law. The review is organized according to a typology of public health law which encompasses the use of law in deliberate interventions designed to reduce mental illness and its associated harms as well as the incidental and infrastructural effects of law on mental health. The proposed research agenda identifies gaps in the evidence bases across the three types of public health law and suggests potential research designs which have the potential to illuminate them. In a time when our understanding of the burden of mental illness on population health is growing and continued economic pressures threaten individual and community resources for adequate treatment, this timely paper aims to catalyze new lines of research essential to determining how law and legal reform can best respond to mental illness as a public health problem of the highest order.

S09-01 Schizophrenia and motherhood

Increasingly women with schizophrenia are becoming mothers. This can cause different problems for them, their partners, their relatives and other caregivers.Traditionally women with schizophrenia suffered from infertility - partly due to the illness itself and its psychosocial impacts such as social isolation and lack of partnership, partly due to treatment with hyperprolactinaemia-/infertility-inducing neuroleptics. Recently this has changed dramatically, due to better community-based psychosocial treatments and also due to prolactin-sparing neuroleptics. Many women with schizophrenia now become pregnant - planned or unplanned. This, as well as motherhood, can be a considerable strain to the women concerned and her caregivers.Counselling a women with schizophrenia therefore always has to include her fertility situation, her desire to become a mother or not, contraception or planning pregnancy and motherhood (considering the course of her illness, her medication, her psychosocial situation, partnership, social support etc.). Counselling in case of unwanted pregnancy is of utmost importance as well as addressing issues such as medication, prenatal care, etc. during pregnancy. Cooperation with the obstetrician, midwife, paediatrician and childcare agencies is necessary. After delivery, parenting assessment in mother-baby-units can be very helpful to evaluate the need for additional care. Long-time programmes for training parenting skills and “parenting rehabilitation” are urgently needed and should also support the relatives and others who care for the woman and her child.

Cross-Ethnic Measurement Invariance of the Brief Symptom Inventory for Individuals with Mental Illness

The purpose of this study was to test the measurement invariance of the Brief Symptom Inventory's (BSI) secondary factor model across African, white, and Latino Americans using multiple-group confirmatory factor analyses. This study provides an examination of the BSI's validity for use in mental health service research for people with severe and persistent mental illness (SPMI). The sample consisted of 1,166 individuals receiving treatment for SPMI in a publicly funded mental health system in Los Angeles, California. The results showed that the secondary factor model fit the data very well. The findings suggest that the BSI can be used with African, white, and Latino Americans diagnosed with SPMI to assess their psychological distress and that it can be useful in comparing systematic group differences in observed means and covariance matrices across the three ethnic groups. It is recommended that the nine subscale scores and the Global Severity Index score of the BSI be used in practice and research with African, white, and Latino Americans with SPMI. KEY WORDS: Brief Symptom Inventory; confirmatory factor analysis; ethnic disparities; measurement invariance; severe and persistent mental illness ********** Valid measurement tools are critical for assessing a wide range of phenomena in mental health. Measurement instruments are used in clinical practice and in research to identify patients in a general population, to assess psychological symptoms, and to evaluate individual changes in symptoms resulting from treatment. A critical issue in the use of psychological measures is the possible variance resulting from differences across ethnic groups. The surgeon general's report (U.S. Department of Health and Human Services, 2001) emphasized that conceptual and scale equivalence, also called measurement invariance, is important to mental health services and research. For example, community-based psychosocial treatment programs for people with severe and persistent mental illness (SPMI) are limited in their ability to demonstrate program effectiveness in the case of ethnic minority groups because of the lack of standardized treatment outcome measures that are equivalent across different ethnic groups (National Institute of Mental Health, 2003). Plausible cultural differences can prohibit measures of psychological symptoms from being equivalent across ethnic groups, which results in the lack of validity in making clinical assessments and evaluating treatment outcomes. Recent discussions about ethnic disparities in the access, utilization, and outcome of health and mental health services (Ramirez, Ford, Stewart, & Teresi, 2005; Snowden, 2003) have highlighted the need for assessment tools that are valid across ethnic groups so that these disparities can be adequately understood and ameliorated. Thus, it is imperative to test whether symptom measures of interest hold measurement invariance across ethnic groups. The Brief Symptom Inventory (BSI) is a self-report mental health symptom scale (Derogatis & Melisaratos, 1983). It is a 53-item version of Symptom Checklist-90 (SCL-90-R) (Derogatis, 1992). According to the BSI manual (Derogatis, 1993), it is designed to assess general psychiatric distress using nine subscales. A Global Severity Index (GSI) can be derived, which is the average score of all 53 items. The BSI has been used with a wide range of adult populations. For example, an Ovid Medline search yielded more than 260 publications since 2000 that used the BSI, and PsycINFO listed more than 1,700 publications since 2000 that have used the BSI. The BSI is also widely used in mental health research on people with SPMI as a psychiatric symptom measure. For example, the BSI has been used in studies of comparative culture (Coelho, Strauss, & Jenkins, 1998), pharmacology (Salokangas et al., 1996), quality of life (Ritsner, 2003), family issues (Jenkins & Schumacher, 1999), involuntary outpatients (Swartz, Swanson, Wagner, Burns, & Hiday, 2001), program effectiveness (Kingsep, Nathan, & Castle, 2003), service systems (Mares, Young, McGuire, & Rosenheck, 2002), and measurement studies (Preston & Harrison, 2003). …

Understanding Associations Between Serious Mental Illness and HIV Among Patients in the VA Health System

Understanding Associations Between Serious Mental Illness and HIV Among Patients in the VA Health System

Abstinence incentives improve stimulant abusers’ compliance with community-based psychosocial treatments

Abstinence incentives improve stimulant abusers’ compliance with community-based psychosocial treatments

Impact of Community-Based Psychosocial Treatment on Clients' Level of Functioning

The results of this study support the conclusion that a comprehensive psychosocial program is effective in helping chronic mentally ill individuals achieve a higher level of functioning. Its effectiveness was particularly apparent on the more objective measures of recidivism and social adjustment. The significant improvement in demonalization self-reports, which parallebed improvements in SAM scores, also supports the program's effectiveness. Future research into client functioning in community-based treatment programs should use a more comprehensive social adjustment measure that would include other dimensions in addition to indepen- dent living and vocational status. Such an instrument would provide a more sensitive gauge of social adjustment than the one used in this study. Measuring interpemsonal skills, as well as family and social relationships, might also reflect more subtle functional improvements in a chronically ill popula- tion. Finally, it is hoped that future research will provide a greater o...