Community Mental Health Service Providers Research Articles

Mobilising strategic alliances with community organisations to address work-related mental injury: a qualitative study guided by collaboration theory

BackgroundA critical policy issue in Australia and worldwide is the escalating rates of work-related mental injury that have been linked to the lack of help-seeking behaviours of at-risk workers. Strategic alliances between community organisations, statutory bodies, and mental health service providers could expand the efficacy and reach of mental health literacy and peer support initiatives that can encourage help-seeking, however, there is limited evidence to support the development of such approaches. This study used a qualitative design based on collaboration theory to explore the factors influencing community organisation leaders’ decisions to provide such initiatives through collaboration with relevant third parties.MethodsRepositories of submissions into mental health reviews and publicly available registers in Australia were used to identify twenty-two participant organisations (n = 22), which were categorised according to the International Classification of Non-Profit Organisations (Culture & Recreation, Social Services, and Development & Housing). Eleven of these organisations demonstrated an interest in collaborating with third parties and extending efforts to deliver work-related mental health initiatives through contributions to mental health reviews. Leaders were interviewed to understand differences in perspectives on potential collaborations.ResultsOrganisations that did not make submissions were reluctant to engage in such efforts due to limitations in expertise/capacity, and perceived mission misalignment. Third-party support from statutory bodies and mental health service providers addressing these perceived limitations may improve their confidence, and willingness to engage. Regardless of their category, all considered the benefit of such collaboration included improving the acceptability, approachability, availability, and efficacy of work-related mental health initiatives. Equity was seen as supporting decision-making/leadership, while power imbalance was a barrier. Third-party contributions that could facilitate collaboration included expert support/credibility, administration, formal structures, supportive policy, and joining networks, however, red tape was a challenge. Shared values, vision, practice, and networking were identified as supporting positive communication and interpersonal relations.ConclusionThe study establishes that, adequately supported and resourced, community organisations are willing to align strategically with statutory bodies and mental health service providers to use their unique position in the community to deliver work-related mental health literacy and peer support programmes for at-risk workers to improve help-seeking behaviours.

Perspectives on Migrant Children's Mental Health Needs and Existing Services: A Qualitative Study Among Psychological Service Providers of Chinese Social Organizations.

China is comprehensively promoting the construction of social psychological service system. Social organizations provide psychosocial care services to migrant children in China and hold important information and perspectives different from educators and parents on children's mental health. This study aims to analyze mental health service delivery to migrant adolescents for their psychological well-being, to explore how society responds effectively to their psychological needs and to support in better program implementation of mental health services for migrant children. Following qualitative approach semi-structured interviews were conducted with community mental health service providers experienced in working with migrant children. The 15 individual interviews were conducted in Hubei province and Guangdong province, including professionals working with different social organization and social psychological service program in communities. The data were analysed through coding, comparing fragments, constant comparison and recognizing patterns. The analysis yielded 3 categories (Stimulate the internal strength, Reconstruct the support systems, Understanding and participate in social activities) and 6 sub-categories (Improve the understanding of "me" and explore excellent qualities, Clearly envision "my" future and clear career planning, Improve the parent-child relationship and understand the family environment, Improve subjective support and actively develop support system, Acquire reasonable cognition and behavior and interact with surrounding ecology, Take greater responsibility and cultivate a sense of ownership). The results found that individual traits, family, communities and multiple factors affect the mental health of migrant children and identified the urgent needs, and ways to improve mental health service in efficiently and economically. Social psychological service providers contribute in strengthening the psychological well-being of the migrant children. Social psychological service sectors need to be strengthened to enhance the psychological well-being of the migrant children. The inherent gaps between the service required and service provided needs to be addressed through further studies on mental health needs of the migrant children.

Treating Trauma in Criminal Justice-Involved with SMI: "Trauma Is a Huge Part of It".

Individuals with serious mental illness are both disproportionately represented in the criminal justice system and more likely to experience correlates with offending (e.g., trauma, substance abuse, and homelessness). Moreover, research using the Adverse Childhood Experiences has found strong correlation between childhood trauma and later negative outcomes, including criminal justice involvement. Despite this, research has yet to examine how trauma can influence treatment decisions for criminal justice-involved individuals with SMI. Using a qualitative approach and in-depth semi-structured interviews with 61 community mental health service providers, the current study addresses this gap in the literature. Findings confirm the high prevalence of trauma in this population as well as suggests a number of key findings for this population including (1) how trauma affects treatment decisions, (2) the existing barriers related to the treatment of trauma, and (3) what service providers need to effectively treat trauma. Implications for policy and practice are extensive.

지역사회 정신건강서비스 제공자의 회복지향실천 역량강화 방안

This study examined alternative practice experiences based on a philosophy that respects the subjective experience of people with psychosocial disabilities to explore ways to strengthen the recovery-oriented practice capabilities of community mental health service providers. To this end, focus group interviews were conducted with 14 service providers who had learned Research and Mutual Help and narrative therapy and applied them in the field. A general qualitative research method was conducted to derive 5 major themes and 15 sub-themes. The main themes are ‘Recognizing the limitations of practice and facing the person as one person’, ‘Striving for a cooperative relationship with the person concerned’, ‘Struggling to support the person’s various recovery’, ‘Formation of a culture of alternative practice’ ‘Efforts are made for the future’, and education suitable for new attempts is desperately needed. Based on this, implications and suggestions for strengthening the capacity of mental health service providers in the community to practice recovery are presented.

Using the interRAI brief mental health screener to identify persons with mental disorders having repeat contact with police

Repeat contacts between persons with serious mental disorder (PSMD) and police officers are costly to both police services and hospitals in terms of service utilization and can be viewed as a direct indicator of unmet needs and gaps in service provision. The intent of the current study was to examine the demographic and clinical characteristics of PSMD who had repeat contact with police officers in London, Ontario from 2016 to 2019 using data collected using the interRAI Brief Mental Health Screener (BMHS). Negative binomial regression was used on a sample of 4143 cases to develop a model predictive of repeat police contacts. The most parsimonious model predicting police contact based on items on the BMHS included age, command hallucinations, lack of insight, verbal abuse, known to possess weapons and family, friends and caregivers expressing concern over the possibility of self harm. Delusions were also independently significantly associated with repeat encounters. Unique to this study is the observation that possessing a weapon in the past 12 months was included in the predictive model. The results of the study add to the sparse research devoted to identifying the characteristics of PSMD who have repeat contact with police officers. Recommendations include integrating the findings into police training to ensure police officers flag those who have the potential for repeat encounters and refer them to appropriate community mental health service providers for proactive outreach services.

Issues behind the Utilization of Community Mental Health Services by Ethnic Minorities in Hong Kong

ABSTRACT This study collected data on the utilization rates of community mental health services among ethnic minorities and explained the results from the frontline social workers’ perspective. Information about users’ ethnicity was collected from 11 community mental health service providers from 2015 to 2018. This was followed by two sessions of focus groups conducted with 10 frontline social workers from six community mental health centers in Hong Kong. A hybrid analysis model was employed to analyze the qualitative data. The average utilization rates of community mental health services by ethnic minorities were 0.49%, 0.58%, and 0.68% in the years 2015–16, 2016–17, and 2017–18, respectively, showing that ethnic minorities who comprised 8% of the population were significantly underrepresented. It is worth noting that supply-side and demand-side factors are interrelated, suggesting the low utilization rate may be overcome by implementing a proactive social work service strategy.

An evaluation of a tailored care program for complex and persistent mental health problems: Partners in Recovery program

Partners in Recovery (PIR) is a nation-wide Australian program designed to improve coordinated care for people with severe and persistent mental health problems. This study evaluated PIR’s effectiveness for individual and system-level outcomes. A total of 25 PIR participants (male = 7, female = 15, not stated = 3) provided data for the evaluation of the program across six community mental health service providers in Canberra, Australia. Individual-level measures included quality of life, social inclusion, and perceptions of recovery. System-level individual measures included confidence in the health system, perceptions of organisation of care, and network analyses. Global single-item scores were measured at baseline (retrospectively), midpoint, and endpoint. Scaled scores for quality of life and social inclusion were measured at midpoint and endpoint only. Multi-level fixed effect models demonstrated significant improvements in global quality of life (p = .008), social inclusion (p = .025), perceptions of recovery (p < .001), and confidence in the health system (p = .013) from baseline to endpoint. Mean scaled scores did not improve from midpoint to endpoint. Two network analyses demonstrated the central role of the support facilitator. This study provides preliminary evidence for increasing quality of life, level of social inclusion, and perceptions of recovery for people with severe mental illness and complex needs.

General practitioners\u2019 experiences and perceptions of mild moderate depression management and factors influencing effective service delivery in rural Australian communities: a qualitative study

BackgroundRural communities in Australia face significant disadvantages relating to geographical isolation and limited access to mental health services. Documenting general practitioners’ (GP) experiences and perception of mental health services in rural Australia may be useful to gain insight into rural GP management of mild to moderate depression.AimsTo explore GPs’ experience and views on which factors influence access to mental health services for mild to moderate depression.MethodThis qualitative study was conducted in 2014 in the Northern Rivers, NSW, Australia. Data were obtained from semi-structured in-depth face-to-face interviews with ten GPs, and analyses were performed using a general inductive method of thematic analysis.ResultsMost GPs believed that the current services for managing mild-moderate depression were adequate, however they also identified the need for better access and more services that were free for patients. GPs had a positive perception of management of depression in a rural setting, identifying advantages including better doctor-patient relationships, continuity of care and the proximity of services. However, GPs also identified several barriers to access to mental health services in a rural setting, including long waiting-times, inadequate patient rapport with referred professionals, cost of treatment, transportation, geographical location, stigma, and lack of education about available mental health services. As a result, GPs frequently self-managed patients in addition to referring them to other community mental health service providers where possible.ConclusionOverall, GPs appeared relatively satisfied with the resources available in their communities but also identified numerous barriers to access and room for improvement. Rural GPs often self-managed patients in addition to referring patients to other mental health services providers. This should be taken into account when designing mental health policies, developing new services or re-designing current services in rural communities.

Collaboration With Community Mental Health Service Providers

Schools have played an increasingly central role in providing mental health services to youth, but there are limitations to the services that are available through school-based mental health professionals. Thus, collaboration with non-school-based community mental health providers is oftentimes necessary. As collaboration can address limitations of school-based services and enhance and complement school-based services, it has been identified as best practice in comprehensive mental health service delivery. This collaboration column provides a brief review that highlights the critical opportunities for collaboration between school- and non-school-based professionals. Potential barriers to effective collaboration are also discussed, and strategies are introduced to overcome these barriers in order to provide effective and complementary mental health services to students in need.

Life history strategies and psychopathology: the faster the life strategies, the more symptoms of psychopathology

There is little extant empirical literature examining the associations between life history strategies and symptoms of psychopathology. The current study (N=138) investigated the associations between life history strategies, symptoms of psychopathology, aggression, incidence of self-harm behaviour, and attachment (perceived parental support) in sample drawn from the general population and community mental health service providers. The results from the study indicate those with a faster life strategy report greater levels of aggression and symptoms of psychopathology. Further, perceptions of poorer parental support were associated with a faster life history strategy. Implications for life history theory, conceptualising psychopathology, and future research directions are discussed.

Development Of Community Psychiatric Crisis Management Indicators And Assessment Framework In Taiwan: A Focus Group Study

This study was to develop the Community Psychiatric Crisis Management (CPCM) Model for community-dwelling psychiatric patients of Taiwan. Purposes of this study were: 1. To develop psychiatric patients’ community crisis management indictors; 2. To develop the psychiatric patients’ community crisis management framework. Methods: Three focus group interviews involving a total of 42 experts, included psychiatrists, psychiatric nurses, social worker, and community mental health service providers were implemented. Interview data were analyzed with qualitative content analysis. Results: The model of CPCM concretized the objectives, crisis assessment indicators, and crisis intervention services for community psychiatric patients, and proved to be an important part of CPCM. The level of crisis severity and impact of patient can be assessed by the four indicators: medical care seeking behaviors, psychiatric symptom severity and impact, history of violence and substance abuse, and protective factors of family and social support system. In addition, the severity and impact of CPCM score could be implement to provide home visiting care and crisis management interventions. The recommended CPCM model enabled community mental health care professionals’ assessment and management the patient’s crisis problems in three stages, from crisis, acute and maintenance stage. Conclusions: The CPCM model was improved practically, and the contents of the intervention were constructed. It is important to integrate crisis management with the preventive intervention to the community psychiatric patient care.

Learning from those we serve: Piloting a culture competence intervention co-developed by university faculty and persons in recovery.

This article describes the development and piloting of a bilevel intervention codeveloped by persons in recovery from mental illness and addiction and university faculty with expertise in cultural competence to improve the cultural competence of a community mental health center in the northeastern United States. Two faculty and 5 persons in recovery met for 6 months to develop the bilevel training intervention. They discussed experiences of culturally responsive care and developed experiential activities and case examples for the 2-day training. Forty-five community mental health service providers attended the 2-day training. Trainees' self-reported awareness, knowledge, and skills in cultural competence were measured pre and post training and analyzed with repeated measure t tests. Next, faculty and persons in recovery provided follow-up training and helped to establish an infrastructure supported to support the agency cultural competence plan. One hundred twenty-five providers completed the Organizational Multicultural Competence Survey and between-subjects t tests measured increases in organizational cultural competence. Significant increases were found in providers' multicultural knowledge, awareness, and skills. Qualitative responses demonstrated the contribution of the experiences of persons in recovery to the training. Ratings of the organizational-level cultural competence intervention showed significant improvements in the agency's cultural competence policies (e.g., implementation of strategies to hire and retain a diverse workforce). These data suggest that bilevel interventions codeveloped by persons in recovery and researchers may be effective in increasing provider and organizational-level cultural competence. Future research should evaluate the effect of these interventions on consumers and health outcomes.

ICommunity@ East: an integrated community mental health and dementia support network in Singapore

Aim: This paper describes the establishment of iCommunity@East: An Integrated Community Mental Health (CMH) and Dementia Support Network in Singapore. Background: Mental wellness is an emerging area of need, given our fast ageing population. . The current prevalence rate for dementia is 6%(1) and 5.7%(2) for depression amongst seniors in the community. Coupled with our growing number of seniors and shrinking old-age support ratio, there will be a growing number of seniors (and their caregivers) who will require support to enable them to age in place. Therefore, we need a more extensive, community-based and preventive approach to better support the mental health (MH) of the community. A population survey which interviewed 2,558 elderly living in East region was conducted in 2011. The outcome showed that 1 out of 10 elderly is not able to live independently and about 14.6% show signs of depression or dementia. This survey also projected that almost 30% of elderly will require health or social services. Current gaps: The gaps of the existing MH system are: i) services are overly driven by the acute care sector where the expertise reside, ii) limited number of community MH service providers who lack support and development and iii) insufficient integration across sectors. Good CMH care is associated with higher self-reported quality of life and service satisfaction ratings among service users. Meeting the needs The iCommunity@East is a pilot project to address these gaps in the Eastern region, Singapore. It is a community based MH care network that integrates MH with social services and medical system so that elderly with/at risk of dementia or mental illness are supported to continue staying at home.

Stigma and discrimination as a barrier to mental health service utilization in India

Stigma towards, and discrimination against, people with mental disorders is an important barrier to mental health service utilization in India. It contributes to delays in seeking care, impedes timely diagnosis and treatment for mental disorders, serves as an impediment to recovery and rehabilitation, and ultimately reduces the opportunity for fuller participation in life. In India there is a need to generate evidence base for context specific interventions that will address negative attitudes towards people with mental disorders and ensure implementation of these interventions by involving users, care-givers, community health workers and mental health service providers.

Spiritual Strengths Assessment in Mental Health Practice

Proponents of recovery and strengths-based approaches recognise spirituality as an important factor in mental health recovery. Minimal guidance is available, however, for how to assess spirituality with people diagnosed with severe mental illnesses. To address this gap, six focus group interviews were conducted with a total of fortyeight community mental health service providers and users who have been involved in spiritual strengths assessment. An additional panel of ten international leaders in the strengths case management approach gave feedback on focus group insights in order to expand recommendations congruent with the strengths model. Findings revealed that, while spirituality can be a recovery-related resource for people with severe mental illnesses, some service providers and users experience challenges related to spiritual strengths assessment such as a sense of discomfort about the topic, and uncertainty related to defining spirituality and setting relevant case management goals. This article addresses these and other challenges by offering guidelines for spiritual assessment within the context of the strengths model.

RELATIONSHIP OF EVIDENCE‐BASED PRACTICE AND TREATMENTS: A SURVEY OF COMMUNITY MENTAL HEALTH PROVIDERS

Evidence‐based treatments (EBTs) are interventions that have been proven effective through rigorous research methodologies. Evidence‐based practice (EBP), however, refers to a decision‐making process that integrates the best available research, clinician expertise, and client characteristics. This study examined community mental health service providers’ knowledge of EBP and perceived advantages, disadvantages, reasons for not implementing full EBT protocols, and attitudes toward EBTs. Qualitative examination of mental health service providers’ definitions of EBP reveals confusion between the terms EBP and EBT. Service providers indicated several advantages and disadvantages of using EBTs. Analysis suggests that many perceived EBT disadvantages would be eliminated if EBTs are implemented as part of the EBP approach, thus allowing for clinician expertise and patient characteristics to be combined with EBTs. Alternatively, distinguishing between EBP and EBT may be more confusing than useful for most community mental health practitioners, which indicates new terminology may be needed.

VA Community Mental Health Service Providers’ Utilization of and Attitudes Toward Telemental Health Care: The Gatekeeper's Perspective

Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. The purpose of this study was to investigate the attitudes of CBOC providers about TMH services, current utilization of these technologies in their clinics, and sources of knowledge regarding TMH. The study employed a mixed-methods design to examine aspects of TMH in CBOCs located in a VA network in the south-central United States. Semistructured, on-site group interviews conducted with 86 CBOC MH providers were followed by in-depth phone surveys with an MH provider identified as a key informant at each of 36 CBOCs in the VA network. The utilization of TMH services varied widely between CBOCs, and the scope of services provided typically focused on delivery of medication management, with little provision of psychological services. Further, several important barriers to expanded use of TMH were identified, including limited education and training and shortage of dedicated space for TMH encounters. General attitudes toward TMH were positive, and most CBOC providers indicated that they would like to expand use of TMH in their clinics.

Developing a Comprehensive Understanding of the Working Alliance in Community Mental Health

The concept of a working alliance as a key ingredient within therapeutic processes has been emphasized by many community mental health researchers and practitioners. However, few studies have provided insights into the dimensions and operationalization of the concept. To address this gap, the authors analyzed data on the working alliance derived from two qualitative data sets: (a) interviews conducted with 33 users of community mental health services, family members, and service providers; and (b) content extracted from a systematic review of 48 articles in the area of community mental health services. Three superordinate themes emerged: Building and negotiating trust, I'm on your side, and Tools and strategies. The authors discuss implications for community mental health practice.

Surviving the Tornado of Mental Illness: Psychiatric Survivors' Experiences of Getting, Losing, and Keeping Housing

Surviving the Tornado of Mental Illness: Psychiatric Survivors' Experiences of Getting, Losing, and Keeping Housing

Open Forum: Surviving the Tornado of Mental Illness: Psychiatric Survivors' Experiences of Getting, Losing, and Keeping Housing

This qualitative study explored experiences of psychiatric consumer-survivors related to housing. Nine focus groups involving 90 people were conducted in urban and rural areas in South-Western Ontario. A set of open-ended questions was used. Many participants described a devastating experience of losing much of what was important to them and going through a long arduous process to rebuild their lives. Group discussions were audiotaped and transcribed. Individual and team analyses of the transcripts revealed that psychiatric survivors experienced three levels of upheaval, loss, and destruction, similar to the effects of a tornado: losing ground, struggling to survive, and gaining stability. Within each of these levels, five major themes were identified: living in fear, losing control of basic human rights, attempting to hold onto and create relationships, identifying supports and seeking services, and obtaining personal space and place. A caring community response, including adequate housing, income support, and community care, can help people rebuild their lives.