Community Mental Health Service Users Research Articles

Machine-Learning for Prescription Patterns: Random Forest in the Prediction of Dose and Number of Antipsychotics Prescribed to People with Schizophrenia.

ObjectiveWe aimed to predict antipsychotic prescription patterns for people with schizophrenia using machine learning (ML) algorithms.MethodsIn a cross-sectional design, a sample of community mental health service users (SUs; n = 368) with a primary diagnosis of schizophrenia was randomly selected. Socio-demographic and clinical features, including the number, total dose, and route of administration of the antipsychotic treatment were recorded. Information about the number and the length of psychiatric hospitalization was retrieved. Ordinary Least Square (OLS) regression and ML algorithms (i.e., random forest [RF], supported vector machine, K-nearest neighborhood, and Naïve Bayes) were used to estimate the predictors of total antipsychotic dosage and prescription of antipsychotic polytherapy (APP).ResultsThe strongest predictor of the total dose was APP. The number of Community Mental Health Centers (CMHC) contacts was the most important predictor of APP and, with APP omitted, of dosage. Treatment with anticholinergics predicted APP, emphasizing the strong correlation between APP and higher antipsychotic dose. RF performed better than OLS regression and the other ML algorithms in predicting both antipsychotic dose (root square mean error = 0.70, R2 = 0.31) and APP (area under the receiving operator curve = 0.66, true positive rate = 0.41, and true negative rate = 0.78).ConclusionAPP is associated with the prescription of higher total doses of antipsychotics. Frequent attenders at CMHCs, and SUs recently hospitalized are often treated with APP and higher doses of antipsychotics. Future prospective studies incorporating standardized clinical assessments for both psychopathological severity and treatment efficacy are needed to confirm these findings.

Survey of High Expressed Emotions Experienced By Community Mental Health Service Users in Hong Kong During the COVID-19 Pandemic.

BackgroundHigh expressed emotion (EE) experienced by people with mental illness is a known risk factor of relapse. With drastically increased time spent at home and limited health and social service provision during the COVID-19 pandemic, patients’ experience of high EE warranted attention.Aims and MethodsThe study aimed to investigate the experience of high EE among people with mental illness during the COVID-19 pandemic. We surveyed the service users of 2 community mental health centers, including participants with psychotic and nonpsychotic disorders.ResultsValid responses from 303 participants indicated an overall high EE prevalence of 71.62%, much higher than previous findings, which range between 30% and 40%. People with other psychotic and nonpsychotic disorders showed a higher probability of experiencing high EE than people with schizophrenia. Participants reported a higher probability of experiencing high EE as a result of caregiving by other family relatives and friends than by parents.ConclusionFindings suggest a significantly elevated high EE prevalence among people suffering from mental illness in the community during the COVID-19 pandemic. It is worth further evaluating the long-term effects of high EE beyond the pandemic.

Potentially preventable hospitalisations for physical health conditions in community mental health service users: a population-wide linkage study.

Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions. A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016-2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR). MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5-3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2-5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5-5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6-3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5-6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1-5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20-29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage. PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.

Reliability and validity of the Japanese version of the INSPIRE measure of staff support for personal recovery in community mental health service users in Japan

BackgroundSupporting personal recovery in people with mental health difficulties is central to mental health services. This study aimed to develop the Japanese version of INSPIRE and Brief INSPIRE measure of staff support for personal recovery and to evaluate its reliability and validity.MethodsA questionnaire survey was conducted from October to December 2015. The authors asked users to participate in the survey of 14 community mental health services in the Kanto region of Japan. The service users completed self-administered questionnaires that include the Japanese version of INSPIRE, the Recovery Assessment Scale, the Client Satisfaction Questionnaire, the patient version of the Scale to Assess Therapeutic Relationship in Community Mental Health care and the Short Form Health Survey. Internal consistency was assessed using Cronbach’s alpha coefficient, and test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. Convergent validity was examined by assessing correlation with other scales. Factor validity was evaluated by exploratory factor analysis (EFA) with generalized least-squares mean and oblimin rotation. In addition, confirmatory factor analysis was used to check the fitness of the factor structure models derived from the EFA.ResultsA total of 195 out of 212 users gave written informed consent and participated in the study. Data from 190 respondents were analyzed (response rate 89.6%). INSPIRE, Brief INSPIRE, and the subscales all showed Cronbach’s alpha coefficient over 0.78. ICC and weighted kappa derived more than 0.92 for subscales and Brief INSPIRE. These numerical values indicated good reliability. The convergent validity of Brief INSPIRE and the subscales was significantly positively correlated with the other scales. Different from the previous study, the factor structure was extracted using EFA. Both factor structures were checked by CFA, but the degree of fitness index was not good in either. Therefore, the factor analysis did not show goodness of fit.ConclusionsThis study found the Japanese version of INSPIRE and Brief INSPIRE to be reliable and valid for use among community mental health service users in Japan.

Predictors of overall and mental health-related internet use in adults with psychosis

As digital interventions are beginning to be developed to support self-management of psychosis, it is important to understand how illness-related and individual factors may affect internet use and engagement with digital mental health resources among people with psychotic disorders. This study aimed to identify demographic, clinical, and personal variables associated with overall and mental health-related internet use in a sample of 189 adult community mental health service users with nonaffective and affective psychotic disorders. Among participants who regularly used the internet (87.3%), most (67.9%) reported using the internet for mental health information. Higher frequency of overall internet use was predicted by younger age, completion of post-secondary education, and less severe negative symptoms. Internet use for mental health information was predicted by younger age, higher levels of overall internet use, current productive employment, and higher loneliness. This study is the first to quantitatively examine how clinical and personal measures relate to overall and mental health-related internet use in people with psychosis. Although cognitive difficulties and negative symptoms impacted overall internet use, these disorder-related difficulties did not further impact internet use for mental health information. Digital mental health resources should be designed to optimise engagement for this population.

Adverse childhood experiences and dissociation among Hong Kong mental health service users

ABSTRACTAdverse childhood experiences (ACEs) have become a major concern in the mental health field. The literature suggests that ACEs could be associated with various mental health problems. Yet, ACEs require further investigation in Chinese cultures, especially in Hong Kong. Both the frequency of ACEs and their relationships with dissociation remain unknown in clinical settings in Hong Kong. In this study, we administered the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ) and the 10-item Adverse Childhood Experiences (ACEs) Questionnaire to 202 community mental health service users in Hong Kong. The frequency of ACEs and dissociation is reported and the trauma model of dissociation can be observed in this sample. Consistent with the Western literature, we found that ACEs are associated with mental health problems and that participants with childhood abuse and/or neglect report a significantly higher level of dissociation. While this study is preliminary, we suggest that ACEs and dissociation should receive more attention in the Chinese mental health field. Implications for practice are highlighted. Further studies are warranted.

Mortality Rates and Trends Among Bologna Community Mental Health Service Users: A 13-Year Cohort Study.

The present study aimed to determine mortality rates and trends among community mental health service users in Bologna (Italy) between 2001 and 2013. Standardized mortality ratios (SMRs) were calculated, and Poisson multiple regression analysis was performed. The cohort comprised 42,357 patients, of which 3556 died. The overall SMR was 1.62 (95% confidence interval = 1.57-1.67). SMRs for natural causes of death ranged from 1.25 to 2.30, whereas the SMR for violent deaths was 3.45. Both serious and common mental disorders showed a significant excess of mortality, although higher rates were found in severe mental disorders, especially in personality disorders. Different from most published studies, the overall SMR slightly decreased during the study period. The present study, though confirming that people with mental disorders present a higher risk of mortality, calls for prevention strategies oriented to all psychiatric diagnoses.

Traditions of research in community mental health care planning and care coordination: A systematic meta-narrative review of the literature.

ContextIn response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users.MethodsA systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA.FindingsThree research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified.ConclusionsThe research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.

Focus Group in Community Mental Health Research: Need for Adaption.

The article presents an analysis of the use of focus groups in researching community mental health users, starting with the reasons for using them, their implementation in mental health service users' research, and the adaptations of focus group use when researching the experiences of users. Based on personal research experience and a review of scientific publications in the Google Scholar, Web of Science, ProQuest, EBSCOhost, and Scopus databases, 20 articles published between 2010 and 2016 were selected for targeted content analysis. A checklist for reporting on the use of focus groups with community mental health service users, aiming to improve the comparability, verifiability and validity was developed. Adaptations of the implementation of focus groups in relation to participants' characteristics were suggested. Focus groups are not only useful as a scientific research technique, but also for ensuring service users' participation in decision-making in community mental health and evaluating the quality of the mental health system and services .

Youth perceptions of positive mental health

Introduction Positive mental health underpins individual well-being and occupational participation. Internationally, youth mental health services are expanding to include interventions that promote positive mental health and prevent mental illness, to reduce the growing burden of disease caused by mental illness across the lifespan. Policy initiatives have increased the funding of early intervention initiatives, and evidence is required to inform changes in practice. Method This study aimed to explore youths’ perceptions of positive mental health. An interpretive descriptive qualitative study design was utilized, which involved purposive sampling to recruit three adolescent community mental health service users. Data were collected using the digital storytelling method within a series of three individual interviews. The Canadian Model of Occupational Performance and Engagement was used as a lens to guide thematic analysis. Findings Five main themes emerged, including: Components of spirituality; Occupational factors; Aspirations; Social influences; and Challenges and barriers. Positive mental health was developed through experiences with adversity, primarily mental illness, and being able to increase adequate coping strategies and resilience. Spirituality was expressed through experiences with identity formation and positive mental health was linked with a strong sense of self, being able to accept oneself and embracing one’s identity. Equally important were aspirations and hope, engagement in leisure occupations, role models and positive relationships with family and friends. Conclusion Using the Canadian Model of Occupational Performance and Engagement, personal, occupational and environment factors were demonstrated as being important in how youth perceive positive mental health, with spirituality being particularly influential. Further exploration of positive mental health for adolescents is required to inform policy and practice for community youth mental health services, and more broadly for preventative public health campaigns. Research, such as through the use of digital storytelling method, should actively engage young people in developing definitions, to ensure that they are meaningful to youth and that services understand their unique developmental needs.

Reaching Out: Improving the Continuity of Care of Community Mental Health Services Through a Weekly Climbing Group

ABSTRACTThis mixed-method study examined the impact of a novel activity group on engagement in care. Thirty-two participants were recruited from National Health Service (NHS) community mental health services in three inner-London boroughs. Participants undertook eight weekly sessions of supervised climbing. There was a significant quantitative improvement in the domain “individual progress” (Z = 2.12, p = 0.03). Qualitative data indicated a wide range of benefits. The study identified both direct and indirect benefits to continuity of care. The study validates the use of a climbing activity group to engage and benefit community mental health service users.

The Response of Mental Health Services to Domestic Violence

Despite numerous policies advocating for routine enquiry of abuse by mental health professionals, it is not known if such enquiry is acceptable to service users and clinicians. Furthermore, limited evidence exists on clinicians' response to domestic violence. This study aims to explore the acceptability of routine enquiry and experiences of responding to domestic violence from service user and professional perspectives. A qualitative study design was used to conduct individual interviews with a purposive sample of community mental health service users (n = 24) and professionals (n = 25). Thematic analysis was employed to establish superordinate and subordinate themes, which were transformed into conceptual maps. All service users considered routine enquiry about domestic violence in mental health settings to be acceptable but a small minority of professionals did not. Service users described positive experiences of help seeking, including receiving acknowledgement for the abuse and support for their multiple needs, and negative experiences, including nonvalidating responses from clinicians following disclosure, discrimination, and an absence of support from services. Main themes for professionals included difficulties in assessment and management of domestic violence, reporting requirements, and unclear referral pathways. To respond to the needs of mental health service users experiencing domestic violence, services need to articulate a clear care and referral pathway.

The Association Between Income Source and Met Need Among Community Mental Health Service Users in Ontario, Canada

We examined income source and match between recommended and received care among users of community mental health services. We conducted a secondary analysis of needs-based planning data on adults in Ontario community mental health programs from 2000 to 2002. The outcome was whether clients were severely underserved (yes/no) based on the match between level of care recommended and received. A logistic regression model investigated if income source predicted this outcome. 13% of clients were severely underserved. Over 40% were on public assistance and they had a higher risk of being severely undeserved than the others. Men were at greater risk. One aim of mental health reform is to increase access to care for vulnerable individuals. The finding that among users of community mental health services, individuals with public assistance income support are most vulnerable to being severely underserved should be considered by service planners and providers.

Bio-Somatic-Power

Biopower is a prominent force in mental health, with psychiatry having a strong influential grasp across the areas of definition of mental disorders, diagnosis, care, treatment, and legislation. One area that impacts upon the everyday lives of community mental health service users is treatment, largely dominated by medication. This paper will explore biopower in relation to the practices and management of mental health service users’ medication regimens. Michel Foucault’s insistence in his later work that power is the product of bodily forces will be drawn upon in highlighting the importance of undertaking analysis of medication regimens. Taking examples from a project focused on service user experience, the concept of ‘somatic enactment’ is suggested as a means through which to open up biopower to the localised concerns of service users with regard to the issue of managing one’s body on a day to day basis, as affected by medication. In doing so, the author seeks to move towards a notion of biopower that does not only work on a ‘top down’ manner, and in which processes of embodied subjectification can be illuminated, without recourse to a straightforward power-resistance framework.

Social network and social support characteristics amongst individuals recently discharged from acute psychiatric units.

This study compares the social support network of a diagnostically heterogeneous group of community mental health service users recently discharged from acute inpatient units, with that of a mental health service user comparison group with no history of hospital admission. Social data were elicited by a structured interview schedule (the Social Network Schedule). It was observed that the study group was characterized by smaller overall social networks, particularly within the primary network, but conversely the group had a greater proportion of service user peer contact. Few differences in perceived social support between groups were observed, although the study group reported fewer confidants. The implications of the study for nursing staff are discussed.