Community Mental Health Support Research Articles

Association between mental health and community support in lockdown communities during the COVID-19 pandemic: Evidence from rural China

Governments worldwide have taken unprecedented social distancing and community lockdown measures to halt the COVID-19 epidemic, leaving millions of people restrained in locked-down communities and their mental well-being at risk. This study examines Chinese rural residents' mental health risk under emergency lockdown during the COVID-19 pandemic. It investigates how the environmental, socioeconomic, and behavioral dimensions of community support affect mental health in this emergency context. We also explore whether community support's effectiveness depends on the strictness of lockdown measures implemented and the level of individual perceived COVID-19 infection risk. We collect self-reported mental health risk, community support, and demographics information through a cross-sectional survey of 3892 Chinese rural residents living in small towns and villages. Ordinary least square regressions are employed to estimate the psychological effects of community support. The results suggest that the COVID-19 epidemic and lockdown policies negatively affect psychological well-being, especially for rural females. The capacity for community production has the largest impact on reducing mental health risks, followed by the stability of basic medical services, community cohesion, housing condition, the stability of communications and transportation supply, and the eco-environment. The effectiveness of different community support dimensions depends on the level of lockdown policy implemented and the levels of one's perceived risk of COVID-19 infection. Our study stresses the psychological significance of a healthy living environment, resilient infrastructure and public service system, and community production capacity during the lockdown in rural towns and villages.

Promoting Community-based Engagement with Pregnant and Postpartum Women with Substance Use Disorder via Human-centered Design

Background: 
 Pregnant women with substance use disorder (SUD) are a vulnerable population that often contends with stigma, socioeconomic inequity, and mental health issues. The Community-based Addiction Reduction (CARE) Program connects pregnant and postpartum women with SUD in Central Indiana with addiction recovery coaches (ARCs) and attachment theory therapists, who provide linkage to community resources and mental health support. However, recruitment and retention of participants continue to be challenging. 
 
 The goals of this research are to identify barriers and facilitators to recruitment/retention and to translate findings into patient engagement materials. 
 
 Methods: 
 ARCs are women with family or personal experience with SUD, and serve as proxies for patient perspectives. Qualitative data from nine semi-structured interviews conducted with ARCs and their supervisors were clustered thematically to identify barriers and facilitators to recruitment/retention. Rapid prototyping, a methodology within human-centered design (HCD), was then employed to iteratively develop deliverables, incorporating several rounds of critique from ARCs, weekly case conferences, and discussions with clinician-investigators and designers. 
 
 Results: 
 Facilitators to recruitment/retention included: (1) ability to personally relate to ARCs and (2) ARC advocacy when navigating community and health system resources. Barriers to recruitment/retention included: (1) distrust (associated with participants’ histories of adverse childhood events and other trauma); (2) overwhelming number of interactions with various agencies (DCS, clinics, counseling, etc.); (3) fluctuating phone access, (4) intensive enrollment process, and (5) overall program visibility. 
 
 The following deliverables were designed: (1) introduction videos of ARCs (2) brief videos of patient advocacy stories told by ARCs, (3) personalized cards paired with existing gift card incentives, and (4) journal for self-reflection and self-motivation. 
 
 Potential Impact: 
 Qualitative findings underscore the importance of patient-centeredness in engagement with CARE participants, who are often overwhelmed and wary of others. HCD approaches within multidisciplinary teams can be leveraged to enhance program uptake and delivery within underserved populations.

Benefits of a Recovery-Oriented Knowledge Translation Program for Mental Health Community Support Teams: A Qualitative Study

In most developed countries, health systems are attempting to compensate for underuse scientific evidence and its integration into healthcare services and practices. This qualitative study aimed to identify perceived benefits of a knowledge translation program implemented within mental health community services ((At your fingertips, Quebec, 2016-2018)). Results suggests that the production of a collaborative platform composed of a variety of activities and techno-educational tools, derived from integrated knowledge, facilitates the uptake by professionals in a context of reflective practices. Dissemination of these tools through technology of information and communication provides access to best recovery-oriented practices at your fingertips.

Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities

ObjectiveTo estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years.DesignWe conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian...

MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness

IntroductionPeople with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare...

“It's a much more relaxed atmosphere”: Atmospheres of recovery at a peer respite

The peer respite model is an emerging model of community mental health support in the United States, yet, it remains understudied and undertheorized in post-asylum geographies and posthuman scholarship on recovery. A focused ethnography sought to address this gap by considering the sensibilities and urgencies that emerged at a peer respite in the U.S. Southwest. More broadly, this paper describes atmospheres of recovery that formed within the space itself, among peer staff who aimed to motivate guests (service users) to acquire social services during their stay and guests who often experienced homelessness. Beyond an anthropocentric, individualized notion of recovery, we describe the spatial arrangements, temporal urgencies, and material scarcities that mediated guests’ experiences of their stay and suggest that the peer respite can be understood as a site of transformation that both enables and limits possibilities for feelings of wellbeing and recovery to arise.

A qualitative investigation of models of community mental health care for women with perinatal mental health problems

Background Specialist community perinatal mental health teams support women diagnosed with moderate to severe psychiatric difficulties in pregnancy or postnatally. These teams are being expanded across the UK, and there is considerable international interest in this model of care. However, not all women access these teams, and many are instead supported by community mental health services that do not specialise in the perinatal period. Aims To explore perinatal women’s experiences of specialist perinatal versus generic non-perinatal community mental health support. Methods Semi-structured interviews were conducted with 36 women diagnosed with perinatal mental health difficulties who were supported in the community either by a specialist perinatal or general non-perinatal mental health service. Data were analysed thematically. Results Women felt that specialist perinatal and non-perinatal services alike were under-resourced and somewhat too narrow in their remit, but reported positive experiences across both settings. They particularly valued the specialist expertise offered by perinatal teams, but also valued greater continuity of care over a longer period, which some non-perinatal teams provided. Conclusions The findings suggest that women who experience perinatal mental health difficulties value specialist perinatal expertise, but that general, non-perinatal teams may also have advantages for some. Further research into optimal care arrangements is merited.

Commissioning for health and community sector reform: perspectives on change from Victoria.

Commissioning health and community services is a complex task involving planning, purchasing and monitoring services for a population. It is particularly difficult when attempting system-level reform, and many barriers to effective commissioning have been documented. In Victoria, the state government has operated as a commissioner of many services, including mental health community support and alcohol and other drug treatment services. This study investigated the perceived consequences of a reform process in these two sectors after recommissioning was used as a mechanism to achieve sector-wide redesign. Semi-structured interviews were conducted with 23 senior staff from community health, mental health and drug and alcohol services 6 months after implementation. The process was affected by restructuring in the commissioning department resulting in truncation of preparatory planning and technical work required for system design. Consequently, reform implementation was reportedly chaotic, costly to agencies and staff, and resulted in disillusionment of enthusiastic reform supporters. Negative service system impacts were produced, such as disruption of collaborative and/or comprehensive models of care and strategies for reaching marginalised groups. Without careful planning and development commissioning processes can become over-reliant on competitive tendering to produce results, create significant costs to service providers and engender system-level issues with the potential to disrupt innovative models focused on meeting client needs.

A mixed methods evaluation of an integrated adult mental health service model

BackgroundThe Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a ‘one-stop’ mental health service hub.MethodsWe conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale — Domains and Stages (RAS–DS) scores at intake and review (n = 108); (2) RAS–DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation.ResultsInterviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS–DS measurements, averaging 5 months apart. RAS–DS ‘total recovery’ scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS–DS domains (‘Looking forward’, p < 0.001; ‘Mastering my illness’, p < 0.001; and ‘Connecting and belonging’, p = 0.001). Corresponding improvements, except in ‘Connecting and belonging’, were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant.ConclusionsDespite the lack of a control group and small follow-up sample size, Floresco’s integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.

“It is not simply the loss of a child”: The challenges facing parents who have lost their only child in post-reproductive age in China

The death of one’s only child in post-reproductive age (in Chinese, shidu) is a traumatic event that has specific cultural implications in China. This study investigates the experience of a changed life and emerging challenges amongst Chinese shidu parents. Thematic analysis of 36 interviews revealed four main life consequences following shidu: impairment of psychological and physical health, weakening of social networks and interactions, loss of meaning in life, and lack of care and security. We suggest that health monitoring and mental health intervention, adequate social and community support, and improved social security are the critical needs in this vulnerable group.

REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial

Recovery-oriented practice promotes the strengths and recovery potential of individuals. We aimed to establish whether individuals who access mental health services where staff have received the REFOCUS-PULSAR intervention, an adaptation of the UK's REFOCUS recovery-oriented staff intervention for use in Australia, show increased recovery compared with people using non-intervention services. We did a pragmatic, two-step, stepped-wedge, randomised controlled trial at 18 sites grouped into 14 clusters across public mental health services and mental health community support services in Victoria, Australia. Eligible staff were working part-time or full-time in a direct service role at one of the 18 sites and had consumers being recruited for this study. Eligible consumers were receiving care from a participating cluster, with contact in the 3 months before data collection; aged 18-75 years; and not imprisoned. Clusters were randomly assigned with a web-based randomisation tool to receive the REFOCUS-PULSAR intervention in either the first year (step one) or second year (step two). Consumers, but not staff, were masked to treatment assignment. The primary outcome was the Questionnaire about the Process of Recovery (QPR), for which cross-sectional data were collected across three timepoints (baseline [T0], year 1 [T1], and year 2 [T2]). The primary analysis was done by intention to treat. This trial is registered with ANZCTR, number ACTRN12614000957695. 190 staff (111 from public mental health services and 79 from mental health community support services) received the REFOCUS-PULSAR recovery-oriented training intervention. Between Sept 18, 2014, and May 19, 2017, 942 consumers were recruited across the three timepoints (T0: n=301; T1: n=334; T2: n=307). The mean QPR score was 53·6 (SD 16·3) in the control group and 54·4 (16·2) in the intervention group (adjusted difference 3·7, 95% CI 0·5-6·8; p=0·023). The Cohen's d value for the intervention effect was small (d=0·23). The REFOCUS-PULSAR intervention had a small but significant effect on the QPRs of individuals using community mental health services and might be effective in promotion of recovery-oriented practice across sectors. Victorian Government Mental Illness Research Fund.

What Are the Personal Recovery Needs of Community-Dwelling Individuals with Mental Illness? Preliminary Findings from the Canadian Personal Recovery Outcome Measurement (C-PROM) Study

Personal recovery is an overarching goal that underpins mental health community support and clinical services in Canada. Surprisingly, little information is available about the personal recovery needs of community-dwelling Canadians with mental illness. The purpose of this study is to describe these needs in a sample of adults living in a large urban centre. We performed a multi-site cross-sectional survey of adults who receive community-based mental health services in an urban setting. Participants were asked to complete six patient-reported outcome (PRO) measures about personal recovery, hope, mastery, and depression. We used descriptive and correlational analyses to summarize the data according to an established evidence-based theoretical conceptualization of recovery. Two hundred and twenty-eight individuals participated in the study. Participants indicated high levels of self-reported empowerment and hope and optimism about the future. In contrast, participants reported low levels of perceived connectedness, identity, and meaning in life. In conclusion, this study identified that recovery-oriented PRO measures can improve our understanding of the needs and goals of individuals with mental illness and highlight the ways in which individuals can achieve a sense of meaning in life. Understanding the recovery needs of Canadians with mental illness may help foster recovery-oriented healthcare by bringing person-centred approaches to the point of treatment, so as to ensure greater quality and accountability of mental health services.

Referral patterns and implementation costs of the Partners in Recovery initiative in Gippsland: learnings for the National Disability Insurance Scheme.

The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland. Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective. Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care. Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS.

Barriers and facilitators of participation in intervention research by mental health occupational therapists

Statement of context Occupational therapists in clinical practice are required to deliver interventions within clinical trials to demonstrate the effectiveness of occupational therapy interventions. Challenges to participation in intervention research by occupational therapists working in community mental health have been identified and require further investigation. Critical reflection on practice A cross-sectional online survey of occupational therapists working in mental health was used, and obtained a 50% ( n = 144) response rate. Limited time, large generic caseloads, and lack of skills and experience in research were identified barriers to participation in occupational therapy intervention research. Occupational therapists had limited dedicated time to carry out occupational therapy interventions and outcome measurement was limited. Implications for practice Occupational therapy roles need to be regained in adult community mental health alongside routine outcome measurement. This will enable occupational therapy interventions to contribute to community mental health services and support participation in clinical trials of occupational therapy interventions.

Factors Supporting the Employment of Young Adult Peer Providers: Perspectives of Peers and Supervisors.

Peer providers are a promising practice for transition-age youth community mental health treatment engagement and support, yet little is known about the experience of being a young adult peer provider or what helps to make an individual in this role successful. Utilizing a capital theory lens, this study uses data from focus groups (two with young adult peer providers and two with their supervisors) to examine facilitators of young adult peer provider success in community mental health treatment settings. Eight factors were identified as critical to young adult peer provider on-the-job success: persistence, job confidence, resilience, job training, skilled communications with colleagues, regular and individualized supervision, support from colleagues, and family support. Findings suggest that young adult peer providers may benefit immensely from an agency level focus on fostering social organizational capital as well as more individualized efforts to increase cultural, social, and psychological capital through training and supervision.

Unmet needs among men with human immunodeficiency virus in community mental health care: a cross-sectional study

ABSTRACTWhile community-based mental health services play an important role in caring for persons with HIV (human immunodeficiency virus) and co-existing mental health disorders, the extent to which their support needs are addressed in this setting is unknown. Accordingly, we examined if HIV infection was associated with unmet support needs among men living with and without HIV receiving community mental health care. This cross-sectional study examined 215 men (135 living with HIV and 80 without HIV) receiving case management services in urban Ontario. Using the Camberwell Assessment of Need, we ascertained the prevalence of support needs in 13 domains grouped into three clusters: Basic needs (accommodation, food, benefits, and money management); self-care/functional needs (daytime activities, self-care, and looking after the home); and health/safety needs (physical, psychological distress, psychotic symptoms, safety to self, and safety to others). We used generalized estimating equations with a logit link to examine the association between HIV and unmet need in each domain. Compared to HIV-negative men, men with HIV were more likely to have mood and concurrent disorders, and intellectual and developmental disabilities. Following multivariable analyses, men with HIV had greater unmet needs related to food (odds ratio + 95% confidence interval: 9.36 (4.03, 21.75), p < 0.001); money (OR: 1.90 (1.04, 3.47), p = 0.036) [basic need domains]; psychological distress (OR: 2.39 (1.68, 3.41), p < 0.001); drug use (OR: 5.10 (2.16, 12.08) p < 0.001); and safety to self (OR: 3.35 (1.51, 7.52), p < 0.003) [health and safety domains]. Despite living in a setting with universal health insurance, men with HIV receiving community mental health support had greater unmet need in basic and health domains than HIV-negative men receiving such support. Further research is required to develop and evaluate interventions to best support community-dwelling persons with HIV and mental health disorders.

Trauma and Returning to Work: Women’s Lived Experiences and its Implications for Vocational Rehabilitation Counseling

This study examined the experiences of fifteen women trauma survivors who were returning to work. All participants had histories of interpersonal violence and were receiving mental health counseling for post-traumatic stress disorder (PTSD) and vocational services from a state vocational rehabilitation program. Using a feminist qualitative research method, the participants were interviewed and the data analyzed for common and emergent themes. The findings highlight their experiences with vocational counseling and counselors, and underscore significant factors that affected their return to work including health concerns, mental health treatment, family and community support, and accessing resources. Implications for vocational rehabilitation counselors include increased awareness of the challenges that influence mental health, career decision making, job readiness, and a need for examining institutional barriers.

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.

Mental health community support needs don’t stop at 65

Mental health community support needs don’t stop at 65

Planning estimates for the provision of core mental health services in Queensland 2007 to 2017

To derive planning estimates for the provision of public mental health services in Queensland 2007-2017. We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were identified as priorities.