Community Mental Health Treatment Research Articles

'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.

Changing the Game? Increasing the Impact of Peer-Run Organizations.

Employment and deployment of peer support specialists in both clinical and non-clinical mental health settings has increased substantially since the 1990's. Peer-run organizations are defined as those led and managed by individuals with self-disclosed lived experience of mental health conditions. Many peer-run organizations promoting advocacy and offering services have been established during the past 30 years. Some adherents assert the effectiveness of peer-run organizations over hybrid mental health service providers in which peer support workers are integrated or partnered with existing community mental health agency multidisciplinary clinical and treatment teams. Although research has indicated the positive contributions of peer-run organizations to service user recovery, the impact of peer-run organizations on system transformation is not well documented. This concept paper explores benefits, accomplishments, and challenges faced by a peer-run organization during its 30-year evolution in offering self-help groups, supported housing, peer support services, peer specialist training, and systems change projects in Los Angeles County, California. Future research topics and policy options are suggested, along with recommendations for the SAMHSA Office of Recovery.

The Prevalence of Sexually Transmitted Infections and Subsequent Association with Exposure to Childhood Violence and Mental Health Outcomes for Adolescents and Young Adults in Zimbabwe

Sexually transmitted infections (STIs) represent a major public health concern for young people in developing nations, impacting approximately two-thirds of individuals below the age of 25. This study examined the prevalence and the association between self-reported STIs, childhood violence exposure, and mental health outcomes among adolescents and young adults (13-24 years old) in Zimbabwe. Secondary data from the 2017 Zimbabwe Violence Against Children and Youth Survey (n=8,715) was utilized. Data analysis was performed using chisquare to determine the prevalence estimates for bivariate. Seven logistic regression models were used to examine the significant association between independent variables and outcomes for multivariate. About 45.5% of adolescents and young adults with self-reported STIs were exposed to multiple forms of childhood violence, 49.8% reported lifetime suicide risk, and 44.9% reported moderate-to-severe mental distress in the past 30 days. Furthermore, logistic regression results indicated that adolescents and young adults with self-reported STI diagnoses were more likely to be exposed to multiple forms of childhood violence, including physical, emotional, and sexual violence, as well as mental distress in the past 30 days and lifetime suicide risk compared to those without STIs. Therefore, this study underscores the importance of implementing comprehensive public health strategies to protect the wellbeing of adolescents and young adults with STIs. Interventions should also prioritize raising awareness, destigmatizing STIs, implementing and strengthening violence prevention policies, and addressing mental health problems through community mental health treatment programs in Zimbabwe. Keywords: Childhood violence, Emotional violence, Exposure, Mental distress, Physical violence, Sexual violence, Sexually transmitted infections (STIs), Suicide risk, Zimbabwe.

Community Mental Health Treatment for Suicidality: Implementation of a Culturally Adapted Youth Suicide Prevention Program

Community Mental Health Treatment for Suicidality: Implementation of a Culturally Adapted Youth Suicide Prevention Program

Executive control training for adolescents with ADHD: Study protocol for a randomised controlled trial

BackgroundAttention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent neurodevelopmental conditions diagnosed during childhood and adolescence. In addition to the commonly observed symptoms of inattention, hyperactivity, and impulsivity, individuals with ADHD often experience impairments in executive functions (EFs). Goal management training (GMT) is a cognitive remediation intervention targeting EFs, with empirical support from studies with adult populations, including ADHD. The objective of the upcoming trial is to assess the effectiveness of GMT for adolescents with ADHD. MethodsThis pre-registered protocol outlines a multi-centre randomised controlled trial (RCT) comparing GMT to treatment as usual (TAU) to improve EFs. We aim to recruit 120 participants, aged 12 to 18 years, recently diagnosed with ADHD. Participants will be randomly allocated to the group-based GMT intervention in addition to TAU, or the TAU condition, through block randomisation with site stratification. GMT will be delivered in groups of four to six participants, with weekly two-hour sessions for seven weeks, complemented by separate parent and teacher sessions. TAU is standard community mental health treatment. The primary outcome measure will be parent-reported EF assessed with the Behaviour Rating Inventory of Executive Function 2 (BRIEF-2). Secondary outcomes will include ADHD symptom measures, social functioning, quality of life, and neuropsychological tests (attention span, inhibition, working memory, and visuo-motor speed). The outcome assessments will be conducted at baseline, 12 weeks, 12 months, and 24 months post-treatment. ConclusionThe study findings will contribute to determine the effectiveness of a non-pharmacological ADHD treatment, including outcome trajectories up to 24 months post-treatment.

Mental health services implementation in Colombia-A systematic review.

Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).

A Community Mental Health and Well-Being University Level Course: Design and Implementation

Background: Community mental health is growing discipline in psychology that recognizes the importance of creating a community that fosters wellness. Although universities provide many individuals a sense of community, little research has examined how community mental health interventions can be implemented into a classroom setting. Purpose: This paper provides a proof of concept of a university course that was created to give students the opportunity to interact with their campus community while receiving course credit over two semesters. Approach: In the first semester, the course provided students with content and theory as it relates to community mental health, well-being, and health promotion. The second semester implemented experiential learning, where students applied knowledge and skills to a placement related to mental health and well-being within their university. Conclusions: This university course can provide benefits to the university (e.g., cost-efficiency), the students (e.g., networking), and the community (e.g., accessible mental health services). This research presents a course framework that other post-secondary institutions can build upon and implement into their own programs. Implications: Future research should focus on implementing experiential learning courses that provide opportunities in the mental health field for undergraduate psychology students to facilitate post-graduate student success.

The impact of early intervention for first episode psychosis on cognitive functioning.

Impaired cognitive functioning is a core characteristic of schizophrenia, present from the onset of the illness and relatively stable thereafter. Despite evidence supporting the impact of early intervention services (EIS) on improving symptoms and functioning in first episode psychosis (FEP), controlled research has not examined its impact on cognitive functioning. To evaluate the longitudinal course of cognitive functioning in FEP patients participating in a large, controlled study comparing EIS with usual services. A total of 404 persons ages 15-40years old with non-affective FEP participated in the Recovery After Initial Schizophrenia-Early Treatment Program. A cluster randomized controlled trial was conducted with 34 community mental health treatment centers across the U.S. randomized to provide either an EIS program (NAVIGATE) or usual Community Care (CC) to FEP patients for 2years. Cognitive functioning was assessed with the Brief Assessment of Cognition in Schizophrenia (BACS) at baseline and 1- and 2-years later. Older participants (≥20years old) in both treatment groups improved on all BACS tests. Younger participants (15-19) in NAVIGATE improved significantly more on Digit Sequencing (working memory) than those in CC, whereas both groups improved on most of the other BACS tests. Improvements in cognitive functioning occurred mostly over the first year and were correlated with reductions in symptom severity. EIS do not improve cognitive functioning more than usual care for older FEP patients but may improve working memory in younger FEP patients. Interventions targeting cognition may be required to enhance cognitive functioning in most FEP patients.

Clinical profiles and factors associated with treatment initiation in survivors of sex trafficking: A comparison with survivors of domestic violence and sexual assault.

Little is known about formal help-seeking for mental health issues in survivors of human sex trafficking (ST) and if their experiences are different from those initiating treatment for sexual assault (SA) or domestic violence (DV). This study sought to characterize the clinical and trauma profiles of treatment-seeking survivors of ST as compared with DV and SA and the predictors of mental health treatment initiation in these three groups. The research was based on a secondary data analysis of data gathered from 1,264 treatment-seeking adults from a community mental health treatment facility in the United States. Compared with DV and SA survivors, ST survivors were significantly younger, female, Black, single, unemployed, completed less than high school, and were from the United States. Despite the presence of clinical symptoms among all three groups, findings suggest significant differences in clinical and trauma profiles, with ST survivors reporting lower levels of mental health symptomology compared to DV and SA survivors. Older age (OR = 1.03, 95% CI [1.01, 1.05]), female sex (OR = 3.03, 95% CI [1.89, 4.88]), employment (OR = 0.40, 95% CI [0.24, 0.66]), and better social relationships (OR = 1.09, 95% CI [1.01, 1.16]) were significantly associated with treatment initiation. This research highlights some important predictors of formal help-seeking, including perceived social relationships. Assessing for support systems in these three groups of survivors of interpersonal violence early when engaging survivors is recommended. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial

Background Obesity is common in individuals with severe mental illness (SMI), contributing to a significantly shortened lifespan when compared to the general population. Available weight loss treatments have attenuated efficacy in this population, underscoring the importance of prevention and early intervention. Objective Here, we describe a type 1 hybrid study design for adapting and pilot-testing an existing mobile health intervention for obesity prevention in individuals with early SMI and Class I or early-stage obesity, defined as a BMI of 30-35. Methods An existing, evidence-based interactive obesity treatment approach using low-cost, semiautomated SMS text messaging was selected for adaptation. Community mental health clinics and Clubhouse settings in Eastern Missouri and South Florida were identified to participate. This study has the following 3 aims. First, using the Enhanced Framework for Reporting Adaptations and Modifications to Evidence-based interventions, contextual aspects of the clinical and digital treatment environments are identified for adaptation, considering 5 main stakeholder groups (clinical administrators, prescribing clinicians, case managers, nurses, and patients). Following a 2-week trial of unadapted SMS text messaging, Innovation Corps methods are used to discover needed intervention adaptations by stakeholder group and clinical setting. Second, adaptations to digital functionality and intervention content will be made based on themes identified in aim 1, followed by rapid usability testing with key stakeholders. A process for iterative treatment adaptation will be developed for making unplanned modifications during the aim 3 implementation pilot study. Individuals working in partner community mental health clinics and Clubhouse settings will be trained in intervention delivery. Third, in a randomized pilot and feasibility trial, adults with 5 years or less of treatment for an SMI diagnosis will be randomized 2:1 to 6 months of an adapted interactive obesity treatment approach or to an attentional control condition, followed by a 3-month extension phase of SMS text messages only. Changes in weight, BMI, and behavioral outcomes, as well as implementation challenges, will be evaluated at 6 and 9 months. Results Institutional review board approval for aims 1 and 2 was granted on August 12, 2018, with 72 focus group participants enrolled; institutional review board approval for aim 3 was granted on May 6, 2020. To date, 52 participants have been enrolled in the study protocol. Conclusions In this type 1 hybrid study design, we apply an evidence-based treatment adaptation framework to plan, adapt, and feasibility test a mobile health intervention in real-world treatment settings. Resting at the intersection of community mental health treatment and physical health promotion, this study aims to advance the use of simple technology for obesity prevention in individuals with early-stage mental illness. Trial Registration ClinicalTrials.gov NCT03980743; https://clinicaltrials.gov/ct2/show/NCT03980743 International Registered Report Identifier (IRRID) DERR1-10.2196/42114

Implementation of Early Intervention Services (OPUS) in Denmark and results of 20 year follow-up of the OPUS trial

Abstract: BackgroundThe OPUS trial is the largest randomized controlled trial (RCT) testing early intervention services with 20-years of follow-up among individuals with a first episode of psychosis in the schizophrenia spectrum.MethodsA total of 547 individuals with first episode psychosis in the schizophrenia spectrum were included into the OPUS I trial between January 1998 - December 2000 and allocated to either two years of early intervention services or treatment as usual. Clinical and trained staff, blinded to the original treatment allocation, performed the five, ten and 20-year follow-up assessments.The early intervention service consisted of two years of assertive community treatment including social skill training, psychoeducation and family involvement delivered by a multi-disciplinary team (staff patient ratio 1:10). The standard treatment was based on the available community mental health treatment (1:20 –1:30).ResultsA total of 164 participants (30%) of 547 were interviewed at the 20-year follow-up. No significant differences were found between the early intervention group (OPUS-group) compared to the Treatment As Usual group (TAU-group) on global functional levels, psychotic and negative symptom scores after 20 years. Likewise, no differences was found ten to 20-years after randomization between the OPUS-group and TAU-group on days of psychiatric hospitalizations (Incidence Rate Ratio (IRR), 1.202, 95% CI 0.733 - 1.997, P=0.46), or number of outpatient contacts (IRR: 1.197, 95% CI 0.889 - 1.612, P=0.24). Of the entire cohort, 40% were in symptom remission and 18% were in clinical recovery at the 20-year follow-up. The mortality rate 20 years after randomization was 13.1% in the OPUS-group and 15.1% in the TAU group, P=.47.Conclusions and RelevanceNew initiatives are needed to maintain the positive outcomes achieved after two years of early intervention servicesDisclosure of InterestNone Declared

Integration of Substance Use Disorder Treatment Into a Traditional Community Mental Health Treatment System.

In response to the opioid crisis, Catholic Charities of Baltimore sought to integrate substance use disorder treatment into their outpatient community mental health clinics. The agency developed a systematic practice improvement strategy that included a competency-based curriculum and supervision plan for psychiatric providers and therapists. Psychiatric providers developed competency with medications used to treat substance use disorders, and therapists developed competency in therapeutic modalities to treat substance use disorders, all of which were gradually integrated into outpatient clinics. This column demonstrates that integration of substance use disorder treatment into outpatient community mental health care is feasible and beneficial.

School-based community mental health intervention: Partnership and social work model

School-based community mental health intervention: Partnership and social work model

YouBelong Home: A Ugandan Community Mental Health Intervention

In Uganda, low resources for mental health provision combine with disadvantage and inadequate supports for family and community-based care. Catalysed by the need to reduce overcrowded psychiatric hospital wards and frequent readmissions at Butabika National Referral Mental Hospital (BNRMH) in Kampala, the nongovernment organisation YouBelong Uganda (YBU) developed the YouBelong Home (YBH) intervention. YBH is a theoretically eclectic pre and post hospital discharge intervention. This paper reports on qualitative findings of the project Curtailing Hospital Readmissions for Patients with Severe Mental Illness in Africa (CHaRISMA), which explored how to refine the YBH intervention. The project was funded by a UK Joint Global Health Trials (JGHT) Development Grant. Data was collected through structured interviews with service users and caregivers, reflective practice by the YBH implementing team and a stakeholder focus group. A summary of refinements to the YBH intervention follows the TIDieR format (Template for Intervention Description and Replication).

The challenge of community mental health interventions with patients, relatives, and health professionals during the COVID-19 pandemic: a real-world 9-month follow-up study

Since the beginning of the COVID-19 pandemic, the need to implement protocols that respond to the mental health demands of the population has been demonstrated. The PASMICOR programme started in March 2020, involving a total of 210 requests for treatment. Out of those subjects, the intervention was performed in 53 patients with COVID-19 without history of past psychiatric illness, 57 relatives and 60 health professionals, all of them within the area of Salamanca (Spain). Interventions were carried out by professionals of the public mental health service mostly by telephone. Depending on clinical severity, patients received basic (level I) or complex psychotherapeutic care combined with psychiatric care (level II). The majority of attended subjects were women (76.5%). Anxious-depressive symptoms were predominant, although sadness was more frequent in patients, insomnia in relatives and anxiety and fear in health professionals. 80% of the sample, particularly most of the health professionals, required a high-intensity intervention (level II). Nearly 50% of the people treated were discharged after an average of 5 interventions. Providing early care to COVID-19 patients, relatives and professionals by using community mental health resources can help to reduce the negative impact of crises, such as the pandemic, on the most affected population groups.

Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making

Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients’ decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists’ decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists’ decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings.

The impact of the COVID-19 pandemic and earthquake on mental health of persons with severe mental illness: A survey study among people receiving community mental health care versus treatment as usual in Croatia.

The COVID-19 pandemic led to the disruption of mental health services in most countries. Croatia has been developing and strengthening its mental health system, including the introduction of community mental health teams (CMHT) for persons with severe mental illness (SMI), whose implementation was ongoing during the pandemic through the RECOVER-E project. The aim of this study was to assess the differences in mental health outcomes, perceived social support and healthcare utilization in the group of participants receiving treatment as usual (TAU group) compared to the group receiving TAU and additional care by the CMHT (CMHT group) during the COVID-19 pandemic and two earthquakes. This is a cross-sectional survey administered among 90 participants with SMI at two time points: in May/June 2020 (first COVID-19 wave, earthquake) and in December 2020/January 2021 (second COVID-19 wave, earthquake). A significantly larger proportion of participants from the CMHT group visited the general practitioners in both waves of COVID-19 (first wave: CMHT 72.1%, TAU 44.2%, p = .009; second wave: CMHT 91.1%, TAU 64.1%, p = .003), as well as psychiatric services in the second wave (CMHT 95.3%, TAU 79.5%, p = .028). The use of long-acting injectables was also more frequent in the CMHT group (p = .039). Furthermore, analysis of the first wave showed higher perceived support of significant others (p = .004) in the CMHT group. We did not identify any differences in mental health outcomes between groups in either wave. While mental health outcomes did not differ between TAU and CMHT group, people in CMHT used services and treatments more frequently than those in TAU during the pandemic, which may indicate that CMHT services enable the continuity and accessibility of care for people with SMI under the circumstances where standard care is interruped (for example pandemic, disaster conditions).

16.2 Youth Voice in Project Youth Empowerment and Support (YES): An Online Anonymous Adolescent Mental Health Single Session Intervention to Decrease Hopelessness

16.2 Youth Voice in Project Youth Empowerment and Support (YES): An Online Anonymous Adolescent Mental Health Single Session Intervention to Decrease Hopelessness

Severe Mental Illness and Family Involvement During Treatment

Treating clients with severe mental illness in community mental health settings can be challenging. Often, they lack solid intrapersonal support and have utilized surrounding resources to the best of their ability; yet, they still find themselves caught in the system of repeat treatment with no actual results. We can resolve these issues, which are amendable to family treatment and intervention, per previous research. It is essential for effective community mental health treatment that does not result in clients re-entering treatment on numerous occasions. Doing so could assist progress and advocate for inclusivity and emotional empowerment in identified clients—including their family members in treatment as a collective unit. This article proposes an ecological and systemic approach to mental health treatment for severe mental illnesses and provides treatment implications for clinicians.

Enacted Ebola Stigma and Health-related Quality of Life in Post Ebola Epidemic: A Psychosocial Mediation Framework Through Social Support, Self-Efficacy, and Coping.

On-site experiences and reports have shown that the multiple outbreaks of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) resulted in pervasive experience of stigma against many people who have recovered from EVD as well as their families and close relatives. Three evidence-based protective factors which are supposed to mitigate the impact of enacted Ebola stigma on health-related quality of life (HRQoL) of individuals in this epidemic context were identified. We expected that positive religious coping, perceived social support, and general self-efficacy would mediate the relationship between enacted Ebola stigma and HRQoL. These hypotheses were tested through multiple mediation model using the structural equation modeling among a large sample of adult populations (N = 1614; 50% women) in the province of Equateur in the DRC, in the aftermath of the 9th Ebola outbreak. The mediation model yielded adequate fit statistics and the results provided strong evidence that higher levels of enacted Ebola stigma were associated with lower HRQoL. They confirmed the synergetic mediating effects of positive religious coping, perceived social support from family (but not from others sources) and general self-efficacy. Futher exploratory findings revealed that the perceived social support from family buffered the impact of enacted Ebola stigma on HRQoL. If replicated by a longitudinal study, our findings lay a solid foundation for empirical-based community mental health interventions for reducing enacted Ebola stigma and promoting HRQoL during epidemics, especially in the DRC.