Community Mental Health Workers Research Articles

Community mental health work – WHO recommendations and the perspective of people experiencing mental health problems

This article was written in response to the publication by the World Health Organization of a document containing recommendations and a toolkit for promoting mental health and addressing the problems of people with mental disorders (Mental Health Gap Action Programme – mhGAP). The conclusions in the WHO proposal were compared with the perspective of people in mental crisis, which was reconstructed through qualitative research (in the interpretative paradigm). The analysis of the empirical material, which consisted of 35 autobiographical narrative interviews with people who have experienced mental disorders, showed that the WHO proposals correspond to the needs declared by the people struggling with mental problems. The compliance concerns both the expected fields of action (fight against stereotypes, prevention, health promotion) and methods (activities in the residential environment of people in need of support). At the same time, however, the analysis revealed a number of elements worth noting when orienting future community mental health work. These elements include: the increasing role and importance of people experiencing mental disorders in the orientation of action, strengthening community co-creation with people experiencing a mental disorder, moving away from one-sided teaching and training towards collaborative learning.

Cultural issues on accessing mental health services in Nepali and Iranian migrants communities in the UK.

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.

Impact of Jointly Using an e-Mental Health Resource (Self-Management And Recovery Technology) on Interactions Between Service Users Experiencing Severe Mental Illness and Community Mental Health Workers: Grounded Theory Study.

Backgrounde–Mental health resources are increasingly available for people who experience severe mental illness, including those who are users of community mental health services. However, the potential for service users (SUs) living with severe mental illness to use e–mental health resources together with their community mental health workers (MHWs) has received little attention.ObjectiveThis study aims to identify how jointly using an interactive website called Self-Management And Recovery Technology (SMART) in a community mental health context influenced therapeutic processes and interactions between SUs and MHWs from their perspective.MethodsWe conducted a qualitative study using a constructivist grounded theory methodology. Data were collected through individual semistructured interviews with 37 SUs and 15 MHWs who used the SMART website together for 2 to 6 months. Data analysis involved iterative phases of coding, constant comparison, memo writing, theoretical sampling, and consultation with stakeholders to support the study’s credibility.ResultsA substantive grounded theory, discovering ways to keep life on track, was developed, which portrays a shared discovery process arising from the SU-worker-SMART website interactions. The discovery process included choosing to use the website, revealing SUs’ experiences, exploring these experiences, and gaining new perspectives on how SUs did and could keep their lives on track. SUs and MHWs perceived that their three-way interactions were enjoyable, beneficial, and recovery focused when using the website together. They experienced the shared discovery process as relationship building—their interactions when using the website together were more engaging and equal.ConclusionsJointly using an e–mental health resource elicited recovery-oriented interactions and processes between SUs and MHWs that strengthened their therapeutic relationship in real-world community mental health services. Further work to develop and integrate this novel use of e–mental health in community mental health practice is warranted.

Collaborative and scalable training model for rural comunities of La Sierra Madre in Chiapas, México: An opportunity for global mental health in low-middel income areas

IntroductionIn Chiapas, Mexico, it is estimated that 1,356 million people suffer from depression; there are about 210 psychologists (1/24,847 people) and 4 psychiatrists (1/1,304 people). Collaborative task sharing, which engages nonspecialists in mental health care delivery, is essential to address the large global burden of mental illness. The collaborative care model (CoCM), a specific type of task-sharing strategy, incorporates a team-based approach with: a primary care provider (PCP); a behavioral health professional, who is the care manager (CM); and a consulting psychiatrist. CoCM has shown improved outcomes for both mental and general health, expanded access to care, and cost-effectiveness.ObjectivesOur objective is to implement one of the arms of the phased model and CoCM, through supervision and training of health professionals not specialists in Mental Health, in different clinical spaces of community primary care, by specialists.MethodsWe implemented a training program taught by psychiatrists and psychologists for health workers in communities of La Sierra Madre in Chiapas, which includes: training of intern nurses, training and supervision of intern doctors and on-site supervision and training of community mental health workers (CMHW); all undergoing a process of monitoring, evaluation and quality.ResultsOf the patients that were treated (202; 89% women), more than 80% had a diagnosis of anxiety and depression. The most notable clinical improvement (measured with the PHQ-9 depression scale) occurred in the intervention group of CMHW + interns (reduction PHQ-9 58%).ConclusionsThis strategy seems acceptable to address the large gaps in the availability of mental health providers in low-income countries.DisclosureNo significant relationships.

Increasing culturally responsive care and mental health equity with indigenous community mental health workers.

There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental Health Workers’ Perceptions of Risk Factors for Human Trafficking in Nairobi, Kenya: A Preliminary Qualitative Investigation

The researchers of this pilot study conducted three in-depth semi-structured interviews with four mental health workers in Nairobi to obtain a deeper understanding of their perceptions of human trafficking in Kenya. Four themes that increased vulnerability for entrance into the human trafficking trade were identified. Individuals were at increased risk for forced labor exploitation due to socioeconomic factors, traditional African practices, cultural beliefs, and political risk factors. This article provides implications for practice and support for community mental health workers, counselors, and educators working with survivors of human trafficking. Implications for future research and practice are discussed.

Living Six Hours Away from Mental Health Specialists: Enabling Access to Psychosocial Mental Health Services Through the Implementation of Problem Management Plus Delivered by Community Health Workers in Rural Chiapas, Mexico

Living with a mental health condition in rural Chiapas, the southernmost state of Mexico, where adversity, poverty and health in accessibility prevail, make it challenging to reach for mental health services since they are mostly centralised in urban settings, understaffed and underfunded. The Mexican sister organisation of the international non-profit, Partners In Health, has served in marginalised communities in collaboration with the Mexican Ministry of Health and has provided mental health services since 2014. In 2019, community mental health workers began delivering individual Problem Management Plus (PM+) sessions to people with mental health conditions through home visits. This field report aims to share implementation practice findings through the voice of four implementers, two of whom currently deliver PM+, and through two brief case reports. Results show PM+ has had a positive impact on patients’ symptoms and community health workers’ attitudes toward mental health and themselves. However, incompletion of sessions, appropriateness and acceptability of the intervention are issues that implementers still need to tailor to the context. Despite having made adaptations, complex problems such as intimate partner violence, stress due to structural adversity and grief related to the emerging COVID-19 pandemic represent challenges that the intervention needs to address to meet the needs of underserved areas.

Occupational stress, mental health, and self-efficacy among community mental health workers: A cross-sectional study during COVID-19 pandemic.

During the COVID-19, community mental health care workers (CMHWs) faced much heavier workloads, which make them vulnerable to mental problems. This study aims to investigate coronavirus disease-related occupational stress and its single and cumulative effect on mental health and self-efficacy among CMHWs. A quick-response online cross-sectional survey WA conducted during the coronavirus disease outbreak. A total of 536 CMHWs were recruited in March 2020, in China. Demographics, occupational stress, depression, anxiety, positive and negative emotions, and self-efficacy were collected. Logistic regression analysis was employed to test the single and cumulative effect of occupational stress on mental health and self-efficacy. CMHWs did not show high level of depression or anxiety in this study. Those who provided service for suspected people who were quarantined reported higher risk of depression and anxiety. Staying out for more than 3 days was a risk factor of depression while cleaning/sterilising streets or communities was a protective factor of depression. Those who received psychiatric training showed higher positive emotion and self-efficacy, and providing psychological assistance online increased the self-efficacy. CMHWs with two different types of work had 0.996 times more risk of depression than those with only one type of work. The potential cumulative effect of occupation stress suggested that reasonable job assignment and organisational support are necessary safeguards for CMHWs.

Hybrid Telepsychiatry: A United States Perspective with Relevance to India.

Telepsychiatry provides a platform for mental health care delivery in rural and remote areas. Hybrid Telepsychiatry model combines home-based telepsychiatry with domiciliary visits by community mental health workers. This involves use of different modes of teledevices which ensures safe and secure clinical platform. Research evidence supports that incorporating this model seems to use the specialist time efficiently where the resources are limited and services need to be catered for larger geographical community. The current telepsychiatry practice in the United States, specifically the hybrid model, has indisputably shown significant benefits in caring for psychiatric patients. Such valuable clinical model and its relevance to current mental practice and also its application in the Indian scenario can be helpful in providing comprehensive multidisciplinary treatment. This review evaluates and highlights the potential risks and benefits of adopting the hybrid telepsychiatry model in the Indian mental health system.

정신건강복지센터 종사자의 조직몰입에 영향을 미치는 요인에 관한 연구 - 운영형태의 차이를 중심으로 -

본 연구는 정신건강복지센터 종사자를 대상으로 조직몰입에 영향을 미치는 요인을 살펴봄에 있어, 민간위탁형과 보건소직영형의 운영형태에 따른 차이를 비교분석하였다. 연구대상은 서울, 경기소재 정신건강복지센터에 근무하는 종사자를 대상으로 하였으며, 온라인 설문을 통해 수집된 246부의 자료를 최종분석 하였는데, 그 주요 결과는 다음과 같다. 첫째, 운영형태는 조직몰입에 영향을 미치는 유의미한 요인으로써, 민간위탁형 종사자의 조직몰입 수준이 보건소직영형 종사자의 조직몰입 수준보다 높은 것으로 나타났다. 둘째, 민간위탁형 종사자의 근속기간, 임금수준, 기관에 대한 서비스 질 인식수준이 조직몰입에 영향을 미치는 요인으로 확인되었다. 셋째, 보건소직영형 종사자의 나이와 임금수준이 조직몰입에 영향을 미치는 요인으로 확인되었다. 이러한 연구결과를 바탕으로 정신건강복지센터 종사자의 조직몰입을 높이기 위한 사회복지 실천적, 정책적 함의를 논의하였다.

Contributing Factors to Burnout Development in the Community Mental Health Workers

Contributing Factors to Burnout Development in the Community Mental Health Workers

Study Protocol of Brief Daily Body-Mind-Spirit Practice for Sustainable Emotional Capacity and Work Engagement for Community Mental Health Workers: A Multi-Site Randomized Controlled Trial.

BackgroundGiven the emotional demanding nature of social services, we developed a brief daily body-mind-spirit (BMS) program and successfully piloted it with workers at elderly services. The proposed study focuses on community mental health workers who are often under chronic stress and vulnerable to burnout.MethodsThe study aims to evaluate the program for fostering sustainable emotional capacity and work engagement for community mental health workers. A multi-site randomized controlled trial design is adopted. All the 24 the Integrated Community Centre for Mental Wellness (ICCMW of Hong Kong will be approached to join this program. Assuming conservatively, 60% ICCWM (14 centers) will respond and participate. At each site, a pair of intervention and control groups will be run. The targeted total sample size is 224. To investigate the course of changes in burnout and engagement, each group will last 6 months, including 3-month intervention and 3-month follow-up. Measures will be taken at monthly intervals.DiscussionIn light of literature and the pilot trial’s findings, participants in the Brief Daily BMS intervention group are expected to have a reduced burnout level and a narrowing of range in work engagement during the 3 months intervention. And within the 3 months post-intervention period, a rebound of burnout level and a widening of range in work engagement are expected to be observed in the same group of participants. Hopefully, this study will contribute to the deeper understanding of burnout and work engagement, and shed light on sustainable intervention for emotionally demanding workplaces.Clinical Trial RegistrationThe trial has been registered in the Clinical Trials Centre of the University of Hong Kong. HKUCTR-2763 Registered 27 December 2019 – Retrospectively registered, http://www.hkuctr.com/Study/Show/eb930d24e2c647afb7a922055163f24b.

Mental health practitioner experiences of engaging with service users in community mental health settings: A systematic review and thematic synthesis of qualitative evidence.

WHAT IS KNOWN ON THE SUBJECT?: Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. ABSTRACT: Introduction Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals' experiences and understanding of effective engagement have been published. Aim This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners' experiences of engagement in community mental health settings was conducted. Results Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualized person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings.

A time motion study of community mental health workers in rural India

BackgroundCommunity Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve.MethodsA continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation.ResultsHome visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily.ConclusionThe CHW’s are “dedicated” mental health workers as opposed to being “generalists” and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.

Perceptions of Community Involvement in the Peruvian Mental Health Reform Process Among Clinicians and Policy-Makers: A Qualitative Study.

Background: The global burden of mental health conditions has led to the implementation of new models of care for persons with mental illness. Recent mental health reforms in Peru include the implementation of a community mental health model (CMHM) that, among its core objectives, aims to provide care in the community through specialized facilities, the community mental health centers (CMHCs). Community involvement is a key component of this model. This study aims to describe perceptions of community engagement activities in the current model of care in three CMHCs and identify barriers and potential solutions to implementation.Methods: A qualitative research study using in-depth semi-structured interviews with clinicians from three CMHCs and with policy-makers involved in the implementation of the mental health reforms was conducted in two regions of Peru. The interviews, conducted in Spanish, were digitally recorded with consent, transcribed and analyzed using principles of grounded theory applying a framework approach. Community engagement activities are described at different stages of patient care.Results: Twenty-five full-time employees (17 women, 8 men) were interviewed, of which 21 were clinicians (diverse health professions) from CMHCs, and 4 were policy-makers. Interviews elucidated community engagement activities currently being utilized including: (1) employing community mental health workers (CMHWs); (2) home visits; (3) psychosocial clubs; (4) mental health workshops and campaigns; and (5) peer support groups. Inadequate infrastructure and financial resources, lack of knowledge about the CMHM, poorly defined catchment areas, stigma, and inadequate productivity approach were identified as barriers to program implementation. Solutions suggested by participants included increasing knowledge and awareness about mental health and the new model, implementation of peer-training, and improving productivity evaluation and research initiatives.Conclusion: Community engagement activities are being conducted in Peru as part of a new model of care. However, their structure, frequency, and content are perceived by clinicians and policy-makers as highly variable due to a lack of consistent training and resources across CMHCs. Barriers to implementation should be quickly addressed and potential solutions executed, so that scale-up best optimizes the utilization of resources in the implementation process.

Perceived inability to help is associated with client-related burnout and negative work outcomes among community mental health workers.

Community mental health is a vital service, but it faces ongoing challenges from its high staff-turnover rates. The current study provides a preliminary test of a novel explanation for employee disengagement in community mental health. It is proposed that providing assistance to clients, while simultaneously feeling that only limited progress is being made, is associated with client-related burnout among community mental health providers, leading to negative work outcomes. Employees (N=349) from three non-governmental community mental health organisations in Australia completed a survey assessing their perceptions of client improvement from treatment, client-related burnout and a range of organisational outcomes. Analyses revealed that perceptions that clients are not improving was associated with burnout, which in turn is related to lower job satisfaction, decreased job engagement, poorer workplace well-being, and increased turnover intentions. These findings suggest that interventions that highlight positive changes among clients could reinforce the important service provided by community mental health employees and may minimise burnout and negative work outcomes.

Open-door psychiatry and community mental health work

In connection with the UN Convention on the Rights of Persons with Disabilities, mental healthcare concepts increasingly focus on the prevention of violence and coercion. Hospital care with an open-door policy is linked with areduction in violence and coercive measures. The authors describe aspecific therapeutic milieu aiming to promote social resources and to reduce institutional exclusion. Open-door policies can be extended to and tied in with outreach community mental health work. Model projects according to §64b of the German Social Code (SGBV) on interdisciplinary care enable flexible needs-based care including home treatment for severe mental illness.

Comparisons in the attitudes toward suicide among urban residents, lawmakers and community mental health workers in South Korea

The attitudes of the general public and lawmakers toward suicide can influence the degree to which suicide prevention is prioritized in public policymaking. In this study, we compared the attitudes of urban residents, lawmakers, and community mental health workers toward suicide. Urban residents (N = 501) were surveyed through a telephone interview, while self-reported questionnaire was administered by lawmakers (N = 156) and community mental health workers (N = 121) through office visit and post, respectively. We used the Suicide Opinion Questionnaire to measure attitudes toward suicide in all three samples. Both the general public and legislators had insufficient knowledge and more permissive and uncaring attitudes toward suicide, whereas community mental health workers were more inclined to have sufficient knowledge of suicide and more intolerant and caring attitudes towards suicide. Therefore, lawmakers and the general public require education on suicide and suicide prevention, which may help lower South Korea's high suicide rate ranking among the Organization for Economic Co-operation and Development member states.

The implementation of a team training intervention for school mental health: Lessons learned.

Children obtain more mental health services through schools than through any other system. In urban, low-resource schools, mental health care often is provided by teams of contracted community mental health workers. Implementation of intended services may struggle in the context of challenges related to team functioning. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an efficacious approach for improving team functioning in health care. In collaboration with stakeholders, we adapted TeamSTEPPS for school mental health teams and pilot-tested it in 3 schools participating in an ongoing implementation of cognitive-behavioral therapy. In total, 3 teams randomized to receive TeamSTEPPS were compared with 3 teams who did not participate in TeamSTEPPS. Feasibility and acceptability of the adapted TeamSTEPPS and the impact on team skills and behavior were assessed through qualitative interviews and field notes and quantitatively over the course of 1 school year. In this article, we describe the process of adapting and implementing TeamSTEPPS. In addition to providing the researchers' perspective, we illustrate participant perspectives using qualitative data when possible. Key challenges included leader and staff turnover, logistical barriers (e.g., difficulty securing private space for qualitative interviews in schools), and navigating the protection of participant rights and autonomy given that prospective participants were employed by an agency with a vested interest in their participation. Concrete suggestions for overcoming challenges are provided to guide future research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Understanding the needs of LGBTQ clients and their risk for commercial sexual exploitation: Training community mental health workers

Training on commercial sexual exploitation (CSE) and victimization of lesbian, gay, bisexual, transgender, and queer (LGBTQ) youths can increase awareness among professionals who provide services to this community. This study evaluated the effectiveness of a community-based training program geared toward mental health workers in a diverse metropolitan city. The training provided information about the continuum of sexuality and gender identity, sensitivity when working with LGBTQ clients, LGBTQ clients’ risks for CSE, and ways to improve service delivery to this population. Participants’ (N = 64) knowledge level of these areas was examined prior to the training, immediately thereafter, and in a six-month follow-up. Participants showed an increase in knowledge from pretest to posttest. Follow-up testing on a limited sample revealed scores that were lower than posttest scores, but higher than pretest scores. Overall, through this community-based training, participants gained knowledge about the continuum of sexual and gender identity, appropriate service delivery when working with LGBTQ individuals, and the risk factors for CSE for LGBTQ youths. Participants also reported feeling satisfied with the training approach and format. Implications for future training to enhance mental health workers’ competence with LGBTQ victims of sexual exploitation are explored.