Consumers Of Mental Health Care Research Articles

What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study

BackgroundThe purpose of this study was to identify and describe common views of people with lived experience of mental health challenges – consumers and carers, families and supporters – of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care.MethodsParticipants (n = 111) were people living in the state of Victoria, Australia, who identified as consumers of mental healthcare (n = 38); carers, family members and/or supporters (n = 43); or both (n = 30). Factor analysis based on Q-Methodology was used to identify clusters of people who hold similar viewpoints. Common viewpoints were described in terms of the characteristics of the group, and a qualitative interpretation was conducted on the basis of distinguishing statements and quotes provided in participants’ own words.ResultsWe identified four common views: (1) safety before all else, prioritizing physical, sexual and psychological safety; (2) hope and partnership in processes of care; (3) physical and emotional health and wellbeing; and (4) care access, continuity and partnership with families. Although different priorities were identified for each viewpoint, key priority areas that were common to all views were having an environment in the health service that fosters respect and dignity, and that consumers feel heard and listened to. In sub-group and qualitative analyses, differences were observed regarding the likelihood of consumers and carers holding each of the views, as well as by age group.ConclusionsWhile some differences were noted between the views of consumers and carers and different age groups, there was also common ground regarding what outcomes are of most importance to measure. Including these measures in evaluation frameworks would provide a way of focussing mental healthcare decisions on the aspects of mental healthcare that are of most value to consumers and carers, thereby addressing an important shortcoming of current approaches to decision-making in mental healthcare.

Mental Healthcare Consumers' Experiences of Mental Health Care: Variation in Knowledge by the Family Members and Support.

Knowledge and support by members of the family towards the care of the consumers of mental health services is the core priority and is noticeable by the users as it gives and eases the life of the users during therapy and rehabilitation. However, there have been documented instances of families that neglect their relatives with mental illnesses. This study explored the experiences of mental healthcare consumers regarding family members' knowledge of mental disorders and support. Participants who were granted leave of absence were selected through nonprobability, purposive sampling. Data were collected using face-to-face unstructured discussions. Data were analyzed using Colaizzi's technique. Findings revealed misconceptions versus insight on the cause of mental disorders, knowledge deficit on the effect of treatment, poor support from family members, financial challenges perceived as a source of poor support, and lack of psychological support and its consequences. Mental healthcare consumers verbalized limited support from family members. They reported variation in terms of family members' knowledge of their mental condition. Training family members on mental health illness is critical to the future of health care as there will be no misunderstanding between them and the consumers of mental health care. Healthcare consumers' feelings of sadness and anxiety could be avoided by avoiding conflicts over their social grants. The government should invest in assisting family members of mental healthcare consumers.

In-Depth Co-Design of Mental Health Monitoring Technologies by People with Lived Experience

Advancements in digital monitoring solutions collaborate closely with electronic medical records. These fine-grained monitoring capacities can generate and process extensive electronic record data. Such capacities promise to enhance mental health care but also risk contributing to further stigmatization, prejudicial decision-making, and fears of disempowerment. This article discusses the problems and solutions identified by nine people with lived experience of being mental health care consumers or informal carers. Over the course of ten facilitated focus group format sessions (two hours) between October 2019 and April 2021, the participants shared their lived experience of mental health challenges, care, and recovery within the Australian context. To support the development, design, and implementation of monitoring technologies, problems, and solutions were outlined in the following areas—access, agency, interactions with medical practitioners, medication management, and self-monitoring. Emergent design insights include recommendations for strengthened consent procedures, flexible service access options, and humanized consumer interactions. While consumers and carers saw value in digital monitoring technologies that could enable them to take on a more proactive involvement in their personal wellness, they had questions about their level of access to such services and expressed concerns about the changes to interactions with health professionals that might emerge from these digitally enabled processes.

Deinstitutionalisation and mental health activism in Australia: emerging voices of individuals with lived experience of severe mental distress, 1975–1985

Starting in the 1960s, large numbers of patients in Australia’s mental hospitals were released even though hardly any support services were available in the community. By the 1970s, a small number of psychiatrists, psychologists, social workers, volunteers, and consumer advocates were building alliances and coalitions with each other and with politicians and health bureaucrats to realise change. Using archival records and interviews as sources, we analyse how, in the early 1980s, Simon Champ, Meg Smith, and Janet Meagher, three pioneering Australian consumer advocates, started to speak out and influence discussions about mental health policy. They were also invited to join boards of non-government organisations in mental health care, foreshadowing later developments. Today, the participation of consumers of mental health care in mental health services is taken for granted and mandated, and most services have consumer advisory groups.

Consumers' Suggestions for Improving the Mental Healthcare System: Options, Autonomy, and Respect.

While the mental healthcare-consumer voice has gained in legitimacy and perceived value, policy initiatives and system improvements still lack input from consumers. This study explores consumers' suggestions for improving the mental healthcare system. Participants (N = 46) were conveniently recruited and responded to an online survey asking: "What are your suggestions for improving the mental healthcare system?" Eight themes were identified using iterative, inductive and deductive coding. Themes included treatment options, autonomy and empowerment, respect and relationships, medication management, peer support, insurance and access, funding and government support, and treatment environment. Theoretically, there is interdependence among themes where five of the themes are foundational for the three main themes (i.e. treatment options, autonomy and empowerment, respect and relationships). Findings suggest that consumers see the need for improvement in patient-centered care. While access is the focus of much mental healthcare policy discussions, the ultimate goal should be provisioning person-centered mental healthcare.

Perceptions of mental health care consumers regarding their conditions

BackgroundDistress is experienced, understood, expressed and communicated differently across various cultures. Individuals assign meaning to their mental health problems from their own personal, social and cultural context. Mental healthcare consumers (MHCCs) often attribute their symptoms to a cultural or spiritual cause, and as a result, tend to visit spiritual or traditional healers before attending psychiatric units.AimThe aim of the study was to determine patients’ perspectives on mental health – what they perceived to be the cause of mental problems and what they believed the most appropriate treatment options would be. The role of culture, religion and spirituality in patients’ understanding of and coping with mental problems was explored, as well as their attitudes toward their treatment and the perceived effectiveness and appropriateness of the different treatment modalities.MethodsA quantitative survey was done using a questionnaire designed to explore and analyse patients’ cultural and religious beliefs about mental illness and the actions they take in their search for recovery from mental disturbances. The questionnaire was compiled by incorporating demographic information, together with certain items of the World Health Organisation Quality of Life Spiritual, Religious and Personal Beliefs questionnaire, the Cultural Formulation Interview, the Rating of Medication Influences Scale, and the South African Traditional Beliefs Scale.ResultsNinety-four patients (58.5% male) were included in the study, with a mean age of 36 years. The majority of the participants (75.5%) were black people; most were Christian (79.8%), followed by African traditionalists (17.0%), and 41.4% indicated that they were actively involved in their religious communities. Although most (72.0%) believed that faith in God and help from religious leaders (34.4%) could contribute to their mental wellbeing, 29.0% reckoned that keeping their ancestors happy would protect them from sickness and bad luck. Approximately one quarter (22.3%) believed that traditional medicine could be the only cure for mental illness related to bewitchment, and 29.0% believed that Western medicine could worsen such problems. Roughly a third of participants (30.9%) were of the opinion that Western medicine cannot cure mental illness caused by angry ancestors.ConclusionThe impact cultural and religious belief systems have on MHCCs’ perceptions of mental illness has been demonstrated and appeals to the availability of accepta ble mental health care services. Mental healthcare providers’ sensitivity to cultural and religious beliefs will enrich the therapeutic relationship; hence healthcare providers should receive training focusing on the influence these belief systems have on patients’ perceptions of mental illness and their consequent help-seeking behaviour. Likewise, findings of the current study suggest a need for the incorporation of complementary and alternative treatment strategies in the rendering of mental healthcare services. Such inclusion acknowledges MHCCs’ preferences and may reduce the time required to obtain remission and recovery. Although its application has limitations, future research may provide useful insight for the formulation and implementation of interventions that MHCCs believe to be effective.

The “religiosity gap” in a clinical setting: experiences of mental health care consumers and professionals

ABSTRACTIn Western countries, professionals in mental health care (“professionals”) tend to be less religious than “consumers”. This qualitative study explores the meaning of this “religiosity gap” for professionals and consumers in mental health care. Both a regular, secular and a Christian clinic in the Netherlands participated in this study. Content analysis was applied to 35 consumer interviews and 18 interviews with professionals. Consumers reported negative experiences (e.g., perceived disrespect and a lack of confidence) and/or negative expectations (e.g., misunderstanding and misinterpretation) related to a religiosity gap. They also mentioned advantages of a “religiosity match”, like safety and confidence and appreciated professionals’ religious/spiritual self-disclosure. Professionals in secular care setting tended to avoid religion and spirituality. In both clinics, they tended to neutralise religious/spiritual differences and be reticent in self-disclosure. Professionals are recommended to recognise the relevance of a religiosity gap and to consider different strategies in approaching religion/spirituality.

Elderly Mental Health in Developing Countries

Geriatric Psychiatry deals with specific issues and challenges that arise in the assessment and management of mental health problems in elderly. As a specialty it has not received much attention in developing countries until recently. Elderly will soon be major consumers of mental health care in developing countries. Common psycho-social issues among the elderly and their impact on the mental health in the developing regions of the world and the complex interplay between physical health and mental health in the elderly are described. Dementia and depression are described in some detail focussing on relevant research to highlight the challenges in developing countries. Potential solutions to address the challenges of elderly mental health in developing countries are discussed.

Elderly Mental Health in Developing Countries

Geriatric Psychiatry deals with specific issues and challenges that arise in the assessment and management of mental health problems in elderly. As a specialty it has not received much attention in developing countries until recently. Elderly will soon be major consumers of mental health care in developing countries. Common psycho-social issues among the elderly and their impact on the mental health in the developing regions of the world and the complex interplay between physical health and mental health in the elderly are described. Dementia and depression are described in some detail focussing on relevant research to highlight the challenges in developing countries. Potential solutions to address the challenges of elderly mental health in developing countries are discussed.

Mental health care consumers' relative valuing of clinician performance information.

Research demonstrates significant variability in mental health clinicians' overall and domain-specific effectiveness with their patients. Despite calls to increase patient access to performance information, little is known about patients' relative valuing of this information in the context of other treatment factors. We aimed to obtain an understanding of patients' relative valuing of provider performance track records and other therapist and treatment characteristics for their mental health care decision making. Participants were 403 (Mage = 41.20; 66.5% female) community mental health patients who completed a multicomponent survey that included an adapted delayed-discounting paradigm to examine the relative valuing. Multiple descriptive, quantitative indices of relative valuing were calculated, as well as an exploratory latent profile analysis to ascertain the presence of homogenous relative-valuing subgroups. Overall, participants valued provider track record information. They also evidenced relatively higher preference values for working with therapists who had specific efficacy in treating their primary problem domain, charged less, and with whom there is a high likelihood of establishing a good alliance. Two latent profiles were identified: one representing higher valuing of provider performance and another consistently representing less emphasis. Participants with higher track-record valuing were younger, believed that therapists are not interchangeable, and endorsed trust in the collection and use of performance information. Harnessing clinician information to make more personalized and informed treatment decisions could potentially promote better treatment engagement, retention, and outcomes. (PsycINFO Database Record

Supplemental Material for Mental Health Care Consumers’ Relative Valuing of Clinician Performance Information

Supplemental Material for Mental Health Care Consumers’ Relative Valuing of Clinician Performance Information

Perceptions of mental healthcare consumers regarding their conditions

ABSTRACTDistress is experienced, understood and communicated differently across various cultures. The aim of the study was to investigate the role of culture, religion and spirituality in patients’ understanding of and coping with mental problems. A quantitative survey was done at a psychiatric institution. A questionnaire was designed to explore patients’ cultural and religious beliefs about mental illness, and how these beliefs and perceptions influenced their actions in search for recovery. Questionnaires were completed by 94 patients. The majority of participants were Christian (79.8%), followed by African traditionalists (17.0%). Seventy-two per cent believed that faith in God, and 34.4% that help from religious leaders, could contribute to mental wellness. Approximately a third (29.0%) believed that by keeping their ancestors happy, they would be protected from sickness and bad luck. Mental healthcare providers’ sensitivity to cultural and religious beliefs will translate into a more comprehensive management plan, ensuring a satisfying therapeutic relationship.

Provider behaviors or consumer participation: How should we measure person-centered care?

Current research has found that higher rates of person-centered care (PCC) are associated with greater treatment adherence and positive treatment outcomes. However, the instruments used to access PCC primarily collect data on provider behavior, rather than consumer participation in PCC, despite the necessary co-equal and collaborative nature of PCC interactions. The objective of the current study was to test the hypotheses that: (1) the Perceived Involvement in Care Scale (PICS) consumer information subscale and the consumer decision making subscale are not correlated with the PPPC subscales and, (2) consumer perceptions of person-centeredness and of consumer involvement in care are significant independent explanatory variables for the theoretically or quantitatively grounded outcomes of therapeutic alliance, treatment adherence, and mental health care system mistrust. Cross-sectional survey data was collected from 82 mental health care consumers receiving services at two Veterans Health Administration (VHA) facilities. Participants completed surveys on perceptions of PCC, consumer involvement in care, therapeutic alliance, medication adherence, and mental health care system mistrust. Significant correlation between the consumer participation and PCC subscales was mixed. Higher levels of PCC were associated with greater therapeutic alliance, less suspicion of mental health care systems, less perception of lack of support from providers, and less beliefs about group disparities in care. Consumer involvement was only significantly related to suspicion of mental health care systems. These findings may be a function of the locus of each outcome variable. When conducting PCC research investigators should consider how the outcomes they are examining inform the method through which they measure patient-centeredness.

Is Telemental Health Services a Viable Alternative to Traditional Psychotherapy for Deaf Individuals?

Access to mental health treatment is a vital part of a comprehensive health care plan. Deaf individuals often have difficulty accessing mental health services. Four-hundred twenty-two participants completed an anonymous questionnaire about their perspectives of telemental health services for deaf individuals. Results showed that several variables, such as if the participant was unable to receive another type of psychotherapy and whether the therapist was ASL-fluent, were significantly related to whether the respondent would use TMH. The participants reported that TMH services are a viable option for treating a variety of mental health issues. Telemental health services can act as a bridge between consumers of mental health care and their providers allowing accessible and equitable healthcare opportunities.

Building mobile apps for underrepresented mental health care consumers: A grounded theory approach

ABSTRACTCell phone mobile application (“app”) use has risen dramatically within the past several years. Many individuals access apps to address mental health issues. Unlike individuals from privileged backgrounds, individuals from oppressed backgrounds may rely on apps rather than costly mental health treatment. To date, very little research has been published evaluating mental health apps’ effectiveness. This article focuses on three methods through which grounded theory can facilitate app development and evaluation for people underrepresented in mental health care. Recommendations are made to advance mobile app technology that will help clinicians provide effective treatment, and consumers to realize positive treatment outcomes.

Promoting Health and Behavioral Health Equity in California.

Behavioral health disparities are not usually considered part of the same system of health disparities. However, the California Department of Public Health focused its health equity strategies on reducing behavioral health disparities through its California Statewide Plan to Promote Health and Mental Health Equity. This statewide plan was developed through a community-wide stakeholder engagement and outreach process. In addition, the California Reducing Disparities Project is a prevention and early intervention effort to reduce mental health disparities in underserved populations. This strategic plan represents the voice of several racial/ethnic communities, such as African American, Asian and Pacific Islander, Latino, Native American, as well as lesbian, gay, bisexual, transgender, and queer and questioning communities in California, through 5 strategic planning workgroups. The workgroups were composed of a broad range of stakeholders, including community leaders, mental health care providers, consumer and family members, individuals with lived experience, and academia. This case example highlights the various efforts of California's Office of Health Equity in eliminating behavioral health disparities and promoting mental health equity, as well as discusses the unique statutory and regulatory role of the Office of Health Equity's deputy director.

호주의 국가정신보건전략을 통한 정신보건개혁과 융복합 정책적 함의

본 논문은 호주의 국가정신보건전략에 대한 주요 내용과 국가정신보건전략을 통한 정신보건개혁 이후의 변화들, 그리고 정신보건개혁에 대한 논의를 통해서 우리나라의 정신보건정책의 문제점들을 개선하기 위한 현실적인 시사점과 융복합 정책적 함의를 찾는데 그 목적이 있다. 1992년에 발표되어 2008년에 개정된 국가정신보건정책, 1993년부터 2014년까지 네 차례에 걸쳐 수립된 국가정신보건 5개년 계획, 2006년 호주정부협의회에 의해 수립된 정신보건실행계획, 그리고 2012년 호주정부협의회에서 채택한 국가정신보건개혁을 위한 로드맵(2012-2022)을 포함한 국가정신보건전략은 지난 20년 동안 호주의 정신보건개혁의 광범위한 과정을 선도하는 대단히 중요한 정책 준거를 제공하였다. 1992년 시작된 국가정신보건전략을 통해서 정신보건재정 확충, 지역사회 중심의 치료 및 보호시스템 구축, 정신병상의 변화, NGO의 참여와 역할의 증대, 정신장애인과 가족(보호제공자)의 참여 확대 등과 같은 변화를 이루었다. This study aims to understand main contents of the National Mental Health Strategy and changes after mental health reform through the National Mental Health Strategy in Australia, and to find some convergence policy implications on mental health policy in South Korea. The direction of reform has changed considerably over the 20 years that the National Mental Health Strategy has been in place including the National Mental Health Policy(1992, 2008), the National Mental Health Plan(1993~2014), COAG National Action Plan on Mental Health(2006~2011), the Roadmap for National Mental Health Reform 2012-2022. The National Mental Health Strategy has advocated fundamental change in the national spending on mental health, mental health service provision, the expansion of community-based mental health services and care system, NGO, consumer and carer participation in mental health care.

EPA-1115 - Psychiatrists and mental patients, looking for the bridges

The incidence of mental disorders is constantly growing. In Russia ca 15-20% of population need treatment and only 5-5.5% get or apply for it. Therapeutical possibilities of the modern psychotropic drugs have achieved their limits. The use of new medicines didn't increase dramatically the therapy adherence rate. Psychosocial issues are still neglected in daily practice. In the beginning of treatment we have to define the subjective meaning of illness for patient. Here phenomena of stigmatization and selfstigmatization play an important role. Self-stigmatization is generally defined as patients reaction to his illness and attitude to mentally ill in the society, also as a result of appliance to one's self the environmental stereotypes. Self-stigmatization brings about the change in relationship system, conception of illness. Psychiatry itself also suffers from mythologisation, stigmatization and social and professional isolation. Conclusion of the survey made by Russian Psychiatric Association was that majority of professionals as well as mental health care consumers. Responders in both groups revealed less than average satisfaction of mental health care system. In spite of the same opinion about there are still a lot of obstacles on the way to productive cooperation. In the Bekhterev Institute a complex treatment model was researched in a study of 312 patients. The combination of pharmacotherapy, psychotherapy psychoeducative programs and psychosocial interventions were proved to be more effective, than just use of pharmacotherapy with psychoeducative course. In our model we divide 6 stages with different ratio between methods mentioned above in accordance with the state of patient.

1195 – Psychiatry in russia today. social dimension

Mental health is the fundamentals of intellectual, creative, productive and defense capability of the nation. According to the Russian health ministry evaluation about 15-20% of population need mental health care services and only about 5-5.5% really get it. Psychiatry today can be defined as stigmatized, suffering from social and professional isolation medical discipline. We have to take it seriously the strong influence of psychiatric mythology, stigmatization and self-stigmatization are the other parts of social and social-psychiatric reality, defining the patient decision to cooperate with psychiatrists. The survey made by Russian Psychiatric Association revealed that majority of professionals as well as mental health care consumers are not satisfied with mental health care system in Russia today. Reorganization of social consciousness is one of the main challenges for psychiatry today. The following steps have to be done. Rebuilding of the mental health care system on the voluntary principle, with legislative definition of the involuntary hospitalization in the patient interests. Systematic educative work is necessary. The discrepancy between the defined by mythology expectations and psychiatric reality has to be overcome in the work with patients and their relatives. Mandatory is not only radical restricting of the mental hospital functioning, but also development of various with differentiated services outpatient mental health care facilities, including the organization of the so-called outer dispensaries mental health services in general medicine institutions. It is necessary to develop and widen psychotherapeutic and social services, providing the mental health services at the different stages of patient treatment and observation.

Treatment Resistant Depression: A Roadmap for Effective Care

Back to table of contents Previous article Next article Book ReviewsFull AccessTreatment Resistant Depression: A Roadmap for Effective CareElizabeth A. Jensen, M.D., Ph.D.Elizabeth A. JensenSearch for more papers by this author, M.D., Ph.D.Published Online:1 Aug 2012https://doi.org/10.1176/appi.ps.20120p837AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Treatment Resistant Depression: A Roadmap for Effective CareGredenJohn F.M.D.RibaMichelle B.M.D., M.S. and McInnisMelvin G.M.D.; Washington, D.C., American Psychiatric Publishing, 2011, 364 pages, $69The book Treatment Resistant Depression: A Roadmap for Effective Care was edited by three experts from the University of Michigan's Comprehensive Depression Center. It aims to summarize and educate on recent advances in treatment-resistant depression. In many ways, it is a continuation of Treatment of Recurrent Depression, edited by Greden in 2001. Both books call for advancements in research to address the disability and cost burdens associated with depression, particularly over the course of a lifetime of intermittently treated symptoms. Treatment-resistant depression is defined as “failure to achieve remission after two evidence-based antidepressant treatment courses known to have been of acceptable dose and duration.” The book suggests that rapid recognition and assertive treatment earlier in the disease, rather than later, are critical in managing depressive symptoms. There is a focus on chronicity of illness and on self-management of depressive symptoms.Several authors with years of expertise in treating mood disorders contribute chapters on various topics, including pharmacotherapy for depression, psychotherapy for depression, approaches to sleep hygiene, nutrition, concomitant substance abuse, and medical comorbidities. Treatment-resistant depression is examined in multiple populations, with separate chapters devoted to adolescents, college students, pregnant women, and the geriatric population. Each chapter is written by a different set of authors with different styles, leading to a mosaic of topics. For the most part, the book maintains its focus in proposing multiple treatment modalities in different populations. However, the chapter on the medical care model for bipolar disorder is discontinuous with the treatment-resistant depression theme and would have been better placed in a separate volume.Given that the authors originate from the University of Michigan, a strong research university and authority on electroconvulsive therapy (ECT), there is a heavy focus on evidence-based medicine guided by research, as well as a chapter containing detailed information on the use of ECT and neuromodulation to treat depression. There is a well-written chapter on psychotherapy, but in the context of the book as a whole, this approach is underemphasized. There is an interesting and informative chapter on the role of peer support and community resources for individuals suffering from depression and a concise and easily understandable chapter focusing on the genetics of mood disorders—an important area of development in depression research. The book is well referenced and has a comprehensive and organized index.The book is complete and accurate; however, it is rather dry and not stimulating to read. Instead of feeling motivated to use these treatment algorithms, I quietly filed away the information and looked forward to the next vignette. The case vignettes are very enlightening, and I would have liked to see more of these. The Key Clinical Concepts sections are useful summaries and may be all a busy clinician has time to read. Overall, I am glad to have the material as a reference and will remember various points to benefit the patients I treat.This book would be most useful to psychiatrists, psychiatric residents, and medical students. More specific information on therapy would make the book more useful to psychologists, social workers, and other therapists. For consumers of mental health care and legislators, this book may not be a good starting place to understand this complicated, debilitating, and multifactorial set of illnesses. A more patient-centered book with more illustrations, first-person accounts from patients, and details about how individuals utilized their roadmap toward achieving health would be more appropriate for this audience. Graphics in each chapter depicting individuals with treatment-resistant depression would have breathed life into the information presented.In summary, this volume is a good start for addressing the dearth of information available on treatment-resistant depression. It is well referenced and complete and contains summaries of critical research studies. It will be helpful for psychiatrists and psychiatrists in training. In the next edition, the inclusion of more illustrations and a more patient-centered approach could greatly expand the audience who would benefit from this highly informative book.Dr. Jensen is a fourth-year psychiatry resident at Tulane University, New Orleans, Louisiana.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited byNone Volume 63Issue 8 August 2012Pages 837-837 Metrics PDF download History Published online 1 August 2012 Published in print 1 August 2012