Experience Of Serious Mental Illness Research Articles

Health and social care professionals' views and experiences of supporting parents with serious mental illness.

A significant number of individuals with a serious mental illness (SMI) such as schizophrenia or bipolar disorder are also parents of dependent children. Despite the risk of adverse psychological, behavioral, and social outcomes their needs often go unmet. To better understand the needs of parents with SMI and their children it is necessary to gain insight into the perspectives and experiences of the professionals in adult mental health and children's services who work with them, and who, ultimately, are best placed to meet those needs. To explore the views and experiences of health and social care professionals working with parents with SMI to understand the needs of, and their role supporting, parents with SMI and their children. Semi-structured interviews were conducted with seventeen professionals from six NHS and Local Authority settings in England, UK. Participants were included if they were employed in adult mental health or local authority children's services and had experience of working with parents with SMI. Sampling was purposive, including a wide range of professions in these settings. Interview data were analyzed using template analysis taking a critical realist perspective. Three top-level themes were generated: (1) Impact of parental SMI on the child, (2) Accessing support from services, (3) Role of professionals working with parents with SMI. Themes highlight diverse, wide-ranging effects of SMI on the child and a reluctance from parents to seek help due to stigma and fear. Available services are reported to be inaccessible and unacceptable to parents with SMI and practitioners experience conflict when balancing the needs of the parent and child. A whole-family approach facilitated by improved communication between services is advocated. Participants believed that parents with SMI experience complex parenting challenges over and above other parents, describing a largely detrimental impact on the child. Support services were deemed inadequate, and participants stressed the need to develop specialist services tailored toward the needs of parents with SMI and their children. Although participants endorsed joined up working across health and social care settings to facilitate a whole family approach, they required greater service knowledge and training in parental SMI.

BRIDGE: A randomized trial of person-centered collaborative care for adults with serious mental illness (SMI) and newly diagnosed cancers.

216 Background: Individuals with SMI experience increased cancer mortality due to inequities in cancer care. Proactive psychiatry care may improve cancer care outcomes for patients with SMI, yet access to mental health care remains inadequate. The BRIDGE trial assessed the impact of person-centered collaborative care vs enhanced usual care (EUC) on cancer care disruptions for adults with SMI and newly diagnosed cancers. Methods: Eligible patients had SMI (schizophrenia spectrum, bipolar, or severe major depressive disorders) and potentially curable head/neck, lung, breast, or gastrointestinal cancers. Patients were randomized 1:1 to BRIDGE (person-centered collaborative care: proactive psychiatry consultation, linkage to a social work/navigator team, and co-management with oncology across care settings) or EUC (proactive identification at cancer diagnosis using an algorithm to inform the oncology team of the SMI diagnosis and patient of psychosocial resources). The primary outcome was clinically significant cancer care disruptions over 24 weeks (delays in treatment initiation, deviations from guideline-concordant care recommended/received, or interruptions in planned cancer treatment). Oncologists blinded to intervention arm determined the presence of disruptions (yes/no) using NCCN guidelines; discrepancies were resolved by a consensus panel. Secondary outcomes included psychiatric illness severity according to the Brief Psychiatric Rating Scale (BPRS), Clinical Global Severity (CGI), and depression/anxiety measures (Patient Health Questionnaire [PHQ] 9, Generalized Anxiety [GAD] 7) at 24 weeks. The rate of disruption was compared using Fisher’s exact test, and secondary outcomes were compared using ANCOVA and logistic regression. Results: From May 2019-December 2021,120 of 141 eligible patients enrolled in the trial. Participants had a mean age of 63 years, were 65% female, 87.5% reported White race, 52.5% had income <25,000, 51.7% had Medicaid, 38.3% were on disability, 39.4% reported current smoking, and 49% reported past/current substance use disorder. Patients assigned to BRIDGE were significantly less likely to experience cancer care disruptions compared to those receiving EUC (17.2% vs 35.1%, p=.035). BRIDGE patients had significantly improved psychiatric illness severity and anxiety (BPRS: 31.91 vs 36.65, p=.02; CGI: 15% vs 25%, p=.02; GAD: 4.86 vs 6.86, p=.02) compared to EUC patients. Differences in PHQ were not significant (6.62 vs 7.72, p=.28). Conclusions: In this randomized trial of person-centered collaborative care for adults with SMI and cancer, the BRIDGE intervention led to significantly fewer disruptions in cancer care and improvement in psychiatric illness severity. Findings support the need for multi-site trials that include community settings to enhance generalizability. Clinical trial information: NCT03360695 .

The ambiguities of social inclusion in mental health: learning from lived experience of serious mental illness in Ghana and the occupied Palestinian territory

PurposeSocial inclusion of people living with serious mental illness is widely promoted. However, only limited consideration has been given to the meanings of social inclusion within different settings and the ways in which it is envisioned, negotiated, and practised. In this paper, we explore meanings and practises of social inclusion from the perspectives of people living with serious mental illness and their families in Ghana and Palestine and how this is shaped by differing political and socio-cultural contexts.MethodsThis paper draws on comparative ethnographic research including participant observation and interviews with people living with mental illness and family members in Ghana and the occupied Palestinian territory. Data were triangulated and analysed using thematic analysis.ResultsParticipants described experiences of social inclusion and participation within communities, home and family life, friendships and social life, and work and livelihoods. This revealed how such experiences were variously shaped by differing political contexts and socio-cultural norms and expectations within the two settings. These in turn intersected with aspects such as gender roles, age, and socio-economic status. Aspirations for inclusion included greater awareness and understanding within society, accompanied by opportunities and support for meaningful inclusion at the political as well as community level.ConclusionFindings point to the value of a contextual understanding of social inclusion, taking account of the impact of the wider socio-cultural, political, and economic environment. They also point to the need for an intersectoral approach, beyond communities and mental health services, to provide meaningful opportunities and support for social inclusion.

Dual Relationships in Mental Health Peer Support.

Mental health peer support is a growing care modality; yet, understanding is limited regarding the ethical complexities that distinguish it from clinical mental health services. In particular, clinicians in mental health care do not navigate boundaries in the same way as peer workers, whose relationships with clients are notably different and may include interactions with clients outside designated support programs ("dual relationships"). Drawing on data from ongoing qualitative research, two researchers with lived experience of serious mental illness highlight the implications of dual relationships for both peer practice and research.

Formal peer-support services that address priorities of people with psychiatric disabilities: A systematic review.

Formal peer-support services are provided by people with shared lived experience of serious mental illness and recovery to help others with psychiatric disabilities address their priorities in, among other things, transitioning from hospitals, dealing with physical health, and illness management/recovery. This article summarizes a systematic review of the impact of formal peer services on these priorities. We used PRISMA Guidelines to review the existing research literature from 1995 to 2020; the first wave of our review yielded 424 studies which were then reduced to 68 quantitative investigations included for coding and syntheses. A graph of the trajectory of published articles per 5-year period showed a steady increase up to 2015 when the frequency of studies then leveled out. Using randomized controlled trials (RCTs) as one index of design quality, we found more than two-thirds of studies included an RCT. We used inferential analyses based on primary impact as defined by hypotheses as outcome indicator. Four of 68 studies suggested iatrogenic effects of peer services related to hospitalization, physical quality of life, and employment. A frequency of significant positive benefits for outcome ranged from 46.2% to 100% of findings. Future research should seek to identify personal-level factors that indicate greater benefits for peer support; this provides direction for tailoring the intervention. Personal-level variables include the role of diversity and social disadvantage in the benefits of formal peer-support programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Serious Mental Illness Exacerbation Post-Bereavement: A Population-Based Study of Partners and Adult Children.

PurposeThe death of a close family member is commonly accompanied by intense grief, stress, and loss of social support. We hypothesized that recent bereavement would be associated with an increase in symptom exacerbations among adults with serious mental illness (SMI) whose partners or parents had died.Patients and MethodsAdults whose partners and parents had died in Denmark between January 1, 2010, and June 30, 2016, were identified using linked population-based registries. History of SMI was defined as having a diagnosis of schizophrenia and schizoaffective disorders, major depression, and bipolar disorder in the five years preceding their family member’s death in the Danish Psychiatric Central Research Register using International Classification of Diseases-10 codes. The odds of SMI exacerbation (ie, attempt or completion of suicide or psychiatric hospitalization) among partners and children in the first two years after death in 3-month intervals were estimated with generalized estimating equations.Results12.8% of partners and 15.0% of adult children with a history of SMI experienced any SMI exacerbation two years after bereavement. Among bereaved partners, older age (80+ years) was associated with a lower risk of experiencing an SMI exacerbation compared with partners aged 18–49 years (ORadj=0.29, [0.18–0.45]). Partners with a history of SMI had significantly increased odds of SMI exacerbations three months after their partners’ death compared to prior to their partners’ death (ORadj = 1.43, [1.13–1.81]). There was no evidence that adult children with SMI experience increased SMI exacerbations after the death of their parents compared to prior to death.ConclusionAdults with a history of SMI whose partners had died are at increased risk for an SMI exacerbation post bereavement. Additional bereavement resources and support should be provided to those with a history of SMI, especially in the period immediately after death.

Investing in a Research Workforce With Personal Experience of Serious Mental Illness

This Viewpoint argues that the involvement of individuals with lived experiences of psychosis in research leadership positions has the potential to innovate and advance the treatment of individuals with serious mental illness.

Serious mental illness in healthcare and academia: A lived experience.

WHAT IS KNOWN ON THE SUBJECT?: There are individuals living with serious mental illness in both healthcare and academia. The high stress nature of these fields can worsen or trigger mental illness, burnout, moral injury, and compassion fatigue in employees. Mental health nurses have the needed skillset to foster change in these settings. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper describes the holistic experiences of a nurse faculty member living with serious mental illness and highlights lessons learned in both healthcare and academic settings. In addition to insights from the experience, the paper also shares suggestions for moving forward, reducing burnout, and supporting employees in these fields. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This lived experience narrative showcases the effect that high-pressure occupations have on individuals with serious mental illness. Mental health nurses have the training and experience to transform the experiences of employees in healthcare and academia. Through assessment, deep listening, and powerful questioning, these nurses in partnership with the employees themselves can design and implement interventions that have a lasting impact for these populations. ABSTRACT: Introduction First-hand accounts from clients living with mental health challenges deepen provider understanding and offer direct insight into the lives of those with chronic mental illness. There is a gap in the literature surrounding the lived experience of serious mental illness in the professional setting. Aim This narrative outlines the challenges and opportunities for those living with serious mental illness in healthcare and academia. Methods The author reviewed personal journals and reflected upon her years as both a nurse and faculty member to highlight the experience of living with serious mental illness in these professions. Findings These high-pressure fields place inordinate demands on faculty and staff; yet, there are few organizational supports in place for employees. Despite the push to improve resiliency and ease burnout, healthcare organizations and academic institutions still struggle to identify the best interventions and methods of support for staff. Discussion Mental health nurses and nurse coaches are uniquely positioned to ease this burden and help create inclusive workplaces for those with serious mental illness.

Rapprochement and Reform: Overcoming Factionalism in Policy Making for Serious Mental Illness.

This article traces the history of factionalism in policy making and advocacy for persons with serious mental illness from deinstitutionalization to the present. The authors draw on deliberative democratic theory to illustrate how factionalist advocacy causes advocates and policy makers to fail in their duties to represent and develop policy in support of people with serious mental illness. The authors discuss how this factionalism has bred distrust and undermined efforts to address the needs of people with serious mental illness. They propose the formation of a Public Mental Health Policy Commission, guided by principles of deliberative democracy, to overcome factionalism and to improve policy making to meet the needs of people with serious mental illness. The commission must include a diverse array of stakeholders, especially individuals with lived experience of serious mental illness.

Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis

AimsTo systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.

Factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS): A study on persons with serious mental illness living in the community

ObjectivesResilience, the ability to bounce back from a stressful situation, is a valuable asset for aiding adults with serious mental illness (SMI) in navigating the recovery process. People with SMI experience stress, including traumatic experiences at disproportionate rates. The purposes of this study were to examine the factor structure, internal reliability, and construct validity of the Brief Resilience Scale (BRS) among adults with SMI living in the community.DesignA cross‐sectional survey design was used. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlational analyses were employed.MethodsThree hundred fifteen adults with SMI were recruited for two studies (Sample 1, n = 122; Sample 2, n = 193) from three states. All participants completed the BRS along with nearly identical positive psychology‐ and psychopathology‐related measures.ResultsEFA revealed the BRS was unidimensional and explained 61.20% of the variance. Results from seven CFA models suggested a bifactor structure for the BRS, which fit the data best. Internal reliability of the BRS was computed to be within acceptable ranges (α = .87, ω = .90). The BRS was positively correlated with measures of positive coping and life satisfaction, providing convergent validity. Divergent validity was supported by negative correlations between the BRS and measures of psychiatric symptoms, succumbing, and self‐stigma.ConclusionsThe BRS is a valid measure that can be used by clinical and research professionals to assess levels of resilience in adults with SMI at baseline and across time.Practitioner points The Brief Resilience Scale (BRS) was developed to measure a person’s ability to bounce back from stressful situations. The BRS was examined in adults with serious mental illness living in the community. The BRS presented a bifactor structure measuring resilience (an outcome) and correlated with positive psychology‐ and psychopathology‐related measures. The BRS can be used by practitioners to assess levels of resilience in their clients at baseline and over time to evaluate the effectiveness of therapeutic interventions.

Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions

The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability -meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live sucessfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.

Improving Lung Cancer Screening Access for Individuals With Serious Mental Illness

Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system–level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness.

Play provides social connection for older adults with serious mental illness: A grounded theory analysis of a 10-week exergame intervention

Introduction: The number of older adults with serious mental illness (SMI) is predicted to reach 15 million by 2030. Social isolation is known to contribute to morbidity and mortality, and those with SMI experience more social isolation than older adults in the general population. Social isolation in these older adults is complex and involves factors including organic psychopathology, effects of medications and/or other substances, medical co-morbidity, disability, and social stigma. The burgeoning field of inquiry of exergames, which are video games with gestural interfaces, for older adults has found that they are safe, effective, enjoyable, and may decrease social isolation. This qualitative study was conducted to gain insight into the effects of group exergame play on the psychosocial wellbeing of older adults with SMI.Methods: We explored the psychosocial effects of a 10-week group exergame program for 16 older adults with SMI using grounded theory methodology within a symbolic interactionist framework.Results: Participants experienced positive social contact, engaged in social attunement, and expressed motivation to take risks and face problem-solving and physical challenges. Two interrelated concepts emerged from the integrated data: Social connectedness and competence. The theoretical construct that was abducted from these concepts was that play and playfulness were the vehicle for many interacting social processes to take place.Conclusion: Group play through exergames for older adults with SMI may promote recovery and healthy aging by increasing social integration, improving self-efficacy, and promoting physical health through exercise.

Medical Students' Beliefs and Attitudes towards Schizophrenia before and after Psychiatric Training in Almaarefa Colleges, Riyadh, Saudi Arabia

Background: Public surveys have shown that the general population has limited knowledge about mental illness and holds unfavorable attitudes towards the people who suffer from it in various, culturally diverse, countries. Aims: The aim of the present study was to explore medical students’ beliefs and attitudes towards people with schizophrenia (PwS) prior to receiving any training in psychiatry and to assess the impact of the psychiatric placement on changing them. Methods: A questionnaire addressing beliefs, attitudes and desired social distance from PwS was distributed to all final year medical students before the beginning of their 4-week undergraduate psychiatric placement and upon its completion. Results: Students did not endorse stereotypes commonly attached to PwS, such as being dangerous, lazy or of lower intelligence, but they held the view that PwS are unpredictable and suffer from split personality. Furthermore, the baseline level of desired social distance was found to increase as the intimacy of the interaction increased, and the only variable associated with it was personal experience of serious mental illness. Moreover, the placement was found to have either no influence at all or in a negative direction. Upon its completion more students were found to believe that PwS couldn’t recover, have no insight into their condition, cannot make reasonable decisions, cannot work in regular jobs and are dangerous to the public. No difference was recorded in social distance scores. Conclusions: A close and critical examination of the various elements of the undergraduate placement in psychiatry is needed in order to develop an evidence based, fully rounded education with an anti-stigma orientation.

In the Eye of the Beholder: Recovery and Personal Narrative

Despite the term recovery being commonplace in mental health circles, there continues to be debate about how it should be conceptualized. Some policy makers, researchers, and professionals link level of recovery with tangible outcomes ranging from symptom reduction to the ability to work and live independently. By contrast, the definitions offered by people with lived experience of mental illness tend to focus heavily on the process of recovery, and given this, recovery is commonly referred to as a journey. This paper presents findings from a qualitative study focused on understanding how those with serious mental illness conceptualize and live out their own recovery. Drawing upon Frank’s classic work, The Wounded Storyteller, participants’ recovery narratives are classified into three categories including recovery as restitution, recovery in the midst of chaos and recovery as quest. This study illustrates how recovery involves a range of multifaceted and complex factors. The authors advocate for a conceptualization of recovery that takes into consideration the unique personal histories of those with the lived experience of serious mental illness. Tentative implications for practice are offered.

Recovery stories: An anthropological exploration of moral agency in stories of mental health recovery.

Moral agency has been loosely defined as the freedom to aspire to a "good life" that makes possible intimate relationships with others. This article uses ethnographic research to further the discussion of the role of moral agency in mental health recovery. This article attends to the ebb and flow of moral agency in the life stories of three people diagnosed with a serious psychiatric disability at different stages in their individual recoveries to illustrate particular aspects of moral agency relevant for recovery. From these, a more complex notion of moral agency emerges as the freedom not only to aspire to a "good life," but also to achieve a "good" life through having both the intention to aspire and access to resources that help bring one's life plans to fruition. Each storyteller describes an initial Aristotelian peripeteia, or "breach" of life plan, followed by an erosion of moral agency and sense of connection to others. The stories then diverge: some have the resources needed to preserve moral agency, and others attempt to replenish moral agency that has been eroded. In these stories, the resources for preserving and nourishing moral agency include the ability to cultivate the social bases of self-respect, autobiographical power, and peopled opportunities. These stories cumulatively suggest that without such resources one's attempts to preserve or nourish the moral agency needed for recovery after the peripeteia, which is often perpetuated by the onset and experience of serious mental illness, may fall short.

Cancer and serious mental illness--patient, caregiver and professional perspectives: study protocol.

To explore the experience of serious mental illness and cancer from the perspective of patients, significant others and healthcare professionals involved in their care. Serious mental illness is associated with poorer cancer outcomes. Those suffering from this comorbidity receive fewer specialist interventions and die earlier than the general population. Prior qualitative research in this area has comprised of a single study focussing on healthcare professionals and there is little evidence regarding the experiences of patients and caregivers. A qualitative exploration using approximately 36 semi-structured interviews. Semi-structured digitally recorded interviews conducted with: adults living with serious mental illness and diagnosed with cancer; those providing them with informal support and care; and healthcare professionals. Questions will focus on the experience of having cancer and serious mental illness or caring for someone with this comorbidity, experiences of healthcare and priorities for patients and carers. Framework analysis will be used. Research Ethics Committee and Trust Research & Development approval was obtained. A steering group comprising six people with experience of either cancer or mental illness provided feedback and ratified the patient information sheets and interview schedules. There is a paucity of research addressing stakeholder perspectives on the experience of cancer and of cancer services for people with serious mental illness. Dissemination of findings will inform practice relating to the care of an often neglected population, informing better support for their significant others and the professionals involved in their care.

Service users' experiences of participation in decision making in mental health services

Despite the potential positive impact of shared decision making on service users knowledge and experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. This study highlights the desire of users to participate more actively in decision making and demonstrates that persons with SMI struggle to be seen as competent and equal partners in decision-making situations. Those interviewed did not feel that their strengths, abilities and needs were being recognized, which resulted in a feeling of being omitted from involvement in decision-making situations. The service users describe some essential conditions that could work to promote participation in decision making. These included having personal support, having access to knowledge, being involved in a dialogue and clarity about responsibilities. Mental health nurses can play an essential role for developing and implementing shared decision making as a tool to promote recovery-oriented mental health services. Service user participation in decision making is considered an essential component of recovery-oriented mental health services. Despite the potential of shared decision making to impact service users knowledge and positively influence their experience of decisional conflict, there is a lack of qualitative research on how participation in decision making is promoted from the perspective of psychiatric service users. In order to develop concrete methods that facilitate shared decision making, there is a need for increased knowledge regarding the users' own perspective. The aim of this study was to explore users' experiences of participation in decisions in mental health services in Sweden, and the kinds of support that may promote participation. Constructivist Grounded Theory (CGT) was utilized to analyse group and individual interviews with 20 users with experience of serious mental illness. The core category that emerged in the analysis described a 'struggle to be perceived as a competent and equal person' while three related categories including being the underdog, being controlled and being omitted described the difficulties of participating in decisions. The data analysis resulted in a model that describes internal and external conditions that influence the promotion of participation in decision making. The findings offer new insights from a user perspective and these can be utilized to develop and investigate concrete methods in order to promote user's participation in decisions.

Women and the Experience of Serious Mental Illness and Sexual Objectification: Multicultural Feminist Theoretical Frameworks and Therapy Recommendations

As Objectification Theory (Frederickson & Roberts, 1997) has advanced, the implications of the experience of sexual objectification of women have increasingly been identified. Objectification Theory provides a feminist theoretical framework for understanding the unique experiences of women who live in a culture that objectifies and sexualizes their bodies. This theory has now been linked to mental health problems such as depression, eating disorders, body shame, substance abuse, and sexual dysfunction (for a review, see Moradi & Huang, 2008). However, the intersections of sexual objectification and serious mental illness among women have not been sufficiently researched. This article will explore the intersections of the experience of sexual objectification and serious mental illness among women from a Multicultural Feminist Therapy framework, offering implications and recommendations for the therapeutic context.