Severe Mental Illness Experience Research Articles

Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study

BackgroundLittle is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia.MethodsIn-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach.ResultsStudy participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return.ConclusionsHomelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support.

Hepatitis C treatment in a co-located mental health and alcohol and drug service using a nurse-led model of care.

Hepatitis C virus (HCV) is more prevalent among people with experience of severe mental illness compared to the general population, due in part to higher levels of injecting drug use. Delivering HCV care through mental health services may reduce barriers to care and improve outcomes. A nurse-led HCV program was established in a co-located mental health and addiction service in Melbourne, Australia. People with a history of injecting drug use, including current use, were referred for HCV testing by nurses, with support provided on-site from a general practitioner and remotely from infectious disease and hepatology specialists. A nurse practitioner, general practitioner or specialists were able to prescribe HCV treatment. One-hundred and thirty people were referred to the nurse-led service, among whom 112 (86%) were engaged in care. Of those 112, 84 (75%) were found to have detectable HCV RNA, 70 (83%) commenced treatment; 28 (40%) prescriptions were nurse initiated, 19 (27%) were general practitioner initiated and 20 (29%) were prescribed from hospital clinics or elsewhere. All people with an SVR result (48/70) achieved HCV cure (intention to treat SVR 69%, per-protocol SVR 100%). Treatment commencement was highest among people prescribed opioid agonist therapy (28/29, 96%) compared to those who were not (18/26, 69%). In conclusion, a nurse-led, HCV service for people with severe mental illness including pathways to specialist support when needed can achieve high treatment uptake and cure. Further implementation work is required to improve treatment uptake, particularly among people not prescribed opioid agonist therapy, and to improve follow-up for SVR testing.

Attitudes to physical healthcare in severe mental illness; a patient and mental health clinician qualitative interview study

BackgroundPeople with severe mental illness experience physical health significantly worse than the general population. Physical health monitoring is shared between primary care and secondary mental healthcare services, though there is debate whether mental health teams should provide more physical healthcare. The views of mental health clinicians and patients with mental illness towards physical healthcare provision are unclear.AimsTo explore the attitudes of Community Mental Health Team (CMHT) clinicians and patients experiencing severe mental illness towards physical healthcare and its provision.Design and settingQualitative study in a CMHT setting.MethodsInterviews were carried out with CMHT clinicians and patients with severe mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis.ResultsThere were 14 patients and 15 clinicians recruited. Patients varied in their awareness of the association between physical and mental health, but were engaged in physical health monitoring. Clinicians were aware of the importance of physical healthcare but reported barriers to provision, including lack of training, resource constraints and uncertainty in their role. There was no consensus in either group regarding how physical healthcare should be provided, with diverse attitudes expressed for why CMHTs should and shouldn’t provide more physical healthcare.ConclusionsIncreasing physical healthcare provision from mental health teams requires healthcare-related barriers be addressed, but it remains unclear whether CMHT clinicians or patients believe this to be a solution.

The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada.

To examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness. Participants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures were intervention group (HF vs. treatment as usual), Axis I mental health diagnoses, emergency department (ED) visit, and history of traumatic brain injury (TBI). Logistic regression was used to examine the association between exposures and incarceration. Of 508 participants, 220 (43.3%) were incarcerated at least once during the study period. Among those incarcerated, 81.9% were male, 52.7% had been diagnosed with alcohol dependence/abuse, 60.9% had been diagnosed with substance dependence/abuse, 65.1% reported having visited an ED within the last 6months, and 66.4% had a history of TBI. After adjusting for demographic covariates, substance dependence/abuse (aOR: 2.06; 95% CI: 1.40, 3.03), alcohol dependence/abuse (aOR: 1.52, 95% CI: 1.04, 2.22), ED visit (aOR: 1.54; 95% CI: 1.02, 2.32), and history of TBI (aOR: 2.60; 95% CI: 1.75, 3.85) were associated with incarceration. We found no significant effect of the HF intervention on incarceration outcome (aOR: 1.08; 95% CI: 0.76, 1.55). Among adults with experiences of homelessness and severe mental illness, those with substance and alcohol dependence/abuse disorders, history of TBI, and recent ED visits were at increased odds of incarceration. Strategies are needed to prevent and reduce incarceration for this population, including treatment of mental illness in the community.

Guidelines for news media reporting on mental illness in the context of violence and crime: A Delphi consensus study

Despite its rare occurrence, severe mental illness is commonly linked to violence and crime in the news media. To reduce harmful effects of reporting, this study aimed to develop best practice guidelines for media reporting on mental illness in the context of violence and crime. Best practice was determined through the Delphi expert consensus method where experts rated statements according to importance for inclusion in the guidelines. In this study, the experts represented three groups: people with lived experience of severe mental illness, media professionals and mental health professionals. The 77 statements that were endorsed as ‘important’ or ‘essential’ by 80 per cent or more of experts were included in the guidelines, while 36 items were rejected from inclusion. There was a high degree of consensus among stakeholder groups. These guidelines expand on existing media guidelines, elaborating on accurate portrayals and appropriate language and extending coverage to areas of mental health literacy, considering impact, reporting relevant risk factors, using social media and implementation in news organizations.

Health Disparities in Black Patients with Severe Mental Illness and the Role of Structural Racism

Black patients with severe mental illness (SMI) experience health disparities when compared to White patients. These disparities include differences in the availability of culturally appropriate, affordable care; a disproportionate diagnosis of psychotic illnesses; differential and inequitable access to certain medications and treatments; and a decreased likelihood of being referred to higher-quality, evidence-based after-care programming. These disparities are not due to Black people being “sicker,” but instead are due to implicit bias and structural racism. In this article, we describe the health disparities that Black patients with SMI suffer in access to mental health care, diagnosis, treatment, and aftercare. We discuss the origins of these disparities and some ways that each of us can combat them in our day-to-day practice. [ Psychiatr Ann . 2020;50(11):483–488.]

An exercise intervention for people with serious mental illness: Findings from a qualitative data analysis using participatory theme elicitation.

BackgroundPeople with severe mental illness (SMI) often have poorer physical health than the general population. A coproduced physical activity intervention to improve physical activity for people with SMI in Northern Ireland was evaluated by co‐researchers (researchers with lived experience of SMI) and academic researchers using a new approach to participatory data analysis called participatory theme elicitation (PTE).ObjectiveCo‐researchers and academic researchers analysed the data from the pilot study using PTE. This paper aimed to compare these analyses to validate the findings of the study and explore the validity of the PTE method in the context of the evaluation of a physical activity intervention for individuals with SMI.ResultsThere was alignment and congruence of some themes across groups. Important differences in the analyses across groups included the use of language, with the co‐researchers employing less academic and clinical language, and structure of themes generated, with the academic researchers including subthemes under some umbrella themes.ConclusionsThe comparison of analyses supports the validity of the PTE approach, which is a meaningful way of involving people with lived experience in research. PTE addresses the power imbalances that are often present in the analysis process and was found to be acceptable by co‐researchers and academic researchers alike.

Enhancing physical health monitoring in people with severe mental illness: the development of a health passport

People with severe mental illness (SMI) experience significant health inequalities, and their physical health needs are often not addressed. This article describes the development and implementation of a physical health passport, known as My Physical Achievement Log (My PAL), which aims to improve physical health monitoring in people with SMI. The article explains how a literature search and information from official reports were used to identify physical health indicators and to devise a system for recording these. It also describes how feedback was obtained from mental health nurses to improve the My PAL tool and pilot it in mental health services. Further research to evaluate service users’ experiences of using the My PAL tool is being undertaken to enhance its usability.

Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment).

PurposePeople with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting.DesignSingle arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention.MethodPeople with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise.ResultsForty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks.ConclusionsA brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors.Clinical Trial RegistrationThe trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)—U1111-1211-4009.

Workers with severe mental illness coping with clinical symptoms: Self-directed learning of work-health balance strategies.

Most workers with a severe mental illness (SMI) experience brief job retention, usually under 6months. Managing their clinical symptoms to maintain employment is a constant challenge. However, little is known about the personal initiatives these workers undertake to learn to manage their clinical symptoms at work. The study presented here documented, from an emic perspective, the self-directed learning of work-health balance strategies applied in the workplace. The study was conducted with five adults with SMI employed in the competitive labour market and six support persons. Between March 2017 and May 2018, a dataset was constructed based on 21 semi-structured interviews, eight observation sessions, and photographs taken of 15 objects used by the workers to manage their clinical symptoms. The analysis was guided by Mendez's retrospective and current temporal analysis of social processes. The workers experienced four different self-directed learning patterns (preparation, post-crisis, active self-directed learning, and identity transformation) and used five types of strategies to facilitate work-health balance: preparation for work, reassurance, validation, assertiveness, and work-rest transitions. These workers with SMI, all of whom had job retention of 2years or more in competitive employment, learned and applied work-health balance strategies. Self-directed learning was enhanced by customised pharmacological treatment, mindfulness activities, active listening by support persons and psychotherapy specific to the mental illness.

"If somebody could just understand what I am going through, it would make all the difference": Conceptualizations of trauma in homeless populations experiencing severe mental illness.

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.

Appraisal of physical health guidelines for severe mental illness.

Objectives The aim of this study was to identify current physical health guidelines for severe mental illness (SMI) and appraise them using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Methods Relevant research databases and grey literature were systematically searched to identify physical health guidelines for people with SMI. The grey literature was explored by web searches and targeted searches of the English websites of relevant peak bodies and government health agencies from Organisation for Economic Co-operation and Development countries. Included guidelines were independently appraised by two authors (NF and JH) using the AGREE II Instrument. Results Of the 5352 records screened, 33 were assessed for eligibility. Fifteen practice guidelines met the inclusion criteria. The median domain scores as rated by the AGREE II Instrument ranged from 17% to 69%. The World Health Organization guideline, which demonstrated a broad range of clinical recommendations and sound methodological rigour, was rated the best. Conclusions Most guidelines scored poorly when rated by the AGREE II Instrument. However, these guidelines may still be useful in assisting evidence-based clinical practice. The methodological rigour of future guidelines can be improved by ensuring the AGREE II domains are addressed during the development phase. What is known about the topic? Compared with the general population, people with SMI experience greater chronic disease morbidity and mortality. There is limited evidence from randomised controlled trials to guide physical health care monitoring for people with SMI. Current guidelines and practice are largely based on expert consensus, clinical experience and good intentions. What does this paper add? Using the AGREE II Instrument, this paper appraises the current physical health guidelines for people with SMI. The attributes of the guidelines examined included the evidence base, clarity of presentation, applicability in the real world, the involvement of stakeholders and conflicts of interest of various parties involved in guideline development. What are the implications for practitioners? This review highlights the scarcity of high-quality and evidence-based guidelines for clinicians and researchers to address the physical health of people with SMI.

Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication

People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. Individuals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to individuals living with SMI.

Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers.

BackgroundVirtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway.ObjectiveWe aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers.MethodsA collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians—four from specialist mental health services and four from municipal mental health services—was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR’s potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted.ResultsVR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete.ConclusionsWe found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation.

PENERAPAN MODEL KOMUNIKASI INTERPERSONAL TERHADAP PENYEMBUHAN PASIEN (STUDI PADA RUMAH SAKIT ISLAM METRO DAN RSU MUHAMMADIYAH METRO)

Care and healing patients in hospitals is not just a matter of medical care, more than that requires a holistic-comprehensive approach covering the spiritual aspects of patients. The importance of spiritual aspects in supporting the healing of patients cannot be negotiated anymore, because patients in hospitals, especially inpatients with acute illness not only suffer from various physical ailments but they also experience various stresses and spiritual mental disorders from mild to severe as the result of his illness. Patients who suffer from severe illness experience various anxieties, fears, as well as patients who will face surgery and post-surgery, patients who face critical moments such as facing death, dying, is not the realm of medical care issues alone, but it really needs assistance, services, and spiritual assistance. This study tries to apply a communication model carried out by spiritual guidance (Binroh) to patients in the Islamic Hospital and Muhammadiyah Metro Hospital. This research aims to determine the application of interpersonal communication models of spiritual guidance (binroh) at Islamic Hospital and Muhammadiyah Metro Hospital to the healing of patients, as well as the results achieved in the application of interpersonal communication in both hospitals. This research uses a qualitative approach. Terminologically qualitative research is research that produces descriptive data in the form of written or oral words from people or observable behavior. Qualitative research methods seek to understand and interpret the meaning of an event in human behavior interactions in certain situations. Researchers in this case make direct observations in the process of fostering patients by spiritual staff in Islamic Hospital and Muhammadiyah Metro Hospital.

“If You Want to Know About the Book, Ask the Author”: Enhancing Community Engagement Through Participatory Research in Clinical Mental Health Settings

Participatory research, in which people with lived experience of the study phenomenon are involved as collaborators, has been conducted for decades; however, these innovations have struggled to take hold in mental health settings—until recently. The slow uptake of community partnered research in mental health has been unfortunate, especially because this field already suffers from poor community relations, pervasive community mistrust, and racial and ethnic disparities. But now, people with lived experience of severe mental illness—long considered to be “incapable” of functioning as co-researchers—are beginning to be included on research teams. However, training and opportunities for conducting such work are still lacking. This report describes a two-year initiative to improve the quality and quantity of participatory research being conducted in a department of psychiatry at a large medical school, which culminated in an innovative training program for both researchers and patients, developed in direct collaboration with stakeholders. In addition to detailing this program, we also discuss the deep legacy of mental health mistrust and our own efforts to address issues of social justice and health equity.

MP05-18 DISPARITIES IN BLADDER CANCER TREATMENT AND SURVIVAL AMONGST ELDERLY PATIENTS WITH A PRE-EXISTING MENTAL ILLNESS

INTRODUCTION AND OBJECTIVES:There is an abundance of evidence demonstrating that patients with severe mental illness experience inferior care and excess mortality in both the general medical and on...

Four cases of procedural consolidation with electroconvulsive therapy

Patients with severe mental illness experience greater morbidity and mortality than the general population, in part because of differences in the provision of necessary medical care.1 At times, this can be due to agitation, catatonia, impaired capacity, or persistent symptoms that contribute to ongoing morbidity and may prevent performance of necessary diagnostic procedures. In such situations, performing procedures under general anesthesia may be the only safe way to provide essential care to an already vulnerable patient. In patients receiving ECT for severe mental illnesses, combining procedures while anesthetized not only provides the ability to perform necessary examinations or diagnostics safely, but also limits anesthesia exposure, often the greatest risk associated with ECT. We will describe four cases of safe and successful procedural consolidation with ECT. We will emphasize the importance of coordination of care between medical subspecialties and with our anesthesia colleagues to limit risk while optimizing care.

Making a difference: ethnic inequality and severe mental illness.

In this paper, we explore ethnic inequalities in severe mental illness and care experiences. We consider the barriers to progressive and cohesive action and propose ways of overcoming these. Clinical and policy leadership must bring together hidden patient voices, divergent professional narratives and quality research.Declaration of interestK.B. is Editor of the British Journal of Psychiatry, but has not played any role in the decision-making for this paper. K.B. leads and J.N. is a partner and K.H. a researcher in the Synergi Collaborative Centre.

Concepts, Practices and Advantages of Spirituality Among People with a Chronic Mental Illness in Melbourne.

There is a relative paucity of literature in the field of spirituality among people who have a lived experience of severe mental illness from Australia. Sixteen individuals with a severe mental illness were interviewed on their experiences of spirituality. The three themes that emerged from the data were concepts of spirituality, benefits of intentional spiritual practices and perceived spiritual benefits of recreational pursuits and physical activity. This paper adds to the relatively sparse literature on spirituality among persons with a mental illness in Australia.