Experiences Of Mental Health Services Research Articles

Bisexuals’ Experiences of Mental Health Services: Findings from the Who I Am Study

Despite bisexual people being found to have significantly poorer mental health than their gay, lesbian and heterosexual counterparts, research into their experiences of mental health service use remains sparse. This paper presents findings from one of the largest studies of bisexual people to date (n = 2651) and examines their access to, and experiences with, mental health services. The Who I Am study surveyed adults living in Australia who reported bisexual identity, attraction and/or experience. Univariate analyses and chi square tests were conducted to quantify experiences of mental health service use and how this use is associated with gender and psychological distress. Results of an ordinal logistic regression analysis identify psychosocial predictors of disclosure/non-disclosure of bisexuality in the healthcare setting. Findings suggest that while bisexual people are highly engaged in mental health services, there are barriers to disclosure of their sexual orientation. In addition, the majority of respondents reported wanting more access to services specialising in working with bisexual people. Gender and psychological distress were found to be significantly associated with most service use variables. Despite high levels of engagement in mental health services, barriers to care still exist for bisexual people. Findings presented in this paper provide new insights into the experiences of bisexual people accessing mental health services. These findings will inform future policy development which will direct improved services delivery in this field.

Lesbian, gay and bisexual individuals experience of mental health services - a systematic review

Purpose Lesbian, gay and bisexual (LGB) individuals experience higher rates of mental health difficulties in comparison to their heterosexual counterparts (Meyer, 2003; Plöderl and Tremblay, 2015). This is in part due to the experience of homophobia and stigmatisation within society. This discrimination has also been perpetuated within the mental health field, where LGB individual’s sexuality has been pathologised. In response to this historical stigmatisation a number of policies have been created to develop ethical practice while working with this minority group (APA, 2012; BPS, 2019; HSE, 2009; PSI, 2015). The purpose of this paper is to capture the experience of LGB individuals within mental health services and examine if these guidelines are being adhered to. Design/methodology/approach This study is a meta-narrative synthesis of 13 empirical papers, published between 1999 and 2019. Findings This study has found both negative and positive experiences of service users. The paper discusses major themes, implications for practice and directions for future research. Originality/value This is the first systematic review to look at the experiences of clients who have attended mental health services.

The Transformative Potential of Kaupapa Māori Research and Indigenous Methodologies: Positioning Māori Patient Experiences of Mental Health Services

This article presents a description of a specific Indigenous research methodology, Kaupapa Māori Research (KMR), followed by a discussion of the potential contribution that KMR and other Indigenous frameworks make toward understanding and addressing widespread mental health inequities affecting the world’s Indigenous peoples. The contribution of existing qualitative KMR to the fields of health and mental health in New Zealand is discussed, and innovative approaches employed within these studies will be outlined. This paper describes the utility of KMR methodology which informed the development of qualitative interviews and the adaptation of an analytic framework used to explore the impact of systems on the experiences of Māori (the Indigenous peoples of New Zealand) with bipolar disorder (BD). This paper adds to others published in this journal that describe the value, inherent innovation, and transformative potential of KMR methodologies to inform future qualitative research with Indigenous peoples and to enact systemic change. Transformation is achieved by privileging the voices of Māori describing their experiences of mental health systems; presenting their expert critique to those responsible for the design and delivery of mental health services; and ensuring equal weight is given to exploring the clinical, structural and organizational changes required to achieve health equity. It is proposed that this approach to research praxis is required to ensure that studies do not perpetuate institutional racism, which requires close adherence to Indigenous research priorities and partnership with Indigenous peoples in all steps of the research process.

Contact with recovered peers: buffering disempowering service experiences and promoting personal recovery in serious mental illness.

Mental health patients can experience involuntary treatment as disempowering and stigmatising, and contact with recovered peers is cited as important for countering stigma and fostering agency and autonomy integral to recovery. To advance understanding of the interaction between involuntary treatment and contact with recovered peers, and explore hypothesised relationships to mechanisms of self-evaluation relevant to recovery. Eighty-nine adults diagnosed with serious mental illness completed items to assess involuntary treatment experience and the extent of prior contact with recovered peers, the Internalised Stigma of Mental Illness Scale, the Self-efficacy for Personal Recovery Scale, the Questionnaire about the Process of Recovery and relevant demographic and clinical scales. Contact with recovered peers was found to moderate the effects of involuntary treatment on internalised stigma. Sequential conditional process models (i.e. moderated mediation) then demonstrated that conditional internalised stigma (i.e. moderated by contact with recovered peers) mediated the indirect effect of involuntary treatment on recovery-specific self-efficacy, which in turn influenced recovery. Compared with those with low contact with recovered peers, recovery scores were 3.54 points higher for those with high contact. Although study methods limit causative conclusions, findings are consistent with proposals that contact with recovered peers may be helpful for this patient group, and suggest this may be particularly relevant for those with involuntary treatment experience. Directions for future research, to further clarify measurement and conceptual tensions relating to the study of (dis)empowering experiences in mental health services, are discussed in detail.

The personality disorder patient pathway: Service user and clinical perspectives.

There have been recent policy developments and research into care provision for service users with personality disorder. However, few studies have focused on service user and staff perspectives on how services could be improved. A qualitative study was undertaken in the UK between 2016 and 2017. We conducted six focus groups with clinicians in mental health services with experience of working with people with personality disorder. Using an online survey, we asked current and past service users with personality disorder to describe their experiences of mental health services and make recommendations for improvements. A thematic analysis was conducted. Forty-five clinicians participated in the focus group and 131 service users contributed to the online survey. The main areas of concern identified by both staff and patients were the diagnosis of personality disorder, the absence of a coherent care pathway, access to psychological treatment and staff training. The care pathway for individuals with personality disorder is unclear to clinicians and service users, and elements of the pathway are disjointed and not working as effectively as they could. Guidelines recommended by National Institute for Health and Care Excellence are not being followed. Specialist psychological interventions should be available to ensure consistent and stable care provision. © 2019 John Wiley & Sons, Ltd.

Ethnic differences in psychosis-Lay epidemiology explanations.

BackgroundMuch research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves.AimsTo determine how Black African and Caribbean service users perceive and explain these apparent differences.MethodsWe conducted four focus groups between 2014 and 2015 with 35 participants from the Black African and Black Caribbean community in Lambeth and Southwark, South East London, diagnosed with a psychotic illness. Recruitment was through a local voluntary sector organization and other community contacts.ResultsEach group described an elevated risk of psychosis in their community and explanations followed the following themes, with increased rates due to: (a) an accumulation of stressors due to disadvantaged ethnic minority status, (b) further disadvantage due to inequitable experiences of mental health services, (c) an absence of community support and (d) a double stigma: as a result of external discrimination, due to ethnicity, and internal stigma about mental illness from within the Black community itself.ConclusionsBlack mental health service users attributed an elevated risk of psychosis in their community to an accumulation of stressors directly related to ethnic minority status.

Carer experiences of services for adults with intellectual disabilities and Co-morbid mental ill health or challenging behaviour

ABSTRACT The aim of this study was to examine carer experiences with mental health services for individuals with dual disabilities in Australia. This qualitative study involved semi-structured interviews with nine parents with an adult offspring with an intellectual disability in 2016. Parents who had received a mental health service for their offspring within the past two years in Australia with adequate spoken English were included. Parents were asked four open ended questions relating to their experiences of mental health services for their offspring. Findings revealed parents reported more negative experiences with mental health services perceived to hold limited expertise in dual disabilities. They also reported difficulties in accessing appropriate services and highlighted the importance of collaboration and adjustments to suit individual needs of their child. The findings are discussed in terms of the implications for service provision and training for practitioners working with families with intellectual disabilities. Acknowledging the important role of carers as key informants and partners in treatment decision making is highlighted as necessary aligning services with best practice standards.

Family and caregivers’ experience of mental illness in migrants with intellectual disability – reflections on practice

Purpose The purpose of this paper is to investigate the families’ and professional caregivers’ experience of mental health services for patients in the migrant population with intellectual disability (ID). Design/methodology/approach To highlight this rarely studied topic, the authors chose a qualitative approach, using a semi-structured interview guide. The authors performed a search for relevant articles. Three families of former patients of a specialized psychiatric inpatient unit and 12 professional caregivers were interviewed. The interviews were taped, transcribed and analyzed using a thematic analysis. Findings In total, 17 themes from the families’ answers and 14 themes from the caregivers’ answers were grouped into four main themes each. Two main themes were identical for both groups: perspectives on mental illness and “the Norwegian system.” Additionally, the families were concerned about the impact on the patient and family and coping strategies. The caregivers highlighted patient–caregiver interaction and family–caregiver interaction. Research limitations/implications Further research should include the patients’ opinions based on the findings of this study. Also, studies including larger samples from both specialist services and community services are needed to develop evidence-based services for these patients. Practical implications Proposed adaptations to enable assessment and treatment of mental illness in migrants with ID should be adapted to cultural preferences. The following adaptations are proposed: inclusion of the entire family, awareness of cultural dimensions, information about the health care system, education in mental illness, the use of interpreters and adequate time spent with the families. Originality/value Mental health services for this group are an understudied topic. Clinical experience indicates that professionals struggle when providing services for such patients.

Integrating mental health peer support in clinical settings: Lessons from Canada and Norway.

Mental health peer support is an evidence-based approach called for by Canada's mental health strategy that presents health leaders with an opportunity to transform mental health service experiences, improve health outcomes, and lower overall system costs. Originally offered in community settings, peer support has been expanding to clinical settings, but challenges to integration exist. This qualitative case study of peer support in clinical settings in Canada and Norway examines the perceived value of peer support and change management strategies that health leaders, managers, staff, and peer support providers can use to support integration of peer support in existing healthcare teams in clinical settings. Recommended strategies for health leaders include adopting a gradual approach to integration, building champions, demonstrating value, focusing on resistant groups, adopting a continuous improvement approach, setting peer support as an organizational priority, and linking peer support to patient-centred care.

A systematic review of ethnic minority women's experiences of perinatal mental health conditions and services in Europe.

BackgroundWomen from ethnic minority groups are at greater risk of developing mental health problems. Poor perinatal mental health impacts on maternal morbidity and mortality and can have a devastating impact on child and family wellbeing. It is important to ensure that services are designed to meet the unique needs of women from diverse backgrounds.AimThe aim of the review was to explore ethnic minority women's experiences of perinatal mental ill health, help-seeking and perinatal mental health services in Europe.Data sourcesSearches included CINAHL, Maternity and Infant Care, MEDLINE and PsycINFO with no language or date restrictions. Additional literature was identified by searching reference lists of relevant studies.DesignThis was a mixed method systematic review. Study selection, appraisal and data extraction were conducted by two researchers independently. A convergent approach was adopted for the analysis and the data were synthesised thematically.ResultsThe 15 eligible studies included women from a range of minority ethnic backgrounds and were all undertaken in the United Kingdom (UK). Seven overarching themes were identified; awareness and beliefs about mental health, isolation and seeking support, influence of culture, symptoms and coping strategies, accessing mental health services, experiences of mental health services and what women want.ConclusionLack of awareness about mental ill health, cultural expectations, ongoing stigma, culturally insensitive and fragmented health services and interactions with culturally incompetent and dismissive health providers all impact on ethnic minority women's ability to receive adequate perinatal mental health support in the UK. Future research should focus on in-depth exploration of the experiences of these women across multiple European settings and interventions to reduce health inequalities among vulnerable mothers and families affected by perinatal mental ill health.

“A plea for recognition” Users’ experience of humiliation during mental health care

BackgroundStudies reveal that users of mental health care services sometimes experience humiliation during care. These experiences may influence the users' recovery process and treatment satisfaction. MethodThirteen informants with experience in mental health services were recruited for semi-structured interviews. Informants were recruited through collaboration with users' organisations. Modified text condensation was used for analysis of the qualitative data. ResultsUsers' experiences with humiliation in mental health care were sorted into three main themes. These are themes related to different perspectives between staff and users; themes related to violence of user autonomy; and experiences related to staff attitudes. DiscussionThe service users in this study spoke about many different kinds of experiences with humiliation during care. It was a main finding that the feeling of not being recognized for one's own perception of the situation was experienced as a humiliation. This study is a contribution to a better understanding of the humiliation process between staff and users in mental health care services. The findings may be used to improve interaction between staff and users, improve quality of care and to prevent such experiences.

Sharing wisdom II: Integrated care in partnership – Designing youth mental health services in Queensland, Australia

An extended inpatient treatment facility for adolescents with severe and complex mental illness in Queensland, Australia closed in January 2014. Following the closure of the centre, three former patients died by suspected suicide, which led to widespread community concern about the processes and support offered to patients around the closure. In 2015, the Queensland Government of Australia established a Commission of Inquiry into the closure of the facility with a final report provided to Government in 2016 recommending the development of new youth mental health facilities and acknowledging the marked lack of consumer and carer consultation throughout the closure process. Consequently, the Queensland Department of Health through the Division of Clinical Excellence’s Mental Health Alcohol and Other Drugs Branch, along with the Queensland Department of Education, Health Consumers Queensland the peak organisation representing the interests of health consumers and carers in Queensland and the Destravis Group a strategic building consulting firm, joined in partnership to co-design an integrated mental health service system for young people. Commencing with the development of a model of service and continuing to the finalisation of building designs, this approach has put young people, their families and their carers at the centre of the design process, in direct contrast to the closure of the previous facility. The partnership has led to an unprecedented level of participation and inclusion of people with a lived experience of mental health services, and an unparalleled approach to integrating expertise from the clinical, education, user and design perspectives, building an integrated methodology from the ground up. It has enabled people with lived experience to become true co-creators in the development of new services, by building relationships of trust and respect. This interactive workshop prepared and delivered by consumers, carers and the project team including Destravis, building consultants, aims to share the principles utilised and the practical activities that continue to facilitate collaborative co-creation in the development of new youth mental health services. Through a combination of group work and discussion, the workshop will consider the innovative approach taken, lessons learned, and issues for sustainability when developing new services in collaboration with consumers and carers. In addition, the workshop will also explore how these co-design lessons can be transferred to the development of health services in other settings. The workshop is suitable for clinicians, administrators, consumers, carers, policymakers, academics, architects, and health building designers. This workshop session discussion will include four brief oral poster presentations relating to co-design of mental health services internationally.

The patient experience in community mental health services for older people: a concept mapping approach to support the development of a new quality measure

BackgroundThe patient experience is a crucial part of the measurement of service quality. However, instruments to evaluate experiential quality in the community mental health care of older adults are lacking. Before designing a new instrument, clarity is needed about what is to be measured, and how care experiences are articulated by patients. The study aimed to construct a framework to describe older patients’ experience of community mental health and social care.MethodsConcept mapping blends structured qualitative data collection with quantitative analysis in a mixed method approach. Five activities were undertaken. Patients first identified sentences describing the care experience; a card-sort exercise then grouped these thematically; multidimensional analysis portrayed these data in a map of clusters; interpretation was by patient advisers; finally a new questionnaire was designed. The research involved 22 older people with mental health problems and 29 mental health practitioners, from one region of England.ResultsSixty-seven statements were identified that described the care experience. Analysis of card sort data revealed seven clusters, which were interpreted by patient advisers to the study as: personal qualities and relationships; communication problems; feeling powerless; in-and-out care; bureaucracy; focus on life, not just mental health; and continuity of care. These themes and the component statements were used as a foundation for later work, developing a new measure of the care experience in mental health services for older people.ConclusionsConcept mapping has many strengths as an empirical and participant-driven means for underpinning new measurement instruments. A group of older people identified 67 candidate statements that could act as questionnaire items grouped within seven themes. Future research will establish the psychometric properties of the new measure.

From disintegration to integration: The value of spiritual care within mental health

‘And therefore as a stranger give it welcome. There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy.’(William Shakespeare, Hamlet)A service user describes her experience of mental health services and the dilemmas this has brought to her spiritual and religious beliefs through pathologising her deeply meaningful personal life. Her later experience of the Spiritual Care Team and the support provided by the chaplain are described, demonstrating how she was able to integrate her experiences into her self-identity and is now able to flourish without medication.

Service seeking experiences of college-aged sexual and intimate partner violence victims with a mental health and/or behavioral disability

ABSTRACTObjective: To examine mental health service experiences following sexual violence (SV) and intimate partner violence (IPV) victimization among college women with a disability. Participants: College women (n = 27, ages 19 to 24) with a disability who experienced at least one SV/IPV occurrence; interviewed July/August 2016. Methods: Qualitative study using in-depth interviews, with thematic analysis. Results: Women tended to wait several months (or did not seek care at all) following SV/IPV, because they downplayed their experience (e.g., not wanting to label an experience as “rape”). Those seeking services primarily did so because of escalating mental health concerns. Among service seekers, women were satisfied when professionals validated their experiences/concerns; and were dissatisfied when faced with extended wait time for care and/or professionals unskilled with SV/IPV and mental health. However, women still sought care following negative experiences. Conclusions: Improved access to integrated care for SV/IPV and mental health, along with skilled professionals, is essential.

Don't ask me what's the matter, ask me what matters: Acute mental health facility experiences of people living with autism spectrum conditions.

Background This qualitative study explored how mental health inpatients with autistic spectrum conditions (ASCs) experience and cope with anxiety when admitted to an acute mental health inpatient facility in the United Kingdom. Anxiety is a common characteristic for people who live with ASCs and whilst a plethora of studies on anxiety in this population is published which correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations. This study adds to a body of evidence which considers anxiety experienced by people with autism. The rationale for this study includes the need to heighten mental health practitioners' understanding, of the responses, motivations to engage and support required to overcome fears and anxieties when admitted to a mental health inpatient unit. Method The study used a qualitative naturalistic research design, to explore the emotional and psychological experiences of being a mental health inpatient living with an ASC. During 2015-2017. audio-recorded semistructured interviews captured the experiences of 20 adults from the east of England who were former psychiatric inpatients with an established diagnosis of ASC. Interpretative phenomenological analysis enabled the identification of broad themes which explained in rich detail, participant reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, manifestations of anxiety and responses to their anxiety. Findings Broad response patterns were identified that could be associated with their anxiety that is isolating themselves from others, including patients and staff, ceasing to eat and sleep adequately and all too often self-harming or exhibiting aggressive and violent responses. Conclusions The anxiety caused by the physical environment appears to be overlooked by mental health practitioners so attention to anxiety-inducing encounters is needed when planning acute care mental health service improvement and research is required to clearly understand the experiences of this vulnerable group.

Consumer views on youth-friendly mental health services in South Australia

ABSTRACTObjective: This study sought to understand the perspectives of young people (12–25 years) with experience of mental health services on what makes for youth-friendly mental health services.Method: A purposive strategy was used to recruit 32 young people aged 12–25 years with diverse backgrounds, through mental health and youth services. Six semi-structured group interviews were undertaken and one individual interview. We were especially interested in aspects that facilitated or obstructed young people from seeking help, and key experiences across their consumer journey. Transcripts were analysed thematically to identify shared experiences and perspectives across the interviews.Results: Five key themes emerged: the central role that teachers, school counsellors, parents, and friends play in help seeking and responding to crisis; the impact of fear, uncertainty, and stigma in decision-making and engaging with services; finding the right therapist and effective help; ways to improve flexibility and ease of access; the need for better quality consumer information for accessing a mental health service.Discussion: The results of the study have implications for the design of mental health services, providing important insights that can increase young people’s engagement with services, and ultimately, improve the mental health and well-being of young people in Australia.

Depression, anxiety, and mental health service experiences of women with a twin-twin transfusion syndrome pregnancy.

Symptoms of emotional distress during and after pregnancy may be introduced or exacerbated by unexpected medical conditions in the mother or fetus. Twin-twin transfusion syndrome (TTTS), which accounts for 17% of fetal deaths in twins and entails substantial medical uncertainty, may represent a particularly challenging pregnancy experience. Yet, little is known about the impact of TTTS on women's emotional health. We retrospectively surveyed 350 women who experienced a TTTS pregnancy about their experiences at three time points (prior to, during, and after pregnancy) to examine symptoms of anxiety and depression, mental health diagnoses, thoughts of seeking mental healthcare, help received, and preferred mental health services. Women in this study experienced significantly elevated symptoms of depression and anxiety during and after pregnancy, regardless of their pregnancy outcome (double survivor, single survivor, or double loss). Women reported feeling devastated by their experience and indicated they would have accepted mental healthcare had it been offered and had barriers to care been addressed. Prospective studies of women experiencing TTTS pregnancies are needed to examine TTTS effects on maternal mental health and to determine how to best address emotional care needs.

Mental health among Asian and African migrant working mothers: new vulnerabilities, old religious coping resources

ABSTRACTA qualitative research is presented to explore sources of psychosocial distress, expressive idioms, coping strategies, resilience resources, and experiences of mental-health services in Filipino, Sao Tomean and Indo-Mozambican migrant working mothers settled in Portugal. Findings suggest that shared gender roles and working conditions do not lead to similar modes of expressing mental distress. Particular manifestations take on cultural meanings in relation to specific vulnerabilities and stressors. Despite their higher level of psychosocial distress, these migrant mothers make little use of mental-health services. Comparative analysis has brought to light how religious participation provides them with a variety of expressive and coping resources that support and guarantee the fulfilment of their gender and mothering responsibilities, thus triggering desired changes that affect the lives of their children and families in both the short and long term.

A personal reflection of the experience of mental health services: Overcoming unsafe and aversive practices

A personal reflection of the experience of mental health services: Overcoming unsafe and aversive practices