Experiences Of Mental Health Services Research Articles

“I didn’t want to leave my country” – mental health services as experienced by Bosnian refugees in Australia

PurposeDespite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental health services, there is a lack of in-depth studies specifically focusing on Bosnian refugees in Australia – one of the largest ethnic groups of displaced peoples. This qualitative investigation seeks to convey the experiences of mental health services by five Bosnian refugees in Melbourne, highlighting perceived pathways and barriers to service utilisation. This study aims to address two primary research questions: firstly, what characterises the experiences of Bosnian refugees in Australia when accessing mental health services? Secondly, what are the main barriers encountered by this population when seeking mental health services?Design/methodology/approachThis study used qualitative inquiry and in-depth interviews to investigate the experiences of Bosnian refugees with mental health services in Australia. Data was collected through face-to-face interviews with five Melbourne-based Bosnian refugees who had previously accessed mental health services. Participants were recruited from community groups or associations using purposive sampling. Thematic analysis was used.FindingsKey themes were revealed, such as the crucial role of social and community services, preferences for individual vs group therapy, potential re-traumatisation from therapeutic engagement, distrust of government-run mental health services and concerns regarding psychopharmaceutical prescription practices. Addressing barriers to mental health service access necessitates a multifaceted approach, including flexible social and community service support, an increased number of co-ethnic professionals and a recognition of cultural variations for effective service provision. Implementing these strategies can enhance help-seeking behaviours, provide culturally appropriate mental health services and improve the experiences of Bosnian refugees in Australia.Originality/valueTo the best of the authors’ knowledge, this study is the first to qualitatively explore how Bosnian refugees in Melbourne perceived the adequacy and availability of mental health services upon arrival to Australia. They are a large and potentially vulnerable community, due to experiences of war trauma and dislocation from country of origin. A lack of understanding regarding how this cohort engage with mental health services can lead to persistent inequities and ineffective service provision. This study identifies unique experiences and perspectives of Bosnian refugee participants, including distrust of government-run mental health services, and concerns regarding psychopharmaceutical prescription practices. This research is expected to contribute positively to the discourse on mental health service provision for Bosnian refugees and wider refugee communities in Australia.

Collaboration With Researchers With Intellectual/Developmental Disabilities: An Illustration of Inclusive Research Attributes Across Two Projects

Abstract Researchers have implemented inclusive research for over 30 years. This article describes how two research projects collaborated with researchers with disabilities and aligns the description with four attributes of inclusive research developed by a consensus of international experts with and without disabilities. The first project, the Person Experiences Interview Survey (PEIS) Workgroup, reviewed and revised items for a self-report survey of mental health service experiences. The second project describes the peer-led implementation of the Self-Determined Career Design Model (SDCDM) intervention. Four factors facilitated or were barriers to the projects’ alignment with inclusive research attributes. First, relationships enhanced capacity to engage in meaningful ways. Second, balance between consistency and adaptability promoted engagement. Third, long-term capacity was enabled by ongoing engagement and peer mentorship. Fourth, time and funds impacted inclusive implementation. Engaging researchers with disabilities meaningfully enhanced the research process and products.

Caregiving and receiving experiences in UK community mental health services during COVID-19 pandemic restrictions: A qualitative, co-produced study.

WHAT IS KNOWN ON THE SUBJECT?: At the outset of the COVID-19 pandemic, little was known about ways of delivering registered nurse practice within CMHTs under restrictions associated with a global pandemic. Emerging research focused on broad healthcare staff wellbeing during the pandemic. Qualitative research explored the overall response of COVID-19 on people with existing health needs or remote working more specifically. Over the past 2 years studies have emerged detailing experiences but no studies have used qualitative research to understand community mental health nurses and service users experience of services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This co-produced qualitative study is the first to explore the changes to CMHT care from the experience of service users and nurses later in the COVID-19 pandemic. The study questions whether recovery-based approaches are possible in a hybrid way of working. The findings identify challenges for nurses' well-being and work-life boundaries when working from home. The study adds to historical professional narratives of mental health nursing. WHAT ARE THE IMPLICATIONS FOR PRACTICE: While hybrid approaches developed in response to COVID-19 restrictions may offer more choice these approaches need further co-produced evaluation on the impact of recovery-focused care and therapeutic relationships. Mental health nurses need to review how future hybrid working continues to impact nurses' mental health and emotional safety. Nurses and service users need to raise awareness within society and policy on the impact that COVID-19 had on people with existing mental health conditions. ABSTRACT: Introduction Community Mental Health Team responses to COVID-19 included fundamental service delivery adaptations. Aim/Question Our co-produced study sought to understand which service delivery changes experienced by service users and registered nurses were helpful or unhelpful to caregiving and receiving. Method Qualitative semi-structured interviews were undertaken with 10 service users and 13 registered nurses from 3 NHS England sites. Co-produced throughout, people with lived experience of mental health services and nurses wishing to improve their research experience undertook interviews following training. Data were analysed thematically. Findings Care radically changed from in-person to large phone or video contact. This reportedly altered therapeutic relationship building and raised questions about whether recovery-focused care was possible. Hybrid working was viewed as helpful but raised challenges for nurse wellbeing. Discussion Changes to care delivery challenged the fundamentals of recovery-focused interventions and therapeutic relationships. Service users and nurses well-being consequently suffered. The impact of the pandemic on people with existing mental health conditions was poorly acknowledged in the media. Implications for Practice Recovery-focused interventions and relationship building need evaluating in the light of ongoing hybrid working. Teams need to consider the well-being of nurses engaged in complex service-user interactions from home.

Development and content validity of the Person Experiences Interview Survey (PEIS): a measure of the mental health services experiences of people with developmental disabilities.

People with developmental disabilities and mental health service experiences have a right to be included in healthcare decisions, including the evaluation of their mental health services and providers. However, few self-report measures address this need. This study aimed to fill this gap by developing and evaluating the content validity, including comprehension, relevance, and comprehensiveness, of the Person Experiences Interview Survey (PEIS) with people with developmental disabilities and mental health experiences. The research team established a measurement framework based on the Family Experiences Interview Survey (FEIS), resulting in 21 PEIS items that were written in collaboration with young adults with developmental disabilities and mental health service experiences. Comprehension, relevance, and comprehensiveness were evaluated through cognitive interviews with people with developmental disabilities and mental health service experiences (respondents; n = 9) ages 23-49 years. Comprehensiveness and relevance were also evaluated in focus groups with family caregivers (n = 9) and mental health providers (n = 10) who serve this population. Two researchers independently coded open-ended responses to the PEIS for comprehension. A content validity index (CVI), indicating relevance, was calculated for each participant group for each item, and comprehensiveness was rated for item sets. Fifteen of the 21 items met the criteria of ≥80% comprehension, with 89-100% of responses containing all or some intended information. All items met the CVI ≥80% criterion in at least two of the three groups. In all item sets, between 1 and 4 family members or providers felt one question was missing. Respondents used the response scale in a manner that corresponded with their open-ended descriptions, and family caregivers and providers had positive feedback about the response scale's visual cues and number of choices. Using these findings, four items were removed and six items were revised, resulting in a 17-item measure. This study presents a novel and promising measure, the Person Experiences Interview Survey (PEIS). It also demonstrates that the employment of accessible methods allows people with developmental disabilities to meaningfully evaluate mental health services and providers. The PEIS shows great promise for application in the field by engaging those directly involved in the evaluation of mental health services and providers.

“I literally had no support”: barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

BackgroundThere has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people’s (10–25 years) and carers’ experiences of mental health services, focusing on barriers and facilitators to services supporting young people’s psychosocial functioning.MethodsThis study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10–25 years with experience of mental illness, and 29 carers (n = 12 parent–child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level.ResultsYoung people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people’s psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments.ConclusionsThis study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.

Advance Statements for Black African and Caribbean people (AdStAC): protocol for an implementation study

BackgroundThe UK government committed to legislating for Advance Choice Documents/Advance Statements (ACD/AS) following their recommendation by the Independent Review of the MHA (2018). ACDs/AS are yet to be implemented in routine practice despite evidence and high demand; they are associated with improved therapeutic relationships and a reduction (25%, RR 0.75, CI 0.61–0.93) in compulsory psychiatric admission. Barriers to their implementation are well documented, ranging from low knowledge levels to logistical challenges in accessing the content during episodes of acute care. In the UK this is an issue for Black people, who experience detention rates disproportionately (over three times) higher than those of White British people and have poorer care experiences and outcomes. ACDs/AS allow for Black people to have their concerns heard by mental health professionals in a care system where they often feel their views are ignored. AdStAC aims to improve Black service users’ experiences in mental health services in South London by co-producing and testing an ACD/AS implementation resource with Black service users, mental health professionals and carers/supporters of Black service users.Methods/designThe study will take place in South London, England over three phases: 1) formative work through stakeholder workshops; 2) co-production of resources through a consensus development exercise and working groups; and 3) testing of the resources using quality improvement (QI) methods. A lived experience advisory group, staff advisory group and project steering committee will support the study throughout. The implementation resources will comprise: advance choice document/advance statement (ACD/AS) documentation, stakeholder trainings, a manual for mental health professionals to facilitate the processes of creating and revising advance statements, and informatics development.DiscussionThe implementation resources will help increase the likelihood of the new mental health legislation in England being implemented effectively; through aligning evidence-based medicine, policy and law to effectively provide positive clinical, social and financial outcomes for Black people, the National Health Service (NHS) and wider society. This study will likely benefit a wider group of people with severe mental illness, as when marginalised groups who are least engaged, can be supported with these strategies, then the strategies are likely to work for others.

Developing a System of Health Support for Young People Experiencing First-Episode Psychosis: Protocol for a Co-design Process.

People living with psychosis face a substantially increased risk of poor psychological well-being and physical health and premature mortality. Encouraging positive health behaviors from an early stage is crucial to the health and well-being of this population but is often overshadowed by symptom management within early intervention services. Experience-based co-design is a participant-centered approach that aims to combine service user narratives with service design methods to design systems of support for health and well-being. This study aims to use experience-based co-design principles to co-design a system that supports the health and well-being of young people experiencing first-episode psychosis (FEP), which considers the lived experience of these people within the context of early intervention services. We also aim to develop a set of principles to guide future systems to support the health and well-being of young people experiencing FEP. Up to 15 young people living with FEP aged 16 to 24 years who are service users of early intervention services in psychosis, their immediate support networks (family or friends), and health professionals involved with early intervention services in psychosis will be invited to participate in a series of co-design workshops. Data will be collected in various forms, including expressive forms (eg, art and spoken word) and traditional methods (interview transcription and surveys), with phenomenographic and thematic analyses being used to understand these data. Furthermore, the co-design process will draw upon indigenous (Māori) knowledge and the lived experience of mental health services from the perspectives of the members of the research team. The co-design process will be evaluated in terms of acceptability from the perspective of service users via rating scales and interviews. The study will be conducted within the Lower North Island in Aotearoa New Zealand. Data collection will be performed between August 2022 and February 2023. Drawing from extended consultations with service users and service providers, we have developed a robust co-design process with which we intend to collect rich qualitative and quantitative data. The results of this process will be used to create a system of support that can be immediately applied and as preliminary evidence for funding and resource applications to deliver and evaluate a "full" version of the co-designed system of support. The co-designed system of support and accompanying set of principles will offer a potentially impactful health and well-being intervention for young people experiencing FEP in Aotearoa New Zealand. Furthermore, making the co-design process transparent will further the field in terms of providing a blueprint for this form of participant-focused research. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12622001323718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384775&isReview=true. DERR1-10.2196/44980.

Adapting to a new home: resettlement and mental health service experiences of immigrant and refugee youth in Montreal

Resettlement and mental health services are critical support systems for refugee and immigrant youth (RIY) as they navigate the complexities of settling into their new homes. These services play a vital role in meeting the needs of RIY and helping them feel welcomed into Canadian society. The purpose of this study is to provide insight into RIY’s experiences with resettlement and mental health service providers in Montreal, Canada. Adopting a descriptive quantitative research approach, this study utilized online surveys to gather data. The findings indicate that cultural and linguistic barriers are the major obstacles faced by refugee and immigrant youth when accessing resettlement and mental health services in Montreal. Protective resources, such as family, friends, and ethnic communities, were identified as important facilitators of successful integration into Canadian society. To improve services, cultural sensitivity should be a priority for providers, as recommended by this study. By acknowledging the significance of cultural barriers in accessing resettlement and mental health services, this study emphasizes the need for service providers to prioritize cultural sensitivity in their efforts to improve services.

Addressing equality, diversity and inclusion as part of CBT training: a course evaluation study

Abstract It is widely documented that Black, Asian and Minority Ethnic (BAME) communities experience poorer mental health, and have a poorer experience of mental health services. Therapists delivering cognitive behavioural therapy (CBT) in services such as NHS Talking Therapies Services for Anxiety and Depression, are working with increasingly diverse client groups, but treatment access and recovery rates remain below what they should be compared with the White British population. Previous research indicates that CBT therapists may not receive appropriate training that allows them to develop the skills required to work effectively transculturally. The present study therefore aimed to evaluate a CBT training programme within this context, from the perspective of previous course graduates. Thirty participants took part in an online survey with questions requiring both Likert-scaled answers and free-text responses. Descriptive statistics, inferential statistics and template analysis were used to analyse the data. The results of the survey were favourable overall for both White British and BAME respondents. Positive areas of practice highlighted included peer learning within a diverse cohort, building awareness of own biases, and reflective learning spaces. Areas of development included increased integration of teaching focused on adapting CBT models for minority groups, diversification of teaching staff, and reducing fear and avoidance of exploring issues related to equality, diversity and inclusion. Tentative implications for improving CBT training course delivery in this context have been offered. Key learning aims (1) To acknowledge the challenges faced by service users from BAME communities in accessing equitable mental health treatment, including cognitive behavioural psychotherapy. (2) To consider explanations for why CBT therapists working in NHS services might find it difficult to work effectively transculturally. (3) To establish ways in which CBT training programmes might help therapists to embark more successfully on the journey of developing cultural competence, during training and beyond.

Is 'another' psychiatry possible?

In this paper, we examine a number of approaches that propose new models for psychiatric theory and practices: in the way that they incorporate 'social' dimensions, in the way they involve 'communities' in treatment, in the ways that they engage mental health service users, and in the ways that they try to shift the power relations within the psychiatric encounter. We examine the extent to which 'alternatives' - including 'Postpsychiatry', 'Open Dialogue', the 'Power, Threat and Meaning Framework' and Service User Involvement in Research - really do depart from mainstream models in terms of theory, practice and empirical research and identify some shortcomings in each. We propose an approach which seeks more firmly to ground mental distress within the lifeworld of those who experience it, with a particular focus on the biopsychosocial niches within which we make our lives, and the impact of systematic disadvantage, structural violence and other toxic exposures within the spaces and places that constitute and constrain many everyday lives. Further, we argue that a truly alternative psychiatry requires psychiatric professionals to go beyond simply listening to the voices of service users: to overcome epistemic injustice requires professionals to recognise that those who have experience of mental health services have their own expertise in accounting for their distress and in evaluating alternative forms of treatment. Finally we suggest that, if 'another psychiatry' is possible, this requires a radical reimagination of the role and responsibilities of the medically trained psychiatrist within and outside the clinical encounter.

Mental Health Service Experiences Among Transition-Age Youth: Interpersonal Continuums that Influence Engagement in Care.

Purpose. Transition-age youth (TAY) who have experienced or are experiencing complex trauma, system involvement and homelessness are at increased risk for serious mental health needs and related challenges. However, these vulnerable and historically marginalized TAY typically have low rates of mental health service engagement. This study examines how and why TAY experiencing system involvement, homelessness, and serious mental health and substance use symptoms engage in mental health services, and what facilitates and/or hinders their engagement in services. Methods. Twenty-one TAY completed a virtual interview about their previous and current mental health service experiences, and why they did or did not engage with mental health services. A modified grounded theory qualitative analysis approach was used to understand how participants' personal sense of meaning interacted with programmatic factors to construct participant experiences with mental health services. Results. Most participants (81%, n = 17) received mental health services, namely psychiatry (76%, n = 16) and counseling/therapy (48%, n = 10), and peer support (10%, n = 2). Participants described their mental health service experiences along three interpersonal and relational continuums between themselves and their providers: feeling (mis)understood, being treated with (dis)respect, and experiencing (dis)trust. Discussion. Study findings reveal that for these particularly vulnerable and marginalized TAY, relational and interpersonal factors significantly influenced their engagement in mental health services. Study findings call for providers to re-imagine their working alliance with highly vulnerable TAY through culturally-attuned practices that promote understanding, respect, and trust. Findings also call for TAY-serving programs and policies to re-imagine peer support as a mental health service option for this highly vulnerable population.

Central and Eastern European migrants’ experiences of mental health services in the UK: A qualitative study post-Brexit

ObjectiveCentral and Eastern European (CEE) migrants are a large minority group in the UK who are vulnerable to experiencing mental health problems. However, due to their shared ‘whiteness’ with the majority population, health service disparities may be overlooked. This is the first study exploring CEE-born people’s experiences of mental health services post-Brexit. MethodThirteen CEE migrants who had received mental health services in the UK were interviewed and data was thematically analysed. ResultsBarriers and facilitators to engagement reflected: 1) attitudes towards help-seeking; 2) cultural in/visibility; and 3) professional-service user communication. Some barriers were unique to the CEE community and not shared by other minority groups, such as the ‘invisibility’ of ethnic identity and this framed the way participants navigated interactions with services. ConclusionsCultural differences and mental health stigma were reported to influence understanding of mental health, attitudes to help-seeking, and experiences of services. Flexible ethnic identity and majority group “passing” could conceal inequalities in healthcare. Practice implicationsThe need for culturally informed approaches, professional upskilling, strengthened inter-agency working, and collaboration with CEE communities. The need to build on pre-existing strengths, for self-directed and self-care activities, for appropriate pacing and confidentiality discussions, and the use of web-based resources.

Mental health problems among adolescents and young adults with childhood-onset physical disabilities: A scoping review.

AimThis scoping review aims to better understand the extent and nature of research activity on the topic of mental health problems in young people with childhood-onset physical disabilities. Specifically, we document what has been investigated in terms of the occurrence and experience of mental health problems among young people with childhood-onset physical disabilities, and their access to mental health services.MethodsWe searched four databases (Medline, PsycINFO, CINAHL, Embase) for articles published between 2007 and 2019. Studies were included if they addressed: (1) young people between the ages of 13 and 24 with a childhood-onset physical disability, and (2) mental health assessment, treatment, or service access and use.ResultsWe identified 33 peer-reviewed studies that focused mainly on young people with cerebral palsy, juvenile arthritis, and spina bifida. The most common mental health problems investigated were depression and mood related difficulties (73%), anxiety (39%), and social/behavioural issues (33%) and the most common age range was 13 to 17. Ten studies explored access, use, and experiences of mental health services; stigma; caregiver mental health; and value for comprehensive care, using qualitative, quantitative, or mixed methods.ConclusionsFindings suggest the importance of developing integrated models of service delivery to identify and address the mental health needs of this population, and consensus on best practices for assessment and reporting rates of subclinical symptoms and psychiatric conditions.

Life Experiences of Borderline Personality Disorder Survivors in the Recovery Process: A Qualitative Study

Background: Borderline Personality Disorder or BPD is a personality disorder with the main symptoms are emotional instability, impulsive behavior, negative self-concept, and impaired interpersonal function. Recovery in BPD is directed at the existence of satisfaction and meaning in life even with limited conditions due to symptoms of the disorder that still exists.Purpose: The aim of this study is to explore the life experiences of BPD survivors in their recovery processMethod: This research is a qualitative research with a phenomenological approach. In-depth interviews were conducted with 10 BPD survivors from the Indonesian BPD Community. Interview transcripts were analyzed using the Colaizzi method.Result: Six themes were extracted in this study, namely, the recovery process is not found alone, it is difficult to understand and love oneself, it is difficult to build stable relationships with others, the journey to make peace with oneself, the most painful experiences that come from the closest people and the experience of mental health services in Indonesia.Conclusion: The process of self-identification has been the first step in an individual's journey with BPD in the recovery process. The available support system has helped BPD survivors to be able to adapt to the experience resulting from BPD symptoms. It is necessary to increase the knowledge of nurses about BPD in order to be able to provide good nursing careKeyword: borderline personality disorder, life experience, recovery

An exploratory study of South Asian women’s experiences of mental health services in England: a thematic analysis of cultural sensitivity

Purpose Despite government and national health service demands for equality within mental health (MH) services, racial inequalities remain. South Asian (SA) women underutilise MH services, yet research regarding their experiences and the cultural sensitivity (CS) of services is sparse. The purpose of this study was to explore the experiences of SA women who have used MH services and the cultural sensitivity of the latter. Design/methodology/approach Thematic analysis was used for data analysis of semi-structured interviews carried out with 16 SA women. Findings Analysis yielded an overarching theme of “degree of understanding” and three main themes: “shared background and understanding” “humanity” and “cultural factors” and their subsequent subthemes. Results demonstrated mixed experiences, illustrating varied levels of CS and the impacts of this upon experiences. Cultural understanding underpins CS: participants’ experiences demonstrated the benefit of significant understanding and the detriment of limited understanding. Research limitations/implications All participants were well educated, English-speaking and from psychology, health or research backgrounds. SA culture is nuanced; thus, the demographic of “South Asian” could be too broad. However, because current understanding is limited, this research provides fundamental empirical knowledge. Practical implications Clear recommendations were co-produced with participants, highlighting strong impacts for service development and best practice. Social implications The research provides valuable insight into SA women’s experiences of MH services and wider understanding of CS. This raises cultural awareness in a field lacking understanding. Findings and recommendations can, therefore, provide foundational knowledge for broader societal issues experienced by people from this demographic and challenge preconceptions. Originality/value This research offers unique recommendations for more culturally sensitive practice, co-produced with participants.

Anxiety in female adolescents with autism spectrum disorder: Lessons for healthcare professionals

Background: Despite awareness of the high prevalence of anxiety in females with autism spectrum disorders (ASD), females report high unmet service needs regarding mental health concerns. Aim: This study explored experiences of anxiety in female adolescences with ASD, their management of it, and their experiences of mental health services in the United Kingdom. Methods: Utilising an Interpretative Phenomenological Analysis, six females with ASD, aged between 13 to 15 years and referred to mental health services, took part in semi-structured interviews. Results: The analysis generated the following themes: the central experience of anxiety; the impact of the surrounding world; mismatch between needs and support; and the value of self-management. The themes emphasised a need for a more general acceptance of ASD-related anxiety triggers such as sensory overload and uncertainty to change. Discussion: Adolescents raised concerns around the appropriateness of support provided for their anxiety, including awareness raising initiatives around ASD which only served to heighten their anxiety. Conclusions: Healthcare professionals need to have a better understanding of ASD-related anxiety in females. To improve outcomes, better service knowledge and communications around ASD-related anxiety are important for the assessment of anxiety as well as tailored ASD interventions.

“There wasn’t any build up to it, it was just like, now you have to go over.” Disengagement during the Child to Adult Community Mental Health Service Transition

This study explored the personal, real-time experience of accessing adult mental health services after aging out of child mental health services. Mean age of the 19 participants at enrollment was 18. Eleven identified as women, five as men, and two as gender non-conforming. Over half of the sample identified as Hispanic or Latinx. This study employed a longitudinal, qualitative design with three interviews over 12-months (e.g., baseline, 6-months, 12-months), and monthly check-ins to prevent study attrition. Interviews explored previous and current mental health service experiences; the transition experience from child-to-adult services, and perceived service barriers and facilitators. Research team members used thematic coding to code each interview individually, focusing on identifying the disengagement timeline, experience, and related factors. Universally, participants saw a benefit in continuing mental health services, but almost all disengaged due to difficulty in navigating care and getting their needs met during the transition from child to adult services. This study provides a young adult perspective on the real gap between child and adult services within one community mental health agency. Improved transition practices and tailoring services to young adult development may prevent mental health disengagement during the transition from child to adult service systems.

The initiation or continuation of mental health services in the transition to college

Objective: To examine what factors impact college students in the United States who are deciding to initiate or continue mental health services. Participants: Spring 2021 undergraduate students (N = 453) at a large urban university. Methods: Online, cross-sectional survey with mental health service experience as the independent variable and social support, accessibility, attitudes toward mental health, mental health literacy, and trust of mental health professionals as the dependent variables, as well as thematic analysis of reasons to discontinue services. Results: Individuals with lower levels of social support and higher levels of mental health literacy were more likely to have received therapy. Participants tended to discontinue services because of negative experiences, accessibility problems, negative attitudes toward services, or they felt better. Conclusions: Mental health literacy, social support, and accessibility are significant predictors of college student service use and should be taken into consideration by university administration.

The desire and fear of discharge from mental health units by people with autistic spectrum conditions: a phenomenological study

Background/Aims Anxiety is a common characteristic for people who live with an autistic spectrum condition and while studies on anxiety in this population are commonplace and case studies correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations, particularly during the discharge process. This aim of this study was to explore how mental health inpatients with autistic spectrum conditions experienced and coped with discharge from a UK acute mental health inpatient facility. Methods Between 2018 and 2019, audio-recorded semi-structured interviews captured the experiences of 20 adults from the east of England, who were former psychiatric inpatients with an established diagnosis of an autistic spectrum condition. Results Themes were identified through interpretative phenomenological data analysis, which explained participants' reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, behavioural manifestations of anxiety and responses to the discussion of discharge. Broad behavioural patterns were established that could be associated with their anxiety, such as self-harming or exhibiting aggressive and violent behaviours. Conclusions The anxiety caused by the discussion of the discharge process appears to be overlooked by mental health practitioners, so attention to potentially anxiety-inducing dialogue is needed when planning discharge from acute care mental health services. The nature of patient–practitioner interactions and dialogue leading up to discharge needs to be handled with sensitivity to the unique needs of the patient so that the experience of discharge becomes less daunting. Transformative research is required to clearly understand the experiences of this vulnerable group and to act as a vehicle to enhance pre-discharge dialogue and support.

Position paper: Peer-Support and involvement of people with lived experience in mental health services

Position paper: Peer-Support and involvement of people with lived experience in mental health services