Mainstream Mental Health Services Research Articles

Walking together in friendship: Learning about cultural safety in mainstream mental health services through Aboriginal Participatory Action Research.

Culturally safe service provision is essential to improving social and emotional wellbeing among Aboriginal and Torres Strait Islander communities, and to eliminating health inequities. Cultural safety is about ensuring that all people have a safe and healing journey through services, regardless of their cultural background. In this project, we aim to (1) understand how Aboriginal and Torres Strait Islander peoples conceptualise cultural safety, and (2) co-design a qualitative interview for the next phase of this project, where we plan to learn about experiences of cultural safety within mental health services. We conducted six focus groups (in one metro and two regional areas, Western Australia). Following an Aboriginal Participatory Action Research methodology, we yarned with Aboriginal and Torres Strait Islander mental health service users, carers, community members, mental health professionals and Cultural Healers about cultural safety. Participants described a culturally safe service as one where Aboriginal cultural knowledges, life experiences, issues and protocols are understood and acknowledged, and reported that mainstream mental health services are not currently culturally safe. Participants emphasised the importance of building trust, rapport, reciprocity and following appropriate relational processes when designing a qualitative interview for the next phase. A lack of cultural safety in mental health services is likely to contribute to the disparity in outcomes between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Embedding cultural safety into research design allows for authentic community engagement and facilitates knowledge sharing around ways to improve cultural safety in mental health services.

Aboriginal young people’s experiences of Cultural Safety in mental health services in two regions of New South Wales, Australia

This article assesses the Cultural Safety of mainstream mental health services in two regions of New South Wales, Australia, based on the experiences and perspectives of Aboriginal young people aged 16 – 25. Yarning semi-structured in-depth interviews were conducted with thirteen Aboriginal young people in two regions of New South Wales. Thematic analysis was undertaken by all research members to identify themes from the data and conceptual connections between them. Identified themes from individual analysis and coding were triangulated during several analysis meetings to finalize key themes and findings. Aboriginal young people identified that Aboriginal Community Controlled Health Services offered culturally safe Social and Emotional Wellbeing service supports, whereas mainstream mental health services did not. Aboriginal young people proposed that institutional reforms such as increasing engagement with cultural competency programs, employing more Aboriginal staff, and implementing culturally meaningful services, would increase Cultural Safety in mainstream mental health services. Cultural Safety within mainstream mental health services should be enhanced to ensure the subjective Social and Emotional Wellbeing support needs of Aboriginal young people are understood, addressed, and supported. Without Aboriginal young people having confidence that mainstream mental health services and systems are prioritising Cultural Safety when providing supports, mainstream mental health systems risk failing to reduce mental health and Social and Emotional Wellbeing disparities unjustly experienced by Aboriginal young people in New South Wales.

Nurturing the Positive Mental Health of Autistic Children, Adolescents and Adults alongside That of Their Family Care-Givers: A Review of Reviews.

The rising prevalence of autism internationally has been accompanied by an increased appreciation of the poorer mental health experienced by people with this condition and also of their family care-givers. In particular, higher incidences of anxiety and depression are reported in high-income nations and these conditions are likely to be under-recognised and under-reported in lower-resourced regions or countries. Mainstream mental health services seem to be ill-equipped to respond adequately to the needs of autistic persons and their care-givers. This literature review of 29 recently published reviews covering nearly 1000 journal articles summarises the insights and strategies that have been shown to promote the mental health and emotional wellbeing of autistic persons. In particular, a focus on family-centred, community-based supports is recommended that aim to enhance social communication, extend social connections and promote an individual's self-esteem, self-determination and social motivation. These low-cost interventions are especially pertinent in low-resourced settings, but they can be used internationally to prevent mental illness and assist in the treatment of anxiety and depression in autistic persons and their family carers. The priority is to focus on primary-care responses with cross-sectoral working rather than investing in high-cost psychiatric provision.

Mental health services for Muslim communities in England and Wales: developing a more collaborative model

ABSTRACT The landscape of mental health services for Muslim communities in England and Wales remains fragmented with many Muslims unsure how to access services that accommodate their religious beliefs and practices. This article reports findings from a pilot study of mental health services and Muslim communities in England and Wales. It explores the role of Muslim mental health organisations, charities, therapists, counsellors, faith leaders and community groups in supporting the communities they serve. The study’s aim was to establish a larger project to identify and amplify best practice across mainstream and non-mainstream mental health services in relation to improving provision for Muslim communities. Focus group data from key informants was analysed using grounded theory. Four analytical themes emerged from the analysis: “Knowledge gaps”, “Policy gaps”, “Working together” and “Moving forward”. Based on this, the authors argue for an asset-based approach to building collaborative partnerships between Muslim communities and mental health providers.

Vicarious Trauma and Health Outcomes in Forensic Mental Health Nurses.

Nurses working in forensic mental health settings are at risk of vicarious trauma because of their exposure to traumatized patients and distressing material such as the aversive details of patient crimes. The aim of this study was to determine the incidence of vicarious trauma and explore its impact on health and absence from work. A cross-sectional descriptive correlational study was undertaken. All 205 forensic mental health nurses working in a high-security inpatient facility were invited to participate. An online survey included the Vicarious Trauma Scale and the SF-36v2 to measure mental and physical health. Absence from work was also explored. Sixty-seven respondents completed the survey. Almost half of respondents had a moderate level of vicarious trauma, and only over one-quarter experienced high levels. Higher levels of vicarious trauma were associated with poorer mental health (r = -0.59, p < 0.000) and absence from work (r = 0.27, p < 0.010). Forensic mental health nurses are at a greater risk of vicarious trauma than nurses working in mainstream mental health services, given their exposure to aversive details of patients' violent crimes. Adverse mental health consequences of vicarious trauma, and other forms of workplace trauma experienced by forensic mental health nurses, are likely to include trauma-related symptoms, depression, and anxiety. Forensic mental health nurses experiencing vicarious trauma may use sick leave as time away from work to care for their own mental health or a coping mechanism for workplace-induced psychological distress.

Conceptualizing the peer contribution in Open Dialogue practice.

In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the "between" of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI). The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure - and hence how they may be able to contribute an additional dimension to dialogical practice.

Evaluating online teaching on working with people with learning disabilities to high intensity Improving Access to Psychological Therapies (IAPT) trainees

People with learning disabilities are known to experience barriers to accessing mainstream mental health services, and also, to have higher rates of mental health needs. Training has previously been delivered to mainstream practitioners to enhance their confidence and self-efficacy when working therapeutically with people with learning disabilities and to promote positive attitudes towards working with this group of people (Dagnan et al., 2018; Cantrell &amp; Westbrook, 2019) with positive outcomes on these areas. Our service evaluation was of a one-day online training course to high intensity Improving Access to Psychological Therapies (IAPT) trainees. It found that the teaching also demonstrated positive change in confidence, self-efficacy and attitudes. Although the percentage increase was smaller than most of those shown in previous studies this was found to be due to a higher baseline for this sample. Ideas for further research were identified including the further exploration of High intensity (IAPT) trainees’ prior experience of working therapeutically with people with learning disabilities and how this could translate into more tailored training. A key recommendation was the use of online training for IAPT trainees and practitioners to be considered as an option due to benefits in terms of the flexibility this offers including training large groups.Easy to read summary■We delivered teaching to trainee therapists who work in mental health services.■The teaching was online.■Before the teaching we asked the trainees about their confidence to give therapy to people with learning disabilities and how important they thought it was for mental health services to work with people with learning disabilities.■We asked them the same questions at the end of the teaching.■The trainees were more confident to work with people with learning disabilities after the teaching.■The trainees were more positive about working with people with learning disabilities after the teaching.

Culturally Adapted Cognitive Behaviour Therapy (CaCBT) to Improve Community Mental Health Services for Canadians of South Asian Origin: A Qualitative Study.

South Asian (SA) Canadians are disproportionately affected by higher rates of mood and anxiety disorders. SA Canadians with depression report significant barriers to accessing mental health care and the highest proportion of unmet mental health needs. The Mental Health Commission of Canada (MHCC) advocates for culturally and linguistically relevant services for SA Canadians. Culturally adapted cognitive behavior therapy (CaCBT) has shown to be more effective than standard cognitive behavior therapy (CBT). Adapting CBT for the growing SA population in Canada will ensure equitable access to effective, culturally-appropriate mental health interventions. The study used a qualitative design to elicit stakeholder consultation via in-depth interviews. This study is reported using the criteria included in Consolidated Criteria for Reporting Qualitative Studies (COREQ). The analysis follows an ethnographic approach and was informed by the principles of emergent design. Five themes were identified from the analysis, (i) Awareness and preparation: factors that impact the individual's understanding of therapy and mental illness. (ii) Access and provision: SA Canadians' perception of barriers, facilitators, and access to treatment. (iii) Assessment and engagement: experiences of receiving helpful treatment. (iv) Adjustments to therapy: modifications and suggestions to standard CBT. (v) Ideology and ambiguity: racism, immigration, discrimination, and other socio-political factors. Mainstream mental health services need to be culturally appropriate to better serve SA Canadians experiencing depression and anxiety. Services must understand the family dynamics, cultural values and socio-political factors that impact SA Canadians to reduce attrition rates in therapy.

"Ngany Kamam, I Speak Truly": First-Person Accounts of Aboriginal Youth Voices in Mental Health Service Reform.

Aboriginal young people are experts in their own experience and are best placed to identify the solutions to their mental health and wellbeing needs. Given that Aboriginal young people experience high rates of mental health concerns and are less likely than non-Indigenous young people to access mental health services, co-design and evaluation of appropriate mental health care is a priority. Increasing Aboriginal young people's participation in mental health service reform is key to ensuring services are culturally secure, relevant and accessible. This paper presents first-person accounts from three Aboriginal young people who worked alongside their Elders and in a positive and constructive partnership with mainstream mental health services on a three-year participatory action research project in Perth, Western Australia, in Whadjuk Nyoongar boodja (Country). The young people recount their experiences as participants and co-researchers on a systems change mental health research project and share their views on the importance of privileging Aboriginal youth voices. Their accounts highlight that Aboriginal young people's participation and leadership must be understood through a decolonising lens and that working in genuine partnership with the community is key to increasing their contact and engagement with mental health care and improving mental health and wellbeing outcomes.

Development of a Technology-Based Intervention to Improve Help-Seeking in Distressed Non-Treatment-Seeking Young Adults With Common Mental Health Concerns.

Background There is a dearth of interventions aimed at improving help-seeking for common mental health concerns among distressed young adults, particularly in the urban Indian context. Availability of cost-effective, targeted intervention for improving appropriate help-seeking can pave the way for reducing the treatment gap. This could prove especially beneficial in low-resource settings. This study describes the guiding principles, underlying theory, and development process of a simple technology-based help-seeking intervention for distressed non-treatment-seeking young adults. Methods Several models of professional help-seeking behavior were examined to ascertain a suitable theoretical framework for the development of the intervention to enable help-seeking among distressed non-treatment-seeking young adults. Pilot work was carried out before the development, along with content validation of the intervention by field experts. Results Help-seeking intervention was developed based on the preferences of young adults and literature review. Eight core intervention components and one optional component were developed, which were built on selected theoretical frameworks. These components have been postulated to enhance awareness of common mental health problems, the utility of self-help, and support of significant others, and to increase the skills to understand when it may be appropriate to step up to professional help-seeking. Conclusion Help-seeking interventions delivered beyond the traditional clinic and hospital setups prove useful as low-intensity interventions acting as gateways to seek mainstream mental health services. Further research will evaluate the feasibility, acceptability, and effectiveness of the intervention in reducing perceived barriers and enhancing inclination to seek professional help and help-seeking behavior among distressed non-treatment-seeking young adults.

Mainstream Integration of Mental Health Peer Support in Canada: A Mixed Method Study

Mental health peer support was one of the key recommendations of the Mental Health Commission of Canada’s Workforce Advisory Committee (Cyr et al., 2016 [2012]) and highlighted as one way to transform the mental health system in Canada. This mixed methods study explored the work experiences of mental health peer support workers across Canada and their perceptions of integration within mainstream mental health services. The findings revealed that role confusion, stigma, lack of support to practice authentically and peer drift challenged the full integration and participation of peer support workers within Canada’s mental health system. Recommendations to mitigate these challenges are suggested.

Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway.

The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Family carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery. The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services.

Benefits of Hearing Voices Groups & Other Self-Help Groups for Voice Hearers: A Systematic Review

People who hear voices that others do not often rely on mainstream mental health services. Several alternatives to treatment have grown in popularity including “Hearing Voices Groups” and other self-help groups for voice hearers. The aim of this systematic review is to evaluate the current evidence relating to the use of Hearing Voices Groups (HVGs) and other self-help groups for voice hearers, and identify the benefits felt by those attending such groups. The following databases were searched for relevant academic articles: CINAHL; APA PsycArticles; APA PsycInfo; Social Sciences; SocINDEX; UK & Ireland Reference Centre and Medline, with 13 papers identified for inclusion. Participants reported several benefits of attending a HVG/self-help group, which reduced isolation, improved social and coping skills, and gave them a better understanding of the meaning and context of their voices. The groups also provide hope for the future and act as a catalyst for recovery. These study findings suggest that voice hearers find some benefits from attending HVGs/self-help groups. Evidence indicates that voice hearers can live meaningful lives and continue to hear voices once context and meaning to their voices become clear. HVGs/self-help groups provide a vital service to voice hearers, which they felt was not available within mainstream mental health services. If mental health providers gained a better understanding of the HVN, they may be able to integrate the values and ethos of the HVN into groups for voice hearers within mainstream mental health services or signpost voice hearers to these groups.

Aboriginal Young People's Experiences of Accessibility in Mental Health Services in Two Regions of New South Wales, Australia.

This article assesses the accessibility of mainstream mental health services (MMHSs) in two regions of New South Wales (NSW), Australia, based on experiences and perspectives of Aboriginal young people aged 16-25. Semi-structured yarning interviews were conducted with thirteen Aboriginal young people in two regions of NSW. Thematic analysis was undertaken by all research team members to identify major themes from the data and conceptual connections between them. The identified themes from individual analysis and coding were triangulated during several analysis meetings to finalise the key themes and findings. Aboriginal young people had no experience of engaging with early-intervention MMHSs. MMHSs were identified as inaccessible, with most participants unaware that MMHSs existed in each region. Due to MMHSs being inaccessible, many Aboriginal young people presented to emergency departments (EDs) during a crisis. Aboriginal Community Controlled Health Services (ACCHSs) were identified as key providers of accessible, culturally meaningful, and effective social and emotional wellbeing (SEWB) service support for Aboriginal young people in NSW. If health and wellbeing outcomes are to improve for Aboriginal young people in NSW, MMHSs must increase accessibility for Aboriginal young people requiring SEWB support.

Scalable interventions for refugees.

Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.

”I don’t want to say the wrong thing”: mental health professionals’ narratives of feeling inadequately skilled when working with gender diverse adults

ABSTRACT Trans, gender diverse and gender questioning adults are highly likely to experience mental health difficulties, for multiple reasons including transphobia or minority stress. However, gender diverse adults often describe having negative experiences accessing mental healthcare in the UK. Concurrently, health professionals have described feeling inadequately skilled, and lacking confidence in their ability to support gender diverse people. There has been limited research exploring the experiences of mental health professionals who provide care for gender diverse people in mainstream mental health services, and even less in the UK. In this study, the accounts of seven mental health professionals from a range of disciplines were analysed with a constructionist narrative analysis, to better understand the nature of stories and positioning of individuals, within the local, social and historical contexts of the narratives’ construction. This paper focuses on participants’ narratives of feeling inadequately skilled when working with gender diverse individuals, which were drawn on and resisted in their stories. Implications for clinical practice and training are suggested.

Access to healthcare for street sex workers in the UK: perspectives and best practice guidance from\xa0a national cross-sectional survey of frontline workers

BackgroundStreet sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered ‘hard to reach’, but many individuals and organisations have extensive experience of working with this group.MethodsWe conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice.Results50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness.ConclusionsAccess to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision for marginalised groups the norm, not the exception.

The experience of isolated practice for Indigenous mental health and addictions workers

Background In Australia, the gap in mental health and addictions outcomes between Indigenous and non-Indigenous people is well documented. The integration of Indigenous mental health and addictions (IMHA) workers into mainstream mental health services has been adopted to provide more culturally appropriate services, and address health disparities. However, processes for utilizing the role and strategies for supporting this workforce are unclear. This study aimed to understand the experiences of IMHA workers in two Metropolitan Hospital and Health Services (HHSs) to assist in the development of policy and workforce support strategies. Methodology In-depth semi-structured interviews were conducted with IMHA workers (n = 17) and analyzed thematically. Results The IMHA workforce is extremely valuable, but complex, and confronted by challenging systemic barriers. Experiences of isolation, lack of cultural safety, and limits on practice are common. This situation creates difficulty for the IMHA workers and undermines their effectiveness to work in ways preferred by the IMHA workers. Conclusion Enhancing cultural safety for the IMHA workforce is a crucial precursor to achieving culturally appropriate service provision for Indigenous consumers. The interaction of cultural safety for IMHA workers with consumer outcomes and experiences is an important area for future research.

Services for people with intellectual disabilities and mental health problems in Singapore: perspectives from mainstream mental health professionals

Background: Generic mental health staff often have contact with people with intellectual disabilities when they access mainstream mental health services. To date, there has not been any research conducted in non-western countries to explore their views. This paper investigates the views and experiences of mainstream mental health professionals regarding the mental health services for people with intellectual disabilities in Singapore. Methods: Eight staff members from generic mental health services were interviewed. Thematic analysis was used to identify main themes. Findings: The main themes are related to their work experiences, perceptions of people with intellectual disabilities, ideal staff characteristics and service recommendations. Conclusions: Participants identified a lack of experience and knowledge when working with this population. They highlighted the challenges they face promoting choice and autonomy for people with intellectual disabilities. The discussion includes recommendations for improving staff knowledge through training opportunities, consideration of non-pharmacological approaches and early collaboration with caregivers during the treatment process.

A multitier model of refugee mental health and psychosocial support in resettlement: Toward trauma-informed and culture-informed systems of care.

Refugees endure tremendous trauma during migration and resettlement. Despite the wide range of needs and challenges refugees have, previous research on refugee mental health has concentrated on the clinical treatment of certain common mental disorders related to premigration trauma. This narrow attention creates an environment in which positive mental health and social functioning are seen merely as a lack of mental illness among refugee populations. The consequences of such a focus are increased stigma of mental health issues and a negligence of other psychosocial needs critical to the community integration of refugee newcomers. There are few models and studies that focus on service delivery and systematic approaches to guide coordination of mental health services and psychosocial supports for refugee newcomers. To fill such gaps, this paper provides a framework to align stratified interventions and addresses the multilayered mental health needs in refugee communities. We have adopted and applied a multitier mental health and psychosocial support (MHPSS) model developed by the Inter-Agency Standing Committee to provide a holistic framework for a system of care. We have also proposed a two-pillar approach, trauma-informed and culture-informed care, which is embedded into each tier of the MHPSS program. This approach is designed to fill the gaps between mainstream mental health services and refugee resettlement programs, both of which tend to work in silos. Using the case of a statewide refugee mental health initiative in Virginia, we discuss the challenges and opportunities of programs to build capacity and partnerships for coordinated care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).