Mental Health Rehabilitation Services Research Articles

MH Court Cuts Violence, Even in Felony Cases

Back to table of contents Previous article Next article Professional NewsFull AccessMH Court Cuts Violence, Even in Felony CasesAaron LevinAaron LevinSearch for more papers by this authorPublished Online:9 Apr 2015https://doi.org/10.1176/appi.pn.2015.4b13AbstractFelony defendants’ lowered risk of violence over the following 12 months was statistically significant.Participation in a San Francisco mental health court reduced perpetration of violence by felony defendants over the following 12 months, according to a report in Psychiatric Services in Advance.In their early days, mental health courts dealt largely with nonviolent misdemeanors. In recent years, more of these special courts have accepted felony cases. Nevertheless, little prospective research is available on how involvement of felony defendants in mental health courts can influence their risk of later violence, said researchers led by Dale McNiel, Ph.D., a professor of psychiatry at the University of California, San Francisco, School of Medicine and chief psychologist at the Langley Porter Psychiatric Hospital and Clinics.McNiel and colleagues (including APA President-elect Renȳe Binder, M.D.) compared 88 mental health court enrollees with mental illness with 81 matched jail detainees who received treatment as usual. In both cohorts, about seven of 10 individuals had been arrested on felony charges.The difference between a misdemeanor charge and a felony may seem quite distinct, but the latter may often reflect just a marginal increase in severity, said Virginia Hiday, Ph.D., a professor of sociology at North Carolina State University, who has studied mental health courts extensively.“If a theft has a dollar value above the misdemeanor limit or a loitering arrest turns into a shoving match with a cop, the charge will escalate,” Hiday, who was not involved in McNiel’s research, told Psychiatric News.Participants were not randomized in the current study, so a propensity-score method was used to reduce the effects of potential confounders such as demographic, clinical, criminal-justice involvement, and other factors.Using both self-report and arrest records, the researchers found that after one year, the strongest association with the likelihood of violence was found among participants with a history of violence in the six months prior to entry (odds ratio=3.52). However, they also found that only 25 percent of the court participants had perpetrated violence, compared with 42 percent of the comparison group (odds ratio=0.39).“These findings extend previous work by providing prospective evidence that participation in [a mental health court] can reduce the risk of violence among justice-involved individuals with mental illness,” wrote McNiel and colleagues.Exactly why mental health courts might reduce violence or recidivism remains an open question, they said. It may be obvious elements like mental health treatment, rehabilitation services, or help with housing and employment. Or perhaps the process itself plays a significant role, said Hiday.“Things slow down,” said Hiday. “The defendant is treated with respect and is allowed to talk. Everything that goes on is explained, which may not happen in a regular criminal courtroom.”This idea of “procedural justice” allows people to feel that they’re being treated fairly and so are more apt to cooperate with the system, she said.Outcomes research like this may help to counter popular beliefs equating violence and mental illness, beliefs that stigmatize mental health courts as well as people with mental illness, suggested McNiel. It also buttresses the view that mental health courts can work with defendants charged with some felonies and improve public safety.“[T]argeting intensive services to the needs of offenders at higher risk of recidivism yields more demonstrably effective interventions in reducing recidivism,” concluded McNiel and colleagues. The courts can’t achieve this alone, though. “[Mental health courts] considering inclusion of higher-risk individuals need to ensure availability of services to address their needs.” ■“Prospective Study of Violence Risk Reduction by a Mental Health Court” can be accessed here. ISSUES NewArchived

The ongoing need for local services for people with complex mental health problems

Despite developments in mental healthcare over recent decades, there remains a group of people with very complex needs who require lengthy admissions and high levels of support in the community on discharge. This is the group that mental health rehabilitation services focus on. In the context of contemporary mental health services that minimise in-patient lengths of stay, the needs of this group must not be overlooked. Providing a local, ‘whole system, integrated rehabilitation care pathway’ requires intelligent commissioning in order to avoid the social exclusion of this group to the ‘virtual asylum’ of out-of-area placements.

Suicide risk in adults with Asperger's syndrome

Suicide risk in adults with Asperger's syndrome

La recuperación: servicios que ponen a las personas en primer lugar

This brief review intends to synthe- size the fundamental literature regarding the reco- very model (or paradigm) in mental health servi- ces. Approaching the original English-language literature, this work reviews longitudinal and sub- jective studies and explores the fundamental con- cepts of recovery in terms of values, results and phases. The discussion argues for the reorientation of mental health and psychosocial rehabilitation services towards recovery.

Cognitive behaviour therapy in a forensic rehabilitation service

The purpose of this article is to consider the applicability of cognitive behaviour therapy (CBT) within forensic mental health settings, primarily within a forensic mental health rehabilitation service. As such, the article takes cognisance of the fundamental aspects of implementing CBT-related to training, supervision and governance issues.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England

Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

Predictors of outcomes for users of mental health rehabilitation services: a 5-year retrospective cohort study in inner London, UK

There have been few recent studies reporting on the outcomes for users of psychiatric rehabilitation services. This group has complex, longer-term mental health problems. We aimed to investigate 5-year outcomes for this group and identify factors associated with outcome. Clinical outcome data on 141 users of a mental health rehabilitation service in inner London, UK, surveyed in 2005, were collected retrospectively 5years later. Positive outcome was defined for those who were inpatients in 2005 as achieving and sustaining community discharge, and for those who were community patients, as progressing to and sustaining a less supported community placement. Negative outcome was defined as remaining in the same placement, moving to more supported placement or having a psychiatric admission. Over 5years, 17 (12%) people died, 50 (40%) had a positive outcome, 33 (27%) remained in a placement with a similar level of support and 41 (38%) moved to a more supported placement and/or had a psychiatric admission. Thirteen (10%) people moved to independent accommodation and sustained their tenancy successfully. Those with a record of non-adherence with medication during the 5years were more likely to have a negative outcome (OR 8.60, 95% CI 3.41 to 21.70). Adherence to medication is an important factor in facilitating successful community discharge for people with complex mental health problems who require psychiatric rehabilitation.

Development and Evaluation of the Consumer Recovery Satisfaction Survey

Objective: The purpose of this study was to develop and evaluate a consumer satisfaction instrument for its psychometric properties and utility as part of a mental health rehabilitation service's quality improvement strategy. Methods: The instrument was developed and evaluated qualitatively using the Nominal Group Technique and quantitatively using factor analysis and Structural Equation Modelling. Findings: The study resulted in the development of Consumer Recovery Satisfaction Survey (CRSS), an instrument with strong psychometric properties. Discussion: Satisfaction survey instruments tend to be biased towards identifying what is important to an organization. Consumers, however, have different priorities and this was evidenced through their significant contribution to the development and evaluation of the CRSS. Conclusion: The CRSS is a standardized instrument that can be used with confidence as part of a mental health rehabilitation service's internal quality improvement programme as well as benchmarking against other organizations.

Mental health rehabilitation services in Ireland: vision and reality.

The Irish national mental health policy document, A Vision for Change , included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision. A structured questionnaire was sent to consultant rehabilitation psychiatrists in all mental health catchment areas of Ireland that had any rehabilitation services to gather data on various aspects of service provision. Twenty-six of the 31 mental health areas of Ireland had some form of rehabilitation service. Sixteen teams working in 15 of these areas fulfilled A Vision for Change criteria to be defined as specialist rehabilitation services and all 16 responded to the survey. The overall response rate was 73% (19/26). Most services lacked a full multidisciplinary team. Only one service had an assertive outreach team with acceptable fidelity to the assertive outreach model. Urban services were less well resourced than rural services. This is the first national survey to describe the provision of mental health rehabilitation services in Ireland. Although there has been an increase in the provision of consultant-led specialist rehabilitation services nationally, these services lack multidisciplinary input. There also appears to be a lack of planned provision of the facilities required to provide comprehensive rehabilitation services with unequal distribution of resources between urban and rural areas. This has potential cost implications for local mental health services in relation to 'out of area treatment' placements and perhaps more importantly to the overall quality of patient care.

P03-214 - Anxiety sensitivity depending on presence of positive symptoms in psychosis

IntroductionAn important corpus of scientist evidence is linking psychotic activity and anxiety-related processes (Freeman and Garety, 2003).ObjectivesWe intended to assess differences in Anxiety Sensitivity dimensions between patients diagnosed by psychosis with and without positive symptoms.MethodsParticipants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 24 patients had positive symptomatology.Design, materials and procedure: A Cross-sectional design (one measurement) for a co-relational method of comparison between groups.We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandîn et al, 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.ResultsPatients with positive symptoms showed a higher sensitivity to cognitive (z = -3.22, p < 0.01) and social anxiety (z = -2.66, p < 0.01), as well as higher punctuations in ASI-total (z = -2.91, p < 0.01), than patients without positive symptoms.ConclusionsPatients with positive symptoms show significant fears of symptoms of different anxious domains (ASI-total) with regard to patients without this kind of symptomatology. Specially, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive) and about social reactions before their own publicly observable anxiety manifestations (ASI-social).

P03-329 - Relationship between positive symptoms and anxiety sensitivity in psychosis: A research centered on the symptom

IntroductionResearching from a symptom approach avoids possible spurious associations, given the co-occurrence of symptoms in a disorder (Costello, 1992). Here, we deepen the evidenced relationships among anxiety, delusions and hallucinations.ObjectivesWe intended to assess differences in Anxiety Sensitivity dimensions between patients with psychosis depending on presence/absence of hallucinations and/or delusions.Methods/ participants49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, of whom 7 only deluded, 6 only hallucinated, 11 deluded-hallucinated and the remaining 25 neither hallucinated nor deluded.Design, materials and procedureA Cross-sectional design (one measurement) for a co-relational method of comparison between groups.We used the Spanish validated Anxiety Sensitivity lndex-3 -ASI 3- (Sandín et al., 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.ResultsAll analysis were accepted at p < .05. Patients only hallucinators showed a higher anxiety sensitivity in Social Subscale than non-hallucinative/non-delusional patients; the former presented lower punctuations in ASI-total and ASI-cognitive than patients with hallucinations and delusions. The latter showed a higher anxiety sensitivity in Cognitive Subscale than patients who only deluded.ConclusionsIt's hypothetized that both delusional and hallucinative activity is necessary for emergence of cognitive anxiety sensitivity.

P03-301 - Anxiety sensitivity in patients with psychosis regarding a non-clinical sample

IntroductionThere is increasing empirical evidence that links the classical separated psychopathological spectrums neurosis and psychosis. In this sense, anxiety is a factor for delusional/hallucinative development and maintenance (Freeman and Garety, 2003).ObjectivesWe intended to assess differences in Anxiety Sensitivity dimensions between patients with psychosis and a non-clinical sample.MethodsParticipants: 49 patients with DSM psychosis diagnosis (42 men and 7 women; mean age: 40), who attended a Mental Health Rehabilitation Service in 2008, were compared with a non-clinical sample (n = 582) from another study (Sandín, Valiente, Chorot and Santed, 2007).Design, materials and procedureA Cross-sectional design (one measurement) for a co-relational method of comparison between groups.We used the Spanish validated Anxiety Sensitivity Index-3 -ASI 3- (Sandín et al., 2007), a 18-item Likert self-report that assesses fears of anxious symptoms. It presents a hierarchical structure (a general factor and three subscales -Physical, Cognitive and Social Concerns-). It's also used the first and third items (delusions and hallucinatory behaviour) of The Positive and Negative Syndrome Scale -PANSS- (Kay, Opler and Lindenmayer, 1988) to detect positive symptoms.ResultsPatients present a higher anxiety sensitivity in the General Factor (t = 2.06, p < 0.05) and Cognitive Subscale (t = 3.91, p < 0.001) than nonpatient sample.ConclusionsPatients with psychosis show significant fears of symptoms of different anxious domains (ASI-total) regarding a non-clinical sample. Particularly, they are worried about the possibility that concentration difficulties and restlessness lead to mental incapacitation (ASI-cognitive).

Meeting the Needs of Women in Mental Health Rehabilitation Services

A service evaluation investigated the gender sensitivity of a London mental health rehabilitation service, including interventions to increase participation in women-only groups and activities. Method: A total of 40 female service users and 13 staff teams from 13 inpatient and community-based rehabilitation projects completed questionnaires regarding the service's gender sensitivity. Results: Most projects provided women-only space and the majority of female service users had a female keyworker, but there was limited provision and uptake of women-only groups and activities. Conclusion: A focus on collaboration with female service users to identify and establish, where lacking, groups and activities that appeal to women service users is needed to increase meaningful occupation.

A Fair Deal for mental health includes local rehabilitation services

SummaryLack of policy for mental health rehabilitation services has led to disinvestment and expansion of out-of-area placements in in-patient, nursing and residential care settings in the independent sector. Although a minority provide very specialist services that cannot be provided locally, and many provide good-quality care, there are significant concerns about the lack of rehabilitation focus in some of those services, poor links with local care managers and the social dislocation caused by being placed many miles from home. Additionally, out-of-area placements cost more than local rehabilitation services. There is, therefore, a compelling case for all individuals with complex mental health problems to have access to local rehabilitation services in order to expedite their recovery and social inclusion. The Faculty of Rehabilitation and Social Psychiatry of the Royal College of Psychiatrists has recently published a service template to guide commissioners and service providers in the UK in the kinds of rehabilitation services they need to provide locally.

A Brief Measure of Vocational Activity and Community Participation: Development and Reliability of the Activity and Participation Questionnaire

Social and economic marginalization are significant problems for many people living with mental illness. Clinicians and policy-makers have increased their focus on these aspects of recovery. Current outcome measures, however, do not support this focus, and detailed functional measures are not suitable for routine clinical use. This report describes the development and test-retest reliability of the Activity and Participation Questionnaire (APQ6); a self-report measure of vocational activity and social participation for routine use in community mental health services. The APQ6 was developed from concepts of the Australian Bureau of Statistics Labour Force Surveys and Census. Field testing and consumer consultation were undertaken in New South Wales (NSW) mental health rehabilitation services. Test-retest reliability trials were conducted simultaneously by research teams in NSW and Queensland. Pairs of short-cycle test-retest reliability interviews were obtained from 129 mental health service consumers. Consumer feedback and test-retest reliability results at question and item levels indicate good construct validity. The measure has utility as both a telephone and a personal interview in community mental health settings. The reported psychometric properties support the proposed use of the APQ6 as a recovery-orientated measure focusing on vocational activity and community participation. The APQ6 is being introduced for routine use by NSW mental health services.

Implementing the Essential Elements of a Mental Health Court: The Experiences of a Large Multijurisdictional Suburban County

Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts.

Mental health rehabilitation services in the UK in 2007

Aims and MethodA survey of UK consultants in rehabilitation psychiatry was carried out to investigate current service provision and changes over the past 3 years.ResultsMost services had undergone multiple changes, with an overall reduction in over half and an overall expansion in a minority. the proportion with low secure provision had doubled. Around a third reported reinvestment of rehabilitation resources into other specialist in-patient and community services.Clinical ImplicationsRehabilitation services are undergoing rapid change with diversion of resources into services that may lack rehabilitation expertise. This risks an increase in independent sector referrals for in-patient rehabilitation for those with complex needs. Expansion of community services should be balanced against the need for local in-patient rehabilitation services.

The lived experience of mental health service users in a UK community rehabilitation scheme

Aims There is a paucity of research on the lived experience of mental health service users in community rehabilitation services. This exploratory study researched this phenomenon within one UK community rehabilitation scheme. Methods A non-experimental phenomenological design and analysis of semi-structured interviews enabled an exploratory description of the phenomenon. Use of this design was based on policy recommendations and gaps in the literature on the lived experience of users. Findings Interpretative phenomenological analysis of data yielded five overarching themes not previously reported: belief about mental illness; the value of independence; community rehabilitation scheme accommodation/peer relationships; adjusting to a community setting; and feeling involved in care; all of which emerged from 64 sub-themes related to the phenomenon. Conclusions The study revealed shared and unique experiences and highlighted how being cared for within a community mental health rehabilitation service involved users carefully/logically weighing up gains/disadvantages; such as being provided with accommodation/financial benefits together with feeling ‘labelled’/coping with a potentially stigmatising diagnosis. The study yielded rich and varied data as individual experiences are posited as differing according to users' own perceptions, experiences and social context. Implications are discussed for professionals working in community mental health rehabilitation settings.

The impact of psychotropic weight gain on people with psychosis – patient perspectives and attitudes

Objectives: To explore weight gain and its impact on quality of life, body image and medical adherence in patients suffering from psychosis. To investigate what methods they tried to lose weight and which medications they thought impacted on their weight.Method: This was a cross-sectional study of patients belonging to the Mental Health Rehabilitation service of Inner-West Area Mental Health Service/Royal Melbourne Hospital, Melbourne, Victoria. Of 66 patients of the service, 63 were offered participation; 42 completed all components of survey. The chief outcome measures were the Impact of Weight on Quality of Life (IWQOL-lite) Scale, a set of nine figural stimuli to measure body image and a questionnaire addressing medication adherence and methods used to lose weight. In addition, anthropometric measures were taken.Results: A substantial proportion of patients were overweight or obese. Subjects underestimated their weight and wished to be thinner. Subjects indicated that their quality of life had been affected by their weight gain across a number of domains. A majority believed their medication had contributed to their weight gain, and as a result had considered ceasing it.Conclusions: Patients' weight gain and the management thereof needs to be an integral part of overall treatment planning and monitoring for people on antipsychotic medications.Declaration of interest: None.

Hippocampal and Amygdala Volumes According to Psychosis Stage and Diagnosis

Magnetic resonance imaging studies have identified hippocampal volume reductions in schizophrenia and amygdala volume enlargements in bipolar disorder, suggesting different medial temporal lobe abnormalities in these conditions. These studies have been limited by small samples and the absence of patients early in the course of illness. To investigate hippocampal and amygdala volumes in a large sample of patients with chronic schizophrenia, patients with first-episode psychosis, and patients at ultra-high risk for psychosis compared with control subjects. Cross-sectional comparison between patient groups and controls. Individuals with chronic schizophrenia were recruited from a mental health rehabilitation service, and individuals with first-episode psychosis and ultra-high risk were recruited from the ORYGEN Youth Health Service. Control subjects were recruited from the community. The study population of 473 individuals included 89 with chronic schizophrenia, 162 with first-episode psychosis, 135 at ultra-high risk for psychosis (of whom 39 subsequently developed a psychotic illness), and 87 controls. Hippocampal, amygdala, whole-brain, and intracranial volumes were estimated on high-resolution magnetic resonance images and compared across groups, including first-episode subgroups. We used 1- and 2-way analysis of variance designs to compare hippocampal and amygdala volumes across groups, correcting for intracranial volume and covarying for age and sex. We investigated the effects of medication and illness duration on structural volumes. Patients with chronic schizophrenia displayed bilateral hippocampal volume reduction. Patients with first-episode schizophrenia but not schizophreniform psychosis displayed left hippocampal volume reduction. The remaining first-episode subgroups had normal hippocampal volumes compared with controls. Amygdala volume enlargement was identified only in first-episode patients with nonschizophrenic psychoses. Patients at ultra-high risk for psychosis had normal baseline hippocampal and amygdala volumes whether or not they subsequently developed a psychotic illness. Structural volumes did not differ between patients taking atypical vs typical antipsychotic medications, and they remained unchanged when patients treated with lithium were excluded from the analysis. Medial temporal structural changes are not seen until after the onset of a psychotic illness, and the pattern of structural change differs according to the type of psychosis. These findings have important implications for future neurobiological studies of psychotic disorders and emphasize the importance of longitudinal studies examining patients before and after the onset of a psychotic illness.