Mental Health Treatment Systems Research Articles

Cultural perspectives and experiences of mental healthcare in Kwa-Zulu Natal, South Africa

Background: Healthcare systems reflect worldviews, specifically in mental health, where norms dictate what is normal and abnormal. The era of coloniality promoted Western dogma over collectivist cultures, which were marginalised. This study explored the perspectives and experiences of Black, isiZulu-speaking, South Africans who utilised multidisciplinary services, based on a Western-based therapy model at a private psychiatric facility in KwaZulu Natal. Methods: A qualitative descriptive design was utilised. Purposive sampling was utilised to recruit 10 participants. Data was collected through semi-structured interviews. Braun and Clarke’s six phases of thematic analysis were used to guide the data analysis. Findings: Three themes with sub-themes emerged from the data: personal perceptions, which explored how isiZulu-speaking people made sense of mental health and mental illnesses. Cultural perceptions were the collectivist method of problem-solving, which stressed the importance of spiritual beliefs. Health-seeking behaviour considered the experience of the isiZulu-speaking mental health care user. Cognitive dissonance prevailed due to the difference between westernised mental health treatment and traditional healing systems. Conclusion: The family and community are intertwined in participation, reputation, and healing. There is an emphasis on enduring hardship and following traditions, which are preserved by valued elders. Disregarding these norms can outcast the Zulu individual who strives toward inclusion within the community. Implications for practice: Intervention cannot only be at individual level but also community level. Including the family in psychoeducation and therapeutic goal settingwould be beneficial to the Zulu MHCU. Group programmes should address gender-specific issues. Occupational therapists must recognise the importance of participating in spirituality for the healing of the Zulu MHCU and appropriately include it in intervention. Mental health resources and awareness programmes need to be disseminated atcommunity level. Competency in the isiZulu language is recommended.

Beyond the Asylum Walls: Tracing the Tapestry of Mental Health Interventions Across Eras and Cultures.

This article offers an extensive review of the changing field of mental health therapies, charting a transformational path from traditional methods to modern breakthroughs and speculating on potential future developments. The story develops by investigating historical viewpoints while reflecting on the present and highlighting the lessons learned and their impact on contemporary practices. We have advanced from the stigmatized constraints of asylums to a paradigm that puts human rights, dignity, and individualized, culturally sensitive treatment first. Modern methods are much more varied and evidence-based, from cutting-edge technical advancements to evidence-based psychotherapies. The ethical considerations arising from the delicate balance of pharmacological therapies underline the responsibility of administering drugs that significantly affect mental health.Cultural factors become a pillar, highlighting how crucial cultural sensitivity is to promoting tolerance. By acknowledging how many facets of the human experience are interrelated, holistic methods help close the gap between the mind and body. Integrative medicine and alternative therapies represent a shift away from reductionist approaches and towarda holistic viewpoint. The delivery of mental health treatment is being reimagined by technological advancements, with virtual and digital environments opening up new access and support channels. These developments cut beyond regional boundaries, reinventing conventional therapy dynamics and paving the way for individualized therapies. Cultural concerns highlight the significance of cultural competency in navigating the complex mental health treatment system and adapting interventions to fit the particular requirements of various cultural contexts. With telepsychiatry, virtual reality, and artificial intelligence among the new technologies that promise to further revolutionize mental health therapies, the essay looks to the future. This review concludes by imagining a day when mental health is prioritized, therapies are available, and the diversity of human experience is valued. The path to a society that values, nurtures, and celebrates mental health continues.

Communication and collaboration in a drug court team.

A multidisciplinary team is a hallmark feature of drug courts and other specialized treatment dockets. Comprised primarily of practitioners from the criminal legal system and mental health and addictions services treatment systems, team members exchange information and engage in shared decision-making. Though practitioners in these contexts have some guidance regarding organizational and structural elements needed to facilitate efficient and effective communication and collaboration, less is known about the role individual team members' actions and behaviors play in this process. Using data from a survey, process evaluation, and qualitative interviews administered to 19 members of a single drug court team in a Midwestern urban setting, this study describes several communication and collaboration practices of drug court team members and explores how they may contribute to the general effectiveness of the drug court. This study underscores the potential utility of operationalizing and measuring day-to-day, individual-level communication and collaboration practices in future studies of drug court process, in order to index drug court team dynamics that may contribute to its effectiveness. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Environmental factors’ influence on criminal legal involvement for people with serious mental illness

Summary Efforts to assess the risk of criminal legal system involvement among people with serious mental illness (SMI) often rely on strategies that locate the risk at the individual level. The present study examines environmental factors that contribute to criminal legal involvement for people with SMI in mental health treatment settings. Thirty-one people with serious mental illness and prior criminal legal involvement were interviewed in this qualitative study. Interviews focused on factors that contributed to and protected against criminal legal involvement. The research team engaged in inductive thematic analysis of interview data. Findings Findings reveal that understanding of physical, social, and treatment environments is critical to risk assessment with this population. In highlighting the role of the environment, we offer findings that may lead to improved strategies for service delivery with this population. Complicating contemporary approaches to risk assessment, our findings suggest that mental health treatment systems that serve individuals with serious mental illness should engage in meaningful consideration of environmental factors. Applications Identification of protective and risk factors in clients’ physical, social, and treatment environments is critical for social work practice with individuals who have a history of criminal legal involvement and serious mental illness. Treatment settings can create opportunities for the development of protective factors by integrating wrap-around services, treatment services that follow an empowerment-participation strengths model, and post-incarceration services with clients.

Integration of Substance Use Disorder Treatment Into a Traditional Community Mental Health Treatment System.

In response to the opioid crisis, Catholic Charities of Baltimore sought to integrate substance use disorder treatment into their outpatient community mental health clinics. The agency developed a systematic practice improvement strategy that included a competency-based curriculum and supervision plan for psychiatric providers and therapists. Psychiatric providers developed competency with medications used to treat substance use disorders, and therapists developed competency in therapeutic modalities to treat substance use disorders, all of which were gradually integrated into outpatient clinics. This column demonstrates that integration of substance use disorder treatment into outpatient community mental health care is feasible and beneficial.

The Complexity of Psychotropic Medication Prescription and Treating Trauma Among Youth in Foster Care: Perspectives from the Lived Experience.

Youth in the US foster care system are disproportionately prescribed antipsychotic and psychotropic medication compared to youth not involved with foster care. Research on the relationship between experiences of trauma, mental health symptoms, evidence-based treatment, and safe psychotropic prescribing practices for youth in foster care is limited. We explored stakeholders' perspectives of the relationship between psychotropic medications and trauma informed care (TIC) for youth in foster care. We conducted semi-structured individual and group interviews with foster caregivers, caseworkers, prescribing clinicians, and alumni of the foster care system. Data were recorded and transcribed verbatim, and analyzed using a directed content analysis approach. Five themes emerged across and within stakeholder groups: (1) acknowledging trauma; (2) role of psychotropic medication; (3) psychosocial resources; (4) additional supports; and, (5) training and education. Stakeholders identified TIC as an important component of mental health services for youth in foster care. There was not consensus around the role of psychotropic medication in treating trauma; however, most stakeholders felt that it was overused. Respondents suggested including additional supportive team members to help guide youth through the mental health treatment system, and emphasized the importance of support from individuals with common lived experiences. Results demonstrate the need for a system that emphasizes trauma-sensitive clinical interactions and psychosocial supports. Improving training and education for stakeholders, and providing additional sources of support for youth in foster care, could help better identify and treat the effects of trauma and the safe pharmacotherapy for youth in foster care.

Assessing a digital peer support self-management intervention for adults with serious mental illness: feasibility, acceptability, and preliminary effectiveness

Objective To assess the feasibility, acceptability, and preliminary effectiveness of digital peer support integrated medical and psychiatric self-management intervention (“PeerTECH”) for adults with a serious mental illness. Methods Twenty-one adults with a chart diagnosis of a serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or treatment-refractory major depressive disorder) and at least one medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 18 years and older received the PeerTECH intervention in the community. Nine peer support specialists were trained to deliver PeerTECH. Data were collected at baseline and 12-weeks. Results This pilot study demonstrated that a 12-week, digital peer support integrated medical and psychiatric self-management intervention for adults with serious mental illness was feasible and acceptable among peer support specialists and patients and was associated with statistically significant improvements in self-efficacy to manage chronic disease and personal empowerment. In addition, pre/post non-statistically significant improvements were observed in psychiatric self-management, medical self-management skills, and feelings of loneliness. Conclusions This single-arm pre/post pilot study demonstrated preliminary evidence peer support specialists could offer a fidelity-adherent digital peer support self-management intervention to adults with serious mental illness. These findings build on the evidence that a digital peer support self-management intervention for adults with serious mental illness designed to improve medical and psychiatric self-management is feasible, acceptable, and shows promising evidence of improvements in clinical outcomes. The use of technology among peer support specialists may be a promising tool to facilitate the delivery of peer support and guided evidence-based self-management support. People with serious mental illness (SMI; defined as individuals diagnosed with schizophrenia spectrum disorder, bipolar disorder, or treatment-refractory major depressive disorder) are increasingly utilizing peer support services to support their health and recovery. Peer support is defined as shared knowledge, experience, emotional, social, and/or practical assistance to support others with similar lived experiences (Solomon, 2004). Most recently the definition also includes the provision of evidence-based peer-supported self-management services (Fortuna et al., 2020). Mental health peer support can augment the traditional mental health treatment system through providing support services to maintain recovery between clinical encounters (Solomon, 2004) and is classified by the World Health Organization as an essential element of recovery (World, Health, and Organization, About social determinants of health, 2017).

The Productivity Commission inquiry into mental health.

The report of the Productivity Commission Inquiry into mental health was released in November 2020, estimating the economic cost of mental illness in Australia at over $200 billion a year. The report makes wide-ranging recommendations for improving the mental health of the population, reforming the mental health treatment system, and in the way mental health is managed in other sectors of society.

Deinstitutionalization Through Optimism: The Community Mental Health Act of 1963.

Deinstitutionalization Through Optimism: The Community Mental Health Act of 1963.

Coronavirus Trauma and African Americans' Mental Health: Seizing Opportunities for Transformational Change.

The COVID-19 pandemic is a natural disaster of historic proportions with widespread and profound psychological sequelae. African Americans fall ill and die more than whites from COVID and more survivors and loved ones face psychological risk. African Americans also experience greater personal, social, and financial stress even when not personally touched by COVID illness, and they are again vulnerable as COVID diminishes African American community’s capacity for mutual support. Enactment of the American Rescue Act of 2021 can moderate if not eliminate African Americans’ greater adversity and greater psychological challenge; other provisions can move the mental health treatment system beyond its previous failure to reach African Americans as it constructively responds to the crisis that COVID presents. From outreach through trusted community actors and institutions for meeting African Americans’ needs of varying intensity and duration, and by providing a spectrum of evidence supported interventions—culturally adapted as needed—newfound success can mark a turning point toward new approaches and lasting success.

Campus Intelligence Mental Health Searching System Based on Face Recognition Technology

The phenomenon of teenage campus suicide has become the focus of attention of parents, schools and the society. The causes behind it are extremely complicated, and the root cause is psychological and spiritual problems. However, one's negative psychology is often hidden, and it is difficult to detect and effectively intervene before the tragedy. How to effectively identify students with suicidal tendencies in order to prevent tragedies has aroused extensive research and discussion among the government, academia and the public. Through investigation and research, it is found that the current popular computer cutting-edge technologies such as artificial intelligence and computer vision can be well used for human emotion recognition and behavior prediction, and put into use in schools as a mental health auxiliary diagnosis and treatment system, thus effectively reducing the suicide rate on campus. The scenario assumes that machine learning can be used to deduce the risk of psychological problems in human samples by analyzing the frequency of negative emotions in facial expressions. Based on this, this paper proposes an effective solution for campus suicide prediction, and designs a set of auxiliary diagnosis and treatment system based on campus monitoring network system for suicide behavior prediction and student mental health analysis. Through preliminary experimental analysis and verification, the suicide psychological auxiliary diagnosis and treatment system has achieved good results in face recognition success rate, emotion recognition success rate and behavior prediction success rate. With the input of more experimental data and the increase of self-training time, the prediction system will perform better.

Effect of screening, brief intervention and referral to treatment for unhealthy alcohol and other drug use in mental health treatment settings: a randomized controlled trial.

To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. A multi-centre, longitudinal, two-group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90days. A motivation-based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n=354) or a health education session (control condition) (n=364). Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end-point 3months post-baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12-month follow-up and the use of addiction treatment services. Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR)=0.53; 95% credible interval (CrI)=0.48-0.6] and fewer days of stimulant use (OR=0.58; 95% CrI=0.50-0.66) at the 3-month follow-up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3-month follow-up (OR=0.93; 95% CrI=0.85-1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use.

Campus Intelligence Mental Health Searching System Based on Face Recognition Technology

The phenomenon of teenage campus suicide has become the focus of attention of parents, schools and the society. The causes behind it are extremely complicated, and the root cause is psychological and spiritual problems. However, one's negative psychology is often hidden, and it is difficult to detect and effectively intervene before the tragedy. How to effectively identify students with suicidal tendencies in order to prevent tragedies has aroused extensive research and discussion among the government, academia and the public. Through investigation and research, it is found that the current popular computer cutting-edge technologies such as artificial intelligence and computer vision can be well used for human emotion recognition and behavior prediction, and put into use in schools as a mental health auxiliary diagnosis and treatment system, thus effectively reducing the suicide rate on campus. The scenario assumes that machine learning can be used to deduce the risk of psychological problems in human samples by analyzing the frequency of negative emotions in facial expressions. Based on this, this paper proposes an effective solution for campus suicide prediction, and designs a set of auxiliary diagnosis and treatment system based on campus monitoring network system for suicide behavior prediction and student mental health analysis. Through preliminary experimental analysis and verification, the suicide psychological auxiliary diagnosis and treatment system has achieved good results in face recognition success rate, emotion recognition success rate and behavior prediction success rate. With the input of more experimental data and the increase of self-training time, the prediction system will perform better.

California county embarks on new MH spending plan with unspent MHSA funds

Sacramento County officials in California have embarked on a new plan to address homelessness and to, among other things, expand existing programs for adults and children with mental health disorders. The mental health delivery and treatment system facilitated by unspent Mental Health Services Act (MHSA) funding, also known as Prop. 63, will focus on implementing programs under community services and supports (CSS), prevention and early intervention (PEI) and innovation programs.

What Makes an Organization Public? Managers’ Perceptions in the Mental Health and Substance Abuse Treatment System

The question “What makes an organization public?” is a leading point of scholarly inquiry in the field of public administration. This study supplements existing theory on publicness by further exploring the primary influences on an organization’s publicness—influences identified by analyzing data from in-depth interviews with senior-level managers of mental health and substance abuse treatment facilities. Results from a grounded theoretical analysis of these managers’ perceptions provide support for a conceptual framework of organizational publicness in which political authority, horizontal engagement, and public engagement are associated with higher levels of publicness. Better understanding of the prism through which senior managers conceptualize publicness may enhance managerial awareness of the most salient structural and institutional mechanisms that empower treatment facilities to effectively support individuals suffering from mental health disorders such as substance abuse, emotional distress, and depression.

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

AbstractResearch in the area of social networks and health has demonstrated that lay social network members play a critical role in the early stages of the illness career, influencing key decisions and pathways to formal care. Here, we revisit and extend this body of work, examining how the lay social network context can moderate the influence of treatment experiences on recovery outcomes as the illness career unfolds. To achieve this goal, we address two research questions, drawing on a longitudinal sample of people making their initial contact with the mental health treatment system: First, we explore how treatment experiences, lay social network characteristics, and recovery outcomes change over 2 years, beginning with the point of entry into treatment. Second, we examine whether the relationship between perceived treatment experiences and recovery outcomes is contingent on characteristics of the lay network context in which clients are socially embedded, focusing on the network's cultural orientation toward medical professionals. We find that positive treatment interactions facilitate improved self-esteem, mastery, role functioning, recovery optimism, and global functioning when the lay network culture is pro-medical, but largely have null effects on the recovery process when the lay network is more hostile to medical professionals.

Strategies for preventing excess mortality after discharge from psychiatric emergency room.

AbstractPatients with severe mental illness have increased risk for severe physical diseases. In addition, there is evidence that this patient group is less likely to receive standard levels of care for most physical diseases, which may contribute to their shortened life expectancy. Further, illness behaviour among individuals with schizophrenia is different as they are less likely to seek medical attention, which emphasise the need for increased awareness and early intervention when visiting an emergency psychiatric facility. Adults with severe mental illness have increased rates of substance abuse, which adversely affect their illness and outcome. Separate and parallel mental health and substance abuse treatment systems do not offer interventions that are integrated or personalised for the presence of substance abuse concurrent with severe mental illness. Therefore, the authors suggest an establishment of multidisciplinary teams capable of delivering a full range of psychiatric interventions and integrated treatment for substance use disorder in the community and psychiatric emergency room to those who otherwise would have required admission to an acute hospital bed. Keywords: Psychiatric emergency room; Crisis resolution; mortality; severe mental illness

Population targeting amid complex mental health programming: Are California's Full Service Partnerships reaching underserved children?

California's Mental Health Services Act (MHSA) created Full Service Partnership programs (FSPs) targeting socially and economically vulnerable children with mental illness who are underserved by counties' public mental health treatment system. To determine whether FSPs reach a distinctive group of children, this study compares indicators of FSP-targeted underservice for FSP entrants (n = 15,598) versus everyone treated in the counties' public mental health systems (n = 282,178) and for FSP entrants versus entrants in the most intensive Medicaid delivered program in California, Therapeutic Behavioral Services (TBS, n = 11,993). Results identify that, despite first encountering mental health services systems at earlier ages, FSP clients had fewer months of treatment and were less likely to have been treated in the prior 6 months, except for crisis care, as compared to all other children served, after considering clinical severity and indicators of service need. FSP entrants also had more substance abuse and trauma-related problems. Although less seriously ill than TBS served children, FSP served children were significantly underserved. The results indicate that, amid overlapping policies and programs, carving out and reaching a distinctly underserved population can be achieved in practice, and that specialized programs, such as the FSP program, which target underserved children, have the potential to augment a system's ability to reach the underserved. (PsycINFO Database Record

Durée de psychose non traitée : état des lieux et analyse critique

IntroductionPrognosis of schizophrenia has not significantly improved despite extensive research. There is often a relatively long delay between onset of symptoms and treatment initiation. Lately, duration of untreated psychosis (DUP), the time between the onset of psychosis and initiation of treatment, has been one of the most studied variables in patients presenting for a first psychotic episode in order to evaluate the impact of early intervention on the prognosis of schizophrenia. In the literature, a variety of criteria have been used to define both transition to psychosis and initiation of treatment. Furthermore, the dating of both of these variables is usually retrospective, further complicating the measurement of DUP. MethodsWe conducted a comprehensive review about DUP using Pubmed and Google Scholar databases up to January 2015 using the following keywords “schizophrenia”, “duration of untreated psychosis”, “duration of untreated illness” and “early intervention”. Papers were included if they were published in French or English. ResultsThe mean DUP was found to be 2 years but it can vary according to multiple factors such as denial of illness by the patient and family, withdrawal and isolation from friends and relatives, diagnostic errors, paranoid views of the mental health treatment systems, or negative symptoms. Long DUP may also be a correlate of poor premorbid functioning or of an insidiously unfolding psychosis. Considerable discrepancies exist in the way that DUP is estimated in different studies. Although the clinical interview remains the most common way of measuring DUP, so far there is no evidence for favoring one method over another. Regardless of measurement method, a longer DUP is found to be associated with poorer outcome in schizophrenia in both the short and long-term across a number of domains: symptoms severity, remission rates, the risk of relapse, global functioning and quality of life. Its role in functional outcome appears to be mediated largely by negative symptoms, for which there is still no effective treatment. A recent meta-analysis has shown that shorter DUP is associated with less severe negative symptoms at short and long-term follow-up, especially when DUP is shorter than 9 months. The mechanism of the relationship between DUP and outcome is still undefined. A hypothesis is that the shorter the DUP, the more likely the intervention is being applied during the period in which neurobiological deficit processes in schizophrenia are most active. DiscussionA study of the duration of untreated illness (DUI), which is defined as the DUP and the prodromal phase, seems necessary because results of studies evaluating the effect of early detection and intervention in individuals with clinical high risk for psychosis are promising. A number of interventions such as omega 3 fatty acids and integrated psychosocial interventions seem to delay transition in the at-risk population. However, replication studies are lacking, and a great proportion of at high-risk individuals will spontaneously remit or develop diseases other than chronic psychosis, making us question the advantages and disadvantages of a treatment. Taking into consideration the high prevalence of comorbidities in individuals referred for clinical high-risk state and their effect on the individual's functioning, future interventions in the field need to address not only the preventative efficacy on psychosis transition but also their effectiveness in improving the functioning of this population and their effect on the outcome of schizophrenia when transition to psychosis has occurred. ConclusionDespite the huge advances in the field of schizophrenia, many questions remain unanswered and huge efforts are still necessary to understand the pathophysiology of this illness in order to improve its outcome.

At the intersection of lay and professional social networks: how community ties shape perceptions of mental health treatment providers.

The therapeutic alliance is a critical determinant of individuals' persistence and outcomes in mental health treatment. Simultaneously, individuals' community networks shape decisions about whether, when, and what kind of treatment are used. Despite the similar focus on social relationship influence for individuals with serious mental illness, each line of research has maintained an almost exclusive focus on either 'inside' (i.e. treatment) networks or 'outside' (i.e. community) networks, respectively. For this study, we integrate these important insights by employing a network-embedded approach to understand the therapeutic alliance. Using data from the Indianapolis Network Mental Health Study (INMHS, n=169, obs=2206), we target patients experiencing their first major contact with the mental health treatment system. We compare patients' perceptions of support resources available through treatment providers and lay people, and ask whether evaluations of interpersonal dimensions of the therapeutic alliance are contingent on characteristics of community networks. Analyses reveal that providers make up only 9% of the whole social network, but are generally perceived positively. However, when community networks are characterized by close relationships and frequent contact, patients are significantly more likely to report that treatment providers offer useful advice and information. Conversely, when community networks are in conflict, perceptions of treatment providers are more negative. Community-based social networks are critical for understanding facilitators of and barriers to effective networks inside treatment, including the therapeutic alliance. Implications for community-based systems of care are discussed in the context of the USA and global patterns of deinstitutionalization and community reintegration.