Psychiatric Agencies Research Articles

Preventing male suicide through a psychosocial intervention that provides psychological support and tackles financial difficulties: a mixed method evaluation

BackgroundTo help resolve high suicide rates in Bristol, North Somerset and South Gloucestershire, the charity Second Step was commissioned to roll-out the Hope service offering a psychosocial intervention for men, supporting them through acute distress and addressing financial difficulties. This study evaluated the impact of the Hope service on men at risk of suicide experiencing financial and other difficulties.MethodsMixed methods study using: (i) a prospective cohort study design to compare depression, suicidal ideation and financial self-efficacy scores of men aged 30–64, referred to the service between October 2018 and July 2020, at baseline and 6 months follow-up and between low and moderate to high-intensity service users; and (ii) a qualitative interview study to evaluate the acceptability and impact of the Hope service to Hope service users.ResultsThere was a 49% reduction in depression score (mean reduction − 10.0, 95% CI − 11.7 to − 8.3) and in the proportion of service users with suicidal ideation (percent reduction − 52.5, 95% CI − 64.1% to − 40.9%) at 6 months follow-up compared to baseline. Financial self-efficacy scores increased by 26% (mean increase 2.9, 95% CI 1.8 to 3.9). Qualitative accounts illustrated how ‘Hope saved my life’ for several men interviewed; most respondents described being able to move forward and tackle challenges with more confidence following the Hope intervention. Professional advice to tackle financial and other difficulties such as housing helped to relieve anxiety and stress and enable practical issues to be resolved.ConclusionsThe Hope service offered practical and emotional support to men who have experienced suicidal feelings, redundancy, homelessness and poverty and occupies an important space between mental health and social care provision. Hope demonstrates the value of an intervention which cuts across traditional boundaries between psychiatric care and social advice agencies to provide, what is, in effect, an integrated care service.

Unconscious Processes of Organizing: Intergroup Conflict in Mental Health Care

AbstractA critical but overlooked issue in Weick’s seminal work, The Social Psychology of Organizing (1969/1979), concerns ‘the heat’ of organizing processes, namely, the underground emotional processes underpinning the organizing of conflictual work relationships. We present a qualitative case study of psychiatric agencies mandated by public policy to collaborate but instead engaged in persistent conflict despite its deleterious effects on their working relationship and on the wellbeing of the clients they intended to serve. To explain these conflictual features of organizing, we integrate Weick’s organizing theory with systems psychodynamics to deepen the understanding of emotions in organizing, specifically the motivational forces underpinning sensemaking and actions between interacting psychiatric agencies. This integration of theories reveals a critical feature of the relationship between the conscious and unconscious organizing processes: When a threat is involved, sensemaking and action are overtaken by social defences, resulting in dysfunctional organizing of the primary task. Drawing on these findings, we enrich Weick’s seminal work by developing a model that portrays organizing as the ritualized interaction of emotions, sensemaking and behavioural responses.

Política psiquiátrica e agência religiosa: notas sobre caixas-pretas, o lúdico e a noção de in(ter)venção em saúde mental

Este artigo reflete sobre complexidades e caixas-pretas como Bruno Latour elaborou, aqui para as políticas de saúde mental no Brasil. Caixas-pretas são ‘máquinas’ que não se consegue destrinchar, panaceia de complexidades. O que abordo é uma caixa-preta dos estudos, e como decorrência, da intervenção, em saúde mental. Discuto a (des)articulação deletéria entre atitude e conduta a partir de um olhar semantizado pelas noções de práxis psiquiátrica, práxis terapêutica e agência religiosa. O ponto de partida digamos explorativo da reflexão é considerar que há nesta (des)articulação um regime estabelecido por inconsistências empíricas e epistemológicas, condicionado pelo jogo que chamei in(ter)venção, partindo da contribuição de Roy Wagner, e para considerar que intervenção e invenção são dispositivos articulados e inseparáveis.

HIV risk behaviors among deaf people with mental illness

ABSTRACTHIV-related prevention and intervention efforts for deaf adults with mental illness have been developed in the absence of empirical data regarding the risk behaviors in which this group engages. This study analyzes data provided by 66 deaf adults who received specialized services from a large psychiatric rehabilitation agency. Deafness-related social, linguistic, and behavioral factors are examined in relation to risky sexual behaviors, substance use, and serious mental illness. Risky behavior was significantly elevated among those who use cocaine and alcohol, have a history of sexually transmitted infections, have low levels of social integration and above average linguistic (sign) ability. Proficient sign language ability and engagement in the Deaf community interacted with substance use to increase the risk for HIV. Risk reduction for deaf adults should consider the interaction between mental health symptoms and the social consequences of deafness (e.g., delayed language acquisition). As well, interventions must be straightforward and administered by fluently signing, clinical staff.

Reliability and validity of the scale of hurting factors participation for mental disorders

Objective To test reliability and validity on the scale of hurting factors participation for mental disorders (SHFP-MD). Methods 402 cases were retrospectively evaluated by SHFP-MD from 13 forensic psychiatric appraisal agencies in China, and all cases were involved causal relationships in mental injury from July 2010 to June 2012.42 cases were evaluated a month later again.13 raters evaluated respectively for five cases. 52 cases involved causal relationship of mental impairment were evaluated prospectively in January 2013 to June 2014. The validity of the scale was tested by experts assessed as a criterion level of relationship. Results ①The retest correlation coefficient on all items of SHFP-MD were between 0.746-0.989, and the time reliability of test-retest on the full scale score was 0.970 interval of one month. Raters reliability between 0.57 to 1.00; overall average reliability was 0.84 (P 0.05). Conclusion SHFP-MD has good reliability and validity, and met the basic requirements of scale assessment. Key words: Mental disorders; Causal relationship; Participation of hurting factors; Rating scale; Reliability; Validity

Group size and therapists’ workplace ratings: Three is the magic number

Summary The present implementation study compares therapists’ workplace ratings of collective efficacy, collaboration, and teamwork in Norwegian child welfare and child psychiatric agencies. Participating therapists were trained in Parent Management Training Oregon model (PMTO) as part of a nationwide implementation of the program. Participating therapists ( N = 83) worked in 67 Norwegian social service agencies. Respondents were part of three conditions: (1) PMTO therapists working in agencies with no other PMTO therapists ( n = 45), (2) two PMTO therapists working together in the same agency ( n = 23), and (3) three therapists working together in the same agency ( n = 15). Findings Therapists working in clusters of 3 rated their workplaces more positively than therapists who worked in agencies with 1 or 2 PMTO interventionists, β = .29, p = .03; Cohen’s d = .80. The result was independent of agency size, leadership quality, service population, and therapist education. There was no difference in workplace ratings between PMTO therapists working in agencies in pairs (2 PMTO therapists) and those working in agencies alone (1 PMTO therapist), p = .45. Applications PMTO therapists working in clusters of three appeared to have better experiences with their workplace than therapists with no other PMTO colleagues, and those with only one other PMTO colleague. This result suggests that clustering therapists together in groups of at least three may create a better work environment for therapists using newly-implemented interventions.

Homeless mentally ill in Athens area: A cross-sectional study on unmet needs and help-seeking

Homelessness, a worldwide psychosocial phenomenon, is now also prevalent in Greece, mainly in Athens area. The possible psychiatric morbidity related to help-seeking and the underlying factors were explored in a sample of 254 homeless people from Greater Athens area, using the Mini International Neuropsychiatric Interview (M.I.N.I.). The sample was predominantly male (74%) with mean age of 51 years, being in their majority homeless for over 25 months, 34.3% of them living in rough sleeping places. Overall, 56.7% of the sample met the criteria for a current Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) psychiatric disorder with 20.8% comorbidity. Only 36.2% of the identified psychiatric cases had any recent psychiatric care, while 44.4% were taking non-prescribed medication and 20.2% have been hospitalized in the last year. On the contrary, 70% of alcohol- and drug-dependent persons have been treated in a psychiatric agency, while 60.0% of them participated in rehabilitation program the last year. Logistic regression analysis revealed that being older, more educated with longer duration of homelessness, recognizing the suffering from a psychiatric problem as well as being diagnosed as 'psychotic' increased the likelihood to seek help. The vast majority of the homeless mentally ill persons were lacking any current psychiatric care. The planning of a mental health-care delivery parallel to the existing social welfare system is needed to serve the unmet mental health needs of this population.

Development of a collective efficacy measure for use in social service organizations

• Summary: The present study summarizes the development of a collective efficacy measure for use in social service organizations: The Collective Efficacy Measure for Social Services (CEMSS). The measure was adapted from Goddard's Collective Efficacy Scale (2002). Factorial validity was assessed for a sample of 278 respondents employed at child welfare and child psychiatric agencies across Norway. Exploratory factor analysis (EFA) was conducted with a random split-half sample of 139 respondents; the second random split-half sample ( n = 139) was tested using confirmatory factor analysis (CFA). Tests for construct validity were conducted using Teamwork, Leadership, and Organizational Culture subscales from the Readiness for Organizational Learning and Evaluation Questionnaire (ROLE; Preskill & Torres, 1999). • Findings: A six-item scale was identified in the first sample using EFA. The CFA conducted with the second sample, indicated good model fit, χ2(10) = 14.34, p = .16; CFI = .97; RMSEA = .06. Scale reliability for the entire sample was adequate (α = .74). As expected, the six-item scale was significantly correlated with Teamwork, r(250) = .34, p < .01; Leadership, r(273) = .36, p < .01; and Organizational Culture, r(276) = .41, p < .01. • Applications: The results of the analyses support the use of the CEMSS as a valid measure of collective efficacy. This measure has a variety of possible applications for organizational assessment and research in social service agencies.

Clients with intellectual disabilities on psychiatric units: care coordination for positive outcomes

The transition from residential facilities to and from the psychiatric hospital setting is difficult for individuals with intellectual disabilities (ID). In the U.S.A., specialized psychiatric units for individuals with ID are uncommon and this population is usually served in generalized services. Nevertheless, providers of mental health services in the U.S.A. receive little training in their specific needs. Best practices call for coordination of plans between psychiatric units and community agencies, multidisciplinary care plans, staff education and comprehensive discharge planning in order to improve outcomes of psychiatric hospitalization. An inner city psychiatric unit in a major academic medical centre and a community agency providing residential care for individuals with ID cooperated to provide a plan of care for a client with ID both for hospitalization and for discharge leading to improved outcomes.

Evidence-Based Practices and Recovery at Thresholds: Transformation of a Community Psychiatric Rehabilitation Center

The following series of articles describes how a community psychiatric rehabilitation agency serving individuals with severe mental illness has integrated recovery-oriented services and evidence-based practices in its service delivery model. The lead article describes the rationale and organizational commitments required to implement the model, followed by several case studies of individual evidence-based practice implementation highlighting successes and challenges. The final article offers perspectives from three consumers of these services.

What Affects Self-Esteem of Persons with Psychiatric Disabilities: The Role of Causal Attributions of Mental Illnesses.

This study addresses the factors which affect the self-esteem of persons with psychiatric disabilities, with a specific focus on the role of causal attributions of mental illnesses. It is based on data collected from 461 persons with psychiatric disabilities (consumers) served through psychiatric rehabilitation agencies. The results of regression analyses revealed that household income, diagnosis, psychiatric symptoms, service satisfaction, perceived stigma, and perceptions of social roles were all related to self-esteem. Consumers' causal attributions did not have direct effects on self-esteem, but the effects of causal attributions on self-esteem were moderated by psychiatric symptoms and by perceptions of social roles, suggesting that self-esteem enhancement strategies should be tailored to consumers' psychiatric and cognitive characteristics.

Mental health care in Piedmont: a description of its structure and components using a new technology for service assessment

The northern-Italian region of Piedmont has a total population of 4.3 million. The regional territory is currently divided into 22 local health services, each serving a population not exceeding 300,000 and incorporating a Department of Mental Health. The organization of psychiatric assistance can be described as relatively stable and conforms with the standards imposed by national regulations. Drawing upon previous research experience, and with the support of the relevant regional authorities, our survey implements the methodology developed by the EPCAT team and will eventually embrace about 80% of all local health service areas in this region. The survey was preceded by a number of preliminary steps including the training of four researchers, inter-rater reliability testing (particularly for the International Classification of Mental Health Care), and the adjustment of the methodology developed by the EPCAT team to facilitate understanding and use of the instrumentation by the psychiatric professionals involved in the data collection. This paper summarizes data on the structure and components of the mental health service in three areas of Piedmont, with special reference to structures funded by the National Health System. Overlooking the imbalances affecting both the resources available for different populations, and the operational profiles of psychiatric agencies of the same type, our data allow an assessment of the descriptive and comparative capabilities of the proposed methodology.

Diversion at the point of arrest: mentally disordered people and contact with the police

A 'Diversion at the Point of Arrest' scheme was introduced in South Birmingham in 1992. An initial evaluation of the first 12 months demonstrated its apparent effectiveness. This paper provides a further description of all referrals to the substantive service for the 4-year period 1 November 1993 to 31 October 1997. There were 492 referrals of 420 individuals during the study period. The majority of those assessed were single, unemployed Caucasian males who were living alone. Of these, 95% were from Birmingham or the surrounding areas. The most frequent diagnosis made was schizophrenia, followed by drug or alcohol dependence and neuroses. Only 16 individuals disclosed a criminal history but 67% had had previous contact with psychiatric services. The majority of offences committed by those referred were public order or acquisitive, or involved destruction of property. This scheme has been successful in preventing some mentally disordered individuals being inappropriately taken into custody and has identified others who might require further assessment at a later stage. It has also fostered lasting and productive links between psychiatric services, the police and other agencies.

Implementing psychosocial rehabilitation with long-term patients in a public psychiatric hospital.

Introduction by the column editors: Implementation of a rehabilitation innovation in a clinical facility or program typically involves overcoming many obstacles. They include lack of administrative support and endorsement, unavailability of consultants who are experts in the innovation and who can assist staff in changing professional behavior, and lack of "internal champions" who can spearhead the requisite changes in the organization. Other obstacles include the incongruence between the philosophical assumptions of the innovation and those of the facility and its treatment traditions and satisfaction with the status quo, and hence lack of motivation for staff to change their practices.With the external stressors of managed care and other strategies for cost-efficiency now pressing on psychiatric agencies and institutions to change their practices, it is refreshing to read the following account from South Carolina State Hospital, where Rosalind Smith and a few key colleagues achieved a wholesale and successful transformation of the institution from a custodial orientation to an emphasis on rehabilitation. Ms. Smith and her team have done just about everything right, and their efforts and results during the past few years can serve well as a case study in organizational change. For those in the throes of change in our current climate of budgetary cutbacks and staff downsizing, important lessons can be learned from Ms. Smith and her team at the South Carolina State Hospital.

Short-term child psychiatric inpatient treatment. Place of residence as one-year outcome measure.

In this study, 100 patients consecutively admitted to four child psychiatric inpatient wards in Finland were prospectively followed 12 months after discharge from short-term inpatient treatment. It turned out that 50 patients were discharged back to their previous residence and to outpatient treatment, 40 patients were admitted to long-term inpatient treatment and 10 patients were placed in some institution. The child's antisocial behaviour on admission was the strongest determinant for long-term treatment or placement at the 12 month follow-up. Other predictors of long-term treatment or placement in an institution included a high total score in teacher's behaviour ratings, being referred by a psychiatric agency and living in a semi-rural area. No statistically significant relationship was found in the child's age, gender, parents' education level or occupation, family characteristics, total life events, parent's ratings of total behaviour, total life events, parent's ratings of total behaviour, CGAS ratings by a clinician or a wide range of treatment variables.

Practice Guidelines and Professional Challenges

Drs Persons, Thase, and Crits-Christoph 1 are to be congratulated for a concise, thorough, and well-executed review of the empirical basis supporting or contradicting the various recommendations for the psychotherapy of depression in the American Psychiatric Association and Agency for Health Care Policy and Research guidelines. The recommendations about guideline development given by the authors are eminently reasonable. What is most striking about the overall field of psychotherapy is the paucity of outcome research available. It behooves the mental health professions to understand this deficiency and to decide on a remedial course of action. Psychotherapy does not have a major research tradition. Psychoanalytic psychotherapy, the most widely practiced technique, has developed as a professional service delivered by psychiatrists, psychologists, and social workers who have received training in graduate and postgraduate programs organized and operated by professional guilds. Therapeutic techniques have been taught by practicing professionals based on texts written by

A Quality Improvement Program in a State Hospital During a Period of Downsizing

In response to changes in population patterns, resource allocation, and public attitudes, the New York State Office of Mental Health has revised its approach to psychiatric treatment. State psychiatric ftcilities have been downsized and now provide primanly intermediate and long-term care for individuals with serious and persistent mental illness (1). General hospitals are becoming the sole providers of acute psychiatric care, and county or nonprofit agencies are assuming additional responsibility for community support programs. During such periods of change, mental health facilities may be tempted to postpone attention to quality improvement until less hectic times. However, implementing a quality improvement program in the midst ofsystem change may actually increase a ftcility’s likelihood of a successful transition. This paper describes implementation of a quality improvement program at a state hospital in rural New York that was faced with substantial downsizing.

Using concept mapping to develop a conceptual framework of staff's views of a supported employment program for individuals with severe mental illness.

This article describes the use of concept mapping to develop a pictorial multivariate conceptual framework of staff views of a program of supported employment (SE) for individuals with severe mental illness. The SE program involves extended individualized supported employment for clients through a mobile job support worker (MJSW) who maintains contact with the client after job placement and supports the client in various ways. All 14 staff members of a psychiatric rehabilitation agency with assignments associated with the SE program. They brainstormed a large number of specific program activity statements (N = 96), sorted and rated the statements, and interpreted the map that was produced through multidimensional scaling and hierarchical cluster analysis. The resulting map enabled identification of 4 issues that should be included in any theory of SE programs--the specific activity sequences that characterize the program itself; the pattern of local program evolution; the definition of program staff roles; and the influence of key contextual factors such as the client's family or the program's administrative structure. The implications of concept mapping methodology for theory development and program evaluation are considered.

Providing a forensic psychiatry service to a magistrates' court: A follow-up study

Abstract In 1991 we carried out a 6-week pilot study providing an on-site psychiatry service to a large inner city magistrates' court. This is an 18-month follow-up of the 22 patients for whom psychiatric or social care was arranged. The majority of these patients were still being seen by district psychiatric services or other agencies to whom referrals were made.

Psychiatric Consultation with Children in Underserviced Areas: Lessons from Experiences in Northern Ontario

There are only 350 child psychiatrists in Canada. It is therefore unrealistic to expect them to be able to provide sufficient direct treatment, even in small densely populated communities with abundant resources. Such expectations are even more unrealistic in underserviced, sparsely populated areas. A review of the literature on psychiatric consultation in underserviced areas is presented along with a description of the consultation process, taking advantage of the "multiplier effect." Some of the realities of mental health consultation in underserviced areas are discussed, stressing the importance of consultation as a way of professional life. Some guidelines for the psychiatric consultant are outlined which would enhance the "multiplier effect". It is maintained that the training of psychiatric residents should include a supervised experience consulting in underserviced areas. Finally, it is hoped that psychiatric training programs, funding bodies, hospitals, and agencies, will recognize the value of this use of psychiatric expertise.