Serious Mental Illness Research Articles

Group Home Staff Experiences With Work and Health in the COVID-19 Pandemic in Massachusetts

ImportanceDirect reports of the experiences of staff working in group homes for people with serious mental illness (SMI) and/or intellectual or developmental disabilities (ID/DD) are rarely reported. Hearing from workers about their experiences in the COVID-19 pandemic may inform future workforce and public policy.ObjectiveTo gather baseline data on worker experience with the perceived effects of COVID-19 on health and work in the pandemic prior to initiating an intervention to mitigate the spread of COVID-19 and to measure differences in worker experience by gender, race, ethnicity, education, and resident population served (persons with SMI and/or IDD/DD).Design, Setting, and ParticipantsThis mixed-mode, cross-sectional survey study was conducted using online then paper-based self-administration from May to September 2021 at the end of the first year of the pandemic. Staff working in 415 group homes that provided care within 6 Massachusetts organizations serving adults aged 18 years or older with SMI and/or ID/DD were surveyed. The eligible survey population included a census of staff who were currently employed in participating group homes during the study period. A total of 1468 staff completed or partially completed surveys. The overall survey response rate was 44% (range by organization, 20% to 52%).Main Outcomes and MeasuresSelf-reported experiential outcomes were measured in work, health, and vaccine completion. Bivariate and multivariate analyses explore experiences by gender, race, ethnicity, education, trust in experts and employers, and population served.ResultsThe study population included 1468 group home staff (864 [58.9%] women; 818 [55.7%] non-Hispanic Black; 98 [6.7%] Hispanic or Latino). A total of 331 (22.5%) group home staff members reported very serious perceived effects on health; 438 (29.8%) reported very serious perceived effects on mental health; 471 (32.1%) reported very serious perceived effects on health of family and friends; and 414 reported very serious perceived effects (28.2%) on access to health services, with statistically significant differences observed by race and ethnicity. Vaccine acceptance was higher among persons with higher educational attainment and trust in scientific expertise and lower among persons who self-reported as Black or Hispanic/Latino. A total of 392 (26.7%) respondents reported needing support for health needs, and 290 (19.8%) respondents reported needing support for loneliness or isolation.Conclusions and RelevanceIn this survey study, approximately one-third of group home workers reported serious personal health and access to health care barriers during the first year of the COVID-19 pandemic in Massachusetts. Addressing unmet health needs and access to health and mental health services, including inequities and disparities by race, ethnicity, and education, should benefit staff health and safety, as well as that of the individuals with disabilities who rely on them for support and care.

Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study.

Objective: People with serious mental illness (SMI) have high rates of cardiometabolic illness, receive low quality care, and experience poor outcomes. Nevertheless, studies of existing integrated care models have not consistently shown improvements in cardiometabolic health for people with SMI. This study assessed the effect of a novel model of enhanced primary care for people with SMI on cardiometabolic outcomes. Enhanced primary care is a model of integrated care wherein comprehensive primary care delivery is adapted to the needs of people with SMI in coordination with behavioral care. Methods: We conducted a propensity-weighted cohort study comparing 234 patients with SMI receiving enhanced primary care to 4,934 patients with SMI receiving usual primary care using electronic health data from a large academic medical system covering the years 2014–2018. The propensity-weighted models controlled for baseline differences in outcome measures and patient characteristics between groups. Results: Compared to usual primary care, enhanced primary care increased hemoglobin A1c (HbA1c) screening by 18 percentage points (95% confidence interval , 10 to 25), low-density lipoprotein (LDL) screening by 16 percentage points (CI, 8.8 to 24), and blood pressure screening by 7.8 percentage points (CI, 5.8 to 9.9). Enhanced primary care reduced HbA1c by 0.27 percentage points (CI, −0.47 to −0.060) and systolic blood pressure by 3.9 mm Hg (CI, −5.2 to −2.5) compared to usual primary care. We did not find evidence that enhanced primary care consistently affected glucose screening, LDL values, or diastolic blood pressure. Conclusions: Enhanced primary care can achieve clinically meaningful improvements in cardiometabolic health compared to usual primary care.

SMI Adviser to Bring Hands-On Learning to Annual Meeting

SMI Adviser to Bring Hands-On Learning to Annual Meeting

Optimization of Sleep classification in Patients With Serious Mental Illness Using Accelerometer and ECG Data From a Wearable Patch

AbstractIntroductionSleep is an important behavioral biomarker for patients with serious mental illness (SMI). The ability to accurately quantify sleep in a real-world setting could thus provide insight into patient well-being. In this study, patients in a sleep lab wore a patch that is part of a digital medicine system (aripiprazole with sensor (AS)) designed to provide objective records of medication ingestion. The patch provided accelerometer and electrocardiogram (ECG) data; polysomnography (PSG) data was collected to be used as the gold standard for sleep stage classification. The accelerometer and ECG data were used to build machine learning classification models to distinguish periods of wake from periods of sleep. To optimize these models for a real-world environment, different data sampling paradigms and methodologies were explored, and resultant model performances were analyzed.MethodsData was collected for a total of 220 nights, across 73 unique subjects—42 subjects had a diagnosed SMI (schizophrenia, bipolar disorder I, or major depressive disorder) and 31 subjects were healthy volunteers. PSG data, which provides a sleep stage designation at 30-second intervals, was combined into 5-minute windows, labeled as either “Sleep” or “Wake” based on which class comprised the majority of the 30-second intervals within the window. Accelerometer and ECG features were derived for each 5-minute window. Models were trained with three learning methodologies: a light gradient boosting machine (LGBM), a conditional random field (CRF), and a long short-term memory (LSTM) network. Model performance was tested with the full complement of accelerometer and ECG data, as well as down-sampled subsets of data. Additionally, ECG data from the PSG system was incorporated to test the effect of other ECG sampling strategies.ResultsCRF models produced the best classification performance (AUC = 0.91) with the full patch dataset. Down-sampling to include less than half of the accelerometer data did begin to degrade the specificity of the model. Down-sampling to include less frequent ECG collection did not have a significant effect on model performance; however, changing the sampling paradigm to continuous ECG collection from a block sampling paradigm did lead to more robust classification of when a patient was awake.ConclusionsAccurately recording sleep in a logistically simple way can provide insights into the well-being of SMI patients. Combining these insights with the objective medication ingestion records provided by AS would be of great value to SMI patients, as well as their caregivers and physicians. This research explores what amount of sensor data is required to accurately quantify sleep and some of the machine learning strategies that can ameliorate data limitations, providing guidance for the optimization of digital device design.FundingOtsuka Pharmaceutical Development & Commercialization, Inc.

Study finds breast cancer deaths higher in patients with SMI

Observing that prior studies have suggested that death from breast cancer is higher among patients with preexisting serious mental illness (SMI) compared with those without an SMI, a new study points to reduced access to early cancer screening as one of the reasons.

“Everyone means well but the one person who's really going to go to bat” - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness

In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Street Psychiatrists Build Trust, Offer Hope to Homeless Patients With SMI

Designing Practical Motivational Interviewing Training for Mental Health Practitioners Implementing Behavioral Lifestyle Interventions: Protocol for 3 Pilot Intervention Studies

Motivational interviewing (MI) is an evidence-based, patient-centered communication method shown to be effective in helping persons with serious mental illness (SMI) to improve health behaviors. In clinical trials where study staff conducted lifestyle interventions incorporating an MI approach, cardiovascular disease (CVD) risk profiles of participants with SMI showed improvement. Given the disproportionate burden of CVD in this population, practitioners who provide somatic and mental health care to persons with SMI are ideally positioned to deliver patient-centered CVD risk reduction interventions. However, the time for MI training (traditionally 16-24 hours), follow-up feedback, and the coaching required to develop and maintain patient-centered skills are significant barriers to incorporating MI when scaling up these evidence-based practices. We describe the design and development of the following 2 scalable MI training approaches for community mental health practitioners: real-time brief workshops and follow-up asynchronous avatar training. These approaches are being used in 3 different pilot implementation research projects that address weight loss, smoking cessation, and CVD risk reduction in people with SMI who are a part of ALACRITY Center, a research-to-practice translation center funded by the National Institute of Mental Health. Clinicians and staff in community mental health clinics across Maryland were trained to deliver 3 distinct evidence-based physical health lifestyle interventions using an MI approach to persons with SMI. The real-time brief MI workshop training for ACHIEVE-D weight loss coaches was 4 hours; IMPACT smoking cessation counselors received 2-hour workshops and prescribers received 1-hour workshops; and RHYTHM CVD risk reduction program staff received 4 hours of MI. All workshop trainings occurred over videoconference. The asynchronous avatar training includes 1 common didactic instructional module for the 3 projects and 1 conversation simulation unique to each study's target behavior. Avatar training is accessible on a commercial website. We plan to assess practitioners' attitudes and beliefs about MI and evaluate the impact of the 2 MI training approaches on their MI skills 3, 6, and 12 months after training using the MI Treatment Integrity 4.2.1 coding tool and the data generated by the avatar-automated scoring system. The ALACRITY Center was funded in August 2018. We have implemented the MI training for 126 practitioners who are currently delivering the 3 implementation projects. We expect the studies to be complete in May 2023. This study will contribute to knowledge about the effect of brief real-time training augmented with avatar skills practice on clinician MI skills. If MI Treatment Integrity scoring shows it to be effective, brief videoconference trainings supplemented with avatar skills practice could be used to train busy community mental health practitioners to use an MI approach when implementing physical health interventions. DERR1-10.2196/44830.

APA Foundation Program to Decriminalize SMI Honored

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Foundation Program to Decriminalize SMI HonoredKatie O’ConnorKatie O’ConnorSearch for more papers by this authorPublished Online:10 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.32AbstractThe Judges and Psychiatrists Leadership Initiative works to decriminalize mental illness and connect judges and psychiatrists to help people with mental illness in the criminal justice system.The APA Foundation’s Judges and Psychiatrists Leadership Initiative (JPLI) has been named a winner in the 2nd Annual Anthem Awards by the International Academy of Digital Arts & Sciences.JPLI’s goal is to bring together psychiatrists and judges in an effort to divert and deflect people with serious mental illness (SMI) from incarceration, instead connecting them with treatment. It is an initiative that the APA Foundation (APAF) leads in collaboration with the Justice Center of the Council of State Governments and the National Center for State Courts. JPLI was named a silver winner in the 2023 Anthem Award’s community engagement category for nonprofit organizations.“JPLI does vital work to improve the lives of people living with SMI,” said Saul Levin, M.D., M.P.A., CEO and medical director of APA and chair of APAF’s Board of Directors. “Having a mental illness does not make someone a criminal—the individual has an illness that can be treated, just like diabetes or hypertension. The more we spread that message, especially in courtrooms, the more likely it is that our patients will be treated with the dignity and respect they deserve.”Central to JPLI’s work is creating connections between judges and psychiatrists. Through trainings, the judges and psychiatrists are able to increase the understanding within the legal system of how mental illnesses present, especially in the courtroom. Frequently, JPLI’s staff conducts train-the-trainer events, during which they train judge-and-psychiatrist teams on how to train those within their own communities to work with people with SMI in the legal system (Psychiatric News, Judges, Psychiatrists Trained to Share Education About MH in Justice System).“We are incredibly proud of what JPLI has accomplished with the support of the APAF Board of Directors, a growing number of APA members across the country who have embraced JPLI, and over 1,300 judges across 43 states who have come to understand that SMI is not a crime,” said APAF Executive Director Rawle Andrews Jr., Esq. “Together, we can take the first step to decriminalize mental health and promote well-being.”The Anthem Awards were launched in 2021 by The Webby Awards. The awards’ stated goal is to honor the purpose- and mission-driven work of people, companies, and organizations worldwide. “We’re defining a new benchmark for impactful work that inspires others to take action in their own communities,” states the Anthem Awards’ website.“Serious mental illness is not, and should have never been, a crime, but that is the sad reality that our communities face,” said Christopher Chun-Seeley, APAF’s program director of school and justice initiatives. “With our work to empower judges to use their convening power in their communities and psychiatrists to use their mental health expertise to reclaim our community members from the justice system, we are making an impact to decriminalize mental illness. But there is more work to be done, and we cannot do it alone.”There are numerous opportunities to get involved with JPLI. It will host three train-the-trainer events: May 17 to 19 in San Francisco, August 12 to 14 in Denver, and October 14 to 16 in Washington, D.C.Further, at APA’s 2023 Annual Meeting, APAF will present two sessions related to mental health and justice. “Answering the Judges Gavel: Decriminalizing Mental Illness and the National Judicial Mental Health Task Force” will be held on Sunday, May 21, from 10:30 a.m. to noon. “Mental Health Professionals’ Role in the Criminal Justice System: How to Be an Agent of Change” will be held on Sunday, May 21, from 1:30 to 3 p.m.Finally, the JPLI Annual Leadership Summit, during which the winners of the 2023 Judge Stephen S. Goss Memorial Award will be announced, will be held on Thursday, May 18, in San Francisco. For more information about this or other events, email [email protected]. ■ResourceMore information about JPLI’s award ISSUES NewArchived

Physical Function Assessment of Older Veterans With Serious Mental Illness

To characterize the physical function of older veterans with serious mental illness (SMI) across endurance, strength, and mobility domains. Retrospective analysis of clinical performance data. Gerofit program, a national outpatient supervised exercise program for older veterans, delivered in Veterans Health Administration sites. Older veterans aged 60 and older (n=166 with SMI, n=1,441 without SMI) enrolled across eight national Gerofit sites between 2010 and 2019. Performance measures of physical function covering endurance (6-minute walk test), strength (chair stands, arm curls), and mobility (10-m walk, 8-foot-up-and-go), were administered at Gerofit enrollment. Baseline data from these measures were analyzed to characterize the functional profiles of older veterans with SMI. One sample t tests were examined to compare functional performance of older veterans with SMI to age- and sex-based reference scores. Propensity score matching (1:3) and linear mixed effects models were used to evaluate differences in function between veterans with and without SMI. Older veterans with SMI performed worse on all measures of function (chair stands, arm curls, 10-m walk, 6-minute walk test, 8-foot-up-and-go) compared to age- and sex-based reference scores with statistically significant differences present in the male sample. Functional performance of those with SMI was also worse compared to propensity-score matched older veterans without SMI with statistically significant differences on chair stands, 6-minute walk test, and 10-m walk. Older veterans with SMI have compromised strength, mobility, and endurance. Physical function should be a core component of screening and treatment for this population.

Development and initial evaluation of a behavioural intervention to support weight management for people with serious mental illness: an uncontrolled feasibility and acceptability study

BackgroundThe rates of obesity and associated health problems are higher in people with serious mental illness (SMI), such as schizophrenia and bipolar disorder, than the general population. A primary care referral to a behavioural weight management programme can be an effective intervention, but people with SMI have reported barriers to engaging with them and bespoke options are rarely provided in routine practice. It is possible that adjunct support addressing these specific barriers could help. Here we report the development, feasibility and acceptability of an intervention to improve uptake and engagement with a mainstream weight management programme for people with SMI.MethodsWe worked with people with a lived-experience of SMI and used the person-based approach to develop the ‘Weight cHange for people with sErious mEntal iLlness’ (WHEEL) intervention. It comprised a referral to a mainstream weight management programme (WW®) to be attended once a week, in-person or online, for 12-weeks. The adjunct support comprised a one-off, online consultation called Meet Your Mentor and weekly, telephone or email Mentor Check Ins for 12-weeks. We assessed the feasibility of WHEEL through the number of programme and adjunct support sessions that the participants attended. We analysed the acceptability of WHEEL using a thematic analysis of qualitative interviews conducted at baseline and at 12-week follow-up. Our exploratory outcome of clinical effectiveness was self-reported weight at baseline and at end-of-programme.ResultsTwenty participants were assessed for eligibility and 17 enrolled. All 17 participants attended Meet Your Mentor and one was lost to follow-up (94% retention). Nine out of 16 attended ≥50% of the weekly programme sessions and 12/16 attended ≥50% of the weekly check-ins. Participants reported in the interviews that the adjunct support helped to establish and maintain a therapeutic alliance. While some participants valued the in-person sessions, others reported that they preferred the online sessions because it removed a fear of social situations, which was a barrier for some participants. The mean change in self-reported weight was − 4·1 kg (SD: 3·2) at 12-weeks.ConclusionsA mainstream weight management programme augmented with brief and targeted education and low-intensity check-ins generated sufficient engagement and acceptability to warrant a future trial.

‘Main the gap!’ The view of healthcare professionals on gains and pitfalls of traditional and innovative models for providing mental health care to imprisoned persons with a severe mental illness in Spain

IntroductionDifferent mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models.ObjectivesTo explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain.Methods21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis.ResultsHealthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome.ConclusionsInnovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges.Disclosure of InterestNone Declared

A qualitative investigation of healthcare professionals’ viewpoints of the healthcare process of persons with a serious mental illness in prisons with a traditional model for mental health care provision in Spain

IntroductionHealthcare delivery in prisons depends on the national Ministry of Interior in 14 of 17 autonomous regions in Spain. A traditional model for health and mental health care provision prevails.ObjectivesTo increase understanding of the mental health care process of imprisoned persons with a serious mental illness (SMI) in Spanish prisons with a traditional model of health care provision.Methods10 healthcare professionals (6 physicians, 3 nurses, 1 pharmacist) working in small (<450 imprisoners), middle size (450-1,000) and big (>1,000) prisons took part in 3 online focus groups between 31st May and 2nd June 2022. The moderator used open-ended questions to research into the healthcare process (diagnosis, treatment, follow up, prevention) of imprisoners with SMI. Focus groups lasted 2 hours, and were audiotape recorded and transcribed. Transcripts were analysed applying constant comparative method and theoretical saturation.ResultsMental healthcare provision varies across prisons, but commonalities exist. Healthcare professionals reported that about 60% of SMI are diagnosed by the correctional general practice physician (GP) at incarceration. Severe cases are assessed by an external psychiatrist. Once a week (average) the psychiatrist visits the prison to either confirm diagnoses or adjust treatments. One third of imprisoners who would benefit from a psychiatric assessment has it. Follow up occurs in the prison infirmary for close supervision. If addiction concurs, referral to therapeutic modules happen. Polypharmacy and overmedication are common. Simplification of therapies and slow-release injectable formulations of antipsychotics are desirable. Everyday mental health care and rehabilitation take place throughout a specific, little equipped, psycho-social support programme implemented in most prisons but restricted to the most disabled SMI persons. Acute psychiatric episodes occur due to treatment interruptions or deviations and are managed by the correctional GP. Hospital referrals are problematic without protocols. Prevention of relapses relies on imprisoners supervision and staff observation. Healthcare records are only available to healthcare professionals working in prisons. Outside prisons, continued care needs of mental health and social support in the community. Due to healthcare services modest readiness to respond to needs and poor social networks, SMI persons are prone to relapse and recidivism.ConclusionsFocus groups found that working in isolation from the public healthcare system, shortage of psychiatrists, poorly implemented therapeutic and rehabilitation programmes, and lack of mental health and social care services in the community negatively affect the care of imprisoners with SMI in Spain.Disclosure of InterestNone Declared

Pilot feasibility trial of a brief mobile-augmented suicide prevention intervention for serious mental illness.

People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content. The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness. A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high. START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"We don't get a chance to prove who we really are": A qualitative inquiry of workplace prejudice and discrimination among Black adults with serious mental illness.

Studies focused on prejudice and discrimination have traditionally explored the impact of one kind of prejudicial experience (e.g., race, gender, criminal history) within a particular context and thus, there is weak base of understanding about the experiences of individuals who may contend with concurrent prejudicial and/or discriminatory experiences across multiple characteristics. In this study, our aim was to better understand the prejudicial and/or discriminatory work experiences of Black adults with serious mental illness (SMI). Specifically, we highlight instances where individuals endorse the salience of multiple sources of prejudice and discrimination during a given workplace incident. Using a semistructured interview guide and a grounded theory approach, we interviewed 24 Black adults with SMI recruited from two clubhouses in the Boston metropolitan area. To validate findings, we also conducted follow-up focus groups with participants (n = 9) at each recruitment site. We identified 19 personal attributes/characteristics contributing to the prejudicial/discriminatory experiences of Black adults with SMI in the context of work. We also found that respondents would organize these prejudicial/discriminatory experiences in clusters whereby two or more characteristics were viewed as the reasons for prejudice and discrimination during a given workplace incident. Black adults with SMI contend with a range of prejudicial and discriminatory experiences, often experienced simultaneously, highlighting the importance of an intersectional framework in research designs and/or clinical interventions addressing the needs of this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Co-producing a physical activity intervention in two forensic psychiatry settings in the UK: The IMPACT study

IntroductionIn the UK there are 3500 individuals detained in medium secure forensic psychiatry units. Service users in such settings have complex and serious mental illness (SMI), often with co-morbid physical health problems and a life expectancy of at least 10 years shorter than the general population. They often have low levels of physical activity. There is little evidence about physical activity interventions for medium secure service users in the United Kingdom.ObjectivesOur objective is to co-produce, with medium secure service users, the content and delivery of an intervention to increase physical activity. We shall assess feasibility, acceptability and pilot data collection methods for outcomes relevant for a future randomised controlled trial.MethodsThis is a 24-month mixed-methods project that will follow the Medical Research Council (MRC) framework Developing and Evaluating Complex Interventions. The study has 4 phases.- Phases 1-2 will gather information required to co-develop an evidence based intervention in Phase 3.- Phase 4 will assess the intervention in a feasibility study, evaluating and testing the intervention for a future pilot study.Study settings: Two NHS Medium Secure In-Patient Psychiatric Hospitals in the UK.ResultsThis paper presents the findings from the Phase 1 questionnaire and focus groups with service users and hospital staff that identified the barriers and facilitators to physical activity in such settings. The results are then discussed in relation to the Phase 2 qualitative results that explored stakeholders’ and service users’ opinions into how to increase physical activity among medium secure service users by identifying potential elements for inclusion in a physical activity intervention, to gain insight into how we can establish engagement of this group with the intervention, maintain commitment, avoid drop-out and develop the intervention design. All findings are presented using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model), which is widely used to identify what needs to change for a behaviour change intervention to be effective.ConclusionsThe findings of Phases 1-2 are allowing the team to move forward with Phase 3 that is currently developing an intervention to increase physical activity for adult inpatient service users in the medium secure units. This phase will be guided by the MRC framework and the COM-B model to define the target behaviours and select the most suitable intervention components (functions and techniques) and implementation approach.Disclosure of InterestNone Declared

Attitudes toward and patterns of medication use among people with serious mental illness: There's more than meets the eye.

There are growing concerns about the long-term effects of psychiatric medication after a major psychiatric crisis. Recent evidence shows a diverse impact of long-term use on various outcome domains, which may help explain why non-adherence is so common. In the current study we explored the subjective perceptions of factors that impact both attitudes toward and patterns of use of medication among individuals with serious mental illness (SMI). Sixteen individuals with an SMI and a recognized psychiatric disability who had used psychiatric medication for at least 1 year were recruited for the study via mental health clinics and social media. Participants were interviewed using a semi-structured interview based on the narrative approach, focusing on attitudes toward and patterns of use of psychiatric medication. All interviews were transcribed and analyzed using thematic analysis. Three discrete sequential phases emerged, each characterized by different themes referring to attitudes toward medication and patterns of use: (1) "loss of self" and a high level of medication use; (2) accumulating experiences of using/reducing/stopping medication; and (3) forming more stable attitudes toward medication and developing one's own pattern of use. The transition between phases was dynamic in nature and represents a non-linear process. Complex interactions were generated at different phases between the related themes, which shaped attitudes toward medication and patterns of use. The current study reveals the complex ongoing process of forming attitudes toward medication and patterns of use. Recognizing and identifying them via a joint reflective dialog with mental health professionals can enhance alliance, shared decision-making, and person-centered recovery-oriented care.

Quality of life and psychiatric distress in people with serious mental illness, the role of personal recovery.

When considering the personal recovery of people with serious mental illness (SMI), it is essential to examine their reported psychiatric distress and quality of life (QoL). However, there is no consolidated model in the literature that clearly relates these variables. In this study we first analysed the relationships between QoL, psychiatric distress and recovery, and several sociodemographic variables. Second, we analysed the linear effects of psychiatric distress and recovery on QoL. Third, and most important, we tested two hypotheses that considered personal recovery as a moderator or mediator of the relationship between psychiatric distress and QoL. 234 volunteers with a diagnosis of SMI completed three self-report questionnaires, The Recovery Assessment Scale-24, The World Health Organization QoL and the Clinical Outcomes in Routine Evaluation-Outcome Measure, which showed very good levels of validity and reliability. The PROCESS macro for SPSS developed by Hayes (Introduction to mediation, moderation, and conditional process analysis: A regression-based approach, The Guilford Press, 2022) was applied using the Bootstrap method to verify our moderation and mediation hypotheses. We found a negative linear effect of psychiatric distress on QoL, as well as a positive effect of recovery on said variable. Our results do not confirm the moderating effect of recovery on the relationship between distress and QoL. However, we do confirm the second hypothesis; recovery functioned as a mediating variable between psychiatric distress and QoL. These findings allow us to reflect on how personal recovery affect the relationship between psychiatric distress and QoL and discuss its theoretical and practical implications as public policies.

Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms.

A prospective design was used to investigate the relationship of current psychiatric symptoms of incarcerated people with serious mental illness (SMI) and aggressive behavior on a penitentiary ward for crisis intervention. One hundred sixty detainees with SMI, detained in a high-security penitentiary psychiatric facility, were screened every 2 weeks with the Brief Psychiatric Rating Scale-Extended (BPRS-E) by trained clinicians, to ensure that the data on psychiatric symptoms were up-to-date. Aggressive behavior was registered with the Staff Observation Aggression Scale-Revised. A binary logistic regression analysis was performed to examine the relationships between factor scores of the BPRS-E and aggressive behavior. Significant relationships between the BPRS-E factor hostility, antisocial traits, and aggressive incidents were found, but not between the positive symptoms or manic factor scores and aggressive incidents. Symptoms of SMI measured with the BPRS-E did not help to explain the occurrence of aggressive behavior. This is not in line with what is commonly found. The implication is that it can be expected that this population will display aggressive behavior but that symptoms do not help in predicting when this will occur. In addition, hostility and antisocial traits were related to aggressive behavior. For this specific population, an interactional approach might be more effective in the management of aggression than treatment of symptoms of SMI.

Self-injury and the embodiment of solitary confinement among adult men in Louisiana prisons

Solitary confinement is a harrowing human rights and public health problem that is currently inflicted as a routine punishment for a litany of prison rule violations, a reactionary tactic to quell resistance to prison conditions, and as a destination of last resort for people serious mental illnesses (SMI) who are especially vulnerable to its harms. An extensive body of research has documented clusters of psychiatric symptoms—emotional distress, cognitive deficits, social withdrawal, anxiety, paranoia, sleeplessness, and hallucinations—linked to solitary confinement that often manifest in decompensating behaviors, which include self-injury and suicide. This study summarizes the historical evolution of solitary confinement, recaps its linkages to self-injury and suicidality, and offers a theoretical framework grounded in ecosocial theory, and supplemented with concepts from theories of dehumanization and carceral geography. Findings bolster extant evidence on the harms of solitary confinement by focusing on whether and how exertions of power by prison staff to deploy mechanisms of dehumanization—as a pathway between SMI and self-injury among a cross section of adult men (n = 517) exposed to solitary confinement in Louisiana prisons in 2017. Findings reinforce the need for structural interventions that diffuse forms of carceral power and practices that continue to subject people to isolation, dehumanization, and violence.