scholarly journals MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040610
Author(s):  
Renée O'Donnell ◽  
Melissa Savaglio ◽  
Debra Fast ◽  
Ash Vincent ◽  
Dave Vicary ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Controlled Trial ◽  
Community Based ◽  
Admission Rates ◽  
Mental Health Support ◽  
Health Support

IntroductionPeople with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI.Methods and analysisThis is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18–64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience.Ethics and disseminationThis study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences.Trial registration numberACTRN12620000673943.

scholarly journals Business as Un-usual: Access to mental health and primary care services for people with severe mental illness during the COVID-19 restrictions

2021 ◽  
Author(s):  
Elizabeth Newbronner ◽  
Panagiotis Spanakis ◽  
Ruth Wadman ◽  
Suzanne Crosland ◽  
Paul Heron ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Support ◽  
Health Support

Aims: To explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services. Materials and Methods: A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically. Results: 367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person. Discussion: Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

scholarly journals Rainbow experiences of accessing mental health support in Aotearoa New Zealand: A community-based mixed methods study

2021 ◽  
Author(s):  
◽  
Gloria Fraser
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Community Members ◽  
Community Based ◽  
Aotearoa New Zealand ◽  
Mental Health Settings ◽  
Mental Health Support ◽  
Health Support

<p>While we know that rainbow people in Aotearoa New Zealand (that is, people of diverse sexualities, genders, and sex characteristics) experience high rates of adverse mental health outcomes, we know much less about the extent to which Aotearoa’s rainbow community members are receiving the mental health support they need. To address this gap I used mixed methods and a reflexive community-based approach to extend current understandings of rainbow mental health support experiences, and to explore how the provision of mental health care can be improved for rainbow people in New Zealand.  I first conducted interviews with 34 rainbow community young adults about their experiences of accessing mental health support. My thematic analysis showed that rainbow people across New Zealand faced significant structural barriers to accessing mental health support. Participants understood mental health settings as embedded within a heteronormative and cisnormative societal context, rather than as a safe place outside this context. This, together with a widespread silence from mental health professionals around rainbow identity, meant that participants actively negotiated coming out in mental health settings. Participants shared a variety of perspectives as to whether it should be standard practice for mental health professionals to ask about rainbow identities, but agreed on a number of subtle acts that could communicate a professional or service is rainbow-friendly. Knowledge about sexuality, gender, and sex characteristic diversity, together with clinical skills of empathy, validation, and affirmation, were described as key components for the provision of effective mental health support.  I conducted a second thematic analysis of data from a subset of the initial interviews, in which 13 participants discussed their experiences of accessing gender-affirming healthcare. Participants reported a lack of funding for gender-affirming healthcare in New Zealand, and described its provision a “postcode lottery”; the care available was largely dependent on the region participants were living in. Mental health assessments for accessing gender-affirming care were often described as tests of whether participants were “really” transgender, and participants discussed the need to express their gender in a particular way in order to access the healthcare they needed.  Thematic analyses of interview data informed the development of an online survey about rainbow peoples’ experiences of accessing mental health support and gender-affirming healthcare in New Zealand (n = 1575). Survey results closely reflected interview findings, indicating that rainbow people have mixed experiences in New Zealand’s mental health settings, and that accessing gender-affirming healthcare is a lengthy and convoluted process.   Finally, interview and survey data were used to develop a resource for mental health professionals, to guide their work with rainbow clients. I sought and incorporated feedback from key stakeholders (n = 108) during resource development. I then distributed the resource to mental health professionals around New Zealand, both in print and online.  Overall, my research shows that widespread knowledge gaps compromise the ability of New Zealand’s mental health professionals to provide culturally competent support to rainbow clients. Knowledge from this thesis can be used to increase awareness of rainbow community members’ mental health support needs, and to inform mental health professionals’ training and self-reflection around sexuality, gender, and sex characteristic diversity.</p>

Knowledge and attitudes towards hepatitis C and injecting drug use among mental-health support workers of a community managed organisation

2013 ◽  
Vol 37 (5) ◽  
pp. 654 ◽  
Author(s):  
Grenville Rose ◽  
Elena Cama ◽  
Loren Brener ◽  
Carla Treloar
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Hepatitis C ◽  
Drug Use ◽  
Injecting Drug Use ◽  
Negative Attitudes ◽  
Positive Attitudes ◽  
People With Mental Illness ◽  
Mental Health Support ◽  
Health Support

Objectives People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. Methods Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. Results Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. Conclusions Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV. What is known about this topic? The limited research available suggests that there are gaps in HCV knowledge among mental-health-service providers, although such research has generally targeted physicians. What does this paper add? This paper is the first to assess HCV knowledge, attitudes towards PWID and HCV among mental-health support workers. The findings suggest that although HCV knowledge is moderate, significant gaps exist, which are related to negative attitudes towards PWID. What are the implications for practitioners? Supportive and non-judgemental care is essential for people with mental illness and HCV, due to the potential for a double stigma arising from negative attitudes towards both mental illness and injecting drug use. This paper highlights the importance of targeted education for workers in the mental-health sector, to increase HCV knowledge and promote positive attitudes towards people with co-occurring mental-health, substance use problems and HCV.

Attitudes of the Vietnamese Community towards Mental Illness

1993 ◽  
Vol 1 (3) ◽  
pp. 110-112 ◽  
Author(s):  
On Lien
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Services ◽  
Psychiatric Disorder ◽  
Refugee Camps ◽  
Adult Group ◽  
Community Based ◽  
High Prevalence ◽  
Vietnamese Community

There are approximately 155,000 Vietnamese born people in Australia, with 46,000 in Victoria. The majority came to Australia as refugees. Many were subjected to the reality or threat of war, persecution, imprisonment, discrimination, economic deprivation, violence, the loss of family or other major stressors. These stressors have included the hazards of the escape, lengthy stays in refugee camps and, on arrival in Australia, lack of familiarity with English and with the culture. The Vietnamese Community in Australia was expected to have a high prevalence of mental illness, especially when newly arrived from refugee camps. In a study published in 1986 as “The Price of Freedom” [1] 32% of the young Vietnamese adult group was found to suffer from psychiatric disorder. At follow-up two years later, the prevalence of psychiatric disorder, without any major intervention, had dropped to 5–6%, a prevalence lower than that in the Australian-born community. In addition, the Vietnamese community's use of mental health services (inpatient and community-based) is lower than that of any other ethnic group.

scholarly journals Challenges and Innovations in a Community-Based Participatory Randomized Controlled Trial

2016 ◽  
Vol 44 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Jessica R. Goodkind ◽  
Suha Amer ◽  
Charlisa Christian ◽  
Julia Meredith Hess ◽  
Deborah Bybee ◽  
...  
Keyword(s):  
Mental Health ◽  
Controlled Trial ◽  
Control Group ◽  
Ethical Challenges ◽  
Community Based ◽  
Support Intervention ◽  
Randomized Controlled ◽  
Research Interviews ◽  
Important Design

Randomized controlled trials (RCTs) are a long-standing and important design for conducting rigorous tests of the effectiveness of health interventions. However, many questions have been raised about the external validity of RCTs, their utility in explicating mechanisms of intervention and participants’ intervention experiences, and their feasibility and acceptability. In the current mixed-methods study, academic and community partners developed and implemented an RCT to test the effectiveness of a collaboratively developed community-based advocacy, learning, and social support intervention. The goals of the intervention were to address social determinants of health and build trust and connections with other mental health services in order to reduce mental health disparities among Afghan, Great Lakes Region African, and Iraqi refugee adults and to engage and retain refugees in trauma-focused treatment, if needed. Two cohorts completed the intervention between 2013 and 2015. Ninety-three adult refugees were randomly assigned to intervention or control group and completed four research interviews (pre-, mid-, and postintervention, and follow-up). Several challenges to conducting a community-based RCT emerged, including issues related to interviewer intervention to assist participants in the control group, diffusion of intervention resources throughout the small refugee communities, and staff and community concerns about the RCT design and what evidence is meaningful to demonstrate intervention effectiveness. These findings highlight important epistemological, methodological, and ethical challenges that should be considered when conducting community-based RCTs and interpreting results from them. In addition, several innovations were developed to address these challenges, which may be useful for other community–academic partnerships engaged in RCTs.

scholarly journals Critical time Intervention for Severely mentally ill Prisoners (CrISP): a randomised controlled trial

2017 ◽  
Vol 5 (8) ◽  
pp. 1-138 ◽  
Author(s):  
Jenny Shaw ◽  
Sarah Conover ◽  
Dan Herman ◽  
Manuela Jarrett ◽  
Morven Leese ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Services ◽  
Controlled Trial ◽  
Intervention Group ◽  
Critical Time ◽  
Critical Time Intervention ◽  
Randomised Controlled ◽  
Male Prisoners

BackgroundThe transition from prison to community is difficult for prisoners with mental illness. Critical time intervention (CTI) is designed to provide intensive support to meet health, social care and resettlement needs through close working between client and key worker pre, and up to 6 weeks post, release.ObjectivesTo establish whether or not CTI is effective in (1) improving engagement of discharged male prisoners who have mental illness with community mental health teams (CMHTs) and (2) providing practical support with housing, finance and re-establishing social networks.Trial designA multicentre, parallel-group randomised controlled trial, with follow-up at 6 weeks and at 6 and 12 months. A subset of prisoners and case managers participated in a complementary qualitative study.SettingEight English prisons.ParticipantsOne hundred and fifty adult male prisoners, convicted or remanded, cared for by mental health in-reach teams and diagnosed with severe mental illness, with a discharge date within 6 months of the point of recruitment.InterventionParticipants were randomised to either the intervention or the control (treatment as usual). The intervention group was assigned a case manager who assessed mental and physical health before and following release, made appropriate links to health, housing and financial services and supported the re-establishment of family/peer contact.OutcomeThe primary outcome measure was engagement with a CMHT 6 weeks post discharge. Secondary outcomes included contact with mental health services at 6 and 12 months. A health economic evaluation was undertaken using service contact at the follow-up time points. We were unable to assess the intervention’s effect on reoffending and longer-term health-care use because of study delays.ResultsOne hundred and fifty prisoners were recruited: 72 were randomised to the intervention and 78 were randomised to the control. Engagement with teams at 6 weeks was 53% for the intervention group compared with 27% for the control group [95% confidence interval (CI) 0.13% to 0.78%;p = 0.012]. At 6 months’ follow-up, intervention participants showed continued increase in engagement with teams compared with control participants (95% CI 0.12% to 0.89%;p = 0.029); there were no significant differences at 12 months. Increased engagement resulted in higher levels of service use and costs for the intervention than for the control. Qualitative data showed the intervention group reporting better continuity of care and improved access to services.ConclusionThe intervention significantly improved contact with services at 6 weeks, although at a higher cost than the control. This is important as, in the days and weeks following release, recently released individuals are at a particularly high risk of suicide and drug overdose. Further research is required to establish how teams can better maintain contact with clients when the intervention ends.Future workFurther studies are indicated for groups with different needs, for example women, young prisoners and those in police custody, and at other transition points, for example following arrest and short-term custody, and at points of transition between different mental health services.Trial registrationCurrent Controlled Trials ISRCTN98067793.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.

scholarly journals RE: Supporting women who develop postnatal mental illness: What support do fathers receive to support their partner and their own mental health?

2019 ◽  
Author(s):  
Andrew Mayers ◽  
Sarah Hambidge ◽  
Olivia Bryant ◽  
Emily Arden-Close
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Emotional Support ◽  
Support Services ◽  
Healthcare Professionals ◽  
Partner Support ◽  
Online Questionnaire ◽  
Recent Interest ◽  
Mental Health Support ◽  
Health Support

Abstract Recent interest has been shown regarding support provided for maternal postnatal mental illness. Fathers appear to play an important role within this support, however many feel alienated within maternal services. The current qualitative study aimed to investigate fathers’ experience of support provided to fathers, to help support their partner through postnatal mental illness. Twenty-five fathers participated in an online questionnaire regarding their experience of their partner’s mental illness and the support provided to fathers. Thematic analysis revealed three main themes: ‘Support received to help support their partner’, ‘Support fathers wanted that was not received’ and ‘Father’s mental health’. These themes, and subsequent sub-themes, are discussed, highlighting an overall lack of support for many fathers, despite many wanting support on how to help their partner, and information on their own mental health and the services available. Fathers specifically wanted healthcare professionals to sign-post them to someone they can talk to for emotional support, and to be taught coping strategies which would help them to support both their partner and baby. The implications for these findings will also be explored, especially in light of the need to inform mental health support services.

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