Collaborative mental health in rural and isolated Canada: stakeholder feedback

This article presents research findings from the Rural and Isolated Working Group, one of six groups established by the Canadian Collaborative Mental Health Initiative (CCMHI). Funded through Health Canada's Primary Health Care Transition Fund, the goal of the CCMHI is to improve the mental health and well-being of Canadians by increasing collaboration among primary health care and mental health care providers, consumers, families, and caregivers. Qualitative data obtained from mental health care providers and consumers across all regions of Canada are presented in this article. Policy and regulation problems, barriers to mental health care access, service providers' perspectives of the challenges to consumer involvement, and solutions for addressing these issues are discussed. The article concludes by identifying how this research has informed and influenced initial steps toward mental health promotion and treatment of mental illness in rural and isolated Canada.     

Against all odds: Revitalization of local self-help alternatives by longterm mental health consumers

The article presents a grounded theory case study of a consumer-run alternative services organization, operated by and for people labeled chronically mentally ill in Michigan. We analyze the organization's emergence and development as a process of revitalization through which participants mobilized to transform their private and public identities. Innovations, including self-disclosure rituals and advocacy strategies, were developed by the group's founder during a period of social dislocation following deinstitutionalization. Subsequently, through their advocacy efforts for and with other consumers, group members laid the foundation for a unique form of locally-based political activism, blending innovative self-advocacy strategies with a critique of conventional mental health care. Active participants' efforts have created a mental health consumer organization that members perceive as an empowering and sometimes rehabilitative alternative within Michigan's public mental health care system.     

Physical health decision making and decision aid preferences of individuals with severe mental illness

Individuals with severe mental illness (SMI) often suffer from comorbid physical health conditions that reduce quality of life and longevity. The integrated care movement has improved access to primary care services, but system change does not necessarily impact health behaviors. In an effort to better understand health behaviors of persons with SMI in integrated care, we explored physical health decision making and decision aid preferences. We conducted three focus groups, including two consumer groups and one mental health staff group. Data were analyzed using a grounded theory approach, employing independent coding, thematic analysis, and meaning-making processes. Data suggest that overall, the consumer groups preferred a shared decision making process, with the doctor making the final treatment decision. Staff indicated that decision making depended on a consumer’s functioning level. Consumers liked the idea of using a decision aid, and reported preferring the computerized aid. Staff felt that decision aids were dependent on consumer level of functioning. Consumers generally view primary care doctors as experts, but like the idea of using decision aids to assist in making medical decisions. Staff feel that consumers may need help in both decision making and decision aid use in primary care.     

Consumer participation in the employment rehabilitation process: contextual factors and implications for practice

Rehabilitation models of practice have emerged that offer persons' with disabilities opportunities to have an active role in the work entry or re(entry) process. Despite the growth and interest in empowering client involvement in practice, consumer views on the determinants of participation are not fully understood. Thus, consumer feedback on using a self-directed approach to employment rehabilitation was elicited to identify factors integral to their participation in the process. Focus groups were conducted with 35 adult consumers with developmental, mental health, physical and learning disabilities to gain insights into their involvement in a participatory approach to find employment. Content analysis of data revealed barriers and facilitators, which hindered or enabled consumer involvement in the vocational service process. This article discusses the importance of considering issues across the rehabilitation system, practice and lived contexts when implementing participatory approaches in vocational rehabilitation settings.     

A Critical Review of Family Caregiving of Mental Health Consumers in Hong Kong

ABSTRACT

This paper is a critical review on the family caregiving of mental health consumers in Hong Kong. The writer has a brief review on related studies of family caregiving of mental health consumers. In comparing with those in the U.K. and the U.S.A., family caregivers of mental health consumers in Hong Kong are lonely, stigmatized and unsupported by mental health services and members in the community.     

The MHSIP mental health report card. A consumer-oriented approach to monitoring the quality of mental health plans. Mental Health Statistics Improvement Program

Health care report cards have been endorsed as a mechanism for efficiently comparing key quantifiable aspects of performance across a range of health systems or plans. There are challenges in determining what to measure; how to gather and analyze data; and how to report, interpret, and use findings. Mental health has received little attention, and a consumer perspective is typically not included. The proposed MHSIP mental health report card (MMHRC) addresses these concerns. General issues for report cards are discussed, and the MMHRC is described in terms of content, data sources and quality, and analysis and reporting.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Family Grief and Mental Health: A Systemic,Contextual and Compassionate Analysis

Although not always named, grief is central to the experience of mental illness — for people diagnosed, their families and their friends. Yet grief is almost absent from the literature and practice of mainstream psychiatry. This curious fact led to the writing of this article by two workers and a carer, with editorial and political advice from a consumer, as a small step in the direction of integrating perspectives of workers, carers and consumers. It examines the nature of grief associated with mental illness, its impact on family members, and why mainstream mental health services do not directly address it, with suggestions for some therapeutic ways to conceptualise and work with it.     

Walking our talk in Social Work Education: partnering with consumers of Mental Health Services

Social work education emphasizes the importance of partnership and collaboration with clients, defining clients as experts in their lives and needs. However, academic departments of social work do not usually model this concept of partnership by fully collaborating with clients in the process of educating social work students. Clients are seldom partners with academic educators in curriculum development, information dissemination, or student evaluation. The authors developed and implemented a facilitated dialogue process between consumers of mental health services and social work students as a way to begin to address this issue. Areas of discussion included consumer views on helpful social worker actions and interventions, as well as ways consumers could be, and wished to be, included in social work education. This paper reports on the strategies and recommendations generated by consumers during the dialogue, and discusses implications for social work education.     

Managing physical and mental health conditions: Consumer perspectives on integrated care

Despite the growing trend of integrating primary care and mental health services, little research has documented how consumers with severe mental illnesses (SMI) manage comorbid conditions or view integrated services. We sought to better understand how consumers perceive and manage both mental and physical health conditions and their views of integrated services. We conducted semi-structured interviews with consumers receiving primary care services integrated in a community mental health setting. Consumers described a range of strategies to deal with physical health conditions and generally viewed mental and physical health conditions as impacting one another. Consumers viewed integration of primary care and mental health services favorably, specifically its convenience, friendliness, and knowledge of providers, and collaboration between providers. Although integration was viewed positively, consumers with SMI may need a myriad of strategies and supports to both initiate and sustain lifestyle changes that address common physical health problems.     

Rural and Urban Differences Among Mental Health Consumers in One Midwestern State

Abstract

This study examines differences in rural and urban mental health service utilization and service satisfaction. A cross-sectional survey design was used to gather information from a sample of 311 mental health consumers regarding their use of services relative to accessibility, availability, affordability, and acceptability. Data were collected from respondents individually or in small groups in various locations in one Midwestern state. Study findings showed that rural consumers are aware of fewer services, use fewer services, and are less satisfied with services than are urban consumers. Implications for rural mental health policy, practice, and future research are discussed.     

Young consumer identity in a restrictive school environment — Addictive substances,symbolic goods and consumer skills

For young people, consuming is an act of constructing identity, where goods, services and styles are important parts of signifying who they are. Our study focuses on young people who are living in restrictive environments, such as special boarding schools. They have been placed there because of social and educational reasons. Although aspects of education and health of young people in out-of-home care have been studied, their consumer behavior has been given limited attention. Our study shows that young people openly report the use of addictive substances such as cigarettes, alcohol, drugs as well as gambling. They also build up their consumer identity by appreciating symbolic goods, such as clothes, music and sport. Spending on expensive clothes serves their favorable self-image. The fact that the schools provide all their essential needs makes the learning of consumer skills challenging although the schools reinforce management skills such as planning the use of money. Young people struggle with their identities at the borders of their school environment (i.e. education, school discipline) and the temptations of consumer culture. Even if they manage to break their damaging life path, they will be consumers throughout their life, meaning their consumer skills need to be strengthened by special education.     

Organizational culture,climate and person-environment fit: Relationships with employment outcomes for mental health consumers

Although the effects of organizational culture, climate and person-environment fit have been widely studied in the general population, little research exists in this area regarding consumers of mental health services. This research focuses on organizational culture, climate and person-environment fit and their relationship to employment outcomes for mental health consumers. It also examines specific components of organizational culture which are both desired and perceived by mental health consumers. Thirty-six (N=36) consumers were recruited into one of two groups: individuals who were employed at the time of the study and those who had recently left their jobs. Instruments used were the Workplace Climate Questionnaire (WCQ) and the Organizational Culture Profile (OCP). Significant differences were found between groups along the dimensions of organizational culture/climate and person-environment fit. Although few differences were found between groups with regards to desired workplace characteristics, many differences in perceived characteristics were found. The findings point to the importance of assessing the organizational culture/climate and its congruence with individuals' value systems as part of the work integration process.     

Mental illness etiology beliefs among African American men with serious mental illness and their social support networks

Semi-structured qualitative interviews were conducted with 26 African American men with serious mental illness who were consumers of community mental health services and 26 members of their social support networks. All participants were asked what they believed had caused the consumers’ mental illness. Consumer participants most commonly identified chronic life stressors as a causal factor, while social supports most often identified intrinsic factors such as genetics or biology as causes of mental illness. Some support participants believed that unintentional drug use had precipitated the onset of mental illness or had no causal theories. The fact that some support participants could not identify a causal explanation may indicate failure on the part of mental health care systems to engage with consumers’ social support networks and provide education about mental illness and its causes. The implications of etiology beliefs on mental health service utilization are discussed.     

NAMI'S managed care report card. National Alliance for the Mentally Ill

This article reports on the National Alliance for the Mentally Ill (NAMI) national report card to examine quality of care under managed care. The national report card will provide a summary of state policies underpinning the move of managed care into the public mental health system, and directly probe consumer and family member perceptions and experiences of managed care and the policies and practices of managed care organizations.     

"Who believes most in me and in my recovery": the importance of families for persons with serious mental illness living in structured community housing

In this article, the authors report on qualitative findings on the role of family in supporting recovery for mental health consumers living in structured, community housing in a large Canadian city. Despite living separately from families and relying heavily on formal services, residents identified their families more often than mental health professionals, friends, and residential caregivers as those who most believe in them and their recovery. Families supported recovery by providing affection and belonging, offering emotional and instrumental support, and by staying actively involved with residents. Families are a vital, untapped resource for social workers in promoting independent living.     

Mental Health Consumer and Carer Participation in Professional Education: ‘Getting There Together’ for Children of Parents with Mental Illness and Their Families

Abstract

‘Getting There Together’ is a professional education seminar developed as a collaborative project by professionals, mental health consumers and carers aimed at service providers who work with children of parents with mental illness and their families. The need for such professional education concerning this group is well recognised and the project reported herein was initiated by a reference group of professionals, consumers and carers focusing on children of parents with mental illness in the Eastern region of Melbourne (Victoria, Australia). The project began and continued as a collaborative effort during development and implementation, which ensured the experience, point of view and voice of consumers and carers was central to the material prepared, and at the time of seminar presentations. Seminar participants were from the family welfare, child care and supported housing sectors. Seminar participants found the first person accounts of consumers and carers the most helpful aspects of the seminars because they gave new insights into the experiences of carers and of mental health consumers as parents, as well as an understanding of ‘… the whole family, and how the child fits into the picture’.     

Research assessing consumer satisfaction with mental health treatment: A review of findings

This article reviews the findings of studies examining consumer satisfaction with mental health treatment. Typically, published studies find the vast majority of patients satisfied with treatment. Despite the numerous methodological problems in this research, it remains highly probable that the majority of consumers are satisfied with the services received. More specific findings in this literature remain less well demonstrated; there generally are few studies relevant to each specific question and the methodology of these studies often has been weak. However, trends point to weak relationships between patient demographic variables and satisfaction; significant relationships between patient diagnosis, treatment history, and psychological status and satisfaction; strong relationships between length of treatment and manner of termination and satisfaction; a strong relationship between satisfaction and patient global report of outcome; and a weak relationship between satisfaction and therapist rating of outcome. Satisfaction also appears to be multidimensional, although a large general factor is evident in most studies. A number of additional findings are catalogued; and research lying outside the formal domain of satisfaction research, but relevant to this body of research, is reviewed.     

Successful Vocational Rehabilitation for Individuals with Significant Mental Disabilities

ABSTRACT

Individuals with significant mental disabilities (SMD) frequently have scattered work histories (Finch, 1997; Tan, 1996). Often the SMD consumer is unable to find competitive employment or, if a job is secured, termination repeatedly ensues because of impaired interpersonal skills, faulty behaviors such as the inability to interact with coworkers, inadequate follow-through such as not reporting to work, and poor hygiene (Tan, 1996). The services provided to SMD consumers in this study were designed to address a cadre of support needs that would foster job retention and increase the number of successful employment closures. This cross-sectional exploratory study sampled 211 SMD consumers who received vocational rehabilitation support services through a vocational rehabilitation center in Columbus, Ohio. The SMD consumers sampled experienced both successful and unsuccessful employment closures.     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.