Correlates of Treatment Retention Among Persons with Serious Mental Illness Receiving Integrated Care in a Community Mental Health Setting

ABSTRACT

Knowledge about methods to retain community mental health (CMH) clients in integrated primary and behavioral health care (PBHC) programs is needed to address longstanding health disparities. A preexisting data set that contained the clinical records of 446 PBHC program participants was used to examine whether baseline sociodemographic, health, and psychosocial characteristics predicted retention in care at 6 months post-enrollment. Results indicated that less than half of PBHC participants (43.7%) were retained in care, and approximately 17% of the variance in retention was explained by the inclusion of seven predictors in the model (overall health, medications, laboratory data, primary care provider, disorder type, transportation, and living arrangement). Clients with thought disorders were almost twice as likely as those with mood disorders to be retained in care, and greater frequency of prescribed medications also increased the likelihood of treatment continuation (ORs = 1.99 and 1.20, respectively). Future research should identify factors that improve retention in integrated PBHC programs overall, and among persons with mood disorders, in particular.     

Providing Mental Health Services to Older People Living in Rural Communities

Summary

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional well-being and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.     

Community Treatment Orders for People with Serious Mental Illness: A New Zealand Study

New Zealand legislation allows for the involuntary outpatienttreatment of people with serious mental illness. This studyexamines the views of service users, family members and mentalhealth professionals (MHPs) about the impact of this regime.Semi-structured interviews were completed with forty-two serviceusers, twenty-seven family members and ninety MHPs, with recentexperience of the regime. Participants were asked to commenton the functions of community treatment (or non-resident) orders,their benefits and restrictions, decisions about their terminationand any impact on relationships. Most service users believedthe main purpose of the order was to ensure they took medication.They also believed the order provided better access to othertreatments, supported accommodation and care from MHPs. Familiesconsidered the orders provided relief for them and a supportivestructure for their relative’s care. MHPs found the ordersuseful for engaging service users in a continuing therapeuticrelationship, and for promoting treatment adherence. In eachgroup, a majority of those interviewed viewed involuntary communitytreatment in a generally positive light, while acknowledgingthe restrictions imposed on service users’ freedom.     

“老来得子”幸福吗？--农村地区大龄生子与心理健康分析

从生育行为主体出发、基于子女性别结构,利用2013年中国社会综合调查（ CGSS）数据,分析了大龄生子群体的心理健康状况。初步研究发现,大龄生子群体的心理健康低于非大龄生子群体,“老来得子”忧大于喜;“38岁前仅生女、38岁及以后生子”群体的心理健康低于“38岁前已生子、38岁及以后生子／女”群体。这说明,男孩偏好下的“老来得子”并不必然提高心理健康;生育作为复杂的人口事件,子女数量、子女性别以及生育年龄等均成为心理健康的扰动因素。     

Structuring Mental Health Within Senior Services: A Case Study of an Outpatient Mental Health Clinic Serving Latinos

The article presents a case study of an outpatient mental health clinic serving Latino older adults. The study explored staff perceptions on the clinic development and the context within an immigrant multicultural community. The study used in-depth, semistructured interviews with support staff, clinical social workers, and administrators. Interviews were analyzed using a thematic content analysis. The mental health clinic formation was perceived by staff as an ecological process stemming from the needs of the Latino immigrant senior clients. A close knit and interdependent culture allowed the clinic to adjust to diversity and changing cultural contexts.     

Use of Nondeliberative Practice in Groups for Older Adults with Substance Use and Mental Health Disorder: Group in an Art Gallery

ABSTRACT

This article presents an application of Norma Lang’s nondeliberative theory in groupwork with clients of Community Outreach Programs in Addictions (COPA), a Toronto community-based organization that assists adults age 55 and older who struggle with addictions and mental health. The article illustrates how we challenged concepts of group work which are predominantly discussion-based problem solving or premeditated by hosting a group in a major art gallery with clients considered difficult to serve. What was done is juxtaposed with what might have been done with greater knowledge of nondeliberative theory.     

International Perspectives on the Use of Community Treatment Orders: Implications for Mental Health Social Workers

Substantial changes to mental health law and policy have occurredthroughout the Western world during the last decade. The drifttowards control, particularly in the form of Community TreatmentOrders (CTOs), has profound implications for the role of mentalhealth social workers, yet this issue is rarely discussed inacademic literature. This paper seeks to redress this gap inknowledge by examining aspects of law, policy and practice usingthree case studies: Victoria, Australia; Ontario, Canada; andregions of the UK. The paper begins by critically reviewingselected literature on CTOs, revealing competing claims aboutefficacy and their impact upon service users¹ and practitioners.A discussion of policy and practice contexts in the three jurisdictionsis then presented and supported with a typology, to illustratecontrasts and comparisons. In their conclusions, the authorsassert that mental health social workers often have a crucialpart to play in the implementation of CTOs but that this isnot always acknowledged in law and organizational policy. Socialworkers’ roles and responsibilities need to be more explicitlyidentified in mental health law. At the same time, there shouldbe a continuing debate about how such coercive powers fit withcodes of ethics and practice standards, at national and internationallevels.     

Policy Changes in Community Mental Health: Interventions and Strategies Used in Sweden over 20 Years

The deinstitutionalization of mental health care has changed the responsibilities of involved authorities and has led to a continuous need for new treatment forms and interventions. This article describes this development in Europe, and in particular how these new conditions have been handled in Sweden over the past 20 years at the level of governmental policy‐making. Three major policy documents from 1994, 2009 and 2012 were included in this study. To increase our understanding of the policies' contents, we have used theoretical concepts concerning governance, implementation and political risk management. Although our main interest was to find out how the government handles interventions for users of the mental health care system, we found that the policy work is progressing stepwise. The first document, from the deinstitutionalization era, did not discuss interventions clearly. Instead, it was mainly concerned with both practical and economical areas of responsibility. The second document, from the post‐deinstitutionalization era, was more focused on what services should be delivered to the users, while the most recently published document to a greater extent addressed the question of how the support is supposed to be designed. The trend in European community mental health policy has been to advocate services in open forms that are integrated into the society's other care systems. This is also the case in Sweden, and continuous work is being done by the government to find strategies to support the development, and to meet the needs at both political and local levels.     

Yarning about gambling in Indigenous communities: an Aboriginal and Islander Mental Health Initiative

Gambling impacts upon the health, wellbeing and finances of many people throughout Australia. This study aimed to explore the socioeconomic and cultural factors linked with gambling in urban and remote Indigenous settings in the Northern Territory to inform the development of a gambling public health strategy. The Aboriginal and Islander Mental Health Initiative developed a semi‐structured questionnaire with Aboriginal partner organisations following consultation. Indigenous consumers of substance use treatment facilities participated in focus group discussions and key informant interviews were conducted with nine service providers at two time points, a year apart. Participants described key strengths in community as family, health and culture, while key worries included substance misuse, health concerns and family disharmony. Regulated gambling and card playing were also identified as important community worries. Financial and family concerns and addictive behaviour were seen as negative consequences of gambling. There was increasing concern linked with card playing and electronic gaming machines and an increased call for awareness campaigns, support from government for change and greater regulation. The findings of this study provide the most recent insight into attitudes, behaviours and consequences linked with Indigenous gambling in the Northern Territory.     

Consistencies and Inconsistencies: Mental Health, Compulsory Treatment and Community Capacity Building in England, Wales and Australia

In relation to mental health, it is clear that medicalized underpinnings,the provision of a clinically orientated evidence base for practiceand the need to contain ‘risk’ continue to be prioritized,particularly when compulsory intervention is considered. Thisis despite the increasing influence of a citizenship and socialjustice agenda which is being promoted by psychiatrists involvedin the development of ‘postpsychiatry’, as wellas by service users/survivors. These drivers are not mutuallyexclusive, but in the context of compulsory treatment, thereare clear tensions. In this article, the policy surroundingmental health and compulsory intervention in Australia and inEngland and Wales is explored. In the context of this discussion,three ways in which current government policy can be interpretedare examined and links made between these interpretations anddifferent ways of viewing the relationship between mental healthand community capacity building. With regard to social workpractice, it is argued that a response to mental ill healthwhich concentrates on an individualized ‘diagnose andtreat’ approach, which particularly comes to the foreat times of compulsory intervention, has limited capacity tofacilitate community engagement, foster social inclusion andgenerate reciprocal dynamics between positive mental healthand community capacity building.     

An Exploratory Study of Social Work with Older Persons in Cuba

Abstract

Assuring a satisfactory quality of life for Cuba's large and fast growing older population is a national challenge. Social work plays an important part in addressing this challenge through its role in Cuba's National Program for the Care of Older Persons. This article explores the role of social work in Cuba's programs for the elderly and its implications for social work practice in the US. The information was obtained from 25 qualitative interviews with policy makers, social work practitioners, and community members in Havana, Cuba in 2003. The community oriented and interdisciplinary nature of Cuban social work with older persons distinguishes it from social work in the US and has implications for social work in this country. Despite the differences between Cuba and the US, the Cuban social work model provides important insights for social work in this country.     

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland

In mental health services over recent decades, the positivemove away from hospital-based care to community-based serviceshas entailed that people with higher levels of need are beingsupported by community mental health services. This paper beginsby reviewing the literature on coercion in the field of community-basedmental health care and treatment. It is argued that the lackof a critical understanding of the concept and how it is usedby practitioners and agencies can have serious repercussionsfor the rights of service users. Using a quasi-experimental,longitudinal design, the authors then seek to test some of theideas about coercion by comparing the activities of assertiveoutreach and community mental health teams in Northern Ireland,particularly the key ideas of perceived coercion, workers’strategies and engagement with services. Key findings were thatassertive outreach appeared to be more successful at reducingperceived coercion, minimizing the need for coercive strategies,engaging high-risk clients and reducing inpatient bed use. Thesefindings are compared with other studies in this area. The authorsalso argue that there is a need for greater transparency inthe way that practitioners use coercive measures and more explicitguidance is required in this crucial area of mental health practice.     

Community care for adults with severe mental disorders in rural China: A case study

In China, family care is the dominant form of care for people with mental disorders. Since 2004, the government has been developing a community‐care model that places more responsibility on community organisations and the local governments at the provincial, municipal and county levels for the provision of formal care. As a large number of people with severe mental disorders live in rural China, this case study was conducted in a rural county in order to examine the development of community care. It was found that, although family care remains dominant, families’ need for formal care is increasing. Community services have improved, but their development is constrained by several contextual and micro factors. In this study, it is argued that the community‐care model introduces a process of reconfiguration of the relative responsibility for care among the family, social organisations and the government, but progress depends on further administrative and fiscal reforms.     

Shaping the Future of Mental Health Policy and Legislation in Northern Ireland: The Impact of Service User and Professional Social Work Discourses

This paper explores the complex interrelationship between serviceuser and professional social work discourses and provides acritical commentary on their respective contributions to therecent review of mental health policy and legislation in NorthernIreland. The analysis indicates that dominant trends in mentalhealth care, as mediated through service structures and institutionalidentities, have tended to prioritize the more coercive aspectsof the social work role and reinforce existing power inequalitieswith service users. It is argued that such developments underlinethe need for a ‘re-focusing’ debate in mental healthsocial work to consider how a more appropriate balance can beachieved between its participatory/empowering and regulatory/coercivefunctions. Whilst highlighting both congruence and dissonancebetween respective discourses, the paper concludes that opportunitiesexist within the current change process for service users andsocial workers to build closer alliances in working togetherto reconstruct practice, safeguard human rights and developinnovative alternatives to a traditional bio-medical model oftreatment.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

Patients with Minor Mental Disorders Leading to Sickness Absence: A Feasibility Study for Social Workers' Participation in a Treatment Programme

Minor mental disorders are common among patients who visit theirgeneral practitioner. In the Netherlands, they are associatedwith high costs due to absenteeism, disability benefits andmedical consumption (consumption of drugs as well as expenditureof medical staff’s time). In the Netherlands, a protocolwas developed for the treatment of minor mental disorders, basedon the principles of brief cognitive behaviour therapy. Thecost-effectiveness of this protocol was tested in a group ofpatients whose minor mental disorders had lead to sickness absence.The protocol was completed by Dutch social workers, one of whosecore tasks normally is to provide psychosocial care. The mainaims of the protocol are for the patient to regain functionalityand to prevent long-term disability. The protocol emphasizespatients’ own responsibility and active role in the recoveryprocess, includes homework assignments and stresses the importanceof early work resumption. This article focuses on a discussionof the feasibility of this treatment for minor mental disorders.The evidence for or against the protocol’s cost-effectivenesswill be discussed in future papers. The results show that patients,social workers and general practitioners were motivated to participateand that the protocol was well received by all three groups.If the treatment also proves to be cost-effective, it wouldappear to be a promising intervention for a frequently encounteredproblem in primary care.     

Mental health in postgraduate social work curriculum: Review of training contents in Indian schools of social work

Training of social workers according to the changing needs of the society is important. To this end, we decided to review the adequacy of mental health training in postgraduate programme in social work. The Mental Health Care Act 2017 defines psychiatric social worker (PSW) in India to have additional higher qualification beyond post‐graduation in social work. The number of such qualified PSWs appears to be limited due to small number of institutes that offer advanced training in the country. Though, the number of available PSWs with such qualifications is rising, the manpower in proportion to the mental health needs in the country continues to remain low. It is therefore, relevant to review the quality of psychiatric social work education at postgraduate level if this level is to be considered as the desirable qualification for PSW. In this context, postgraduate social work syllabi from 71 universities including autonomous institutions were reviewed using semi‐structured assessment. The results show a lack of uniform teaching components, training methods and insufficient skill orientation towards mental health interventions. These observations suggest that curricula and training are modified with strengthening and enhancing the quality of training of mental health at post‐graduate level in Social Work.     

“反精神医学”的谱系： 精神卫生公共性的历史及其启示

基于对上世纪后半叶以来“反精神医学”历史的考察,本文试图提出反精神医学运动如何影响精神卫生公共性建设的问题。文章结合当时欧美社会民权运动的背景,从“反精神医学”诸种思潮中梳理出其指涉公共性的各个面向,探讨其历史经验与启示。在传统精神医学陷入危机之时,反精神医学的精神卫生观转向以精神病患为主体,其中对“全控机构”的批判和标签论颠覆了传统精神医学的神话,成为“去机构化”意识形态的合力;同时,草根组织的援助改变了被收容者的社会处置方式;巴扎利阿的精神医疗改革则进一步解放了被收容者,其提出的废除精神病院、通过立法保障患者权益的案例,进一步彰显出精神卫生的公共性何以可能的历史经验。在此基础上,文章对精神卫生的公共性所指涉的目标和价值取向、精神卫生改革中的公众参与以及争取合法保障精神卫生相关权益的经验进行了讨论。