Objective: This article describes the characteristics and early imple- mentation experiences of community behavioral health agencies that received Primary and Behavioral Health Care Integration (PBHCI) grants from the Substance Abuse and Mental Health Services Adminis- tration to integrate primary care into programs for adults with seriousmentalillness. Methods: Data were collected from 56 programs, across 26 states, that received PBHCI grants in 2009 (N=13) or 2010 (N=43). The authors systematically extracted quantitative and qualitative infor- mation about program characteristics from grantee proposals and semi- structured telephone interviews with core program staff. Quarterly reports submitted by grantees were coded to identify barriers to imple- menting integrated care. Results: Grantees shared core features re- quired by the grant but varied widely in terms of characteristics of the organization, such as size and location, and in the way services were integrated, such as through partnerships with a primary care agency. Barriers to program implementation at start-up included difficulty recruiting and retaining qualified staff and issues related to data col- lection and use of electronic health records, licensing and approvals, and physical space. By the end of the first year, some problems, such as space issues, were largely resolved, but other issues, including problems with staffing and data collection, remained. New challenges, such as patient recruitment, had emerged. Conclusions: Early implementation experi- ences of PBHCI grantees may inform other programs that seek to integrate primary care into behavioral health settings as part of new, large-scale government initiatives, such as specialty mental health homes. (Psychiatric Services in Advance, April 15, 2013; doi: 10.1176/ appi.ps.201200269)
Through the acute phases of their illness, participants showed little sign of autonomous action and tended to be (were, perhaps, required to be) passive receivers of treat- ments and therapies. Low levels of personal control and autonomy have been widely implicated in mental health problems of various types (Cloninger, 1999; Deci & Ryan, 1995; Nix et al, 1999), and may be an inherent result of experiencing seriousmentalillness (see Chadwick, 1997 for a discussion). Medical records as well as interview data from participants and health professionals suggest that, during the more debilitating stages of illness, the partici- pants’ lives were characterised by a high degree of depend- ence on their treatment providers, support workers, family and friends. These high levels of dependence during the acute phase/s of illness make the preliminary signs of autonomy in participants’ accounts particularly striking. Notably, initial demonstrations of autonomy often occurred in physical activity settings.
This is an important omission because in gen- eral, positive parenting practices—positive, nur- turant parenting attitudes, supervision of and in- volvement in school and activities, and authoritative parenting style—all relate to better outcomes for children and adolescents (Bornstein, Tal, & Tamis-LeMonda, 1991; Gray & Steinberg, 1999; Harris & Marmer, 1996). Poverty (Samaan, 2000) plus material and social stress (Furstenberg, Hughes, & Brooks-Gunn, 1992), have all been re- lated to breakdowns in positive parenting both generally and among African American mothers in particular (McLoyd, 1990). Maternal poverty is also related to increased risk of using a negative, punishing parenting style (McLoyd, 1998). Cur- rent multiple risk models tend to be additive— simply positing that more risks are worse for chil- dren than fewer; although important, these models do not go far enough in determining the relative weight of each factor in concert with the others (Greenberg, Lengua, Coie, Pinderhughes, & The Conduct Problems Prevention Work Group 1999). Because poverty and lack of social support often co-occur with maternal mentalillness, only by studying them in concert will it be possible to es- timate the total effect of these risk factors on pos- itive parenting. By highlighting mediating factors, such an analysis will provide insights into appro- priate preventive strategies as well. In the current research, we attempt to address these gaps by ex- amining antecedents of positive parenting practic- es among low-income, African American mothers with seriousmentalillness.
The results of this survey were not in keeping with the pre- diction that pet owners would report higher levels of physical community integration than non–pet owners. This mea- sure’s low sensitivity to detect differences in the type of physical community integration expected in the context of pet ownership may help to explain this finding. For example, pet ownership is unlikely to influence attendance at local community entertainment, religious, or work sites. In addi- tion, it may be that the type of pets owned influences physi- cal integration. Cats, a popular pet among the study sample, are unlike dogs in that they are not typically associated with their owners’ venturing into the community. Consistent with previous research on community participation (Fairman & Huebner, 2000; Guest et al., 2006; Valentine et al., 1993), social interactions (McNicholas & Collis, 2000; Sams et al., 2006), and community integration (Allen & Blascovich, 1996), our key finding was that pet owners scored higher than non–pet owners on social community integration. Higher scores among pet owners for community integration were consistent with De Souza’s (2000) qualitative study of the experience of quality of life as defined by people with seriousmentalillness living in the community.
researcher (name of author) engaged in prolonged immersion in the field over an 18 month period where he participated in the daily life of a vocational rehabilitation centre for people with seriousmentalillness. During this time, he took part in sport and exercise groups as well as social and day-to-day activities which helped build relationships with potential participants. For the second author (name of author), trusting relationships and familiarity with participants were established through her attending the centre on a weekly basis and coaching a golf activity group which was offered alongside other sport and exercise sessions at the centre.
Background & Significance: Despite estimates that persons with seriousmentalillness (SMI) are between 2 and 8 times more likely to commit acts of violence than are members of the general population and that approximately 50% of all acts of violence by persons with SMI are against family members, the subject of family violence by persons with SMI has received little research attention. Hypothesis: After reviewing the literatures on community and family violence by persons with SMI, it was hypothesized that family violence by this population is associated with factors in four domains: 1) Perpetrator, 2) Victim, 3) Interaction, and 4) Community. Methods: A cross-sectional survey design was used. Between December 29, 2015 and April 1, 2017, 523 persons with SMI living in the U.S. completed an online survey. Respondents were recruited from a range of mental health organizations across the U.S. Respondents provided information regarding themselves, a reference relative, and the interactions they and reference relatives had with each other in the past 6 months, including possible acts of violence. The association of factors with the occurrence of violence by persons with SMI towards reference relatives was estimated with multivariate logistic regression. Results: Twelve percent (n = 13) of persons with SMI reported having committed violence towards their reference relative in the past 6 months. In the final multivariate logistic regression model, the following factors were significantly associated with violence by persons with SMI towards reference: Perpetrator—history of ever committing serious violence; Victim—age; Interaction— use of limit-setting practices by relatives, psychological abuse by persons with SMI and relatives, and violence by relatives. Conclusions: Mutual violence appears to play a considerable role in family violence by this population. Practitioners may better serve clients with SMI by offering to involve family members in their treatment and by assessing and intervening in family conflict. Interventions aimed at decreasing psychological abuse may help deescalate conflict and prevent physical violence. Interventions intended to decrease or modify limit-setting practices used by relatives towards persons with SMI may decrease the risk of family violence by this population.
Strict adherence to the CONSORT statement (Moher 2001) would have provided us with more useable data. We were unable to use data from some studies because raw scores were not pre- sented. Instead outcomes were presented as inexact P values with- out means and standard deviations. Randomisation techniques were not always made clear and blinding was untested - although, of course, difficult to achieve for this type of study. There is an obvious lack of research in this area and the small number of in- cluded studies fails to reflect the huge amount of healthcare advice given to people with seriousmentalillness.
Information obtained from physical health monitoring is often the catalyst for more intensive medical input, which can be ei- ther curative, palliative or preventative. The routine employment of simple and relatively inexpensive physical health monitoring has the potential to identify current, and pre-empt future, health problems. Subsequent action could improve the quality and dura- tion of life for sufferers of seriousmentalillness. Additional ben- efits may include a reduction in dependence on medical services. “There are potential savings to be made on prescribing and acute care budgets through prevention or early detection of serious ill- ness in these groups of service users” (DoH 2006).
Results: Eighteen studies that met the inclusion criteria were identified. Digital health tech- nologies (DHTs) assessed in the selected studies included mobile applications (apps), digital medicine, digital personal health records, and an electronic pill container. Smartphone apps accounted for the largest share of DHTs. The intended uses of DHTs could be broadly classified as monitoring to gain a better understanding of illness, clinical assessment, and intervention. Overall, studies indicated high usability/feasibility and efficacy/effectiveness, with several reporting validity against established clinical scales. Users were generally engaged with the DHT, and mobile assessments were deemed helpful in monitoring disease symptoms. Conclusion: Rapidly proliferating digital technologies seem to be feasible for short-term use in patients with seriousmentalillness; nevertheless, long-term effectiveness data from naturalistic studies will help demonstrate their usefulness and facilitate their adoption and integration into the mental health-care system.
Case management is a comprehensive approach to managing seriousmentalillness, with evidence suggest- ing that intensive case management may be effective in reducing hospitalisation in people with SMI . Mental health nurses (MHNs) account for a considerable pro- portion of case managers; they also represent the great- est percentage of the mental health workforce . Consequently, MHNs are likely to have the largest face- to-face time with people living with SMI than any other discipline . As such, MHNs are well placed in their role to support people with SMI and to prevent relapse.
sharply after six months, with less than half the participants able to stick with the program (71). It is un- realistic to expect adherence rates to be any better for individuals with se- rious mentalillness. In fact, individ- uals with seriousmentalillness often face substantial illness-related barri- ers to physical activity that healthier individuals do not face. However, our experience and existing research suggest that exercise is well accepted by people with seriousmentalillness (91) and is often considered one of the most valued components of treatment (92). If programs are made available as part of psychiatric services, individuals will choose to enroll, and adherence appears com- parable to that in the general popu- lation (93). Longitudinal program designs that require participants to attend sessions regularly in order to keep up may pose a problem for in- dividuals who frequently but inter-
It is unclear why so few studies have been conducted in this field? In our review we found that many studies were excluded as they contained additional components such as dietary advice or measures to reduce weight. The focus on physical activity alone may be being lost in interventions designed to address the current increasing general concerns about obesity and metabolic problems in this population . This is in addition to a general lack of well designed studies aiming to address the health problems and risk factors in this population. For example, smoking levels in people with seriousmentalillness remain about two to three times levels found in the general population. However relatively few randomised trials have been con- ducted with the primary aim of achieving smoking cessa- tion in this population .
Although much less research has explored the benefits of physical activity for people with seriousmentalillness such as schizophrenia, several studies suggest that, for some people at least, benefits occur through regular participation (Beebe, Tian, Morris, Goodwin, Allen, & Kuldau, 2005; Carless & Douglas, 2004; Faulkner & Biddle, 1999; Faulkner & Sparkes, 1999; Fogarty & Happell, 2005). Seriousmentalillness (SMI) is defined as “a diagnosable mental disorder found in persons aged 18 years and older that is so long lasting and severe that it seriously interferes with a person's ability to take part in major life activities” (United States Department of Health and Human Services, n.d.). Given the high levels of disability experienced by people with SMI, it is perhaps unreasonable to expect participation in physical activity to lead to remission. However, as part of a more holistic care package physical activity
As Corrigan and Phelan (2004) suggest, social support is a multi-faceted and complex construct. In presenting here examples of how and when four specific dimensions of social support have been manifest in the exercise and sport experiences of men with seriousmentalillness we have attempted to shed some new light on this complexity. In keeping with the ethos of interpretive research, we aim to illuminate rather than finalise the ways in which social support processes operate in the context of exercise and seriousmentalillness. We hope that our findings can assist psychiatric and mental health nurses who may wish to offer and/or promote exercise opportunities for their clients in planning and implementing effective social support on the basis of the four types we have discussed.
This report assesses the cost impact on individuals, and on the national economy, of the comorbidities of chronic physical illness and seriousmentalillness. It defines seriousmentalillness on the basis of the severity of the different types of mentalillness. Within the literature seriousmentalillness and severe mentalillness are interchangeable terms. Two alternative methods are used to assess the cost of seriousmentalillness and associated comorbidities. The first uses a ‘top-down’ estimate of the prevalence and overall burden of disease of seriousmentalillness in Australia and New Zealand based on the findings of the Global Burden of Disease Study for 2010 (IHME 2015a). It is widely recognised that these data underestimate the burden of disease from premature death due to comorbidities (Charlson et al. 2014) so revised estimates are calculated to account for this based on a number of recent studies. Estimates are presented for schizophrenia, severe anxiety and severe depression. Mental illnesses and substance-use disorders are often considered together, so opioid dependence is included separately in this analysis, as it is a severe substance-use disorder. The difference between the original and revised estimates is then taken as a measure of the burden of disease due to comorbidities.
Ben (a pseudonym) was one of four participants taking part in a larger study of physical activity and mental health (Carless, 2003). At the time the research began, Ben was 36 years old and had been living with seriousmentalillness for ten years. Throughout this time, Ben had been treated with antipsychotic medication and his illness had a profound impact on all areas of his life. At the most severe times he had been hospitalised, while at other times he lived a relatively normal life in a supported environment. Although some difficulties remained and he continued to be prescribed antipsychotic medication, Ben had made significant improvements in terms of his mental health and general well-being by the time he took part in this study. Indeed, at the time of our final interview, Ben was about to leave the vocational rehabilitation centre he had been attending for several years to take up a voluntary work placement. Ben described himself as “nearly one-hundred percent. Just the odd attack every now and again but other than that I’m fine … I feel that I’m OK now, nearly better now. Bit of luck, hopefully, I could be one-hundred percent in a few years.”
Screening for cardiovascular risk factors in adults with serious mental illness a review of the evidence Baller et al BMC Psychiatry (2015) 15 55 DOI 10 1186/s12888 015 0416 y RESEARCH ARTICLE Open Ac[.]
Methods: Seven databases including CINHAL, MEDLINE, Embase, PsycINFO, Health Management Information Consortium, Cochrane databases and Web of Science will be searched against five main facets (age, seriousmentalillness, sign, deterioration and patient) and a subsequent comprehensive list of search terms. Searches will be run individually in each database to reflect each unique set of relevant subject headings and appropriate MeSH terms. Inclusion and exclusion criteria were developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction and appraisal, to ensure reliability. A narrative synthesis of the data will also be conducted.
Estimates of the prevalence of seriousmentalillness (SMI) provide a measure of the population with the most severe mental health problems and indicate those persons who are most in need of treatment. SMI is defined in this report as having at some time in the past year a diagnosable mental, behavioral, or emotional disorder that met the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, 4 th edition (DSM-IV) (American Psychiatric Association [APA], 1994), that resulted in functional impairment that substantially interfered with or limited one or more major activities. Studies have shown that mental disorders co-occurring with substance use disorders are more chronic than mental disorders alone and that the co-occurrence between a mental disorder and a substance use disorder can create serious complications for treatment (Kranzler & Liebowitz, 1988). Adults with SMI and a co-occurring substance use disorder may have a greater need for treatment than adults with a less severe mental disorder co-occurring with a substance use disorder.
There are several important outcomes that may result from this project. First results may lead to an improved cli- nical staging model for SMI and prediction algorithms that can be used by health care providers as decision-support tools in their practices. Secondly, our research will lead to a greater understanding of clinical, social and cognitive factors associated with the clinical stages of development of a SMI, as well as new insights from neuroimaging and later neuro- chemical biomarker studies regarding predisposition to SMI development and progression through the clinical stages of illness. Our results will also be used to inform health policies, health education and promotion activities that are related to the predictors in the algorithms. Seriousmentalillness results in impaired quality-of-life, medical morbidity and suicide. Improved identification of youth at risk represents our best chance at providing effective, appropri- ate and cost-effective treatment to each young person who needs help.