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Barriers for homeless with dual diagnosis: lessons learned from intensive mobile psychosocial assertive community treatment program
- Authors:
- ZOLNIKOV Tara Rava, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(4), 2021, pp.169-182.
- Publisher:
- Emerald
Purpose: Dual diagnosis is a term that describes the co-occurrence of mental health disorders or illness and substance use or abuse disorders. Because this co-occurrence results in multiple diseases, layers of treatment are often needed to successfully create positive change in the individual. The purpose of this study is to explore factors of treatment that could facilitate improvements in functionality and quality of life for those with a dual diagnosis. Design/methodology/approach: A secondary data analysis, using both quantitative and qualitative data, was completed. Secondary analysis is an empirical exercise that applies the same basic research principles as studies using primary data and has steps to be followed, including the evaluative and procedural steps commonly associated with secondary data analysis. Documentation data from the intensive mobile psychosocial assertive community treatment program was gathered for this analysis; this program was used because of the intensive and community-based services provided to patients with a dual diagnosis. Findings: The major findings from this secondary analysis suggested that significant barriers included “denial” (e.g. evasion, suspension or avoidance of internal awareness) of diagnoses, complicated treatment and other barriers related to housing. Ultimately, these findings provided greater insight into potential effective treatment interventions for people living with a dual diagnosis. Originality/value: This study adds to the growing body of literature showing that patient-centred care allows for more effective treatment and ultimately, improved health outcomes. (Edited publisher abstract)
The impact of Covid-19 on access to psychological services
- Authors:
- PURRINGTON Jack, SANTAMBROGIO Jacopo
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(4), 2021, pp.119-131.
- Publisher:
- Emerald
Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. (Edited publisher abstract)
The role of occupational meaningfulness and citizenship as mediators between occupational status and recovery: a cross-sectional study among residents with co-occurring problems
- Authors:
- NESSE Linda, et al
- Journal article citation:
- Advances in Dual Diagnosis, 14(3), 2021, pp.99-118.
- Publisher:
- Emerald
Purpose: Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach: The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings: Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value: The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems. (Edited publisher abstract)
Locked down and drinking? Are more people self-identifying as having mental health difficulties alongside their drinking via an online platform?
- Authors:
- CALCAN Angela, HOLMES Mark
- Journal article citation:
- Advances in Dual Diagnosis, 14(3), 2021, pp.159-166.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people’s engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times. Design/methodology/approach: A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021). Findings: Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users. Research limitations/implications: Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria. Practical implications: Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new “normal” way of living and working. Routine screening of mental health and alcohol use are recommended. Originality/value: This paper offers insight from an established online/digital service and the impact of the pandemic on people’s engagement with the service. (Edited publisher abstract)
Political engagement in the 2019 UK general election of patients with autism and/or a learning disability detained in a psychiatric hospital
- Author:
- ARMSTRONG Richard
- Journal article citation:
- Tizard Learning Disability Review, 26(2), 2021, pp.77-86.
- Publisher:
- Emerald
Purpose: This case study aims to describe how patients with autism and/or a learning disability detained in a psychiatric hospital were supported to register and vote in the 2019 UK general election. Design/methodology/approach: A speech and language therapist supported patients to register and vote. Data on the number of patients who registered and voted are reported as well as feedback from patients about their experiences. Findings: Forty-two per cent of patients registered to vote; 27% did not want to register; and 31% could not understand the information provided and/or state a clear preference because of the severity of their cognitive and communication difficulties. Fifteen per cent of patients voted and were all first-time voters. Originality/value: This study demonstrates that it is possible to support significant numbers of autistic and learning disabled patients in a psychiatric hospital to register for and vote in a parliamentary election. (Edited publisher abstract)
Commentary on “Political engagement in the 2019 UK general election of patients with autism and/or a learning disability detained in a psychiatric hospital”
- Author:
- WALTZ Mitzi
- Journal article citation:
- Tizard Learning Disability Review, 26(2), 2021, pp.87-89.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide a commentary on the article “Political engagement in the 2019 UK general election of patients with autism and/or a learning disability detained in a psychiatric hospital”. Design/methodology/approach: This paper considers the wider issue of political participation by persons with disabilities, especially those whose freedom is restricted. Findings: Access to voting rights remains problematic for many disabled people. It is crucial that this basic form of political participation is ensured, but there is further to go. Originality/value: This paper suggests the need for greater attention to and support for disabled peoples’ right to political participation, including people with learning disabilities and autism. (Edited publisher abstract)
When policy fails try something different integrated practice improve outcomes for dual diagnosis co-occurring service users accessing mental health services
- Authors:
- DUGMORE Lois, BAUWERAERTS Saskia
- Journal article citation:
- Drugs and Alcohol Today, 21(2), 2021, pp.157-170.
- Publisher:
- Emerald
Purpose This paper aims to discuss an initiative developed between, Leicestershire Partnership National Health Service Trust and Turning Point, which is the locally commissioned drug and alcohol service in Leicester, Leicestershire and Rutland. The aim was to improve outcomes for clients with dual diagnosis (co-occurring mental health and substance misuse) issues. The purpose of the change in working practice was to engage with local substance misuse agencies more effectively to improve clinical outcomes within this service user group. This was achieved through four interrelated approaches. This comprising providing an integrated service. It included building relationships with substance misuse services, providing specialist dual diagnosis clinics and the introduction of substance misuse workers onto mental health wards and group work specific to substance misuse. The outcomes included easier access to services for service users and greater uptake of service users who were moving onto substance misuse services. This led to a reduction in risk related to prescribing and fewer incidents related to prescribing changes and greater engagement in services. When service users were moving between services better communication led to prescriptions being transferred with no delay and to reduced dropout rates in service. There was improved access to substance misuse services, more referrals and take up of service taking place. There was a greater understanding by staff of co-occurring substance misuse and how to work with this client group. Closer working relationship with substance misuse services and shared skills led to greater confidence in managing this service user group. This demonstrates a cost effective service that can be replicated within similar settings. Design/methodology/approach: Group Substance Misuse programmes. Findings: Working within an integrated model, yet maintaining separate organisations, by offering joint training and clinics has led to a greater understanding of each organisation’s work and increased engagement within the service user group. The introduction of substance misuse workers to acute and rehab mental health inpatient services encouraged service users to engage at the point of admission and to be referred into locally commissioned substance misuse services prior to the point of discharge. Engagement with staff has demonstrated better engagement with substance service by service users following discharge. For clients able to take leave assessment could take place prior to discharge. This led to an increased uptake in services. Due to no opiate substitution given on discharge decreased risk of prescribed medication overdose at point of discharge and led to increase in returning straight to substance misuse services. This meant that service users received medication quicker and the right dose and on discharge ensured reduced risk. The prescribing of Naloxone at discharge is yet to be assessed, but the risk of an overdose within seven days is well-documented and Naloxone is key in reversing this trend. This change in practice can be replicated in any mental health setting and has increased access to services for those using substances. Originality/value: Is original no other services have substance workers or joint clinics across the UK. First inpatient unit to welcome patients back post-discharge to attend groups. (Edited publisher abstract)
Cross-cultural conceptualization and implementation of recovery in mental health: a literature review
- Author:
- SOFOULI Eleni
- Journal article citation:
- Mental Health and Social Inclusion, 25(1), 2021, pp.32-40.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to review the literature in terms of the conceptualization of the recovery concept among cultural and ethnic minorities drawing on the connectedness, hope and optimism about the future; Identity, meaning in life, empowerment (CHIME) framework; highlight the cultural adaptations of supported housing – a prominent recovery-oriented intervention, as it was implemented in a multicultural western country; and delineate the future implications for research, policy and practice in regard to mental health recovery interventions for cultural and ethnic minorities. Design/methodology/approach: An online search was performed to identify recent empirical studies published in English in peer-reviewed journals. Findings: Included studies confirmed what the authors of CHIME had initially reported: spirituality and support networks could act as enablers or inhibitors in the recovery process of mental health services users with diverse cultural backgrounds. The stigma surrounding mental illness is a key challenge that skews the recovery experience. Other cultural-specific factors include linguistic peculiarities of the maternal language and gender. The cultural adaptation of a recovery-oriented intervention was feasible and effective but also challenging. Originality/value: By studying the cultural variations of mental health recovery, the intention is to inform mental health practitioners and other key stakeholders of the distinct cultural components that influence the recovery process, thereby promoting the development of culturally sensitive, accessible and effective recovery-oriented interventions. It is worth noting that providing culturally appropriate mental health services could be viewed as a human right issue for minority groups. (Edited publisher abstract)
COVID-19 and intellectual disability/autism spectrum disorder with high and very high support needs: issues of physical and mental vulnerability
- Authors:
- BUONAGURO Elisabetta F., BERTELLI Marco O.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(1), 2021, pp.8-19.
- Publisher:
- Emerald
Purpose: The COVID-19 outbreak has profoundly plagued the world, and current health efforts are focused on providing prevention and ensuring access to intensive services for people with the most severe symptomatology. Many reports have already described substantial psychological distress in the general population. Nevertheless, disasters tend to affect vulnerable subjects disproportionately, and individuals with intellectual disabilities/autism spectrum disorder with high and very high support needs (PwID/ASD-HSN) seem to be counted among the hardest hit populations. The present paper aims to provide a comprehensive discussion and evaluation of COVID-19 related issues specific to PwID/ASD-HSN. Design/methodology/approach: Commentary on available literature and analysis of new preliminary data on PwID/ASD-HSN’s physical and psychic vulnerability factors. This knowledge is fundamental to provide families and caregivers special advice to counteract the risks associated with the current pandemic. Findings: PwID/ASD-HSN represent one of the most vulnerable population to the COVID-19 outbreak and the associated factors of mental distress for several reasons, including multimorbidity, low levels of health literacy, difficulties to understand and communicate, reliance on other people for care, low compliance with complex hygiene rules, the strong need of routine/sameness and low adaptive skills. Originality/value: In the present work, the authors analyze the specific factors of physical and mental vulnerability in PwID/ASD-HSN, corroborating the dissertation with a discussion on the first data published worldwide and with preliminary data collected on the Italian territory for what concerns prevalence rates of COVID-19 and complications in persons with PwID/ASD-HSN and signs and symptoms of psychic distress during the mass quarantine period. (Edited publisher abstract)
Social recovery: a new interpretation to recovery-orientated services – a critical literature review
- Authors:
- NORTON Michael John, SWORDS Calvin
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 16(1), 2021, pp.7-20.
- Publisher:
- Emerald
Purpose: In 2020, the significance of “lived experience” and “service user” accounts of recovery has become central to the delivery of mental health policy and practice. Reflecting on the first known account of personal recovery in the late-20th century provided new hope and encouragement that those living with mental illness could live a fulfilling life. Taking this into consideration, the purpose of this paper is to explore the relevance to this experience of those using services today. Design/methodology/approach: The authors present a critical literature review, which is underpinned by a systematic approach adopted from Higgins and Pinkerton (1998). This involved a six-step approach seeking to answer the question – What are the service users’ views on the recovery concept within mental health services? Findings: The conceptualisation of recovery continues to focus on biomedical parameters. A new interpretation of recovery is beginning to materialise: social recovery. This new interpretation appears to be achievable through six key influencers: health, economics, social interaction/connection, housing, personal relationships and support. Originality/value: Building on Ramon’s (2018) argument regarding the need for mental health policy to focus on the concept of social recovery, this study extends on this proposition by providing a foundational evidence base. More specifically, it not only supports the need for this shift in policy but also identifies a new interpretation building in practice. Furthermore, the authors highlight six key pillars that could potentially shape such provisions for policy. (Edited publisher abstract)