UPSIDES Mental Health Peer Support in Face of the COVID-19 Pandemic: Actions and Insights.

The outburst of the COVID-19 pandemic challenged vulnerable populations such as individuals with significant mental illness. In this fresh focus, we describe the innovative development of the UPSIDES mental health peer support intervention, in face of the COVID-19 pandemic in Israel. While the research program is still ongoing, in this paper we focus on the processes and lessons learned from dealing with the rapidly changing circumstances of the pandemic. We portray additional activities conducted above and beyond the UPSIDES protocol in order to maintain continuation and prevent dropout. We learned that an essential combination of keeping a close adherence with the core peer principles and UPSIDES' systematic program and the use of flexible telecommunication means, helped to maintain social connection and service users' participation throughout these times. The sudden pandemic challenges appeared to level out power imbalances and accelerated the formation of reciprocal and supportive relational interactions within the intervention. These processes highlight experiential knowledge as a unique asset, and peer support services as useful in supporting individuals with significant mental illness throughout COVID-19.

Why do mental health consumers who receive rehabilitation services, are not using them? A Qualitative Investigation of Users' Perspectives in Israel.

A recovery-oriented approach to mental health involves creating person centered services and enhancing engagement in psychiatric rehabilitation. Israel's Rehabilitation in the Community of Persons with Mental Disabilities Law is a progressive initiative that shifted the locus of psychiatric care to community care supporting individualized rehabilitation and recovery-oriented processes. Yet over a quarter of applicants do not implement their assigned rehabilitation plans and services. This qualitative study investigated reasons and experiences related to lack of utilization from applicants' perspectives. Fifteen service users were interviewed face to face in semi-structured interviews analyzed using Grounded theory approach. Seven categories emerged: (1) Lack of knowledge and orientation; (2) Negative perceptions about rehabilitation services (3) Lack of active participation/shared decision-making; (4) Not feeling heard by the committee; (5) Lack of congruence between participants' goals and committee's final decisions; (6) Lack of escorting professionals' competencies; and (7) Family members' influence. The results are interpreted at the structural and human process levels. Suggestions are provided for augmenting systemic procedures and human interactions processes.

[Psychiatric advance directives--medical models into psychiatric medicine].

Since the year 2005, in the field of general medicine, the legislature in Israel determined ways to implement medically advanced directives according to the power of the law. Different states in the world had implemented parallel legislation for patients who suffer from mental illness. Psychiatric Advance Directives is a legitimate document which is valid in Australia, New Zealand, Scotland, England and in 25 countries in the U.S.A. Psychiatric advance directives (PAD's) allow competent persons, through advance instructions, to state their preferences for future mental health treatment in the event of an incapacitating psychiatric crisis. Self Determination Theory, Self Care and Autonomy are dominant supportive approaches in the creation of Psychiatric Advance Directives. Research conducted on psychiatric advance directives shows positive potential benefits for mental health clients, therapists and psychiatrists. More research in that area must be conducted. Psychiatric advance directives are currently developed and implemented with the cooperation of the Tauber Foundation and the Beer Sheva Mental Health Center. This is the first step in learning of effective ways to use this intervention in Israel and change perceptions toward a positive connection between medical efficiency and client preferences.

The Israeli law for the rehabilitation in the community of persons with psychiatric disabilities: Achievements and challenges.

OBJECTIVE: The Community Rehabilitation of Persons with Mental Health Disability Law (2000a) is one of Israel's most important pieces of social legislation. It grants persons with psychiatric disabilities the right to receive rehabilitation in the community. This article is a case study of the development and implementation of a policy that led to the Rehabilitation Reform and that has become an important component in Israel's comprehensive mental health reform. The purpose of the study was to review and analyze the law and its elements, examine its implementation during its first two decades of operation, and to identify the issues it faces entering its third decade of application. METHOD: The study examined the key components of the reform such as intended beneficiaries, financing, workforce, and services provided. It used Israel's official statistical data and drew upon a series of interviews with officials and experts on rehabilitation, mental health and social services. RESULTS: In 2020, 30,000 persons were receiving community psychiatric rehabilitation services, constituting about one fifth of the estimated eligible population. In addition to the reform's achievements, this article also identifies a number of issues. Toward the end of the second decade, problems between the psychiatric Rehabilitation Unit and the mental health services became apparent. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: As the Rehabilitation Law enters its third decade, it is recommended to establish an independent committee of experts to examine needed modifications in light of the conclusions drawn about the first two decades of its implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stigma experienced by persons under psychiatric care.

Mental health-related stigma causes suffering and interferes with care and social inclusion. This study explored stigma as experienced by mental health service users. Particular attention is given to their use of coping mechanisms. Interviews were held with 167 adults undergoing outpatient psychiatric treatment; two-thirds of them had previously been hospitalized. Examples of frequency of stigma-related situations included the following: Over half of service users expect people to refuse to have a person with a mental disorder as a co-worker or neighbor, or to engage in other types of social contact. A sizeable group acknowledged that they feared or had experienced rejection. A third of respondents reported they feared or had experienced inappropriate treatment by their doctor. Service users utilize several coping mechanisms to deal with stigma, among them: education, withdrawal, secrecy, and positive distinctiveness. Although we studied a convenience sample of service users, our findings provide sufficient basis to suggest different types of intervention, i.e., to address stigma in the course of treatment in the specialist settings, to promote the establishment of mutual support groups, and to raise family physicians' awareness with regard to the stigma that may be present when caring for persons with mental disorders.

Attitudes, knowledge and preferences of the Israeli public regarding mental health services.

We examined the public's preferences regarding the site of provision of mental health care and the basis for those preferences. A representative sample of the adult Israeli population (N = 1,583) was interviewed by telephone about their knowledge and attitudes. Self-referral to mental health professionals and primary medical doctors for milder disorders was low. Psychiatric clinics were preferred by 46% of the public; 35% preferred the general clinics, and the remaining 19% were indifferent. Quality of care was noted by 78% of respondents for their preference for psychiatric clinics. General hospitals were preferred for psychiatric inpatient care by 51% of the respondents compared to 23% who opted for psychiatric hospitals. Despite reasonable familiarity with mental health care, one-third of the respondents did not know whether there was a clinic in their neighborhood. Implications for action are discussed in light of the transfer of responsibility for psychiatric care from the Ministry of Health to the health maintenance organizations

Selecting and implementing evidence-based practices in psychiatric rehabilitation services in Israel: a worthy and feasible challenge.

Major recent conceptual and legal advancements in Israel have generated a profound shift in the services provided for people with severe mental illness. Perhaps the most influential development has been the passage of the act for the rehabilitation of persons with a psychiatric disability in the community in the year 2000. In this paper we argue that the psychiatric rehabilitation services defined by the recent legislation lack explicit standards or criteria for selection, and thus could benefit from incorporating interventions that evidence has shown to be effective in assisting clients to achieve desirable outcomes. We propose a practical five-step plan to facilitate the implementation of these evidence-based practices including creating demand, selecting the EBPs, preparing practitioners and agencies, monitoring and feedback, and ensuring sustainability. The importance of an ongoing dialogue between stakeholders to facilitate the integration of research evidence, clinical expertise and rehabilitation values to improve the quality of service is discussed.

A program of supported education for adult Israeli students with schizophrenia.

This report describes a supported education program (SEP), a novel community-based program of rehabilitation for psychiatric patients, started in Israel in 1999. Objectives, target population and activities are described. In addition, initial findings of two program-related studies are presented. One study explored the relationship of psychological distress with students' coping strategies and perceived social support. The second study is a survey of mental health literacy and attitudes of heads of schools for adult education where the SEP was implemented. Studies' findings suggested a "case for action" with the following objectives: to develop interventions to prevent distress among SEP users, and to enhance mental health knowledge and foster positive attitudes among school personnel aimed at decreasing dropout rates and encourage the utilization of the opportunities provided by SEP.

The subjective experience of people with severe mental illness: a potentially crucial piece of the puzzle.

Over the last two decades there has been growing interest in the subjective experiences of persons with severe mental illness (SMI). Despite this interest, little research has been carried out to understand whether and how such experiences are related to the course of SMI. In addition, few psychotherapeutic and rehabilitation interventions have been developed especially for persons with SMI that seriously take these persons' subjective experiences into account. In the present paper we discuss why the use and investigation of the subjective experience of people with SMI has been neglected, and we point out the potential importance of this experience. We then review the growing literature that focuses on the subjective experience of (1) the illness, (2) the self, and (3) the self as influenced by the social context of persons with SMI. Finally, the implications of this review for rehabilitation, recovery and research are discussed.

On the way to Psychiatric Reform in Israel: notes for an ideological and scientific debate.

Israel has launched its program for Psychiatric Reform. However, the implementation of its three areas of action, as the Reform has been conceived thus far, is uneven. While the development of the rehabilitation component has progressed as planned, the one that refers to the insurance component remains stalled. The third one, dealing with dehospitalization and community care, has advanced only in part. Although many of the issues related to the three components of the Reform, of a curative and rehabilitative nature, have been adequately addressed, some crucial aspects are still awaiting a more extensive discussion by all mental health stakeholders. This paper reviews some value-laden and scientific issues as well as strategic measures that are suggested to be taken into account in a forward-looking and democratic Reform. Examples of these issues are: the quest for equity, at the time when the poor population is increasing in the country; scientific issues (e.g., the application of epidemiological data in planning for community needs, training for community-based personnel), that if left aside bear the risk of undermining the depth of the Reform; and strategic measures, purported to recruit the support of professionals and the general public that is essential in a movement that thrives on inclusion and promotes community-based care.

What is in a name? Professionals and service users' opinions of the Hebrew terms used to name psychiatric disorders and disability.

OBJECTIVES: Stigma constitutes the hidden burden of mental disorders. Its ubiquitous presence may be reinforced by iatrogenic factors, such as the terms used to name mental disorders and disability. This preliminary study examines opinions with regard to the use of these terms in Hebrew. METHODS: Two samples of convenience, mental health professionals (n=330) and service users (n=75), were asked to complete a self-administered questionnaire about their respective acceptance of the current term in use to name psychiatric disorders and disability, as well as their preference for alternative terms that may carry a lesser degree of stigma. The distribution of responses was compared within and between these two groups. RESULTS: There was consensus in both groups that a substantial proportion of service users reject the current term used to name mental disorder, mahalat nefesh (disease of the soul). Mental health professionals had a statistically significant acceptance of this term compared to service users. The term hafra'a nafshit (disorder of the soul) was reported to carry a lesser degree of stigma. No specific term was selected by more than a third of the respondents to best define disability resulting from a psychiatric disorder. CONCLUSION: A case for study and possible subsequent action was established by this pilot inquiry.

The SES setting of psychiatric hospitalization in Israel.

OBJECTIVES: This study examined the relationship between the SES level of localities and psychiatric hospitalization measures to determine the SES place in the planning of mental health services. METHODS: The unit of analysis in this study was the city. Data collected from Central Bureau of Statistics (CBS), the National Insurance Institute and the national psychiatric hospitalization case register were used to investigate the association of SES for each city, the number of disability pension recipients for each city and the hospitalization measures: admission rates, length of inpatient episode and the length of tenure in the community. RESULTS: The socioeconomic level of cities correlated significantly with the number of disability pension recipients in each city and the hospitalization measures: admission rates, length of inpatient episode and the length of tenure in the community. However, the relationship between the SES and both the psychiatric admission rates and the psychiatric disability rates differed between the lower and the higher parts of the SES scale: Both measures went up as the SES went up from level 1 to level 3 and went down as the SES level went up from level 4 to level 8. CONCLUSIONS: The demand for psychiatric hospitalization was higher in the poorer communities. Reaching equity in distributing community public mental health resources seems to be not only more appropriate but also more cost-effective.