Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa.

BACKGROUND: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. METHODS: We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. RESULTS: The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). CONCLUSIONS: Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

Prevalence and Predictors of Mental Health Programming Among U.S. Religious Congregations.

OBJECTIVE: This study assessed the prevalence of and factors associated with congregation-based programming in support of people with mental illness. METHODS: To estimate the proportion of congregations that provide mental health programming, this study reports analyses of survey responses from the 2012 National Congregations Study, a nationally representative survey of religious congregations in the United States (N=1,327). The analysis used multivariate logistic regression to identify congregational characteristics associated with the provision of mental health programming. RESULTS: Nearly one in four U.S. congregations (23%) provided some type of programming to support people with mental illness. Approximately 31% of all attendees belonged to a congregation that provided mental health programming. Congregational characteristics associated with providing mental health programming included having more members and having members with higher incomes, employing staff for social service programs, and providing health-focused programs. Other significant predictors included engaging with the surrounding community (that is, conducting community needs assessments and hosting speakers from social service organizations) and being located in a predominantly African-American community. CONCLUSIONS: Greater coordination between mental health providers and congregations with programs that support people with mental illness could foster more integrated and holistic care, which in turn may lead to improved recovery outcomes.

A holistic view in psychiatric rehabilitation: the effects of structure in psychiatric institutions.

Achieving independence in society following hospitalization is difficult for people with mental illness. Using quantitative and qualitative research methods, this study examines rehabilitation procedures and identifies possible deficiencies. Patients (n = 150) and employees (n = 50) were invited to participate. The results show little coordination among professionals, patients, and programs. Employees generally believe rehabilitation is more beneficial than do users. Better results could possibly be achieved if the interactional model was used along with the medical model. The findings emphasize the validity of giving patients voices that can lead to better rehabilitation and quality of life.

Developing a trauma-informed, emergency department-based intervention for victims of urban violence.

The Surgeon General's report on youth violence, the Centers for Disease Control and Prevention, and other national organizations are calling for public health approaches to the issue of youth violence. Hospital-based violence intervention programs have shown promise in reducing recurrent violence and decreasing future involvement in the criminal justice system. These programs seldom address trauma-related symptoms. We describe a conceptual framework for emergency department-based and hospital-based violence intervention programs that intentionally addresses trauma. The intervention described--Healing Hurt People--is a trauma-informed program designed to intervene in the lives of injured patients at the life-changing moment of violent injury. This community-focused program seeks to reduce recurrent violence among 8- to 30-year-olds through opportunities for healing and connection. Healing Hurt People considers the adversity that patients have experienced during their lives and seeks to break the cycle of violence by addressing this trauma.

A discourse analysis on how service providers in non-medical primary health and social care services understand their roles in mental health care.

Enhancing collaboration between specialist mental health services, primary health care and social care services has been a key priority in mental health policy reform in many countries for about 20 years and remains so. Yet progress in terms of widespread implementation of demonstrably effective models of collaborative care has been slow. The views that different providers hold regarding the parameters of their roles, and the values that guide their approach to service delivery, are likely to exert profound effects on engagement with collaborative initiatives. Little research has explored these issues. In this study, discourse analysis from a structurational perspective was used to explore the views of providers in a diverse purposive sample of non-medical primary health and social care services in the state of Victoria, Australia regarding their mental health care roles. Four interconnected discourses were revealed as supporting role positions constructed in opposition to the putative role positions of specialist mental health services: an informal as opposed to a formal approach; a normalising as opposed to a pathologising approach; holistic social and emotional health and wellbeing, and an individualised or client-focused model of care as opposed to an illness-focused model. These oppositional role constructions may contribute to reluctance among providers in these sectors to engage with some agendas being promoted by specialist mental health services, through either reduced self-efficacy or active resistance to innovations that conflict with strongly held values. Greater awareness of, and critical reflection upon, contrasting role constructions, and the implications of these for practice may facilitate the design of more appropriate collaborative models and stronger commitment to their implementation.

Mental health care roles of non-medical primary health and social care services.

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Integrating health and social care in community mental health teams in the UK: a study of assessments and eligibility criteria in England.

The purpose of this cross-sectional survey was to examine the relationship between assessments and eligibility decisions made by health and social care staff in multidisciplinary community teams in England. The data were collected between December 2004 and August 2005. The study was a replication of a study that took place in the same eight locations in England before the modernization of health and social care by the present government. Four hundred and thirteen care coordinators responded from 71 teams to produce a total of 1481 clients. Sixty per cent (n = 884) of the sample of clients were categorised as having a psychotic illness compared to 63% in 1997 to 1998. Fair Access to Care Services (FACS) criteria determine access to social care services, and the Care Programme Approach (CPA) determines the level of mental health services provided. There was a close but an incomplete association between FACS and CPA judgements (kappa = 0.37; 95% confidence interval 0.31-0.43). Compared to the standardised Matching Resources to Care version 2 indication of complex needs, social workers' judgements were the most closely aligned to FACS judgements (F = 5.80; d.f. = 2 and 1203; P < 0.01). This raises the question of the need for training for health professionals in order to make decisions about social assessment and eligibility determination.

Opportunity seized or missed? A case study of leadership and organizational change in the creation of a Care Trust.

This paper describes an action research study which focused on an exploration of the aspirations for and initial achievements of Stratham Mental Health NHS and Social Care Trust. Local leaders perceived that Stratham had a good history of health and social care partnership working and as such, adopted an integrationist view of culture to help shape the context of the new structural form. In doing so, consistency remained a key message to staff throughout this organizational transition and the change did not appear to cause the distraction to core business which the literature suggests it would do so. However, this continuity may have come at a cost, at least initially. In the process of formalizing the previous partnership into a Care Trust, Stratham may not have produced all the beneficial effects of synergy which are usually (albeit eventually) associated with mergers in the private sector. Certainly, local actors could see opportunities that had been missed. By focusing on the structural manifestation of the relationship, the opportunities to broaden informal horizontal linkages may have been underexploited. The study of Stratham serves to confirm that the integrationist conception of culture is limited and that the differentiation of professional groupings and the ambiguity of individual experience will always make contested the meanings that are attributed to organizational change.

[The psychiatric department of the general hospital in community mental health care]. / Die Rolle der psychiatrischen Fachabteilung am Allgemeinkrankenhaus in der gemeindepsychiatrischen Versorgung.

Decentralizing mental health care and integrating psychiatry in general hospitals requires new strategies for mental health work. The Austrian Structural Plan for Health 2006 identifies psychiatric departments in general hospitals as pacemakers in creating a needs-based service organization on a regional level. We describe psychiatric departments in general hospitals, how they specialize in responding to the needs of a particular region, and how they relate to community mental health services and general health care.

African-Americans in public housing: a traditional social work approach to substance abuse treatment.

In recent years, an increased and special emphasis on family issues of public housing residents emerged among social service professionals in northeast Georgia. This emphasis was launched because of the disparity between the number of substance-dependent African-Americans and those who sought and remained in substance abuse treatment programs. The relationship between these factors prompted an examination of preferences for substance abuse treatment among African-Americans in three northeast Georgia public housing complexes. This paper describes the implementation and evaluation of a traditional social work practice approach involving the identification of families where substance abuse was present, the examination of their preferences for substance abuse treatment, and the efficacy of home-based, family-centered practice. The evaluation results support the claim that elements of traditional social work practice, such as community or home-based, family-centered treatment, can be effective in addressing substance abuse issues of African-Americans residing in public housing complexes. In addition, this form of treatment supports the notion that African-American families residing in public housing can be assisted in the resolution of substance abuse issues.

Mental health recovery paradigm: implications for social work.

Social workers have long been involved in developing, administering, and providing services for people with psychiatric disabilities. Critics of the system, including social workers and mental health consumer-survivor practitioners, have noted that the medical model has been a driving force in policy and services provision. This model is detrimental to consumers' self-efficacy and sense of hope and conflicts with a number of central social work values. The article argues that the values and beliefs of the consumer-survivor recovery movement are closely aligned with those of the profession, and that the movement offers social workers a more promising perspective from which to practice. The primary concepts and values of the evolving recovery paradigm are delineated, and implications for direct practice, administration, policy making, education, and research are discussed.

Clinical social work and family medicine: a partnership in community service.

Traditionally, family physicians have been called on to handle the emotional problems of their patients. Their ability to address these concerns has been inconsistent. In hospital settings, where interdisciplinary teams are common, nonmedical professionals have been able to provide counseling services to patients. But this is a problem in private medical practices. This article presents a model for collaboration between family medical and clinical social work practice and describes a holistic approach for primary care practice.

Radicalizing recovery: addiction, spirituality, and politics.

Treatment centers and self-help recovery programs promote individual solutions to substance abuse through changing dysfunctional behavior and relying on spiritual beliefs and practices. The root problems are understood to be diseases within the person. However, the social conditions implicated in causing the addiction remain unaddressed. Although class, race, and gender do not predict substance abuse, many people entering clinics are from disempowered groups. Can social workers bring recovery and social justice methods together? What can radical social workers in the addiction-recovery industry do?