Dismantling Structural Stigma Related to Mental Health and Substance Use: An Educational Framework.

Stigma related to mental health and substance use (MHSU) is a well-established construct that describes how inequitable health outcomes can result from prejudice, discrimination, and marginalization. Although there is a body of literature on educational approaches to reduce stigma, antistigma education for MHSU has primarily focused on stigma at the social, interpersonal/public, and personal (self-stigma) levels, with little attention to the problem of structural stigma. Structural stigma refers to how inequity is manifested through rules, policies, and procedures embedded within organizations and society at large. Structural stigma is also prominent within clinical learning environments and can be transmitted through role modeling, resulting in inequitable treatment of vulnerable patient populations. Addressing structural stigma through education, therefore, has the potential to improve equity and enhance care. A promising educational approach for addressing structural stigma is structural competency, which aims to enhance health professionals' ability to recognize and respond to social and structural determinants that produce or maintain health disparities. In this article, the authors propose a framework for addressing structural MHSU stigma in health professions education that has 4 key components and is rooted in structural humility: recognizing structural forms of stigma; reflecting critically on one's own assumptions, values, and biases; reframing language away from stereotyping toward empathic terms; and responding with actions that actively dismantle structural MHSU stigma. The authors propose evidence-informed and practical suggestions on how structural competency may be applied within clinical learning environments to dismantle structural MHSU stigma in organizations and society at large.

Making the implicit explicit: A visual model for lowering the risk of implicit bias of mental/behavioural disorders on safety and quality of care.

Persons with mental illness and/or addictions have poorer health outcomes than the general population. Lower quality of healthcare has been identified as an important factor. A main contributor to lower quality of care for people with mental illnesses and/or addictions may be the cognitive implicit bias of mental versus physical care when assessing and categorizing a patient's clinical presentation. The objective of this article is to highlight how this implicit cognitive bias of mental versus physical care can result in human factor risks to quality of care. We provide three specific case examples of where these quality concerns arise. We also propose the use of a new visual tool to help educate and create awareness of this implicit-bias-based risk and quality care problem.

Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

Treatment Within an Adult Mental Health Day Program: Examining Psychosocial Outcomes.

Day hospital programs provide stabilization, medication optimization, and therapeutic intervention for individuals experiencing acute psychiatric illnesses. The current study investigated treatment impact within an adult day hospital setting in a large Canadian general acute care hospital. A total of 196 patients were sampled in a naturalistic design. Participants filled out measures at admission and discharge, including the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the World Health Organization Disability Assessment Schedule 2.0, the Behavior and Symptom Identification Scale-24, the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, and the Emotion Regulation Questionnaire (ERQ). Paired sample t-tests revealed significant improvements from admission to discharge on all but one measure, the ERQ Suppression scale. Overall, patients improved during treatment in terms of psychopathology and disability, and perceived quality of life. When the emotion regulation strategy of reappraisal was increasingly used over the duration of the treatment, improvements were observed in symptomatology, quality of life, and enhanced functionality. This article highlights the impact of therapeutic interventions received within a Canadian day hospital program.

Interaction between Psychotropic Medications and Alcohol: Perceptions among Patients Attending an Adult Mental Health Day Hospital Program.

BACKGROUND: Interaction between alcohol and certain medications can lead to adverse consequences. Individuals with mental health disorders are particularly vulnerable because of their psychotropic medications, which are typically taken over extended periods and which are known to have pharmacokinetic and pharmacodynamic interactions with alcohol. It is unknown what education these patients receive from their health care providers and how such interactions are managed. OBJECTIVES: To determine whether individuals with mental health disorders are aware of alcohol-drug interactions and if so, how they use such information. METHODS: A questionnaire was developed to explore the perceptions of mental health patients concerning alcohol-drug interactions. The questionnaire included questions in 3 domains: knowledge of potential alcohol-drug interactions, consumption of alcohol while taking psychotropic medications, and source of advice regarding the interactions. Attendees of an adult mental health day hospital program were invited to participate. RESULTS: A total of 131 participants answered the questionnaire between July 2014 and February 2015; 31 of the questionnaires were incomplete and were excluded from analysis. Of the 100 participants included in the analyses, 75 reported having received counselling from a health care provider about alcohol-drug interactions, and 49 of these reported following the advice provided. The most common advice reported by participants was to avoid alcohol consumption while taking medications. Serious adverse effects, such as worsening of a psychiatric condition, admission to hospital, and increased drowsiness, were reported by 23 participants. Sixty-nine participants considered physicians to be the best source of information about these interactions. CONCLUSIONS: Most participants reported that they had received information about strategies to avoid negative consequences from alcohol-drug interactions. Nevertheless, consumption of alcohol occurred, and almost one-quarter of participants reported a serious adverse effect related to consuming alcohol. These self-reported data indicate that patients do not necessarily follow the advice of their health care providers. Future studies should explore reasons for the gap between advice and action and how to minimize it.

CONTEXTE: L'interaction entre l'alcool et certains médicaments peut mener à des conséquences cliniques. Les personnes atteintes de troubles mentaux y sont particulièrement vulnérables à cause des médicaments psychotropes qu'ils prennent d'habitude sur une période prolongée et pour lesquels les interactions pharmacocinétiques et pharmacodynamiques avec l'alcool sont notoires. On ne sait pas quels conseils ces patients reçoivent de leurs fournisseurs de soins de santé et comment de telles interactions sont gérées. OBJECTIFS: Déterminer si les personnes atteintes de troubles mentaux sont conscientes des interactions entre l'alcool et les médicaments et, si oui, dévoiler comment elles agissent à la lumière de cette information. MÉTHODES: On a mis au point un questionnaire pour enquêter sur les perceptions qu'ont les patients atteints de troubles mentaux des interactions alcool-médicaments. Les questions y étaient regroupées en trois catégories : conscience des interactions potentielles alcool-médicaments, consommation d'alcool en prenant des psychotropes et source des conseils sur les interactions. Les participants à un programme hospitalier de jour pour adultes atteints de troubles mentaux ont été invités à participer à l'étude. RÉSULTATS: Au total, 131 participants ont rempli le questionnaire entre juillet 2014 et février 2015; 31 des questionnaires étaient incomplets et ont été exclus de l'analyse. Parmi les 100 participants inclus dans les analyses, 75 ont indiqué avoir reçu des conseils d'un fournisseur de soins de santé sur les interactions alcool-médicaments et 49 d'entre eux ont affirmé avoir suivi les conseils offerts. Le conseil le plus fréquent selon les répondants était d'éviter la consommation d'alcool lorsqu'on prend des médicaments. De graves réactions indésirables, telles que la détérioration d'un trouble psychiatrique, l'admission à l'hôpital et une somnolence accrue, ont été soulignées par 23 participants. Soixante-neuf participants considéraient les médecins comme les meilleures sources d'information à propos de ces interactions. CONCLUSIONS: La plupart des participants ont indiqué avoir reçu de l'information sur les stratégies permettant d'éviter les conséquences des interactions alcool-médicaments. Certains ont tout de même consommé de l'alcool et près du quart des participants ont signalé une réaction indésirable grave liée à la consommation d'alcool. Ces données autodéclarées révèlent que les patients ne suivent pas nécessairement les conseils de leurs fournisseurs de soins de santé. Des études ultérieures devraient se pencher sur les raisons expliquant l'écart entre les conseils et les actions et sur les solutions pour réduire cet écart.

Think You Can Shrink? A Proof-of-Concept Study for Men's Health Education Through Edutainment.

Connecting people to useful, actionable health resources is a substantive challenge that sits at the heart of health communication. Digital media provides means of producing, distributing and revising content and creates possibilities for new and multiple channels for reaching and engaging audiences, particularly when combined with social media. While there is much promise of digital media forms to deliver audiences and promote engagement, the health communication landscape is still largely hit-and-miss with few 'best practice' examples to follow. Proof-of-concept studies allow for a structured, focused exploration of ways to leverage the potential of digital media and learn what approaches have the promise to invest resources in amid a sea of possible options. Think You Can Shrink? (TYCS) is a multi-episode web series modelled on a reality TV show format. The show's key objective is to educate men and demonstrate, through modelling, ways men can support other men to encourage help-seeking behaviours and greater health communication, which in turn, may also lead to better health outcomes. Given the newness of the approach, the project was launched as a proof-of-concept study to explore: (a) whether this approach could engage the interest of men, (b) what initial impact this approach might induce and

Staff perspectives: What is the function of adult mental health day hospital programs?

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care. No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as "bridge" between these intensive services and purely outpatient treatment. Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings. In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings. ABSTRACT: Introduction Despite the benefits of psychiatric day hospitals (DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care. Method Twenty-five DH staff members completed semi-structured qualitative interviews. Two independent coders applied content analysis to achieve data saturation. Results Four major themes emerged: (1) program purpose and function, (2) what is in a name, (3) perceived patient motivation, and (4) room for improvement. Discussion Findings highlighted the importance of a multidisciplinary team delivering education and skill-focused interventions. Services were cited as "bridging" different mental health settings. Challenges included barriers to treatment access and inadequate length of treatment. Implications for Practice Understanding the function and purpose of this treatment service may enhance service delivery by enabling programs to integrate identified key ingredients. Providers can also note treatment duration and consider how to best use that time. Finally, language used within a DH setting appears to impact staff delivering services, and may also alter patients' understanding of the services they will receive and purpose of the program.

Theoretical and Practical Considerations for Combating Mental Illness Stigma in Health Care.

Reducing the stigma and discrimination associated with mental illness is becoming an increasingly important focus for research, policy, programming and intervention work. While it has been well established that the healthcare system is one of the key environments in which persons with mental illnesses experience stigma and discrimination there is little published literature on how to build and deliver successful anti-stigma programs in healthcare settings, towards healthcare providers in general, or towards specific types of practitioners. Our paper intends to address this gap by providing a set of theoretical considerations for guiding the design and implementation of anti-stigma interventions in healthcare.