The effectiveness of uloa as a model supporting Tongan people experiencing mental distress.

This article is based on a larger research project, which investigates the effectiveness of a culturally appropriate model, namely uloa, when working with Tongan people. Uloa is a communal method of fishing in Tonga, which includes all members of the community. A previous paper described the three phases of uloa: presenting the concept to health providers and community groups; phase two amended the model based on phase one. This paper reports on phase three and findings related to the increased awareness of uloa model within the mental health services and to raise awareness of how to work with Pacific people and adjust the health service to suit the needs of this population to test its effectiveness. Using reflexive thematic analysis, results highlighted a number of patterns both across the groups, described as napanapangamalie (harmony, balance), ngaue fakataha (working together/oneness), and toutai (fisher). These findings continue to support that the conventional biomedical approach employed in the mental health services overlooks elements of Tongan constructions of mental illness and the intersections between Tongan and biopsychosocial themes. Care that is based only on the 'medicine' rather than bringing the spiritual aspect into care planning (fake leaves) will not serve the needs of the Tongan community.

A Secondary-Primary Mental Health Integrated Care Model for Communities with Diverse Population and Complex Health Needs - a Case Study with Health Care Utilization Evaluation.

Integrated care is expected to improve patient experience, patient outcomes and assist with the increasing demand on health services from those with long term conditions including mental disorder. Few studies have evaluated health care utilization as a consequence of increased integration of mental health care. This study considers the factors known to influence secondary health service utilization and investigated the impact of a locality based mental health integrated model of care (ILoC) providing specialist consultation and liaison advice to primary care, to support early diagnosis and treatment. Using existing hospital databases, the study-cohort was identified (service users supported by ILoC, and then referred within 6 months to specialist mental health services (MHS) care between 2017- 2018) and compared on health services utilization with a matched-cohort (without ILoC support before referral to specialist services). The length-of-care in the non-acute MHS was 71% shorter for the ILoC study-cohort, and differences increased in the subgroup taking antidepressants. The ILoC study-cohort was less likely to be admitted to acute MHS on first referral post ILoC intervention and had a 25% lower relative risk of acute MHS admissions at any time in follow-up. There was no difference in the average MHS inpatient length-of-stay. The risk of general hospital acute inpatient admission was marginally higher in the ILoC study-cohort. Conclusions: ILoC appears to shorten non-acute length-of-specialist-care and reduce acute mental health admission. The study provides a first step in understanding the clinical characteristics and specialist services health-care utilization of patients supported by an integrated mental care approach.

A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders.

Integrated care approaches have been recommended to remove barriers to healthcare and improve the physical health outcomes of people living with serious mental illness (SMI) and/or substance use disorders (SUDs). The aim of this systematic scoping review was to describe empirical investigations of interventions designed to integrate physical, mental, and addiction healthcare for this population. An iterative and systematic search of five electronic databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus) was conducted to identify peer-reviewed articles published between January 2000 and April 2019. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. Data from each included publication were extracted independently by two reviewers using a standardised spreadsheet. A total of 28 eligible publications were identified, representing 25 unique studies. Over half of the included studies investigated the use of case managers to provide self-management skills or to coordinate mental and physical healthcare (n = 14). Other interventions examined the co-location of services (n = 9) and the implementation of screening and referral pathways to specialist treatment (n = 2). Less than half of the included studies described a framework, theory or model that was underpinning the intervention tested. While some aspects of integrated care have been identified and addressed by interventions, other key dimensions have not been considered, such as shared decision-making. Identification of a comprehensive model of integrated care is recommended to inform the development and evaluation of future interventions for people with SMI/SUDs.

'The right thing to do': Fostering social inclusion for mental health service users through acts of citizenship.

The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of mental health workers that promote the social inclusion of people in their care. Acts make a claim for justice when one's rights and responsibilities of citizenship are denied. Semistructured interviews were conducted with 12 participants, seven mental health clinicians and five peer support workers, recruited from a mental health facility in Connecticut, USA. Two themes are presented, breaking the rules and the right thing to do, a rights-based practice that fosters inclusion for service users. Results suggest that staff undertake hidden acts of citizenship to promote inclusion and rights of service users by responsibly subverting the rules and norms of the organization. Changes to organizational practices to make visible such inclusionary acts are required. Implications for practice and considerations of organizational change through the development of a citizenship framework to underpin practice are recommended.

Insiders or outsiders? Mental health service users' journeys towards full citizenship.

The present study explores the journeys towards full citizenship for those using mental health services as they lobbied to be included as full citizens with the same rights and responsibilities as others in society. Qualitative data were collected through semistructured interviews with 17 service users, five government representatives, and seven registered mental health nurses. A conceptual framework of citizenship containing four domains - the extent, content, depth and acts of citizenship - was used to analyse the data. This paper reports the findings from the service users' data in the first domain, the extent of citizenship, defined as the rules and norms of inclusion and exclusion. The degree to which the service user participants were accepted as full citizens with the same civil, political, and social rights as others was contingent on their ability to adopt their society's rules and norms and appear as 'normal' citizens. Participants often experienced being 'othered' and excluded from the many rights and responsibilities of citizenship due to society's perception that service users lack certain attributes of normal, productive citizens. Participants reported that being labelled with a mental illness led to them being marginalized and ostracized, thus placing conditions and barriers on their citizenship status. Findings show that in response to experiencing conditional citizenship, participants shaped their behaviour to assimilate with other citizens. As well, they engaged in practices of inclusion to challenge and broaden the social rules and norms in order to be accepted without disavowing their differences.

Consumer involvement in the tertiary-level education of mental health professionals: a systematic review.

A systematic review of the published work on consumer involvement in the education of health professionals was undertaken using the PRISMA guidelines. Searches of the CINAHL, MEDLINE, and PsychINFO electronic databases returned 487 records, and 20 met the inclusion criteria. Further papers were obtained through scanning the reference lists of those articles included from the initial published work search (n = 9) and contacting researchers in the field (n = 1). Thirty papers (representing 28 studies) were included in this review. Findings from three studies indicate that consumer involvement in the education of mental health professionals is limited and variable across professions. Evaluations of consumer involvement in 16 courses suggest that students gain insight into consumers' perspectives of: (i) what life is like for people with mental illness; (ii) mental illness itself; (iii) the experiences of admission to, and treatment within, mental health services; and (iv) how these services could be improved. Some students and educators, however, raised numerous concerns about consumer involvement in education (e.g. whether consumers were pursuing their own agendas, whether consumers' views were representative). Evaluations of consumer involvement in education are limited in that their main focus is on the perceptions of students. The findings of this review suggest that public policy expectations regarding consumer involvement in mental health services appear to be slowly affecting the education of mental health professionals. Future research needs to focus on determining the effect of consumer involvement in education on the behaviours and attitudes of students in healthcare environments.

Service user involvement in undergraduate mental health nursing in New Zealand.

This paper describes a service user role in the mental health component of an undergraduate nursing programme in New Zealand. The paper provides a background to mental health nursing education in New Zealand and discusses the implications of recent reforms in the mental health sector. The undergraduate nursing programme at the University of Auckland has a strong commitment to service user involvement. The programme aims to educate nurses to be responsive and skillful in meeting the mental health needs of service users in all areas of the health sector and to present mental health nursing as an attractive option for nurses upon graduation. We outline the mental health component of the programme, with an emphasis on the development of the service user role. In the second half of the paper, we present a summary of responses to a student satisfaction questionnaire. The responses indicate that the service user role is an important element of the programme and is well received by a substantial proportion of students. We consider the implications for nursing education and for recruitment into mental health nursing. Finally, we discuss some issues related to service user involvement in the development of new models of mental health service delivery.

Searching for self: the layers and labels of panic disorder: a New Zealand study.

The diagnosis and management of panic symptoms are relatively neglected. If not treated, people can develop a panic disorder, a condition that has an adverse effect on the client's quality of life and psychological well-being. The aim of this New Zealand research is to understand the clients' perspective of panic disorder and how it impacts on their quality of life. Ten participants were interviewed and the data were analyzed using thematic analysis. The research findings indicate that recovery from panic disorder occurs in a process of the search for self that is made up of self-understanding and the reclaiming the self. The findings provide a psychosocial perspective of panic disorder that will assist nurses who work with these clients. Nurses are pivotal in teaching clients about their body's response to stress and health anxiety, the giving of supplementary health information, and timely referral for specialist treatment. The recommendations for nurse specialist input and biopsychosocial assessments are discussed.

Cardiac pain or panic disorder? Managing uncertainty in the emergency department.

Emergency department admissions for chest pain might be related to a psychological problem, such as panic. Panic disorder adversely affects the person's lifestyle, general health, and psychological well-being. Panic disorder is difficult to recognize, so nursing assessment and management of these clients is important. This paper presents research findings from a New Zealand study that explored emergency nurses' differentiation of non-cardiac chest pain from panic disorder and raised significant issues in the nursing assessment and management of such clients. The data were gathered from focus group interviews and were analyzed thematically. Three themes, prioritizing time, managing uncertainty and ambiguity, and the life-threatening lens, were identified. The findings confirm that a panic disorder is not always diagnosed when biomedical assessment is used in isolation from a psychosocial assessment. Emergency nurses are pivotal in reversing the cycle of repeat presenters with non-cardiac chest pain. Recommendations for assessing and managing this complex condition are presented.