Mental health service utilization and help seeking behaviours of adult Cambodians living in Western countries: A systematic scoping review.

BACKGROUND: Health disparity and under-utilization of health services is prevalent among Asian refugees and migrants in Western countries and can profoundly impact health outcomes. Cambodians who survived extreme physical and emotional trauma during the genocides enacted by the Khmer Rouge regime in the 1970's are particularly vulnerable to poor mental health outcomes decades later. Understanding the experiences of help-seeking and service use by displaced Cambodians in Western countries may help to design more effective and culturally safe healthcare services. AIMS: To identify characteristics or factors associated with help seeking behaviours and service utilization of displaced Cambodians with mental health issues living in Western countries. METHODS: This review followed the Arksey & O'Malley methodological framework for scoping reviews. Articles for review were identified through searches of nine electronic databases and manual searches. Relevant articles were selected, and data was extracted and synthesized into key themes. RESULTS: This review included 15 articles. Most of the studies were conducted in the USA (n = 13) with one each conducted in Canada and New Zealand. Seven studies used qualitative interviews, five used a cross-sectional survey approach, two used a mixed-methods approach and one was a narrative review and case series. Key findings highlighted the impact of Cambodian cultural beliefs about mental health (guilt, shame and help-seeking stigma) on service utilization and the disconnect between Western models of service provision and preferred Cambodian ways of receiving support. CONCLUSION: Mental health services in Western countries are likely to be under-utilized by Cambodians due to a mismatch between health beliefs and Western models of care. Further investigation of the association between health beliefs and barriers to service utilization among adult Cambodian refugees is warranted.

Creating "an oasis of hope, inclusion and connection": students and stakeholders' experiences of a pilot Recovery College.

BACKGROUND: Recovery Colleges are an innovative approach to promoting personal recovery for people experiencing mental illness. AIMS: This study was to explore experiences of students, supporters, staff, educators and external stakeholders (i.e. partner organisations) of a pilot Recovery College in the Australian Capital Territory (ACTRC), and the impact of participation in the College for students and supporters. METHODS: ACTRC students, supporters, staff and educators, and external stakeholders were invited to participate in a mixed-method evaluation via an online survey, interviews and/or focus groups. The survey included questions regarding experiences and recovery-orientation of the College environment, and for students and supporters only, satisfaction with the College. Qualitative data from interviews and focus groups was inductively coded, thematically analysed and triangulated with survey responses. RESULTS: The findings suggest that the ACTRC provides a safe space, promotes meaningful connections within and beyond the college, and offers steppingstones supporting recovery and growth. Participants spoke positively about cross institutional partnerships and collaboration with several organisations within the ACT. CONCLUSIONS: This evaluation reiterates the role of Recovery Colleges as an innovative approach to promoting personal recovery for people living with mental illness. Adequate resourcing and collaboration are essential in realising the value of co-production whilst ensuring sustainability.

"Burnout felt inevitable": Experiences of university staff in educating the nursing and allied health workforce during the first COVID-19 waves.

Introduction: Maintaining progress in the face of looming burnout during the first 2 years of the COVID-19 pandemic was crucial for the health workforce, including those educating the next generation of health professionals. The experiences of students and healthcare practitioners have been explored to a greater degree than the experiences of university-based health professional educators. Methods: This qualitative study examined the experiences of nursing and allied health academics at an Australian University during COVID-19 disruptions in 2020 and 2021 and describes the strategies that academics and/or teams implemented to ensure course continuity. Academic staff from nursing, occupational therapy, physiotherapy, and dietetics courses at Swinburne University of Technology, Australia provided narratives regarding the key challenges and opportunities they faced. Results: The narratives highlighted the strategies generated and tested by participants amidst rapidly changing health orders and five common themes were identified: disruption; stress; stepping up, strategy and unexpected positives, lessons, and legacy impacts. Participants noted challenges related to student engagement in online learning and ensuring the acquisition of discipline-specific practical skills during periods of lock-down. Staff across all disciplines reported increased workload associated with converting teaching to on-line delivery, sourcing alternative fieldwork arrangements, and dealing with high levels of student distress. Many reflected on their own expertise in using digital tools in teaching and their beliefs about the effectiveness of distance teaching for health professional training. Ensuring students were able to complete required fieldwork hours was particularly challenging due to constantly changing public health orders and conditions and staffing shortages at health services. This was in addition to illness and isolation requirements further impacting the availability of teaching associates for specialist skills classes. Discussion: Solutions such as remote and blended learning telehealth, and simulated placements were rapidly implemented in some courses especially where fieldwork could not be rescheduled or amended at the health settings. The implications and recommendations for educating and ensuring competence development in the health workforce during times when usual teaching methods are disrupted are discussed.

A journey of living well: a participatory photovoice study exploring recovery and everyday activities with people experiencing mental illness.

BACKGROUND AND AIM: Engagement in everyday activities has been identified as an important element in personal recovery from the experience of mental illness and a key priority for service-users. This study explored the role of everyday activities in recovery. METHOD: This study used a photovoice participatory research. Twenty-one participants experiencing mental illness were recruited from a community-managed mental health service in Melbourne, Australia. Data collection included individual interviews and photovoice courses. The courses included group discussions and required participants to take photographs about their everyday activities that support recovery. A lived experience co-facilitator contributed to development and delivery of the course. The interviews and group discussions were transcribed verbatim and analysed using constant comparative methods. RESULTS: Recovery as a "journey of living well" was identified as the central theme that encompasses three interlinked categories: (1) living a life on hold; (2) choosing to recover; and (3) learning and navigating strategies. CONCLUSIONS: The findings suggest that recovery involves a range of experiences embedded in people's everyday lives. Recovery-oriented practice should provide opportunities for engagement in meaningful activities, to help consumers identify their potential and strategies to live well, and to adopt co-production at all levels.

Oral health interventions for people living with mental disorders: protocol for a realist systematic review.

BACKGROUND: The increasing number of people who experience mental disorders is a global problem. People with mental disorders have high rates of co-morbidity and significantly poorer oral health outcomes than the general public. However, their oral health remains largely a hidden and neglected issue. A complex range of factors impact the oral health of this group. These include anxiety and dental phobia, dietary habits, including the heavy consumption of sugary drinks, substance misuse of tobacco, alcohol, and/or psychostimulants, the adverse orofacial side effects of anti-psychotic and anti-depression medications, and financial, geographic, and social barriers to accessing oral health care. METHODS: The aim of this realist systematic review is to (a) identify and synthesise evidence that explores oral health interventions for people living with mental disorders; (b) explore the context and mechanisms that have contributed to the success of interventions or the barriers and challenges; (c) produce program theories on causal, contextual and mechanistic factors to facilitate outcomes and (d) produce recommendations and guidelines to guide future oral health interventions for people with mental disorders at both the policy and practice level. Using a five-step process, that incorporates primary data collection from key stakeholders, a beginning theoretical framework will be developed to describe contextual and mechanistic factors and how they might impact on the success or failure of oral health interventions for people with mental disorders. Key database searches will be conducted, with data extraction focused on the factors that might have impacted on intervention implementation and outcomes. Quality appraisal of studies will occur, and the theoretical framework will be populated with extracted data. Stakeholder input will support the development and refinement of a theory on oral health interventions for people with mental disorders. DISCUSSION: This will be the first review to take a realist approach to explore the broad scope of causal factors that impact on the success or failure of oral health interventions for people with mental disorders. The approach includes extensive stakeholder engagement and will advance realist systematic review methodology. Review outcomes will be important in guiding policy and practice to ensure oral health interventions better meet the needs of people with mental disorders.Systematic review registration This review protocol is registered with PROSPERO (Number) 155969.

Place for being, doing, becoming and belonging: A meta-synthesis exploring the role of place in mental health recovery.

BACKGROUND AND AIM: The role of place in mental health recovery was investigated by synthesizing qualitative research on this topic. METHODS: Using a meta-ethnographic approach, twelve research papers were selected, their data extracted, coded and synthesized. FINDINGS: Place for doing, being, becoming and belonging emerged as central mechanisms through which place impacts recovery. Several material, social, natural and temporal characteristics appear to enable or constrain the potential of places to support recovery. CONCLUSIONS: The impact of place on recovery is multi-faceted. The multidimensional interactions between people, place and recovery can inform recovery-oriented practice. Further research is required to uncover the role of place in offering opportunities for active engagement, social connection and community participation.

Recovery as an occupational journey: A scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues.

BACKGROUND/AIM: Mental health recovery can be defined in variety of different ways. First person accounts of people experiencing mental health issues and qualitative studies of recovery suggest engaging in personally meaningful and socially valued occupations is important during the process of recovering. This scoping review sought to explore how occupational engagement and recovery are interrelated. METHODS: Using Arksey and O'Malley's (2005) framework to guide the scoping review, searches of four electronic databases, manual citation tracking, and key authors' publications were conducted. Seventeen studies, published in the last 30 years, relevant to the topic were identified. Each was reviewed and data extracted to categorise the similarities and differences into themes. RESULTS: Most studies used qualitative, phenomenological and narrative research approaches. Findings across the studies indicate recovery is an ongoing occupational process that seems to involve experiences of gradual re-engagement, engaging within the stream of everyday occupational life, and full community participation. Engaging in meaningful and valued occupations appears to support recovering through fostering connectedness, hope, identity, meaning, and empowerment; establishing structured routines and assisting people in managing illness. CONCLUSION: This scoping review indicates occupational engagement is an important dimension of the recovery process: recovering is experienced through engaging in occupations, which, in turn, fosters personal recovery. Employment and volunteering have received most attention in studies of occupation and recovery. A broader view of the experiences and factors involved in the processes of 'occupational recovery' warrants further exploration to advance theory and inform recovery-oriented occupational therapy practice.