Recovery Programs for People With Mental Illness in Taiwan: A Feasibility Study.

IMPORTANCE: Most recovery programs have been developed in Western countries. This study explores the cultural adaptation of a recovery program to a non-Western country. OBJECTIVE: To test the feasibility of a recovery group developed for people with mental illness in Taiwan. DESIGN: Mixed-methods feasibility study. SETTING: Community psychiatric rehabilitation center in southern Taiwan. PARTICIPANTS: Twenty-four people with mental illness living in the community. INTERVENTION: The authors designed a recovery group based on the Pathways to Recovery program and the mental health recovery literature. The curriculum included two phases: recovery profile and recovery plan. The group gathered for a 1-hr session once a week for 18 wk. OUTCOMES AND MEASURES: Outcomes were assessed preintervention, mid-intervention, and postintervention. Data collected included Stages of Recovery Scale (SRS) scores, course assessments, and course discussions. RESULTS: Most participants were satisfied with the recovery program and its implementation. Scores on the Social Functioning/Role Performance subscale of the SRS showed a medium to large effect size (r = .36) for the Recovery Stage 1-3 subsample (n = 16). CONCLUSION AND RELEVANCE: This study affirmed the feasibility of a recovery group for people with mental illness in Taiwan. Prospective randomized controlled trials should be used to verify recovery groups' effectiveness. WHAT THIS ARTICLE ADDS: Recovery programs tailored to people with mental illness in non-Western countries may need more examples and longer sessions to enable participants to fully understand and implement the concepts of recovery.

Peer navigators to promote engagement of homeless African Americans with serious mental illness in primary care.

Homeless African Americans with serious mental illness experience higher rates of morbidity and mortality than adults with severe mental illness alone. Peer navigators, individuals with similar lived experiences, may help these individuals navigate the healthcare system to improve healthcare utilization. This study examined whether the Peer Navigator Program (PNP) improved scheduling and achieving healthcare appointments compared to treatment as usual (TAU) over the course of 12 months, including three periods within that timeframe: engagement (first three months), impact (middle six months), and maintenance (final six months). Results indicated no change during the first three months of the study, a significantly greater improvement in scheduled and achieved appointments for PNP compared to TAU during the middle six months, and maintenance of appointment change improvements over the final three months of the study. This research suggests peer navigators may offer a promising solution to barriers in utilizing the healthcare system for people with severe mental illness, especially those who may be homeless or from minority racial groups.

Using Peer Navigators to Address the Integrated Health Care Needs of Homeless African Americans With Serious Mental Illness.

OBJECTIVE: The study examined the impact of a peer navigator program (PNP) developed by a community-based participatory research team and used with a group of African Americans with serious mental illness who were homeless. METHODS: Sixty-seven research participants were randomly assigned to receive PNP or treatment as usual (control) for one year. Data on general health and mental health, recovery, and quality of life were collected at baseline and at four, eight, and 12 months. RESULTS: Findings from group × trial analyses of variance of omnibus measures of the four constructs showed significant impact over the year for participants in PNP compared with those in the control group, with analyses showing small to moderate effect sizes: general health status (η2=.24), psychological experience of physical health (η2=.42), recovery (η2=.36), and quality of life (η2=.14). These differences emerged even though both groups showed significant reductions in homelessness and increases in insurance coverage. CONCLUSIONS: Implications for improving in-the-field health care for this population are discussed. Whether these results occurred because navigators were peers per se needs to be examined in future research.

Community-based participatory research examining the health care needs of African Americans who are homeless with mental illness.

African Americans with mental illness who are homeless experience significant health risks and illnesses leading to high mortality and morbidity rates. A community-based participatory research (CBPR) team conducted a qualitative study to begin to describe these problems. Results from focus groups and key informant interviews of 42 individuals yielded 98 themes which were sorted into three categories: problems, solutions, and peer navigators. Results included a review of the problems and solutions which the community or people might adopt. An additional goal was to understand and develop impact of peer navigators for addressing health problems in this group. Results yielded a list of values in hiring peer navigators as well as skills and resources they might need to successfully do their job. Findings from the study are currently being used by the CBPR team to develop a peer navigator program for this community.

Peer navigators and integrated care to address ethnic health disparities of people with serious mental illness.

People of color with serious mental illnesses experience high rates of morbidity and mortality. Patient navigators, developed for cancer care, may help this group benefit from integrated care. This review examined patient navigators' key ingredients for cancer care for relevance to patients of color for application of peer services to psychiatric goals. Among cancer patients, navigators lead to greater treatment engagement and improved health outcomes for ethnic minority groups. Research also suggests peers can improve integrated care by providing effective psychiatric services to individuals with mental illness. Ongoing research examines peer navigators' impact on integrated care for patients of color.

Psychiatric symptoms moderate the effects of mental illness self-management in a randomized controlled trial.

Depression has been shown to moderate the effects of physical illness self-management (ISM) programs. We attempted to replicate these findings for a mental ISM intervention. Outpatients with serious mental illness (N = 428) from eight Tennessee communities were randomly assigned to receive a peer-led self-management intervention called Building Recovery of Individual Dreams and Goals Through Education and Support or services as usual. Psychiatric symptoms were assessed with the Brief Symptom Inventory; the outcome of personal empowerment was measured by the Empowerment Scale. Intent-to-treat analysis using mixed-effects random regression found significant interaction effects between study condition and three moderating symptom profiles. Empowerment was greater for the intervention participants with high levels of depressive symptoms, anxiety symptoms, and general symptom distress than for the experimental participants with low symptom levels and the control subjects with high or low levels of symptoms. These results shed light on how mental ISM programs operate and ways these can be improved.

Recovery of people with psychiatric disabilities living in the community and associated factors.

OBJECTIVE: Consumer-oriented recovery has been discussed for more than two decades in the mental health field. Although there some qualitative recovery studies have shown important findings, few quantitative studies of this concept currently exist. This study examined the relationship between recovery and associated social-environmental and individual factors. METHOD: A total of 159 people with psychiatric disabilities receiving services from a large community mental health agency participated in the study. Participants completed a self-report survey that assessed individual recovery status, social support, perceived recovery-oriented service quality, psychiatric symptoms, and demographics. One hundred twenty-four surveys were analyzed. Hierarchical multiple regression analysis was conducted to examine the relationship between recovery and associated factors. RESULTS: Social support and perceived recovery-oriented service quality had significant positive relationships with recovery; psychiatric symptoms had a significant negative relationship with recovery. The final regression model accounted for 58% of the variance in recovery, F(9, 114) = 17.72, p < .001. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Social-environmental factors play an important role in people's recovery, even after taking into account psychiatric symptoms. Namely, people with psychiatric disabilities can pursue recovery with symptoms as long as they receive appropriate support and services. Mental health professionals should provide services adhering to recovery principles in order to help their clients achieve personal recovery.

Consumer empowerment and self-advocacy outcomes in a randomized study of peer-led education.

This study examined the effectiveness of the Building Recovery of Individual Dreams and Goals (BRIDGES) peer-led education intervention in empowering mental health consumers to become better advocates for their own care. A total of 428 adults with mental illness were randomly assigned to BRIDGES (intervention condition) or a services as usual wait list (control condition). Interviews were conducted at enrollment, at the end of the intervention, and 6-months post-intervention. Random regression results indicate that, compared to controls, BRIDGES participants experienced significant increases in overall empowerment, empowerment-self-esteem, and self-advocacy-assertiveness, and maintained these improved outcomes over time. Peer-led education interventions may provide participants with the information, skills and support they need to become more actively involved in the treatment decision-making process.

Early outcomes and lessons learned from a study of the Building Recovery of Individual Dreams and Goals through Education and Support (BRIDGES) program in Tennessee.

OBJECTIVE: Peer-led education interventions have the potential to provide mental health consumers with the knowledge, skills and support they need to live successful and rewarding self-determined lives. However, few studies have explored whether and how these interventions enhance recovery. This study addresses this knowledge gap by examining changes among 160 participants in the Building Recovery of Individual Dreams and Goals (BRIDGES) education program. BRIDGES is a peer-led 8-week course taught by trained instructors who publicly disclose the fact that they are in recovery from mental illness. METHOD: Structured interviews assessing recovery outcomes were conducted with participants in the month prior to their receipt of BRIDGES, and immediately after receipt of the intervention. Paired t-tests were conducted to examine changes in psychiatric symptoms, hopefulness, social support, self-advocacy, empowerment, adaptive coping, and recovery pre-receipt and post-receipt of BRIDGES. RESULTS: Post-receipt of BRIDGES, participants reported significantly fewer psychiatric symptoms, decreased use of maladaptive coping behaviors, and increased feelings of hopefulness, self-advocacy, empowerment, and recovery. CONCLUSIONS: These promising early results from our ongoing study of BRIDGES suggest that peer-led education interventions are a valuable resource. Additional research is needed to better understand the effectiveness of these interventions, including potential long-term post-program participation benefits.