Efficacy of dual focus mutual aid for persons with mental illness and substance misuse.

BACKGROUND: Previous studies have indicated that persons with co-occurring mental health and substance use problems can benefit by attending dual-focus mutual aid groups. However, to date, a trial to test the efficacy of these groups has not been published. METHOD: This study randomly assigned 203 substance misusing clients attending a mental health or dual-diagnosis facility to either a dual-focus 12-step group (Double Trouble in Recovery; DTR) or a waiting list control group. Participants were followed for 3-6 months. The primary outcome was substance use (days used in the past 30 with saliva testing to detect under-reporting); secondary outcomes included psychiatric medication adherence, attendance at traditional (single-focus) 12-step meetings (e.g., AA/NA); and improvement in mental health and substance use problems (quality of life). Multilevel model (MLM) regression was used to analyze the nested effect of participants within 8 facilities (7 in New York City and 1 in Michigan). Regression imputation was used to adjust for drug use under-reporting. RESULTS: At follow-up 79% of the subjects were interviewed. In intent to treat analysis, DTR subjects compared with control subjects used alcohol (p=.03) and any substances (p=.02) on fewer days. DTR compared with control subjects were also more likely to rate themselves as experiencing better mental health and fewer substance use problems (p=.001). There were no effects for DTR on drug use only, medication adherence or NA/AA attendance. CONCLUSION: Findings reported in previous studies on the association between exposure to DTR and reductions in substance use were partially supported in this efficacy trial.

Consumers' Experiences in Dual Focus Mutual Aid for Co-occurring Substance Use and Mental Health Disorders.

Mutual aid fellowships have been shown to improve outcomes for those with co-occurring substance use and mental illness disorders. Processes associated with usefulness include helper therapy (the assumption of a helping role to foster commitment) and reciprocal learning (the sharing of problems and solutions among members). The present qualitative investigation used focus groups comprised a subset of participants in Double Trouble in Recovery (DTR), a 12-step mutual aid group for those with co-occurring disorders, to gather their subjective perceptions of the groups. Participants emphasized that in linking them to others with similar problems, the DTR groups played a vital emotional role in their lives and provided a needed venue for information sharing that might have been otherwise unavailable.

Factors associated with mental health clinicians' referrals to 12-Step groups.

As substance use and mental illness services are increasingly integrated, mental health professionals are presented with opportunities to refer greater numbers of dually diagnosed clients to 12-Step groups. This study examined the relationships among clinicians' 12-Step experiences, attitudes, and referral practices in 6 mental health clinics in New York, New York. A path analysis model showed that greater interest in learning about 12-Step groups directly predicted 12-Step referral practices and that 12-Step interest was predicted by clinicians' perception of the helpfulness of 12-Step groups and the severity of their patients' problems with substance abuse. Clinicians' responses to open-ended questions supported this model. Didactic and experiential education for clinicians in substance abuse and mutual aid would likely increase patient referrals to 12-Step groups.

Implementing routine suicide risk screening for psychiatric outpatients with serious mental disorders: I. Qualitative results.

The objective of this study was to acquire process information, clinician and client feedback during implementation of a routine suicide risk screening program for outpatients with serious mental disorders. We studied implementation of a suicide-screening tool in a large public mental health outpatient facility in New York City. Most clinical staff who provided an opinion indicated screening was useful, feasible and helpful; most clients did not mind screening. Facilitators to program implementation included administrative support and ease of use. Barriers included consent, misperceptions, and concerns regarding potential liability. It is feasible to implement a suicide-screening tool in a public outpatient clinic. However, even experienced clinicians harbor unfounded myths. Effective large scale use will require vigorous training and oversight.

Implementing routine suicide risk screening for psychiatric outpatients with serious mental disorders: II. Quantitative results.

To test feasibility of a routine screening tool and to examine factors associated with suicide and suicidal behaviors. Subjects included outpatients with serious mental disorders. One hundred and sixteen clinicians routinely screened randomly selected adult clients for suicide risk during a 6-month period. Forty-three (9%) clients reported thoughts to hurt/kill self (screened positive), which spurred enhanced clinical intervention. There was no increase in frequency of suicide attempts. A history of multiple suicide attempts, recent stressful events, and present hopelessness were associated with a positive risk screen, clinician rating of risk, or altered treatment plan. It is feasible to safely implement a brief routine screening process in psychiatric outpatient settings. Future research is needed to determine overall utility for routine screening.

Reduction of concurrent antipsychotic prescribing practices through the use of PSYCKES.

The New York State Office of Mental Health has implemented the browser based Psychiatric Clinical Knowledge Enhancement System (PSYCKES) medication application throughout its inpatient system of care. PSYCKES provides detailed current medication regimens and histories, as well as medication best practices reports at the patient, psychiatrist, ward, and facility levels. South Beach Psychiatric Center (SBPC) has made specific use of a best practices report which details proportions of caseloads and number of patients on two or more concurrent antipsychotic medications. Psychiatrists received extensive application and desktop support and individual and group training was conducted. PSYCKES current and historical medication regimens were reviewed for individual cases and best practices reports were used in psychiatry supervision from January 2004 to March 2005. SBPC psychiatrists achieved marked reductions in the proportions of their caseloads on two or more concurrent antipsychotics. Although we cannot impute causality from this pre-post implementation design, the results of this evaluation suggest that the use of PSYCKES was effective in reducing such regimens for inpatients.

Male sexual dysfunction and quality of life in schizophrenia.

OBJECTIVE: To describe the prevalence and clinical correlates of sexual dysfunction in a sample of adult male outpatients with schizophrenia treated with olanzapine, risperidone, quetiapine, or haloperidol, focusing on associations between sexual dysfunction and patient-perceived quality of life. METHOD: Sexual dysfunction was assessed in 139 outpatients with DSM-IV schizophrenia who were receiving olanzapine, risperidone, quetiapine, or haloperidol, but no other medications associated with sexual side effects. Structured assessments were made of psychiatric symptoms, quality of life, and relationships. RESULTS: Sexual dysfunction occurred in 45.3% of patients. Patients with and without sexual dysfunction did not significantly differ with respect to severity of psychiatric symptoms. However, as compared with patients without sexual dysfunction, patients with sexual dysfunction reported significantly lower ratings on global quality of life (t = 2.4, df = 136, p = .02) and the level of enjoyment in their life (t = 2.5, df = 136, p = .01). Patients with sexual dysfunction were significantly less likely than those without sexual dysfunction to report having a romantic partner (17.5% vs. 43.4%; chi(2) = 10.7, df = 1, p = .001), though they were not significantly less likely to report difficulty making friends (27.0% vs. 32.9%; chi(2) = 0.57, df = 1, p = .45). Among patients with romantic partners, those with sexual dysfunction reported significantly poorer quality of their relationships (t = 2.3, df = 42, p = .02) and were less likely to talk to their partner about their illness (t = 2.0, df = 42, p = .047). CONCLUSIONS: Sexual dysfunction is common in men with schizophrenia who are treated with olanzapine, risperidone, quetiapine, or haloperidol and is associated with diminished quality of life, decreased occurrence of romantic relationships, and reduced intimacy when relationships are established. High prevalence and substantial interference with quality of life combine to make sexual dysfunction an important area for clinical assessment and appropriate intervention in the community management of schizophrenia.

Effect of type of survey administrator on Consumer Assessment of Care.

This study evaluated the possible effects of peer, unit staff, and quality management staff survey administrators on item means of the inpatient version of the Consumer Assessment of Care, a 14-item mental health service satisfaction survey developed by the New York State Office of Mental Health and administered at South Beach Psychiatric Center. Of 511 inpatients who completed the survey, 215 were administered by unit staff, 156 by consumers, and 140 by quality management staff. Each subgroup used a mixed-mode administration method for consecutive 6-mo. periods. Reliability and factor analysis indicated the survey was psychometrically robust. Item means for the types of administrator were significantly different. Tukey HSD multiple-comparisons indicated that item means were significantly higher for unit staff administrators than peer and quality management staff administrators, which did not differ from each other. Response set, acquiescence, or socially desirable responding may elicit higher item means for unit staff administrators.

The development and administration of the Consumer Assessments of Care by New York State Office of Mental Health downstate facilities.

This article reports on the work of the New York State Office of Mental Health Downstate Alliance, which is comprised of eight psychiatric centers that have formed a consortium to create new initiatives and solve common problems. The first of these initiatives are the inpatient and outpatient versions of the Consumer Assessments of Care, which assess satisfaction with care and quality of life (QOL). Consumers from peer run organizations who administered the survey used a mixed-mode administration method, which leveraged the strengths of the personal interview and anonymous self-report methods. Inpatients reported realistic levels of satisfaction and showed areas for improvement for inpatient units across facilities. Outpatients were considerably more satisfied with care, but ratings were lower on the work and community involvement dimensions of QOL. Factor analyses indicated that a one-factor model, satisfaction with care, fit the data well for the inpatient survey. A two-factor solution, satisfaction with care and QOL, was successfully fit to the outpatient data. Internal consistency reliability levels were excellent for both assessments.

Psychometric properties of the Behavior and Symptom Identification Scale administered in a crisis residential mental health treatment setting.

The psychometric properties of the Behavior and Symptom Identification Scale, administered in a crisis residential mental health treatment setting, were investigated. Analyses indicated that Cronbach alpha reliabilities were very good compared to published research from inpatient and outpatient settings. Univariate and multivariate covariance analyses provided evidence supporting validity in terms of sensitivity to change during treatment and concurrent validity. Evidence supported the contention that women were more honest and realistic in their self-assessments but also that crisis residence treatment was efficacious for both sexes.