Risks for re-hospitalization of persons with severe mental illness living in rehabilitation care settings.

BACKGROUND: The high rates of psychiatric re-hospitalizations (also termed "revolving door") presents a "wicked problem" which requires a systematic and holistic approach to its resolution. Israel's mental-health rehabilitation law provides a comprehensive set of services intended to support the ability of persons with severe mental illness to rely on community rather than in-patient facilities for their ongoing care needs. Guided by the Health Behavior Model, we examined the relationship between psychiatric re-hospitalizations and the three Health Behavior Model factors (predisposing factor: socio-demographic characteristics and health beliefs; enabling factor: personal and social/vocational relationships facilitated by rehabilitation interventions and services; and need factor: outcomes including symptoms, and mental health and functional status) among persons with severe mental illness receiving rehabilitation services. METHODS: Logistic regression models were used to measure the association between re-hospitalization within a year and variables comprising the three Health Behavior Model factors on the sample of consumers utilizing psychiatric services (n = 7,165). The area under the curve for the model was calculated for each factor separately and for all three factors combined. RESULTS: A total of 846 (11.8%) consumers were hospitalized within a year after the study began. Although multivariable analyses showed significant associations between re-hospitalization and all three Health Behavior Model factors, the magnitude of the model's area under the curve differed: 0.61 (CI = 0.59-0.64), 0.56 (CI = 0.54-0.58), 0.78 (CI = 0.77-0.80) and 0.78 (CI = 0.76-0.80) for predisposing, enabling, need and the full three-factor Health Behavior Model, respectively. CONCLUSION: Findings revealed that among the three Health Behavior Model factors, the need factor best predicted re-hospitalization. The enabling factor, comprised of personal relationships and social/vocational activities facilitated by interventions and services representing many of psychiatric rehabilitation's key goals, had the weakest association with reduced rates of re-hospitalization. Possible explanations may be inaccurate assessments of consumers' personal relationships and social/vocational activities by the mental healthcare professionals, problematic provider-consumer communication on the consumers' involvement in social/vocational activities, or ineffective methods of facilitating consumer participation in these activities. Clearly to reduce the wicked "revolving-door" phenomenon, there is a need for targeted interventions and a review of current psychiatric rehabilitation policies to promote the comprehensive integration of community rehabilitation services by decreasing the fragmentation of care, facilitating continuity of care with other healthcare services, and utilizing effective personal reported outcomes and experiences of consumers with severe mental illness.

Promoting Positive Self-Identity of Youths With Mental Disorders: Collaboration Between Academia and a Ministry of Education.

Inclusive schools reflect the dominant approach to education, yet many youths with mental disorders still attend special education schools. Although special education schools address educational, social, and developmental needs, they may increase students' self-stigma and hinder positive identity formation. Israel's Ministry of Education and an academic community mental health department partnered to address this challenge by developing a manual-based intervention for special education school settings. About 180 teachers were trained, and approximately 400 students participated in the self-management and positive identity group intervention. This partnership demonstrates the importance and potential of collaborations to address challenges that arise in real-world settings.

Blended care in psychosis - A systematic review.

Blended-care, a psychosocial intervention combining traditional, face-to-face therapy with digital mental health tools, has shown potential for improving therapeutic processes, fostering patient engagement, and augmenting clinical outcomes. This systematic review aimed to evaluate the development and effectiveness of blended-care interventions tailored for adults diagnosed with schizophrenia-spectrum disorders or other conditions with psychotic features. Our search strategy spanned three electronic databases (PsycINFO, Web of Science, and PubMed) in accordance with the reporting guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We identified 11 papers, each examining the use of one of eight distinct blended-care interventions. Significantly, the majority of these papers (10/11, 91 %) examined these interventions exclusively within controlled research environments, demonstrating both acceptability and favourable impacts on symptomatology and recovery (e.g., 0.22 ≤ Cohen's ds ≤ 1.00). Only one intervention was examined in research settings and real-world conditions, and the shift resulted in low real-world uptake (e.g., only 50 % of practitioners were able to engage at least one of their clients with the intervention) and an inability to reproduce positive changes in clinical outcomes. Additional research is needed to determine the viability of successfully developing and implementing blended-care interventions for psychosis in real-world conditions. An exploration of the developmental processes that could facilitate the transition from research settings to routine clinical practice is vital.

Promoting Reflection on the Process of Recovery: Unique Contributions from Literature and the Humanities for Practitioner.

Recovery from serious mental illness requires persons to make their own meaning and deal with evolving challenges and possibilities. Psychiatric rehabilitation thus must offer more than manualized curricula that address symptoms and skills. We suggest that exposure to the humanities and in particular literature may offer practitioners unique avenues for developing interventions that are sensitive to the processes that enable meaning to be made. We suggest that through what the poet Keats called negative capability, reading novels may enhance practitioners? abilities to see and accept uncertainty, tolerate ambiguity without need for complete resolution, and accept the complex and ambiguous nature of persons. As an illustration we described how reading two novels, The Trial and Slaughterhouse-Five enhanced the process of meaning making while supporting the recovery of one prototypical person with serious mental illness during his efforts to make sense of his experience of returning to work.

Unique contributions from the arts on the process and practice of psychiatric rehabilitation.

This article presents an introduction to the special issue of Psychiatric Rehabilitation Journal. This special issue explores what exposure to various forms of art can add to the understanding of human nature, including mental health, and in particular, efforts and ways to advance psychiatric rehabilitation and recovery. While psychiatric rehabilitation is increasingly positioned as a scientific enterprise, we ask whether this field can benefit from lessons learned from the arts. More specifically, the authors explore how the arts can enhance the field of psychiatric rehabilitation by helping those in this field to understand, through new perspectives, the experiences of people with mental health issues. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Facilitators and barriers in the implementation of a culturally adapted Arabic version of Illness Management and Recovery (IMR) among Palestinian Arabs in Israel.

The Illness Management and Recovery (IMR) program has been implemented in several countries including Israel. This study examines, from the perspective of Arab practitioners, facilitators and barriers in the implementation of a culturally-adapted version of the IMR intervention among Arabs with serious mental illness in Israel. Fourteen Arab practitioners who had delivered the culturally adapted IMR were interviewed. The analysis of the interviews identified facilitators and barriers, divided into universal factors found when implementing the intervention elsewhere in the world, and culture-specific ones. Facilitators included the manual on which the intervention was based, bypassing verbal communication, ongoing supervision during implementation, the group process, co-facilitation and the cultural adaptations. The barriers included three universal ones: Meeting needs beyond IMR due to service shortage, Reputation is everything: Self- and social stigma and Pulling the others back: Difficulties in reading and writing-and one that was culture-specific: family over-involvement. Identifying facilitators and barriers in the implementation of the adapted IMR can contribute to the implementation of evidence-based practices (EBPs) in the mental health area. Notably, multiple culture-specific facilitators have been identified, as opposed to only one culture-specific barrier, suggesting that cultural differences may be overcome in implementing EBPs developed in the West.

Attitudes toward and patterns of medication use among people with serious mental illness: There's more than meets the eye.

Background and aim: There are growing concerns about the long-term effects of psychiatric medication after a major psychiatric crisis. Recent evidence shows a diverse impact of long-term use on various outcome domains, which may help explain why non-adherence is so common. In the current study we explored the subjective perceptions of factors that impact both attitudes toward and patterns of use of medication among individuals with serious mental illness (SMI). Method: Sixteen individuals with an SMI and a recognized psychiatric disability who had used psychiatric medication for at least 1 year were recruited for the study via mental health clinics and social media. Participants were interviewed using a semi-structured interview based on the narrative approach, focusing on attitudes toward and patterns of use of psychiatric medication. All interviews were transcribed and analyzed using thematic analysis. Results: Three discrete sequential phases emerged, each characterized by different themes referring to attitudes toward medication and patterns of use: (1) "loss of self" and a high level of medication use; (2) accumulating experiences of using/reducing/stopping medication; and (3) forming more stable attitudes toward medication and developing one's own pattern of use. The transition between phases was dynamic in nature and represents a non-linear process. Complex interactions were generated at different phases between the related themes, which shaped attitudes toward medication and patterns of use. Conclusions and implications: The current study reveals the complex ongoing process of forming attitudes toward medication and patterns of use. Recognizing and identifying them via a joint reflective dialog with mental health professionals can enhance alliance, shared decision-making, and person-centered recovery-oriented care.

Meaning, recovery, and psychotherapy in light of the art of jazz.

OBJECTIVE: Psychotherapy as a practice in the field of psychiatric rehabilitation is increasingly seen as a means to promote recovery from serious mental illness (SMI). While mostly informed by mental health theory and research, art might offer profound and enduring insights to inform psychotherapy with people with SMI. In this article, we argue that jazz, a form of art which entails both structure and improvising, may enrich and broaden clinicians' abilities to facilitate meaning-making with clients to promote recovery. METHOD: Through the literature review and theoretical synthesis, we explore how jazz may be a space where specific processes can be observed and accordingly guide psychotherapy focused on subjective forms of recovery. RESULTS: We argue that jazz offers a space to see how timing, risk-taking, the ability to be simultaneously inside and outside an activity, and support for the process of tension and release can inform and inspire the process of improvisation within psychotherapy. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Jazz offers a creative framework which can help clinicians observe and facilitate recovery processes in psychotherapy. The perspective of jazz in the therapeutic arena of psychiatric rehabilitation emphasizes the potential of the arts and humanities to continue to enrich our understanding and guide our teaching and training. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Do symptoms moderate the association between participation and executive functions outcomes among people with schizophrenia?

BACKGROUND: Literature explains participation limitations among people with schizophrenia through the context of metacognitive limitations, specifically in symptoms and in executive functions (EF). Research has shown mixed results regarding associations between symptoms and participation, reporting association with negative symptoms, positive symptoms, or only metacognitive limitations. The aim of this study was to deepen understanding of the symptoms' impact on the association between participation and executive function among people with schizophrenia. METHODS: Forty-three participants with schizophrenia received 8 group sessions of focused metacognitive intervention (MCG) aimed at promoting participation by focusing on EF components (e.g., analyzing individual cognitive strategy use). Three measures were administered: the Positive and Negative Syndrome Scale (PANSS) to evaluate symptoms, the Weekly Calendar Planning Assessment (WCPA) to assess EF, and the Activity Card Sort (ACS) to measure participation at the baseline and 12 weeks following completion of the intervention. Scores were compared to a matched control group of 41 people with schizophrenia who instead received treatment as usual. The role of PANSS as moderator was examined using multiple hierarchical regressions, entering interactions between the PANSS scores and WCPA change scores in the final regression step. RESULTS: Relationships were not significant for participants with high PANSS scores. A positive relationship existed between change in WCPA and change in ACS for participants with low PANSS scores. CONCLUSIONS: These results demonstrate that low PANSS scores moderate the association between EF and participation and highlight the importance of symptoms as a predictor of participation following the MCG intervention. TRIAL REGISTRATION: The trial was retrospectively registered at clinical. TRIAL: gov. CLINICALTRIALS: gov Identifier: NCT05556941. Clinicaltrial.gov registration date: 27/09/2022.

Mental Health Public Stigma in US Jewish Communities.

ABSTRACT: Stigma is a multifaceted barrier for individuals living with mental illness, contributing to negative stereotypes, prejudice, and discrimination, and is underinvestigated in minority ethnic groups. This study examines the stigma within the US Jewish communities, specifically the following: a) differences in public stigma dimensions based on mental illness ( e.g. , major depressive disorder, anxiety disorder, schizophrenia, or alcohol use disorder) and sex; and b) whether participant characteristics influence the public stigma. A community-based sample of 317 self-identified Jewish individuals participated in an experimental randomized vignette survey on stigma and help-seeking beliefs toward various mental illness. Findings indicate differences in stigma based on stigmatized individuals' sex and diagnosis as well as participants' demographics. Schizophrenia and alcohol use disorder were stigmatized similarly, with lower stigma for depression and the least stigma toward anxiety. Of interest, younger males have the most treatability and professional efficacy stigma, and tailored stigma-reducing interventions are recommended.

A longitudinal study of headspace youth oriented mental health service satisfaction, service utilization and clinical characteristics.

AIM: This study examined satisfaction with accessibility, staff attitudes, personal outcomes service components of youth-oriented mental health service, Headspace, and those components' associations with psychological distress and functional status at intake, service utilization patterns and demographic characteristics at middle and end of treatment. METHODS: Data were collected between March 2016 and June 2018 from 112 participants (12-25 years) who consented and completed at least seven sessions at the Headspace youth integrated-care centre in Israel using the centre's registries and the Youth Service Satisfaction Scale. RESULTS: Headspace participants attended an average of 12 sessions (SD = 3.12), they waited up to 2 weeks for their first intake (n = 57; 73%), after which most were offered a psychotherapy session (n = 80, 71%) within 2 months. Participants' satisfaction with Headspace was above the mid-point for all service aspects. The overall effect for time was not significant, F(1) = 1.14, p > .05. However, a significant increase in satisfaction with personal outcomes was found between the middle and the end of treatment, F(2,4) = 3.11, p < .05 compared to all other aspects. The length of waiting time, level of distress, number of sessions attended by parents and age were correlated with satisfaction. Correlations were found with waiting time, distress level, number of sessions attended by parents and age. CONCLUSIONS: High levels of satisfaction with Headspace service aspects strengthens the evidence for areas of importance in designing youth mental health services: youth-friendly staff, general environment, accessibility and outcomes achievement.

Formation of donor-specific antibodies depends on the epitope load of mismatched HLAs in lung transplant recipients: A retrospective single-center study.

The development of donor-specific antibodies (DSA) has a significant impact on graft outcome in solid organ transplantation. Mismatched HLAs are recognized directly and indirectly by the recipient immune system. Both pathways occur in parallel and result in the generation of plasma cells, DSA, cytotoxic and T helper lymphocytes. Here, we present the results of an analysis of the epitope load of mismatched HLAs in a cohort of 220 lung transplant recipients using two in silico algorithms, HLAMatchmaker and PIRCHE-II (Predicted Indirectly ReCognizable HLA Epitopes). De novo DSA (dnDSA) were detected by single antigen bead assays. The percentage of recipients who developed dnDSA was significantly higher in the group of patients who received lung transplants with a mismatching score above the detected threshold than in the group of patients who received lung transplants with a mismatching score below the threshold. In a multivariate Cox proportional hazard analysis, the PIRCHE-II score appeared to be a superior predictor of dnDSA formation. In addition, PIRCHE-II technology was shown to be useful in predicting separate dnDSA1 and dnDSA2 formation. We conclude that both algorithms can be used for the evaluation of the epitope load of mismatched HLAs and the prediction of DSA development in lung transplant recipients.

Meta-Analysis of the Effect of Psychotherapy in an Inpatient Setting: Examining the Moderating Role of Diagnosis and Therapeutic Approach.

OBJECTIVE: The current meta-analysis investigates the efficacy of psychotherapy during psychiatric hospitalization and examines the moderating role of diagnosis and therapeutic approach. METHODS: We conducted systematic searches in literature databases, including PubMed, PsycInfo, and Google Scholar. In total, 37 samples were included for the meta-analysis with a total of 4,443 patients. The primary outcome was the standardized mean differences in clinical status measured by symptomatic and functional measures. RESULTS: The meta-analysis of 22 samples without a control group resulted in the upper end of the medium effect size for the overall effect of treatment during psychiatric hospitalization that included psychotherapy (k = 22, Cohen's d = 0.70, and 95% Cl 0.36 to 1.04). The meta-analysis of 15 samples with a control group resulted in the upper end of the low effect size for the contribution of psychotherapy to the improvement of patients' clinical status measured by symptomatic and functional measures (k = 15, Cohen's d = 0.43, and 95% CI 0.06 to 0.81). No significant effects were uncovered for psychotherapy orientation. Diagnosis was found to moderate the contribution of psychotherapy in an inpatient setting to the improvement of patients' clinical condition. CONCLUSION: Psychotherapy during psychiatric hospitalization may be an effective treatment. Across the various samples, psychotherapy has a moderate effect on the reduction of psychiatric symptoms beyond the overall effect of ward treatment.

Implementation of the Recovery Guide in inpatient mental health services in Sweden-A process evaluation study.

BACKGROUND: Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. METHODS: A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. RESULTS: Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well-being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. CONCLUSIONS: The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. PATIENT AND PUBLIC CONTRIBUTION: The current study involved stakeholders including a service user organization, the public, first-line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.

Exploring the relation between clinician ratings and patient-reported experience and outcomes.

BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly recognized as important ways for patients to be more actively involved in their treatment and enhance shared decision-making. OBJECTIVE: The current study investigated the associations between PROMs, PREMs and various symptoms measures reported by clinicians and psychiatric patients. METHOD: One hundred and twenty people admitted to a psychiatric hospital completed two PREMs, one PROM (the shortened version of the Manchester Short Assessment of Quality of Life scale) and Effects of Symptoms on Daily Functioning (the Sheehan Disability Scale), the Patient Clinical Global Impression and the Modified Colorado Symptom Index. Their psychiatrists rated them using the Global Assessment of Functioning scale, the Health of the Nation Outcome Scales and the Therapist Clinical Global Impression. RESULTS: There was a strong correlation between patient's evaluation of their quality of life (PROM), experience of their care (PREM) and the overall severity of their condition and their progress. The pattern of correlation between patients' and clinicians' measures revealed a three-layer structure representing a continuum from inner experience to external presentation of experiences. CONCLUSION: Together these findings help identify and emphasize various domains of subjective experiences and their relation to external ratings.

Gender differences in quality of life and the course of schizophrenia: national study.

BACKGROUND: Evidence from various sources suggests that females with schizophrenia tend to report lower quality of life than males with schizophrenia despite having a less severe course of the disorder. However, studies have not examined this directly. AIMS: To examine gender differences in the association between quality of life and the risk of subsequent psychiatric hospital admissions in a national sample with schizophrenia. METHOD: The sample consisted of 989 (60.90%) males and 635 (39.10%) females with an ICD-10 diagnosis of schizophrenia. Quality of life was assessed and scored using the Manchester Short Assessment of Quality of Life. The course of schizophrenia was assessed from the number of psychiatric hospital admissions. Participants completed the quality of life assessment and were then followed up for 18-months for subsequent psychiatric admissions. Hazard ratios (HR) from Cox proportional hazards regression models were estimated unadjusted and adjusted for covariates (age at schizophrenia onset and birth year). Analyses were computed for males and females separately, as well as for the entire cohort. RESULTS: A subsample of 93 males and 55 females was admitted to a psychiatric hospital during follow-up. Higher quality of life scores were significantly (P < 0.05) associated with a reduced risk of subsequent admissions among males (unadjusted: HR = 0.96, 95% CI 0.93-0.99; adjusted HR = 0.96, 95% CI 0.93-0.99) but not among females (unadjusted: HR = 0.97, 95% CI 0.93-1.02; adjusted HR = 0.97, 95% CI 0.93-1.02). CONCLUSIONS: Quality of life in schizophrenia is a gender-specific construct and should be considered as such in clinical practice and future research.