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1.
J Music Ther ; 56(4): 381-402, 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742643

RESUMO

The MAP is an innovative receptive music therapy intervention derived from psychomusical relaxation methods that aims to foster the well-being and recovery of youths with mental health problems by providing them with an adaptive and effective music-assisted means to regulate their mood states. In this quasi-experimental pilot study, we assessed the mood-enhancing potential of participation in MAP sessions delivered by a music therapist in an in-patient mental health facility for children and adolescents. Using short standardized self-reported questionnaires, 20 participants aged 9-17 years old (M = 14, SD = 2.4), mainly girls (13 = 65%), rated their affective state immediately before and after two to four MAP sessions and a similar number of regular unit activity sessions used as comparison. This created a 2 × 2 (Time × Condition) single-group within-individual design. We analyzed pre-post session changes in affect using multilevel mixed models and found participation in MAP sessions to be associated with systematic reductions in self-reported general negative affect and state anxiety. These variations were of modest-to-large magnitude and significantly greater than those associated to participation in regular unit activities. While only a first step towards the validation of the MAP as an effective intervention to foster more adaptive and effective day-to-day mood regulation in youths with mental health problems, this study supports its specific potential to alleviate negative affects and provides a rare demonstration of the putative benefits of music therapy in a pediatric mental health inpatient context.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/reabilitação , Musicoterapia/métodos , Música/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Terapia de Relaxamento/métodos , Adolescente , Afeto , Ansiedade/terapia , Criança , Emoções , Feminino , Humanos , Masculino , Saúde Mental , Projetos Piloto , Inquéritos e Questionários
2.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 543-551, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747145

RESUMO

The study conducted in the framework of "Our Patient - Our Citizen" Project has examined methods and possibilities of rehabilitating mentally ill people who were prone to anti-social behaviors and have been committed to involuntary treatment. The research has introduced the criteria for identifying patients with high rehabilitation potential. The work has described methods and possibilities of their rehabilitation in hospital (training psychological programs, ergotherapy, art therapy, occupational therapy, etc.) and analyzed possibility of their outpatient implementation. Concrete examples of such successful rehabilitation have been considered. Financial value was determined.


Assuntos
Transtornos Mentais , Pessoas Mentalmente Doentes , Humanos , Transtornos Mentais/reabilitação , Defesa do Paciente
3.
Niger Postgrad Med J ; 26(4): 211-215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621660

RESUMO

Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.


Assuntos
/efeitos adversos , Transtornos Mentais/epidemiologia , Pacientes/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adolescente , Adulto , Distribuição por Idade , Alcoolismo/epidemiologia , Alcoolismo/reabilitação , Criança , Comorbidade/tendências , Estudos Transversais , Feminino , Hospitais Psiquiátricos , Humanos , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Abuso de Maconha/epidemiologia , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pacientes/psicologia , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Adulto Jovem
4.
Psychiatriki ; 30(2): 108-119, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425139

RESUMO

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.


Assuntos
Transtornos Mentais/reabilitação , Cooperação do Paciente/estatística & dados numéricos , Reabilitação Psiquiátrica/organização & administração , Grupos de Autoajuda/estatística & dados numéricos , Adulto , Doença Crônica , Centros Comunitários de Saúde Mental , Feminino , Humanos , Relações Interpessoais , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Reabilitação Psiquiátrica/estatística & dados numéricos , Psicoterapia de Grupo , Esquizofrenia/reabilitação , Fatores Socioeconômicos
5.
Psychiatriki ; 30(2): 120-128, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425140

RESUMO

Despite the large progress during the last decades in the medical treatment of HIV/AIDS infection, people living with HIV nevertheless face multiple adversities at various levels of their lives. Mental disorders, in particular, are the most common comorbidities in HIV infection with negative consequences in adherence to antiretroviral medication, disease progress and overall quality of life. HIVrelated stigma, still quite intense in Greece, is one of the most debilitating factors concerning people's living with HIV mental health. The present study looked at the clinical presentation at intake and treatment requests of 191 (83% males) people living with HIV who addressed the psychological support service of the non-governmental organization 'Centre for Life' during the years 2016- 18. Data were collected through a semi-structured clinical interview and administration of adapted questionnaires (PHQ-9, BAI, CAGE), which resulted in 7 dichotomous variables related to clinical presentation and 13 dichotomous variables related to treatment requests at intake. To analyze data, we constructed frequency tables and performed chi-square tests. In the whole sample, 42.2% presented anxiety disorders, 40.3% depression, 28.8% occasional substance use, 17.5% problematic use of alcohol and 13.6% intravenous drug use. Moreover, 14% reported at least one suicide attempt in the past and 9.2% current suicidal ideation. Apart from more frequent intravenous drug use among heterosexual males and more frequent occasional/recreational drug use among men who have sex with men, no other differences related to gender, age group, sexual orientation or ethnicity were observed in the initial clinical presentation. Similarly, the most frequent treatment requests were homogenously distributed in our sample, such as depressive symptoms (58.6%), difficulties in romantic relationships (48.7%), accepting being HIV positive (42.9%), anxiety symptoms (42.4%) and issues of negative self-esteem (40.8%). The presence of clinically significant depression was found to be related to a wider range of treatment requests compared to other mental health problems. A large group of requests focused on interpersonal relationships difficulties (e.g. disclosure anxiety, social isolation, disturbed relationships with familiar persons). This indicates an important area of psychological intervention. HIV infection may affect many levels of an individual's life, including their mental health. Respectively, HIV treatment needs to adopt a more holistic approach.


Assuntos
Síndrome de Imunodeficiência Adquirida/psicologia , Síndrome de Imunodeficiência Adquirida/terapia , Infecções por HIV/psicologia , Infecções por HIV/terapia , Psicoterapia/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adulto , Idoso , Aconselhamento/estatística & dados numéricos , Feminino , Grécia/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Saúde Mental , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Autoimagem , Minorias Sexuais e de Gênero , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Tentativa de Suicídio/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Inquéritos e Questionários
6.
BMC Public Health ; 19(1): 1154, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438912

RESUMO

BACKGROUND: The paper presents two-year findings from a study investigating the effectiveness of Housing First (HF) with assertive community treatment (ACT) in helping individuals with serious mental illness, who are homeless or precariously housed and living in a small city, to become stably housed. METHODS: The research design was a parallel group non-blinded RCT with participants randomly assigned after the baseline interview to receive HF with ACT (N = 100) or treatment as usual (TAU; N = 101). Participants were interviewed every 3 months over 21/24 months to investigate changes on a range of housing and psychosocial outcomes. The primary outcomes were housing stability (as defined by a joint function of number of days housed and number of moves) and improvement in community functioning. Secondary predicted outcomes were improvements in self-rated physical and mental health status, substance use problems, quality of life, community integration, and recovery. RESULTS: An intent-to-treat analysis was conducted. Compared to TAU participants, HF participants who entered housing did so more quickly (23.30 versus 88.25 days, d = 1.02, 95% CI [0.50-1.53], p < 0.001), spent a greater proportion of time stably housed (Z = 5.30, p < 0.001, OR = 3.12, 95% CI [1.96-4.27]), and rated the quality of their housing more positively (Z = 4.59, p < 0.001, d = 0.43, 95% CI [0.25-0.62]). HF participants were also more likely to be housed continually in the final 6 months (i.e., 79.57% vs. 55.47%), χ2 (2, n = 170) = 11.46, p = .003, Cramer's V = 0.26, 95% CI [0.14-0.42]). HF participants showed greater gains in quality of life, (Z = 3.83, p < 0.001, ASMD = 0.50, 95% CI [0.24-0.75]), psychological integration (Z = 12.89, p < 0.001, pooled ASMD = 0.91, 95% CI [0.77-1.05]), and perceived recovery (Z = 2.26, p = 0.03, ASMD = 0.39, 95% CI [0.05-0.74]) than TAU participants. CONCLUSIONS: The study indicates that HF ends homelessness significantly more rapidly than TAU for a majority of individuals with serious mental illness who have a history of homelessness and live in a small city. In addition, compared to TAU, HF produces psychosocial benefits for its recipients that include an enhanced quality of life, a greater sense of belonging in the community, and greater improvements in perceived recovery from mental illness. TRIAL REGISTRATION: International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374 , assigned August 18, 2009.


Assuntos
Serviços Comunitários de Saúde Mental , Pessoas em Situação de Rua/psicologia , Habitação/estatística & dados numéricos , Transtornos Mentais/reabilitação , Adolescente , Adulto , Canadá , Cidades , Integração Comunitária , Feminino , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Índice de Gravidade de Doença , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 524, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349841

RESUMO

BACKGROUND: Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs. METHODS: We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively. RESULTS: We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers. CONCLUSIONS: Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR's focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations. Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/.


Assuntos
Comportamento Cooperativo , Programas Governamentais/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Austrália , Doença Crônica , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Humanos , Lógica , Avaliação de Programas e Projetos de Saúde , Índice de Gravidade de Doença
8.
Int J Soc Psychiatry ; 65(5): 413-424, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31159628

RESUMO

AIMS: Social inclusion is increasingly understood to have positive and beneficial implications for the mental health outcomes of people with severe mental illness. The concept is plagued by definitional inconsistencies and a lack of consensus regarding what it means to be socially included, in particular for groups most vulnerable to social exclusion, such as people with mental illness. The aim of this study was to obtain a consensus regarding the key contributors to social inclusion from the perspective of people with and without a lived experience of mental illness (consumers of mental health services, carers, and general community members). METHODS: Delphi methodology was employed to reach consensus agreement. The Delphi questionnaire was based on a previous review of the literature and consisted of 147 items categorized into 13 domains. It was presented to participants over three rounds. Participants (N = 104) were recruited into three groups (32 consumers, 32 carers of people with a mental illness, and 40 members of the general community - neither consumers nor carers). Retention of participants from Round 1 to Round 3 was 79.8%. RESULTS: Similarities and differences were observed between the groups. A number of items were very strongly endorsed as key contributors to social inclusion, relating to social participation, social supports, housing, neighbourhood, community involvement, employment and education, health and well-being and service utilization. CONCLUSION: Findings supported previous work, indicating the importance of having a strong sense of connection with others as well as the importance of safe and stable housing, support services and personal motivation and hope. We obtained a well-rounded perspective among groups regarding the key contributors to social inclusion, with a particular relevance to people living with mental illness. This perspective has significant clinical and research utility.


Assuntos
Cuidadores , Transtornos Mentais/psicologia , Serviços de Saúde Mental/normas , Distância Social , Isolamento Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnica Delfos , Feminino , Humanos , Masculino , Transtornos Mentais/reabilitação , Pessoa de Meia-Idade , Participação Social , Apoio Social , Adulto Jovem
9.
Tijdschr Psychiatr ; 61(5): 326-334, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-31180571

RESUMO

BACKGROUND: Mental health complaints are among the most important causes for drop-out in the of labour market. At the same time, work has a positive influence on people's psychological health.
AIM: To describe and evaluate the integrated approach of specialist mental health care and Employee Insurance Agency (UWV).
METHOD: The integrated approach was evaluated for a group of 15 clients with anxiety and depressive disorders. Experiences with the approach were explored by treatment evaluation reports and semi-structured interviews with clients, practitioners, an insurance physician, a labour expert and several reintegration coaches. The degree of work participation was measured with the Participation Scale and the complaints were measured by regular ROM measurements.
RESULTS: The degree of work participation increased during the integrated approach: 8 clients found an unpaid work experience placement, 2 found a paid job. No indications were found that the approach negatively influenced complaint recovery. The interviews showed that clients felt helped and that they experienced a clearly supportive network of committed professionals.
CONCLUSION: The integrated approach, including work-focused therapy, was evaluated positively by all stakeholders and seems to contribute to work participation.


Assuntos
Comunicação Interdisciplinar , Transtornos Mentais/reabilitação , Retorno ao Trabalho/psicologia , Terapia Cognitivo-Comportamental , Emprego/psicologia , Humanos , Seguro Saúde , Transtornos Mentais/psicologia , Saúde Mental , Países Baixos , Projetos Piloto , Reabilitação Vocacional , Licença Médica
10.
Early Interv Psychiatry ; 13 Suppl 1: 20-28, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243907

RESUMO

AIM: In many parts of the world, there is growing concern about youth homelessness. Homeless youth are particularly vulnerable to psychological distress, substance use and mental disorders, and premature mortality caused by suicide and drug overdose. However, their access to and use of mental health care is very limited. METHODS: The Réseau d'intervention de proximité auprès des jeunes (RIPAJ), a Montreal network of over 20 community stakeholders providing a wide array of cohesive services, was created to ease homeless youth's access to mental health and psychosocial services. Its philosophy is that there should be no "wrong door" or "wrong timing" for youth seeking help. In 2014, the network partnered with the pan-Canadian transformational research initiative, ACCESS Esprits ouverts. RESULTS: Created through this partnership, ACCESS Esprits ouverts RIPAJ has been promoting early identification through outreach activities targeting homeless youth and agencies that serve them. An ACCESS Clinician was hired to promote and rapidly respond to help-seeking and referrals. By strengthening connections within RIPAJ and using system navigation, the site is working to facilitate youth's access to timely appropriate care and eliminate age-based transitions between services. A notable feature of our program, that is not usually evident in homelessness services, has been the engagement of the youth in service planning and design and the encouragement of contact with families and/or friends. CONCLUSION: Challenges remain including eliminating any remaining age-related transitions of care between adolescent and adult services; and the sustainability of services transformation and network coordination. Nonetheless, this program serves as an example of an innovative, much-needed, community-oriented model for improving access to mental health care for homeless youth.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Jovens em Situação de Rua/psicologia , Comunicação Interdisciplinar , Colaboração Intersetorial , Serviços de Saúde Mental/organização & administração , Melhoria de Qualidade/organização & administração , Serviços Urbanos de Saúde/organização & administração , Adolescente , Criança , Feminino , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Equipe de Assistência ao Paciente/organização & administração , Quebeque , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
11.
Early Interv Psychiatry ; 13 Suppl 1: 14-19, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31243911

RESUMO

AIM: This paper outlines the transformation of youth mental health services in Edmonton, Alberta, a large city in Western Canada. We describe the processes and challenges involved in restructuring how services and care are delivered to youth (11-25 years old) with mental health needs based on the objectives of the pan-Canadian ACCESS Open Minds network. METHODS: We provide a narrative review of how youth mental health services have developed since our engagement with the ACCESS Open Minds initiative, based on its five central objectives of early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. RESULTS: Building on an initial community mapping exercise, a service network has been developed; teams that were previously age-oriented have been integrated together to seamlessly cover the age 11 to 25 range; early identification has thus far focused on high-school populations; and an actual drop-in space facilitates rapid access and linkages to appropriate care within the 30-day benchmark. CONCLUSIONS: Initial aspects of the transformation have relied on restructuring and partnerships that have generated early successes. However, further transformation over the longer term will depend on data demonstrating how this has impacted clinical outcomes and service utilization. Ultimately, sustainability in a large urban centre will likely involve scaling up to a network of similar services to cover the entire population of the city.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Serviços Urbanos de Saúde/organização & administração , Adolescente , Adulto , Alberta , Criança , Assistência à Saúde , Feminino , Humanos , Masculino , Equipe de Assistência ao Paciente/organização & administração , Encaminhamento e Consulta/organização & administração , Adulto Jovem
14.
BMC Health Serv Res ; 19(1): 235, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014331

RESUMO

BACKGROUND: Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. METHODS: Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. RESULTS: Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies' design and quality varied, and PIR s' were conducted differently. Five studies explored PIR s' as a separate intervention after restraint use, in the other studies, PIR s' were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients' personal recovery processes, and 3) stimulate professional reflection on organizational development and care. CONCLUSION: Scientific literature directly addressing PIR s' after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR's potential to contribute to restraint prevention in mental healthcare.


Assuntos
Restrição Física , Canadá , Assistência à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transtornos Mentais/reabilitação , Serviços de Saúde Mental , Grupos Populacionais , Relações Profissional-Paciente , Suécia , Reino Unido , Estados Unidos
15.
Int J Ment Health Nurs ; 28(4): 798-815, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938019

RESUMO

Service user involvement in mental health research is on the international political agenda, for example mirrored by an emphasis on user involvement in funding of research. The idea is that service users contribute with their lived experiences of mental distress to the research process and thereby heighten the quality and relevance of the research. The purpose of this scoping review was to identify and evaluate empirical research of how mental health service users actually partake in collaborative research processes and to summarize this research in dialogue with mental health user-researchers. The review included 32 studies. Main findings indicated that actual involvement of service user-researchers in research processes encompassed a complex set of precarious negotiation practices, where academics and service user-researchers were positioned and positioned themselves in alternative ways. The review accounts for how mental health service users were involved in collaborative research processes. The extracted themes concerned: (i) Expectations of research processes, (ii) Contribution to research processes, and (iii) Training and learning from research processes. The study reveals that collaborative research in mental health requires changes to traditional research practices to create and support genuine collaborative partnerships and thereby avoid tokenism and power inequalities.


Assuntos
Pesquisa Biomédica , Transtornos Mentais/terapia , Participação do Paciente , Pesquisa Participativa Baseada na Comunidade , Humanos , Transtornos Mentais/reabilitação
16.
J Affect Disord ; 251: 227-230, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30927584

RESUMO

BACKGROUND: High levels of positive mental health protect individuals from mental illness. This study investigates longitudinal change in positive mental health as a predictor of mental illness recovery in a cohort group. METHODS: Using data from the 1995 and 2005 Midlife in the United States cross-sectional surveys (n = 1,723), logistic regression was used to estimate the odds ratio that individuals diagnosed with a mental illness in 1995 would have recovered in 2005 based on whether their level of positive mental health changed over the 10-year period. RESULTS: Individuals who maintained or gained the highest levels of positive mental health were more than 27.6 and 7.4 times, respectively, more likely to recover when compared to those who maintained the lowest level of positive mental health. Those who maintained or gained moderate levels of positive mental health had more moderate likelihood of recovery, and those whose positive mental health declined to the lowest levels had no significantly different likelihood of recovery compared to participants whose positive mental health remained low. LIMITATIONS: This study was limited by the age of the data, and the inability to control for some predictors of recovery. CONCLUSIONS: This study suggests that positive mental health may be an important resource for individuals to recover from mental illness and stay mentally healthy. Results point to the need to include positive mental health assessment and interventions into mental health care systems.


Assuntos
Nível de Saúde , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Recuperação da Saúde Mental , Saúde Mental , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estados Unidos
17.
Psychiatr Rehabil J ; 42(2): 169-181, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30843721

RESUMO

OBJECTIVE: Recovery, defined as a personal process of living with mental illness, has become a prominent concept in mental health care. We aimed to map the state of the art of conceptualizing recovery, its promoting and impeding factors, recovery-oriented practice, and the assessment of recovery. METHOD: A scoping review of systematic reviews and meta-analyses was performed. Systematic searches were conducted, supplemented with hand-searching in reference lists. RESULTS: Of 228 articles that were identified and 33 that were reviewed, a total of 25 were included. This review showed that the CHIME conceptual framework for personal recovery is widely endorsed, containing the elements of connectedness, hope and optimism, identity, meaning in life, and empowerment. Although personal recovery first and foremost starts from individual preferences, the CHIME framework should be adapted according to culture and unique population characteristics. "Difficulties and trauma" should be added, and the person's choice, risk taking, and coping with challenges should be emphasized. Barriers to recovery are stigma and negative effects of mental health services and medication. Facilitators of recovery include spirituality, personal agency, and social support. Recovery-focused interventions, in which peer providers are involved, enhance recovery, hope, and empowerment. For assessing recovery outcomes, multiple instruments are accepted as methodologically sound. CONCLUSIONS: Personal recovery is conceptualized as complementary to clinical recovery and represents processes rather than outcomes. Additional work is needed to bridge the gap between the concept of recovery-oriented practice and routinely provided interventions. A broad framework of recovery is needed, and more research is needed into the working mechanisms of personal recovery processes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Metanálise como Assunto , Revisão Sistemática como Assunto , Humanos
18.
Int J Soc Psychiatry ; 65(2): 136-143, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30808231

RESUMO

BACKGROUND: Implementing recovery-oriented mental health services is a policy priority in many countries. In addition, some governments have prioritised new forms of organising, financing and governing the provision of mental health services with a stronger focus on co-delivery and involving communities. Most research in the recovery field has focused on interventions. There is limited knowledge about the role of organisational characteristics and environments in which people experience recovery. AIM: To understand the organisational characteristics of initiatives that implement recovery-oriented practice at the interface between mental health services and communities, as well as the mechanisms they employ to alter the conditions in which they operate. METHOD: Semi-structured interviews and a focus group workshop with managers of five initiatives in England that implemented recovery-oriented practice at the interface between mental health services and communities. RESULTS: Our cross-sector initiatives shared a range of characteristics and employed mechanisms that created favourable conditions for recovery-oriented practice: strong social value and process (rather than performance) orientation; participatory approaches and shared decision-making; flat hierarchies; creating and seizing business opportunities; utilising networking and (social) marketing opportunities; risk-taking; valuing and supporting all members of their organisations; entrepreneurial and value-driven leadership. CONCLUSION: Recovery-oriented practice takes place in certain organisational environments that importantly influence an individual's recovery. Our research highlights the need to consider organisational characteristics when evaluating recovery interventions as well as a broader shift of research towards understanding the environments in which people experience recovery as members of society, and how those can be altered.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais/reabilitação , Modelos Organizacionais , Valores Sociais , Inglaterra , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto
19.
Psychiatr Rehabil J ; 42(2): 147-157, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30730171

RESUMO

OBJECTIVE: Recovery is the process through which one learns to overcome, manage, or live with the negative consequences of physical illness, mental illness, alcohol or drug misuse, or trauma. Homeless individuals endure many, or all, of these experiences. Previous research has shown that characteristics of homeless services, particularly the amount of choice they afford to service users, can influence recovery experiences, potentially by increasing a sense of mastery. The purpose of this study was to test the hypothesis that choice in housing and services would predict recovery in a number of domains, and that these relationships would be mediated by mastery. METHOD: Using survey data collected from a sample of homeless services users (n = 160) in Ireland, we conducted a series of cross-sectional mediation analyses to predict recovery in domains of physical health, psychiatric symptoms, alcohol and drug use, and community integration. RESULTS: We observed the hypothesized mediational relationship for each recovery domain except alcohol use. That is, personal mastery mediated the relationship of perceived choice to self-appraised physical health, psychiatric symptoms, drug use, and physical and psychological aspects of community integration, but not alcohol use. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings add further support to the growing body of evidence that suggests choice is centrally important to recovery experiences among individuals in homelessness. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Comportamento de Escolha , Nível de Saúde , Pessoas em Situação de Rua/psicologia , Transtornos Mentais/reabilitação , Autonomia Pessoal , Autoeficácia , Participação Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto Jovem
20.
Prog Brain Res ; 244: 387-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30732846

RESUMO

Social behavioral disturbances are central to most psychiatric disorders. A disequilibrium within the cortical excitatory and inhibitory neurotransmitter systems underlies these deficits. Gamma-aminobutyric acid (GABA) and glutamate are the most abundant excitatory and inhibitory neurotransmitters in the brain that contribute to this equilibrium. Several contemporary therapies used in treating psychiatric disorders, regulate this GABA-glutamate balance. Yoga has been studied as an adjuvant treatment across a broad range of psychiatric disorders and is shown to have short-term therapeutic gains. Emerging evidence from recent clinical in vivo experiments suggests that yoga improves GABA-mediated cortical-inhibitory tone and enhances peripheral oxytocin levels. This is likely to have a more controlled downstream response of the hypothalamo-pituitary-adrenal system by means of reduced cortisol release and hence a blunted sympathetic response to stress. Animal and early fetal developmental studies suggest an inter-dependent role of oxytocin and GABA in regulating social behaviors. In keeping with these observations, we propose an integrated neurobiological model to study the mechanisms of therapeutic benefits with yoga. Apart from providing a neuroscientific basis for applying a traditional system of practice in the clinical setting, this model can be used as a framework for studying yoga mechanisms in future clinical trials.


Assuntos
Encéfalo/metabolismo , Transtornos Mentais , Modelos Biológicos , Neurotransmissores/metabolismo , Ioga , Humanos , Transtornos Mentais/metabolismo , Transtornos Mentais/prevenção & controle , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação
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