When Trauma Survivors with Psychosis Accuse Staff of Sexual Assault in Inpatient Psychiatric Care.

Inpatient psychiatric settings are now known settings in which sexual assault can occur. When a trauma survivor with psychosis makes an accusation of sexual assault within an inpatient setting, staff and the institution are frequently not well equipped in how to respond. While there is scant literature on how to proceed in such dilemmas there is even more of a dearth on how to effectively provide mental health services, trauma- and culturally informed care, and how to best engage with the individual so that safety can be maintained, and treatment continue. This article seeks to convey some basic supports for institutional response, theoretical frameworks to enhance understanding and clinical skill, and shifts in care so that trauma-informed and culturally informed care can take place within these complex dynamics. The goal of this paper is to support mental health services and interdisciplinary teams in becoming more effective in navigating these complex situations so that they can honor and respect the trauma survivor and continue to be effective at providing a healing environment.Public Significance Statement: This article offers enhanced understanding of managing risk and balancing trauma-informed care at an institutional and multi-systemic level when inpatients make allegations of sexual assault. Included in this is enhancing understanding from a theoretical framework of the traumatic experiences of clients, assessing needs and offering safety, treatment, and care, while also managing the complex dynamics and services of the organization.

Supporting Mental Health Recovery, Citizenship, and Social Justice.

Individuals with serious mental illness (SMI) have historically experienced stigma and marginalization. Mental health providers are well positioned to engage in social justice agendas geared at supporting the civil rights of those with SMI, and ultimately helping open doors to the full rights of participation in the community. By engaging and partnering in a mental health recovery and strengths-based orientation, leaders in these settings have the capacity to influence micro-, meso, and macro-systems. This can shed light on mechanisms to build on the strengths, capabilities, and hopes of individuals to live lives of meaning as they so define, with equal access to resources and rights, within communities of their choice. The article articulates an integrated application of these concepts for embracing and utilizing the concepts of mental health recovery, citizenship, and social justice in public mental health. Additionally, specific examples and practical applications are offered within the context of an inpatient setting and a community setting.

When Sexual Trauma Survivors with Severe Psychiatric Disabilities Experience Institutional Care.

Individuals with severe psychiatric disabilities face many challenges from their experience of mental health problems, but also from disenfranchisement, marginalization, and stigmatization from a sociocultural experience. Those who are sexual trauma survivors also have unique challenges and intersecting experiences, which are not historically well understood, acknowledged, or treated in U.S. systems of care. Both in historic and modern mental health systems there have been methods thought of as interventions that have been or are currently reported as traumatizing to those who experience them. This article highlights the specific challenges, needs, and organizational shifts that U.S. systems of care need to be aware of and embark upon in order to provide treatment that is more efficacious with and cognizant of the experiences of those who are sexual trauma survivors. Furthermore, new paradigms for providing mental health treatment are offered in the context of providing trauma-informed as well as trauma treatment to those who are sexual trauma survivors and experience severe psychiatric disabilities.

Shame and Depressive Symptoms: Self-compassion and Contingent Self-worth as Mediators?

Research has identified the experience of shame as a relevant predictor of depressive symptoms. Building upon resilience theory, this is the first study to investigate if self-compassion and/or contingent self-worth (i.e., family support and God's love) mediate the link between shame and depressive symptoms. Participants were 109 African Americans, within the age range of 18 and 64, who sought service following a suicide attempt from a public hospital that serves mostly low-income patients. Findings suggest that shame was related to depressive symptoms through self-compassion but not through contingent self-worth, underscoring the significant role that self-compassion plays in ameliorating the aggravating effect of shame on depressive symptoms. Results highlight the value of incorporating self-compassion training into interventions for suicidal African Americans in an effort to reduce the impact of shame on their depressive symptoms and ultimately their suicidal behavior and as a result enhance their capacity for resilience.

A history of the community mental health movement and individuals with serious mental illness: A vision for the future.

The history of the development of the Global Alliance for Behavioral Health and Social Justice was founded on understanding the social determinants of mental health and society and the necessity for multiple disciplines to organize advocacy for human rights and social justice. This led way to a wide cross-section of disciplines working together to engage at the policy level, in legislation, and within community settings as the Community Mental Health Movement developed and made a path for the reformation of many forms within the mental health field. This article reviews some of that interesting history and the importance of understanding those fundamental roots as we also look at the future for what is next in advocacy, social justice action, and policy directions for advancing the lives of those with serious mental illness, who face some of the most oppressive forms of marginalization and rejection of human rights and citizenship. This article will outline social justice action agendas for the organization and diverse collaborative fields to pursue as we embark upon the future and envision the full rights of citizenship for those with serious mental illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Integrating behavioral, psychodynamic, recovery-oriented, and trauma-informed principles to decrease aggressive behavior in inpatient care.

Positive behavioral support plans have been employed since the 1980s in the service of those with developmental disabilities and in school systems and show efficacy for decreasing challenging behaviors and facilitating skill building. Recent years have seen an increased use of positive behavior support (PBS) technology with adults who experience serious mental illness. Inpatient psychiatric units can be traumatizing places as a consequence of the acuity of units and their use of containment methods to address challenging behaviors, such as aggression against others and self-injury. This has resulted in socially just movements from coercive measures in inpatient care, informed by psychotherapeutic, trauma-informed, and recovery-oriented principles that emphasize safety, person-centered values, and developing a life of meaning while ensuring trustworthiness, collaboration, and empowerment. This article describes the effectiveness of a trauma-informed and recovery-oriented PBS approach, informed by psychotherapeutic principles, in the treatment of individuals with serious mental illness on an inpatient unit in decreasing the frequency and intensity of challenging behaviors. The PBS approach is also founded on the ideals of social justice that all individuals have the right to equity and to the pursuit of a meaningful life in society. This is especially true of persons who experience the most marginalization, such as those who are involuntarily hospitalized and who face coercive measures, and who deserve interventions to help them live a life of meaning. Findings suggest that this psychotherapy integration approach leads to significant decreases in aggressive behaviors while decreasing the likelihood of exposure to traumatic experiences for patients and staff alike. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma-informed behavioral supports (TIBS) for inpatient treatment of individuals who experience BPD.

Trauma-Informed Behavioral Supports (TIBS) is a novel treatment approach targeting aggression against self or against others in individuals who experience borderline personality disorder (BPD). It is based on applied behavior analysis and uses a person-centered and trauma-informed framework. People with BPD hospitalized because of concerning behaviors, [aggression to others, verbal aggression (e.g., defined as aggression in the forms of verbal threats, etc.), physical aggression, and self-injury, etc.] may experience exacerbations of such behavior in the hospital. Individuals diagnosed with BPD were treated with TIBS to diminish the frequency of concerning behaviors in the context of a pilot study. Functioning during a three-month pre-treatment phase was compared with a six-month treatment phase. The TIBS intervention resulted in statistically significant and clinically meaningful decreases in physical and verbal aggression. The results of this pilot investigation approach suggests that TIBS can promote behavior change in the inpatient setting.

PTSD, depressive symptoms, and suicidal ideation in African American women: a mediated model.

Although research has shown positive associations among post-traumatic stress disorder (PTSD), depressive symptoms, and suicidal ideation, the nature of these relations is unclear, especially in African American women. This study examined the associations among these comorbid psychological difficulties in a sample of 136 low-income, African American women. Specifically, the goal of this investigation was to ascertain if overall depressive symptoms, as well as both the cognitive-affective and somatic components of depression, mediated the PTSD-suicidal ideation link. Results from bootstrapping analyses revealed that overall depressive symptoms and the cognitive-affective components of depression, but not the somatic components, mediated the PTSD-suicidal ideation link.

From the medical model to the recovery model: Psychologists engaging in advocacy and social justice action agendas in public mental health.

There is increasing recognition of the need for civil rights advocacy for people with mental illness, as basic human rights continue to be violated in mental health systems. Relatedly, an elevated call for recovery-oriented care creates new opportunities for psychologists to act as social change agents and advocates for patients in state hospital and community settings. Despite lack of specific preparation and training to take on this role, psychologists' overall training places them in a unique position to advocate in many ways. This can be for individuals in the system (patients or staff), for the discipline of psychology, as well as acting as advocates for the continued growth of recovery-oriented approaches, more socially just practices in systems of care, and by engaging in public policy transformation. Psychologists, through creating cultural change, can work to advocate for a transformation from a medical model to a recovery-oriented care model, which focuses on building meaningful lives, autonomy, and rights of the individual. We discuss the many ways in which psychologists can act as advocates in state hospitals and community settings via diverse mechanisms, including at a policy level, the challenges that they encounter, and ways to overcome these. Future directions and ways to increase the effectiveness of advocacy efforts are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Racial identity and reasons for living in African American female suicide attempters.

The current study investigated the association between racial identity and reasons for living in African American women who have attempted suicide. Particular attention was paid to the relation between two elements of racial identity (private regard, racial centrality) and reasons for living, an alternative assessment of suicidal risk. While private regard refers to an individual's beliefs about the African American race, racial centrality describes the importance an individual places on his or her racial identity. The sample included 82 low-income African American women, ages 18-64, who reported a suicide attempt in the past 12 months. Participants, recruited from a large, urban public hospital located in the Southeast, completed the Reasons for Living Inventory and the Multidimensional Inventory of Black Identity, which included the private regard and racial centrality subscales. Results indicated that, as predicted, higher private regard was associated with more reasons for living. Contrary to expectations, racial centrality was not correlated with reasons for living nor was there an interaction between private regard and racial centrality indicating that racial centrality did not function as a moderator in predicting participants' reasons for living scores. Implications for culturally competent clinical interventions that target bolstering private regard are discussed.

A pilot study: Positive behavioral support assessment and intervention for individuals with serious mental illness and criminal justice involvement.

Individuals with serious mental illness (SMI) are consistently interfacing with the criminal justice (CJ) system. They are overrepresented in our nation's prisons and jails rather than being in appropriate treatment settings. They also exhibit behavioral challenges in such CJ settings that result in rule violations leading to punitive consequences, such as segregation and isolation, which have deleterious effects on their mental health and well-being. Individuals with SMI who are incarcerated also make up the majority of suicide attempts and stay longer than those without SMI. Positive Behavioral Support (PBS) is a form of assessment and intervention with demonstrated efficacy for mitigating disruptive behaviors in individuals with SMI. This article describes a pilot study aimed at evaluating the efficacy of implementing PBS to decrease behaviors of concern (BOC) by those who experience SMI and interface with the CJ system. Findings indicated that PBS has a positive impact on reducing the frequency and severity of challenging behaviors and consequentially reducing interactions with the CJ system. Implications of this intervention are explored as a mechanism to support recovery and build lives of meaning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Legally involved individuals in state hospitals and community mental health settings: Introduction to the special section.

Over the past several years, individuals with serious mental illness (SMI) have become involved with the legal system at an increasing rate. State psychiatric hospitals and community mental health programs have seen a high number of referrals and admissions at a time when resources and staffing have been challenges. Individuals with SMI continue to be highly represented among those incarcerated in jails and prisons, often for minor charges. This article serves as an introduction to a special section of Psychological Services on innovations in assessment and treatment of legally involved patients in state hospitals and community mental health settings. Data are presented on the prevalence of legal involvement among individuals with serious mental illness, including the exponential growth in individuals evaluated and found incompetent to stand trial. A brief summary of the articles in the special section is presented, broken down by themes of assessment, treatment, and policy. We hope that the studies described in this issue will lead to further exploration of problems, barriers, and potential solutions for individuals with SMI who become involved with the legal system. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Public servant, silent servant: A call to action for advocacy training in public service settings.

Views on what is important in training for psychologists are evolving, reflecting a broadening understanding of the role psychologists can and should play in societal change. Since the development of the scientist-practitioner model after World War II, arguments around training have focused on the appropriate balance between training in the practice of psychology versus training in research related to psychology. Recent calls reflect more radical change to include an advocacy emphasis within the formal coursework of psychology doctoral programs, well articulated by Mallinckrodt, Miles, and Levy (2014) as the tripartite model of Scientist-Practitioner-Advocate. In this paper, we present the argument for expanding a model that incorporates advocacy training into clinical psychology internships and postdoctoral programs and describe why we believe voices for advocacy have been largely silent in public-sector clinical psychology training and practices. We outline how this may be accomplished in public sector training settings, and we articulate a call to action for public servants to speak out so their voice can ignite a passion for advocacy within public sector psychology service and training. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Expanding our reach: Increasing the role of psychologists in public and community mental health.

Psychologists are currently underrepresented in community and public mental health settings, despite the advanced training and competencies that are salient for service in various unique and important functions in the public sector. This article will explore those functions including: transformation to recovery-oriented care, delivery of positive behavioral support, implementation and evaluation of evidence-based interventions, application of scholarly guided practice, emphasis on context, therapeutic relationship, and history in therapeutic interventions, provision of training, education, program development and evaluation, and development of leadership and leadership training in systems of care. To illustrate these, the authors share specific clinical applications that provide a picture of psychologists serving in these roles, with the aim of providing examples for other organizations to increase the representation of psychologists in the public sector. Finally, the potential opportunities through initiatives such as loan forgiveness and other economic incentives are briefly explored as possible mechanisms to achieve this aim. (PsycINFO Database Record

Personality and Affect When the Central Nervous System is Sensitized: An Analysis of Central Sensitization Syndromes in a Substance Use Disorder Population.

Functional somatic syndromes, or more recently termed central sensitivity syndromes (CSS), comprise a significant portion of the chronic pain population. Although it is evident that personality is intricately related to the pain experience, it has not been widely studied. This article examines the impact of CSS on the clinical presentation of individuals presenting to treatment for a substance use disorder (SUD), with an emphasis on personality and emotional functioning. We examined personality profiles of individuals presenting to treatment with SUD between three groups: those with a CSS (n = 30), non-CSS chronic pain (n = 79), and no pain (n = 232). Based on previous research and a psychodynamic conceptualization of CSS, we hypothesized that predictors of the presence of a CSS in this sample would be higher rates of overall anxiety, traumatic stress, perfectionistic traits, and a need for interpersonal closeness. Logistic regression analyses did not support our hypothesis. Exploratory analyses indicated which personality traits most strongly predicted the presence of CSS. We discuss these findings using descriptive psychopathology literature, with recommendations for future research.

Positive behavioral support planning in the inpatient treatment of severe disruptive behaviors: A description of service features.

Positive behavior support (PBS) plans are increasingly used on inpatient units to assess and treat serious and dangerous behaviors displayed by patients with serious psychiatric impairment. A contemporary extension of traditional applied behavior analytic procedures, PBS plans integrate theories from several domains with perspectives on community psychology, positive psychology, and recovery-oriented care. Because there is little evidence to suggest that more invasive, punitive disciplinary strategies lead to long-term positive behavioral change (Parkes, 1996), PBS plans have emerged as an alternative to the use of seclusion and restraint or other forms of restrictive measures typically used on inpatient psychiatric units (Hammer et al., 2011). Moreover, PBS plans are a preferred method of intervention because more invasive interventions often cause more harm than good to all involved (Elliott et al., 2005). This article seeks to provide an integrated framework for the development of positive behavior support plans in inpatient psychiatric settings. In addition to explicating the philosophy and core elements of PBS plans, this work includes discussion of the didactic and pragmatic aspects of training clinical staff in inpatient mental health settings. A case vignette is included for illustration and to highlight the use of PBS plans as a mechanism for helping patients transition to less restrictive settings. This work will add to the scant literature examining the use of positive behavioral support plans in inpatient psychiatric settings. (PsycINFO Database Record

Childhood Maltreatment and PTSD: Spiritual Well-Being and Intimate Partner Violence as Mediators.

Childhood maltreatment places individuals, including African American women who are undereducated and economically disadvantaged, at risk for developing posttraumatic stress disorder (PTSD) symptoms. Participants were 192 African American women with a history in the prior year of both a suicide attempt and intimate partner violence (IPV) exposure. They were recruited from a public hospital that provides medical and mental health treatment to mostly low-income patients. A simple mediator model was used to examine if (1) existential well-being (sense of purpose) and/or religious well-being (relationship with God) mediated the link between childhood maltreatment and adult PTSD symptoms. Sequential multiple mediator models determined if physical and nonphysical IPV enhanced our understanding of the mediational association among the aforementioned variables. Findings suggest that existential well-being mediated the association between childhood maltreatment and adult PTSD symptoms in a simple mediator model, and existential well-being and recent nonphysical IPV served as sequential multiple mediators of this link. However, religious well-being and physical IPV were not significant mediators. Findings underscore the importance of enhancing existential well-being in the treatment of suicidal African American women with a history of childhood maltreatment and IPV.