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Abstract: Abstract Mental health problems often appear at a young age. As the labour market places higher demands for education and competence, mental health services are focusing on young adults’ support needs for school and career opportunities. This study is a single case of an integrated supported education and employment unit in Sweden over an 18-month period. Multiple data sources illustrate the process of supporting careers and transition to school and work for young service users. This is a promising example of how careers can be supported through a flexible service that provides support for successful individual education and work trajectories among the youth. The service allowed for evolution of an identity process towards recovery through student and work roles. PubDate: 2023-01-16
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Abstract: Abstract Self-report of cognitive deficits in schizophrenia is potentially important in the planning of interventions related to functional outcome and individual therapy. Subjective scale to investigate cognition in schizophrenia (SSTICS) (Stip et al. in Comprehensive Psychiatry 44:331–340, 2003) is a 21 item self-administered scale that is simple and easy to use. It is specifically designed to evaluate subjective cognitive complaints of patients with schizophrenia. It seemed appropriate therefore to validate a Tamil version of this tool for use in patients diagnosed as schizophrenia in Southern India. The study aimed to validate the SSTICS for use in patients diagnosed as schizophrenia in South India and to evaluate the association between subjective and objective cognition. The first step was to adapt SSTICS to the vernacular language (Tamil). A focus group discussion with patients was conducted for the purpose of correcting the wording of the questions and for comments on the applicability of the questions. Patients, with the DSM IV diagnosis of Schizophrenia, (n = 191), fulfilling inclusion / exclusion criteria were recruited from the outpatient department of Schizophrenia Research Foundation, Chennai. A subgroup of 78 subjects were assessed using objective tests for memory, attention and executive functions and psychopathology was assessed using Positive and Negative Symptom Scale (PANSS). Data collected were analysed using SPSS, version 16. Face validity of the Tamil version was established. Internal consistency was found to be good (0.851). Test–retest reliability was assessed and spearman’s correlation coefficient was r = .766, Factor analysis was performed to establish the construct validity of the tool which identified 6 major factors. Correlation between SSTICS and objective cognitive domains found no significant association. The sensitivity and specificity analysis revealed attention domain related questions were more specific and sensitive when compared to other domains. SSTICS, in the Tamil version, appears to be a valid tool to screen for cognitive deficits based on subjective reports. Persons with schizophrenia are able to evaluate subjective cognitive performance in the context of everyday functioning. This can lend itself to the planning of appropriate interventions, despite the lack of corelation to objective measures. PubDate: 2023-01-13
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Abstract: Abstract The history of inpatient psychiatric treatment is a potential source of social stress and stigma for people with mental illness and their kith and kin. People who have spent significant time in mental health care institutions, experience antagonism, and bigotry from their respective social networks. Their caregivers and family members also sense unfriendly and dogmatized behaviour from others. Society tends to put on a tag on individuals who have dealt with mental health conditions, i.e., 'returned from mental hospital', and deliberately dissociates them from mainstream societal affairs. Because of this reason, many a time, people with mental health conditions who are treated successfully at mental healthcare facilities are not taken up by their caregivers, and they have to stay in the hospital for an indefinite period. These people are being deserted by their family members, and they have to rely on the hospital's mercy to secure their livelihood. This case series demonstrates the barriers, challenges, and opportunities in their discharge process, where patients were left back for a long duration without any follow-up by their caregivers. The discharge of a person with mental illness is challenging because of family rejection, limited opportunities for integration with work, unawareness about the government services and mental health care services, poor support system, stigma, and high chances of relapse. PubDate: 2023-01-09
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Abstract: Abstract Homelessness resulting from a complex set of reasons is a growing problem worldwide, particularly due to the higher prevalence of somatic and mental disorders among homeless people. In Germany, there is a system of assistance to prevent loss of housing and overcome homelessness, along with various forms of assisted living for mentally ill people, especially residential care facilities. Aim of our study was to determine access routes of patients to such facilities in North Rhine-Westphalia (NRW) as an example of the situation in middle European countries. We performed a questionnaire survey in residential care facilities in NRW to determine the sociodemographic characteristics and service trajectories of residents. Based on data from 997 residents, 16% of residents lived in “not secure” housing conditions prior to moving into the facility (including 7.1% house-/roofless). The most common diagnoses were psychotic disorders and substance use disorders (SUD; also frequently in combination as dual diagnosis). Majority of residents from “not secure” housing conditions had no/only a few social support/contacts. Significant relations were found between housing situation before moving in and employment at the time of moving in, legal status, and social support. This clearly demonstrates that efforts to improve care pathways should focus on addressing individuals with severe psychotic disorders and SUD. Preexisting social support seems to be a major beneficial factor in addressing the needs of those living in “not secure” housing situations and suffering from mental illness. PubDate: 2023-01-07
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Abstract: Abstract The helping relationship is central in mental health interventions and a good relationship is instrumental in achieving numerous outcomes, including personal recovery. However, scant research has been conducted on the mechanisms of the helping relationship that promote mental health recovery. A study was undertaken to describe these mechanisms through the lens of critical realism by crossing the views of persons in recovery with those of their service professionals. In a cross-sectional qualitative study, semi-structured interviews were conducted with 15 persons in recovery and 15 professionals providing them with health and social services in private practice or the public or community sectors. Thematic analysis was used to identify and describe different interpersonal mechanisms and their interconnections. Seven mechanisms of the helping relationship that promote recovery were identified: presence, trust, communication, emotional support, problem-focused support, influence, and transcending the professional role. Agreement was explored between the people in recovery and their professionals on 12 social support functions. Their views coincided on most, except reciprocity and the power balance in the relationship. Some themes run counter to the traditional role of the professional and highlight both the balance that professionals must strike between maintaining a professional distance and disclosing parts of their personal life and on the role of influence and reciprocity. Results present an interdisciplinary model of the helping relationship that transcends the framework of psychotherapy without excluding it. Also, these relational components might serve to operationalize the recovery-oriented helping relationship. PubDate: 2022-12-27
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Abstract: Abstract Many people with complex behavioral health conditions are reluctant to access professional services, but little is known about providing outreach and assistance to this population. This report describes the process of delivering care in the Supported Employment Demonstration, a large Social Security Administration study that attempted to engage and provide services to such individuals. In the Supported Employment Demonstration, 60 multidisciplinary teams across the U.S. attempted to provide services and supports to nearly 2000 individuals identified by an initial denial of their disability claims based on a mental health impairment. Most of the participants were initially ambivalent toward or rejecting services. Four experienced quality monitors met with the teams monthly from 2017 through 2021, providing technical assistance and linking teams with consultants. The quality monitors, along with a larger implementation team of consultants, identified common challenges that clinical teams encountered while serving these participants and the strategies they used to overcome barriers. Participants presented with four common challenges: extreme poverty, hesitance to participate in services, complex medical and psychosocial conditions, and dangerous behaviors. To address these barriers, the teams assisted with basic needs, enhanced outreach efforts, accessed expert consultations, and reframed threatening behaviors as reactions to trauma. Many people with serious behavioral health conditions are reluctant to access professional services. These individuals may need help with basic needs, extensive outreach, consultations regarding multiple complex conditions, and professionals who understand their histories of trauma to enable their participation in standard behavioral health and vocational services. PubDate: 2022-12-16
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Abstract: Abstract The rehabilitation of persons with mental illness and making them life-ready again was a concept that was unheard of in the late nineteen sixties and seventies. The ground-breaking work done by Dr Joyce Siromoni to bring this need to the forefront laid the foundation for The Medico-Pastoral Association (MPA), Bangalore, as we know it today. From being a wholly volunteer-led and funded initiative in the first few years of its operations to its current system, the Medico-Pastoral Association has established itself as a pioneer in mental health care in India and made its mark as the country’s first Half-Way Home and residential rehabilitation centre. The MPA is a structured and cohesive therapeutic community that follows a goal-oriented, multi-dimensional, multi- faceted approach to residential rehabilitation, focussed on reintegration (Pathak 2015), without compromising on kindness. At present, the MPA is home to 32 residents (half-way home, extended care, Long-term care and day care programs included) and 50 years since its initiation, it stands proud even today as the provider of compassionate and uncompromising mental health care and advocacy. Bangalore’s first telephonic suicide prevention helpline, SAHAI, was an MPA/NIMHANS/Rotary initiative and has been operational from within the MPA premises since 2002. PubDate: 2022-12-15
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Abstract: Abstract Lived experience research related to mental health recovery is advancing, but there remains a lack of narrative material from the perspectives of people from under-represented, non-dominant cultural backgrounds in this domain. This study aimed to explore the lived experiences of mental health recovery in people of culturally and linguistically diverse (CALD) backgrounds in the Australian context. The current study involved a secondary analysis of audio and visual data collected during the digital storytelling project Finding our way in Melbourne, Australia. Thematic analysis was used to understand the lived experience narratives of nine participants in relation to mental health recovery. Five themes were identified through an iterative process of analysis, including Newfound opportunities and care, Family as key motivators and facilitators, Coping and generativity, Cultivating self-understanding and resilience, and Empowerment through social engagement. First person lived experience narratives offer deep insight into understanding the ways in which individuals of marginalised communities conceptualise and embody recovery. These findings further the literature and understanding on how to better serve the needs of people with mental health challenges from CALD communities through informed knowledge of what may be helpful to, and meaningful in, individuals’ recoveries. PubDate: 2022-12-05
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Abstract: Abstract To identify the key requirements for promoting the autonomy of work motivation in people with mental illnesses with the process of increasing autonomy. We interviewed 11 employed individuals with mental illnesses and analyzed their responses using the Modified-Grounded Theory Approach (M-GTA). ssembling a subjective perception of “I am ready” and discovering pathways to employment promoted the decision to return to work. Emotional interactions with supporters and maintaining dignity were necessary to make positive adjustments for working lives, while coping with their disabilities. In addition, encountering a job was the most motivating factor to work. The self-awareness of “I am able to do my job” and familiarity with others generated the sense of presence as a worker, and employment provided fulfillment, which promoted better working lives. These factors promoted autonomous work motivation. Expanding access to work, maintaining and promoting self-dignity, and work that provided a sense of presence as a worker are the key requirements of promoting the autonomy of work. PubDate: 2022-12-05
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Abstract: Abstract Mental illness is one of the brimming issues in the society. Persons With Mental Illness (PWMI) experience a myriad number of problems as a result they are unable to enjoy all the constitutional rights because of their disability. Apart from that, society looks at them as aliens that add to their psychological issues. Talking about those homeless PWMI who wander on the streets, face issues like hostility, trafficking, physical abuse, sexual abuse, etc. If at all, they are brought to any mental health establishment for treatment, it becomes very difficult for the treating team to treat them because of their condition and allied medical issues. The case becomes more challenging when there is/are no family member (s) available to provide history of the patient. Keeping the same situation in consideration, the present paper elucidates the interventions in tracing out the family members of a homeless person with Intellectual Disability. PubDate: 2022-12-01
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Abstract: Abstract Although studies have examined caregiver centred intervention programmes on caregiver wellbeing, patient focused interventions to improve caregiver outcome is less studied, especially in India. We examined the impact of a patient focused, structured day care skill training programme on caregiver burden and quality of life in Indian context. Using a post-test only design, we conducted this study among a naturalistic cohort of 60 caregivers of patients with severe mental illness. The carers were recruited from two-day care skill training units and outpatient department of a tertiary mental health centre in Kerala. Caregiver burden and quality of life were measured using Burden Assessment Scale (BAS) and WHOQOL-BREF. Independent sample t test was used to compare the outcomes. Caregivers of patients attending the day-care skill training programme have reported significantly lower burden on various domains of BAS including physical & mental health (t = − 4.758; P < .001; d = − 0.829), external support (t = − 4.563; P < .001; d = − 0.778), caregivers routine (t = − 7.104; P < .001; d = − 0.834), support of patient (t = − 4.038; P < .001; d = − 0.834), taking responsibility (t = − 2.320; P < .05; d = − 0.599), other relations (t = − 7.636; P < .001; d = − 0.972), patients behaviour (t = − 6.350: P < .001; d = − 0.640) and caregiver strategy (t = − 2.991; P < .05; d = − 0.772) as compared to the caregivers in comparison group. They also reported significantly higher quality of life on various domains of WHOQOL-BREF including physical quality of life (t = 4.62; P < .001; d = 0.793), psychological quality of life (t = 7.23; P < .001; d = 0.867), social relationship quality of life (t = 7.94; P < .001; d = 1.252) and environment quality of life (t = 7.93; P < .001; d = 1.349). Caregivers of patients attending the day care skill training demonstrated lesser burden and better quality of life. The findings underscore the importance of a long-term patient focused day-care skill training for caregivers’ health and wellbeing. PubDate: 2022-12-01
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Abstract: Abstract Following predictions of a dramatic drop in the developmental-behavioral healthcare workforce by 2023 due to retirement and/or burnout, much has been written about ways to replenish or sustain needed personnel. To date, we continue to have a crisis of not enough new clinicians being attracted to the field to replenish the third of the workforce that is expected to retire. Recent concerns about increased clinician mental health problems and burnout in the wake of COVID-19 and other societal stressors add further complexity and urgency. This crisis will not be solved solely by a top-down focus on intensive graduate training or marketing to newly licensed professionals. Through the lived experience of three fellows from the Leadership Education in Neurodevelopmental and related Disabilities (LEND) program, this paper offers a “grassroots” approach to supporting people with disabilities (PWD) to weather this rebuilding period by increasing (a) their material wealth through entrepreneurship and (b) capacities for self-determination through thoughtful mentorship and considered changes in institutional culture. PubDate: 2022-12-01
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Abstract: Abstract Goal setting is at the heart of mental health rehabilitation, but its joint negotiation by clinicians and clients has proven to be a challenging endeavor. This paper investigates goal setting decision-making in the context of Clubhouse Communities: non-profit organizations designed to pave the way for the recovery of individuals diagnosed with mental illnesses. Using the method of conversation analysis, we demonstrate how clinicians make and account for proposals to involve clients in the discussion as more equal partners. In these accounts, clinicians highlight the client’s potential in terms of either competence or interest. Clients, in turn, resist clinicians’ proposals by invoking the opposing factor: when clinicians highlight clients’ competence, clients appeal to their lack of interest and vice versa. In this way, clients are able to reject clinicians’ goal-proposals without disagreeing with the rationalizations of their competence or interest. By contrast, jointly formulated decisions are best reached when clinicians focus the talk on the characteristics of the desired activity rather than on the characteristics of the client. In so doing, clients are able to claim personal ownership of the goal. PubDate: 2022-12-01
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Abstract: Abstract Mental illness has various dimensions ranging from core biological reasons to socio-environmental reasons. The overwhelming social stressors, including unemployment, poverty, migration, family disintegration, has ascribed sociogenic reasons for mental illness. Sociogenic factors can impact the family's overall functioning and the mental health outcomes of the client. Family centric rehabilitation focuses on the family rather than the individual. The study used retrospective file review to explore the sociogenesis of mental illness in families of people with mental illness. This paper depicts two case examples of how family-centric rehabilitation can be used as an effective intervention to deal with the sociogenesis of mental illness; especially in improving the functioning of the individual, better understanding of the family members about the illness, a significant reduction in the family expressed emotions and an improvement in the social support to the client. Family centric rehabilitation can be a helpful intervention to mitigate the sociogenesis of mental illness in the family. PubDate: 2022-12-01
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Abstract: Abstract Many approaches are undertaken to improve employment participation of persons with disabilities (PwDs) including incentives for employers. India provides quota-based employment (QBE) within public sector jobs while incentivizing the private sector to act similarly. As per the Rights of Persons with Disabilities (RPWD) Act 2016, PWDs have 4% quota in public sector employment—comprising 1% for PWDs due to mental health conditions (PWDMHC). Public sector jobs must be identified as ‘suitable’ for disability types and extents- recent notification lists > 3500 jobs. Hitherto, inclusion of PWDMHC has not been studied. To examine inclusion, frameworks of reasonable accommodations and relaxations of PWDMHC in the job identification notification applicable for public sector employment compared to other disability types. In-depth descriptive analysis of the list of jobs identified in the notification dated January 4, 2021 issued by the Ministry of Social Justice and Empowerment listing all government jobs across groups A to D was undertaken. Employment groups A to D categorize jobs in a descending order of skills, administrative responsibility and remuneration. Total 3566 jobs listed, categorized as group A = 1046, group B = 515, group C = 1724, and group D = 281. 3296 (92%) jobs are described as ‘suitable’ for PwD with mental illness, 3240(90%) for persons with specific learning disability, 2419 (68%) for PWD with autism spectrum disorder, 963 (27%) for PWD with intellectual developmental disorder. Inclusion of PWD with mental illness and specific learning disability is greater compared to visual and hearing disabilities. No guiding framework for reasonable accommodations and no elaboration of criteria to adjudge jobs as ‘suitable’ or ‘unsuitable’ have been made available. Such a system in the long run poses challenges for inclusion in employment. PubDate: 2022-12-01
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Abstract: Abstract Mental health services need to transform from a primary focus on symptom reduction to a recovery-oriented delivery. Research on recovery-oriented practices is mainly based in community mental health settings, while research on specialized mental health care remains scarce. In this article, we aim to identify and explore the experiences faced by professionals working in specialized mental health care units that aim to be recovery-oriented. Data were collected during seven focus group interviews with 45 professionals from four psychiatric hospitals and district psychiatric centers in Norway. We used reflexive thematic analysis to interpret the data. Three main themes emerged from the analysis: (a) disease-oriented structures, (b) negotiating roles and (c) risk management. This study identified the many tensions professionals face as they try to shift specialized mental health care toward a recovery-oriented paradigm. Specifically, professionals must balance managing risks and promoting self-determination. To succeed, it is not sufficient to implement practices that are characterized as recovery-oriented without also changing existing systems, structures, and frameworks. We suggest approaching recovery orientation through shared decision-making. This could contribute to the promotion of self-determination and increased inpatient safety in specialized mental health care. PubDate: 2022-12-01
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Abstract: Abstract Use of Smart phones had created new opportunities for individuals with developmental disabilities for the meaningful engagement in different activities during the pandemic situation. Online learning provides extensive opportunities for individuals during this pandemic situation when everything is closed due to the fear of transmission of COVID-19. Similarly individuals with developmental disabilities are also getting opportunity to learn online through Smartphone. Special educators were conducting online classes with students with developmental disabilities to make them meaningfully engaged during this pandemic situation. 415 students and their parents with developmental disabilities were approached by their special educators on telephone to know if they can use smartphone. This paper reports on use of Smart phones by individuals with developmental disabilities. It was found that they can learn academics like others if there is availability of Smart phones during daytime and proper training and assistance provided by parents or sibling. PubDate: 2022-12-01
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Abstract: Abstract Psychosis is an encumbering cluster of mental illnesses which has a significant impact on the daily life of individuals. Recovery from psychosis is a personalised process due to the unique nature of the lived experiences of these individuals. Although numerous research have been conducted, there exists a research gap in taking into consideration the perspectives of practitioners in treating the illness. This study aimed to identify the perspectives of psychologists on the impact of interpersonal and intrapersonal factors that impact recovery from psychosis. Five participants were interviewed to qualitatively explore this utilising Interpretative Phenomenological Analysis (IPA). Findings suggested that recovery from psychosis can occur on four different dimensions; Behavioural, Insight, Cognitive, and Social Recovery. There are several interpersonal and intrapersonal factors impacting these dimensions collaboratively. An Integrated Recovery Model was generated to summarise these findings which could potentially assist the recovery process of individuals. Limitations of the study and future implications were also addressed. PubDate: 2022-12-01
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