Evaluation of an integrated housing and recovery model for people with severe and persistent mental illnesses: the Doorway program

Objective The Doorway program is a 3-year pilot integrated housing and recovery support program aimed at people with a severe and persistent mental illness who are ‘at risk’ or actually homeless. Participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support. This arrangement is highly innovative, differing from widely favoured arrangements internationally involving congregate and scattered-site housing owned or managed by the support program. The aim of the present study was to determine the effects of the Doorway program on participants’ health, housing, service utilisation and costs. Methods A pre-post study design was used with outcome measures consisting of a number of question inventories and their costs (where relevant). The principal inventories were the Behaviour and Symptom Identification Scale 32 (BASIS-32), a consumer-oriented, self-report measure of behavioural symptoms and distress, the Health of the Nation Outcome Scale (HoNOS), an interviewer-administered measurement tool designed to assess general health and social functioning of mentally ill people and the Outcomes Star (Homelessness) system which measures various aspects of the homelessness experience. Baseline measurements were performed routinely by staff at entry to the program and then at 6-monthly intervals across the evaluation period. Results For 55 of 59 participants, total mean BASIS-32 scores (including as well three of five subscale scores) improved significantly and with moderate effect size. Four of the 10 domain scores on the Outcome Star (Homelessness) inventory also improved significantly, with effect sizes ranging from small–medium (three domains) to large (one domain). Mean usage of bed-based mental health clinical services and general hospital admissions both significantly decreased (with overall net savings of A$3096 per participant per annum). Overall cost savings (including housing) to government ranged from A$1149 to A$19837 depending on the housing type comparator. Conclusion The Doorway program secured housing for this vulnerable group with additional benefits in client outcomes, including reduced use and cost of health services. These findings, if confirmed in larger studies, should have widespread applicability internationally. What is known about the topic? Beneficial effects of housing and recovery programs (Housing First) on people with severe and persistent mental illness and who are ‘at risk’, or actually homeless, are being demonstrated in Northern America. These effects include housing security, well being, health service utilisation and cost effects on government. However, these beneficial effects can only be regarded as settled for housing security. The highly innovative Doorway care model in which participants source and choose properties through the open rental market, with appropriate rental subsidy and brokerage support, has not been investigated previously. What does this paper add? This paper adds new data on the Doorway care models, it’s effects and costs, particularly with regard to participant behavioural distress and social functioning. What are the implications for practitioners? The beneficial effects of this innovative model, if confirmed in larger studies, should have widespread applicability internationally.

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Severe persistent mental illness

Psychiatric Bulletin ◽

10.1192/pb.16.12.743 ◽

1992 ◽

Vol 16 (12) ◽

pp. 743-745 ◽

Cited By ~ 4

Author(s):

Peter F. Liddle

Keyword(s):

Mental Illness ◽

Mental Hospital ◽

Community Care ◽

Community Setting ◽

Detailed Examination ◽

Mental Illnesses ◽

Persistent Mental Illness ◽

Realistic Appraisal

Many patients with persistent mental illnesses enjoy a better life in a community setting than would be possible in a long stay mental hospital. Furthermore, the available evidence indicates that most such patients get better while living in the community. Unfortunately, community care has not served all patients well. Much of the difficulty can be attributed to lack of resources. However, there is also a tendency by planners to underestimate the severity of patients' disabilities. A realistic appraisal demands a detailed examination of the problems of patients whose needs have not been met by community care. One important issue is that of patients who fall through the net of community care and another is that of patients who have not but nonetheless have not survived in the community. This paper addresses the question of the needs of this latter group.

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Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-led Community Support Program (Preprint)

10.2196/preprints.10092 ◽

2018 ◽

Author(s):

Nora E Mueller ◽

Trishan Panch ◽

Cathaleene Macias ◽

Bruce M Cohen ◽

Dost Ongur ◽

...

Keyword(s):

Mental Illness ◽

Text Messaging ◽

Psychiatric Rehabilitation ◽

Community Support ◽

Support Program ◽

Smartphone Apps ◽

Persistent Mental Illness ◽

Community Support Program ◽

Peer Specialists ◽

Peer Specialist

BACKGROUND Management of severe and persistent mental illness is a complex, resource-intensive challenge for individuals, their families, their treaters, and the healthcare system at large. Community based rehabilitation, in which peer specialists provide support for individuals managing their own condition, has demonstrated effectiveness, but has only been implemented in specialty centers. It remains unclear how the peer based community rehabilitation model could be expanded, given that it requires significant resources to both establish and maintain. OBJECTIVE Here, we describe the results from a study of one such program implemented within Waverley Place, a community support program at McLean Hospital emphasizing psychiatric rehabilitation for individuals with severe and persistent mental illness. Key questions were whether the patients could and would successfully use the app. METHODS The smartphone app offered multiple features relevant to psychiatric rehabilitation, including daily task lists and text messaging with peer specialists. Thirteen patients downloaded the app and used it for up to 90 days. RESULTS Only two patients were not able to complete app installation. Five patients were able to use the app regularly as part of their daily lives. No demographic or clinical features predicted ability to use the app in this way, but receiving a message from the certified peer specialist on the first day after installing the app did. Reasons for success or failure were highly individualistic. CONCLUSIONS Smartphone apps may become a useful tool for psychiatric rehabilitation, addressing both psychiatric and co-occurring medical problems. Individualizing functions to each patient and facilitating connection with a certified peer specialist may be an important feature of useful apps.

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The social adjustment of people with severe mental illness in São Paulo, Brazil

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462005000400010 ◽

2005 ◽

Vol 27 (4) ◽

pp. 309-314 ◽

Cited By ~ 1

Author(s):

André Gulinelli ◽

Lilian R C Ratto ◽

Paulo Rossi Menezes

Keyword(s):

Mental Health ◽

Mental Illness ◽

Severe Mental Illness ◽

Social Functioning ◽

Social Adjustment ◽

Psychiatric Symptoms ◽

Sao Paulo ◽

Mental Illnesses ◽

São Paulo ◽

The Social

OBJECTIVE: To investigate the social adjustment of individuals with severe mental illness living in the community in a large urban center of a developing country, and the characteristics associated with poor social functioning. METHOD: A cross-sectional study was performed in the city of Sao Paulo. Eligible subjects were residents of a defined geographic area, aged between 18 and 65, with a diagnosis of functional psychosis who had had contact with any public psychiatric service during a defined period. Structured assessments were used to obtain information on social-demographic characteristics, diagnosis (ICD-10), psychiatric symptoms (PANSS), and social adjustment (DAS). RESULTS: One hundred and eighty-eight subjects were included, of whom, 120 (63.8%) had some degree of impairment in social functioning. The most frequently affected areas of social functioning were work performance and sexual role. Twenty-four patients (12.8%) showed poor or very poor social adjustment in the month prior to the interview. Negative symptoms, number of previous admissions and general symptoms showed statistically significant associations with global social adjustment scores. CONCLUSIONS: The proportion of patients showing any degree of impairment in social adjustment was as high as in more developed societies. In order to successfully implement the new mental health policy in Brazil, better provision of community-based mental health services for those with severe mental illnesses is needed.

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Mental illness prevention in post-ACS men: A partcipatory action research

European Journal of Public Health ◽

10.1093/eurpub/ckz185.050 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Jbilou ◽

F Talbot

Keyword(s):

At Risk ◽

Mental Illness ◽

Pilot Study ◽

Qualitative Study ◽

Scoping Review ◽

Mental Illnesses ◽

Risk Population ◽

Coronary Syndrome ◽

Psychoeducational Program ◽

Group Sessions

Abstract Background The prevalence of social determinants of health (i.e. rurality, low education and poverty) among men put them at an elevated risk for comorbid cardiac disease and mental illness. While, men are particularly vulnerable to mental illnesses (i.e. depression, anxiety) after an acute coronary syndrome (ACS), they are typically averse to seeking medical care, especially for mental health issues. Targeting interventions to at-risk population groups is a well documented approach. However, little in the literature presents how to prevent mental illness in cardiac men. This study aims to develop, implement and pilot a psychoeducational program tailored for post-ACS men. Methods A mixed method including a scoping review, a qualitative study and a quasi-experimental pilot study. Results In total, 42 articles were retrieved to extract key components of cardiac men-sensitive psychoeducation programs. We led 22 focus groups and 14 semi-structured interviews (119 men in total). The mean age was 51.2 years [45-77]. We integrated the gathered data gathered from the scoping review and the qualitative study to develop a psychoeducational program (3 group sessions). The pilot study involved 48 men who completed the baseline, the 3-month and the 6-month data collections. We observed 80% of compliance. Findings show a significant improvement in PHQ-9, GAD-7, IES-R, CSI and EQ-5D scales. We also observed changes in the CMNI-22, a measure of attitudes, beliefs, and behaviors associated with both traditional and non-traditional masculine gender roles. Men appreciated the time flexibility (sessions were scheduled based on participants’ availability) and the responsiveness of the sessions (content was discussed based on their needs and interests). Life partners were invited and 65% attended to all sessions. Conclusions The program was a success and we expect to transform it into a peer-led intervention to improve its delivery in the community and its accessibility for rural and remote areas. Key messages At-risk population-sensitive approaches are key for compliance and effectiveness. Group sessions are effective approaches to improve men’s mental heatlh literacy.

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A Comprehensive Clinical Vocational Assessment: The PACT Approach

Journal of Applied Rehabilitation Counseling ◽

10.1891/0047-2220.22.2.25 ◽

1991 ◽

Vol 22 (2) ◽

pp. 25-28 ◽

Cited By ~ 5

Author(s):

Jana Lane Frey ◽

Michelle Godfrey

Keyword(s):

Mental Illness ◽

Behavioral Assessment ◽

Community Support ◽

Support Program ◽

Vocational Assessment ◽

Persistent Mental Illness ◽

Community Support Program ◽

Vocational Outcomes ◽

Assessment Approach ◽

Model Community

The purpose of this paper is to present an “Integrated Clinical Behavioral Assessment Approach” for use with persons with severe and persistent mental illness. This approach has been viewed as effective in facilitating successful competitive vocational outcomes within a model community support program.

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A consumer-led intervention to improve pharmacists' attitudes toward mental illness

Mental Health Clinician ◽

10.9740/mhc.2016.03.95 ◽

2016 ◽

Vol 6 (2) ◽

pp. 95-100 ◽

Cited By ~ 1

Author(s):

Nathaniel M. Rickles ◽

Alison DaCosta

Keyword(s):

Mental Illness ◽

Student Attitudes ◽

Community Pharmacists ◽

Past Research ◽

Mental Illnesses ◽

Negative Attitudes ◽

Persistent Mental Illness ◽

Positive Attitudes ◽

Before And After ◽

Attitudes Toward Mental Illness

Abstract Introduction: Individuals with a severe and persistent mental illness often manage complex medication regimens and would benefit from support and education from their pharmacist. Past research has shown that community pharmacists have negative attitudes toward mental illnesses, and these attitudes affect willingness to provide services to patients with mental illnesses. Consumer-led interventions have shown benefit to improve student attitudes toward mental illness. However, there are no known studies showing the benefit of consumer-led educational programs to improve pharmacist attitudes toward mental illness and willingness to provide services to those with mental illnesses. The aim of this study is to determine the effects of a consumer-led continuing education program on pharmacists' attitudes toward and willingness to provide services to consumers with mental illnesses. Methods: Fifty pharmacists participated in the program with 2 parts: discussion on the history of mental health care and consumers sharing their experiences. Pharmacists completed 1 survey before and after the program. Surveys asked about pharmacists' attitudes toward mental illness and willingness to provide services to individuals with schizophrenia compared to asthma. Data were analyzed using descriptive and paired t tests. Results: Paired t tests showed a significant decrease in social distance and increase in positive attitudes and willingness to provide services to patients with mental illnesses immediately after the program. Discussion: The immediate increase in positive attitudes and willingness to provide services to consumers with mental illnesses indicates that consumer-led interventions may be an effective way to improve the provision of pharmacy services to patients with mental illnesses.

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Assessing mental health outcomes for residents of supported accommodation services

International Journal for Population Data Science ◽

10.23889/ijpds.v1i1.224 ◽

2017 ◽

Vol 1 (1) ◽

Author(s):

Scott Sims ◽

Fernando Lima ◽

Michael Moltoni ◽

Amanda Harrison ◽

Rebecca Glauert

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health Outcomes ◽

Data Linkage ◽

Mental Health Outcomes ◽

Service Utilisation ◽

Clinical Services ◽

Supported Accommodation ◽

Persistent Mental Illness ◽

And Control

ABSTRACT ObjectivesSupported accommodation services provide housing for people with a severe and persistent mental illness; people who are homeless, at risk of homelessness, in unsuitable accommodation, or residing for long periods in inpatient units. The aim of this research is to examine the extent to which supported accommodation impacts on levels and costs of hospitalisation, utilisation of community based clinical services and mental health outcomes of present and past residents. ApproachThe research will make use of demographic data from supported accommodation services and Western Australian (WA) linked data from existing health data collections by the Data Linkage Branch WA Health. The data linkage methodology used involves the linking and analysis of data between 1997 and 2013 from a diverse number of datasets (Hospital Morbidity data, Mental Health Ambulatory data, Emergency data, Mortality data and Hospital Cost data). The impact of supported accommodation on individuals was measured by tracking any changes in their service utilisation levels and associated hospital costs savings. This allowed us to determine the efficacy of supported accommodation services through time series and control group comparative analysis. ResultsPeople with severe or persistent mental illness who reside in supported accommodation services are more likely to maintain or improve their quality of life and mental health outcomes compared to those who have never entered supported accommodation. Individuals who utilised these services also experienced reduced hospitalizations after the service than before. Cost implications will also be discussed. Conclusions No significant research into the effectiveness of supported accommodation on mental health outcomes for individuals has been conducted in WA to date. Supported accommodation provides people with severe and persistent mental illness, along with their families, carers and supporters, more security and control over their lives, and improved access to appropriate supports and clinical services. This research will support these strategic directions by providing evidence about the effectiveness of supported accommodation options in terms of improving mental health outcomes for individuals.

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Using Smartphone Apps to Promote Psychiatric Rehabilitation in a Peer-Led Community Support Program: Pilot Study

JMIR Mental Health ◽

10.2196/10092 ◽

2018 ◽

Vol 5 (3) ◽

pp. e10092 ◽

Cited By ~ 9

Author(s):

Nora E Mueller ◽

Trishan Panch ◽

Cathaleene Macias ◽

Bruce M Cohen ◽

Dost Ongur ◽

...

Keyword(s):

Mental Illness ◽

Psychiatric Rehabilitation ◽

Community Support ◽

Support Program ◽

Smartphone Apps ◽

Research Staff ◽

Persistent Mental Illness ◽

Community Support Program ◽

Peer Specialists ◽

Day Program

Background Management of severe and persistent mental illness is a complex, resource-intensive challenge for individuals, their families, treaters, and the health care system at large. Community-based rehabilitation, in which peer specialists provide support for individuals managing their own condition, has demonstrated effectiveness but has only been implemented in specialty centers. It remains unclear how the peer-based community rehabilitation model could be expanded, given that it requires significant resources to both establish and maintain. Objective Here, we describe the results from a study of one such program implemented within Waverley Place, a community support program at McLean Hospital, emphasizing psychiatric rehabilitation for individuals with severe and persistent mental illness, as well as describing the challenges encountered during the implementation of the program. Key questions were whether the patients could, and would, successfully use the app. Methods The smartphone app offered multiple features relevant to psychiatric rehabilitation, including daily task lists, activity tracking, and text messaging with peer specialists. A 90-day program of activities, goals, and content specific to the community support program was created on the basis of a prior pilot, in collaboration between members of the app development team (WellFrame), and peers, clinical, and research staff associated with the program. Hospital research staff recruited patients into the study, monitored peer and patient engagement, and handled all raw data acquired from the study. Results Of 100 people approached for the study, a total of 13 provided consent, of which 10 downloaded and used the app. Two patients were unable to complete the app installation. Five used the app regularly as part of their daily lives for at least 20 days of the 90-day program. We were unable to identify any specific factors (eg, clinical or demographic) that affected willingness to consent or engage with the app platform in the very limited sample, although the individuals with significant app use were generally satisfied with the experience. Conclusions Smartphone apps may become a useful tool for psychiatric rehabilitation, addressing both psychiatric and co-occurring medical problems. Individualizing functions to each patient and facilitating connection with a certified peer specialist may be an important feature of useful apps. Unlike prior reports emphasizing that patients with schizophrenia will adopt smartphone platforms, we found that implementation of digital tools into existing community support programs for severe and persistent mental illness has many challenges yet to be fully overcome to realize the potential benefits such apps could have to promote systematization and cost reduction for psychiatric rehabilitation.

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Mitigating Mass Violence and Managing Threats in Contemporary Society

Advances in Psychology, Mental Health, and Behavioral Studies - Mitigating Mass Violence and Managing Threats in Contemporary Society ◽

10.4018/978-1-7998-4957-5.ch003 ◽

2021 ◽

pp. 35-47

Author(s):

Tina Marie Zink

Keyword(s):

At Risk ◽

Mental Illness ◽

Mental Illnesses ◽

Serial Killer ◽

Serial Killers ◽

Contemporary Society ◽

Red Flags ◽

Key Factors ◽

Mass Violence

The purpose of this chapter is to explain the red flags a serial killer may portray and give an understanding of how and/or why one would commit such heinous crimes. This chapter provides a look at what a serial killer is and how each one is unique even though there are many similarities that are shared. The biological and psychosocial perspectives are analyzed to provide a more in-depth understanding on what could have led to these crimes being committed. Many serial killers have been known to have mental illnesses. This chapter explains how and why mental illness may have a helping role in what is occurring. Also, the red flags that can be identified in serial killers and individuals at risk of becoming serial killers are gone over along with how society can identify these red flags and lower the threat by getting these individuals the help that is needed. These red flags key factors in identifying when someone is at risk of committing violent and heinous crimes and knowing these red flags can assist in managing threats in contemporary society.

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Severely increased generalized anxiety, but not COVID-19-related fear in individuals with mental illnesses: A population based cross-sectional study in Germany

International Journal of Social Psychiatry ◽

10.1177/0020764020960773 ◽

2020 ◽

pp. 002076402096077

Author(s):

Eva-Maria Skoda ◽

Alexander Bäuerle ◽

Adam Schweda ◽

Nora Dörrie ◽

Venja Musche ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

At Risk ◽

Mental Illness ◽

Social Isolation ◽

Mental Illnesses ◽

Generalized Anxiety ◽

The Public ◽

Chronic Somatic Diseases ◽

Somatic Diseases

The COVID-19 pandemic affected individuals, governments, and health care centers all around the globe. Social isolation obligation, restricted working shifts, and curfews posed unprecedented challenges for the population. Social isolation, boredom, and financial problems have been shown to stress peoples’ mental health in previous comparable pandemics and even in regular situations. Individuals with a mental illness may particularly be at risk due to an already instable mental health status. While research mainly focused on the pandemic’s impact on somatic health care and risk group patients, psychological obstacles caused by legal restrictions and their impact on already mentally affected individuals have been discussed, but so far only scarcely been investigated in a large sample. For this study, 12,028 people completed an online-survey during that time in Germany, when the COVID-19 outbreak gained momentum with a surge in cases and death rates as well as a lockdown of the public life. Generalized anxiety (GAD-7), depression (PHQ-2), distress (distress thermometer) and COVID-19-specific items, especially COVID-19-related fear, were assessed in healthy individuals, patients suffering from mental illnesses, and in patients with chronic somatic diseases, known to be at risk for an unfavorable course of COVID-19. Results show that the COVID-19-pandemic significantly worsens psychometric scores throughout the population – individuals with already heightened levels, like people with mental illnesses now reach concerning levels. Surprisingly, even though generalized anxiety, depressive symptoms, and perceived distress are elevated in individuals with mental illness, these individuals seem to be less affected by explicit COVID-19-related fear, than the general population or individuals with chronic somatic diseases. This study thus objectively quantifies the psychological impact of COVID-19 in a large sample and provides evidence for not only the public, but also critically affected individuals with a mental illness.

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