Towards holistic dual diagnosis care: physical health screening in a Victorian community-based alcohol and drug treatment service

2016 ◽  
Vol 22 (2) ◽  
pp. 81 ◽  
Author(s):  
Lara Jackson ◽  
Boyce Felstead ◽  
Jahar Bhowmik ◽  
Rachel Avery ◽  
Rhonda Nelson-Hearity

The poorer health outcomes experienced by people with mental illness have led to new directions in policy for routine physical health screening of service users. By contrast, little attention has been paid to the physical health needs of consumers of alcohol and other drug (AOD) services, despite a similar disparity in physical health outcomes compared with the general population. The majority of people with problematic AOD use have comorbid mental illness, known as a dual diagnosis, likely to exacerbate their vulnerability to poor physical health. With the potential for physical health screening to improve health outcomes for AOD clients, a need exists for systematic identification and management of common health conditions. Within the current health service system, those with a dual diagnosis are more likely to have their physical health surveyed and responded to if they present for treatment in the mental health system. In this study, a physical health screening tool was administered to clients attending a community-based AOD service. The tool was administered by a counsellor during the initial phase of treatment, and referrals to health professionals were made as appropriate. Findings are discussed in terms of prevalence, types of problems identified and subsequent rates of referral. The results corroborate the known link between mental and physical ill health, and contribute to developing evidence that AOD clients present with equally concerning physical ill health to that of mental health clients and should equally be screened for such when presenting for AOD treatment.

2018 ◽  
Vol 5 (1) ◽  
pp. 205510291876541 ◽  
Author(s):  
Grenville Rose ◽  
Courtney von Hippel ◽  
Loren Brener ◽  
Bill von Hippel

Research suggests that stigma impacts help-seeking behaviour and health outcomes for people affected by mental illness. This study compared the attitudes of Australian non-governmental organisation support workers towards people with mental illness with those of other health professionals. Three hundred and seventy four support workers were randomly allocated to answer questions about one of the six vignettes. Results indicated that non-governmental organisation support workers held more positive attitudes towards people with mental illness than those of general practitioners, psychiatrists and psychologists measured in prior research. These results suggest that non-governmental organisations may be a more positive and comfortable entry and referral point for mental health clients.


2016 ◽  
Vol 20 (1) ◽  
pp. 21-25
Author(s):  
Tonsha Emerson ◽  
Kimberly Williams ◽  
Maxie Gordon

2008 ◽  
Vol 27 (2) ◽  
pp. 21-36 ◽  
Author(s):  
Ann Bates ◽  
Vivien Kemp ◽  
Mohan Isaac

The physical health of individuals with long-term mental illnesses has long been of concern. In Western Australia, the overall mortality rate from preventable causes of people living with mental illness was reported to be 2.5 times greater than that of the general population. A trial peer support service was initiated to assist people with mental illness to attend to their physical health needs. This paper presents the planning, implementation, and results of this collaborative initiative involving nongovernment agencies, the public mental health service, consumers of mental health services, and the University of Western Australia.


2015 ◽  
Vol 39 (4) ◽  
pp. 370 ◽  
Author(s):  
Brenda Happell ◽  
Chris Platania-Phung ◽  
Stephanie Webster ◽  
Brian McKenna ◽  
Freyja Millar ◽  
...  

Objectives The aim of the present study was to document Australian policies on the physical health of people with mental illness and evaluate the capacity of policy to support health needs. Methods A search of state and federal policies on mental and physical illness was conducted, as well as detailed analysis of policy content and the relationships between policies, by applying the World Health Organization Mental Health Action Plan 2013–2020 as an evaluative framework. Results National policy attention to the physical health of people with mental illness has grown, but there is little interconnection at the national and state levels. State policies across the country are inconsistent, and there is little evidence of consistent policy implementation. Conclusions A coherent national health policy framework on addressing co-occurring physical and mental illnesses that includes healthcare system reforms and ensuring the interconnectedness of other relevant services should be prioritised. What is known about the topic? People with mental illness have a lower life expectancy and poorer physical health than people who do not have a mental illness. Government policy is critical to reducing inequalities in physical health and increasing longevity. What does this paper add? Evaluating policy developments against the World Health Organization’s Mental Health Action Plan 2013–2020, this review identified a lack of cohesive national-level policy on how to improve the physical health of people with mental illness. Although there are some state-based policies regarding strategies for better prevention and management of the physical health of people with mental illness, evidence of policy implementation is either scarce or inconsistent. The capacity of current policy to translate into reforms that increase the physical and overall health of people suffering mental health difficulties seems very limited. What are the implications for practitioners? This paper outlines major policy gaps and an overall need for a national-level policy. National-level leadership on integrated health care is required, with monitoring to ensure health care reforms are genuinely informed by consumer and clinician views and are effective.


2015 ◽  
Vol 12 (4) ◽  
pp. 86-88 ◽  
Author(s):  
Martin Agrest ◽  
Franco Mascayano ◽  
Sara Elena Ardila-Gómez ◽  
Ariel Abeldaño ◽  
Ruth Fernandez ◽  
...  

Studies regarding stigma towards mental illness in Argentina blossomed after the first National Mental Health Law was passed in 2010. Methodological limitations and contradictory results regarding community perceptions of stigma hinder comparisons across domestic and international contexts but some lessons may still be gleaned. We examine this research and derive recommendations for future research and actions to reduce stigma. These include tackling culture-specific aspects of stigma, increasing education of the general population, making more community-based services available and exposing mental health professionals to people with mental illness who are on community paths to recovery.


2000 ◽  
Vol 30 (1) ◽  
pp. 61-70 ◽  
Author(s):  
Shailesh Kumar

Objective: There is a considerable imbalance of power in psychiatry that sits in favor of professionals. The abuse and discrimination of the mentally ill are not just restricted to the mental health system but may also exist in the primary care sector. This article aims to evaluate the effects of power imbalance on discrimination and abuse of people with mental illness by professionals. Methods: A literature search was carried out on MEDLINE using the key words consumerism, client empowerment, abuse, and mental illness. Publications of two leading British consumer organizations: MIND and the Sainsbury Centre for Mental Health were hand searched. Relevant cross-references from the papers reviewed were consulted. Studies with information on the reasons for power imbalance and prevalence of discrimination and abuse of clients were critically reviewed. Explanations are offered as to why abuse and discrimination of clients by professionals may still occur despite the onset of the client empowerment movement. Results and Discussion: The available evidence suggests that reasons for abuse of mental health clients fall under two broad categories: 1) direction from the imbalance of power and 2) those pertinent to the nature of physical or sexual abuse. Different grades of client empowerment and ways of strengthening it are described. Conclusions: There appears to be a link between power imbalance and abuse of clients with mental illness by professionals in all health care sectors. Client empowerment may help rectify the power imbalance. Prospective studies are required to establish whether client empowerment can reduce discrimination and abuse of clients and whether abuse is a consequence of power imbalance. Recommendations for future studies are made.


Author(s):  
Muhamad Taufik Hidayat ◽  
Sharon Lawn ◽  
Eimear Muir-Cochrane ◽  
Candice Oster

Abstract Background Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of ‘unlocking’; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD


2017 ◽  
Vol 41 (6) ◽  
pp. 308-313 ◽  
Author(s):  
Marian Chen ◽  
Stephen Lawrie

Aims and methodMedia portrayals of mental illness have long been recognised as being misleading and stigmatising. Following the campaigns of several advocacy groups to address this issue, we aimed to evaluate the impact on mental health reporting over time. We repeated a survey we did 15 years ago using the same methods. Nine UK daily newspapers were surveyed over a 4-week period and coded with a schema to analyse the reporting of mental health compared with physical health.ResultsIn total, 963 articles – 200 on mental health and 763 on physical health – were identified. Over half of the articles on mental health were negative in tone: 18.5% indicated an association with violence compared with 0.3% of articles on physical health. However, there were more quotes from patients with mental disorders than physical disorders (22.5% v. 19.7%) and an equal mention of treatment and rehabilitation.Clinical implicationsMental health in print media remains tainted by themes of violence, however some improvement in reporting in recent years is evident, in particular by providing a voice for people with mental illness.


BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019412 ◽  
Author(s):  
Frédérique Lamontagne-Godwin ◽  
Caroline Burgess ◽  
Sarah Clement ◽  
Melanie Gasston-Hales ◽  
Carolynn Greene ◽  
...  

ObjectivesTo identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.DesignRealist review.SettingPrimary, secondary and tertiary care.ResultsA systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.ConclusionsA range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.


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