scholarly journals Clinical ethnography in severe mental illness: a clinical method to tackle social determinants and structural racism in personalised care

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Kamaldeep Bhui ◽  
Simon Dein ◽  
Catherine Pope
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Social Determinants ◽  
Mental Illnesses ◽  
Structural Racism ◽  
Care Needs ◽  
Clinical Method ◽  
Clinical Ethnography ◽  
Care Systems ◽  
Crisis Care

Ethnic inequalities in the experiences and outcomes of severe mental illness are well established. These include a higher incidence of severe mental illnesses (psychoses), adverse pathways into and through care, including crisis care, police and criminal justice systems involvement, and care under the powers of the Mental Health Act. The situation persists despite awareness and is driven by a mixture of the social determinants of poor health, societal disadvantage and structural racism, as well as conflictual interactions with care systems, which themselves are configured in ways that sustain or deepen these inequalities. Although training and education are often proposed, this is not shown to have sustained effects. Clinical processes (interviewing/assessment/formulation/intervention) need to address systemic influences and improve the cultural precision with which care is delivered, organised and commissioned. We discuss clinical ethnography and present evidence of its value in addressing systemic as well as individual care needs for diverse communities.

Effective e-health design for those with, and without, mental health disorders: shallow navigation, concentrated contents, modest number of links, one screen area for links. (Preprint)

2018 ◽  
Author(s):  
Armando Rotondi ◽  
Jonathan Grady ◽  
Barbara H. Hanusa ◽  
Michael R. Spring ◽  
Kaleab Z. Abebe ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Success Rate ◽  
Fractional Factorial ◽  
Mental Illnesses ◽  
Schizophrenia Spectrum Disorders ◽  
Design Elements ◽  
Website Usability ◽  
Schizophrenia Spectrum ◽  
Health Applications

BACKGROUND E-health applications are an avenue to improve service responsiveness, convenience, and appeal, and tailor treatments to improve relevance, engagement, and use. It is critical to user engagement that the designs of e-health applications are intuitive to navigate. Limited research exists on designs that work for those with a severe mental illness, many of whom infrequently seek treatment, and tend to discontinuation medications and psychosocial treatments. OBJECTIVE The purpose of this study was to evaluate the influence of 12 design elements (e.g., website depth, reading level, use of navigational lists) on the usability of e-health application websites for those with, and without, mental health disorders (including severe mental illness). METHODS A 212-4 fractional factorial experimental design was used to specify the designs of 256 e-health websites, which systematically varied the 12 design elements. The final destination contents of all websites were identical, only the navigational pages varied. Three subgroups of participants comprising 226 individuals, were used to test these websites (those with schizophrenia-spectrum disorders, other mental illnesses, and no mental illness). Unique to this study was that the 12 design elements were manipulated systematically to allow assessment of combinations of design elements rather than only one element at a time. RESULTS The best and worst designs were identified for each of the three subgroups, and the sample overall. The depth of a website’s navigation, that is, the number of screens/pages users needed to navigate to find desired content, had the strongest influence on usability (ability to find information). The worst performing design for those with schizophrenia-spectrum disorders had an 8.6% success rate (ability to find information), the best had a 53.2% success rate. The navigational design made a 45% difference in usability. For the subgroup with other mental illnesses the design made a 52% difference, and for those with no mental illness a 50% difference in success rate. The websites with the highest usability all had several key similarities, as did the websites with the poorest usability. A unique finding is that the influences on usability of some design elements are variable. For these design elements, whether they had a positive or negative effect, and the size of its effect, could be influenced by the rest of the design environment, that is, the other elements in the design. This was not the case for navigational depth, a shallower hierarchy is better than a deeper hierarchy. CONCLUSIONS It is possible to identify evidence-based strategies for designing e-health applications that result in a high level of usability. Even for those with schizophrenia, or other severe mental illnesses, there are designs that are highly effective. The best designs have key similarities, but can also vary in some respects. Key words: schizophrenia, severe mental illness, e-health, design, website, usability, website design, website usability, fractional factorial design.

scholarly journals Generational Differences in Support and Care of Individuals Diagnosed With Severe Mental Illness

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 94-94
Author(s):  
Deborah Finkel ◽  
Per Bulöw ◽  
Pia Bulöw ◽  
Monika Wilińska ◽  
Cristina Joy Torgé ◽  
...  
Keyword(s):  
Social Support ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Social Services ◽  
Generational Differences ◽  
System A ◽  
Care Systems ◽  
The Difference ◽  
Changes Over Time ◽  
Age Range

Abstract As part of the process of de-institutionalizing the Swedish mental health care system, a reform was implemented in 1995 moving responsibility for social support for people with severe mental illness (SMI) from the county to social services in the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. To investigate possible generational differences in support experiences, two nonoverlapping cohorts were created from surveys conducted every fifth year between 1996 and 2011 in one middle-sized municipality in the south of Sweden, aiming to detect the needs for social support. Cohort 1 includes everyone detected at the 1996 survey aged 65 and 79 years (N = 92). Cohort 2 includes individuals first detected at the 2011 survey who were aged 65 to 79 (N = 104). Results indicates significant differences between the two cohorts in diagnosis, reflecting changes over time in diagnostic tendencies. Cohort 1 was on average 10 years older than Cohort 2, even within the restricted age range. After correcting for age, there were no differences between the two cohorts in education, functioning (CAN and GAF), or marital status. Although Cohort 1 experienced more days of institutionalization than Cohort 2 (median = 424.5 days vs. 382 days), the difference was not statistically significant. Cohort 2 had significantly higher additional subsidies and disposable income, as well as significantly higher income from other sources after retirement. Results indicate the changing demands that older adults with SMI will place on care systems.

Health Disparities in Black Patients with Severe Mental Illness and the Role of Structural Racism

2020 ◽  
Vol 50 (11) ◽  
pp. 483-488
Author(s):  
Uzoamaka Asonye ◽  
Nicholas Apping ◽  
Leonardo V. Lopez ◽  
Dennis M. Popeo
Keyword(s):  
Mental Illness ◽  
Health Disparities ◽  
Severe Mental Illness ◽  
Structural Racism ◽  
Black Patients

scholarly journals A Qualitative Study Exploring the Lived Experience of Unemployment Among People with Severe Mental Illness

2020 ◽  
Vol 42 (5) ◽  
pp. 435-444
Author(s):  
Reema Samuel ◽  
Abirame S. ◽  
K. S. Jacob
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Lived Experience ◽  
Health Care Professionals ◽  
Bipolar Affective Disorder ◽  
Community Support ◽  
Role Expectations ◽  
Mental Illnesses ◽  
Economic Productivity ◽  
Barriers To Employment

Background: Severe mental illnesses lead to deterioration in the life skills of the patient, resulting in socio-occupational dysfunction and low rates of employment. The purpose of this study was to explore attitudes, knowledge, and barriers to employment as experienced by patients and their caregivers in India. Method: Patients with schizophrenia or bipolar affective disorder, aged between 18 and 60 and undergoing inpatient treatment and their caregivers, were approached for written informed consent and recruited for focus group discussions. A total of eight focus groups were conducted until saturation of themes was seen to have been achieved. The data were transcribed, coded, synthesized, and organized into major findings and implications for practice. Results: Role expectations based on gender were seen to influence the decision to work. The possible recurrence of illness due to excess stress and unsupportive working environments was cited as the most common problem that could arise related to employment. Stigma and faulty attributions related to the illness were the most cited barriers to employment. Most participants felt that psychosocial rehabilitation and family and community support were essential for facilitating work. Most participants did not consider mental illness as a disability and were unaware of government schemes for the mentally ill. Conclusion: Considering gender-based role expectations, avenues for self/family employment and improving the awareness of benefits for mental illness both among consumers and health care professionals are essential to enhance economic productivity in people with severe mental illness.

scholarly journals An Overview of Cognitive Remediation Therapy for People with Severe Mental Illness

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Cherrie Galletly ◽  
Ashlee Rigby
Keyword(s):  
Mental Illness ◽  
Cognitive Function ◽  
Mental Disorders ◽  
Severe Mental Illness ◽  
Cognitive Deficits ◽  
Cognitive Remediation ◽  
Mental Illnesses ◽  
Cognitive Remediation Therapy ◽  
Severe Mental Disorders ◽  
Varying Length

Cognitive remediation refers to nonpharmacological methods of improving cognitive function in people with severe mental disorders. Cognitive remediation therapy (CRT) can be delivered via computerised programs, of varying length and complexity, or can be undertaken one-on-one by a trained clinician. There has been a considerable interest in cognitive remediation, driven by recognition that cognitive deficits are a major determinant of outcome in people with severe, chronic mental illnesses. CRT has been shown to be effective, especially if combined with vocational rehabilitation.

scholarly journals Metabolic phenotyping reveals a potential link between elevated faecal amino acids, diet and symptom severity in individuals with severe mental illness

2021 ◽  
Author(s):  
Jack Jansma ◽  
Rogier van Essen ◽  
Bartholomeus C.M. Haarman ◽  
Anastasia Chrysovalantou Chatziioannou ◽  
Jenny Borkent ◽  
...  
Keyword(s):  
Amino Acids ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Symptom Severity ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Therapeutic Interventions ◽  
Schizophrenia Spectrum Disorders ◽  
Potential Link ◽  
The Brain

The brain-gut axis is increasingly recognized as an important contributing factor in the onset and progression of severe mental illnesses such as schizophrenia spectrum disorders and bipolar disorder. This study investigates associations between levels of faecal metabolites identified using 1H-NMR, clinical parameters, and dietary components of forty-two individuals diagnosed in a transdiagnostic approach to have severe mental illness. Faecal levels of the amino acids; alanine, leucine, and valine showed a significant positive correlation with psychiatric symptom severity as well as with dairy intake. Overall, this study proposes a diet-induced link between the brain-gut axis and the severity of psychiatric symptoms, which could be valuable in the design of novel dietary or therapeutic interventions to improve psychiatric symptoms.

scholarly journals Functional disability and associated factors among patients with severe mental illness attending psychiatry outpatient unit at Ayder comprehensive specialized hospital, Mekelle, Ethiopia: a cross-sectional study.

2020 ◽  
Author(s):  
Tesfalem Amare ◽  
Natnael Seifu ◽  
Mirkat Shewangzaw
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Functional Disability ◽  
Social Supports ◽  
Cross Sectional Study ◽  
Mental Illnesses ◽  
Sectional Study ◽  
Cross Sectional ◽  
Duration Of Illness ◽  
Functional Disabilities

Abstract Background According to the World Health Organization (WHO), functional disability associated with severe mental illnesses was pervasive, affecting everyday life, and has a significant contribution to the global functional disability. The severe mental illnesses (schizophrenia, major depressive disorder, and bipolar disorder) were among the top ten leading causes of functional disability as indicated by years lived with a functional disability. These illnesses hurt the academic, occupational, social and family functioning of the patients. Despite this fact, functional disabilities and its contributing factors among severe mental illness were not clear. Therefore this study will assess the prevalence and associated factors of functional disabilities among patients with severe mental illnesses. Methods Institutional based cross-sectional study was conducted from Feb 03 to March 10, 2020, with a total of 423 participants in Mekelle, Ethiopia. A stratified random sampling method was included in the study. Functional disabilities were measured by WHO functional disability assessment schedule version two (WHODAS 2.0). Bivariate and multiple logistic regression analyses were performed to determine the association between independent and dependent variables. Results The prevalence of functional disability among severe mental ill patients was 88.1% (51.3% mild, 27.5% moderate & 9.3% sever functional disabilities). This study revealed that, being jobless [AOR=4.01, 95% CI (1.77, 12.35)], duration of illness ≥11 years [AOR=2.99, 95% CI(1.17,7.64)], those who had poor treatment adherence [AOR= 2.79, 95% CI (1.06, 7.35)], drug adverse effects [AOR= 4.61, 95% CI (1.79, 11.84)], poor social supports [AOR=6.58, 95% CI (2.01, 21.56)], and moderate social supports [AOR=4.16, 95% CI (1.88,9.20)] were significantly associated with functional disabilities. Conclusion The prevalence of functional disability was found to be high. Being jobless, duration of illness ≥11 years, medication non-adherent, having drug side effects and having poor or moderate social support were significantly associated with functional disabilities. Therefore, when treating patients with severe mental illness giving especial attention the bio-psycho-social aspect of treatment is essential.

scholarly journals Mental health and COVID-19: is the virus racist?

2020 ◽  
Vol 217 (2) ◽  
pp. 405-407 ◽  
Author(s):  
Anuj Kapilashrami ◽  
Kamaldeep Bhui
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Ethnic Minorities ◽  
Mental Illnesses ◽  
Care Pathways ◽  
Compulsory Admission ◽  
Care Needs ◽  
Crisis Care

SummaryCOVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises.

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

2005 ◽  
Vol 27 (4) ◽  
pp. 309-314 ◽  
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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